The American Journal of Sports Medicine最新文献

{"title":"The Effect of Platelet-Rich Plasma on Synovial Fibrosis and Cartilage Degeneration in Knee Osteoarthritis","authors":"Jiang-Yin Zhang, Xiao-Na Xiang, Qian Wang, Xiang-Xiu Wang, Ai-Jia Guan, Cheng-Qi He, Xi Yu, Hong-Chen He","doi":"10.1177/03635465251324942","DOIUrl":"https://doi.org/10.1177/03635465251324942","url":null,"abstract":"Background: Synovial fibrosis is a prevalent pathological feature of osteoarthritis and a primary contributor to joint pain and stiffness. Studies indicate that platelet-rich plasma (PRP) is rich in growth factors and cytokines, exhibiting anti-inflammatory, anti-apoptotic, chemotactic, and proliferative properties that can facilitate tissue repair. However, little is known about its effect on synovial fibrosis in knee osteoarthritis (KOA). Purpose: To determine the effect of PRP on synovial fibrosis and cartilage degeneration in KOA. Study Design: Controlled laboratory study. Method: Anterior cruciate ligament transection was performed to induce KOA in male Sprague-Dawley rats, and then rats were randomly assigned to 4 different groups: sham operation, KOA only, KOA treated with phosphate-buffered saline (PBS), and KOA treated with PRP. Synovial collagen fiber deposition was observed using Masson and Sirius red staining, and synovial inflammation was assessed using hematoxylin and eosin (H&E) staining. Moreover, immunohistochemistry was conducted to analyze the expression of synovial fibrosis–related factors including PLOD2, COL1A1, TIMP1, TGF-β1, and α-SMA. KOA severity and articular cartilage degradation were assessed using micro–computed tomography (micro-CT), safranin O–fast green staining, H&E staining, immunohistochemistry, and the Osteoarthritis Research Society International (OARSI) criteria. A quantitative analysis of growth factors (platelet-derived growth factor, IGF-1, epidermal growth factor, TGF-β1, fibroblast growth factor, and endothelial growth factor) in activated PRP was performed using enzyme-linked immunosorbent assay. Results: Micro-CT imaging and histological staining showed that the KOA model had been successfully established. Compared with the KOA and PBS groups, Masson staining and Sirius red staining results showed that PRP aggravated the degree of synovial fibrosis, which was consistent with the results of immunohistochemistry analysis. Immunohistochemistry analysis showed that PRP promoted the protein expression of PLOD2, COL1A1, TIMP1, TGF-β1, and α-SMA, indicating that the degree of fibrosis was aggravated. However, the PRP group showed lower OARSI and synovitis scores, as well as attenuated abnormal tibial subchondral bone remodeling, suggesting that PRP inhibited further cartilage degeneration and synovial inflammation and improved the subchondral bone microarchitecture. Conclusion: PRP may aggravate KOA synovial fibrosis, but it still has an inhibitory effect on cartilage degeneration and abnormal subchondral bone remodeling. Clinical Relevance: Synovial fibrosis is a significant pathological feature in KOA that is closely linked to clinical symptoms like joint pain and stiffness. This study offers insights into enhancing the effectiveness of PRP therapy for patients with KOA.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143666001","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 Smaller Sample Size Is Associated With Lower Rates of Reporting of Harms in Randomized Controlled Trials Cited in the AAOS Clinical Practice Guidelines for Anterior Cruciate Ligament Injuries","authors":"Ryan D. Stadler, Ryan Terrany, Suleiman Y. Sudah, Kathryn Whitelaw, Mariano E. Menendez, Charles J. Gatt, Ryan Plyler","doi":"10.1177/03635465251321100","DOIUrl":"https://doi.org/10.1177/03635465251321100","url":null,"abstract":"Background: Randomized controlled trials (RCTs) significantly influence clinical decision-making, necessitating comprehensive reporting of trial outcomes. However, previous studies have demonstrated that reporting of harms among RCTs is often inadequate. Purpose/Hypothesis: The purpose of this study was to evaluate reporting of harms among RCTs cited within the American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines (CPGs) for anterior cruciate ligament (ACL) injuries, with an emphasis on study characteristics associated with adherence. We hypothesized that &gt;50% of these trials would have incomplete adherence to the checklist items outlined in the Consolidated Standards of Reporting Trials (CONSORT) extension for harms and that a larger sample size would be associated with greater compliance. Study Design: Cross-sectional study. Methods: We identified RCTs cited in the AAOS CPGs for the management of ACL injuries and assessed compliance with the 18-item CONSORT extension for harms checklist. Descriptive statistics were used to summarize overall adherence to the checklist items, and linear regression