The American Journal of Sports Medicine最新文献

{"title":"Influence of Platelet Concentration on the Clinical Outcome of Platelet-Rich Plasma Injections in Knee Osteoarthritis: Letter to the Editor.","authors":"Isabel Andia,Hervé Bard,Etienne Dalmais,Florent Eymard,Martin Lamontagne,Alain Silvestre","doi":"10.1177/03635465251342250","DOIUrl":"https://doi.org/10.1177/03635465251342250","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"26 1","pages":"NP14-NP15"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144521333","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":"The Impact of Posterior Tibial Slope and Static Anterior Tibial Translation on ACL Graft Rupture Rates After Hamstring Autograft Reconstruction With Lateral Extra-articular Tenodesis.","authors":"David Mazy,Nicolas Cance,Clement Favroul,Lucia Angelelli,Gautier Beckers,Michael J Dan,David H Dejour","doi":"10.1177/03635465251350397","DOIUrl":"https://doi.org/10.1177/03635465251350397","url":null,"abstract":"BACKGROUNDThe addition of a lateral extra-articular tenodesis (LET) to anterior cruciate ligament (ACL) reconstruction (ACLR) has been shown to reduce ACL graft rupture rates. Posterior tibial slope (PTS) and static anterior tibial translation (SATT) are also recognized as risk factors for ACL graft rupture.PURPOSE/HYPOTHESISThe purpose was to evaluate the effect of PTS and SATT on graft rupture rates after ACLR using hamstring tendon autografts combined with LET. It was hypothesized that increased PTS and SATT would result in increased ACL graft rupture rates despite the addition of an LET.STUDY DESIGNCase-control study; Level of evidence, 3.METHODSThis retrospective, single-center, single-surgeon study included patients who underwent primary ACLR with hamstring tendon autografts combined with LET between January 2014 and December 2017. Demographic data were collected, and the association between PTS, SATT, and ACL graft rupture rates was assessed with a minimum follow-up of 6 years. Subgroup analyses were performed using PTS thresholds of 9° and 12°, as well as an SATT threshold of 5 mm. Univariate and multivariate analyses were conducted to identify significant risk factors for ACL graft rupture.RESULTSOf the 934 ACLR procedures performed, 207 patients met the inclusion criteria. With a 90% response rate, 186 patients who underwent primary ACLR with hamstring tendon autografts and LET were included for analysis. ACL graft rupture rate for patients with a PTS ≥12° (19.4%) was significantly (P < .001) higher than that for patients with PTS <12° (2.7%). The highest ACL graft rupture rate (26%) was observed in patients with both a PTS ≥12° and an SATT ≥5 mm. Patients with a PTS <9° demonstrated no ACL graft ruptures (0/60). The risk of graft rupture was significantly associated with a PTS ≥12° (OR, 12; 95% CI, 0.1-0.4; P < .001), SATT ≥5 mm (OR, 1.4; 95% CI, 0.2-3; P = .045), and age <18 years (OR, 4.1; 95% CI, 0.8-22.1; P = .015).CONCLUSIONDespite the addition of an LET, almost 20% of patients undergoing ACLR with hamstring tendon autografts experienced graft rupture when PTS was ≥12°. When combined with an increased SATT (≥5 mm), the graft rupture rate rose to 26%. In contrast, no graft ruptures were observed in patients with a PTS <9°. These findings emphasize the importance of evaluating PTS and SATT individually rather than systematically performing LET.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"19 1","pages":"3635465251350397"},"PeriodicalIF":0.0,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144521330","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":"A New Concept of Reverse Glenoid Track to Determine Which Reverse Hill-Sachs Lesion Should Be Treated","authors":"Nobuharu Ishizu, Nobuyuki Yamamoto, Yusuke Koibuchi, Kazuma Sasaki, Atsushi Arino, Rei Kimura, Jun Kawakami, Toshimi Aizawa, Eiji Itoi","doi":"10.1177/03635465251346953","DOIUrl":"https://doi.org/10.1177/03635465251346953","url":null,"abstract":"Background: Humeral and glenoid bone loss is commonly seen in patients with posterior shoulder dislocation, like anterior dislocation. However, which reverse Hill-Sachs lesion should be treated has not yet been clarified. Purpose: To (1) determine the contact area of the glenoid on the humeral head with the arm in various degrees of flexion while keeping maximum internal rotation and horizontal flexion and (2) clarify the surgical indication of a reverse Hill-Sachs lesion. Study Design: Descriptive laboratory study. Method: The authors examined 20 shoulders of 10 healthy