The American Journal of Sports Medicine最新文献

{"title":"Surgeon-Driven Variation in the Cost of Hip Arthroscopic Surgery for Labral Tears: A Time-Driven Activity-Based Costing Analysis","authors":"Michael C. Dean, Nathan J. Cherian, Ana Paula Beck da Silva Etges, Kieran S. Dowley, Kaveh A. Torabian, Zachary L. LaPorte, Scott D. Martin","doi":"10.1177/03635465251341463","DOIUrl":"https://doi.org/10.1177/03635465251341463","url":null,"abstract":"Background: Amid mounting pressure to reduce health care spending, strategies for identifying and eliminating unwarranted variation in costs have garnered significant attention. Previous studies have characterized intersurgeon variation in costs for common orthopaedic procedures, but such variation remains unexplored in the context of hip arthroscopic surgery. Purpose: To (1) characterize variation in the cost of hip arthroscopic surgery between surgeons using time-driven activity-based costing (TDABC) and (2) identify patient characteristics, intraoperative findings, and operative procedures underlying such intersurgeon variation in costs. Study Design: Cohort study; Level of evidence, 3. Methods: Employing TDABC, the authors determined the intraoperative cost of 890 outpatient hip arthroscopic surgery cases performed by 5 surgeons at 4 surgery centers from 2015 to 2022. All costs were calculated in United States dollars. Costs were normalized to protect the confidentiality of internal hospital cost data. Surgeon-specific mean costs were calculated with and without adjustment for patient characteristics, surgical personnel, operative factors, and surgery center. Finally, to elucidate the sources of surgeon-driven cost variation, the authors estimated the proportion of variation attributable to different cost subcategories, including labor, implant/allograft, and other supply costs. Results: The intraoperative cost per patient ranged from 38.2 to 212.8 normalized cost units (mean, 100.0 ± 26.5), with a 1.6-fold variation in the mean cost between the highest and lowest cost surgeons. Operating surgeon alone explained 53.4% of the observed variation in costs. Controlling for case-specific features significantly improved the explanatory power to 91.8% ( <jats:italic>P</jats:italic> &lt; .001), but the adjusted variation in costs between surgeons remained essentially unchanged (decreased by &lt;3%). Each of the 5 surgeons generated costs that deviated significantly from those predicted based on case-specific factors, with mean surgeon deviations ranging from −5.0% to 21.8% ( <jats:italic>P</jats:italic> &lt; .001 for all). Drivers of cost variation differed substantially between surgeons but generally stemmed from labor or other supply costs rather than implant/allograft costs. Conclusion: The cost of outpatient hip arthroscopic surgery varied widely between surgeons; the cause of this deviation was multifactorial and surgeon specific. While within-surgeon cost variation was effectively explained by patient and operative characteristics, most between-surgeon variability remained unexplained by observable factors. These insights may support individual surgeons in cost reduction efforts and, more importantly, may enable the alignment of reimbursement rates with costs.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"402 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228498","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":"Use of Adjunctive Platelet-Rich Plasma for Healing During Arthroscopic Release and Repair for Recalcitrant Lateral Epicondylitis: A Prospective, Double-Blind, Randomized Controlled Trial","authors":"Shangzhe Li, Guang Yang, Renjie Chen, Xu Li, Yi Lu","doi":"10.1177/03635465251341458","DOIUrl":"https://doi.org/10.1177/03635465251341458","url":null,"abstract":"Background: Whether the use of platelet-rich plasma (PRP) as an adjuvant to extensor carpi radialis brevis (ECRB) repair in recalcitrant lateral epicondylitis (RLE) promotes tendon healing and improves clinical outcomes remains unclear. Purpose: To evaluate the tendon healing and clinical outcomes of arthroscopic ECRB repair combined with PRP injection and compared with arthroscopic ECRB repair alone at early-term follow-up in patients with RLE. