Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine最新文献

{"title":"Suture anchor fixation of the pediatric posteromedial and posterolateral meniscotibial ligament complex matches or exceeds native tissue strength: A cadaveric study","authors":"Ian Hollyer ,&nbsp;Thomas M. Johnstone ,&nbsp;Amin Alayleh ,&nbsp;Willemijn H. van Deursen ,&nbsp;Kelly H. McFarlane ,&nbsp;David W. Baird Jr ,&nbsp;Calvin K. Chan ,&nbsp;Marc Tompkins ,&nbsp;Henry B. Ellis ,&nbsp;Theodore J. Ganley ,&nbsp;Yi-Meng Yen ,&nbsp;Seth L. Sherman ,&nbsp;Kevin G. Shea","doi":"10.1016/j.jisako.2025.100385","DOIUrl":"10.1016/j.jisako.2025.100385","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to compare the biomechanical strength and stiffness of the native posteromedial and posterolateral meniscotibial ligament complex (MTLC) to suture anchor repair of the MTLC.</div></div><div><h3>Methods</h3><div>Biomechanical testing was performed on 24 fresh-frozen pediatric human knees. Four conditions were tested: native posteromedial MTLC (n ​= ​14), native posterolateral MTLC (n ​= ​14), posteromedial MTLC repair (n ​= ​5), and posterolateral MTLC repair (n ​= ​5). Load to failure and stiffness were measured for all conditions.</div></div><div><h3>Results</h3><div>The load to failure for the posteromedial suture anchor construct was significantly higher than that for the native MTLC (p ​&lt; ​0.01). The posterolateral suture anchor construct had a significantly greater stiffness than the native MTLC (p ​= ​0.03). Posterolateral MTLC load to failure and posteromedial MTLC stiffness were similar between native tissue and suture-anchor repair. All native MTLCs failed at the meniscus-MTLC interface. The suture anchor groups had various failure modes, including suture pullout and breakage.</div></div><div><h3>Conclusion</h3><div>Suture anchor fixation can match or exceed the native tissue's load to failure. This study supports the viability of suture anchor–based posterior MTLC repairs of the medial and lateral meniscus in pediatric bone.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"11 ","pages":"Article 100385"},"PeriodicalIF":2.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound-guided repair of the anterior talofibular ligament with or without Gould augmentation is safe and improves clinical outcomes for chronic lateral ankle instability: A case series of 49 patients","authors":"Soichi Hattori ,&nbsp;Kentaro Onishi ,&nbsp;Takuya Okada ,&nbsp;Marfred M. Umanes ,&nbsp;Ken Ichikawa ,&nbsp;Shuzo Takazawa ,&nbsp;Shin Yamada ,&nbsp;Yuki Kato ,&nbsp;MaCalus V. Hogan ,&nbsp;Hiroshi Ohuchi","doi":"10.1016/j.jisako.2025.100386","DOIUrl":"10.1016/j.jisako.2025.100386","url":null,"abstract":"<div><h3>Objectives</h3><div>We have previously shown that ultrasound-guided repair results in an accurate anchor placement and restores ankle joint stability using cadaveric models. The objective of this study is to assess the safety and clinical outcomes of ultrasound-guided anterior talofibular ligament (ATFL) repair with or without augmentation.</div></div><div><h3>Methods</h3><div>Forty-nine patients with chronic lateral ankle instability underwent ultrasound-guided ATFL repair with or without augmentation. Following the procedure, patients completed a standardized postoperative rehabilitation protocol. The primary outcome was the complication rate in 49 patients. The clinical outcomes were analyzed as a secondary outcome for 28 patients (20 athletes and 8 nonathletes) after excluding 21 patients with such concomitant injuries that could affect clinical course. These included (1) the Numerical Rating Scale (NRS) for pain, (2) Foot and Ankle Outcome Score (FAOS), (3) Japanese Society for Surgery of the Foot (JSSF) ankle/hindfoot scale (a Japanese equivalent of the American Orthopedic Foot and Ankle Society Ankle-Hindfoot score), and (4) Self-Administered Foot Evaluation Questionnaire Sports (SAFE-Q Sports) score at baseline, 3 months, and 6 months.</div></div><div><h3>Results</h3><div>The overall complication rate was 2.0%, with one superficial peroneal nerve irritation out of 49 cases, which was improving at 6 months. All 4 clinical outcome scores resulted in statistically significant improvement at 6 months. NRS decreased from 3.6 ​± ​2.1 at the baseline to 1.3 ​± ​1.6 (p ​&lt; ​0.001, Student's t-test). FAOS increased from 74.7 ​± ​11.9 to 93.4 ​± ​8.1 (p ​&lt; ​0.001). JSSF scale increased from 56.9 ​± ​15.1 to 90.9 ​± ​10.2 (p ​&lt; ​0.001). All 20 athletes returned to sports at a preinjury level, and their SAFE-Q sports activity scores increased from 40.7 ​± ​17.6 to 90.6 ​± ​0.2 (p ​&lt; ​0.001).