The American Journal of Sports Medicine最新文献

{"title":"Musculoskeletal Findings of the Major League Baseball Combine: A Description of the \"Normal\" Prospective Professional Baseball Player.","authors":"Brandon J Erickson,Christopher L Camp,John D'Angelo,Kevin Ma,Liz Hebert,Helen Casey,Derek Papp,Pamela Lund,Hollis Potter,Peter N Chalmers","doi":"10.1177/03635465251339773","DOIUrl":"https://doi.org/10.1177/03635465251339773","url":null,"abstract":"BACKGROUNDMajor League Baseball (MLB) recently instituted a combine for their prospective players.PURPOSE/HYPOTHESISThe purpose of this study was to report initial epidemiological findings for both physical examination and imaging findings for the MLB Combine. It was hypothesized that most players would have no significant abnormal physical examination findings, but most would have abnormal findings on their shoulder and elbow magnetic resonance imaging (MRI) scans.STUDY DESIGNDescriptive epidemiology study.METHODSAll players who attended the 2023 MLB Combine were included. History was taken and physical examination was performed by an MLB team physician, and MRI of the shoulder, elbow, cervical spine, and lumbar spine was performed on all players and read by 1 of 2 musculoskeletal radiologists. Physical examination notes and imaging reports were reviewed by the authors and recorded. Data were analyzed separately for pitchers and position players.RESULTSOverall, 219 players (112 pitchers [51%], 107 position players [49%]) were included. The mean age was 20.4 ± 1.5 years. The majority of players (95%) had no current pain or limitations; 54 players (25%) had a history of previous surgery. For pitchers, 18% underwent previous elbow surgery. With regard to MRI, >80% of pitchers had some abnormality within their ulnar collateral ligament (UCL), the majority of which was UCL scarring/remodeling. 70% of pitchers and 60% of position players had evidence of an olecranon osteophyte. Increased signal within the ulnar nerve was common in pitchers (40%) but rare in position players (4%). For the shoulder, 95% of pitchers and 93% of position players had some rotator cuff abnormality (often tendinosis within the supraspinatus and infraspinatus muscles). Also, 75% of pitchers had MRI evidence of a superior labrum anterior to posterior (SLAP) tear, while 24% of position players demonstrated this. Lumbar spine MRI showed that 47% of position players had a disk protrusion and 46% had a previous pars fracture.CONCLUSIONMost baseball players who participated in the 2023 MLB Combine had MRI evidence of rotator cuff abnormalities, and many showed evidence of an olecranon osteophyte. Eighteen percent of pitchers had a previous history of elbow surgery. The majority of pitchers had some abnormality within their UCL and evidence of a SLAP tear on MRI scans.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"32 1","pages":"3635465251339773"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087715","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 ACL Continuity on Magnetic Resonance Imaging at 5 Years After an Acute ACL Rupture and 11-Year Outcomes: A Secondary Analysis From the KANON Trial.","authors":"Stephanie R Filbay,Frank Roemer,Ewa M Roos,Aleksandra Turkiewicz,Richard Frobell,L Stefan Lohmander,Martin Englund","doi":"10.1177/03635465251339061","DOIUrl":"https://doi.org/10.1177/03635465251339061","url":null,"abstract":"BACKGROUNDEmerging evidence suggests that anterior cruciate ligament (ACL) ruptures can restore ACL fiber continuity. The relationship between ACL continuity on magnetic resonance imaging (MRI) (sign of ACL healing) and outcomes >5 years after an acute ACL rupture has not been investigated.PURPOSEThis study aimed to (1) describe clinical outcomes and radiographic osteoarthritis (ROA) at 11 years based on ACL continuity status at 5 years and (2) investigate the relationship between 5-year ACL continuity status and 11-year Knee Injury and Osteoarthritis Outcome Score (KOOS4) scores.STUDY DESIGNSecondary analysis of KANON randomized controlled trial; Level of evidence, 3.METHODSOverall, 105 of 121 (87%) active adults with acute ACL ruptures randomized to undergo initial exercise therapy and optional delayed ACL reconstruction (ACLR) or early ACLR and postoperative exercise therapy completed 11-year follow-up. MRI scans at 5 years were evaluated using the Anterior Cruciate Ligament OsteoArthritis Score (0-3), with grades 0 to 2 considered to represent \"ACL continuity.