Orthopaedic Journal of Sports Medicine最新文献

{"title":"An Analysis of Characteristics Associated With Bilateral Versus Unilateral Anterior Cruciate Ligament Injuries: A National Database Analysis.","authors":"Chris Nickelberry, Hannah M Jones, Bethlehem Dawit, Stephan L Pro, Jacqueline M Brady, Melissa Novak, Albert Yim, Jung U Yoo","doi":"10.1177/23259671261447215","DOIUrl":"10.1177/23259671261447215","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament (ACL) injuries are common, yet the specific risk factors that distinguish patients who sustain bilateral injuries from those with unilateral injuries remain poorly characterized. Identifying these factors is crucial for targeted prevention strategies.</p><p><strong>Purpose: </strong>To identify demographic and clinical factors associated with bilateral ACL injuries compared with unilateral ACL injuries.</p><p><strong>Study design: </strong>Case-control study; Level of evidence, 3.</p><p><strong>Methods: </strong>This retrospective cohort study utilized the PearlDiver database to identify patients with unilateral (ACL-ALONE; n = 359,491) or bilateral (ACL-BOTH; n = 3115) ACL injuries. A 2-stage analytical approach was employed. First, demographics and comorbidities were compared between cohorts in the entire population. Second, the analysis was restricted to the female subpopulation to evaluate the specific role of amenorrhea. Multivariable logistic regression models were constructed for both stages to identify factors independently associated with bilateral injury, controlling key confounders.</p><p><strong>Results: </strong>Analysis of the full cohort (N = 362,606) revealed that patients with bilateral ACL injuries were significantly younger than those with unilateral injuries (28.8 vs 31.0 years; <i>P</i> < .001). In the full cohort multivariable model, significant independent risk factors for bilateral injury included the 15- to 19-year age group (adjusted odds ratio [aOR], 1.62; 95% CI, 1.35-1.94; <i>P</i> < .001), tobacco use (aOR, 1.24; 95% CI, 1.13-1.35; <i>P</i> < .001), vitamin D deficiency (aOR, 1.31; 95% CI, 1.14-1.50; <i>P</i> < .001), and hypermobility (aOR, 1.83; 95% CI, 1.18-2.82; <i>P</i> = .006). In the female-specific analysis (n = 179,923), amenorrhea was a significant independent factor (aOR, 1.39; 95% CI, 1.16-1.64; <i>P</i> < .001), while hypermobility showed a strong, nonsignificant trend (aOR, 1.65; 95% CI, 0.99-2.77; <i>P</i> = .05).</p><p><strong>Conclusion: </strong>This study identifies a distinct and multifactorial risk profile for bilateral ACL injury. Independent risk factors in the overall population include younger age (15-19 years), tobacco use, vitamin D deficiency, and hypermobility. In the female subpopulation, amenorrhea emerged as a significant sex-specific risk factor, associated with a 39% increase in the adjusted odds of bilateral injury. The association for hypermobility, while significant in the full cohort, demonstrated a strong, nonsignificant trend in the female-only analysis, suggesting a complex interaction. These findings indicate that bilateral ACL injury etiology extends beyond biomechanics, implicating a confluence of demographic, endocrine, constitutional, and modifiable lifestyle factors.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 7","pages":"23259671261447215"},"PeriodicalIF":2.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13365688/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148448646","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":"Surgical Outcomes of Revision Meniscal Repair: A Case Series.","authors":"Tatsuru Sonobe, Shinya Yanagisawa, Keiichi Hagiwara, Hiroaki Omae, Masashi Kimura, Yoshihiro Matsumoto","doi":"10.1177/23259671261451781","DOIUrl":"10.1177/23259671261451781","url":null,"abstract":"<p><strong>Background: </strong>Revision meniscal repair may yield better postoperative outcomes than meniscectomy. Few studies concerning the postoperative results of revision meniscal repair are available.</p><p><strong>Purpose: </strong>To evaluate the clinical outcomes following revision meniscal repair for meniscal retears after isolated meniscal repair.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>The cases of 11 knees with ≥1 year of postoperative follow-up were retrospectively analyzed after they had undergone revision as a result of retear at the initial suture site between 2018 and 2024. We compared the patients' presurgical and final follow-up values on the Tegner sports activity score (Tegner score), Lysholm score, and International Knee Documentation Committee (IKDC) Subjective Knee Form by Wilcoxon signed-rank test. At 1 year postoperatively, the revision site was structurally evaluated by magnetic resonance imaging (MRI). To account for multiple comparisons across outcome measures, a Bonferroni correction was applied, with statistical significance set at a <i>P</i> value of < .02.