The American Journal of Sports Medicine最新文献

{"title":"A Prospective, Randomized Trial of the Modified Jobe Versus Docking Techniques With Gracilis Autograft for Ulnar Collateral Ligament Reconstruction in the Elbow","authors":"Michael C. Ciccotti, Austin M. Looney, Emma E. Johnson, Christopher J. Hadley, Adam Zoga, Levon Nazarian, Michael G. Ciccotti","doi":"10.1177/03635465241305741","DOIUrl":"https://doi.org/10.1177/03635465241305741","url":null,"abstract":"Background:Ulnar collateral ligament (UCL)reconstruction (UCLR) has transformed UCL injury from career-ending to career-interruptive. The most common surgical techniques are the modified Jobe and docking techniques.Purpose/Hypothesis:The purpose of this study was to perform a prospective, randomized comparison of the modified Jobe versus docking techniques in overhead athletes with respect to patient-reported outcomes (PROs), self-reported baseball-specific metrics, imaging, and complications. It was hypothesized that there would be no significant differences between techniques.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:A single-surgeon, single-blinded, prospective, randomized trial was performed comparing the modified Jobe and docking techniques. Patients were blinded to surgical technique. UCLR was performed with uniform gracilis autograft and identical postoperative rehabilitation. Pre- and postoperative PROs (Kerlan-Jobe Orthopaedic Clinic [KJOC] score, Andrews-Timmerman score, and Conway-Jobe score) were obtained. Pre- and postoperative imaging included stress ultrasound (SUS) and magnetic resonance imaging (including magnetic resonance arthrography). Additional information included demographics, anthropometrics, intraoperative data, complications, and self-reported baseball-specific metrics.Results:Eighty patients were randomized, and >80% follow-up was obtained (65/80 [81%]). There were no significant differences with respect to demographics, anthropometrics, preoperative imaging, or preoperative PROs. Surgically, docking had shorter median tourniquet time (91.5 vs 98.0 minutes; P = .001). There were no differences in Andrews-Timmerman score at any time point. Docking demonstrated a higher median KJOC score at 2 years (93.05 vs 79.20; P = .021). There was no difference with respect to return to play (RTP) by the Conway-Jobe scale (80% good to excellent docking vs 69% good to excellent Jobe; P = .501) or time to RTP (13.92 months docking vs 12.85 months Jobe; P = .267). There were no differences in baseball metrics postoperatively. On postoperative SUS, modified Jobe showed greater graft thickness (7.70 vs 6.75 mm; P = .006). Postoperative MRI revealed no differences. There was no difference in complications (Jobe 5.0% vs docking 7.5%; P > .999).Conclusion:The current study identified high rates of good to excellent results with PROs for both techniques, including RTP rates and times. Docking had shorter tourniquet time and higher 2-year KJOC scores. There were no differences in self-reported baseball-specific metrics or postoperative imaging (except graft thickness for modified Jobe by SUS). As the first prospective, randomized trial evaluating the modified Jobe and docking techniques, this study is the definitive substantiation of these two surgical techniques for UCLR. It provides surgeons with confidence to utilize the technique with which they are most comfortable.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125348","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":"Gimme Shelter","authors":"Brett Owens","doi":"10.1177/03635465251313755","DOIUrl":"https://doi.org/10.1177/03635465251313755","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125312","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 Stability in Remnant-Preserving ACL Reconstruction: Letter to the Editor","authors":"Ruijia Wang, Lingxiao Chen","doi":"10.1177/03635465241296837","DOIUrl":"https://doi.org/10.1177/03635465241296837","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143125313","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 Quantitative Fatty Infiltration Evaluation of the Supraspinatus Muscle: Enhanced Clinical Relevance and Improved Diagnostic Value on Predicting Retear Compared With the Goutallier Classification","authors":"Jianhao