Arthroscopy Sports Medicine and Rehabilitation最新文献

{"title":"Isokinetic Testing After Anterior Cruciate Ligament Injury Showed a Greater Hamstrings/Quadriceps Ratio at 240°/S Over 6 Months From Injury but No Difference of Limb Symmetry Index","authors":"Guillaume Mesnard M.D. ,&nbsp;Gaspard Fournier M.D. ,&nbsp;Nicolas Cance ,&nbsp;Robert A. Magnussen M.D., M.P.H. ,&nbsp;Sébastien Lustig M.D., Ph.D. ,&nbsp;Elvire Servien M.D., Ph.D.","doi":"10.1016/j.asmr.2024.101063","DOIUrl":"10.1016/j.asmr.2024.101063","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess preoperative quadriceps and hamstring strength at various time points after anterior cruciate ligament (ACL) injury but before ACL reconstruction.</div></div><div><h3>Methods</h3><div>Patients who underwent isokinetic muscle strength testing before planned ACL reconstruction were included. Patients were placed in 1 of the following 3 groups on the basis of time from injury to testing: &lt;3 months, 3 to 6 months, and 6 to 12 months. Among these 3 groups, hamstring and quadriceps limb symmetry index (LSI) and hamstring/quadriceps (H/Q) ratios were compared. A total of 100 patients were included (&lt;3 months [n = 55]; 3-6 months [n = 31]; and 6-12 months [n = 14]).</div></div><div><h3>Results</h3><div>There were no significant differences between patients in the 3 groups in regards to age, body mass index, or flexion range of motion, but there was a greater proportion of female patients in the 6 to 12 month group than the other groups. No significant differences in quadriceps or hamstring strength were noted among the 3 groups. H/Q ratio was significantly greater in the 6 to 12 month group than the less than 3 months and 3 to 6 months groups, with concentric testing at 240°/s. No correlation was found between patient sex and LSI or H/Q ratios.</div></div><div><h3>Conclusions</h3><div>Patients who underwent isokinetic muscle strength testing 6 to 12 months after ACL injury had a greater H/Q ratio at 240°/s than those who were testing within 6 months of injury. No differences in hamstring or quadriceps LSI were noted on the basis of time.</div></div><div><h3>Clinical Relevance</h3><div>An understanding of the factors that influence preoperative isokinetic muscle strength testing (including time from injury to surgery) is important, given associations noted between preoperative strength and postoperative strength recovery after ACL reconstruction.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 2","pages":"Article 101063"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal Shockwave Therapy Is Associated With Similar Functional Outcomes for Male and Female Runners With Patellar or Quadriceps Tendinopathy: A Pilot Investigation","authors":"Nicole B. Katz M.D. ,&nbsp;Jonathan P. Fee B.S. ,&nbsp;Andrew S. Nowak M.D., J.D. ,&nbsp;Adam S. Tenforde M.D., F.A.C.S.M.","doi":"10.1016/j.asmr.2024.101024","DOIUrl":"10.1016/j.asmr.2024.101024","url":null,"abstract":"<div><h3>Purpose</h3><div>To characterize functional outcomes in runners with patellar tendinopathy (PT) and quadriceps tendinopathy (QT) following extracorporeal shockwave therapy (ESWT) and explore differences in response by tendinopathy (PT or QT) and by sex (female or male).</div></div><div><h3>Methods</h3><div>This is a retrospective cohort study of runners with PT or QT treated with ESWT (radial or combined radial and focused) at a single sports medicine clinic during a 5-year period. Individuals were included if they had a primary diagnosis of PT or QT, self-identified as a runner, and had complete baseline and final functional outcome questionnaires for ESWT with treatment duration defined by response based on best practices. Functional outcome at baseline and following treatment were assessed using the Victorian Institute of Sport Assessment–Patellar Tendon questionnaires. Treatment success was defined as meeting the minimal clinically important difference (MCID) of ≥13 points.</div></div><div><h3>Results</h3><div>Of the 19 runners included, 26% identified as female and 74% as male; all runners identified as cisgendered. There were 12 runners with PT (17% female, 83% male) and 7 with QT (43% female, 57% male). Median follow-up was 3.0 months (range, 1.0-23.0; interquartile range, 3.0-6.0). Of all runners, 67% with PT and 71% with QT achieved MCID with no significant difference between tendinopathy groups (<em>P</em> = .90). There was also no difference in the percentage that achieved MCID between sexes, with 80% of women and 64% of men meeting MCID (<em>P</em> = .72).