</p><p><strong>Results: </strong>Of the 11 knees, 7 were male and 4 were female (median age at revision: 23 years; IQR, 17-32 years). The median Lysholm and IKDC scores both improved significantly from 57.0 (IQR, 40.0-81.0) and 50.8 (IQR, 37.9-72.4) before revision surgery to 91.0 (IQR, 90.0-100.0) and 88.5 (74.7-94.3) at the final follow-up (<i>P</i> = .002, <i>r</i> = 0.89; <i>P</i> = .002, <i>r</i> = 0.89), respectively. Postoperative MRI findings revealed low-signal intensity changes at the revision site in 8 of 11 patients, whereas 3 patients demonstrated persistent high-signal intensity.</p><p><strong>Conclusion: </strong>Our study showed that revision meniscal repair may improve short-term clinical results in carefully selected patients with retears. Further research is required to define optimal indications and techniques.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 7","pages":"23259671261451781"},"PeriodicalIF":2.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354893/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423039","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":"Achilles Tendon Rupture in the NBA: Return to Play, Performance Decline, and Temporal Trends (2000-2025).","authors":"David Maman, Yaniv Steinfeld, Eyal Ginesin, Yaniv Yonai, Yaron Berkovich","doi":"10.1177/23259671261461403","DOIUrl":"10.1177/23259671261461403","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Achilles tendon rupture is a rare but potentially career-altering injury in elite basketball athletes. Contemporary data specific to National Basketball Association (NBA) players are limited, particularly regarding return-to-play (RTP) timing, functional outcomes, and long-term incidence trends in the modern high-pace era.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate RTP rates, time to return, postinjury performance changes, and temporal patterns of Achilles tendon rupture in NBA players over a 25-year period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Descriptive epidemiology study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;NBA players with a confirmed Achilles tendon rupture between the 2000-2001 and 2024-2025 seasons were identified through multisource verification, including team announcements, league injury reports, Basketball Reference records, NBA.com injury logs, and contemporaneous reporting from major sports media outlets. RTP was defined as participation in at least one official NBA regular season or postseason game after the index rupture. Season-level performance metrics were extracted for the final full preinjury season and the first full postreturn season. Paired pre- versus postinjury comparisons were performed, effect sizes were calculated using Cohen &lt;i&gt;d&lt;/i&gt;, and selected metrics were normalized per 48 minutes to account for changes in playing time. The annual rupture incidence was evaluated in relation to league-wide pace using Pearson correlation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 22 NBA players sustained a confirmed Achilles rupture. Among athletes with adequate follow-up (n = 15), 13 players (86.7%) returned to NBA competition. The mean time to RTP was 10.8 ± 4.3 months. Significant declines were observed in minutes per game (-7.6 minutes; &lt;i&gt;P&lt;/i&gt; &lt; .001), points per game (-5.4; &lt;i&gt;P&lt;/i&gt; &lt; .001), effective field goal percentage (-0.055; &lt;i&gt;P&lt;/i&gt; = .005), rebounds (-1.3; &lt;i&gt;P&lt;/i&gt; = .008), assists (-1.0; &lt;i&gt;P&lt;/i&gt; = .002), defensive rebounds (-1.01; &lt;i&gt;P&lt;/i&gt; = .014), steals (-0.28; &lt;i&gt;P&lt;/i&gt; = .001), and blocks (-0.19; &lt;i&gt;P&lt;/i&gt; = .026). When normalized per 48 minutes, scoring production still decreased significantly (-3.36 points; &lt;i&gt;P&lt;/i&gt; = .004), while defensive metrics were preserved. Games started decreased substantially (-44 percentage points; &lt;i&gt;P&lt;/i&gt; = .003). Annual rupture incidence remained low overall, with a notable spike in the 2024-2025 season, but no significant correlation with league pace was observed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study showed that most NBA players with adequate follow-up returned to professional play after Achilles tendon rupture, typically within approximately 11 months. However, reductions in playing time, scoring output, offensive efficiency, and starting role prevalence were common after return. Per-48-minute analyses suggested that scoring decline persisted even after accounting for reduced playing time, whereas several defensive and rebounding metrics w","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 7","pages":"23259671261461403"},"PeriodicalIF":2.