Xie, Meng Zhou, Zhe Guo, Yiming Zhu, Chunyan Jiang","doi":"10.1177/03635465251313809","DOIUrl":"https://doi.org/10.1177/03635465251313809","url":null,"abstract":"Background:Preoperative assessment of fatty degeneration is important for managing rotator cuff tears. The Goutallier classification is semiquantitative and observer dependent. Discrepancies among surgeons can be prominent. A quantitative method may improve accuracy and reliability in evaluating the exact percentage of fatty infiltration (Fat%).Hypothesis/Purpose:This study aimed to investigate the correlation between the new quantitative method and the Goutallier classification in assessing fatty infiltration (FI) of the supraspinatus muscle and to explore the use of this method in predicting retear after rotator cuff repair. It was hypothesized that the new method would significantly correlate with the Goutallier classification and be more sensitive to retear.Study Design:Cohort study (diagnosis); Level of evidence; 3.Methods:This study included 105 patients who underwent arthroscopic rotator cuff repair for large to massive tears. All patients underwent routine preoperative and 1-year postoperative magnetic resonance imaging and were divided into 2 groups according to tendon healing. Preoperative quantitative Fat% of the supraspinatus muscle was evaluated based on the signal intensity (SI) of the T1-weighted sequence. The Fat% was calculated using the following equation: SI<jats:sub>supraspinatus</jats:sub> = SI<jats:sub>fat</jats:sub>× Fat% + SI<jats:sub>muscle</jats:sub>× (1 – Fat%). The correlation between the Fat% and the Goutallier grade was determined. Univariate and multivariate analyses were performed to identify the independent risk factors for retear.Results:The mean preoperative Fat% of the supraspinatus muscle was 23.77 ± 15.96. A significant correlation was found between the Fat% and the Goutallier grade of the supraspinatus muscle ( R = 0.655; P &lt; .001). The overall retear rate was 21.9%; however, functional status significantly improved regardless of cuff healing. Multivariate analysis identified the Fat% ( P = .005) and the modified Patte classification ( P = .003) as independent risk factors of retear. The receiver operating characteristic curves showed that the cutoff value of Fat% for predicting retear was 33.2%. Fat% &gt;33.2% possessed superior diagnostic accuracy (79.0%), Youden index (0.513), and positive and negative predictive values (51.6% and 90.5%, respectively) compared with the Goutallier grades.Conclusion:Although the quantitative method for assessing Fat% of the supraspinatus muscle significantly correlated with the Goutallier classification, the quantitative method is more clinically relevant to retear. Fat% of the supraspinatus muscle &gt;33.2% possessed higher diagnostic value than the Goutallier grades in predicting retear.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143072481","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":"Clinical Outcomes of Ulnar Collateral Ligament Repair With Internal Brace Versus Ulnar Collateral Ligament Reconstruction in Competitive Athletes","authors":"Jeffrey R. Dugas, Ryan J. Froom, Eric A. Mussell, Sydney M. Carlson, Anna E. Crawford, Graham E. Tulowitzky, Travis Dias, Kevin E. Wilk, Arsh N. Patel, Ariel L. Kidwell-Chandler, Michael K. Ryan, Andrew W. Atkinson, Andrew H. Manush, Marcus A. Rothermich, Matthew P. Ithurburn, Benton A. Emblom, E. Lyle Cain","doi":"10.1177/03635465251314054","DOIUrl":"https://doi.org/10.1177/03635465251314054","url":null,"abstract":"Background:The increasing prevalence of ulnar collateral ligament (UCL) injuries, particularly in young athletes, necessitates optimization of treatment options. The introduction of UCL repair with internal bracing offers an exciting alternative to traditional UCL reconstruction.Purpose:To compare midterm outcomes between UCL repair with internal bracing and UCL reconstruction in competitive athletes.Study Design:Cohort study; Level of evidence, 3.Methods:The authors identified competitive athletes who underwent primary UCL repair with internal bracing or UCL reconstruction between 2013 and 2021 and were at least 2 years postsurgery. To have qualified for repair, patients must have shown complete or partial UCL