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A consecutive series of 80 patients with RLE were enrolled and randomized to the PRP group (arthroscopic ECRB repair followed by 1 PRP injection; n = 40) and the control group (arthroscopic ECRB repair alone; n = 40). Magnetic resonance imaging was performed to assess tendon healing at 3, 6, and 12 months. The visual analog scale (VAS) for pain, the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Patient-Rated Tennis Elbow Evaluation (PRTEE) scale, range of motion, and muscle strength were evaluated at preoperative and follow-up points. The time to return to work was also compared between the 2 groups. Patients and assessors were blinded to the intervention. Results: A total of 80 patients who met the inclusion criteria were enrolled between July 2020 and July 2023, and 73 patients completed follow-up. The PRP group contained 35 patients, 11 men and 24 women, with a mean age of 47.8 ± 8.8 years. The control group contained 38 patients, 13 men and 25 women, with a mean age of 44.5 ± 5.8 years. No significant differences were found in magnetic resonance imaging classification and functional scores between groups at preoperative and follow-up periods. VAS, MEPS, DASH, and PRTEE scores and muscle strength showed significant improvement at 12 months in both groups ( <jats:italic>P</jats:italic> &lt; .001). However, the PRP group showed a significant improvement in grip and wrist extension muscle strength at 6 weeks postoperatively ( <jats:italic>P</jats:italic> = .008 and <jats:italic>P</jats:italic> &lt; .001, respectively), whereas the control group did not ( <jats:italic>P</jats:italic> = .583 and .056). No complications were associated with PRP injection. Conclusion: PRP used as an adjuvant to ECRB repair did not show a difference in tendon healing and functional outcomes compared with ECRB repair alone for RLE at 12-month follow-up. However, PRP treatment showed a difference in muscle strength at 6-week follow-up compared with ECRB repair alone. Registration: NCT04556825 (ClinicalTrials.gov).","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"134 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188968","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":"One-Year Outcomes Predict 10-Year Outcomes in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement","authors":"Emily Berzolla, Katherine L. Esser, Griffith G. Gosnell, Nathaniel Mercer, Daniel J. Kaplan, Thomas Youm","doi":"10.1177/03635465251342119","DOIUrl":"https://doi.org/10.1177/03635465251342119","url":null,"abstract":"Background: While both short- and long-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) have been reported, the predictive relationship between the two has yet to be established. Purpose: To determine whether the degree of improvement in patient-reported outcomes observed at 1 year postoperatively predicts long-term outcomes at 10 years after primary hip arthroscopy for FAIS. Study Design: Cohort study; Level of evidence, 3 Methods: Patients who underwent primary hip arthroscopy for FAIS by a single surgeon at a single institution with 10-year follow-up were identified. Outcomes were assessed using the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) at baseline and 1, 2, 5, and 10 years postoperatively. Patients were classified as either high improvement (HI) or low improvement (LI) based on if they achieved the median 1-year change in mHHS from baseline. Chart review was performed to collect surgical details such as operative procedures, complications, and revision surgery. Outcomes were compared between groups over time using repeated-measures analysis of variance. Failure rates were determined using Kaplan-Meier and Mantel-Cox log-rank analyses. Results: A total of 129 patients with a mean age of 41.0 ± 13.5 years and mean body mass index of 25.0 ± 4.3 kg/m <jats:sup>2</jats:sup> were included. Both the HI and LI groups demonstrated significant improvement in mHHS and NAHS from baseline at all follow-up time points ( <jats:italic>P</jats:italic> &lt; .001). The HI group had significantly higher outcome scores at all time points up to 10 years after arthroscopy compared with the LI group ( <jats:italic>P</jats:italic> = .018). Additionally, a greater proportion of patients in the HI group achieved the Patient Acceptable Symptom State and minimal clinically important difference compared with the LI group at the 10-year follow-up ( <jats:italic>P</jats:italic> = .018). Rates of overall complications, revision arthroscopy, and conversion to total hip arthroscopy were significantly higher in the LI group ( <jats:italic>P</jats:italic> = .013, <jats:italic>P</jats:italic> = .009, and <jats:italic>P</jats:italic> = .004, respectively). The mean hip survival time after the index operation was shorter for the LI group (11.9 ± 0.5 years) than for the HI group (13.2 ± 0.2 years) ( <jats:italic>P</jats:italic> = .002). Conclusion: Patients who experienced greater improvement in the first year after hip arthroscopy had superior 10-year outcome scores, fewer complications, and lower rates of reoperation compared with those who experienced minimal improvement in the same period.