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423019","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":"Elastographic Stiffness of the Rotator Cuff Pre and Post Surgical Repair in 115 Consecutive Patients.","authors":"Antonette Mariama R Bilog, Mina Shenouda, Patrick H Lam, George A C Murrell","doi":"10.1177/23259671261451756","DOIUrl":"10.1177/23259671261451756","url":null,"abstract":"<p><strong>Background: </strong>Higher retear rates after rotator cuff repair have been reported in older patients with large tears. Shear wave elastography (SWE) offers a noninvasive, objective way to assess tendon stiffness, yet the relationship between the preoperative and postoperative elastographic stiffness of the supraspinatus tendon has not been well studied.</p><p><strong>Purpose: </strong>To determine the association between preoperative and 6-week postoperative supraspinatus tendon elastographic stiffness and to assess the effect of age, symptom duration, tear thickness, and tear size on these measurements.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>Included were 115 consecutive shoulders undergoing primary arthroscopic repair of isolated supraspinatus tears using the undersurface technique. SWE measurements were obtained of the torn supraspinatus tendon preoperatively and of the repaired tendon 6 weeks postoperatively using a standardized protocol.</p><p><strong>Results: </strong>The preoperative elastographic stiffness of the torn edge of the supraspinatus tendon was diminished in larger (<i>R</i> = -0.3; <i>P</i> < .0001), full-thickness (<i>R</i> = -0.4; <i>P</i> = .0001) tears and in older patients (<i>R</i> = -0.3; <i>P</i> = .002). The mean (± standard deviation) SWE velocity of the supraspinatus tendon decreased by 12% 6 weeks postoperatively (6 ± 1.8 m/s preoperatively vs 5 ± 0.85 m/s postoperatively). While a modest correlation existed between preoperative and 6-week postoperative SWE (<i>R</i> = 0.3; <i>P</i> = .01), a strong inverse relationship was found between preoperative SWE and the improvement in elastographic stiffness after repair (change in SWE [ΔSWE]) (<i>R</i> = -0.8; <i>P</i> < .0001). Multivariate analysis identified preoperative SWE as the strongest predictor of ΔSWE (<i>F</i> = 60; <i>P</i> < .0001).</p><p><strong>Conclusion: </strong>Preoperative elastographic stiffness of the supraspinatus tendon was only modestly associated with early postoperative elastographic stiffness, a finding largely explained by a regression-toward-the-mean effect. These data support the hypothesis that the elastographic stiffness of supraspinatus tendons decreases with advancing age and with larger full-thickness tears. While it was observed that these tendons were elastographically softer preoperatively, they demonstrated the capacity for significant improvement in elastographic stiffness after repair.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 7","pages":"23259671261451756"},"PeriodicalIF":2.9,"publicationDate":"2026-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13354870/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423008","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":"Subsequent Injury Risk After Return-to-Play From Lower-Extremity Muscle Injuries in Professional Male Football (Soccer).","authors":"Guangze Zhang, Michel S Brink, Dominik Szymski, Lorenz Huber, Werner Krutsch, Volker Alt, Karen Aus der Fünten, Tobias Tröß, Tim Meyer, Koen A P M Lemmink, Anne Hecksteden","doi":"10.1177/23259671261449235","DOIUrl":"10.1177/23259671261449235","url":null,"abstract":"<p><strong>Background: </strong>Injuries to the upper extremity account for nearly half of the overall injury burden in professional football (soccer), with incidence rates differing across major muscle groups under both acute and overuse conditions. Importantly, they are commonly associated with an increased susceptibility to subsequent injury, especially in the weeks after return to play (RTP). However, the specific post-RTP risk trajectories after different lower-extremity muscle injuries remain insufficiently characterized.</p><p><strong>Purpose: </strong>To investigate the risk trajectory for noncontact subsequent injury after returning from major lower-extremity muscle injuries in professional football players, differentiating acute from overuse index injuries.