\" Patient-reported outcomes (KOOS4, 36-Item Short Form Health Survey, Tegner Activity Scale, self-reported new knee injuries), knee laxity, and radiographic findings (tibiofemoral and/or patellofemoral ROA) were assessed at 11 years. The relationship between 5-year ACL continuity and 11-year KOOS4 scores (0-100) was examined using linear regression, adjusted for age, sex, smoking, and baseline KOOS4 scores.RESULTSOf patients managed nonsurgically, 58% (n = 14) had ACL continuity and 42% (n = 10) had ACL discontinuity at 5 years. Analyses suggest that ACL continuity was associated with worse 11-year KOOS4 scores compared with delayed ACLR (adjusted mean difference, -20.2 [95% CI, -31.9 to -8.6]) and early ACLR (adjusted mean difference, -15.5 [95% CI, -26.4 to -4.7]) as well as similar or worse KOOS4 scores compared with ACL discontinuity (adjusted mean difference, -11.4 [95% CI, -26.5 to 3.6]). The proportion of patients with tibiofemoral ROA ranged from 14% (ACL continuity) to 23% (delayed ACLR), and the proportion of patients with patellofemoral ROA ranged from 11% (ACL discontinuity) to 41% (early ACLR).CONCLUSIONACL continuity on 5-year MRI may be associated with worse patient-reported outcomes at 11 years after an ACL injury compared with early or delayed ACLR.REGISTRATION84752559 (ISRCTN).","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"17 1","pages":"3635465251339061"},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144087714","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":"Single-Bundle Autografts Outperform Single-Bundle Achilles Allograft in Posterior Cruciate Ligament Reconstruction in Terms of Posterior Tibial Translation and Clinical Outcomes, but No Differences Exist Between Double-Bundle Grafts: A Network Meta-analysis.","authors":"Lika Dzidzishvili,Sachin Allahabadi,Felicitas Allende,Udit Dave,Trevor A Poulson,Ryan P Rutherford,Jared Rubin,Jorge Chahla","doi":"10.1177/03635465251327675","DOIUrl":"https://doi.org/10.1177/03635465251327675","url":null,"abstract":"BACKGROUNDThe optimal graft choice for posterior cruciate ligament reconstruction (PCLR) remains controversial.PURPOSETo evaluate and compare the biomechanical and clinical outcomes, as well as the complication and failure rates, associated with the use of Achilles allografts; hamstring tendon (HST), quadriceps tendon (QT), and bone-patellar tendon-bone (BTB) autografts; and hybrid (HY) grafts in PCLR.STUDY DESIGNNetwork meta-analysis; Level of evidence, 4.METHODSA comprehensive literature review was conducted to evaluate the use of various graft types in isolation for PCLR. Outcomes assessed included posterior tibial translation (PTT) at 90°, side-to-side PTT differences, Lysholm and Tegner scores, complication rates, and failure rates. Separate analyses compared single-bundle (SB) and double-bundle (DB) techniques within the Achilles, HST, and HY grafts, including different combinations for DB reconstruction.RESULTSA total of 53 studies involving 1861 patients met the inclusion criteria. Graft distribution was as follows: SB Achilles allograft (n = 328), DB Achilles allograft (n = 234), SB HST autograft (n = 646), DB HST autograft (n = 153), SB BTB autograft (n = 111), SB QT autograft (n = 122), and HY grafts (n = 267). Among SB grafts, SB HST exhibited the lowest PTT and highest Lysholm scores, whereas SB Achilles had the highest PTT and lowest clinical scores (P < .001). No significant differences were found between SB autografts (P = .08) or among the DB Achilles, HST, and HY grafts (P = .72). No significant difference in failure rates was observed between the DB graft groups (P = .16). Logistic regression demonstrated that relative to SB BTB, SB Achilles had the highest odds of failure (7.92), followed by SB HST (2.89) and SB QT (1.72). Combined multiligament reconstructions exhibited less PTT than isolated PCLR.CONCLUSIONSB autografts outperformed SB Achilles allograft in terms of PTT, and SB BTB had the lowest failure rates, while SB HST had the highest Lysholm scores. DB PCLR demonstrated superior biomechanical outcomes compared with SB reconstruction, regardless of the type of grafts used. All graft groups demonstrated a clinically significant improvement, exceeding the previously established minimal clinically important difference in the Lysholm and Tegner scores.