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176522","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":"Pharmacologic Mobilization and Chemokine-Directed Recruitment of Mesenchymal Stromal Cells to the Surgically Repaired Rotator Cuff","authors":"Kevin C. Baker, Mackenzie Fleischer, Michael D. Newton, Lisa Galasso, Leonardo Cavinatto, Kevin M. Weisz, Samantha Hartner, Tristan Maerz, Lindsey Lammlin, Erin A. Baker, Answorth A. Allen, Asheesh Bedi","doi":"10.1177/03635465251341439","DOIUrl":"https://doi.org/10.1177/03635465251341439","url":null,"abstract":"Background: Mesenchymal stromal cell (MSC) techniques represent a promising method to enhance the surgical repair of rotator cuff tears. To eliminate the resource-intensive process of cell isolation and culture expansion, a method to recruit endogenous MSCs was investigated in an established rat model of rotator cuff repair. Hypothesis: MSCs can be pharmacologically mobilized from the peripheral blood and recruited to the operative rotator cuff to enhance tendon-bone healing. Study Design: Controlled laboratory study. Methods: The rat model of supraspinatus tendon detachment and acute surgical repair was used to compare the ability of 3 different chemokines (SDF-1β, MIP-3α, and MCP-1) to recruit optically labeled MSCs to the operative shoulder from circulation. Additional experimentation was undertaken to assess the effects of pharmacological MSC mobilization using a combination of a β <jats:sub>3</jats:sub> adrenoreceptor agonist (BRL37344) and a CXCR4 antagonist (AMD3100) on chemokine-directed recruitment to the shoulder. Finally, the effects of this therapeutic strategy on tendon-bone healing were assessed. Results: MCP-1–loaded hydrogels recruited the greatest number of MSCs from circulation. MCP-1–driven MSC recruitment was significantly enhanced by a regimen of subcutaneous BRL37344 and AMD3100. Postmortem micro–computed tomography imaging performed at a 6-week endpoint revealed that local MCP-1 delivery was associated with significant reductions in trabecular spacing and apparent mineral density, and a significant increase in trabecular number, while pharmacological MSC mobilization had no significant effects. MCP-1 delivery was associated with a lower tendon cross-sectional area and a significant increase in percent relaxation ( <jats:italic>P</jats:italic> = .006). Pharmacological MSC mobilization was associated with significantly increased peak stress ( <jats:italic>P</jats:italic> = .039), significantly increased elastic modulus ( <jats:italic>P</jats:italic> = .037), and a nonsignificant increase in both equilibrium stress ( <jats:italic>P</jats:italic> = .057) and ultimate stress ( <jats:italic>P</jats:italic> = .058). Local MCP-1 delivery was associated with significant improvements in tenocyte morphology. Conclusion: Endogenous MSCs can be pharmacologically mobilized into peripheral blood and recruited to the site of rotator cuff repair via local delivery of MCP-1. This therapeutic strategy was associated with improvements in the static and dynamic mechanical properties of the tendon-bone interface. Clinical Relevance: The healing of rotator cuff repairs represents an ongoing clinical challenge in orthopaedic surgery. This study demonstrates a method to use endogenous MSCs to enhance healing of the rotator cuff.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183783","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 Addition of Remplissage to Arthroscopic Bankart Repair and Effect on Recurrent Instability in Shoulders With Critical Humeral Bone Loss.","authors":"Fritz Steuer,Stephen Marcaccio,Ting Cong,Shaquille Charles,Rajiv P Reddy,Sophia McMahon,Albert Lin","doi":"10.1177/03635465251340082","DOIUrl":"https://doi.org/10.1177/03635465251340082","url":null,"abstract":"BACKGROUNDRecent literature has shown that inferior Hill-Sachs extension for on-track shoulders is predictive of recurrent instability after arthroscopic Bankart repair alone. Specifically, there is a high risk for recurrent instability when the lesion extends below the humeral equator on sagittal magnetic resonance imaging. This worrisome inferior extension has been termed \"critical humeral bone loss (CHBL).