</p><p><strong>Study design: </strong>Descriptive epidemiology study.</p><p><strong>Methods: </strong>Prospectively collected injury data from clubs in the first and second German Bundesliga over 3 seasons (2022-2023 to 2024-2025) were used for time-to-event analysis. Index injuries (ie, injuries from which players returned to play during the study period) of interest included hamstring, quadriceps, adductor, and calf injuries. Acute and overuse index muscle injuries were analyzed separately across these locations. Noncontact time-loss subsequent injuries occurring in the same season as RTP were considered the event of interest. Built upon previously published methodology, the Kaplan-Meier survival function was used to estimate the cumulative hazard function, from which the continuous hazard function was derived.</p><p><strong>Results: </strong>During the 3 analyzed seasons, 374 acute and 304 overuse index injuries were identified at the 4 lower-extremity muscle groups. Observed noncontact subsequent-injury rates were 27.9%, 26.2%, 39.3%, and 21.2% after acute hamstring, quadriceps, adductor, and calf index injuries, respectively, and 28.1%, 27.7%, 27.2%, and 27.4% for overuse index injuries. While the time course of noncontact subsequent injury risk globally aligned with previous findings, differences between muscle groups were observed. Players returning from acute hamstring and adductor injuries showed elevated risk, which diminished within approximately 12 and 4 weeks, respectively, and leveled off thereafter. By contrast, a delayed risk peak around 3 weeks after RTP was found for overuse calf index injuries.</p><p><strong>Conclusion: </strong>This descriptive study further confirms the time-varying nature of subsequent injury risk for specific lower-extremity muscle injuries. The observed differences in risk trajectories across muscle groups highlighted the need for careful RTP decision-making based on each index injury.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 7","pages":"23259671261449235"},"PeriodicalIF":2.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13351198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423060","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":"Changes in Opioid Prescription Patterns Following Implementation of the Controlled Substance Utilization Review and Evaluation System.","authors":"Amy Steele, Claire E Perrin, Daniel R Massillon, James D Bomar, Eric W Edmonds","doi":"10.1177/23259671261450619","DOIUrl":"10.1177/23259671261450619","url":null,"abstract":"<p><strong>Background: </strong>Drug overdose and poisoning deaths in the pediatric and adolescent population have recently surpassed cancer as the third-leading cause of death, resulting in the opioid epidemic being declared a public health emergency. Federal mandates, such as the Controlled Substance Utilization Review and Evaluation System (CURES) database that followed, were created to improve monitoring of opioid prescriptions. The impact of CURES on pain management for children and adolescents undergoing common arthroscopic procedures has not been assessed.</p><p><strong>Hypothesis: </strong>Post-CURES reduction in opioid prescriptions will not result in additional postsurgical triage contacts or additional prescription needs in a pediatric and adolescent cohort undergoing arthroscopic procedures.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Pediatric and adolescent patients (ages 10-19 years) undergoing common arthroscopic knee and shoulder procedures by a single surgeon at a single, tertiary care pediatric hospital from 2013 through 2023 were reviewed. Demographics, surgical details, and postoperative outcomes were compared across pre- (before 2018) and post-CURES (2018 and later) cohorts defined as before and after implementation of a change in opioid prescription habits that occurred in response to the mandatory reporting in CURES. Primary outcomes included phone calls or messages to the triage nurse related to pain. Secondary outcomes included additional opioid prescriptions required to manage pain.</p><p><strong>Results: </strong>The post-CURES cohort (N = 224) was prescribed significantly fewer morphine milligram equivalents (total MMEs prescribed) compared with the pre-CURES cohort (N = 244) (89.4 ± 8.3 vs 444.3 ± 66.0; <i>P</i> < .001). Patients in the post-CURES cohort were more likely to call regarding pain (13% vs 7%; <i>P</i> = .03). However, there were no differences in additional pain prescriptions required (4% pre- vs 4% post-CURES; <i>P</i>≥ .99) to manage pain.