</div></div><div><h3>Conclusions</h3><div>Similar functional outcomes were observed in female and male runners with QT or PT following radial and combined ESWT, with most achieving MCID. This study suggests that ESWT, in combination with physical therapy, may be an effective treatment for runners with PT or QT and that ESWT could be considered for PT or QT refractory to physical therapy.</div></div><div><h3>Level of Evidence</h3><div>Level IV, retrospective case series.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 2","pages":"Article 101024"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Repair for Posterior Shoulder Instability Is Associated With Favorable Outcomes and High Return to Sport or Work: A Systematic Review and Meta-Analysis","authors":"Antonio Cusano M.D. ,&nbsp;Alexander J. Ment B.A. ,&nbsp;Kevin A. Hao M.D. ,&nbsp;Jayson Saleet B.A. ,&nbsp;Patrick Nian B.A. ,&nbsp;Emily Curry M.P.H. ,&nbsp;Michael Groot M.S. ,&nbsp;David Novikov M.D. ,&nbsp;Hussein Abdul-Rassoul M.D. ,&nbsp;Robert L. Parisien M.D. ,&nbsp;Brett D. Owens M.D. ,&nbsp;Xinning Li M.D.","doi":"10.1016/j.asmr.2024.101032","DOIUrl":"10.1016/j.asmr.2024.101032","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess clinical outcomes of primary arthroscopic repair for unilateral posterior shoulder instability (PSI) in all patients, to evaluate clinical outcomes in athletes, and to compare clinical outcomes between contact and overhead athletes.</div></div><div><h3>Methods</h3><div>A systematic review was performed using PRISMA Guidelines. Included studies reported on primary arthroscopic treatment of PSI with at least 1 year of follow-up. Studies were excluded if they were not in English, included revisions/open procedures or anterior/multidirectional instability, had fewer than 10 patients or no full text available, or were biomechanical analyses/descriptions of surgical technique. Primary outcomes were rates of return to sport (RTS), return to preinjury level (RTPL), recurrent instability, and revision surgery. Outcomes were evaluated in all patients and all athletes, with further subdivision for <em>contact</em> and <em>overhead</em>.</div></div><div><h3>Results</h3><div>Of the 1,504 screened studies, 30 met inclusion criteria (1,649 shoulders). Mean age at surgery was 23.3 years (range: 12.4–65 years), and mean follow-up was 35.5 months (range: 12–140.4 months). There were 1,051 males and 196 females. RTS rates were 91.7% among all patients and 90.9% in all athletes, with no statistical difference between contact and overhead athletes (92.8% vs 88.1%; <em>P</em> = .176). RTPL rates were 78.7% among all patients and 75.6% in all athletes, with no statistical difference between contact and overhead athletes (90.8% vs 62.3%; <em>P</em> = .072). Recurrent instability rates were 7.0% among all patients and 8.0% in all athletes, with no statistical difference between contact and overhead athletes (7.3% vs 7.4%; <em>P</em> = .981). Revision rates were 3.7% among all patients and 3.3% in all athletes, with no statistical difference between contact and overhead athletes (6.8% vs. 0%; <em>P</em> = 1).</div></div><div><h3>Conclusion</h3><div>Primary arthroscopic treatment of PSI is associated with favorable outcomes and high return to sport and work rates. Recurrent instability and pain were the most common reasons for revision.</div></div><div><h3>Level of Evidence</h3><div>Level IV, Systematic review and meta-analysis of Level II to IV studies.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 2","pages":"Article 101032"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood Flow Restriction Training: A Tool to Enhance Rehabilitation and Build Athlete Resiliency","authors":"Mark Murphy P.T., D.P.T., S.C.S., C.S.C.S.","doi":"10.1016/j.asmr.2024.101022","DOIUrl":"10.1016/j.asmr.2024.101022","url":null,"abstract":"<div><div>Blood flow restriction training (BFRT) is a tool utilized in rehabilitation and injury prevention to improve muscle strength and size, particularly in load-compromised individuals. BFRT facilitates gains in muscular strength and hypertrophy at lower loads, allowing for accelerated recovery and less disuse atrophy. BFRT must be applied appropriately and with caution, particularly in individuals with cardiovascular concerns. There are applications for BFRT across a wide spectrum of human performance training and in rehabilitation of both lower and upper extremity conditions, providing a high-quality adjunct to improve muscle strength, power, and endurance.