\" Remplissage has yet to be explored as a potential useful augmentation in patients with CHBL.HYPOTHESISThe addition of remplissage would decrease recurrence rates for Hill-Sachs lesions with inferior extension or CHBL compared with arthroscopic Bankart repair alone in patients with on-track Hill-Sachs lesions.STUDY DESIGNCase series; Level of evidence, 4Methods:Retrospective analysis was performed on the records of patients who underwent primary arthroscopic Bankart repair with or without the addition of remplissage from 2007 to 2021. Off-track shoulders, revision stabilization, glenoid bone loss (GBL) >20%, and those with follow-up <2 years or incomplete medical data were excluded. The primary outcome was recurrent instability, defined as either postoperative dislocation or subluxation. The Hill-Sachs position was measured relative to the humeral axis on sagittal magnetic resonance imaging as previously described. Univariate and multivariate logistic regression analyses were implemented to determine the protective effect of remplissage.RESULTSA total of 219 patients were included for analysis with a mean age of 21.1 years (range, 12.9-40.5 years) and mean follow-up of 7.0 years (range, 2-14.4 years); 44 patients (20%) underwent remplissage in addition to arthroscopic Bankart. In multivariate analysis, remplissage significantly reduced the risk of recurrent instability (OR, 0.06; P = .002) and CHBL was a significant predictor of recurrent instability (OR, 3.0; P = .029) while adjusting for age, multiple preoperative dislocations, contact athlete status, and percent GBL. When stratified by CHBL, remplissage remained protective (OR, 0.013; P = .007) against recurrent instability.CONCLUSIONThe addition of a remplissage for CHBL in patients with subcritical GBL and on-track Hill-Sachs lesions reduces the risk of recurrent instability in patients undergoing arthroscopic Bankart repair.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"23 1","pages":"3635465251340082"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144136674","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 Medial Closing Wedge Distal Femoral Osteotomy on Tibial Tuberosity-Trochlear Groove Distance in Patients With Genu Valgum According to Diagnosis (Lateral Osteoarthritis or Patellar Dislocation).","authors":"Hyung Jun Park,Hyung Suh Kim,Dong Hun Suh,Jae Gyoon Kim,Kyung-Wook Nha","doi":"10.1177/03635465251342093","DOIUrl":"https://doi.org/10.1177/03635465251342093","url":null,"abstract":"BACKGROUNDMedial closing wedge distal femoral osteotomy (CWDFO) is used to correct valgus deformities and manage lateral osteoarthritis (OA) and patellar dislocation (PD). However, its effect on the tibial tuberosity-trochlear groove (TT-TG) distance remains debated, with limited studies evaluating contributing factors.PURPOSETo determine whether TT-TG distance changes after CWDFO differ by the underlying diagnosis prompting the procedure and to identify preoperative factors influencing the extent of TT-TG distance changes.STUDY DESIGNCase series; Level of evidence, 4.METHODSThis study analyzed 43 knees of 34 patients with valgus deformity who underwent CWDFO, categorized into the lateral OA (n = 14) and PD (n = 29) groups. Radiographic parameters, including the TT-TG distance, were assessed preoperatively and at least 1 year postoperatively. Regression analyses were conducted to identify the factors influencing TT-TG distance changes. A predictive model with 95% confidence intervals determined the thresholds for deviations from the expected values.RESULTSThe TT-TG distance significantly decreased from 14.7 ± 5.1 to 11.5 ± 4.7 mm after CWDFO (P < .001). On average, the TT-TG distance decreased by 21.8% after CWDFO. Changes in the TT-TG distance did not significantly differ by diagnosis (lateral OA: -3.0 ± 2.3 mm; PD: -3.3 ± 4.5 mm; P = .771). The preoperative TT-TG distance and osteotomy type significantly influenced TT-TG distance changes. A higher preoperative TT-TG distance was correlated with a greater reduction (odds ratio, -0.375; P = .001), and biplanar osteotomy showed a more pronounced effect than uniplanar osteotomy (odds ratio, -3.083; P = .013). Patients with preoperative TT-TG distances >23.5 mm demonstrated greater variability in TT-TG distance changes in the predictive model.CONCLUSIONCWDFO effectively reduced the TT-TG distance regardless of the diagnosis. Preoperative TT-TG distance and osteotomy type were key determinants of this reduction. In cases with preoperative TT-TG distances >23.5 mm, TT-TG distance changes demonstrated greater variability, suggesting that radiographic outcomes may deviate from expected values. These findings highlight the need for careful postoperative assessments and consideration of additional procedures in select cases.