The American Journal of Sports Medicine最新文献

{"title":"Effectiveness of Single Leg Isometric Bridge and Nordic Hamstring Exercise Testing for Prediction of Hamstring Injury Risk in Professional Baseball Players.","authors":"Austin R Driggers,Andrew C Fry,Kristen C Chochrane-Snyman,John P Wagle,Jeffrey M McBride","doi":"10.1177/03635465251371789","DOIUrl":"https://doi.org/10.1177/03635465251371789","url":null,"abstract":"BACKGROUNDSeveral investigations have examined various methods of measuring hamstring strength to determine the effectiveness of these tests in predicting hamstring injury (HSI) risk in athletes. However, no previous studies have examined the effectiveness of hamstring strength and interlimb asymmetry utilizing a newly developed modified single leg isometric bridge test (SLIBT) versus a standard Nordic hamstring exercise (NHE) to predict HSI in professional baseball players.PURPOSETo determine whether preseason hamstring strength and interlimb asymmetry measured using a modified SLBIT versus an NHE are associated with future HSI in professional baseball players, as well as if measures of hamstring strength and interlimb asymmetry using the SLIBT are correlated to values from the NHE.STUDY DESIGNCohort study; Level of evidence, 3.METHODSProfessional baseball players (n = 465) from 8 teams affiliated with a single Major League Baseball organization completed a preseason hamstring strength assessment as part of routine athlete monitoring before the 2019, 2021, and 2022 seasons. A total of 38 new HSI events were recorded among 36 players over 751 player-seasons included in the analysis.RESULTSLower hamstring strength levels in subsequent HSI limbs were observed compared with the 2-limb mean hamstring strength of healthy players for the SLIBT (365.1 ± 58.4 vs 390.9 ± 59.6 N; P = .014) and NHE (403.5 ± 90.4 vs 440.5 ± 76.0 N; P = .017). Players with NHE hamstring strength <377 N exhibited a significantly higher risk of HSI (RR, 2.49; 95% CI, 1.18-5.27; P = .027). Logistic regression indicated an inverse relationship between hamstring strength and HSI risk, with each 10-N increase in the SLIBT and NHE corresponding to a 7.4% and 6.2% risk reduction, respectively (with no interaction effects between tests). Interlimb asymmetry measures from both the SBILT and NHE were not indicative of subsequent HSI. Moderate significant correlations (r = 0.33-0.39) were observed for absolute and relative hamstring strength measured utilizing the SLIBT versus the NHE. No significant correlations were found between measures of interlimb asymmetry when assessed by the SBILT versus the NHE.CONCLUSIONThe current investigation indicates that low levels of hamstring strength measured in both the SLIBT and NHE are associated with an increased risk of future HSI. Thus, these measures could be utilized to identify at-risk players and to develop mitigation strategies to limit the rate of HSI and maximize time at play.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"56 1","pages":"3635465251371789"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083394","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":"Evaluation of Posteriorization Following Pure Distalization Tibial Tubercle Osteotomy.","authors":"Nathan H Varady,Nicolas Pascual-Leone,Ava G Neijna,Andreas H Gomoll,Sabrina M Strickland","doi":"10.1177/03635465251371325","DOIUrl":"https://doi.org/10.1177/03635465251371325","url":null,"abstract":"BACKGROUNDThere are theoretical concerns that tibial tubercle osteotomy with pure distalization (TTO-d) may posteriorize the tibial tubercle (and thus increase patellofemoral contact pressure); however, whether TTO-d actually results in posteriorization of the tibial tubercle has never been empirically investigated.PURPOSETo assess the relative amount of anteriorization or posteriorization of the tibial tubercle that occurs after TTO-d.STUDY DESIGNCross-sectional study; Level of evidence, 3.METHODSConsecutive patients, with preoperative and postoperative lateral knee radiographs, who underwent TTO-d between 2015 and 2023 by 2 surgeons were identified. Measurements of posteriorization were performed by 2 physician raters using a magnetic resonance imaging-validated technique. Comparisons were made with the Student t test, and agreement was assessed with the intraclass correlation coefficient.RESULTSA total of 38 patients (86.8% women) were included, with a mean age of 