analysis evaluated adherence over time. Results: Our analysis included 116 RCTs, the majority of which were single-center studies (81.0%). Most trials had sample sizes of 50-100 patients (45.7%) or 101-500 patients (37.9%). On average, trials adhered to 9.25 of 18 CONSORT items (51.4%), with the most compliant study meeting 15 of 18 items (83.3%) and the least compliant meeting 3 of 18 items (16.7%). Overall, 18 RCTs (15.5%) reported ≤33% of items, and 22 RCTs (19.0%) reported ≥67% of items. Studies with &gt;500 patients had significantly higher adherence compared with studies with &lt;50 patients ( <jats:italic>P</jats:italic> = .046). There was no significant difference in adherence based on the disclosure of funding sources ( <jats:italic>P</jats:italic> = .85) or the implementation of blinding ( <jats:italic>P</jats:italic> = .37). Interrupted time series regression analysis demonstrated no significant change in reporting both before ( <jats:italic>R</jats:italic> <jats:sup>2</jats:sup> = 0.017; <jats:italic>P</jats:italic> = .62) and after ( <jats:italic>R</jats:italic> <jats:sup>2</jats:sup> = 0.21; <jats:italic>P</jats:italic> = .16) the release of the checklist in 2004. Conclusion: On average, RCTs cited within the AAOS CPGs for the management of ACL injuries adhered to 51.4% of CONSORT checklist requirements, with considerable variability across studies. Improvements in reporting practices are warranted to support evidence-based treatment decisions.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143640735","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":"Mitochondria Isolated From Bone Mesenchymal Stem Cells Restrain Muscle Disuse Atrophy and Fatty Infiltration After Rotator Cuff Tears","authors":"Yulong Shi, Jun Qin, Enzhi Yin, Jian Xu, Yuanyuan Chen, Kai Tie, Liaobin Chen","doi":"10.1177/03635465251323001","DOIUrl":"https://doi.org/10.1177/03635465251323001","url":null,"abstract":"Background: Rotator cuff tears (RCTs) commonly lead to muscle atrophy, fibrosis, and fatty infiltration, complicating treatment. Purpose: To investigate the use of mitochondria isolated from bone mesenchymal stem cells (BMSC-Mito) for mitigating complications after RCT, focusing on muscle protection. Study Design: Controlled laboratory study. Methods: RCTs were induced by transecting the tendons of the supraspinatus and infraspinatus in Sprague-Dawley rats. In vivo, 90 rats were randomized into 3 groups: sham (no intervention), RCTs treated with BMSC-Mito, and RCTs treated with phosphate-buffered saline. After 6 weeks of intramuscular injections of BMSC-Mito or phosphate-buffered saline, supraspinatus muscles were harvested for analysis. Evaluations included wet muscle weight, muscle fiber cross-sectional area, fibrosis, fatty infiltration, slow-fast myofiber types and muscle biomechanics, capillary density, mitochondria respiratory chain complex activity, adenosine triphosphate (ATP) concentration, oxidative stress, and mitochondrial ultrastructure. In vitro experiments utilized primary rat skeletal muscle cells pretreated with rhodamine 6G to induce mitochondrial dysfunction, assessing the effects of BMSC-Mito on cell viability, mitochondrial membrane potential, and oxidative stress levels. Results: BMSC-Mito can be effectively transplanted into muscles and integrated into the local mitochondrial network. After RCT, the supraspinatus showed significant mass loss, reduced fiber cross-sectional area, fatty infiltration, and a shift from slow to fast myofiber types, which negatively affected muscle biomechanics. These changes were reversed by BMSC-Mito. BMSC-Mito also preserved vascularity (CD31 and α-SMA) impaired by RCT. Additionally, BMSC-Mito notably improved disuse-induced mitochondrial changes, leading to increased mitochondrial number and COX IV expression; furthermore, BMSC-Mito protected mitochondria morphology and enhanced cytosolic superoxide dismutase activity. This treatment also improved mitochondria respiratory chain complex activity and ATP concentration, reducing oxidative stress. In vitro, BMSC-Mito treatment effectively maintained the mitochondrial membrane potential of skeletal muscle cells, improved cell viability, and restored its mitochondrial function and ATP levels. Conclusion: These findings suggest that BMSC-Mito might play a role in preventing muscle atrophy and fatty infiltration after RCT through the protection of mitochondrial function and the promotion of angiogenesis. Clinical Relevance: BMSC-Mito present a promising therapeutic approach for addressing rotator cuff muscle degeneration.