The American Journal of Sports Medicine最新文献

{"title":"Injectable Fibrocartilage-Forming Cores Enhance Bone-Tendon Healing in a Rat Rotator Cuff Model","authors":"Yuhao Yuan, Yiyang Mao, Buhua Sun, Can Chen","doi":"10.1177/03635465241300138","DOIUrl":"https://doi.org/10.1177/03635465241300138","url":null,"abstract":"Background:After surgical repair of rotator cuff (RC) tears, the torn tendon heals unsatisfactorily to the greater tuberosity owing to limited regeneration of the bone-tendon (BT) insertion. This situation motivates the need for new interventions to enhance BT healing in the RC repair site.Purpose:To develop injectable fibrocartilage-forming cores by tethering fibroblast growth factor 18 (FGF18) on acellular fibrocartilage matrix microparticles (AFM-MPs) and evaluate their efficacy on BT healing.Study Design:Controlled laboratory study.Methods:We harvested normal fibrocartilage tissue from the porcine RC insertion, after which it was decellularized and then micronized for fabricating AFM-MPs. The collagen-binding domain was fused into the N-terminus of FGF18 to synthesize recombinant FGF18 (CBD-FGF18), which was tethered to the collagen fibers of AFM-MPs to prepare the injectable fibrocartilage-forming cores (CBD-FGF18@AFM-MPs). After examining the influence of the CBD-FGF18@AFM-MPs on the viability and chondrogenic differentiation of bone marrow mesenchymal stem cells in vitro, we determined the function of the CBD-FGF18@AFM-MPs on BT healing in a rat RC tear model. A total of 80 Sprague-Dawley rats with RC injuries were randomly assigned to 4 supplemental treatments during RC repair: saline injection (control group), AFM-MPs injection, natural FGF18@AFM-MPs injection, and CBD-FGF18@AFM-MPs injection. At 4 and 8 weeks postoperatively, the harvested RC specimens were evaluated via micro–computed tomography, histologic staining, and mechanical testing.Results:In vitro, the CBD-FGF18@AFM-MPs were highly biomimetic, suitable for cell growth and proliferation, and superior in stimulating chondrogenesis. In vivo micro–computed tomography results showed that the CBD-FGF18@AFM-MPs group had significantly more new bone formation and better bone remodeling than the other 3 groups. Histologically, at 4 and 8 weeks postoperatively, the CBD-FGF18@AFM-MPs group had the best continuity of the BT insertion with regular collagen alignment and extensive fibrocartilage regeneration. Importantly, at 8 weeks postoperatively, the RC specimens from the CBD-FGF18@AFM-MPs group presented the highest failure load and stiffness.Conclusion:The injectable fibrocartilage-forming cores provide a new biological intervention to promote RC healing.Clinical Relevance:The injectable fibrocartilage-forming cores may be a new complementary treatment for surgical repair of RC tears.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908220","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 Novel Proportional Method for the Simplified Assessment of Glenoid Bone Loss in Patients With Anterior Shoulder Instability","authors":"Menglong Li, Mingrui Fan, Yuchen Zhang, Pu Shao, Tong Liu, Jianlin Zuo","doi":"10.1177/03635465241294076","DOIUrl":"https://doi.org/10.1177/03635465241294076","url":null,"abstract":"Background:Surgical planning for anterior shoulder instability (ASI) necessitates accurate measurements of glenoid bone defects, but current methods are either challenging or too complex for practical use. This underscores the need for a simplified, but precise, assessment technique for anterior glenoid bone defects.Purpose:To introduce a new measurement technique that requires only computed tomography (CT) of the affected shoulder joint and simultaneously simplifies the assessment of bone defects in the anterior glenoid.