The American Journal of Sports Medicine最新文献

{"title":"Statistical Robustness of Randomized Controlled Trials Comparing Biceps Tenotomy Versus Tenodesis: A Reverse Continuous Fragility Index Analysis.","authors":"Eric Y Hu,Alyssa D Althoff,Jesus E Cervantes,Udit Dave,Katherine G Kessler,Thomas E Moran","doi":"10.1177/03635465261440392","DOIUrl":"https://doi.org/10.1177/03635465261440392","url":null,"abstract":"BACKGROUNDThe reverse continuous fragility index (rCFI) is a statistical measure utilized to evaluate the relative robustness or fragility of nonstatistically significant findings of randomized controlled trials. Such studies comparing biceps tenotomy versus tenodesis during shoulder arthroscopy have generally shown similar clinical and functional outcomes between the treatments.PURPOSETo evaluate the statistical robustness or fragility of nonsignificant outcomes of high-quality randomized controlled studies comparing clinical outcomes of biceps tenotomy versus tenodesis during shoulder arthroscopy.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 1.METHODSThe PubMed, Embase, and Cochrane Library databases were searched according to the PRISMA guidelines from 2004 to September 2025 with the following search strategy: \"('biceps' OR 'biceps brachii' OR 'long head biceps') AND ('tenodesis' OR 'tenotomy') AND ('Randomized controlled trial' OR 'RCT').\" Studies were included if they were randomized controlled trials that compared clinical outcomes of biceps tenodesis versus biceps tenotomy during shoulder arthroscopy. rCFI was calculated on the primary nonsignificant outcomes of all studies and averaged to obtain the mean rCFI. Loss to follow-up was recorded for each study. The reverse continuous fragility quotient was calculated to account for the study sample size.RESULTSSeven studies with 622 patients were included in the final analysis. The mean rCFI of primary study outcomes of all included studies was 17.7 (SD, 8.6; range, 4-26). When rCFI was calculated, 4 (57.14%) of the 7 studies reported a now-significant outcome, with the tenodesis group having greater outcome scores as compared with the tenotomy group. The total loss to follow-up was 55, with a mean 7.8 across all studies. No studies reported a loss to follow-up that was greater than the calculated rCFI. The mean reverse fragility quotient was 0.227 (SD, 0.104). For studies comparing tenotomy versus tenodesis with concomitant rotator cuff repair, the mean rCFI and reverse fragility quotient were 18.25 and 0.163, respectively.CONCLUSIONHigh-quality randomized controlled trials comparing biceps tenotomy versus tenodesis during shoulder arthroscopy have largely demonstrated statistical noninferiority of clinical outcomes. The evaluation of rCFI of these nonstatistically significant results supports the moderate robustness of these conclusions.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"17 1","pages":"3635465261440392"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731665","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":"Return-to-Work and Clinical Outcomes After Anterior Latissimus Dorsi and Teres Major Tendon Transfer for Irreparable Subscapularis Tears.","authors":"Chang Hee Baek,Bo Taek Kim,Jung Gon Kim,Chaemoon Lim,Seung Jin Kim","doi":"10.1177/03635465261439045","DOIUrl":"https://doi.org/10.1177/03635465261439045","url":null,"abstract":"BACKGROUNDIrreparable subscapularis tears represent a significant clinical challenge, especially in active patients aiming to preserve shoulder function. Anterior latissimus dorsi and teres major (LDTM) tendon transfer has been proposed to restore internal rotation and anterior shoulder stability; however, data on return-to-work (RTW) outcomes remain limited.PURPOSE/HYPOTHESISThe study aimed to evaluate clinical outcomes and RTW rates after anterior LDTM transfer in patients with irreparable subscapularis tears, with the hypothesis that the procedure would provide favorable clinical results and a high RTW rate.STUDY DESIGNCase series; Level of evidence, 4.METHODSA retrospective review was conducted on patients who underwent LDTM transfer for irreparable subscapularis tears, with or without concomitant supraspinatus involvement. Inclusion criteria were irreparable subscapularis tears with medial tendon retraction and grade 3 or 4 fatty infiltration, without