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631326","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":"Effect of Infratuberosity Anterior Closing Wedge Osteotomy for Posterior Tibial Slope Correction on Patellar Height in Patients Undergoing Revision ACL Reconstruction","authors":"Philipp Mayer, Philipp Schuster, Michael Schlumberger, Janina Leiprecht, Micha Immendoerfer, Joerg Richter, Grégoire Micicoi","doi":"10.1177/03635465251323623","DOIUrl":"https://doi.org/10.1177/03635465251323623","url":null,"abstract":"Background: An excessive posterior tibial slope (PTS) is a risk factor for anterior cruciate ligament (ACL) rupture or rerupture, and it can be managed by an anterior closing wedge high tibial osteotomy (ACW-HTO). The effect of slope‐changing osteotomies on patellar height is poorly described after infratuberosity ACW-HTO. Purpose: To assess the effect of ACW-HTO on patellar height using an infratuberosity approach. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent ACW-HTO between January 2019 and March 2024 were assessed for eligibility. Among 98 cases, 94 knees were analyzed with a complete radiographic assessment for the patellar height evaluation. Patellar height was measured on lateral radiographs according to the Caton-Deschamps index (CDI), Insall-Salvati index (ISI), and Blackburne-Peel index (BPI). The change in patellar height was assessed postoperatively, as were the rates of cases with a postoperative difference &lt;0.3, &lt;0.5, or &gt;0.5 points of the respective index. The change in patellar height category (baja, normal, or alta) after correction of the PTS was also evaluated. Results: In univariate analysis, no significant difference was found between pre- and postoperative radiographs for the patellar height indices (differences for ISI: +0.1 ± 0.1, <jats:italic>P</jats:italic> = .18; CDI: +0.1 ± 0.1, <jats:italic>P</jats:italic> = .41; BPI: +0.1 ± 0.2, <jats:italic>P</jats:italic> = .52). The patellar height variation was +0.5 points in only 1 case for CDI, and it was &lt;0.5 points in all other cases (98.9%). Five cases (5.3%) exhibited a postoperative change in patellar height category when measured by the ISI (3 moved up a category, 2 moved down a category; <jats:italic>P</jats:italic> = .65). Eight cases (8.5%) changed category according to the CDI (6 moved up a category, 2 moved down a category; <jats:italic>P</jats:italic> = .14). Twelve cases (12.7%) changed category according to the BPI (7 moved up a category, 5 moved down a category; <jats:italic>P</jats:italic> = .55). Conclusion: Infratuberosity ACW-HTO for tibial slope correction did not lead to significant changes in patellar height. However, slight variations in both directions were possible in a small portion of patients.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"89 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627437","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":"Posttraumatic Arthritis After Anterior Cruciate Ligament Injury: Machine Learning Comparison Between Surgery and Nonoperative Management","authors":"Yining Lu, Kevin Jurgensmeier, Abhinav Lamba, Linjun Yang, Mario Hevesi, Christopher L. Camp, Aaron J. Krych, Michael J. Stuart","doi":"10.1177/03635465251322803","DOIUrl":"https://doi.org/10.1177/03635465251322803","url":null,"abstract":"Background: Nonoperative and operative management techniques after anterior cruciate ligament (ACL) injury are both appropriate treatment options for selected patients. However, the subsequent development of posttraumatic knee osteoarthritis (PTOA) remains an area of active study. Purpose: To compare the risk of PTOA between patients treated without surgery and with ACL reconstruction (ACLR) after primary ACL disruption using a machine learning causal inference model. Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database identified patients undergoing ACLR between 1990 and 2016 with minimum 7.5-year follow-up. Variables collected include age, sex, body mass index, activity level, occupation, relevant comorbid diagnoses, radiographic findings, injury characteristics, and clinical course. Treatment effects of ACLR on the development of PTOA and progression to total knee arthroplasty (TKA) were analyzed with machine learning models (MLMs) in a causal inference estimator (targeted maximum likelihood estimation, TMLE), while controlling for confounders. Results: The study included 1194 patients with a minimum follow-up of 7.5 years, among whom 974 underwent primary reconstruction and 220 underwent nonoperative treatment. A total of 215 (22%) patients developed symptomatic PTOA in the ACLR group compared with 140 (64%) in the nonoperative treatment group ( <jats:italic>P</jats:italic> &lt; .001), whereas 25 (3%) patients underwent TKA in the ACLR group compared with 50 (23%) in the nonoperative treatment group ( <jats:italic>P</jats:italic> &lt; .001). Patients in the ACLR group had delayed TKA compared with patients in the nonoperative treatment group (193.4 vs 166.0 months, respectively; <jats:italic>P</jats:italic> = .02). TMLE evaluation revealed that reconstruction decreased the risk of PTOA by 11% (95% CI, 8%-13%; <jats:italic>P</jats:italic> &lt; .001) compared with nonoperative treatment but did not demonstrate a significant effect on the rate of progression to TKA. Survival analysis with random forest algorithm demonstrated significant delay to the onset of PTOA as well as time to progression of TKA in patients undergoing ACLR. Additional risk factors for the development of PTOA, irrespective of treatment, included older age at injury, greater body mass index, total number of arthroscopic knee surgeries, and residual laxity at follow-up. Conclusion: MLMs in a causal inference estimator found ACLR to exert a significant treatment effect in reducing the rate of development of PTOA by 11% compared with nonoperative treatment. ACLR also delayed the onset of PTOA and progression to TKA.