</div></div><div><h3>Conclusion</h3><div>Ultrasound-guided ATFL repair with or without augmentation for chronic lateral ankle instability is safe and results in clinical improvement at 6 months.</div></div><div><h3>Evidence level</h3><div>IV.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"11 ","pages":"Article 100386"},"PeriodicalIF":2.7,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of isokinetic parameters in individuals with and without chondromalacia patellae","authors":"Thiago Resende Inojossa ,&nbsp;Angelica Castilho Alonso ,&nbsp;Vanderlei Carneiro da Silva ,&nbsp;Felipe Marrese Bersotti ,&nbsp;Celyna da Costa Rodrigues de Sousa ,&nbsp;Marcelo Lacerda Bezerra ,&nbsp;André Pedrinelli ,&nbsp;Guilherme Carlos Brech ,&nbsp;Julia Maria D' Andréa Greve","doi":"10.1016/j.jisako.2024.100383","DOIUrl":"10.1016/j.jisako.2024.100383","url":null,"abstract":"<div><h3>Introduction</h3><div>Chondromalacia patella (CMP) is characterizsed by cartilage degeneration, affects young adults, more women (2:1) and is responsible for 75% of knee pain complaints in the active population. The etiology is multifactorial and may be related to extrinsic factors (trauma and burden) and intrinsic factors (patellar malalignment and quadriceps weakness). Isokinetic dynamometry (ID) can aid in the detection of the causal factors of knee pain related to CMP.</div></div><div><h3>Objectives</h3><div>To evaluate and compare the parameters of the ID of individuals with and without CMP and correlate them with the clinical aspects of individuals with CMP.</div></div><div><h3>Methods</h3><div>This is a retrospective study that analyzed ID of the knee flexors and extensors, performed between 2013 and 2019 in the isokinetic dynamometry sector of the hospital. Six hundred ninety dynamometers tests were included, both sexes, aged between 14 and 59 years, divided into chondromalacia group (342) tests and control group (348) tests. All performed ID in concentric mode for knee extension and flexion, with five maximum repetitions at an angular speed of 60°/s and 180°/s and 20 repetitions at an angular speed of 300°/s, with 30-s intervals between each. After completing the test, the patient points out a number from 0 to 10 on the visual analog scale, regarding the presence and intensity of pain during and after the isokinetic assessment.</div></div><div><h3>Results</h3><div>The groups had similar distribution from sex (P ​= ​0.071); age (P ​= ​0.99) but were different about pain (P ​&lt; ​0.001). CMP had greater levels of pain. In most of the muscle parameters of the extensors and flexors at 60°/s were lower in the CMP group (P ​&lt; ​0.001).</div></div><div><h3>Conclusion</h3><div>The main predictor of chondromalacia is pain. The greater coefficient of variability and time to reach peak torque on the involved side, the average power and morphology of the extensor curve can also be predictors of chondromalacia.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"11 ","pages":"Article 100383"},"PeriodicalIF":2.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Findings of magnetic resonance imaging in the knee with postreconstruction infection of the anterior cruciate ligament: A descriptive and reliability study","authors":"Blake C. Meza ,&nbsp;Niv Marom ,&nbsp;Harry Greditzer ,&nbsp;Eric Bogner ,&nbsp;HSS ACL Registry ,&nbsp;Robert G. Marx","doi":"10.1016/j.jisako.2024.100382","DOIUrl":"10.1016/j.jisako.2024.100382","url":null,"abstract":"<div><h3>Objectives</h3><div>Septic arthritis after anterior cruciate ligament (ACL) reconstruction is a rare but potentially devastating complication. The imaging findings associated with such infections are not well described or quantified. The purpose of this study was to describe and quantify the frequency of the characteristic magnetic resonance imaging (MRI) findings of infection following ACL reconstruction.