The American Journal of Sports Medicine最新文献

{"title":"Association Between Joint Line Convergence Angle and Patient-Reported Outcomes of Opening-Wedge High Tibial Osteotomy","authors":"Takahiro Tsushima, Eiji Sasaki, Yukiko Sakamoto, Yuka Kimura, Eiichi Tsuda, Yasuyuki Ishibashi","doi":"10.1177/03635465241313396","DOIUrl":"https://doi.org/10.1177/03635465241313396","url":null,"abstract":"Background:A larger joint line convergence angle (JLCA) increases the stress load on the medial compartment. Few reports, however, have discussed the effect of the JLCA on the cartilage status and clinical outcomes after opening-wedge high tibial osteotomy (OWHTO).Purpose/Hypothesis:To reveal the effect of the JLCA on clinical results after OWHTO. We hypothesized that a smaller JLCA improves cartilage status and clinical outcomes by reducing mechanical stress in the medial compartment.Study Design:Cohort study: Level of evidence, 3.Methods:This retrospective study included 106 knees that underwent OWHTO and second-look arthroscopy during implant removal 1 year after OWHTO. The mean follow-up period was 5.5 (SD, 2.9) years. The pre- and postoperative JLCAs were measured radiographically. The International Cartilage Repair Society (ICRS) grades of the medial femoral condyle (MFC) and the medial tibial plateau (MTP) were evaluated during the initial and second-look arthroscopy. The relationship between the JLCA and cartilage status, and the Knee injury and Osteoarthritis Outcome Score (KOOS) at the final follow-up were evaluated.Results:Preoperative JLCA was related to improvements in the ICRS grade of the MFC and the MTP, with cutoff values of 2.6° (sensitivity, 0.700; specificity, 0.561; P = .016) and 2.4° (sensitivity, 0.704; specificity, 0.595; P = .028), respectively. In addition, the preoperative JLCA was related to KOOS Pain ( P = .037), Symptoms ( P < .001), Activities of Daily Living ( P = .005), Sports Activities ( P = .005), and Quality of Life ( P = .006) subscales using multivariable linear regression analysis. The postoperative JLCA was not related to the improvement in the ICRS grade of the MFC but was related to the improvement in the ICRS grade of the MTP, with a cutoff value of 1.6° (sensitivity, 0.704; specificity, 0.603; P = .015). Furthermore, postoperative JLCA was related to the KOOS Pain ( P = .004), Symptoms ( P = .002), Activities of Daily Living ( P = .031), Sports Activities ( P < .001), and Quality of Life ( P = .015) subscales.Conclusion:A smaller pre- and postoperative JLCA was related to improvements in the ICRS grade and favorable clinical outcomes, with a mean 5.5-year follow-up after OWHTO.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Osteochondral Fractures in Adolescents With First-time Patellar Dislocation: Three-dimensional Characterization and Association With Radiographic Features","authors":"Annmarie Wang, Beltran Torres-Izquierdo, Jeffrey J. Nepple","doi":"10.1177/03635465241313135","DOIUrl":"https://doi.org/10.1177/03635465241313135","url":null,"abstract":"Background:Consequences of osteochondral fractures associated with patellar dislocation can be severe for younger patients. Precise 3-dimensional characterization of fracture location, size, frequency, and radiographic associations remain undefined in this population.Purpose:(1) To define the topographic characteristics of osteochondral fractures in pediatric and adolescent patients with first-time patellar dislocations and (2) to determine the relationship between these characteristics and radiographic and patient factors.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A retrospective observational study was conducted between 2015 and 2023 of consecutive patients aged &lt;18 years undergoing surgical intervention for displaced osteochondral fractures in the setting of first-time patellar dislocation. Three-dimensional location and relative injury frequency were quantified with heat map analysis. Subgroup analysis of intraoperative osteochondral fracture size and location was conducted using chi-square testing and an independent t test at an alpha of .05.Results:The study cohort included 82 knees (80 patients) with first-time patellar dislocation and osteochondral fracture. A total of 97 osteochondral fractures were identified, with the lateral femur as the most common fracture site at 55% (n = 53), as compared with 43% (n = 42) for the patella and 2% (n = 2) for the lateral trochlea. Patellar osteochondral fractures were significantly larger than femoral lesions (mean ± SD, 258 ± 168 mm<jats:sup>2</jats:sup> vs 126 ± 109 mm<jats:sup>2</jats:sup>; P &lt; .001) and more amenable to fixation than femoral osteochondral fractures (fixation, 57.1% [n = 24] vs 15.1% [n = 8]; P &lt; .001). Patellar and femoral osteochondral fractures were &gt;100 mm<jats:sup>2</jats:sup> in 78.6% (n = 33) and 32.1% (n = 17) of lesions, respectively. Patellar mean fracture size was significantly larger in the group with a tibial tubercle–trochlear groove distance &lt;20 mm ( P = .018). The mean osteochondral fracture size of the lateral femoral condyle was significantly larger in the open physis group as compared with the closed physis group ( P = .027).Conclusion:We found that the most common site for osteochondral fracture was the femur, although patellar osteochondral fractures were significantly larger. Factors that affect anatomic structure and ligamentous laxity appear to contribute to patterns of osteochondral fractures.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"51 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Marrow Aspirate Concentrate Combined With an Appropriate Carrier Effectively Promotes Bone-Tendon Interface Healing in a Rabbit Model of Chronic Rotator Cuff Tear","authors":"Sheng Chen Han, Jian Han, Young Kyu Kim, Myung Jae Hyun, Hyeon Jang Jeong, Joo Han Oh","doi":"10.1177/03635465241313124","DOIUrl":"https://doi.org/10.1177/03635465241313124","url":null,"abstract":"Background:The efficacy of bone marrow aspirate concentrate (BMAC) in promoting bone-tendon interface (BTI) healing without any carriers remains a subject of debate.Purpose:To evaluate BMAC effects with different carriers on tendon regeneration in a rabbit model of chronic rotator cuff tear.Study Design:Controlled laboratory study.Methods:In vitro, the amount of growth factor and the differentiation potential of BMAC with different carriers (polydeoxyribonucleotide [PDRN] and atelocollagen [ATC]) were assessed. In vivo, 64 rabbits were randomly allocated into 4 groups. Different materials were injected into the repair site according to the allocated group: control, saline; BMAC, BMAC and saline; BMAC-PDRN, BMAC with PDRN; BMAC-ATC, BMAC with ATC (n = 16 in each). Genetic and histologic analyses were conducted at 4 and 12 weeks after repair, while biomechanical evaluations were performed at 12 weeks after repair.Results:In vitro, the degree of multilineage differentiation was much stronger using BMAC with ATC as compared with administration of BMAC alone or BMAC with PDRN ( P &lt; .001). In vivo, the BMAC-ATC group had the highest levels of aggrecan expression, bone morphogenetic protein 2, and collagen type I alpha 1 among all groups (all P &lt; .001) at 4 weeks after repair. Furthermore, the BMAC-ATC group showed collagen fiber continuity, denser collagen fibers, and more mature BTI as compared with the other groups (all P &lt; .001) at 12 weeks after repair. Concurrently, the BMAC-ATC group also demonstrated significantly higher load-to-failure versus the remaining groups (all P &lt; .001) at 12 weeks after repair.Conclusion:Local application of BMAC without appropriate carriers could not enhance BTI healing. However, BMAC with 2 different carriers effectively accelerated BTI healing, particularly in the ATC environment. Therefore, the combination of BMAC and ATC may act as a powerful biological agent to promote healing after rotator cuff repair in a chronic rotator cuff tear model using rabbits.Clinical Relevance:Local application of BMAC without appropriate carriers could not enhance BTI healing. However, the combination of BMAC and ATC may synergistically promote rotator cuff tendon healing.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Aligned-to-Random PLGA/Col1-PLGA/nHA Bilayer Electrospun Nanofiber Membrane Enhances Tendon-to-Bone Healing in a Murine Model","authors":"Baoyun Xu, Yunjiao Wang, Gang He, Xu Tao, Shang Gao, Mei Zhou, Yuzhen Tang, Kang-lai Tang, Lin Guo, Wan Chen","doi":"10.1177/03635465241310530","DOIUrl":"https://doi.org/10.1177/03635465241310530","url":null,"abstract":"Background:The challenge of achieving effective tendon-to-bone healing remains a significant concern in sports medicine, necessitating further exploration. Biomimetic electrospun nanomaterials present promising avenues for improving this critical healing process.Purpose:To investigate the biological efficacy of a novel aligned-to-random PLGA/Col1-PLGA/nHA bilayer electrospun nanofiber membrane in facilitating tendon-to-bone healing.Study Design:Controlled laboratory study.Methods:The bilayer membrane’s composition, combining PLGA/Col1 for tendon attachment and PLGA/nHA for bone integration, was examined