29.3 ± 9.7 years. The mean Caton-Deschamps index significantly decreased from 1.32 ± 0.13 preoperatively to 1.02 ± 0.10 postoperatively (P < .001). There was no significant change in sagittal alignment (ie, anteriorization/posteriorization) from preoperatively (21.6 mm) to postoperatively (22.4 mm) (P = .14). The mean amount of anteriorization/posteriorization was 0.82 ± 1.40 mm anterior (range, 1 mm posterior to 4 mm anterior). There were 31 patients (81.6%) who experienced no change or slight anteriorization; no patient experienced >1 mm of posteriorization. Interrater reliability was excellent (intraclass correlation coefficient = 0.93).CONCLUSIONContemporary TTO-d resulted in the successful correction of patella alta without appreciable posteriorization of the tibial tubercle. These results support the positive clinical outcomes seen with TTO-d, including for chondral lesions, and may reduce concerns about inadvertent posteriorization when performing this procedure. While overdistalization with the formation of patella baja can increase patellofemoral contact pressure beyond native ranges, the current results suggest that restoration of a normal patellar height is unlikely to do so.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"30 1","pages":"3635465251371325"},"PeriodicalIF":0.0,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083438","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":"Articular Cartilage Injuries in Pediatric and Adolescent Patients Undergoing Medial Meniscal Ramp Lesion Repair During Primary Anterior Cruciate Ligament Reconstruction: A Multicenter Study.","authors":"Jay Moran,Jason Z Amaral,Christina R Allen,Elizabeth Gardner,Andrew E Jimenez,Michael J Medvecky,Timothy E Hewett,Nikhil N Verma,Jorge Chahla,Robert F LaPrade,Peter D Fabricant,Scott D McKay","doi":"10.1177/03635465251366440","DOIUrl":"https://doi.org/10.1177/03635465251366440","url":null,"abstract":"BACKGROUNDIn young patients with anterior cruciate ligament (ACL) tears, the presence of a meniscal tear may be associated with articular cartilage damage. However, little is known about this potential association of ACL tears with medial meniscal ramp lesions (MMRLs) in pediatric and adolescent patients.PURPOSETo investigate the characteristics and risk factors associated with the presence of an articular cartilage injury in a large multicenter cohort of pediatric and adolescent patients undergoing MMRL repair during primary ACL reconstruction (ACLR).STUDY DESIGNRetrospective cohort study; Level of evidence, 3.METHODSPatients aged &lt;18 years who underwent MMRL repair during primary ACLR at 5 institutions between 2013 and 2025 were included. All MMRLs were diagnosed arthroscopically and were defined as partial or complete peripheral vertical/longitudinal tears of the posterior horn of the medial meniscus at or within 3 mm of the meniscocapsular junction in the red-red zone. The presence, location, and severity of arthroscopically identified articular cartilage injuries were categorized using the International Cartilage Repair Society classification. Patients with and without an articular cartilage injury were compared, and risk factors associated with its presence were identified using a multivariable logistic regression model.RESULTSA total of 189 pediatric and adolescent patients underwent MMRL repair during primary ACLR at a mean age of 16.1 ± 1.4 years (range, 12.0-17.9 years). An articular cartilage injury was identified arthroscopically in 101 patients (53%). Among these, 62% were localized to the medial femoral condyle (MFC), with most injuries classified as grade 1 (57%), followed by grade 2 (30%) and grade 3 (13%). Medial tibiofemoral (MFC and/or medial tibial plateau) articular cartilage injuries were significantly more frequent (62% vs 46%, respectively; P = .043) and of a higher grade (P = .046) than lateral tibiofemoral (lateral femoral condyle and/or lateral tibial plateau) articular cartilage injuries. Obesity (odds ratio [OR], 3.0 [95% CI, 1.3-7.2]; P = .011), a lateral posterior tibial slope ≥12° (OR, 2.9 [95% CI, 1.4-5.8]; P = .003), delayed ACLR and MMRL repair for ≥3 months (OR, 2.4 [95% CI, 1.2-4.8]; P = .016), and age ≥16 years (OR, 2.1 [95% CI, 1.1-3.9]; P = .029) were significant risk factors for the presence of an articular cartilage injury at the time of surgery.CONCLUSIONIn this multicenter study, an articular cartilage injury was