</div></div><div><h3>Methods</h3><div>Seventeen cases were identified from 2010 to 2018, confirmed to meet established definitions for deep infections, and had an MRI obtained within ten days of diagnosis of infection. Two board-certified musculoskeletal radiologists evaluated and scored MRI studies with a predetermined set of imaging characteristics. Cohen's kappa (±) was utilized to determine the extent of agreement between the radiologists. Associations between graft type and microbiologic results and MRI findings were assessed.</div></div><div><h3>Results</h3><div>The overall infection rate was 0.42%, diagnosed at a median 35 days postoperatively (range 9–411). Grafts were retained in 11 of 17 (64.7%) infected cases and 9 patients (52.9%) required repeat irrigation and debridement. Common imaging findings included complex lamellated effusions (k ​= ​0.86), fluid within the femoral tunnel (k ​= ​0.91), and femoral tunnel resorption (k ​= ​0.83). Subcutaneous edema and edema surrounding the femoral tunnel were also identified in the majority of cases. There was no evidence of cortical destruction of the tunnels or chondrolysis. All acute infections demonstrated complex lamellated effusions, whereas all simple effusions were seen in chronic cases. No associations were found between index ACL graft type or microbiologic results and MRI findings.</div></div><div><h3>Conclusion</h3><div>Interrater agreement for common imaging findings, including effusion pattern, edema surrounding the graft tunnels and tunnel resorption was near perfect within infected ACL reconstructed knees. MRI can provide valueable information regarding postoperative infection after ACL reconstruction.</div></div><div><h3>Level of evidence</h3><div>Level IV- epidemiological observational study.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"11 ","pages":"Article 100382"},"PeriodicalIF":2.7,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial subscapularis tear: State-of-the-art","authors":"Ankit Kumar Garg ,&nbsp;Amit Meena ,&nbsp;Luca Farinelli ,&nbsp;Riccardo D'Ambrosi ,&nbsp;Sachin Tapasvi ,&nbsp;Sepp Braun","doi":"10.1016/j.jisako.2024.06.009","DOIUrl":"10.1016/j.jisako.2024.06.009","url":null,"abstract":"<div><div>The subscapularis (SSC) muscle is a crucial anterior glenohumeral stabilizer and internal rotator of the shoulder joint. The partial tears of the SSC might result from traumatic injury or intrinsic degeneration. Partial SSC tears can range in severity and be classified into different categories based on the location of the tear, size of the lesion, and associated pathology. The tear usually begins from the superolateral margin in the first facet and propagates downwards. It is frequently associated with biceps pathology or anterosuperior lesions. These tears are now increasingly recognized as distinct pathology that requires specific diagnostic and management approaches. The current management approaches are shifting towards operative, as partial SSC tears are increasingly recognized as a distinct pathology. At present, there is no consensus regarding the timing of repair, but the relative tendency of the SSC to retract much faster than other rotator cuff muscles, and difficulty in mobilization, advocates an early repair for SSC irrespective of the lesion size. An associated biceps pathology can be treated with either tenotomy (biceps delamination/erosion) or tenodesis. The techniques of partial SSC repair are constantly improving. There is no reported difference in use of 2-anchor-based conventional single-row (SR), a 3-anchor-based interconnected double-row technique, or a 2-anchor-based interconnected hybrid double-row construct in the repair construct. However, the 2-anchor-based interconnected double-row provides an advantage of better superolateral coverage with leading-edge protection, as it helps in placing the superolateral anchor superior and lateral to the original footprint. A timely intervention and restoration of the footprint will help restore and rehabilitate the shoulder. Future directions should prioritise injury prevention, early diagnosis with clinic-radiological cues and targeted interventions to mitigate risk.