volunteers. The magnetic resonance imaging scans were taken in 3 arm positions (0°, 45°, and 90° of flexion) while keeping maximum internal rotation and horizontal flexion. All the scans were reconstructed using 3-dimensional visualization analysis software. The 3-dimensional surface bone models of the proximal humerus and glenoid were reconstructed. The contact area between the humeral head and the glenoid was measured. Results: With an increase in flexion, the glenoid contact area shifted, creating a zone of contact (reverse glenoid track). The distances from the medial margin of the footprint of the rotator cuff tendon to the medial margin of the glenoid were 16.7 ± 3.2 mm (0° of flexion), 18.0 ± 3.7 mm (45° of flexion), and 19.0 ± 3.2 mm (90° of flexion), which were equivalent to 80% ± 15%, 87% ± 14%, and 92% ± 14% of the glenoid width, respectively. The distances from the medial margin of the articular cartilage edge were 11.9 ± 2.2 mm, 10.1 ± 1.4 mm, and 12.1 ± 1.9 mm, which were equivalent to 59% ± 12%, 50% ± 8%, and 59% ± 10% of the glenoid width, respectively. Conclusion: With an increase in flexion, the glenoid contact area shifted, creating a zone of contact (reverse glenoid track). The width of the reverse glenoid track was 50% to 59% of the glenoid width. A reverse Hill-Sachs lesion has a risk of engagement if it extends medially over the medial margin of the reverse glenoid track. Such reverse Hill-Sachs lesion is needed to treated.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"246 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500611","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":"Similar Rate of Return to Sport and Reoperation but Higher Rate of Recurrent Instability in Contact Versus Noncontact Athletes After Primary Arthroscopic Anterior Bankart Repair: A Systematic Review and Meta-analysis","authors":"Jayson Saleet, Kevin A. Hao, Khalid Al-Hourani, Alexander J. Ment, Ross A. Clarke, Patrick Nian, Emily J. Curry, Hussein Abdul-Rassoul, Antonio Cusano, Robert L. Parisien, Xinning Li","doi":"10.1177/03635465251328974","DOIUrl":"https://doi.org/10.1177/03635465251328974","url":null,"abstract":"Background: Anterior shoulder instability (ASI) is often seen in both contact and noncontact athletes, and the arthroscopic Bankart repair (ABR) procedure is among the most utilized procedures to treat patients with this condition. There is a lack of large studies comparing the return to sport (RTS), outcome, and recurrence rates after ABR in contact and noncontact athletes. Purpose: To understand the differences in postoperative RTS, outcomes, and complications in contact and noncontact athletes after primary ABR for ASI. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Included studies reported primary ABR without remplissage to treat ASI in athletes with a 1-year minimum follow-up. Random-effects meta-analysis was performed to compare outcomes. Results: Of the 1575 screened studies, 31 studies (2387 shoulders) were included. The mean age was 23.3 years (range, 13-50 years; SD, 2.97 years), 89% of the athletes were male, and the mean follow-up was 55.1 months (range, 12-107 months; SD, 22.8 months). Contact and noncontact athletes had similar rates of RTS (79% [95% CI, 63%-89%] and 91% [95% CI, 82%-96%], respectively; P = .079) and return to preinjury level (71% [95% CI, 56%-82%] and 79% [95% CI, 73%-85%], respectively; P = .201). Contact and noncontact athletes also demonstrated similar rates of revision surgery (6% [95% CI, 3%-13%] and 4% [95% CI, 3%-7%], respectively; P = .334). Contact athletes, however, exhibited a significantly higher rate of recurrent instability than noncontact athletes (17% [95% CI, 10%-27%] vs 8% [95% CI, 6%-12%]; P = .023). Conclusion: Compared with noncontact athletes, contact athletes demonstrate similar rates of RTS, return to preinjury level of play, and need for revision surgery but a higher rate of recurrent instability after primary ABR for ASI.