using scanning electron microscopy, Fourier transform infrared spectroscopy, and mechanical testing. Positioned between the Achilles tendon and bone, its design aimed for harmonious integration with both types of tissue. In vitro, biocompatibility, cell adhesion, and proliferation of the biomaterial were evaluated using live/dead staining and the CCK-8 assay. Collagen secretion and mineralization were measured for 2 cell types. In vivo, tendon-to-bone insertion samples harvested from mice were analyzed: micro–computed tomography assessed bone formation; histological staining evaluated chondrogenesis, tendinogenesis, and the 4-layer structure of the insertion; and biomechanical testing measured insertion strength. Real-time polymerase chain reaction identified genes involved in tendon-to-bone healing, and transcriptome analysis elucidated the underlying cellular and molecular mechanisms.Results:The optimal composition was determined as 10% 3:1 for aligned PLGA/Col1 and 9% 5:1 for PLGA/nHA. Coculture showed minimal cell death, firm cell adherence, and steady proliferation, with PLGA/Col1 enhancing collagen secretion. In vivo, the material promoted bone and cartilage formation and improved tendon-to-bone interface strength. Transcriptome analysis indicated links to TNF and NF-κB pathways and to genes IL-1β, ADAM8, and EGR2.Conclusion:The novel aligned-to-random PLGA/Col1-PLGA/nHA bilayer nanofiber membrane outperformed other materials in both in vitro and in vivo evaluations, significantly enhancing tendon-to-bone healing. It notably improved cartilage and bone formation, tendon maturation, and biomechanical strength at the surgical interface. These effects may be associated with the TNF and NF-κB pathways and with the genes IL-1β, ADAM8, and EGR2.Clinical Relevance:This study introduces a biomimetic nanofiber membrane enhancing tendon-to-bone healing, which is crucial for sports medicine. Its efficacy in improving healing outcomes, including bone and cartilage formation and biomechanical strength, could significantly lower failure rates in surgical procedures such as rotator cuff repair and anterior cruciate ligament reconstruction. This advancement offers promising implications for patient recovery and the effectiveness of surgical interventions in tendon-to-bone injuries.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of an Autologous Dermal Fibroblast Injection in Reducing the Retear Rate After Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Trial","authors":"Young Kyu Kim, Yong Tae Kim, Yoo-Sun Won, Young Hoon Jang, Sun Tae Hwang, Jikhyon Han, Saewha Jeon, Sae Hoon Kim, Joo Han Oh","doi":"10.1177/03635465241311605","DOIUrl":"https://doi.org/10.1177/03635465241311605","url":null,"abstract":"Background:Interest in biological augmentation for improving bone-tendon interface (BTI) healing after arthroscopic rotator cuff repair (ARCR) is growing. Dermal fibroblasts, known for collagen synthesis similar to tenocytes, have shown effectiveness in BTI healing in chronic rotator cuff tear (RCT) models in rabbits. However, no human clinical trials have been conducted.Purpose:To evaluate the clinical efficacy of autologous dermal fibroblasts (ADFs) for BTI healing after ARCR in patients with full-thickness RCTs &gt;2 cm.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:A total of 86 patients were prospectively enrolled and randomized into 2 groups: an additional ADF injection between the bone and tendon during ARCR (ADF group) or ARCR alone (control group). A skin biopsy from the buttock was performed to obtain ADFs, which were cultured for approximately 4 weeks before surgery. ARCR was standardized to the double-row suture bridge technique to reduce the heterogeneity in different repair methods. The primary variable for evaluating ADF efficacy was the retear rate using magnetic resonance imaging at 6 months postoperatively. Secondary variables included range of motion, the American Shoulder and Elbow Surgeons score, the Constant score, and the Simple Shoulder Test score at baseline and at 6 and 12 months postoperatively.Results:Overall, 13 patients dropped out because of a subscapularis tendon tear, loss to follow-up, or the withdrawal of consent (7 in the ADF group and 6 in the control group). The retear rate was significantly lower in the ADF group (5.6% [2/36]) than in the control group (24.3% [9/37]) ( P = .025). The American Shoulder and Elbow Surgeons, Constant, and Simple Shoulder Test scores showed significant improvement after surgery in both groups (all P values &lt;.001). Functional scores and range of motion did not significantly differ between the 2 groups at 6 and 12 months (all P values &gt;.05).Conclusion:ADF application into the BTI during ARCR significantly decreased the retear rate in patients with full-thickness RCTs &gt;2 cm. Therefore, an ADF injection could be a promising biological supplement to enhance BTI healing in these patients. However, clinical outcomes showed no significant difference between the 2 groups at 6 months and 1 year postoperatively.