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"9 6","pages":"Article 100290"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141443411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gender-based differences in mid-term clinical outcomes and patient acceptable symptomatic state attainment after arthroscopic rotator cuff repair: Minimum 2-year follow up","authors":"Gerald Joseph Zeng ,&nbsp;Ying Hao ,&nbsp;Denny Tjiauw Tjoen Lie","doi":"10.1016/j.jisako.2024.06.002","DOIUrl":"10.1016/j.jisako.2024.06.002","url":null,"abstract":"<div><h3>Objective</h3><div>There is paucity of literature on the impact of patients’ gender on recovery and treatment success after arthroscopic rotator cuff repair. This study investigates the effect of gender on patient-reported outcomes preoperatively and postoperatively (minimum 2 years), and to determine if gender affects the attainment of patient-acceptable symptomatic state (PASS) thresholds.</div></div><div><h3>Methods</h3><div>266 patients (117 males, 149 females), who underwent primary arthroscopic rotator cuff repair for atraumatic, full-thickness tears, were included. Functional outcomes and pain scores were collected preoperatively and postoperatively. Percentage of attainment of PASS for the various outcome scores was calculated and compared between males and females.</div></div><div><h3>Results</h3><div>Women had statistically significantly poorer functional outcome and pain scores preoperatively and at 1 and 2 years postoperatively (P ​&lt; ​0.01). They also experienced less improvement in outcome scores throughout the postoperative period. Women had statistically significantly lower rates of PASS attainment at 2 years postoperatively.</div></div><div><h3>Conclusion</h3><div>Women experience greater pain and poorer shoulder function compared with men preoperatively, and up to 2 years postoperatively. Women are less likely to achieve PASS thresholds postoperatively, compared to their male counterparts.</div></div><div><h3>Study design</h3><div>Retrospective Cohort Study.</div></div><div><h3>Level of evidence</h3><div>III.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"9 6","pages":"Article 100283"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Labral repair, reconstruction, and augmentation improve postoperative outcomes in patients with irreparable or hypoplastic labra: A systematic review","authors":"Jansen Johnson ,&nbsp;Prushoth Vivekanantha ,&nbsp;Benjamin Blackman ,&nbsp;Dan Cohen ,&nbsp;Nicole Simunovic ,&nbsp;Olufemi R. Ayeni","doi":"10.1016/j.jisako.2024.04.012","DOIUrl":"10.1016/j.jisako.2024.04.012","url":null,"abstract":"<div><h3>Purpose</h3><div>To review the postoperative outcomes of arthroscopic surgical options in treating irreparable and hypoplastic labrum of the hip.</div></div><div><h3>Methods</h3><div>Three online databases (PubMed, MEDLINE, and EMBASE) were searched from database inception to June 27, 2023 to identify literature on treatment strategies for hypoplastic/irreparable acetabular labrum. Data pertaining to classification of irreparable tears or labral hypoplasia, indication for surgery, description of treatment, radiographic findings, and clinical outcomes were recorded and described. The methodological quality of included studies was assessed by the Methodological Index for Non-Randomized Studies (MINORS) criteria.</div></div><div><h3>Results</h3><div>Seven level IV case series, eleven level III retrospective cohort studies, and two level II prospective cohort studies comprising 1937 patients were included for analysis. Studies were divided into an irreparable labral group comprising 1002 patients and a hypoplastic labral group comprising 935 patients. Treatments included repair, augmentation, or reconstruction. In the irreparable group, 12 studies recorded improvement of modified Harris Hip Score (mHHS) with preoperative scores ranging from 50.3 to 67.3 and postoperative scores ranging from 76.2 to 95.0. The rate of conversion to total hip arthroplasty (THA) and rate of revision arthroscopy were 6.6% and 5.9%, respectively across all studies. In the hypoplastic group, two studies that focused on repair noted no statistical difference in mHHS for repair in hypoplastic labrum vs repair in non-hypoplastic labrum. One study showed that there was a difference in post-operative mHHS for labral repair for hypoplastic vs non-hypoplastic labrum, with repair in non-hypoplastic labrum showing superior mHHS (p ​&lt; ​0.001).