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"55 1","pages":"3635465251327675"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065791","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":"Arthroscopic Superior Capsule Reconstruction With Combined Fascia Lata Autograft Augmented With Either LARS Ligament or Polypropylene Mesh Synthetic Scaffold Patch Graft: A Comparison of Techniques With a Minimum 2-Year Follow-up for the Treatment of Irreparable Rotator Cuff Tears.","authors":"Mingguang Bi,Zheng Sun,Liyong Wei,Wei Ding,Minzhe Zheng,Jin Li,Shaohua Ding","doi":"10.1177/03635465251336190","DOIUrl":"https://doi.org/10.1177/03635465251336190","url":null,"abstract":"BACKGROUNDArthroscopic superior capsule reconstruction (ASCR) with combined fascia lata autograft and synthetic scaffold patch graft has been reported to improve graft healing and treat irreparable rotator cuff tears (RCTs). Information about the surgical outcomes of using different synthetic scaffold materials is limited.PURPOSETo compare the clinical outcomes of the ASCR technique using LARS ligament with polyethylene terephthalate (PET) material versus polypropylene (PP) mesh scaffold augmentation to treat irreparable RCTs.STUDY DESIGNCase series; Level of evidence, 4.METHODSThe data of 92 patients with irreparable RCTs who underwent ASCR between 2016 and 2022 were retrospectively evaluated. Among them, 82 of 92 patients who met the inclusion and exclusion criteria were available for follow-up. Fascia lata autografts augmented with LARS ligament (LARS with PET; Corin Group) were used in 43 patients (LARS group), and fascia lata autografts with PP mesh augmentation were used in 39 patients (mesh group). Clinical outcomes were evaluated preoperatively and at a final follow-up by a visual analog scale for pain score and range of motion along with the American Shoulder and Elbow Surgeons (ASES) score, University of California, Los Angeles (UCLA) score, and Constant-Murley score (CMS). Radiological outcomes were assessed according to the rotator cuff arthropathy and acromiohumeral distance stages. Graft integrity and muscle fatty infiltration were evaluated by magnetic resonance imaging.RESULTSBoth groups showed significant improvement in clinical and radiological outcomes at the final follow-up. The LARS group showed significantly better outcomes in mean ASES score (92.6 ± 8.0 vs 77.8 ± 21.3; P < .001), UCLA score (31.5 ± 3.9 vs 24.4 ± 7.5; P < .001), and CMS (86.6 ± 7.2 vs 67.9 ± 18.9; P < .001) compared with the mesh group. The mean active elevation was significantly higher in the LARS group (161.4 ± 19.7) than in the mesh group (124.2 ± 31.3) (P < .001). The graft healing rate was also significantly higher in the LARS group (91%) than in the mesh group (72%) (P = .027), and acromiohumeral distance was significantly greater in the LARS group (7.0 ± 1.5 mm) than in the mesh group (6.3 ± 1.5 mm) at the final follow-up (P = .036). Subgroup analysis revealed that patients with intact grafts demonstrated a more substantial improvement in functional outcomes and active elevation.CONCLUSIONCompared with combining ASCR with a synthetic PP mesh scaffold graft, augmenting autogenous fascia lata ASCR with a synthetic LARS ligament scaffold graft achieved better functional outcomes and graft healing rate.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"42 1","pages":"3635465251336190"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065755","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":"Corrigendum to “A Randomized Trial of Autologous Chondrocyte Implantation Versus Alternative Forms of Surgical Cartilage Management in Patients With a Failed Primary Treatment for Chondral or Osteochondral Defects in the Knee”","authors":"","doi":"10.1177/03635465251344510","DOIUrl":"https://doi.org/10.1177/03635465251344510","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144067151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Aerobic Exercise With an Omega-3 Supplement on the Tendon Healing Process.","authors":"Meysam Irani,Reza Farzizadeh,Arash Abdolmaleki,Asadollah Asadi","doi":"10.1177/03635465251339025","DOIUrl":"https://doi.org/10.1177/03635465251339025","url":null,"abstract":"BACKGROUNDAn Achilles tendon rupture is a common orthopaedic injury in athletes and other people. Therefore, it is essential to investigate methods that may yield beneficial results for tendon healing by addressing the inflammatory and gene expression aspects of the healing process.PURPOSEThe objective of this study was to examine the effect of combining aerobic exercise and omega-3 supplementation on the process of Achilles tendon healing in male Wistar rats.STUDY DESIGNControlled laboratory study.METHODSFor the purpose of this experiment, 50 male Wistar rats were randomly assigned to 5 groups, with each group containing 10 rats. These groups were identified as a sham group (surgery without tendon damage), a negative control group (tendon damage), and 3 experimental groups: exercise group (tendon damage + aerobic exercise), omega-3 group (tendon damage + omega-3 supplement), and exercise + omega-3 group (tendon damage + aerobic exercise + omega-3 supplement). The Achilles tendon was cut and subsequently repaired through a surgical intervention. Beginning the day after the injury, the groups receiving omega-3 received