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"67 1","pages":"3635465251342093"},"PeriodicalIF":0.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144145908","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":"Age-Dependent Variation in Cytokine Type and Concentration in Knee Synovial Fluid After Meniscal Injury.","authors":"Vishal Sundaram,Katherine L Esser,Luke Schwartz,Larry Chen,Nathaniel P Mercer,Bradley A Lezak,Heath P Gould,Daniel Kaplan,Eric J Strauss","doi":"10.1177/03635465251339490","DOIUrl":"https://doi.org/10.1177/03635465251339490","url":null,"abstract":"BACKGROUNDMeniscal injuries trigger a local inflammatory response mediated by intra-articular mediators. Proinflammatory cytokines and chemokines can lead to cartilage degradation and subchondral bone changes, contributing to posttraumatic osteoarthritis. The role that age plays in this inflammatory response is unclear.PURPOSETo investigate age-dependent variation in cytokine types and concentrations in knee synovial fluid after meniscal injury.STUDY DESIGNCohort study; Level of evidence, 3.METHODSPatients undergoing arthroscopic knee surgery for isolated meniscal injury were prospectively enrolled between July 2011 and April 2024. Synovial fluid was aspirated from the operative knee, and concentrations of 10 biomarkers were measured. Patients at least 9 years after surgery were invited to complete patient-reported outcome (PRO) surveys. Multivariable linear regression assessed pairwise relationships between age at surgery, log-normalized biomarker concentrations, and PROs, while adjusting for relevant covariates. Conditional process analysis was used to explore age-biomarker relationships, with symptom duration as a moderator and baseline Outerbridge grade as a mediator.RESULTSThe study included 160 patients for biomarker analysis with a mean ± SD age of 50.2 ± 12.5 years. Forty-seven patients who reached a minimum 9 years of follow-up completed PRO surveys. Mean follow-up was 10.2 ± 1.3 years. Regression analysis revealed positive associations between age and log-normalized concentration of preoperative IL-6. Moderator analysis found age to be positively associated with IL-6, VEG-F, and IL-1Ra in chronic meniscal injuries. Mediator analysis found an indirect positive relationship between age and MIP-B, VEGF, and MMP-3 and an indirect negative relationship between age and TIMP-1 and TIMP-2. Preoperative TIMP-1 was positively associated with 10-year Knee injury and Osteoarthritis Outcome Score-Physical Function Short Form score and elevated in treatment responders.CONCLUSIONAge at surgery was associated with higher concentrations of proinflammatory biomarkers and lower concentrations of anti-inflammatory biomarkers in the synovial fluid before meniscal surgery. Anti-inflammatory markers were associated with improved long-term PROs. These findings suggest an age-related intensification of the proinflammatory response and inhibition of the anti-inflammatory response that may contribute to long-term functional decline in older patients after meniscal surgery. There is potential for age-specific immunomodulatory therapeutic strategies to manage inflammation and mitigate the progression toward posttraumatic osteoarthritis in older patients.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"57 1","pages":"3635465251339490"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122220","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 Current and Former Anabolic-Androgenic Steroid Abuse on the Patellar Tendon.","authors":"Ann Damgaard,Grith Højfeldt,Olivia Thorsgaard,Yeliz Bulut,Frederik Hvid Linden,Peter Schjerling,Abigail L Mackey,Caroline Kistorp,S Peter Magnusson,Michael Kjær,Rene B Svensson","doi":"10.1177/03635465251340701","DOIUrl":"https://doi.org/10.1177/03635465251340701","url":null,"abstract":"BACKGROUNDAnabolic-androgenic steroids (AASs) are synthetic derivatives of testosterone that are abused by athletes to enhance their physical appearance and performance. AAS abusers have an increased risk of tendon ruptures compared with nonusers, and it has been proposed that AASs damage tendon tissue. Only a few human studies have investigated the effect of AASs on tendon tissue, and to our