advanced glenohumeral arthritis. Exclusion criteria included prior bone surgery, incomplete follow-up, or loss to follow-up. Clinical assessment included patient-reported outcome measures, such as visual analog scale, American Shoulder and Elbow Surgeons form, Constant score, and Single Assessment Numeric Evaluation, as well as range of motion and strength. Tendon integrity was evaluated via magnetic resonance imaging, and RTW was assessed using structured questionnaires. Multivariable logistic regression was performed to identify factors influencing RTW.RESULTSOf 215 patients, 189 were included after exclusions (126 male, 63 female; mean ± SD age, 64.4 ± 6.7 years; follow-up, 43.4 ± 17.1 months). Overall, 91.0% returned to work (58.2% complete, 32.8% partial), with lighter work groups achieving earlier and higher return rates. Clinical outcomes improved significantly across the cohort, including visual analog scale (4.9 ± 1.1 to 1.9 ± 1.2), American Shoulder and Elbow Surgeons form (49.4 ± 10.0 to 72.9 ± 14.0), Constant score (49.1 ± 6.0 to 65.8 ± 9.9), and Single Assessment Numeric Evaluation (48.7 ± 9.4 to 73.8 ± 13.9), as well as range of motion and strength. No significant differences were observed among work intensity groups. Tendon integrity and occupational work intensity were the strongest predictors of successful RTW.CONCLUSIONAnterior LDTM transfer is a reliable and effective treatment for patients with irreparable subscapularis tears, resulting in favorable clinical outcomes and high RTW rates. Overall, 91.0% of patients returned to work (58.2% complete, 32.8% partial) at a mean 5.4 ± 1.5 months across all work levels. Lighter occupational demands and intact tendon integrity were strong predictors of successful RTW.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"24 1","pages":"3635465261439045"},"PeriodicalIF":0.0,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731658","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":"Association Between Posterior Tibial Slope and Graft Survival in High-Risk Anterior Cruciate Ligament Reconstruction With Lateral Extra-articular Tenodesis.","authors":"Tomas Pineda,David Mazy,José Ramos-Rojas,Nicolas Cance,Michael J Dan,Guillaume Demey,David H Dejour","doi":"10.1177/03635465261439932","DOIUrl":"https://doi.org/10.1177/03635465261439932","url":null,"abstract":"BACKGROUNDPosterior tibial slope (PTS) is a well-established anatomic risk factor for anterior cruciate ligament (ACL) graft failure. Lateral extra-articular tenodesis (LET) is increasingly used as an adjunctive procedure in high-risk patients to reduce rerupture rates; however, how its protective effect varies across the continuum of slope values remains insufficiently characterized.PURPOSETo determine how PTS modifies the protective effect of LET in high-risk patients and to evaluate the influence of PTS on graft failure across different risk profiles.STUDY DESIGNCohort study; Level of evidence, 3.METHODSA retrospective cohort of 585 patients who underwent primary ACL reconstruction (ACLR) with hamstring tendon autografts between 2014 and 2017 was analyzed at a minimum follow-up of 6 years. Patients were nonrandomly allocated according to predefined clinical risk criteria into a low-risk group (isolated ACLR) and a high-risk group (ACLR + LET). A graft rerupture was defined clinically and confirmed by imaging. Multivariable logistic regression was used to assess the association between PTS and graft failure. Restricted cubic spline regression was also used to explore nonlinear relationships and identify slope ranges associated with low and high failure probabilities.RESULTSPTS independently predicted a graft rerupture in both groups, with a stronger effect in the high-risk group (adjusted odds ratio, 1.63; P = .005) compared with the low-risk group (adjusted odds ratio, 1.21; P = .029). The relationship between PTS and graft failure was nonlinear. In the high-risk group, the lowest failure probabilities were observed within a PTS range of 5° to 9°, below which the risk of failure plateaued. In contrast, PTS values exceeding 11° to 12° were associated with high failure probabilities in both groups.CONCLUSIONPTS was independently associated with graft failure in both groups. Although LET was associated with lower failure probabilities within a moderate slope range, increasing PTS values were linked to a progressively higher risk of reruptures in both groups. The association between a steeper slope and failure observed in the ACLR with LET group suggests that an elevated PTS may attenuate the relative protective effect of LET.