a dose of 4.6 g/kg EPA [eicosapentaenoic acid] and 3.8 g/kg DHA [docosahexaenoic acid] orally each day, and those in the exercise groups ran on a treadmill 6 days a week. At 48 hours after completing the protocol, both tissue and blood samples were taken and immediately sent for biochemical (TNF-α, IL-1β, MDA, and SOD), gene expression (MMP-3, MMP-9, and SCX), histological (hematoxylin and eosin and Masson trichrome staining), and tensile analyses. Rats were also administered the Achilles functional index at various time points.RESULTSThe histological results revealed a marked improvement in the arrangement of cells and collagen in the extracellular matrix of the exercise + omega-3 group, displaying a notably uniform and condensed alignment of collagen fibers compared with the other groups, which exhibited a lack of organization. Biochemical results showed that TNF-α, IL-1β, and MDA levels were significantly reduced in the exercise + omega-3 group (P < .05). On the other hand, a significant increase in the Achilles functional index score was shown in the exercise + omega-3 group at all time points (P < .05). In the same group, real-time polymerase chain reaction results demonstrated that the expression of MMP-3 and SCX genes increased and that the expression of the MMP-9 gene decreased (P < .05).CONCLUSIONAerobic exercise with omega-3 supplementation was more beneficial for healing a surgically cut Achilles tendon in a rat model than aerobic exercise or omega-3 supplementation alone.CLINICAL RELEVANCEOur findings suggest that omega-3 supplementation combined with aerobic exercise after an Achilles tendon injury may be able to accelerate the process of Achilles tendon regeneration and healing.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"5 1","pages":"3635465251339025"},"PeriodicalIF":0.0,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144065792","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":"Long-term Outcomes of Partial Proximal Hamstring Avulsion Repair: Mean 10-Year Follow-up.","authors":"Benjamin B Rothrauff,Justin W Arner,David Spaeder,James P Bradley","doi":"10.1177/03635465251338078","DOIUrl":"https://doi.org/10.1177/03635465251338078","url":null,"abstract":"BACKGROUNDOperative repair of partial proximal hamstring avulsions has been shown to improve pain and function at short- and midterm follow-up. Long-term outcomes have not yet been reported. Furthermore, it is unknown whether greater tendon involvement (ie, tendon number) in partial tears affects clinical outcomes.HYPOTHESISHamstring function and patient satisfaction would remain stable over time at minimum 5-year and mean 10-year follow-up, with no differences in outcomes when comparing isolated and combined tendon involvement.STUDY DESIGNCase series; Level of evidence, 4.METHODSPatients who underwent surgical repair of partial proximal hamstring avulsions refractory to nonoperative measures were included. Patient-reported outcome measures were completed and included the Lower Extremity Functional Score (LEFS), Marx Activity Rating Scale, custom LEFS, custom Marx, and total proximal hamstring score. Patient satisfaction, return to play, current sport participation, subjective strength, and postoperative complications were also recorded. Long-term outcomes were compared with midterm outcomes. Outcomes of isolated (semimembranosus or conjoint tendon) versus combined (semimembranosus and conjoint tendon) tendon injuries were also compared.RESULTSA total of 53 patients (57 hamstrings) met the inclusion criteria at a mean follow-up of 10.1 years (range, 5.1-16.2 years). The mean Marx score was 8.0 (range, 0-16), the custom Marx score was 95% (range, 15%-100%), the LEFS and custom LEFS were 90% (range, 22%-100%) and 83% (range, 19%-100%), respectively, and total proximal hamstring score was 89% (range, 19%-100%). In total, 91% of patients were satisfied with surgery and 95% of patients returned to sport at a mean of 11 months after surgery. Current participation in sport was endorsed by 86% of patients. Hamstring strength >75% compared with the contralateral leg was reported in 88% of patients, with 58% of patients reporting equal strength (100%). No differences were found in comparing long-term (mean 10.7 years) to midterm (mean 6.2 years) follow-up with the exception of decreases in the Marx score from 12.0 to 8.5 and custom Marx score from 100% to 95%. One case (1.7%) required revision due to acute reinjury at 4 months postoperatively, with other complications including sitting pain, occasional posterior thigh cramping, and posterior thigh or foot paresthesia.CONCLUSIONSurgical repair of partial proximal hamstring avulsions refractory to nonoperative measures led to successful outcomes and high rates of return to activities with low complications at mean 10.1-year follow-up, with no differences in outcomes comparing isolated versus combined tendon involvement.