</div></div><div><h3>Level of Evidence</h3><div>Level V, expert opinion.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 2","pages":"Article 101022"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sleep Quality and Cognitive Skills Impact Neurocognitive Function and Reduce Sports-Related Injury Risk","authors":"Brett Haskell Ph.D., C.M.P.C. ,&nbsp;Abigail Eiler L.M.S.W., M.S.W. ,&nbsp;Haven Essien L.L.M.S.W., M.S.W.","doi":"10.1016/j.asmr.2025.101077","DOIUrl":"10.1016/j.asmr.2025.101077","url":null,"abstract":"<div><div>Injury prevention in sports is critically influenced by cognitive factors, particularly sleep quality and cognitive skills. Research has underscored the role of cognitive processes in injury risk and recovery, highlighting that inadequate sleep and poor cognitive functioning can significantly elevate injury susceptibility. Despite the well-documented benefits of adequate sleep and cognitive training in mitigating injury risk, access to sports psychology expertise is limited among athletes and health care providers. This work reviews the literature on the effectiveness of cognitive skills and sleep training in reducing sports-related injuries. Sleep affects musculoskeletal recovery, cognitive function, and immune response, which may further exacerbate injury risk. Neurobiological processes during sleep are crucial for muscle repair, cognitive function, and immune efficiency, all of which are integral to reducing the injury risk in athletes. Environmental factors such as travel schedules, training intensity, and competitive pressures disrupt sleep and increase the risk of injury. Cognitive Behavioral Therapy for Insomnia has shown promise in addressing sleep disturbances by improving sleep habits and addressing cognitive distress related to sleep. In addition, cognitive skills training, including mental skills training and mindfulness, enhances perceptual awareness, decision making, and reaction times, potentially reducing injury incidence by improving cognitive and motor function. Evidence supports the pivotal role of sleep and cognitive skills in preventing sports injuries. Interventions like Cognitive Behavioral Therapy for Insomnia and mental skills training can effectively address these factors, suggesting that integrating these approaches into athlete training programs could significantly enhance injury prevention strategies.</div></div><div><h3>Level of Evidence</h3><div>Level V, expert opinion.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 2","pages":"Article 101077"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Academic Productivity at Orthopaedic Surgery Sports Medicine Fellowship Programs in the United States Has a Weak Positive Correlation With Nonresearch Lifetime Industry Earnings","authors":"Benjamin Miltenberg M.D. ,&nbsp;William L. Johns M.D. ,&nbsp;Anthony N. Baumann D.P.T. ,&nbsp;Faheem Pottayil M.S. ,&nbsp;Bradley Richey M.D. ,&nbsp;Albert T. Anastasio M.D. ,&nbsp;Kempland C. Walley M.D. ,&nbsp;Christopher C. Dodson M.D. ,&nbsp;Sommer Hammoud M.D.","doi":"10.1016/j.asmr.2024.101042","DOIUrl":"10.1016/j.asmr.2024.101042","url":null,"abstract":"<div><h3>Purpose</h3><div>To characterize the relationship between academic productivity, as defined by the h-index, and industry payments for fellowship-trained sports medicine surgeons in faculty positions at sports medicine fellowships.</div></div><div><h3>Methods</h3><div>The American Orthopaedic Society for Sports Medicine fellowship directory was used to create a comprehensive list of all fellowship programs nationwide. Fellowship websites were then reviewed to generate a list of the teaching faculty associated with each program. Total nonresearch lifetime earnings were obtained from the Centers for Medicare &amp; Medicaid Services website. Academic productivity of each fellowship faculty was assessed via the h-index. Frequency counts and other descriptive statistic measures were used to describe the data for this study. Correlation was performed for continuous data using Spearman’s ρ.