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:CT scans of the glenoid from 285 healthy participants and 43 patients with unilateral ASI were collected and reconstructed in 3 dimensions. Initially, we established the proportional relationship between the maximum height and width in the superior-inferior and anterior-posterior directions of the glenoid as well as the location of their intersection (point O) in healthy participants. Subsequently, glenoid bone defects in patients with ASI were measured using the contralateral comparison method, the best-fit circle method, the CT-specific formula method, and our novel proportional method. We analyzed the differences in defect ratios and sizes as well as glenoid track calculations among the 4 methods.Results:The mean width-to-height ratio of the glenoid was determined to be 0.69 ± 0.04, allowing for the simplification of the calculation to width = 0.7 × height for clinical convenience. Point O was consistently located at the lower one-third of the glenoid height. There was no statistical significance noted in the measurements of bone defect size and bone defect ratio when comparing the novel proportional method, the contralateral comparison method, and the best-fit circle method; however, a significant increase in bone defect size and bone defect ratio was estimated with the CT-specific formula method (defect size: F = 19.20, P < .0001; defect ratio: F = 15.99, P < .0001).Conclusion:We introduced a novel method for estimating the width of glenoid bone defects through the proportion of glenoid width to height, finding that 70% of the glenoid height at its lower one-third closely approximated its maximum width. This approach, requiring only CT data from the affected shoulder, simplified calculations and matched the accuracy of traditional methods. It offers potential clinical benefits in evaluating glenoid defects.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"343 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142912069","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":"Longitudinal Assessment of Intersegmental Abnormalities in the Lumbar Spine of Adolescent Competitive Alpine Skiers Over 48 Months","authors":"Georg C. Feuerriegel, Daniela Meyer, Daniel P. Fitze, Jonas Hanimann, Christoph Stern, Flavia Schürmann, Stefan Fröhlich, Johannes Scherr, Jörg Spörri, Reto Sutter","doi":"10.1177/03635465241295384","DOIUrl":"https://doi.org/10.1177/03635465241295384","url":null,"abstract":"Background:Overuse-related intersegmental abnormalities in the spine of competitive alpine skiers are common findings. However, longitudinal changes in intersegmental abnormalities and symptoms throughout adolescence have not been assessed.Purpose:To longitudinally assess and compare overuse-related spinal intersegmental abnormalities in adolescent competitive alpine skiers over 48 months and to compare magnetic resonance imaging (MRI) findings in asymptomatic and symptomatic skiers.Study Design:Case series; Level of evidence, 4.Methods:Adolescent competitive alpine skiers were prospectively recruited between November 2108 and February 2019 and underwent 3-T MRI of the lumbar spine at baseline and after 48 months. All MRI scans were assessed for intersegmental changes of the intervertebral disk, vertebral body, and facet joints. At both time points, athletes’ low back pain (LBP) symptoms were assessed via retrospective interviews relating to the 12-month period before the MRI study. Athletes were classified as symptomatic if at least 1 substantial episode of health problems related to back overuse had occurred in the 12 months before the MRI examination. The Wilcoxon signed-rank test and Pearson chi-square test were used to compare the measurements.Results:A total of 63 athletes (mean age at follow-up, 19.6 ± 1.2 years; 25 female) were included in the study. A significant increase in LBP affecting training and competition was observed at follow-up, with only 2 athletes reporting a history of spinal trauma (baseline, n = 13; follow-up, n = 20; P = .04). Of the athletes with LBP (n = 27), 59% (n = 16) reported recurrent LBP, 15% (n = 4) reported permanent LBP, and 26% (n = 7) reported 1-time LBP since baseline. Assessment of intersegmental changes revealed a significant increase in the number of athletes with disk signal reduction (baseline, n = 10; follow-up, n = 21; P = .001), disk bulging (baseline, n = 7; follow-up, n = 19; P = .002), or disk herniation (follow-up, n = 2; P = .04). Overall, intersegmental abnormalities did not correlate with LBP within the last year ( P = .53).Conclusion:Overuse-related intersegmental abnormalities of the lumbar spine are common in adolescent competitive alpine skiers and are often clinically silent at this age. These abnormalities may persist throughout skeletal maturation and even worsen during adolescence.