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"79 1","pages":"3635465261439932"},"PeriodicalIF":0.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147731667","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":"Triamcinolone Acetonide Is Not Harmful to Healthy and Osteoarthritic Human Knee Cartilage","authors":"Annie Porter, Julie Nguyen, Ying Peng, Steven DiStefano, Naod Asres, Lynn Snyder-Mackler, Michael Axe, X. Lucas Lu","doi":"10.1177/03635465261439028","DOIUrl":"https://doi.org/10.1177/03635465261439028","url":null,"abstract":"Background: Intra-articular triamcinolone acetonide (TA) injections are commonly used to manage joint synovitis despite reports that they accelerate cartilage degeneration. Previous studies found that TA minimally affected bovine cartilage, but effects in human cartilage remain unclear. Purpose: To determine how TA in physiologically relevant concentrations influences chondrocyte viability and matrix metabolism in healthy and osteoarthritic (OA) human cartilage. Study Design: Controlled laboratory study. Methods: Human cartilage was harvested from cadaver donor knees (mean age, 38 years; 4 male) or total knee replacement remnants (mean age, 66 years; 9 female, 7 male). Samples were exposed to TA, 200 μM (0.087 mg/mL) or 1 nM, to evaluate chondrocyte viability and gene expression. A high-resolution click chemistry assay quantified glycosaminoglycan (GAG) and collagen synthesis and tracked GAG loss. Two dosing regimens were tested: a continuous 14-day exposure (multiple-injection simulation) and a 2-day exposure followed by a 14-day recovery (single-injection simulation). Results: TA did not reduce chondrocyte viability and did not increase baseline GAG loss from the cartilage samples. In healthy cartilage, TA downregulated <jats:italic toggle=\"yes\">MMP13</jats:italic> (mean ± SD; 1.0 ± 0.8 vs 0.4 ± 0.2; <jats:italic toggle=\"yes\">P</jats:italic> = .04) and <jats:italic toggle=\"yes\">COL2A1</jats:italic> (1.0 ± 0.3 vs 0.5 ± 0.2; <jats:italic toggle=\"yes\">P</jats:italic> = .003). In OA cartilage, 200 μM TA downregulated <jats:italic toggle=\"yes\">MMP13</jats:italic> (1.0 ± 0.7 vs 0.2 ± 0.3; <jats:italic toggle=\"yes\">P</jats:italic> = .02), <jats:italic toggle=\"yes\">ADAMTS5</jats:italic> (1.0 ± 0.3 vs 0.4 ± 0.1; <jats:italic toggle=\"yes\">P</jats:italic> = .03), and <jats:italic toggle=\"yes\">COL2A1</jats:italic> (1.0 ± 0.3 vs 0.7 ± 0.2; <jats:italic toggle=\"yes\">P</jats:italic> = .05). A continuous 14-day 200 μM TA exposure reduced GAG synthesis by 26% in OA cartilage ( <jats:italic toggle=\"yes\">P</jats:italic> &lt; .001) and 18% in healthy cartilage ( <jats:italic toggle=\"yes\">P</jats:italic> = .004), but 1 nM TA had no effect. Collagen synthesis was reduced only in healthy cartilage by 25% (200 μM TA; <jats:italic toggle=\"yes\">P</jats:italic> &lt; .001) and 21% (1 nM TA; <jats:italic toggle=\"yes\">P</jats:italic> = .004). A single-injection simulation produced no change in GAG or collagen synthesis in healthy cartilage. Conclusion: In intact human cartilage under these experimental conditions, TA had no measurable toxicity to chondrocytes and only modestly, reversibly suppressed matrix synthesis at doses far exceeding clinical exposure. Intra-articular TA poses minimal measured direct risk to cartilage integrity when used for synovitis management. Clinical Relevance: These findings support the clinical use of TA for synovitis while alleviating concerns about direct cartilage damage, even with multiple injections.