arthroscopically identified in 53% of pediatric and adolescent patients undergoing MMRL repair during primary ACLR. The medial tibiofemoral compartment was most frequently affected, with the majority of articular cartilage injuries classified as grade 1 or 2 on the MFC. Obesity, a lateral posterior tibial slope ≥12°, delayed ACLR and MMRL repair for ≥3 months, and age ≥16 years were associated with a 2- to 3-fold increase in the odds of having an articular cartilage injury at the time of surger","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"87 1","pages":"3635465251366440"},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145058992","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":"Correlation Between a 3-Step MRI Assessment and Surgical Findings in Classifying Pyramidalis-Anterior Pubic Ligament-Adductor Longus Complex (PLAC) Injuries in 161 Athletes: Validation of Application of the PLAC Classification System.","authors":"Rowena Johnson,Carlton Cooke,Gareth Jones,Jaime Isern-Kebschull,Ernest Schilders","doi":"10.1177/03635465251368389","DOIUrl":"https://doi.org/10.1177/03635465251368389","url":null,"abstract":"BACKGROUNDAdductor avulsions are complex injuries often involving multiple structures, as indicated by several magnetic resonance imaging (MRI) studies. However, no studies have compared MRI assessments using a dedicated groin protocol with surgical findings.HYPOTHESISIt was hypothesized that MRI assessments using a dedicated groin protocol would correlate closely with surgical findings, applicable to both experienced and novice users of the pyramidalis-anterior pubic ligament-adductor longus complex (PLAC) classification.STUDY DESIGNCase series; Level of evidence, 4.METHODSThis retrospective study analyzed 161 athletes who underwent MRI using a dedicated groin protocol, followed by surgical repair of the PLAC. Two musculoskeletal radiologists-1 experienced (rater A) and 1 inexperienced (rater B) in the use of the PLAC classification-independently assessed the MRI scans twice, 6 weeks apart, using a structured 3-step protocol to evaluate (1) adductor longus fibrocartilage (intact, partially avulsed, or completely avulsed), (2) pyramidalis separation from adductor longus (intact, partially separated, or completely separated), and (3) pectineus status (intact or partially avulsed). Agreement between MRI and surgical findings was evaluated using a PLAC injury classification (types 1-5), with intra- and interobserver reliability measured by Cohen kappa.RESULTSAmong the 161 athletes, 93 played soccer, of whom 69 were professional. All athletes exhibited complete fibrocartilage avulsion, with 83 athletes (52%) showing adductor longus separation from the pyramidalis. Isolated adductor longus avulsions (PLAC type 1) were observed in only 36 athletes (22%). The interobserver kappa score between MRI assessments and surgical findings was 0.942 for rater A and 0.858 for rater B. Intraobserver ratings were 0.967 for rater A and 0.875 for rater B. Both inter- and intraobserver scores indicated almost perfect agreement. In combination, these statistical findings support the validity, reliability, and applicability of the MRI protocol using the PLAC classification system for 2 users with varying levels of experience.CONCLUSIONAdductor avulsions were rarely isolated, typically involving multiple muscles. The PLAC classification effectively captured the complexity of these injuries. When used in conjunction with a dedicated MRI protocol, the PLAC classification demonstrated almost perfect agreement and concordance with surgical findings. Together, the PLAC classification and MRI protocol offered a more comprehensive and accurate representation of patients' clinical and radiological features and provided valuable guidance for surgical planning.