avulsion from the sublime tubercle or medial epicondyle. Relevant patient, injury, operative, and revision surgery data were collected via chart review. Preoperative American Shoulder and Elbow Surgeons Elbow assessment form (ASES-E), Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow (KJOC), and Andrews-Carson scores were obtained from an ongoing data repository. ASES-E, KJOC, and Andrews-Carson scores, and return-to-sport (RTS) data were collected at follow-up. Linear regression modeling controlling for relevant covariates was utilized to compare patient-reported outcome (PRO) scores between groups. Proportions of athletes who successfully returned to sport and proportions of subsequent revision procedures between groups were compared using chi-square tests. Lastly, for those with baseline questionnaire data, the authors compared magnitude of change between preoperative and postoperative scores between groups using linear regression modeling with baseline scores and follow-up time as the covariates, and follow-up scores as the dependent variable.Results:A total of 461 athletes were eligible for inclusion with complete clinical and outcome data available (mean age at surgery, 19.1 years; 92% male). The UCL repair group had a significantly shorter follow-up time than the UCL reconstruction group (4.4 vs 6.3 years; P &lt; .01). When controlling for follow-up time, the groups did not differ in ASES-E, KJOC, or Andrews-Carson scores at follow-up. There was no significant difference in proportion of revisions between UCL repair (9%) and UCL reconstruction (8%) ( P = .77). Of the 268 athletes with complete follow-up in the repair group, 247 attempted to return to their preinjury sport, and 241 (98%) were able to RTS. Six athletes reported that they were unable to RTS due to limitations from their surgery. Of the 155 athletes with follow-up in the reconstruction group, 147 attempted to return to their preinjury sport; 145 (99%) were able to successfully RTS, and 2 were unable to return due to limitations from their surgery. The 2 groups, repair with internal brace versus reconstruction, did not statistically differ in the proportions that returned to preinjury sport ( P = .20) but did differ regarding time in months to return to practice (6.7 ± 3","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143072480","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":"Midterm Survivorship and Clinical Outcomes in Fresh Osteochondral Allograft Transplantation for the Treatment of Large Bipolar Lesions of the Knee","authors":"Tony S. Bouz, Tim Wang, Jordan K. Penn, Julie C. McCauley, William D. Bugbee","doi":"10.1177/03635465241313139","DOIUrl":"https://doi.org/10.1177/03635465241313139","url":null,"abstract":"Background:Fresh osteochondral allograft (OCA) transplantation is an established treatment option for patients with chondral or osteochondral lesions of the knee. Predictably positive outcomes are seen in situations of focal or isolated cartilage defects. However, OCA transplantation may also be performed in more complex joint salvage situations in young patients.Purpose:To evaluate survivorship and outcomes in patients who underwent OCA transplantation for large bipolar lesions of the knee.Study Design:Case series; Level of evidence, 4.Methods:Fresh OCAs were implanted for bipolar chondral lesions in 86 patients (89 knees) between 1983 and 2020. A total of 37 male and 52 female knees with a mean patient age of 37.9 years (range, 14.5-66.0 years) were treated. Surgical indications included degenerative chondral lesions, osteoarthritis, osteochondritis dissecans, traumatic chondral injuries, and previous failed OCAs. The clinical evaluation included the modified Merle d’Aubigné-Postel score, International Knee Documentation Committee (IKDC) score, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Outcomes were collected during outpatient clinic visits or via mail. The minimum follow-up was 2 years. Additional procedures after OCA transplantation were documented. OCA failure was defined as a reoperation that involved removal of the allograft.Results:There were 81 knees (91.0%) that had undergone previous surgery, with a mean of 3.2 previous procedures (range, 1-11). The mean treated defect surface area was 16.7 