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725836","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":"Increased Posterior Tibial Slope Correlates With Greater Odds of Reoperation and Failure After Meniscal Allograft Transplantation.","authors":"Andrew S Bi,Nicholas J Lemme,Yusuf Mufti,Jared P Sachs,Chloe H Franzia,Adam B Yanke,Brian J Cole","doi":"10.1177/03635465261438142","DOIUrl":"https://doi.org/10.1177/03635465261438142","url":null,"abstract":"BACKGROUNDHigher posterior tibial slope (PTS) is associated with a greater rate of failure in meniscus root tears and anterior cruciate ligament reconstruction.PURPOSETo analyze the correlation of PTS with patient-reported outcomes (PROs) and rates of reoperation and failure in meniscal allograft transplantation (MAT).STUDY DESIGNCohort study (prognostic); Level of evidence, 3.METHODSA retrospective review of a prospectively maintained database was performed to assess outcomes after MAT in patients between 2003 and 2021 with minimum 2-year follow-up. PTS was measured on lateral knee radiographs, with medial PTS (MPTS) and lateral PTS (LPTS) measured on magnetic resonance imaging (MRI). PROs were collected preoperatively and at minimum 2-year follow-up. MAT failure was defined as revision MAT or conversion to arthroplasty. Multivariable regression was used to correlate PTS with PROs and rates of reoperation and failure. Failure and reoperation were further analyzed separately in medial and lateral MATs for MPTS and LPTS.RESULTSIn total, 175 knees (174 patients) met inclusion criteria with a mean ± SD age of 27.4 ± 9.1 years and follow-up of 8.3 ± 3.8 years. By radiograph, the mean PTS was 8.8°± 3.2°; by MRI, the mean MPTS and LPTS were 5.1°± 2.7° and 5.8°± 3.3°, respectively. MRI measurements significantly underestimated radiographic measurements by 3.3°± 2.9°. Correlation coefficients demonstrated weak to moderate correlations between radiograph and MRI measurements, while intraclass correlation coefficients ranged from 0.920 to 0.931 for intrarater reliability and 0.855 to 0.952 for interrater reliability within MRI or radiographic measurements. There was no association between PTS and postoperative PROs. Sixty cases (34.3%) resulted in reoperation at a mean 2.5 ± 2.8 years, and 8 cases (4.6%) experienced failure at 8.9 ± 2.9 years. Higher radiographic PTS and MPTS were associated with greater odds of reoperation (odds ratio [OR], 1.126 [P = .024]; OR, 1.166 [P = .013]) and failure (OR, 1.654 [P = .001]; OR, 1.712 [P < .001]). Higher LPTS was associated with greater odds of failure (OR, 1.279; P = .018). In medial MAT, MPTS was associated with higher odds of reoperation and failure.CONCLUSIONIncreased PTS, as measured by radiographs and MRI, is correlated with greater risk of reoperation and failure after MAT, with increased MPTS on MRI significantly associated with medial MAT reoperation and failure. There is good to excellent inter- and intrarater reliability for radiographic and MRI PTS measurements, although MRI underestimates radiographic PTS on average 3.3°.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"23 1","pages":"3635465261438142"},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719456","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":"Progressive Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction: Longitudinal Evidence From the Swedish Knee Ligament Registry.","authors":"Piero Agostinone,Iacopo Romandini,Pierre Rotzius,Stefano Zaffagnini,Magnus Forssblad,Alexander Sandon","doi":"10.1177/03635465261438145","DOIUrl":"https://doi.org/10.1177/03635465261438145","url":null,"abstract":"BACKGROUNDChondral lesions and subsequent knee osteoarthritis often occur after anterior cruciate ligament (ACL) injuries, and although ACL reconstruction (ACLR) is common, cartilage degeneration remains more prevalent than in the general population, with inconsistent evidence on whether surgery offers a protective effect.PURPOSE/HYPOTHESISThis study aimed to evaluate the progression of cartilage damage after ACLR using second-look arthroscopy in patients who underwent both primary and revision procedures and to identify risk factors for cartilage degeneration. It was hypothesized that chondral lesions would progress between primary and revision surgery, primarily influenced by characteristics of the initial injury and primary surgery.STUDY DESIGNCohort study; Level of evidence, 3.METHODSA retrospective cohort study was conducted using prospectively collected data from the Swedish Knee Ligament Registry. All patients who underwent both primary and revision ACLR between January 1, 2005, and December 31, 2023, were included. Patients with multiligament injuries or missing key data were excluded. The prevalence, location, and severity of cartilage lesions assessed intraoperatively at both primary and revision ACLR were reported and compared. Secondarily, potential