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144503523","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":"Failure to Achieve the Patient Acceptable Symptom State 2 Years After Anterior Cruciate Ligament Reconstruction Reflects Poor Knee Loading Patterns.","authors":"Jade He,Ashley A Williams,Jennifer C Erhart-Hledik,Constance R Chu","doi":"10.1177/03635465251349105","DOIUrl":"https://doi.org/10.1177/03635465251349105","url":null,"abstract":"BACKGROUNDClinical outcomes vary after anterior cruciate ligament reconstruction (ACLR), and osteoarthritis (OA) risk remains high. Consequently, early identification is needed of patients who show potentially modifiable loading patterns suggestive of higher risk for worse outcomes and pre-OA.HYPOTHESISThis study tested the hypothesis that (1) Patient Acceptable Symptom State (PASS) status derived from the Knee injury and Osteoarthritis Outcome Score (KOOS) is associated with knee loading patterns 2 years after ACLR and (2) failure to achieve the PASS reflects worse knee loading mechanics.STUDY DESIGNCross-sectional study; Level of evidence, 4.METHODSFifty-nine participants with unilateral ACLR (mean ± SD, 33 ± 10 years; 33 [56%] females) assessed by gait analysis and KOOS at 2-year follow-up were categorized according to published KOOS PASS thresholds. Independent t tests compared knee flexion moment (KFM), knee adduction moment (KAM), and their relative percentage contributions to total joint moment between PASS statuses. Associations between loading metrics and PASS were examined using mixed effects logistic regression.RESULTSAlthough PASS rates for KOOS subscales ranged from 42% to 100%, only 36% of participants achieved the PASS on all 5 KOOS subscales. Patients achieving the PASS on a given KOOS subscale exhibited different loading patterns when compared with those who did not (PASS-no). Specifically, PASS-no for pain and knee-related quality of life showed lower KFM (P ≤ .024), and PASS-no for activities of daily living showed higher KAM (P = .009). Lower KFM and higher KAM were associated with lower likelihood of achieving the PASS on the KOOS subscales (P ≤ .035). A shift from KFM dominance to KAM dominance in PASS-no, as suggested by lower percentage KFM (P ≤ .026) and higher percentage KAM (P ≤ .047) to total joint moment, was consistent across the KOOS subscales for pain, knee related quality of life, and function in activities of daily living. Additionally, failure to achieve the PASS on some KOOS subscales was associated with more varus alignments (P ≤ .043), earlier ACLR (P = .006), and lower Tegner activity levels (P = .043).CONCLUSIONNearly two-thirds of ACLR recipients failed to achieve the PASS on all KOOS subscales 2 years after ACLR. Failure to achieve the PASS was associated with knee loading patterns linked to worse longer-term outcomes and greater OA risk.CLINICAL RELEVANCEThe KOOS PASS criterion is an accessible screening tool for identifying patients in need of further assessment and treatment to improve knee health and reduce OA risk after ACLR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"55 1","pages":"3635465251349105"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488101","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":"Microfracture Versus Arthroscopic Debridement for the Treatment of Symptomatic Cartilage Lesions of the Knee: 2-Year Results From a Multicenter Double-Blinded Randomized Controlled Trial","authors":"Per-Henrik Randsborg, Tommy Frøseth Aae, Håvard Visnes, Thomas Birkenes, Jūratė Šaltytė Benth, Øystein Bjerkestand Lian, Heidi Andreassen Hanvold, Asbjørn Årøen","doi":"10.1177/03635465251346961","DOIUrl":"https://doi.org/10.1177/03635465251346961","url":null,"abstract":"Background: Knee cartilage injuries can lead to significant functional limitations, pain, and diminished quality of life. Microfracture (MF) is the most common surgical procedure for smaller (&lt;2 cm <jats:sup>2</jats:sup> ) cartilage lesions of the knee. However, there is no established gold-standard surgical intervention. Purpose: To compare functional and patient-reported outcomes after MF and arthroscopic debridement (AD) for symptomatic, isolated femoral cartilage injuries &lt;2 cm <jats:sup>2</jats:sup> in patients aged 18 to 50 years. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 65 patients were included, randomized to undergo either MF (n = 31) or AD (n = 34), and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscore. Secondary outcomes included scores for the other KOOS subscales, Tegner activity scale, Lysholm score, and visual analog scale for pain. Results: The mean age at the time of inclusion was 33.2 ± 9.7 years. There were 44 (68%) male patients. The mean size of the lesion was 1.2 ± 0.6 cm <jats:sup>2</jats:sup> . There was no statistically significant difference between the groups in the change in the KOOS Quality of Life subscore from baseline to 2 years (3.5 [95% CI, –10.0 to 16.9]; <jats:italic>P</jats:italic> = .61). There were 10 complications in 5 patients in the MF group and 2 complications in 2 patients in the AD group. According