</p><p><strong>Conclusion: </strong>Despite a nearly 5-fold decrease in total MMEs prescribed, there was no increase in additional pain prescriptions required even though there was a 2-fold increase in messages related to pain to the triage nurse via education and reassurance. The hypothesis was upheld in part, suggesting that effective pain management can be achieved with fewer opioids, but that the postoperative care of adolescents undergoing arthroscopy could be further improved.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 7","pages":"23259671261450619"},"PeriodicalIF":2.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13351273/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423075","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 Operative Versus Nonoperative Management of Type III to V Acromioclavicular Joint Dislocations: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Darius Luke Lameire, Matthew Cecere, Ashlee Chan, Ellie Pinsker, Geoffrey Schemitsch, Jeremy A Hall, Jaskarndip Chahal, Daniel B Whelan","doi":"10.1177/23259671261440812","DOIUrl":"10.1177/23259671261440812","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acromioclavicular joint (ACJ) injuries are common; however, there is disagreement about the optimal treatment of Rockwood type ≥III ACJ dislocations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To systematically review and meta-analyze the outcomes of all randomized controlled trials that compared the operative and nonoperative treatment of Rockwood type III to V ACJ dislocations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review; Level of evidence, 2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic search of 4 databases was performed through September 15, 2024. Inclusion criteria included (1) adult patients, (2) acute Rockwood type III to V ACJ dislocations, (3) direct comparisons of operative to nonoperative management, (4) randomized controlled trial methodology, and (5) reporting of clinical outcomes. The primary outcome was the Constant score, and secondary outcomes consisted of other patient-reported outcome measure (PROM) scores, cosmesis, radiographic findings, range of motion, return to work/sport, complications, and unplanned surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 5 comparative studies included in this review with a total of 367 patients: 193 patients underwent operative treatment (102 type III, 11 type IV, 40 type V, and 40 type III-V), and 174 underwent nonoperative treatment (84 type III, 13 type IV, 34 type V, and 43 type III-V). The mean age was 39.1 years for operative patients and 37.4 years for nonoperative patients. The follow-up ranged from 12 to 229.2 months. The mean Constant score at ≥2 years was 92.4 for operative patients and 90.1 for nonoperative patients, with meta-analysis demonstrating no significant differences at ≥2 years (95% CI, -0.03 to 0.43; &lt;i&gt;P&lt;/i&gt; = .2). However, at shorter follow-up durations, individual studies found statistically significant differences favoring nonoperative management. One study found improved return to work rates with nonoperative management at 3 months, with no differences found at other time points. Meta-analysis found no significant differences in major complications between operative and nonoperative management (&lt;i&gt;P&lt;/i&gt; = .84), although there were statistically significantly more minor complications with operative management (&lt;i&gt;P&lt;/i&gt; &lt; .0001). There were few reported outcomes for isolated type III, IV, or V injuries, but where reported, these outcomes followed the overall trend, with early PROM scores favoring nonoperative treatment and comparable outcomes between treatment groups at longer follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;There were comparable PROM scores at ≥1 year when comparing operative to nonoperative treatment in patients who sustained a Rockwood type III to V ACJ dislocation. However, early PROM scores favored nonoperative management. There were comparable satisfaction rates and comparable return to work/sport rates between groups. Therefore, the nonoperative management of type III to V ACJ dislocations resulted in comparable ","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 7","pages":"23259671261440812"},"PeriodicalIF":2.9,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13351202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423063","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":"Prognostic Factors for Repair Integrity After Arthroscopic Rotator Cuff Repair: A Systematic Review and Meta-analysis.","authors":"Lieselotte Pichler, Mélody Mussard, Michael Oyewale, Laurent Audigé, Christian Appenzeller-Herzog, Andreas Marc Müller, Thomas Stojanov","doi":"10.1177/23259671261455856","DOIUrl":"10.1177/23259671261455856","url":null,"abstract":"<p><strong>Background: </strong>Repair integrity is the most frequently assessed objective outcome after arthroscopic rotator cuff repair (ARCR). Multiple studies evaluated independent prognostic factors for repair integrity. However, there is a lack of a comprehensive quantitative review summarizing these findings.