risk factors for cartilage damage at the time of revision surgery were evaluated using multivariate logistic regression analysis, incorporating available patient and surgical variables from the registry.RESULTSA total of 2845 patients were included. The prevalence, size, and severity of cartilage lesions increased markedly across all knee compartments between primary and revision ACLR, which occurred at a median of 2.4 years later. We found 4 independent risk factors for cartilage damage at revision surgery: older age, meniscal and cartilage lesions at primary surgery, and longer time from primary injury to revision ACLR. Each additional month from the initial injury to revision ACLR was associated with a 0.7% increase in the odds of cartilage damage, underscoring a time-dependent degenerative process.CONCLUSIONThis study showed a clear progression of cartilage degeneration between primary and revision ACLR. Although limited to patients requiring revision surgery, these findings contribute to the broader understanding of posttraumatic joint deterioration and reinforce the need for interdisciplinary approaches to mitigate long-term cartilage damage.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"423 1","pages":"3635465261438145"},"PeriodicalIF":0.0,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719452","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":"Isolated Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocations With Increased Femoral Anteversion and an Absent/Mild J-sign.","authors":"Zhijun Zhang,Daofeng Wang,Yang Liu,Xuesong Wang,Hui Zhang","doi":"10.1177/03635465261437776","DOIUrl":"https://doi.org/10.1177/03635465261437776","url":null,"abstract":"BACKGROUNDThe influence of greater femoral anteversion on outcomes after medial patellofemoral ligament (MPFL) reconstruction is increasingly recognized, leading to the more frequent use of combined derotational femoral osteotomy. However, the indications for this additional invasive procedure remain poorly defined, particularly in patients without severe patellar maltracking.PURPOSETo evaluate the clinical outcomes of isolated MPFL reconstruction in patients with recurrent patellar dislocations (RPDs), increased femoral anteversion (>30°), and an absent or mild J-sign.STUDY DESIGNCohort study; Level of evidence, 3.METHODSA retrospective cohort study was conducted on 52 consecutive patients (mean age, 19.1 ± 5.9 years) with RPDs, femoral anteversion >30°, and an absent/mild J-sign who underwent isolated MPFL reconstruction between 2018 and 2022. Rotational deformities of the lower extremities, including femoral anteversion, tibiofemoral rotation, and tibial external torsion, were assessed using computed tomography. Clinical and radiological outcomes were assessed preoperatively and at a minimum 2-year follow-up. Additionally, outcomes were compared between patients with and without severe trochlear dysplasia (Dejour type B or D) to evaluate its potential confounding effect.RESULTSThis study evaluated the outcomes of isolated MPFL reconstruction in 52 patients with RPDs, high femoral anteversion (mean, 35.2°± 6.5°), and an absent/mild J-sign. At a mean follow-up of 2.4 ± 1.1 years, no redislocations occurred. Functional scores improved significantly from preoperatively to postoperatively: Tegner (from 3 to 5; P = .021), Kujala (from 58 ± 9 to 88 ± 9; P < .001), and Lysholm (from 62 ± 7 to 90 ± 11; P < .001). Subgroup analysis demonstrated comparable functional outcomes (all P > .05) but significantly greater patellar tilt (18°± 5° vs 13°± 4°, respectively; P < .001) in patients with severe trochlear dysplasia (n = 17) compared to those without severe trochlear dysplasia (n = 35).CONCLUSIONIsolated MPFL reconstruction provided excellent short-term stability and functional outcomes for patients with RPDs, increased femoral anteversion (>30°), and an absent/mild J-sign. Crucially, the presence of severe trochlear dysplasia did not compromise functional results.