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"183 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143618550","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":"Tackle Techniques and Characteristics Associated With a Concussion in Tackling Players in the National Football League","authors":"Christopher P. Sherwood, Fintan Grogan, Timothy L. McMurry, James R. Funk, Jeff R. Crandall, Allen Sills, Gregory Tierney","doi":"10.1177/03635465251321005","DOIUrl":"https://doi.org/10.1177/03635465251321005","url":null,"abstract":"Background:Concussions remain a major concern in football. A qualitative video review can provide contextual evidence supporting changes in rules and coaching techniques aimed at reducing the risk of players sustaining a concussion.Purpose:To identify tackling techniques and characteristics associated with concussions to the tackling player.Study Design:Case-control study; Level of evidence, 3.Methods:A qualitative review of 51 concussions sustained by tacklers in National Football League (NFL) games between the 2015 and 2019 seasons as well as 96 control tackles was performed using video from multiple perspectives. For each concussive case, 1 to 3 nonconcussive control tackles were matched based on player trajectory and closing speed as determined from on-field player tracking data from Next Gen Stats. Cases and controls were coded for 20 different tackle techniques and characteristics. The data were analyzed using conditional logistic regression models, and the results were expressed as odds ratios (ORs) with 95% confidence intervals (CIs) as well as adjusted and unadjusted P values.Results:Despite attempting to match cases and controls based on closing velocity, closing velocity was significantly associated with the concussion risk in every logistic regression model. Predictors that had the greatest effect on the increased risk of concussions were “tackler leading with helmet” (OR, 5.18 [95% CI, 1.87-14.33]; false discovery rate [FDR]–adjusted P = .0032) and “tackler primary loading” being the helmet as opposed to the shoulder (OR, 4.61 [95% CI, 1.41-15.05]; FDR-adjusted P = .0000). Important factors associated with a reduced concussion risk were the tackler’s “head placed on correct side” of the ball carrier (OR, 4.17 [95% CI, 1.58-11.01]; FDR-adjusted P = .0088) and “ball carrier primary loading,” with the torso having the lowest risk relative to all other body segments.Conclusion:The less a tackler involved his helmet in a tackle, the lower his risk of sustaining a concussion. This study supports teaching players to place their heads on the correct side of the ball carrier (neither into the ball carrier nor into the path of the ball carrier) when tackling to reduce their risk of a concussion, and players should target the torso of the ball carrier as their primary contact point.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143546145","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 in Athletes After Osteochondral Allograft Transplantation: A Systematic Review","authors":"Daniel C. Touhey, Nikko D. Beady, Sina Tartibi, Robert H. Brophy, Matthew J. Matava, Matthew V. Smith, Derrick M. Knapik","doi":"10.1177/03635465251315492","DOIUrl":"https://doi.org/10.1177/03635465251315492","url":null,"abstract":"Background:Management of symptomatic osteochondral defects of the knee remains challenging because of the limited inherent vascularity and healing potential of articular cartilage. Osteochondral allograft (OCA) transplantation has yielded satisfactory results in appropriate patients; however, the effect of OCA transplantation on athletes seeking to return to sport (RTS) remains largely unknown.Purpose:To systematically review the literature to better understand outcomes after OCA, focusing on RTS rate and timing, and the incidence of postoperative complications.Study Design:Systematic review; Level of evidence, 4.Methods:Studies included in the PubMed, EMBASE, and Cochrane Library databases from inception to August 2024 that reported on athletes participating at the recreational, high school, collegiate, and professional levels undergoing OCA transplantation for osteochondral