</div></div><div><h3>Conclusion</h3><div>The findings of this review suggest that treatment of irreparable labra with reconstruction or augmentation results in improved patient-reported outcome measures (PROMs). For the hypoplastic labrum, primary repair also results in improvement in PROMs. Future studies focusing on the hypoplastic labra alone with an appropriate control group, rather than irreparable labral tears, are needed to properly assess patient outcomes and guide surgical indications.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"9 6","pages":"Article 100260"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140779541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the reliability and quality of YouTube videos regarding medial collateral ligament knee injury as a patient education resource","authors":"Jason H. Kim ,&nbsp;Richard M. Danilkowicz ,&nbsp;Zachary D. Meeker ,&nbsp;Kyle R. Wagner ,&nbsp;Zeeshan A. Khan ,&nbsp;Jorge Chahla","doi":"10.1016/j.jisako.2024.06.007","DOIUrl":"10.1016/j.jisako.2024.06.007","url":null,"abstract":"<div><h3>Objectives</h3><div>The purpose of this study was to assess the educational reliability and quality of videos shared on YouTube regarding medial collateral ligament (MCL) injuries of the knee.</div></div><div><h3>Methods</h3><div>Using the search keywords “medial collateral ligament” on YouTube, the first 50 videos were evaluated by two independent reviewers. Video characteristics were extracted, and each video was categorized by upload source and content type. Three scoring systems were used to evaluate the videos: the <em>Journal of the American Medical Association</em> (JAMA) Benchmark Score to assess a video's reliability; the Global Quality Score (GQS) to assess educational quality; the novel MCL Specific Score (MCL-SS) to assess MCL-specific content quality. Linear regression analyses were conducted to explore relationships between video characteristics and scores.</div></div><div><h3>Results</h3><div>Collectively, the videos were viewed 5,759,427 times with a mean number of views per video of 115,189 ​± ​177,861. The mean JAMA score was 1.8, GQS was 2.1, and MCL-SS was 5.6, indicating both poor reliability and quality. Only videos uploaded by physicians showed a statistically significantly higher mean MCL-SS (P ​= ​0.032) but were still of low quality with a mean MCL-SS of 9.2 ​± ​5.9. Multivariate linear regression revealed that videos uploaded by physicians were statistically significant predictors of greater MCL-SS (β ​= ​4.108; P ​= ​0.029). Longer video durations were statistically significant predictors of greater GQS (β ​= ​0.001; P ​= ​0.002) and MCL-SS (β ​= ​0.007; P ​&lt; ​0.001).</div></div><div><h3>Conclusions</h3><div>YouTube videos regarding MCL injuries, despite their popularity, were found to be on average having poor overall reliability and quality as measured by JAMA, GQS and MCL-SS.</div></div><div><h3>Level of evidence</h3><div>III.</div></div><div><h3>Study design</h3><div>Cross-sectional Study.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"9 6","pages":"Article 100288"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141440937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leukocyte-Rich Platelet-Rich Plasma Injection in an Acute-on-Chronic Rectus Femoris Injury of a Professional Soccer Player: A Case Report","authors":"Patricia Nuñez de Aysa ,&nbsp;Jonas Grani Garðarsson ,&nbsp;Ayyoub Al-Dolaymi ,&nbsp;Marcelo Bordalo-Rodrigues ,&nbsp;Markus Laupheimer ,&nbsp;Theodorakys Marín Fermín","doi":"10.1016/j.jisako.2024.06.005","DOIUrl":"10.1016/j.jisako.2024.06.005","url":null,"abstract":"<div><div>This is the case of an 18-year-old male professional soccer player, an attacking midfielder, who presented acute-onset pain in his right thigh during a training match but continued playing and training until the end of the session. Two weeks after the initial symptoms, the athlete's pain increased after kicking the ball and stopping training. He came for consultation a week later with tenderness in his right thigh and impaired gait. A 3 ​cm gap in his right mid-quadriceps muscle and tenderness during resisted knee extension and leg raises with no hip or knee range of motion limitations were observed on physical examination. He was scheduled for magnetic resonance imaging (MRI) after the consultation, revealing