knowledge, there are no data on female sex.PURPOSE/HYPOTHESISThe purpose was to investigate the effect of current and former abuse of AASs on the patellar tendon (PT). It was hypothesized that AASs would not affect tendon tissue.STUDY DESIGNCross-sectional study; Level of evidence, 3.METHODSThis study included recreational athletes with current (female: n = 4; male: n = 18; total: n = 22) or former (female: n = 5; male: n = 7; total: n = 12) AAS abuse and nonusers (female: n = 5; male: n = 9; total: n = 14). The authors investigated the proportion of tendon injuries, PT cross-sectional area by magnetic resonance imaging, mechanical properties by ultrasound, gene expression levels of connective tissue proteins, and cell density by histological staining from tendon biopsy samples.RESULTSThe combined AAS group (both current and former abusers) reported a higher proportion of upper body tendon injuries compared with nonusers (79.4% vs 28.6%, respectively; P = .002). There was no difference in PT cross-sectional area (P = .918) or cell density (fascicular matrix: P = .413; interfascicular matrix: P = .982) between current AAS abusers, former AAS abusers, and nonusers. There was a greater expression of IGF-1 mRNA in current AAS abusers compared with nonusers (P = .043), but there were no group differences in other mRNA targets. Former AAS abusers had significantly higher tendon deformation (P = .030) and strain (P = .026) at common force compared with nonusers. There were no significant differences between male and female participants in the effect of AASs on tendon tissue.CONCLUSIONThese data show that the PT itself was not severely affected by AAS abuse.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"18 1","pages":"3635465251340701"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122218","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":"Sustained Clinical and Functional Outcomes After Primary Anterior Cruciate Ligament Repair: A Minimum 5-Year Follow-up Study.","authors":"Sebastian Conner-Rilk,Gabriel C Goodhart,Fidelius von Rehlingen-Prinz,Jelle P van der List,Kyle N Kunze,Fabian Tomanek,Robert J O'Brien,Gregory S DiFelice","doi":"10.1177/03635465251340087","DOIUrl":"https://doi.org/10.1177/03635465251340087","url":null,"abstract":"BACKGROUNDPrimary anterior cruciate ligament (ACL) repair (ACLPR) demonstrates promising short-term clinical outcomes in select patients; however, it remains poorly understood as to whether previously reported short-term outcomes are maintained at midterm follow-up.PURPOSETo determine whether short-term (2-year) outcomes are maintained at 5 years after ACLPR, evaluate age-stratified failure and reoperation rates, and identify preoperative risk factors for failure.STUDY DESIGNCase series; Level of evidence, 4.METHODSThis prospective study included the first 113 consecutive patients with proximal (type I/II) ACL tears who underwent ACLPR between 2008 and 2017 with a minimum 5-year follow-up. Failure rates were recorded based on instrumented laxity (&gt;3-mm anterior tibial translation side-to-side difference), pivot-shift grade (grade ≥2), and subjective instability. Patient Acceptable Symptom State thresholds were established based on collected patient-reported outcome measure scores. Logistic regression models were constructed to determine associations with independent risk factors for failure.RESULTSA total of 107 patients (median age, 35.5 years [interquartile range, 22.4-43.1 years]) were available at final follow-up (median, 6.0 years [interquartile range, 5.3-7.0 years]). No significant differences were reported in failure rates between 2- and 5-year follow-up: overall non-age-differentiated: 11.5% versus 15.9%, respectively (P = .34); ≤21 years: 37.0% versus 38.5%, respectively (P = .92); and &gt;21 years: 3.5% versus 8.6%, respectively (P = .16). No failures occurred in patients aged ≤21 years, while 4 failures occurred in patients aged &gt;21 years. Additionally, no significant differences were observed in overall non-age-differentiated reoperation rates (6.2% vs 7.5%, respectively; P = .71) and contralateral ACL injury rates (3.5% vs 4.7%, respectively; P = .67). Clinical outcomes and patient-reported outcome measure scores did not significantly differ between time points, and most patients met Patient Acceptable Symptom State thresholds (88% for International Knee Documentation Committee form, 91% for Lysholm scale, 93% for Forgotten Joint Score-12, and 84% for ACL-Return to Sport after Injury scale; all P &lt; .001). Preoperative