to a linear mixed model, there were no statistically significant differences between the groups for any of the secondary outcomes at any time point during the 2-year follow-up period. Conclusion: MF was not superior to AD when treating femoral cartilage lesions of the knee &lt;2 cm <jats:sup>2</jats:sup> .","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500730","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":"Acromioclavicular Fixation Before Coracoclavicular Tunnel Placement and Acromioclavicular Construct Design Improved Reduction and Stability in a Whole-Shoulder Girdle Model: A Pilot Study.","authors":"Nicolas Holzer,Pascal Boileau,Toby Baring,Jean-Yves Beaulieu,Noria Foukia,Michel Lauria,Stéphane Armand,Florent Moissenet","doi":"10.1177/03635465251349143","DOIUrl":"https://doi.org/10.1177/03635465251349143","url":null,"abstract":"BACKGROUNDReconstruction of the acromioclavicular (AC) ligament after an acute AC dislocation as the first surgical step before coracoclavicular (CC) tunnel placement has been proposed to reduce the risk of postoperative loss of reduction. Additional reconstruction of AC ligamentous complex lesions with different types of bracing constructs has also been described to improve outcomes. Still, the effect of the sequence of surgical steps and the AC bracing construct design on the AC kinematics in a whole-shoulder girdle model has not been reported.HYPOTHESISThe primary hypothesis was that postoperative AC joint reduction would improve when the AC joint was reconstructed before CC tunnel placement. The secondary hypothesis was that different AC bracing construct designs affect joint kinematics during physiological motion in a whole-shoulder girdle model.STUDY DESIGNControlled laboratory study.METHODSFive cadaveric specimens (10 shoulders) were prepared for whole-shoulder mobilization with a robotic manipulator. Joint kinematics was acquired during physiological motions using an optical motion capture system. Recorded parameters were (1) the joint reduction in a resting position, expressed as joint displacements and rotations compared with an intact AC joint, and (2) the joint stability during all tested motions, expressed as joint displacements and rotations. The tested joint conditions were intact AC joint, induced Rockwood type 5 lesion, isolated CC reconstruction, and 4 AC joint bracing construct designs. AC reconstruction was performed before (AC-first technique) and after (CC-first technique) CC tunnel placement in 5 shoulders each.RESULTSThe AC-first surgical step improved the AC joint reduction in anterior-posterior tilt compared with CC-first (median difference, -9.4°; P < .001). The AC-first surgical step also demonstrated an increased superior-inferior joint reduction with hyperreduction (median difference, 1.6 mm; P = .041) compared with CC-first. Dispersion of joint reduction values was reduced with the AC-first step and particularly for anterior-posterior tilt (IQR difference, -4.8°) and lateral-medial displacement (IQR difference, -3.4 mm). The double vertical bracing construct design increased the AC joint stability compared with other constructs and reached a statistical significance in all rotational displacement (P < .001 to P = .041) as well as in lateral-medial displacement (P = .001 to P = .015).CONCLUSIONThe AC-first surgical step sequence improved AC joint alignment in the scapular sagittal plane and increased joint hyperreduction. The double vertical bracing construct design achieved the highest joint stability over other tested designs during passive motion.CLINICAL RELEVANCEThe restoration of the preinjury joint alignment and the optimization of the joint stability may improve outcomes and reduce the risk of construct de-tensioning during the rehabilitation phase.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"46 1","pages":"3635465251349143"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144488099","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":"Introducing the Reflection Index: A Novel Radiographic Assessment of Cam Morphology in Femoroacetabular Impingement and Predictor of Outcomes After Hip Arthroscopy With Minimum 2-Year Follow-up","authors":"Andrew S. Paliobeis, John T. Strony, Jason G. Ina, Mingda Chen, Sunita Mengers, Molly Piper, James E. Voos, Michael J. Salata","doi":"10.1177/03635465251346954","DOIUrl":"https://doi.org/10.1177/03635465251346954","url":null,"abstract":"Background: Femoroacetabular impingement (FAI) is commonly treated with hip arthroscopy, and cam