defects in the knee were identified. Inclusion criteria included studies reporting on patients identified as athletes undergoing OCA transplantation with reported origin, lesion characteristics (size and location), RTS rate and timing, complications, reoperations, and patient-reported outcomes.Results:A total of 14 studies, consisting of 471 athletes undergoing OCA transplantation with a weighted mean follow-up of 51.1 months, were identified. The weighted mean patient age was 31.4 years (range, 15-69 years), with 61% of patients being male. Lesion origin was reported in 49% (230/471) of patients, with osteochondritis dissecans (OCD) reported in 44% (100/230). The medial femoral condyle was the most common defect location (44%; 68/153). Lesion size ranged from 1 to 13.94 cm<jats:sup>2</jats:sup>. Sixteen percent (75/471) of patients were classified as competitive athletes, with basketball (n = 21) being the most common sport. RTS was reported in 72% (338/468) of patients, with 84% (231/275) returning at an equal or higher level of play at a weighted mean of 11.1 months (range, 6-26 months) after OCA. Complications were reported in 12% (41/351) of patients, with graft failure accounting for 54% (22/41) of complications in 6% (22/351) of patients.Conclusion:For athletes undergoing OCA transplantation to the knee, OCD was the most commonly reported cause, with the medial femoral condyle most frequently affected. Successful RTS was reported in 72% of patients at a mean of 11.1 months, with graft failure representing the most common complication in 6%.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"47 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462523","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":"Anterior Cruciate Ligament Reconstruction Return to Sport Testing Passing Rates for Healthy People: A Systematic Review","authors":"Audria Wood, Mathew Hargreaves, John N. Manfredi, Maxwell Harrell, Elizabeth Marks Benson, Clay Rahaman, Dev Dayal, Eugene W. Brabston, Thomas Evely, Aaron Casp, Amit M. Momaya","doi":"10.1177/03635465241313194","DOIUrl":"https://doi.org/10.1177/03635465241313194","url":null,"abstract":"Background:Return to sport (RTS) is a common goal after anterior cruciate ligament (ACL) reconstruction (ACLR) but carries a relatively high risk of reinjury with up to 20% to 25% of athletes experiencing graft rupture or contralateral ACL tear. While there is increased emphasis on establishing safe RTS criteria for athletes to return to previous activity levels, studies show that even healthy individuals have difficulty passing RTS testing.Purpose:To synthesize data concerning whether healthy individuals can pass ACLR RTS rehabilitation tests.Study Design:Systematic review; Level of evidence, 4.Methods:Following the established PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, the authors conducted a systematic literature search in May 2023. Three databases were used in the search (PubMed, EMBASE, and SPORTDiscus) to retrieve all studies that conducted ACLR RTS rehabilitation tests on healthy individuals. Tests included were isometric strength, isokinetic strength, hop, and balance tests. The search was performed in duplicate, and a quality assessment of all studies was included.Results:A total of 1724 studies were retrieved, of which 32 were included, involving 1552 controls with no history of ACL injury. From the studies analyzed, 5.3% to 42.2% of healthy participants failed 6 different hop tests, 15.2% failed the Star Excursion Balance Test, 37% failed the isometric knee flexion test, 50% failed the isometric knee extension test, and 23.7% to 28.9% failed the drop vertical jump test. An asymmetry index ≥10% was found in 6 of the 18 isokinetic tests and 2 of the 14 isometric tests. Hop testing was the most common test in the included studies (56.3%), followed by balance testing (31.3%), isometric strength testing (31.3%), isokinetic strength testing (25%), and drop vertical jump (6.3%).Conclusion:Many healthy individuals fail ACLR RTS tests, with some having an inherent variation from side to side that is &gt;10%. The passing threshold for RTS testing should be a value that is practical yet helps reduce reinjury rates.