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142912066","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":"Epidemiology and Characteristics of Meniscal Tears in Patients With Combined ACL and Medial Collateral Ligament Injuries Versus Isolated ACL Tears: A Case-Control Study From the Francophone Arthroscopic Society","authors":"Alexandre Hardy, Emilie Berard, Benjamin Freychet, Corentin Herce, Charles Kajetanek, Christian Lutz, Mohamad K. Moussa, Thomas Neri, Matthieu Ollivier, Nicolas Bouguennec, Etienne Cavaignac","doi":"10.1177/03635465241296879","DOIUrl":"https://doi.org/10.1177/03635465241296879","url":null,"abstract":"Background:The co-occurrence of anterior cruciate ligament (ACL) rupture with medial collateral ligament (MCL) rupture is a compound injury that can be associated with meniscal tears.Purpose:To report the characteristics of meniscal tears in knees with isolated ACL versus combined ACL and MCL injuries, analyzing their frequency, distribution by site, and lesion type.Study Design:Cross-sectional study; Level of evidence, 3.Method:This prospective, multicenter, case-control study, conducted across 10 hospitals in France as part of a symposium of the national French Society of Arthroscopy, compared patients undergoing ACL reconstruction with and without MCL injury. The 2 groups were matched by sex, age (±3 years), and body mass index (±3) to minimize imbalances between groups. All operations were performed by senior surgeons, who systematically explored for ramp, root, and other types of meniscal lesions as well as corner injuries. The primary outcome focused on meniscal injury frequency, with secondary outcomes examining lesion sites and types. A subgroup analysis was performed to compare these outcomes depending on the injury chronicity. Acute ACL injuries were those treated within 3 months of injury, and chronic lesions were those treated after this period.Results:A total of 722 patients were included, with a mean age of 30.32 ± 10.78 years. Meniscal injuries were observed more frequently in the ACL+MCL group, with 217 of 408 patients (53.2%) affected, compared with 130 of 314 patients (41.4%) in the isolated ACL group ( P = .001). Lateral meniscal lesions were significantly more common in the ACL+MCL group at 41.9% compared with 20.8% in the isolated ACL group ( P < .001). The same pattern was found independent of chronicity. Medial meniscal lesions were significantly more common in the isolated ACL group regardless of chronicity status. In terms of types of medial lesions, the ACL+MCL group primarily experienced longitudinal (45.9%) and ramp lesions (28.7%), whereas the isolated ACL group experienced mostly ramp lesion (58.3%; P < .001). No significant difference was observed in the distribution of lateral meniscal injury types.Conclusion:This study demonstrated a higher prevalence of meniscal injuries associated with ACL+MCL injuries compared with isolated ACL injuries, with lateral meniscal lesions particularly more frequent, independent of chronicity status.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142912143","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":"Common Benign Bone Lesions and Return to Sports: A Case Report and Scoping Review","authors":"Lisa A. Kafchinski, Anna E. Crawford, Laurence Stolzenberg, Sara J. Gould","doi":"10.1177/03635465241235947","DOIUrl":"https://doi.org/10.1177/03635465241235947","url":null,"abstract":"Background:Benign bone lesions are a common incidental finding in athletes during workup for musculoskeletal complaints, and athletes are frequently advised to halt participation in contact sports. There are no current guidelines to assist clinicians in referring patients with these lesions to a subspecialist or in advising athletes on the safety of returning to sport.Purpose:To assist sports medicine physicians in appropriate referral for patients with benign bone lesions through presentation of a literature review and the case of an adolescent athlete with a benign bone lesion in a location with a significant fracture risk.