</div></div><div><h3>Results</h3><div>Ninety orthopaedic surgery sports medicine fellowships were identified with a combined total of 574 orthopaedic surgery sports medicine fellowship faculty. There was a weak positive correlation between individual physician h-index and individual physician lifetime earnings at orthopaedic surgery sports medicine fellowships (<em>P</em> &lt; .001; Spearman’s ρ = 0.329). There was a statistically significant difference between individual faculty h-index by quartile and individual faculty lifetime earnings (test statistic: 47.3; <em>P</em> &lt; .001). There was no significant regional difference in payments, but there is remarkable heterogeneity in the distribution of payments to individual physicians, with the top 10% of physicians receiving over 80% of industry dollars.</div></div><div><h3>Conclusions</h3><div>There is a positive correlation between academic productivity and industry payments at both the individual and institutional levels in orthopaedic sports medicine departments, although this relationship was greater at the fellowship level. Furthermore, the majority of nonresearch industry funding goes to a minority of physicians.</div></div><div><h3>Clinical Relevance</h3><div>Evaluating the impact that nonresearch industry payments have on a sports medicine orthopaedic surgeon’s research productivity can offer valuable insights into the relationship between industry compensation and scholarly output in this field.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 2","pages":"Article 101042"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thermal Modalities Including Hot Baths and Cold Plunges Play a Unique Role in Injury Prevention and Recovery","authors":"Kiera L. Vrindten M.B.S. ,&nbsp;Danielle P. Lonati B.A. ,&nbsp;Jillian L. Mazzocca B.A. ,&nbsp;Elizabeth G. Matzkin M.D.","doi":"10.1016/j.asmr.2025.101143","DOIUrl":"10.1016/j.asmr.2025.101143","url":null,"abstract":"<div><div>There are several different modalities for injury prevention to consider in order to help our patients’ reach their ultimate goals. The purpose of this review is to analyze the use of hot and cold therapies to prevent injury. Thermotherapy has been used in clinical rehabilitation settings to treat health conditions. The therapeutic use of cold, known as cryotherapy, is historically the most popular treatment for acute musculoskeletal injury or fatigue. Cold therapy was seen to decrease delayed-onset muscle soreness and help resolve global or generalized muscle injury or fatigue. In sum, both cold and hot therapy play similar but unique roles in injury prevention and recovery. The key to effective use of either depends on understanding the nature of the injury and mastering the appropriate timing of therapeutic application. By leveraging the unique mechanisms of each modality, athletes can optimize their recovery process and reduce the risk of future injury.</div></div><div><h3>Level of Evidence</h3><div>Level V, expert opinion.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 2","pages":"Article 101143"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Surgical Intervention Results in Better Patient-Reported Outcomes Than Delayed Treatment in Patients Undergoing Anterior Cruciate Ligament Reconstruction in the Presence of Concomitant Medial Collateral Ligament Injury","authors":"Blake M. Bacevich B.S. ,&nbsp;Sean Hazzard P.A., M.B.A. ,&nbsp;Mia Lustig B.S. ,&nbsp;Saoirse Connelly B.S. ,&nbsp;Varun Nukala B.S. ,&nbsp;Peter Asnis M.D.","doi":"10.1016/j.asmr.2024.101038","DOIUrl":"10.1016/j.asmr.2024.101038","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the influence of the timing of anterior cruciate ligament (ACL) reconstruction (ACLR) on patient-reported outcomes, comparing patients with and without concomitant medial collateral ligament (MCL) injury.