cm<jats:sup>2</jats:sup>. Graft failure occurred in 31 knees (34.8%). Reoperations (including failures) occurred in 46 knees (51.7%). The mean time to failure was 4.8 years. Survivorship of the bipolar OCA was 73.8% at 5 years, 66.6% at 10 years, and 58.9% at 15 years. Among the 58 knees (65.2%) in which the OCA was still in situ, the mean follow-up was 11.3 years (range, 2.1-27.6 years). The mean modified Merle d’Aubigné-Postel score improved from 12.4 to 14.8 points; 64.3% of knees (36/56 with available data) were considered successful with a score ≥15. The mean IKDC pain score improved from 6.3 to 4.0, and the mean IKDC function score improved from 2.9 to 6.2. The KOOS symptoms, pain, activities of daily living, sports/recreation, and quality of life subscores all increased postoperatively by a mean of 19.7, 25.9, 27.1, 35.4, and 36.4, respectively.Conclusion:OCA transplantation is a salvage treatment option for large bipolar cartilage lesions of the knee with acceptable survivorship and significant clinical improvement in a challenging patient population.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056261","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 Joint Line Convergence Angle and Patient-Reported Outcomes of Opening-Wedge High Tibial Osteotomy","authors":"Takahiro Tsushima, Eiji Sasaki, Yukiko Sakamoto, Yuka Kimura, Eiichi Tsuda, Yasuyuki Ishibashi","doi":"10.1177/03635465241313396","DOIUrl":"https://doi.org/10.1177/03635465241313396","url":null,"abstract":"Background:A larger joint line convergence angle (JLCA) increases the stress load on the medial compartment. Few reports, however, have discussed the effect of the JLCA on the cartilage status and clinical outcomes after opening-wedge high tibial osteotomy (OWHTO).Purpose/Hypothesis:To reveal the effect of the JLCA on clinical results after OWHTO. We hypothesized that a smaller JLCA improves cartilage status and clinical outcomes by reducing mechanical stress in the medial compartment.Study Design:Cohort study: Level of evidence, 3.Methods:This retrospective study included 106 knees that underwent OWHTO and second-look arthroscopy during implant removal 1 year after OWHTO. The mean follow-up period was 5.5 (SD, 2.9) years. The pre- and postoperative JLCAs were measured radiographically. The International Cartilage Repair Society (ICRS) grades of the medial femoral condyle (MFC) and the medial tibial plateau (MTP) were evaluated during the initial and second-look arthroscopy. The relationship between the JLCA and cartilage status, and the Knee injury and Osteoarthritis Outcome Score (KOOS) at the final follow-up were evaluated.Results:Preoperative JLCA was related to improvements in the ICRS grade of the MFC and the MTP, with cutoff values of 2.6° (sensitivity, 0.700; specificity, 0.561; P = .016) and 2.4° (sensitivity, 0.704; specificity, 0.595; P = .028), respectively. In addition, the preoperative JLCA was related to KOOS Pain ( P = .037), Symptoms ( P &lt; .001), Activities of Daily Living ( P = .005), Sports Activities ( P = .005), and Quality of Life ( P = .006) subscales using multivariable linear regression analysis. The postoperative JLCA was not related to the improvement in the ICRS grade of the MFC but was related to the improvement in the ICRS grade of the MTP, with a cutoff value of 1.6° (sensitivity, 0.704; specificity, 0.603; P = .015). Furthermore, postoperative JLCA was related to the KOOS Pain ( P = .004), Symptoms ( P = .002), Activities of Daily Living ( P = .031), Sports Activities ( P &lt; .001), and Quality of Life ( P = .015) subscales.Conclusion:A smaller pre- and postoperative JLCA was related to improvements in the ICRS grade and favorable clinical outcomes, with a mean 5.5-year follow-up after OWHTO.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056257","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":"Osteochondral Fractures in Adolescents With First-time Patellar Dislocation: Three-dimensional Characterization and Association With Radiographic Features","authors":"Annmarie Wang, Beltran Torres-Izquierdo, Jeffrey J. Nepple","doi":"10.1177/03635465241313135","DOIUrl":"https://doi.org/10.1177/03635465241313135","url":null,"abstract":"Background:Consequences of osteochondral fractures associated with patellar dislocation can be severe for younger patients. Precise 3-dimensional characterization of fracture location, size, frequency, and radiographic associations remain undefined in this population.Purpose:(1) To define the topographic characteristics of osteochondral fractures in pediatric and adolescent patients with first-time patellar dislocations and (2) to determine the relationship between these characteristics and radiographic and patient factors.