</p><p><strong>Purpose: </strong>To provide a descriptive synthesis of the published association estimates between candidate prognostic factors and repair integrity after ARCR.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 4.</p><p><strong>Methods: </strong>The EMBASE, Medline, and Scopus databases were screened (January 2014-March 2024) for longitudinal studies with multivariate analyses and at least 6 months of follow-up (registration number: CRD42020199257). Association measures were converted to correlation coefficients (<i>r</i>) and pooled using a random-effects meta-analysis of prognostic factors and repair integrity, with definitions from individual studies. Data extraction, evaluation of the risk of bias in the included studies, and the certainty of the synthesized evidence were assessed by pairs of study authors using the Checklist for Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modeling Studies for Prognostic Factors (CHARMS-PF), Quality in Prognosis Study (QUIPS), and Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tools, respectively.</p><p><strong>Results: </strong>Of 10,568 records, 30 studies met the inclusion criteria, representing 13,161 patients (mean age, 59 years; female participants: 45%). Recurrent defect rates ranged from 5% to 43%. The meta-analysis included 45% (92/206) of reported association measures, covering 15 factors across 27 studies. There was high-quality evidence supporting that increased age (<i>r</i> = 0.02 [95% CI, 0-0.04]) was associated with higher recurrent defect rates. There was moderate quality evidence supporting that larger tear size (<i>r</i> = 0.35 [95% CI, 0.21-0.45]), reduced acromiohumeral distance (<i>r</i> = 0.32 [95% CI, 0.12-0.50]), greater degree of fatty infiltration of the supraspinatus (<i>r</i> = 0.63 [95% CI, 0.14- 0.81]), and greater tear retraction (<i>r</i> = 0.30 [95% CI, 0.15-0.42]) were associated with higher rates of recurrent defects. However, there was substantial heterogeneity across studies. The quality of evidence was deemed low to very low for most of the studied factors. Most included studies had a high risk of bias related to confounding, analysis, and reporting.</p><p><strong>Conclusion: </strong>Moderate- to high-certainty evidence supports 5 prognostic factors-including sociodemographic and diagnostic-related variables-as being associated with higher recurrent defect rates. These results may be used to prioritize further prognostic research studies.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 7","pages":"23259671261455856"},"PeriodicalIF":2.9,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346710/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423016","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":"Influences of Tibial Plateau Morphology on JLCA Change, Clinical Outcomes and Cartilage Regeneration After Medial Opening Wedge High Tibial Osteotomy.","authors":"Yao-Chang Lo, Jen-Hao Liu, Chih-Hao Chang, Hongsen Chiang, Chien-Lin Chen, Jyh-Horng Wang, Tzu-Hao Tseng","doi":"10.1177/23259671261457777","DOIUrl":"10.1177/23259671261457777","url":null,"abstract":"<p><strong>Background: </strong>Medial opening wedge high tibial osteotomy (MOWHTO) is widely used to treat medial compartment osteoarthritis with varus malalignment. Variations in proximal tibial intra-articular morphology may influence alignment correction during osteotomy, but their clinical significance remains unclear.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to evaluate whether different plateau morphologies are associated with differences in radiographic changes, clinical outcomes, and cartilage regeneration. It was hypothesized that proximal tibial plateau morphology does not significantly influence clinical outcomes or cartilage regeneration after MOWHTO.