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature review was performed using the PubMed database. Search terms included “enchondroma,”“unicameral bone cyst,”“UBC,”“simple bone cyst,”“SBC,”“aneurysmal bone cysts, “ABC,”“nonossifying fibroma,”“NOF,”“non-ossifying fibroma,”“chondroblastoma,”“osteochondroma,”“exostosis,”“chondromyxoid fibroma,”“periosteal chondroma,” and “fibrous dysplasia” combined with “fracture,”“sports,”“sport,”“contact sport,”“football,” or “rugby.” Randomized controlled trials, case series, and prospective and retrospective studies were all included. Abstracts were excluded.Results:In total, 42 separate articles were reviewed. The strength of evidence for each lesion was determined using the total number of patients described in the literature with the pathology. Unicameral bone cysts, aneurysmal bone cysts, and fibrous dysplasia, particularly in the spine, are associated with a high risk of fracture; therefore, subspecialist referral is warranted before returning to sport. Osteochondromas (exostosis), juxtacortical chondromas, nonossifying fibromas, chondromyxoid fibromas, and enchondromas were associated with low fracture risk, and decisions regarding referral can be made on a case-by-case basis.Conclusion:The presence of a benign bone lesion does not always necessitate immediate, absolute restriction from participation in contact sports. After appropriate workup and diagnosis, the risk of return to sport should be evaluated based on the pathology present, and the patient and clinician should engage in a shared decision-making process. The guidelines in this paper provide context for stratifying risk and the importance of specialist referral. For athletes with a confirmed diagnosis of an asymptomatic benign bone lesion with a low risk of fracture, return to play without restrictions or referral is often safe.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142912146","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 Sports After Lower Trapezius Tendon Transfer for Posterosuperior Irreparable Rotator Cuff Tears","authors":"Bo Taek Kim, Jung Gon Kim, Seung Jin Kim, Bassem T. Elhassan, Chang Hee Baek","doi":"10.1177/03635465241298611","DOIUrl":"https://doi.org/10.1177/03635465241298611","url":null,"abstract":"Background:Lower trapezius tendon (LTT) transfer has demonstrated promising results for patients with posterosuperior irreparable rotator cuff tears (PSIRCTs). However, there has been no study evaluating return to work (RTW) and return to sports (RTS) after LTT transfer.Purpose/Hypothesis:The purpose of this study was to assess the rates of RTW and RTS and identify associated factors among patients who have undergone LTT transfer for PSIRCTs. It was hypothesized that LTT transfer would result in favorable functional outcomes and high rates of RTW and RTS.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review was conducted on patients who underwent LTT transfer for symptomatic PSIRCTs with minimal glenohumeral arthritis. The clinical assessment included patient-reported outcome measures, testing of active range of motion, and a radiological evaluation of arthritis. Patients were surveyed on occupation, sports activity, RTW or RTS status, time to return, and degree of resumption of previous work and sports levels. Exclusion criteria included a follow-up period of <1 year, revision surgery, postoperative infections, loss to follow-up, and unavailability of data.Results:A total of 110 patients (mean age, 63.0 ± 6.9 years; mean follow-up, 35.3 ± 15.7 months) were included. Clinical scores and active range of motion significantly improved at the final follow-up, with no significant differences between the different work levels. For RTW, 93.6% (n = 103) returned to work (63.1% completely, 36.9% partially), with a mean time to return of 5.2 ± 1.7 months; 6.4% (n = 7) did not return. Patients with lighter work levels had higher return rates and quicker times to return than those with heavier work levels. For RTS, 90.7% (n = 86) returned to sports (70.5% completely, 29.5% partially), with a mean time to return of 5.7 ± 1.3 months. For patients who participated in shoulder sports, 89.9% returned, and 10.1% failed to return. Multivariable logistic regression showed significant associations of higher RTW rates with lighter work levels (odds ratio [OR], 2.72; P = .005) and lower retear rates (OR, 5.41; P = .021). A lower retear rate was also significantly associated with a higher RTS rate (OR, 7.66; P = .010).Conclusion:LTT transfer for PSIRCTs yielded favorable functional outcomes with high rates of RTW and RTS. Patient-related factors, notably work level and retears, influenced successful RTW and RTS.