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A retrospective observational study was conducted between 2015 and 2023 of consecutive patients aged &lt;18 years undergoing surgical intervention for displaced osteochondral fractures in the setting of first-time patellar dislocation. Three-dimensional location and relative injury frequency were quantified with heat map analysis. Subgroup analysis of intraoperative osteochondral fracture size and location was conducted using chi-square testing and an independent t test at an alpha of .05.Results:The study cohort included 82 knees (80 patients) with first-time patellar dislocation and osteochondral fracture. A total of 97 osteochondral fractures were identified, with the lateral femur as the most common fracture site at 55% (n = 53), as compared with 43% (n = 42) for the patella and 2% (n = 2) for the lateral trochlea. Patellar osteochondral fractures were significantly larger than femoral lesions (mean ± SD, 258 ± 168 mm<jats:sup>2</jats:sup> vs 126 ± 109 mm<jats:sup>2</jats:sup>; P &lt; .001) and more amenable to fixation than femoral osteochondral fractures (fixation, 57.1% [n = 24] vs 15.1% [n = 8]; P &lt; .001). Patellar and femoral osteochondral fractures were &gt;100 mm<jats:sup>2</jats:sup> in 78.6% (n = 33) and 32.1% (n = 17) of lesions, respectively. Patellar mean fracture size was significantly larger in the group with a tibial tubercle–trochlear groove distance &lt;20 mm ( P = .018). The mean osteochondral fracture size of the lateral femoral condyle was significantly larger in the open physis group as compared with the closed physis group ( P = .027).Conclusion:We found that the most common site for osteochondral fracture was the femur, although patellar osteochondral fractures were significantly larger. Factors that affect anatomic structure and ligamentous laxity appear to contribute to patterns of osteochondral fractures.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056260","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 Combined With an Appropriate Carrier Effectively Promotes Bone-Tendon Interface Healing in a Rabbit Model of Chronic Rotator Cuff Tear","authors":"Sheng Chen Han, Jian Han, Young Kyu Kim, Myung Jae Hyun, Hyeon Jang Jeong, Joo Han Oh","doi":"10.1177/03635465241313124","DOIUrl":"https://doi.org/10.1177/03635465241313124","url":null,"abstract":"Background:The efficacy of bone marrow aspirate concentrate (BMAC) in promoting bone-tendon interface (BTI) healing without any carriers remains a subject of debate.Purpose:To evaluate BMAC effects with different carriers on tendon regeneration in a rabbit model of chronic rotator cuff tear.Study Design:Controlled laboratory study.Methods:In vitro, the amount of growth factor and the differentiation potential of BMAC with different carriers (polydeoxyribonucleotide [PDRN] and atelocollagen [ATC]) were assessed. In vivo, 64 rabbits were randomly allocated into 4 groups. Different materials were injected into the repair site according to the allocated group: control, saline; BMAC, BMAC and saline; BMAC-PDRN, BMAC with PDRN; BMAC-ATC, BMAC with ATC (n = 16 in each). Genetic and histologic analyses were conducted at 4 and 12 weeks after repair, while biomechanical evaluations were performed at 12 weeks after repair.Results:In vitro, the degree of multilineage differentiation was much stronger using BMAC with ATC as compared with administration of BMAC alone or BMAC with PDRN ( P &lt; .001). In vivo, the BMAC-ATC group had the highest levels of aggrecan expression, bone morphogenetic protein 2, and collagen type I alpha 1 among all groups (all P &lt; .001) at 4 weeks after repair. Furthermore, the BMAC-ATC group showed collagen fiber continuity, denser collagen fibers, and more mature BTI as compared with the other groups (all P &lt; .001) at 