</div></div><div><h3>Methods</h3><div>This study included patients who underwent ACLR between September 2015 and October 2020. The inclusion criteria included patients for whom preoperative and postoperative patient-reported outcome measures were available and a follow-up period of at least 2 years. Patients who sustained grade 2 or 3 MCL injuries with ACL tears were compared with patients with no MCL injuries as a control. All patients underwent ACLR with either bone-tendon-bone autograft or bone-tendon-bone allograft. Patient-reported outcomes (International Knee Documentation Committee [IKDC] score, Lysholm score, and Knee Injury and Osteoarthritis Outcome Score [KOOS]) were recorded, and outcomes were analyzed by sex and time from index injury. A stratified linear mixed-effects regression analysis was conducted.</div></div><div><h3>Results</h3><div>A total of 253 eligible patients with 2-year outcomes were enrolled. Patients with combined ACL-MCL injuries had lower IKDC scores (β = –6.1 vs β = –8.3, <em>P</em> = .003), KOOS Quality of Life values (β = –9.3 vs β = –11, <em>P</em> = .004), and KOOS Sport values (β = –12 vs β = –13, <em>P</em> = .08) if surgery was performed more than 6 weeks after the index injury. Patients with isolated ACL injuries showed lower KOOS Activities of Daily Living values (β = –2.4, <em>P</em> = .045) if surgery was performed at between 3 and 6 months. Among patients with combined ACL-MCL injuries, autograft was found to have worse IKDC scores (β = –11 [95% confidence interval (CI), –18 to –4.2]; <em>P</em> = .002), Lysholm scores (β = –9.2 [95% CI, –15 to –3.1]; <em>P</em> = .004), KOOS Quality of Life values (β = –11 [95% CI, –20 to –1.6]; <em>P</em> = .023), KOOS Pain values (β = –5.1 [95% CI, –10 to –0.03]; <em>P</em> = .049), KOOS Symptoms values (β = –7.6 [95% CI, –10 to –0.03]; <em>P</em> = .02), and KOOS Sport values (β = –21 [95% CI, –32 to –10]; <em>P</em> &lt; .001) than allograft.</div></div><div><h3>Conclusions</h3><div>Patients undergoing ACLR with grade 2 or 3 MCL injuries have improved patient-reported outcomes if surgery is performed within 6 weeks from the time of injury. In this cohort, allografts resulted in better outcome scores compared with autografts.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective cohort study.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 2","pages":"Article 101038"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision Surgery Is the Most Common Definition of Failure in Studies Evaluating Knee Cartilage Restoration Outcomes: A Systematic Review","authors":"Lexy Farrington B.S.,&nbsp;Marcus Trotter M.D.,&nbsp;Ezra Goodrich M.D.,&nbsp;Armin Tarakemeh B.A.,&nbsp;Erik Henkelman M.D.,&nbsp;Paul Schroeppel M.D.,&nbsp;Christopher D. Bernard M.D.,&nbsp;Rachel Long B.S.,&nbsp;Tucker Morey B.S.,&nbsp;Jacob White M.S.,&nbsp;Bryan G. Vopat M.D.","doi":"10.1016/j.asmr.2024.101044","DOIUrl":"10.1016/j.asmr.2024.101044","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the definitions of “failure” of knee chondral restoration surgery in the current literature and to provide a recommendation on what should define failure.</div></div><div><h3>Methods</h3><div>By use of Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria, a systematic search of the PubMed, Embase, Ovid, and Cochrane Library databases was conducted to identify studies published between January 1, 2017, and May 1, 2021. The inclusion criteria consisted of studies containing patients who underwent knee cartilage surgery that included a definition of failure. We excluded animal studies; articles comparing alternative medical treatments, such as rehabilitation, anti-inflammatory medications, and physical therapy; studies enrolling patients with diseases other than those of the knee, and non–English-language studies. Failure data were extracted and categorized as surgical, graft related, or based on patient-reported outcomes (PROs). This information was analyzed to develop a recommendation for a standardized definition of failure of knee cartilage restoration.</div></div><div><h3>Results</h3><div>A total of 61 studies met the inclusion criteria. The most common definition of knee chondral restoration failure was the need for any revision surgery (52 of 61 studies, 85.3%), with failure rates ranging from 3.22% to 75%. Graft failure, defined as delamination and/or graft inadequacy (39 of 61, 63.9%), with failure rates ranging from 2.10% to 47%, and conversion to knee arthroplasty (34 of 61, 55.7%) were also used as definitions. Failure to return to sport and/or regular activity (4 of 61, 6.6%), presence of symptoms (21 of 61, 34.4%), removal of graft or implant (14 of 61, 22.9%), and other unclassified follow-up revisions (8 of 61, 13.1%) were additional definitions of failure documented. Subjective PROs were used in 54.1% of the studies (33 of 61), with failure rates ranging from 3.45% to 59%.