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"129 1","pages":"3635465261437776"},"PeriodicalIF":0.0,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147719457","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":"Predictors of Achieving the Patient Acceptable Symptom State at 5 Years After Primary Hip Arthroscopy in High-Level Adult Athletes.","authors":"Jade S Owens,Michael S Lee,Andrew E Jimenez,W Taylor Harris,Benjamin G Domb","doi":"10.1177/03635465261436058","DOIUrl":"https://doi.org/10.1177/03635465261436058","url":null,"abstract":"BACKGROUNDVariables predictive of achieving clinically meaningful outcomes in high-level adult athletes after primary hip arthroscopy at midterm follow-up remain incompletely defined.PURPOSETo identify variables predictive of achieving the patient acceptable symptom state (PASS) for the Hip Outcome Score-Sports-Specific Subscale (HOS-SSS) at a minimum 5-year follow-up after primary hip arthroscopy in high-level adult athletes.STUDY DESIGNCase-control study; Level of evidence, 3.METHODSData were prospectively collected and retrospectively reviewed for adult (≥18 years old) athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between February 2010 and August 2016. Inclusion criteria consisted of participation in high school, collegiate, or professional sports within 1 year before surgery as well as the availability of preoperative and minimum 5-year patient-reported outcome scores for the modified Harris Hip Score, Nonarthritic Hip Score, HOS-SSS, and visual analog scale for pain. Exclusion criteria were age <18 or >50 years, workers' compensation status, previous ipsilateral hip surgery/conditions, Tönnis grade >1 osteoarthritis, or unwillingness to participate. Patients were stratified based on achievement of the PASS for the HOS-SSS at 5-year follow-up. Univariate and multivariate logistic regression analyses were performed to identify predictors of achieving the PASS. Receiver operating characteristic analysis was utilized to determine clinically relevant threshold values.RESULTSA total of 105 athletes were included, of whom 84 achieved the PASS at a minimum 5-year follow-up and 21 did not. Patient characteristics, preoperative radiographic measurements, intraoperative findings, and intraoperative procedures were similar between groups (P > .05). Multivariate logistic regression identified postoperative alpha angle (odds ratio, 0.89; P = .021) and postoperative anterior center-edge angle (ACEA) (odds ratio, 1.20; P < .001) as independent predictors of achieving the PASS. Receiver operating characteristic analysis demonstrated excellent discrimination (area under the curve = 0.814), with thresholds <47° for the alpha angle and >26° for the ACEA associated with significantly higher rates of achieving the PASS (P < .05).CONCLUSIONPostoperative alpha angle and ACEA were significant predictors of achieving the PASS for the HOS-SSS at a minimum 5-year follow-up in high-level adult athletes undergoing primary hip arthroscopy. These findings emphasize the importance of precise bony correction to optimize long-term patient-acceptable outcomes.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"23 1","pages":"3635465261436058"},"PeriodicalIF":0.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147695013","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":"Bone Marrow Aspirate Concentrate Improves the Early Osseous Integration of Fresh Osteochondral Allografts in the Knee: A Randomized Controlled Trial.","authors":"Pablo Eduardo Gelber,Eduard Ramírez-Bermejo,Gonzalo Caviasso,Joan Juncosa-Chacón,Oscar Fariñas","doi":"10.1177/03635465261437779","DOIUrl":"https://doi.org/10.1177/03635465261437779","url":null,"abstract":"BACKGROUNDFresh osteochondral allograft (FOCA) transplantation is an increasingly used technique for treating symptomatic cartilage defects in young and active patients. However, insufficient osseous integration of the graft remains a primary cause of failure. Bone marrow aspirate concentrate (BMAC), rich in mesenchymal stem cells, may enhance graft integration.PURPOSETo determine whether the use of autologous BMAC in FOCA transplantation of the knee improves osseous integration on computed tomography (CT) during the first postoperative year and yields superior clinical outcomes compared to non-BMAC-treated grafts at 2-year follow-up.STUDY DESIGNRandomized clinical trial; Level of evidence, 1.METHODSWe conducted a single-center, prospective, randomized controlled trial in 36 patients undergoing FOCA transplantation. Patients who met the inclusion criteria were randomly assigned to either a BMAC group or non-BMAC group. CT was performed at 3, 6, and 12 