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"84 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056956","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":"Descriptive Epidemiology of Complete ACL Tears in the Skeletally Immature Population: A Prospective Multicenter PLUTO Study","authors":"Melissa A. Christino, Lauren E. Hutchinson, Andrew T. Pennock, Danielle L. Cook, Christian N. Anderson, Michael T. Busch, Henry G. Chambers, Frank A. Cordasco, Eric W. Edmonds, Peter D. Fabricant, Theodore J. Ganley, Daniel W. Green, Benton E. Heyworth, John Todd R. Lawrence, Matthew J. Matava, Lyle J. Micheli, Matthew D. Milewski, Jeffrey Nepple, Shital N. Parikh, Crystal A. Perkins, Paul M. Saluan, Kevin G. Shea, Eric J. Wall, Samuel C. Willimon, Mininder S. Kocher","doi":"10.1177/03635465241312215","DOIUrl":"https://doi.org/10.1177/03635465241312215","url":null,"abstract":"Background:Anterior cruciate ligament (ACL) injuries are common in pediatric and adolescent patients. Understanding this population's injury characteristics and treatment strategies is vital for managing this high-risk group.Purpose:To report the descriptive epidemiology and treatment strategies of a large cohort of skeletally immature patients with complete ACL tears.Study Design:Cross-sectional study; Level of evidence, 2.Methods:Consecutive skeletally immature patients diagnosed with complete ACL tears were enrolled at 10 institutions across the United States. Treatment was provided by 1 of 23 participating orthopaedic surgeons. Patient characteristics (chronological and skeletal age, sex, race, and ethnicity) as well as anthropometric measures, mechanism of injury, and ACL treatment type were collected.Results:A total of 749 skeletally immature participants were included in the final cohort; the mean chronological age was 12.9 years, and 62% were male. The mean skeletal age (13.2 years) was a mean of 0.34 years (4 months) higher than the mean chronological age ( P &lt; .001). Tanner staging revealed that 18% of participants were Tanner stage 1, 20% were Tanner stage 2, 28% were Tanner stage 3, 30% were Tanner stage 4, and 4% were Tanner stage 5. Five percent of participants reported a previous ipsilateral knee injury, and 30% had a family history of ACL injuries. Sport was the predominant mechanism of injury (89%), with noncontact injuries the most common (64%). The most common sport resulting in an ACL tear among boys was American football (41%) and among girls was soccer (44%). Overall, 99.9% of skeletally immature patients were treated surgically by 1 of 4 reconstruction techniques: transphyseal (53%), partial transphyseal (7%), physeal-sparing all-epiphyseal (13%), and physeal-sparing iliotibial band (ITB) (27%). The most common surgical techniques for patients with a skeletal age &lt;13 years were physeal sparing with ITB (56%) and all-epiphyseal (22%), while in patients with a skeletal age ≥13 years, transphyseal (71%) and physeal sparing with ITB (12%) were the most common. Overall, 57% of patients who underwent ACL reconstruction had arthroscopically documented meniscal tears, with high rates of meniscal repair (90% medial tears and 66% lateral tears).Conclusion:Almost all skeletally immature patients with ACL tears were injured during sports, surgical treatment was overwhelmingly the treatment of choice, and preferred surgical techniques varied based on skeletal ages.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056957","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":"Quantifying Muscle Volume Deficits Among 38 Lower Extremity Muscles in Collegiate Football Athletes After Anterior Cruciate Ligament Reconstruction.","authors":"Naoaki Ito,Jack A Martin,Mikel R Joachim,Silvia S Blemker,David A Opar,Stephanie A Kliethermes,Bryan C Heiderscheit,,Geoffrey Baer,Kurrel Fabian,Erin Hammer,Danielle Heidt,Matthew Kuehl,Kenneth Lee,Michael Moll,Ryan Peot,Jennifer Sanfilippo,Claire Tanaka,Sarah Sund,Yi-Chung Lin,Jack Hickey,Ashleigh Homer,Nirav Maniar,Ryan Timmins,Matthew Cousins,Olivia DuCharme,Xue Feng,Anthony Nguyen,Lara Riem,Joseph Hart,Noah McCoy,Dain Allred,Anthony Beutler,Darren