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"129 1","pages":"3635465251338078"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982509","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 Allograft and Autograft Transplant for Femoral Head Defects: A Multicenter Study.","authors":"Sean C Clark,Christopher V Nagelli,Anthony DeNovio,Kostas J Economopoulos,Mario Hevesi,Rafael J Sierra,Aaron J Krych","doi":"10.1177/03635465251338062","DOIUrl":"https://doi.org/10.1177/03635465251338062","url":null,"abstract":"BACKGROUNDOsteochondral allograft transplant and autograft transplant for femoral head defects have emerged as promising treatments for concomitant cartilage and subchondral bone injuries in young patients.PURPOSETo evaluate the clinical and radiological outcomes of patients who underwent osteochondral allograft or autograft transplant for femoral head defects and identify any risk factors that may lead to conversion to total hip arthroplasty (THA).STUDY DESIGNCase series; Level of evidence, 4.METHODSAll patients who underwent osteochondral allograft or autograft transplant for femoral head defects across 2 institutions were analyzed. Clinical outcomes were assessed at final follow-up with the modified Harris Hip Score (mHHS), Hip Outcome Score-Activities of Daily Living (HOS-ADL), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS), and International Hip Outcome Tool (iHOT-12). Complications and reoperations were recorded. Patients were assessed radiographically preoperatively and at final follow-up for osteoarthritis using Tönnis grading.RESULTSA total of 27 patients were included in this study (19 osteochondral allograft transplant, 8 osteochondral autograft transplant). The mean follow-up for the allograft and autograft cohorts was 2.8 and 9.5 years, respectively. The mean defect size for patients who underwent allograft and autograft transplant was 2.8 × 2.1 cm and 1.6 × 1.0 cm, respectively. The mean mHHS, HOS-ADL, HOS-SSS, and iHOT-12 for the allograft cohort were 86.7, 92.8, 81.4, and 79.0, respectively, and for the autograft cohort were 87.6, 92.7, 83.1, and 82.0, respectively. No significant difference in outcomes was noted for patients who underwent femoral head allograft versus nonorthotopic femoral condyle allograft transplant. For the allograft cohort, 4 patients (21.1%) underwent conversion to THA at a mean of 1.9 years. Of the remaining 15 allograft patients, only 1 patient (6.7%) had radiographic osteoarthritis progression. None of the patients in the autograft cohort underwent conversion to THA.CONCLUSIONOsteochondral allograft and autograft transplant for femoral head defects demonstrated overall favorable clinical outcomes and rates of conversion to THA. Additionally, nonorthotopic femoral condyle allografts demonstrated similar outcomes to femoral head allografts. Both osteochondral allograft and autograft transplant should be considered for patients with focal femoral head defects.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"40 1","pages":"3635465251338062"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992015","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":"Optimizing the Control of Anteromedial Rotatory Knee Instability: A Biomechanical Validation of Different Anteromedial Reconstruction Techniques.","authors":"Florian Gellhaus,James R Robinson,Martin Lind,Adrian Deichsel,Matthias Klimek,Nina Backheuer,Michael J Raschke,Andreas Seekamp,Peter Behrendt,Christoph Kittl","doi":"10.1177/03635465251339820","DOIUrl":"https://doi.org/10.1177/03635465251339820","url":null,"abstract":"BACKGROUNDAnteromedial rotatory instability (AMRI) can result from combined injury to the anterior cruciate ligament (ACL) and medial collateral ligament (MCL) complex (superficial and deep [sMCL and dMCL]).HYPOTHESISAdding an oblique anteromedial (AM) limb to an sMCL reconstruction improves the control of AMRI.STUDY DESIGNControlled laboratory study.METHODSA 6 degrees of freedom robotic setup simulated clinical laxity in 9 unpaired knees under the following tests: 5-N·m external rotation (ER), 8-N·m valgus rotation (VR), and AM drawer (combined 89-N anterior tibial translation and 5-N·m ER). Knees were tested intact after cutting the sMCL and dMCL and after 5 different reconstructions: modified Lind, short sMCL, and sMCL with the addition of an AM graft limb with 3 different obliquities.RESULTSAfter short sMCL reconstruction, AM drawer and ER laxity were not significantly different from either the MCL-deficient state or