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"28 1","pages":"3635465251368389"},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059082","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":"Comparison of Clinical Outcomes, Revision Rates, and Sports Participation Between Hamstring and Quadriceps Tendon Autografts for Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients: A Retrospective Cohort Study.","authors":"Amit Meena,Luca Farinelli,Darren de Sa,Riccardo D'Ambrosi,Christian Hoser,Elisabeth Abermann,Mirco Herbort,Christian Fink","doi":"10.1177/03635465251370616","DOIUrl":"https://doi.org/10.1177/03635465251370616","url":null,"abstract":"BACKGROUNDIn recent years, anterior cruciate ligament (ACL) injuries in children and adolescents (age ≤18 years) have been increasing, and the quadriceps tendon (QT) autograft has been gaining popularity for ACL reconstruction. However, there is no consensus regarding the graft choice for ACL reconstruction in these young patients. There has been a paucity of literature comparing the functional outcomes of hamstring tendon (HT) and QT autografts for ACL reconstruction in patients aged ≤18 years.PURPOSE/HYPOTHESISThe purpose of this study was to compare the outcomes of HT and QT autografts for ACL reconstruction in pediatric and adolescent patients (age ≤18 years) in terms of patient-reported outcome measure (PROM) scores, knee stability, graft failure rates, and sports participation after ACL reconstruction. The hypothesis was that the QT autograft would result in better functional outcomes with a high rate of return to sporting activity and a low rate of graft failure after ACL reconstruction compared with the HT autograft in this population.STUDY DESIGNRetrospective cohort study; Level of evidence, 3.METHODSFrom 2010 to 2022, there were 2417 ACL reconstruction procedures performed at our institution. The inclusion criteria were primary ACL reconstruction using an HT or QT autograft and age ≤18 years. The exclusion criteria were revision ACL reconstruction; utilization of a graft type other than HT and QT autografts; and concomitant posterior cruciate ligament injuries, contralateral knee injuries, and conditions that might interfere with a standard postoperative rehabilitation protocol. A minimally invasive technique was used for QT autograft harvesting. The size of the QT graft ranged from 8 to 9 mm with specific instrumentation. Similarly, the size of the HT graft ranged from 8 to 9 mm. Patients were evaluated preoperatively and at 2-year follow-up for the Lysholm knee score, Tegner activity level, and visual analog scale (VAS) for pain; knee stability (Lachman and pivot-shift tests); graft failure; and sports participation. The Lachman test and pivot-shift test were performed preoperatively under anesthesia and postoperatively at 2-year follow-up.RESULTSThe number of patients in the HT and QT groups was 77 and 80, respectively. The 2 groups did not differ significantly in terms of age, sex, and concomitant injuries. No significant difference was found in preinjury PROM scores (Lysholm, Tegner, and VAS) and knee stability between the 2 groups (P &gt; .05). Similarly, no significant difference was observed at 2-year follow-up between the 2 groups for PROM scores and knee stability (P &gt; .05). The Lysholm, Tegner, and VAS scores improved to preinjury values in both the groups, and no significant difference was found in Lysholm, Tegner, and VAS scores between preinjury and 2-year follow-up (P &gt; .05). At 2-year follow-up, both the groups achieved sports participation at the preinjury level (P &gt; .05). Graft failure occurred in 11 (14%) and 8 (10%) pat","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"19 1","pages":"3635465251370616"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035767","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":"GLP-1RA Reduces Supraspinatus Fatty Infiltration and Promotes Functional Recovery in a Rat Model of Rotator Cuff Repair.","authors":"Jong Pil Yoon,Sung-Jin Park,Dong-Hyun Kim,Yoon Seong Choi,Hyun Joo Lee,Jun-Young Kim,Chul-Hyun Cho,Seok Won Chung","doi":"10.1177/03635465251369517","DOIUrl":"https://doi.org/10.1177/03635465251369517","url":null,"abstract":"BACKGROUNDDespite rotator cuff (RC) tendon repair surgery, fatty infiltration (FI) often progresses due to muscle unloading.PURPOSETo evaluate the effects of liraglutide on enhancing muscle quality and function in a rat model of RC tendon repair.STUDY DESIGNControlled laboratory study.METHODSA total of 40 male Sprague-Dawley rats were randomly divided into the control and liraglutide groups and subjected to RC tendon repair surgery. After surgery, rats in the liraglutide group were administered liraglutide (250 µg/kg) for 12 weeks and then sacrificed. Oil Red O staining was used to evaluate the FI of the supraspinatus muscle. The expression of biomarkers related to muscle atrophy, FI, and fat browning was measured by quantitative real-time polymerase chain reaction. Range of motion tests, a wire