underresection is a common reason for failure. Cam resection is assessed intraoperatively using radiographic parameters. However, currently used parameters have had equivocal results predicting patient-reported outcomes (PROs) after hip arthroscopy for FAI. Purpose/Hypothesis: The purpose of this study was to define a novel radiographic parameter, termed the “reflection index,” which can be used to assess cam resection. The authors hypothesized that the postoperative reflection index would correlate with outcomes after hip arthroscopy. Study Design: Case series; Level of evidence, 4. Methods: Patients with symptomatic FAI undergoing primary hip arthroscopy between 2019 and 2021 were identified. Pre- and postoperative alpha angle, head-neck offset ratio (HNOR), and reflection index were measured. Reflection index was defined as a curvilinear area superior to the femoral neck divided by a curvilinear area inferior to the femoral neck on 45° Dunn lateral radiograph. A reflection index of 1 was defined as a perfect cam resection. PROs were obtained preoperatively and 2 years postoperatively, including modified Harris Hip Score (mHHS), PROMIS Global Physical Health, PROMIS Global Mental Health, and visual analog scale (VAS) for pain. Multivariate and logistic regression models were utilized to evaluate the predictive value of each radiographic measure on outcomes. Results: Sixty-three hips met eligibility criteria; the mean age was 29.13 years and 44 (69.84%) patients were female. Multivariate regression analyses revealed that a reflection index that deviated further from 1 was an independent predictor of lower postoperative mHHS and Global Physical Health and higher VAS, with regression coefficients of −137.099 ( <jats:italic>P</jats:italic> &lt; .001), –49.747 ( <jats:italic>P</jats:italic> = .004), and 9.548 ( <jats:italic>P</jats:italic> = .038), respectively, for the transformed variable abs(log(reflection index)). A reflection index closer to 1 was an independent predictor of achieving the Patient Acceptable Symptom State and substantial clinical benefit for mHHS at 2 years. Alpha angle and HNOR had no association with postoperative mHHS, Global Physical Health, Global Mental Health, or VAS scores. Conclusion: The reflection index can be used to assess cam resection in hip arthroscopy. A postoperative reflection index closer to 1 was an independent predictor of significantly superior PROs at final follow-up. Alpha angle and HNOR failed to predict outcomes. Thus, the reflection index may be a useful radiographic assessment in hip arthroscopy to provide prognostic value postoperatively and potentially guide resection if future technology allows for intraoperative calculation.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"145 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144500582","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":"Compressive Graft Fit Promotes Tendon-to-Bone Integration After Anterior Cruciate Ligament Reconstruction","authors":"Keitaro Fujino, Sinaia Keith, Timur B. Kamalitdinov, Rashad Madi, Xi Jiang, Miltiadis H. Zgonis, Liane M. Miller, Andrew F. Kuntz, Nathaniel A. Dyment","doi":"10.1177/03635465251343011","DOIUrl":"https://doi.org/10.1177/03635465251343011","url":null,"abstract":"Background: Tendon graft integration with adjacent bone in the tunnels after anterior cruciate ligament reconstruction (ACLR) is critical to reach presurgical functional levels and achieve long-term surgical success. Unfortunately, tunnel integration does not always occur, resulting in complications attributed to cyst formation and tunnel widening, necessitating revision surgery. Previous studies have indicated that mechanical factors, including fit of the graft in the tunnel, can influence healing, but the extent to which graft fit facilitates tendon-to-bone integration is unclear. Purpose/Hypothesis: The purpose of this study was to investigate the effect of graft fit in the tunnel on zonal tendon-to-bone integration in a murine ACLR model. It was hypothesized that a tight-fitting graft would promote integration and reduce cyst formation. Study Design: Controlled laboratory study. Methods: ACLR surgery was performed in a compressive-fit group of mice using 27G needles (0.413-mm outer diameter) and 1 mm–diameter tendon autografts. The fit of the graft in the tunnels was modified to a loose fit in additional groups by either increasing the size of the tunnel (25G needle, 0.515-mm outer diameter) or decreasing the size of the graft (0.5 mm). The initial fit of