</div></div><div><h3>Conclusions</h3><div>A variety of definitions of failure are used to evaluate knee chondral restorative surgery outcomes in the orthopaedic literature. Any unplanned revision surgery and graft failure, defined as delamination and/or graft inadequacy, were the most common criteria defining knee chondral restoration failure. Patients’ functionality and quality of life, determined by PROs, were also used to define knee chondral restoration failure in multiple studies. Higher rates of failure were observed after knee chondral restorative procedures when using multiple definitions of failure that were more inclusive. To account for heterogeneity in definitions, procedures, and patient circumstances, we recommend using multiple outcomes, including unplanned surgical procedures, PROs, and the ability to return to the desired level of function, as factors to define failure.</div></div><div><h3>Level of Evidence</h3><div>Level IV, systematic review of Level II to IV studies.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 2","pages":"Article 101044"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient Age and Activity Level, Posterior Tibial Slope, and Use of Allograft Are Significant Risk Factors for Anterior Cruciate Ligament Reconstruction Failure: A Systematic Review","authors":"Jeffrey Lee B.S. ,&nbsp;Johnathon R. McCormick M.D. ,&nbsp;Kevin Credille M.D. ,&nbsp;Navya Dandu M.D. ,&nbsp;Zachary Wang B.S. ,&nbsp;Nicholas A. Trasolini M.D. ,&nbsp;Reem Y. Darwish B.S. ,&nbsp;Jorge Chahla M.D., Ph.D. ,&nbsp;Adam B. Yanke M.D., Ph.D.","doi":"10.1016/j.asmr.2025.101075","DOIUrl":"10.1016/j.asmr.2025.101075","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the consistency of risk factor reporting for anterior cruciate ligament reconstruction (ACLR) failure after primary reconstruction, identify risk factors more frequently associated with ACLR failure, and help clinicians prevent reinjury in patients with risk factors for ACLR failure.</div></div><div><h3>Methods</h3><div>Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used to conduct a systematic review. Initial title and abstract screening yielded 561 studies, from which 76 studies were assessed for eligibility. Thirty-two full-text studies met the following inclusion criteria: (1) clinical studies of anterior cruciate ligament injuries; (2) patients undergoing ACLR; (3) clinical outcome data, including failure rate; (4) studies assessing preoperative risk factors for failure; and (5) manuscripts published within the past 6 years. These studies were subdivided into those that defined ACLR failure as revision surgery or graft failure.</div></div><div><h3>Results</h3><div>Ten risk factors were included in the review for 22 studies defining ACLR failure as revision surgery. Eight risk factors were included in the review for 10 studies defining ACLR failure as graft failure. Posterior tibial slope (PTS) (80%, 4/5 studies), age (79%, 11/14 studies), and graft characteristics (71%, 5/7 studies) such as allograft versus bone–patellar tendon–bone autograft, high-dose radiation, and BioCleanse preparation technique were the most significant risk factors for revision ACLR. PTS (100%, 2/2 studies) and activity level (67%, 2/3 studies) were the most significant risk factors for graft failure.</div></div><div><h3>Conclusions</h3><div>Age, PTS, use of allograft, and activity level are significant preoperative risk factors that should be considered when attempting to prevent reinjury in ACLR candidates. Studies investigating risk factors for ACLR failure often fail to control for confounding variables that can influence outcomes.</div></div><div><h3>Level of Evidence</h3><div>Level IV, systematic review of Level II to IV studies,</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 2","pages":"Article 101075"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143845225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}