hanging test, and electromyography were performed to evaluate shoulder function.RESULTSThe liraglutide treatment group demonstrated a significantly lower body mass index and reduced FI compared with the control group. However, no significant differences were observed in the expression levels of genes related to muscle atrophy and FI. Similarly, there was no significant difference in the expression of uncoupling protein 1 (UCP1), a gene associated with fat browning. In the evaluation of shoulder motor function, internal rotation improved early after RC surgery, while external rotation showed improvement at a later stage. In the assessment of muscle strength, the liraglutide group exhibited significant improvement. Furthermore, in the evaluation of compound muscle action potential (CMAP), the liraglutide treatment group showed significant improvement in CMAP both early and late after surgery.CONCLUSIONThe systemic administration of liraglutide suppresses FI without causing muscle loss after RC tendon repair. Furthermore, liraglutide has significant potential to improve shoulder function and quality.CLINICAL RELEVANCEThis multifaceted mechanism of liraglutide in RC tear treatment may be a powerful clinical strategy for postoperative prognosis management in obese patients with RC tear.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"524 1","pages":"3635465251369517"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035768","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":"Measures of Patellofemoral Morphology Predict the Risk of Local Cartilage Damage Progression: A Yale/MOST Collaborative Study.","authors":"Nancy Park,Johannes M Sieberer,Brooke McGinley,Armita R Manafzadeh,John Lynch,Neil A Segal,Cora E Lewis,Ali Guermazi,Frank W Roemer,Joshua Stefanik,David T Felson,John P Fulkerson","doi":"10.1177/03635465251367716","DOIUrl":"https://doi.org/10.1177/03635465251367716","url":null,"abstract":"BACKGROUNDThe relationship between patellofemoral (PF) morphology and PF cartilage damage in the general population remains unclear.PURPOSEThis study aimed to determine whether 3-dimensional-based metrics of PF morphology are associated with progressive lateral PF cartilage damage.STUDY DESIGNCross-sectional study; Level of evidence, 2.METHODSWe analyzed nonweightbearing computed tomography scans of knees from a subset of participants enrolled in the community-based Multicenter Osteoarthritis Study. Baseline and 2-year magnetic resonance imaging scans of the knee were evaluated for progressive PF cartilage damage using the Magnetic Resonance Imaging Osteoarthritis Knee Score. Tibial tubercle-trochlear groove (TT-TG) distance, patellar tilt, external tibiofemoral rotation (eTFR), patellar height, entry point-trochlear groove angle, and entry point-transition point (EP-TP) angle were measured for each knee. To assess the association of each morphology measure with progressive cartilage damage, logistic regression models with generalized estimating equations were fit using continuous and natural cubic spline models.RESULTSWe analyzed lateral PF cartilage damage in 389 knees (mean age, 53.79 ± 5.51 years; mean body mass index, 28.48 ± 5.13 kg/m2). TT-TG distance (β = 0.23; odds ratio, 1.26; P = .036), eTFR (β = 0.24; odds ratio, 1.27; P = .048), and EP-TP angle (Z = 2.09; P = .036) all demonstrated significant positive associations with worsening lateral PF cartilage damage.CONCLUSIONThe results demonstrated significant associations between 3-dimensional anatomic metrics and progressive lateral PF cartilage damage. Elevated TT-TG distance, eTFR, and EP-TP angle may be keys to understanding the mechanical cause of lateral PF osteoarthritis.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"67 1","pages":"3635465251367716"},"PeriodicalIF":0.0,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035776","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":"Distal Biceps Tendon Repair With Interlinked Knotless All-Suture Anchors Provides Greater Footprint Optimization and Higher Fixation Security Over Intramedullary Cortical Button Repair: A Biomechanical Study","authors":"Jim C. Hsu, Genevieve M. Fraipont, Michelle H. McGarry, Victor T. Hung, Jonathan M. Salandra, Gregory J. Adamson, Thay Q. Lee","doi":"10.1177/03635465251365498","DOIUrl":"https://doi.org/10.1177/03635465251365498","url":null,"abstract":"Background: Recent biomechanical investigations of distal