risk factor analysis only revealed younger age as negatively impacting ipsilateral ACL failure, as the odds decreased by 12.5% for each year of increasing age (P = .002).CONCLUSIONSustained clinical and functional outcomes for ACLPR were observed between short-term and midterm follow-up, with failure rates of 11.5% and 15.9%, respectively. Although younger age was an important risk factor for ipsilateral ACL failure, with a high failure rate of 37.0% in patients aged ≤21 years at short-term follow-up, no additional failures were observed at midterm follow-up. In contrast, patients aged &gt;21 years experienced modest failure rates, increasing from 3.5% at short-term follow-up to 8.6% at midterm follow-up, with no significant","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"31 1","pages":"3635465251340087"},"PeriodicalIF":0.0,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144122386","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 Outcomes in Patients After Central Acetabular Decompression for Central Acetabular Stenosis: A Comparison With a Matched Control Group.","authors":"Benjamin D Kuhns,Ady H Kahana-Rojkind,Tyler R McCarroll,Yasemin E Kingham,Benjamin G Domb","doi":"10.1177/03635465251338064","DOIUrl":"https://doi.org/10.1177/03635465251338064","url":null,"abstract":"BACKGROUNDCentral acetabular stenosis (CAS), defined as an osteophyte within the acetabular fossa, is associated with higher rates of femoral head chondral damage and, when left untreated, inferior short-term outcomes after hip arthroscopic surgery. Central acetabular decompression (CAD) is an arthroscopic technique to resect the osteophyte and resurface the acetabular fossa to improve contact mechanics of the femoral head.PURPOSEThe primary aim was to provide the 5-year hip preservation rate and patient-reported outcomes in patients undergoing hip arthroscopic surgery for femoroacetabular impingement (FAI) concomitantly with CAD for CAS. A secondary aim was to compare outcomes in patients treated with CAD for CAS to a propensity score-matched control group of patients without CAS.STUDY DESIGNCohort study; Level of evidence, 3.METHODSA surgical registry with prospectively collected data was reviewed for patients who underwent CAD for CAS identified during primary hip arthroscopic surgery for FAI. The primary outcome for the study was conversion to arthroplasty within 5 years postoperatively. Secondary outcomes included revision arthroscopic surgery and patient-reported outcome scores. Multivariate regression analysis was performed to evaluate the risk factors for progression to arthroplasty. A propensity score-matched control group based on preoperative age, sex, body mass index, and Tönnis grade was formed of patients undergoing hip arthroscopic surgery for FAI without CAS to evaluate the differences in outcomes between the 2 groups.RESULTSThere were 155 of 189 eligible patients (82.0%) who had a minimum 5-year follow-up. Within this cohort, the mean age was 45.9 ± 10.8 years, with 90 female patients (58.1%). At the 5-year time point, the arthroplasty-free survivorship rate was 80.6% (125/155). For patients not requiring arthroplasty, significant postoperative improvements were durable (P &lt; .001), with high satisfaction. On multivariate analysis, severe acetabular chondral defects were most predictive of conversion to arthroplasty. The control group of patients with FAI without CAS demonstrated lower rates of chondral damage and higher rates of arthroplasty-free survivorship (P &lt; .01). For patients not requiring arthroplasty, postoperative outcome scores, rates of achieving clinically relevant outcome thresholds, and satisfaction with surgery were comparable between the CAD and control groups.CONCLUSIONPatients with CAS undergoing CAD during primary hip arthroscopic surgery for FAI had durable postoperative improvements and high satisfaction with surgery at a minimum 5-year follow-up. As expected, intraoperative chondral damage rates were significantly greater, and arthroplasty-free survivorship rates were lower, in the CAD group compared with the control group. Nonetheless, 81% of patients undergoing CAD who did not require arthroplasty had significant improvements that were comparable with the control group. We conclude that, with appropriate ","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"10 3 1","pages":"3635465251338064"},"PeriodicalIF":0.0,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144114151","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}