months, and imaging findings were evaluated using the semiquantitative assessment CT osteochondral allograft (ACTOCA) scoring system. Clinical outcomes (International Knee Documentation Committee, Kujala, Western Ontario Meniscal Evaluation Tool, and Tegner scores) were assessed preoperatively and at 6, 12, and 24 months.RESULTSOsseous integration at the host-graft junction on CT was superior in the BMAC group at 3 months postoperatively compared with the non-BMAC group (P < .05), with no differences between groups at 6 or 12 months. Regarding graft signal density relative to host bone, differences were observed between groups at 3 and 12 months, with better 3-month graft signaling in the BMAC group and better 12-month graft signaling in the non-BMAC group. No differences were observed at 6 months. Also, no differences were observed between groups in patient-reported outcome scores.CONCLUSIONBMAC augmentation in FOCA transplantation of the knee demonstrated improved early osseous integration at the host-graft junction at 3 months postoperatively, as assessed on CT using the ACTOCA scoring system, with no differences observed at 6 or 12 months. Regarding graft signal density relative to host bone, significant differences were observed at 3 and 12 months, with better 3-month graft signaling in the BMAC group and better 12-month graft signaling in the non-BMAC group. No differences were observed between groups in patient-reported outcome scores.REGISTRATIONNCT04236492 (ClinicalTrials.gov).","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"3 1","pages":"3635465261437779"},"PeriodicalIF":0.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147695014","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":"Knee Chondral Shear Injury Repair: A Biomechanical Laboratory Comparison of Suture Bridge to Chondral Pin Fixation.","authors":"Nneoma O Duru,Austin J Stoner,Christopher Frey,Nicole S Pham,Henry B Ellis,Matthew R Schmitz,Yi-Meng Yen,Marc A Tompkins,Theodore J Ganley,Phil Wilson,Molly C Meadows,Charles Chan,Kevin G Shea","doi":"10.1177/03635465261436052","DOIUrl":"https://doi.org/10.1177/03635465261436052","url":null,"abstract":"BACKGROUNDDelamination of chondral fragments in pediatric patients is common and is usually caused by osteochondritis dissecans (OCD) or patellar dislocations. For fragments with minimal to no bone, fixation with screws may not be ideal due to hardware prominence on the cartilage or suboptimal screw purchase, which can result in hardware migration and loss of fixation. Lower-profile chondral fixation devices may be ideal in these circumstances, such as the suture bridge fixation construct and bioabsorbable chondral pin fixation.HYPOTHESISSuture bridge constructs would provide superior fixation over chondral pins for chondral shear injury fragments.STUDY DESIGNControlled laboratory study.METHODSSeven pediatric cadaveric femurs were utilized. Circular lesions, 15 mm in diameter, were created on both femoral condyles. One lesion was randomized to chondral pin repair, while the other received suture bridge repair using 2-0 suture fixated with suture anchors. Each specimen was then potted before undergoing biomechanical testing on a materials testing frame. Each construct underwent precyclic rotational shear testing, cyclic loading, and postcyclic rotational shear testing. The stiffness (N·m/deg) of each repair during pre- and postcyclic rotational shear testing was recorded and compared using paired t tests.RESULTSSuture bridge fixations, compared with chondral pin fixations, demonstrated significantly higher precycle stiffness (0.0113 vs 0.0067 N·m/deg; P = .0359) and postcycle stiffness (0.0215 vs 0.0089 N·m/deg; P = .0421). While all suture bridge repairs remained intact, 5 of 7 chondral pin repairs fully detached by the end of biomechanical testing.CONCLUSIONSuture bridge repair demonstrated significantly higher fixation stiffness and durability compared with chondral dart repair in the pediatric cadaveric model.CLINICAL RELEVANCEThis study attempts to find the biomechanically superior construct for pediatric chondral shear injuries.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"13 1","pages":"3635465261436052"},"PeriodicalIF":0.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147695015","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}