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>That data of 186 patients who underwent unilateral MOWHTO between 2016 and 2022 were retrospectively reviewed. Based on the angular relationship between the medial and lateral tibial plateaus, knees were classified as depressed (n = 60), flat (n = 83), or convex (n = 43). Radiographic parameters including medial proximal tibial angle, hip-knee-ankle angle, joint line convergence angle (JLCA), and weightbearing line ratio were measured preoperatively and postoperatively. Changes in JLCA were analyzed using repeated-measures analysis of variance. Clinical outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS). Cartilage regeneration was evaluated arthroscopically according to the International Cartilage Regeneration & Joint Preservation Society grading system during second-look arthroscopy.</p><p><strong>Results: </strong>Baseline characteristics and postoperative radiographic parameters were comparable among groups. A significant group × time interaction was observed for JLCA (<i>P</i> = .016), with the convex type showing greater JLCA change than the depressed (<i>P</i> = .018) and flat (<i>P</i> = .049) types; however, the magnitude of the difference was small (<1°). Postoperative KOOS values were similar among groups, and plateau inclination analyzed as a continuous variable was not correlated with KOOS (Pearson <i>r</i> = 0.112; <i>P</i> = .13). Second-look arthroscopy was performed in 103 patients, demonstrating cartilage improvement in 53.1%, 58.3%, and 52.2% of the depressed, flat, and convex groups, respectively (<i>P</i> = .790).</p><p><strong>Conclusion: </strong>Proximal tibial plateau morphology did not significantly affect clinical outcomes or changes in cartilage status after MOWHTO.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 7","pages":"23259671261457777"},"PeriodicalIF":2.9,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423091","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":"Blood Flow Restriction Training After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Yuhui Hu, Long Guo, Xiaolan Zeng, Rongxia Yuan","doi":"10.1177/23259671261440196","DOIUrl":"10.1177/23259671261440196","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament reconstruction (ACLR) is frequently followed by significant quadriceps atrophy and strength loss due to postoperative pain and the necessity for low-load rehabilitation. Blood flow restriction (BFR) training is an emerging modality that may facilitate muscle strength and hypertrophy under low-load conditions, but its efficacy for improving functional outcomes after ACLR remains to be conclusively determined.</p><p><strong>Purpose: </strong>To systematically evaluate the effects of BFR training on lower limb function, quadriceps strength, and knee pain in patients following ACLR.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 3.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, Web of Science, PEDro, EBSCO and CNKI for randomized controlled trials (RCTs) published between January 2015 and August 2025. A total of 606 records were identified through database searching, and 9 RCTs were included after screening. Data on functional scores (Lysholm, International Knee Documentation Committee [IKDC]), quadriceps peak torque (PT), pain (visual analog scale [VAS]), and range of motion (ROM) were extracted and analyzed using RevMan 5.4, and risk of bias was assessed using the Cochrane tool. Meta-analyses were performed using weighted mean differences (WMDs) with fixed- or random-effects models as appropriate, and heterogeneity was assessed using the <i>I</i> ² statistic.</p><p><strong>Results: </strong>Nine RCTs involving 372 participants were included. Meta-analysis revealed that BFR training significantly improved Lysholm scores (WMD, 5.75; 95% CI, 0.60-10.90; <i>P</i> = .03) and quadriceps PT (WMD, 8.34; 95% CI, 7.47-9.22; <i>P</i> < .00001), and increased total work output (<i>P</i> = .006). However, no significant differences were observed in IKDC scores, VAS pain scores, or ROM (<i>P</i> > .05). Sensitivity analyses confirmed the robustness of the primary findings.</p><p><strong>Conclusion: </strong>Our study demonstrated that BFR training may promote early recovery of quadriceps strength and selected aspects of knee function after ACLR under low-load conditions. BFR appears feasible and generally well tolerated in the included trials; however, safety conclusions are limited by inconsistent adverse-event reporting. Its effects on pain relief, joint mobility, and long-term functional recovery require further investigation.</p>","PeriodicalId":19646,"journal":{"name":"Orthopaedic Journal of Sports Medicine","volume":"14 7","pages":"23259671261440196"},"PeriodicalIF":2.9,"publicationDate":"2026-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13346806/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148423022","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}