the graft in the tunnel was assessed during surgery using a dynamometer. The extent of tunnel integration via mineralized fibrocartilage formation and cyst formation was measured at 28 days after surgery using multiplexed mineralized cryohistology. Results: As expected, the compressive-fit group resulted in a higher friction force required to pull the graft through the tunnel during surgery, and tunnels drilled with a 25G needle were wider than 27G tunnels at 28 days after surgery. The compressive fit in the tunnels improved tunnel integration, as assessed by mineralized fibrocartilage formation normalized to tunnel dimensions. Conversely, loose-fit tunnels resulted in higher overall cyst formation when normalized to tunnel dimensions. In particular, wider tunnels correlated with higher cyst formation. Conclusion: Tendon-to-bone integration was improved by creating a compressive fit of the soft tissue tendon graft in the tunnel while minimizing cyst formation as compared with loose-fit grafts. Therefore, the fit of the graft in the bone tunnel is an important consideration for enhancing zonal tendon-to-bone integration. Clinical Relevance: This study demonstrates that a compressive fit of a soft tissue tendon graft to the bone tunnel during ACLR resulted in improved zonal tendon-to-bone integration, providing evidence that sizing grafts toward a compressive fit could improve clinical outcomes.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"45 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144341052","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":"Influence of Neighborhood Disparities on Traumatic Shoulder Instability Severity and Timing of Care in Adolescents.","authors":"Dang-Huy Do,John E Arvesen,James J McGinley,Amareesa K Robinson,Eliza E Lovrich,Henry B Ellis,Philip L Wilson","doi":"10.1177/03635465251346901","DOIUrl":"https://doi.org/10.1177/03635465251346901","url":null,"abstract":"BACKGROUNDIdentifying and understanding socioeconomic disparities among adolescents with traumatic shoulder instability can help to optimize care for patients by improving differences in the disease burden, disease severity, and awareness of resource limitations. Current studies evaluating disparities among patients with shoulder instability are limited to the adult population or surgical patients.PURPOSETo evaluate how educational, health/environmental, and social/economic disparities influence the timing of shoulder instability treatment and shoulder instability severity among adolescents.STUDY DESIGNCohort study; Level of evidence, 3.METHODSA retrospective review of patients aged 10 to 19 years diagnosed with shoulder instability from January 2022 to April 2024 at a single institution was conducted. The Child Opportunity Index (COI) was used to evaluate inequalities in educational, health/environmental, and social/economic opportunities. Disease severity was determined using magnetic resonance imaging (MRI), including glenoid bone loss, Hill-Sachs interval size, distance to dislocation, and presence of an off-track lesion. Continuous variables were analyzed with the Mann-Whitney U test or the Spearman correlation coefficient, while categorical variables were analyzed using the chi-square test. Significance was set at P < .05.RESULTSThere were 181 patients who met the inclusion criteria. Patients with a lower overall COI had a longer time from injury to initial presentation (r = -0.15; P = .048), injury to orthopaedic evaluation (r = -0.17; P = .027), and injury to MRI (r = -0.16; P = .033) but not from injury to surgery. A history of recurrent dislocations was associated with a lower overall COI (B = -3.27; P = .041), lower educational COI (B = -3.01; P = .009), and lower social/economic COI (B = -3.65; P = .049). Patients with a distance to dislocation <10 mm were associated with a lower overall COI (B = -7.59; P = .003), lower educational COI (B = -8.38; P = .045), lower health/environmental COI (B = -7.88; P = .006), and lower social/economic COI (B = -8.22; P = .001).CONCLUSIONChildren living in neighborhoods with fewer educational and social/economic opportunities were associated with longer times from injury to orthopaedic evaluation and from injury to MRI for shoulder instability and were at a higher risk for recurrent shoulder dislocations.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"51 1","pages":"3635465251346901"},"PeriodicalIF":0.0,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144370132","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}