biceps tendon repair (DBTR) constructs have typically evaluated time-zero fixation security, while tendon-bone repair footprint characterization has been limited. Consequently, interactions between repair construct design, fixation security, and repair footprint parameters remain minimally assessed. Purpose/Hypothesis: The purpose was to compare time-zero fixation security and repair footprint parameters between a new DBTR construct with 2 interlinked knotless all-suture anchors and an established DBTR construct with an intramedullary cortical button. It was hypothesized that the new interlinked twin-anchor repair technique would demonstrate greater time-zero fixation security and footprint optimization. Study Design: Controlled laboratory study. Methods: A total of 20 cadaveric elbows in 2 matched groups underwent DBTR with either (1) twin interlinked knotless all-suture anchors or (2) a single intramedullary cortical button. Anatomic and repair footprints were digitally captured with a 3-dimensional coordinate-measuring machine. The repair constructs underwent cyclic loading and then were loaded to failure. Anatomic and repair footprint areas and their overlap, tendon-bone interface and total construct displacement, ultimate failure load, and failure mode were recorded. Anatomic footprint restoration and repair footprint accuracy were calculated. Results: The interlinked knotless twin-anchor repair construct demonstrated a larger repair footprint area (55.1 ± 14.9 vs 35.2 ± 19.8 mm <jats:sup>2</jats:sup> , respectively; <jats:italic>P</jats:italic> = .032), greater anatomic footprint restoration (42.7% ± 12.9% vs 20.2% ± 9.4%, respectively; <jats:italic>P</jats:italic> = .003), lower tendon-bone interface displacement (3.2 ± 1.2 vs 12.4 ± 6.6 mm, respectively; <jats:italic>P</jats:italic> = .003), lower total construct displacement (5.5 ± 1.7 vs 13.9 ± 8.1 mm, respectively; <jats:italic>P</jats:italic> = .015), and higher ultimate failure load (468.3 ± 124.2 vs 313.2 ± 103.4 N, respectively; <jats:italic>P</jats:italic> = .001) compared with the single-button repair construct. The most common failure mode was knot slippage/suture breakage (60%) in the single-button group and suture-tendon interface failure (50%) in the twin-anchor group. Conclusion: While this cadaveric study did not account for the effects of tendon-bone healing, the novel interlinked twin-anchor DBTR construct demonstrated greater time-zero fixation security, a larger repair footprint, and greater anatomic footprint restoration over the established single-button repair construct. Clinical Relevance: A DBTR construct with twin interlinked knotless all-suture anchors offers multiple features, including time-zero fixation security and footprint optimization, that may potentially improve clinical outcomes.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035192","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":"Lateral Retinacular Release During MPFL Reconstruction: A Randomized Clinical Trial","authors":"François Fauré, Julien Erard, Cécile Batailler, Robert A. Magnussen, Sébastien Lustig, Elvire Servien","doi":"10.1177/03635465251366306","DOIUrl":"https://doi.org/10.1177/03635465251366306","url":null,"abstract":"Background: Reconstruction of the medial patellofemoral ligament (MPFL) has become the gold standard treatment for patellofemoral instability. A lateral retinacular release (LRR) may be performed in conjunction with MPFL reconstruction (MPFLR); however, its effect on outcomes is unclear. Purpose/Hypothesis: This study aimed to evaluate the effect of LRR on the outcomes of MPFLR. It was hypothesized that isolated MPFLR would not be inferior to MPFLR with LRR in terms of the subjective International Knee Documentation Committee (IKDC) score and patellar tilt (PT). Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients aged 18 to 45 years undergoing MPFLR without associated osseous procedures were randomized to isolated MPFLR or MPFLR with arthroscopic LRR. Outcome measures were subjective IKDC score and PT assessed by computed tomography with the quadriceps relaxed (PTQR) and contracted (PTQC). Results: Out of 140 patients randomized and included, 3 were excluded from analysis because of the performance of unexpected osseous procedures or the use of a graft other than a gracilis autograft; 9 patients were lost to follow-up; and 3 patients could not complete the study due to medical reasons. A total of 125 patients (89%) were evaluated at a median follow-up of 36 months (range, 24-144 months) postoperatively. The mean subjective IKDC score was 78.1 ± 16 (range, 29-98) in the MPFL + LRR group and 80.7 ± 15 (range, 33-100) in the Isolated MPFL group ( <jats:italic>P</jats:italic> = .309). Postoperatively, the PTQR was 20.9° ± 9.1° in the LRR group and 17.3° ± 7.2° in the isolated MPFL group ( <jats:italic>P</jats:italic> = .097). The PTQC was 24.4° ± 10° in the MPFL + LRR group and 21.5° ± 8.9° in the isolated MPFL group ( <jats:italic>P</jats:italic> = .149). Three complications were noted in each group. Conclusion: Routine performance of LRR in association with MPFLR in the absence of bony procedures does not lead to improved patient-reported outcomes or significant alteration of the PT. Study Registration: ClinicalTrials.gov NCT01719666.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035191","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":"Posterolateral Tibial Plateau Bone Loss in the Setting of ACL Insufficiency Leads to Altered Kinematics During a Simulated Pivot Shift That Can Be Corrected With Combined ACL Reconstruction and Lateral Extra-articular Tenodesis But Not ACL Reconstruction Alone","authors":"David L. Bernholt, Luke V. Tollefson, Mitchell R. Carlson, Erik L. Slette, Grant J. Dornan, Evan P. Shoemaker, Frederick M. Azar, Garrett G. Eggleston, Jewel A. Stone, Bergin M. Brown, Robert F. LaPrade","doi":"10.1177/03635465251371644","DOIUrl":"https://doi.org/10.1177/03635465251371644","url":null,"abstract":"Background: Posterolateral tibial plateau impaction fractures commonly occur in the setting of anterior cruciate ligament (ACL) tears and have been reported to affect clinical outcomes after ACL reconstruction (ACLR), but their biomechanical significance is not well understood. Purpose: To evaluate the biomechanical effect of increasing depths of anteroposterior lateral tibial plateau bone loss on knee kinematics in the ACL-deficient knee and to evaluate the effect of ACLR with and without lateral extra-articular tenodesis (LET) on knee kinematics in the setting of posterolateral tibial plateau bone loss. Study Design: Controlled laboratory study. Methods: This study used 16 cadaveric knee specimens subjected to simulated pivot-shift, anterior tibial translation (ATT), and internal rotation (IR) testing via a robotic system. ACL-deficient specimens with 5, 10, and 15 mm of posterolateral tibial plateau bone loss were examined in addition to specimens that underwent ACLR with and without LET in the setting of 15-mm bone loss. Statistical analysis was performed using 1-factor, random-intercepts mixed-effects models to compare ATT, IR, and valgus angulation during a simulated pivot-shift test. Results: During pivot-shift testing, we observed significant increases in ATT, IR, and valgus angulation when comparing between the ACL intact with no bone loss state and all deficient ACL with bone loss states. For the reconstruction with 15-mm bone loss states, ACLR + LET was able to significantly improve ATT and IR, although valgus angulation remained significantly increased compared with the intact state (mean difference, 0.6 ± 4.0 mm, –4.8° ± 5.7°, and 2.0° ± 3.3°, respectively), while significant differences in ATT, IR, and valgus angulation remained when comparing isolated ACLR to the intact state (mean difference, 4.1 ± 2.8 mm, 3.2° ± 2.1°, and 3.4° ± 2.5°, respectively). Conclusion: With increasing amounts of posterolateral tibial plateau bone loss, there were increased values of ATT, IR, and valgus angulation observed with a simulated pivot shift in ACL-deficient knees in a cadaveric model. In the setting of 15-mm posterolateral tibial plateau bone loss, ACLR combined with LET resulted in a significant decrease in both ATT and IR, but these parameters remained significantly elevated with isolated ACLR. Clinical Relevance: In the setting of high-grade posterolateral tibial plateau bone loss, significant laxity remained after ACLR compared with the ACL-intact state, whereas ACLR with LET was able to better restore kinematics to the ACL-intact state. This suggests that the addition of LET to ACLR should be considered in the setting of high-grade posterolateral tibial plateau bone loss.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145035159","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}