an acute-on-chronic type 2A lateral muscle tear of the distal rectus femoris. A 2 ​ml seroma aspiration was performed five weeks after the initial injury with a subsequent intra-lesional 1 ​ml liquid leukocyte-rich platelet-rich plasma (LR-PRP) injection using intermittent ultrasound guidance within 5 ​min after preparation. The LR-PRP preparation was classified as 3 14–1 3–0 0 according to the Universal Coding System (UCS) by Kon et al. Nine physiotherapy sessions, including an initial assessment, were conducted over five weeks. The rehabilitation started with pulley exercises with hip flexion, tension arch, leg extension, and squatting with supporting exercises for core and hip strength, with a gradual increase in loading. As the player's symptoms improved, he started doing eccentric exercises such as the reverse Nordics and leg extension. He also followed a running program, gradually increasing speed to a full sprint without pain or irritation. The return-to-sports clearance consultation was conducted seven weeks after the injury, previously confirming satisfactory healing on an MRI. The patient was cleared after passing the Rehabilitation Department battery tests and physical examination. The patient was asymptomatic and had no complaints despite his right quadriceps gap, returning to competition nine weeks after injury. After a one-year follow-up, the patient remains playing at a competitive level, asymptomatic, with no reported reinjury. Adequate reporting of rehabilitation programs and PRP injection characterization is crucial for future research quality improvement and reproducibility.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"9 6","pages":"Article 100286"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biologic therapies in stress fractures: Current concepts","authors":"George Jacob ,&nbsp;Kazunori Shimomura ,&nbsp;Norimasa Nakamura","doi":"10.1016/j.jisako.2024.04.008","DOIUrl":"10.1016/j.jisako.2024.04.008","url":null,"abstract":"<div><div>Stress fractures, a common overuse injury in physically active individuals, present a significant challenge for athletes and military personnel. Patients who sustain stress fractures have demanding training regimes where periods of rest and immobilisation have unacceptable negative consequences on sports goals and finances. Aside from being an overuse injury, there are various contributing risk factors that put certain individuals at risk of a stress fracture. The main two being nutritional deficiencies and hormonal variations, which have significant effects on bone metabolism and turnover. Historically, treatment of stress fractures focused on conservative strategies such as rest and immobilisation. Calcium and vitamin D deficiencies have been closely linked to stress fractures and so over time supplementation has also played a role in treatment. With the introduction of biologics into orthopaedics, newer treatment strategies have been applied to accelerate fracture healing and perhaps improve fracture callus quality. If such therapies can reduce time spent away from sport and activity, it would be ideal for treating stress fractures. This article aims to offer insights into the evolving landscape of stress fracture management. It investigates the pre-clinical evidence and available published clinical applications. Though fracture healing is well understood, the role of biologics for fracture healing is still indeterminate. Available literature for the use of biologic therapies in stress fractures are restricted and most reports have used biologics as a supplement to surgical fixation in subjects in studies that lack control groups. Randomised control trials have been proposed and registered by a few groups, with results awaited. Assessing individuals for risk factors, addressing hormonal imbalances and nutritional deficiencies seems like an effective approach to addressing the burden of stress fractures. We await better designed trials and studies to accurately determine the clinical benefit of adding biologics to the management of these injuries.</div></div>","PeriodicalId":36847,"journal":{"name":"Journal of ISAKOS Joint Disorders & Orthopaedic Sports Medicine","volume":"9 6","pages":"Article 100256"},"PeriodicalIF":2.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}