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142912064","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":"Minimum 10-Year Clinical and Functional Outcomes, and Return to Sport After Sternoclavicular Joint Reconstruction for Sternoclavicular Joint Instability","authors":"Maximilian Hinz, Daniel Kopolovich, Ajay C. Kanakamedala, Caleb Davis, Marilee P. Horan, Amelia Drumm, Marco-Christopher Rupp, Matthew T. Provencher, Peter J. Millett","doi":"10.1177/03635465241299426","DOIUrl":"https://doi.org/10.1177/03635465241299426","url":null,"abstract":"Background:Sternoclavicular joint (SCJ) instability can lead to pain, reduced function, and an inability to perform sports and activities of daily living. Reconstruction of the SCJ using hamstring autograft in a figure-of-8 configuration has demonstrated good outcomes at short- and midterm follow-ups, but there is a paucity of literature on long-term outcomes.Purpose:To evaluate the long-term clinical and functional outcomes after SCJ reconstruction, with a focus on return to sport, instability recurrence, and revision surgery.Study Design:Case series; Level of evidence, 4.Methods:Patients who underwent SCJ reconstruction with a hamstring autograft for the treatment of SCJ instability between December 2010 and June 2013 by a single surgeon with a minimum 10-year follow-up were eligible for inclusion. Patient-reported outcome measures, including the American Shoulder and Elbow Surgeons (ASES) Score, short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaire, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and patient satisfaction (1-10 scale, with 10 indicating maximum satisfaction), rates of return to sport, instability recurrence, and revision surgery, were evaluated at short- (2-3 years), mid- (5-8 years), and long-term (minimum 10 years) follow-ups.Results:Eleven patients (13 shoulders) were evaluated at a median of 10.0 years (IQR, 10.0-11.0 years) postoperatively. SCJ instability was chronic in 12 shoulders (92.3%) and acute in 1 shoulder (7.7%). One shoulder underwent revision SCJ reconstruction and was excluded from further analysis (survivorship: 92.3%). Significant pre- to postoperative improvements in shoulder function and pain were observed at short-term follow-up and were either maintained or further improved at mid- and long-term follow-ups. At a minimum of 10 years postoperatively, shoulder function (median ASES score: 95.0 [IQR, 86.2-97.5]; median QuickDASH: 12.5 [IQR, 6.8-15.9]; median SANE: 89.0 [IQR, 81.5-96.3]) was excellent, pain levels were low (median VAS for pain: 0.5 [IQR, 0-1.8]), and patient satisfaction was high (median, 9.0 [IQR, 8.0-10]). All patients returned to sport (n = 10; 100%) at levels equal to or above (n = 3; 30.0%) or slightly below (n = 7; 70.0%) their preinjury level. Two of these patients (20.0%) reported instability-related modifications in activity. One patient had recurrent instability 2.5 years postoperatively but had excellent shoulder function at the final follow-up. The overall rate of instability recurrence was 36.4% (4/11 patients).Conclusion:SCJ reconstruction using a hamstring autograft for the treatment of SCJ instability resulted in significant improvements in shoulder function, low levels of pain, and high return-to-sport rates at long-term follow-up. Revision surgery rates were low.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142912101","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 Sport After ACL Reconstruction With Meniscal Allograft Transplantation Versus Isolated ACL Reconstruction: A Matched-Cohort Study","authors":"Victoria Rigsby, Joshua Shaw, Caroline Stankaitis, Steven Higbie, Jacquelyn Kleihege, William Brooks, Walter R. Lowe, Lane B. Bailey","doi":"10.1177/03635465241296877","DOIUrl":"https://doi.org/10.1177/03635465241296877","url":null,"abstract":"Background:Meniscal allograft transplantation (MAT) is indicated in the setting of anterior cruciate ligament (ACL) reconstruction to restore proper arthrokinematics and load distribution for the meniscus-deficient knee. Objective outcomes after ACL reconstruction with concomitant MAT in athletic populations are scarcely reported and highly variable.Purpose:To compare patient outcomes using an objective functional performance