the intact state. VR was reduced from the MCL-deficient state between 0° and 60° of flexion but not at 90°. For combined sMCL + AM reconstructions, VR was reduced as compared with the MCL-deficient state at all flexion angles. AM drawer laxity and ER laxity were also reduced, similar to the intact state, except at 30° where, for the more oblique T1 and T2 AM reconstructions, laxity was less than in the intact state. The modified Lind reconstruction reduced AM drawer and ER laxity from the MCL-deficient state to values similar to the intact state at all flexion angles. VR laxity was also reduced at all flexion angles, similar to the intact knee at 0° to 30°. However, it was not as good at restraining AM drawer and ER when compared with the sMCL reconstructions with more oblique AM limbs.CONCLUSIONAMRI appears to be better restrained by adding an oblique AM graft limb to an sMCL reconstruction, replicating the function of the sMCL and dMCL in a cadaveric model. The tibial attachment of the AM limb should be anterior to the sMCL, but its precise attachment on the tibia is less important. This offers surgical flexibility, which may be helpful in avoiding anterior cruciate ligament tibial tunnel coalition. The femoral attachment on the posterior medial epicondyle is critical to optimize graft isometry.CLINICAL RELEVANCEAdding an AM limb to a medial reconstruction optimizes the control of AMRI at time zero. The tibial attachment site is less critical, offering surgical flexibility.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"10 1","pages":"3635465251339820"},"PeriodicalIF":0.0,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143992014","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":"Elbow Flexion Excursion: Intra- and Inter-Throwing Arm Kinetic Evaluations in High School and Professional Baseball Pitchers.","authors":"Joseph E Manzi,Brittany Dowling,Jennifer Estrada,Suleiman Y Sudah,Jay Moran,Kathryn D McElheny,Brandon J Erickson,Joseph Ruzbarsky,Michael C Ciccotti,Michael G Ciccotti,Joshua S Dines","doi":"10.1177/03635465251338080","DOIUrl":"https://doi.org/10.1177/03635465251338080","url":null,"abstract":"BACKGROUNDElbow flexion at stagnant time points of the pitch has been associated with increased elbow varus torque (EVT) and elbow injury history.PURPOSETo determine how elbow flexion angle throughout the pitch (excursion) between individual pitchers and a cohort of pitchers influences throwing arm kinetics in high school (HS) and professional (PRO) pitchers.STUDY DESIGNDescriptive laboratory study.METHODSHS (n = 59) and PRO (n = 288) pitchers were instructed to throw 8 to 12 fastball pitches evaluated with 3-dimensional motion capture system (480 Hz). Linear regression models were developed to examine the association between elbow flexion excursion with ball velocity and throwing arm kinetics. An intrapitcher analysis utilizing a linear mixed model was also used, introducing pitchers as a random effect.RESULTSThe mean elbow flexion excursion was significantly greater for HS (70° ± 22°) compared with PRO (63° ± 21°) pitchers (P < .001), while the mean normalized EVT was significantly less for HS pitchers (3.9% ± 0.7% vs 4.8% ± 0.8% body weight [BW] × body height; P < .001). For every 1 SD increase in elbow excursion, ball velocity increased by 0.8 to 1.0 m/s (approximately 2 mph) for intra- and interanalyses (P max = 0.006; β = 0.31-0.39) for HS pitchers, while it increased by only 0.2 to 0.4 m/s (<1 mph) for PRO pitchers (P max = 0.016; β = 0.10-0.17). EVT increased by 0.34 to 0.40 SD for every 1 SD increase in elbow excursion for intra- and interanalyses for HS pitchers and by 0.13 to 0.22 SD for PRO pitchers. Elbow medial force increased by 1.9% to 2.3% BW for every 1 SD increase in elbow excursion for intra- and interanalyses of HS pitchers (β = 0.35-0.44) and by 1.4% to 1.7% BW increase for PRO pitchers (β = 0.23-0.27).CONCLUSIONPRO pitchers have decreased elbow flexion excursion compared with HS pitchers. This may be an advantageous mechanism by which to minimize throwing arm kinetics, including EVT and elbow medial force, supported by both intra- and interpitcher analyses. Ball velocity benefits with increased elbow excursion were marginal for both cohorts.CLINICAL RELEVANCEIn support of previous literature suggesting that increased elbow flexion at later portions of the pitch is associated with increased EVT and injury history, this study further substantiates that this may be deleterious kinematics to baseball pitchers.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"18 1","pages":"3635465251338080"},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143945096","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}