12 weeks after repair. Concurrently, the BMAC-ATC group also demonstrated significantly higher load-to-failure versus the remaining groups (all P &lt; .001) at 12 weeks after repair.Conclusion:Local application of BMAC without appropriate carriers could not enhance BTI healing. However, BMAC with 2 different carriers effectively accelerated BTI healing, particularly in the ATC environment. Therefore, the combination of BMAC and ATC may act as a powerful biological agent to promote healing after rotator cuff repair in a chronic rotator cuff tear model using rabbits.Clinical Relevance:Local application of BMAC without appropriate carriers could not enhance BTI healing. However, the combination of BMAC and ATC may synergistically promote rotator cuff tendon healing.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056264","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":"An Aligned-to-Random PLGA/Col1-PLGA/nHA Bilayer Electrospun Nanofiber Membrane Enhances Tendon-to-Bone Healing in a Murine Model","authors":"Baoyun Xu, Yunjiao Wang, Gang He, Xu Tao, Shang Gao, Mei Zhou, Yuzhen Tang, Kang-lai Tang, Lin Guo, Wan Chen","doi":"10.1177/03635465241310530","DOIUrl":"https://doi.org/10.1177/03635465241310530","url":null,"abstract":"Background:The challenge of achieving effective tendon-to-bone healing remains a significant concern in sports medicine, necessitating further exploration. Biomimetic electrospun nanomaterials present promising avenues for improving this critical healing process.Purpose:To investigate the biological efficacy of a novel aligned-to-random PLGA/Col1-PLGA/nHA bilayer electrospun nanofiber membrane in facilitating tendon-to-bone healing.Study Design:Controlled laboratory study.Methods:The bilayer membrane’s composition, combining PLGA/Col1 for tendon attachment and PLGA/nHA for bone integration, was examined using scanning electron microscopy, Fourier transform infrared spectroscopy, and mechanical testing. Positioned between the Achilles tendon and bone, its design aimed for harmonious integration with both types of tissue. In vitro, biocompatibility, cell adhesion, and proliferation of the biomaterial were evaluated using live/dead staining and the CCK-8 assay. Collagen secretion and mineralization were measured for 2 cell types. In vivo, tendon-to-bone insertion samples harvested from mice were analyzed: micro–computed tomography assessed bone formation; histological staining evaluated chondrogenesis, tendinogenesis, and the 4-layer structure of the insertion; and biomechanical testing measured insertion strength. Real-time polymerase chain reaction identified genes involved in tendon-to-bone healing, and transcriptome analysis elucidated the underlying cellular and molecular mechanisms.Results:The optimal composition was determined as 10% 3:1 for aligned PLGA/Col1 and 9% 5:1 for PLGA/nHA. Coculture showed minimal cell death, firm cell adherence, and steady proliferation, with PLGA/Col1 enhancing collagen secretion. In vivo, the material promoted bone and cartilage formation and improved tendon-to-bone interface strength. Transcriptome analysis indicated links to TNF and NF-κB pathways and to genes IL-1β, ADAM8, and EGR2.Conclusion:The novel aligned-to-random PLGA/Col1-PLGA/nHA bilayer nanofiber membrane outperformed other materials in both in vitro and in vivo evaluations, significantly enhancing tendon-to-bone healing. It notably improved cartilage and bone formation, tendon maturation, and biomechanical strength at the surgical interface. These effects may be associated with the TNF and NF-κB pathways and with the genes IL-1β, ADAM8, and EGR2.Clinical Relevance:This study introduces a biomimetic nanofiber membrane enhancing tendon-to-bone healing, which is crucial for sports medicine. Its efficacy in improving healing outcomes, including bone and cartilage formation and biomechanical strength, could significantly lower failure rates in surgical procedures such as rotator cuff repair and anterior cruciate ligament reconstruction. This advancement offers promising implications for patient recovery and the effectiveness of surgical interventions in tendon-to-bone injuries.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056263","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}