battery, self-reported outcome measures, and return-to-sport rates between individuals undergoing ACL reconstruction with concomitant MAT and a matched group undergoing isolated ACL reconstruction.Study Design:Cohort study; Level of evidence, 3.Methods:A single-surgeon ACL reconstruction database (N = 1431) was used to identify patients undergoing ACL reconstruction with concomitant MAT between 2014 and 2019. Patients were age-, sex-, and revision-matched to a group undergoing isolated ACL reconstruction. Baseline patient and surgical data were obtained. Patients completed an objective functional performance battery at the time of return to sport that included range of motion, single-leg squat performance, single-leg hop test performance, self-reported function (International Knee Documentation Committee [IKDC] score), and psychological readiness (ACL Return to Sports After Injury scale). Between-limb comparisons were assessed using limb symmetry indices. Injury surveillance was conducted for 2 years and included the Single Assessment Numeric Evaluation (SANE), reinjury rates, complications, and current level of sports participation. Between-group comparisons at the time of return to sport and 2 years later were analyzed using generalized linear models for parametric and nonparametric equivalents with an a priori alpha level of .05.Results:A total of 46 patients were included in the ACL reconstruction with concomitant MAT group (38 medial MAT, 8 lateral MAT), and 46 patients were included in the isolated ACL reconstruction group. Baseline differences existed between groups, with the MAT group exhibiting lower body weight (84.0 ± 14.1 vs 93.2 ± 191.8 kg; P = .036) and Marx scores (4.8 ± 4.5 vs 9.3 ± 4.1; P = .024) than the isolated ACL reconstruction group, respectively. At the time of return to sport, the MAT group reported lower IKDC scores (83.2 ± 12.6 vs 91.1 ± 11.3; P = .037); however, no other functional performance or self-reported differences were observed. At 2 years, no significant differences existed between groups for SANE score (87.8 ± 12.3 vs 89.3 ± 11.4; P = .793), ACL graft reinjury rates (6.5% vs 2.2%; P = .688), or level of return to sport ( P > .05). The MAT group demonstrated a significantly lower rate of return to previous level of sport (69.5% vs 78.3%; P = .026).Conclusion:The majority of patients (87%) undergoing ACL reconstruction with concomitant MAT were able to return to some level of sports participation at 2 years with a low risk of revision ACL reconstruction or meniscal transplant failure. P","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142912058","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":"Mid- to Long-Term Clinical Outcomes and Failure Rates After ALPSA Lesion Repair","authors":"Benjamin W. Hoyt, Bobby G. Yow, Scott M. Feeley, Zachary J. Bloom, Kelly G. Kilcoyne, John-Paul H. Rue, Jon F. Dickens, Lance E. LeClere","doi":"10.1177/03635465241295387","DOIUrl":"https://doi.org/10.1177/03635465241295387","url":null,"abstract":"Background:Anterior labroligamentous periosteal sleeve avulsion (ALPSA) lesions are associated with recurrent shoulder instability and higher rates of failure after capsulolabral repair compared with similarly treated Bankart lesions. Although these lesions can portend poor outcomes, there are limited data on the associated conditions and postoperative course in a young, active population.Purpose:To evaluate the mid- to long-term clinical course and failure rates after ALPSA repairs and assess features associated with these outcomes.Study Design:Cohort study; Level of evidence, 3.Methods:The authors identified all patients who underwent primary arthroscopic anterior or combined anterior and posterior labral repair between January 2010 and January 2020 at a single US military academy. Patient and injury characteristics were retrospectively reviewed while excluding patients with follow-up of <2 years. Patients were divided into 2 cohorts based on the presence of an ALPSA lesion as identified using arthroscopy, and patients with non-ALPSA lesions were matched to those with ALPSA lesions in a 5:1 ratio based on age, sex, time from injury to surgery, glenoid bone loss, and follow-up duration. The primary outcome measures were failure and revision surgery. Any recurrent shoulder instability event