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143462485","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":"Radiological Risk Factors for Osteochondral Fractures in Patients With First-Time and Recurrent Patellar Instability: Data From the JUPITER Cohort","authors":"James J. McGinley, Henry B. Ellis, Bennett Propp, Matthew W. Veerkamp, Philip L. Wilson, Dennis E. Kramer, Benton E. Heyworth, Sabrina Strickland, Eric Wall, Jason Koh, Yi-Meng Yen, Matthew Halsey, Robert Magnussen, David Roberts, Jack Farr, Daniel Green, Peter Fabricant, Jacqueline Brady, Marc Tompkins, Lauren H. Redler, Adam B. Yanke, Seth L. Sherman, Shital N. Parikh, Beth E. Shubin Stein","doi":"10.1177/03635465251315170","DOIUrl":"https://doi.org/10.1177/03635465251315170","url":null,"abstract":"Background:Radiological risk factors for an osteochondral fracture (OCF) associated with patellar instability are rarely studied, particularly in patients with recurrent instability.Purpose:To identify specific radiological characteristics that relate to the increased prevalence of OCFs associated with patellar instability.Study Design:Case-control study; Level of evidence, 3.Methods:Patient data (n = 730) from the Justifying Patellar Instability Treatment by Early Results (JUPITER) multicenter study were reviewed for radiological findings. Trochlear crossing sign, Caton-Deschamps index (CDI), tibial tubercle–trochlear groove (TT-TG) distance, patellar tilt, trochlear depth, trochlear bump, sulcus angle, and patellar subluxation were measured on radiography or magnetic resonance imaging and classified into 2 categories based on pathological thresholds for general patellar instability. Patients were grouped according to the presence or absence of an OCF and analyzed with the Mann-Whitney test, chi-square test, and multivariate regression.Results:A high CDI was associated with a 0.43 decreased odds of an OCF, while a high TT-TG distance was a risk factor for an OCF, with a 2.17 times increased odds. Although a first-time dislocation increased the odds of an OCF by 4.72 times, recurrent instability was found to have the same predictive relationship of CDI and TT-TG distance with fracture incidence. A lower CDI, a shallower trochlear depth, a smaller trochlear bump, and the presence of a patellar subluxation were more common in patients with OCFs. A lower CDI, positive trochlear crossing sign, and shallower trochlear depth were more common in the subset of patients with recurrent instability and associated OCFs.Conclusion:Patella alta was protective of OCFs in patients with first-time and recurrent instability, while a lateralized tibial tubercle was a risk factor. These radiological characteristics should guide health care professionals on the risk of future OCFs during treatment planning after a patellar instability event.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143401234","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":"Establishing Benchmarks for Case Minimum Requirements During Accreditation Council for Graduate Medical Education–Accredited Orthopaedic Sports Medicine Fellowship Training","authors":"Jason Silvestre, Harris S. Slone, John D. Kelly","doi":"10.1177/03635465251317502","DOIUrl":"https://doi.org/10.1177/03635465251317502","url":null,"abstract":"Background:Accrediting bodies and professional societies for surgical education are increasingly recognizing the need for case minimum requirements to enhance standardized training.Purpose:To determine case volume benchmarks for operative training during Accreditation Council for Graduate Medical Education (ACGME)–accredited orthopaedic sports medicine fellowships in the United States.Study Design:Cross-sectional analysis; Level of evidence, 3.Methods:Case volume percentiles were calculated across ACGME-defined case categories and temporal changes analyzed with linear regression. Variability was defined as the fold difference between the 90th and 10th percentiles by case volume. Sensitivity analyses were performed to identify potential targets for case minimum requirements.Results:Case logs from 1281 orthopaedic sports medicine fellows were analyzed. There was an increase in the mean reported case volume over the study period (from 323.3 ± 125.0 to 375.6 ± 144.0; P = .049). Pediatric patients accounted for a minority of cases (annual range, 6%-7%). The bottom 10th and 30th percentiles of fellows reported a total of 179 and 239 cases, respectively. Most cases were reported in the rotator cuff (29%), meniscus (26%), and knee instability (21%) categories. Variability in the reported case volume was greatest in hip arthroscopic surgery (37.0), patellofemoral instability (15.5), the foot and ankle (12.9), and elbow instability (10.7). Variability decreased for knee instability ( P = .006) and total ( P = .028) cases over the study period but increased for foot and ankle ( P = .002), knee multiligament repair/reconstruction ( P = .008), and knee osteotomy ( P = .025) cases.Conclusion:Surgical benchmarks can assist future trainees and faculty identify areas to improve the operative experience and reduce variability during fellowship training. The operative experience of recent fellows suggests a potential case minimum target between 179 and 239 cases to achieve the 10th and 30th percentiles, respectively. However, further research is needed to establish evidence-based case minimum requirements for ACGME-accredited orthopaedic sports medicine fellowship training.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143385468","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}