was considered a failure, including subjective or objective subluxation and/or dislocation, recurrence of pain consistent with instability, or functionally limiting apprehension. Survival analysis and both univariate and multivariate logistic regression analyses were performed to identify factors associated with ALPSA lesions and propensity for failure.Results:The authors compared 225 patients with non-ALPSA labral tears against 45 patients with ALPSA lesions. ALPSA lesions were associated with multiple preoperative dislocations (odds ratio [OR], 3.0; 95% CI, 1.5-5.9; P = .00096) and increased prevalence of Hill-Sachs lesions (HSLs) (OR, 6.7; 95% CI, 2.8-16.0; P < .0001) and near-track HSLs (OR, 3.6; 95% CI, 1.7-7.6; P = .00049). At the final follow-up, there was no difference in overall failure or recurrent instability between patients with and without ALPSA lesions (20% vs 16% [ P = .563] and 17.8% vs 10.2% [ P = .147], respectively). On multivariate regression, ALPSA did not affect the likelihood of failure ( P = .625). However, those with ALPSA lesions experienced failure earlier (1.7 vs 3.1 years; P = .020). When revision ALPSA repairs were performed, 43% failed.Conclusion:In patients with anterior instability treated with primary arthroscopic stabilization, ALPSA lesions were associated with HSLs and multiple dislocations. Although ALPSA repair failure occurred at a similar frequency in the mid- to long term compared with Bankart repairs, ALPSA repair failure tended to occur early in the postoperative course.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"132 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142912065","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":"PLGA Conical Nail Fixation for Acetabular Chondrolabral Delamination in Femoroacetabular Impingement Promotes Cartilage and Labrum Regeneration in a Porcine Model","authors":"Cancan Du, Guanying Gao, Yichuan Zhu, Siqi Zhang, Yarui Zhang, Jianquan Wang, Zhenlong Liu, Yan Xu","doi":"10.1177/03635465241299414","DOIUrl":"https://doi.org/10.1177/03635465241299414","url":null,"abstract":"Background:Acetabular chondrolabral delamination (ACD) is one of the most common hip cartilage injuries. However, there are very limited clinical treatments for this injury.Purpose:To evaluate the effectiveness of poly (lactic-co-glycolic acid) (PLGA) conical nail fixation in the treatment of acute and chronic ACD in a porcine model.Study Design:Controlled laboratory study.Methods:In this study, 24 pigs underwent surgically induced delamination of the chondrolabral junction. Pigs were randomly divided into 3 groups: the control group (delaminated chondrolabral junction without treatment), ACD acute refixation (ACDA) group (delaminated chondrolabral junction fixed with a PLGA nail), and ACD chronic refixation (ACDC) group (placement of a nonabsorbable spacer at the stripped chondrolabral junction for 6 weeks before fixation with a PLGA nail). Porcine specimens underwent magnetic resonance imaging (MRI), hematoxylin and eosin staining, safranin O/fast green (SO/FG) staining, immunohistochemistry examination (collagen 1, collagen 2, and collagen 10), and immunofluorescence examination ( SOX9 and aggrecan) to evaluate the chondrolabral regeneration at 6 and 12 weeks postoperatively.Results:MRI showed focal discontinuity of cartilage and fluid located between the acetabular cartilage and subchondral bone plate in the control group. The acetabular cartilage stained with SO/FG showed significantly more proteoglycan deposition at 12 weeks in the ACDA group than in the control group ( P = .0109) and ACDC group ( P = .0484). In accordance with the results of the SO/FG and collagen 10 staining, the aggrecan of the femoral head at 6 and 12 weeks was upregulated in the ACDA group ( P < .0001) and downregulated in the ACDC group ( P < .0001).Conclusion:PLGA conical nail fixation achieved a good treatment outcome on MRI and histological evaluations. Early treatment upregulated the expression levels of SOX9 and aggrecan and promoted proteoglycan deposition.Clinical Relevance:The PLGA conical nail fixation technique may be a viable and effective treatment approach for patients with ACD in clinical practice.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142912067","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}