Campbell,A Wayne Johnson,Malorie Wilwand,Brett Mortensen,Emma Remington,Jonathon Hauenstein,Casey Metoyer,John Wagle,Josh Huff,Nicholas Port,Jordan Reyes","doi":"10.1177/03635465241313235","DOIUrl":"https://doi.org/10.1177/03635465241313235","url":null,"abstract":"BACKGROUNDQuadriceps dysfunction is ubiquitous after anterior cruciate ligament (ACL) reconstruction (ACLR). Addressing quadriceps dysfunction is crucial to improve function, reduce the reinjury risk, and maintain long-term knee health. While deficits specific to the quadriceps are well documented, less is known about the effect of an ACL injury on other lower extremity muscle groups.PURPOSE/HYPOTHESISThe purpose of this exploratory analysis was to quantify and rank lower extremity muscle volume deficits using magnetic resonance imaging in collegiate football athletes after ACLR. It was hypothesized that the quadriceps muscles would present with the greatest deficits and that compensatory hypertrophy of muscles at adjacent joints such as the hip and ankle would be observed.STUDY DESIGNCross-sectional study; Level of evidence, 3.METHODSThis study is a secondary analysis from an ongoing multicenter prospective cohort study involving Division I collegiate football athletes. Athletes who underwent primary unilateral ACLR (1 [3%] allograft, 2 [7%] quadriceps tendon autograft, 22 [73%] bone-patellar tendon-bone autograft, 5 [17%] hamstring tendon autograft) and magnetic resonance imaging were included. Muscle volumes (mL·kg-1·m-1) were quantified bilaterally from 38 lower extremity muscles using machine learning technology. Paired-samples t tests were performed between limbs for each muscle, which were then ranked and visualized in a forest plot based on standardized mean differences (surgical - nonsurgical limb).RESULTSA total of 30 athletes (mean time from surgery, 27.9 ± 19.0 months) were included. The largest muscle volume deficits in the surgical limb were seen in the 3 uniarticular quadriceps muscles, followed by the biarticular triceps surae muscles. The rectus femoris and soleus did not show significant differences between limbs. Conversely, the fibularis muscle group had a greater muscle volume in the surgical limb compared with the nonsurgical limb. Most other muscle groups did not present significant differences between limbs.CONCLUSIONPersistent quadriceps atrophy in a cohort of high-level athletes over 2 years after ACLR was highlighted in this study. Deficits in the gastrocnemius muscles, but not in the soleus, were also identified. This comprehensive approach examining various lower extremity muscles revealed latent muscle volume deficits present after ACLR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"13 1","pages":"3635465241313235"},"PeriodicalIF":0.0,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143056773","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":"Low-Cost Lower Extremity Screening to Predict Shoulder Distraction Force in College Softball Pitchers","authors":"Sophia M. Ulman, Adam R. Nebel, Nicole M. Bordelon, Gretchen D. Oliver","doi":"10.1177/03635465241310243","DOIUrl":"https://doi.org/10.1177/03635465241310243","url":null,"abstract":"Background:During a windmill softball pitch, the throwing shoulder experiences forces greater than the pitcher’s body weight. Various kinematic, kinetic, and performance factors have been related to shoulder forces and torques in softball pitchers, and softball research has examined clinical screening measures such as range of motion, muscular strength, and/or neuromuscular control. However, no studies have explicitly identified low-cost, clinic-friendly screening measures predictive of shoulder distraction forces in softball pitchers.Purpose:To predict shoulder distraction force using low-cost, in-clinic screening measures, including isometric hip rotation strength and trunk mechanics during a single-leg squat.Study Design:Descriptive laboratory study.Methods:Biomechanical and strength data of 46 collegiate softball pitchers (mean age, 19.8 ± 1.1 years; mean height, 1.7 ± 0.1 m; mean weight, 78.9 ± 11.9 kg) were retrospectively analyzed. Data included shoulder distraction forces captured during a windmill pitch, trunk flexion during a single-leg squat, and isometric hip rotation strength. Subsequently, 4 separate linear regressions with model comparisons were performed to determine if the isometric hip rotation strength and trunk flexion during a single-leg squat could independently predict peak shoulder distraction force after accounting for body mass and pitch velocity.Results:The null model, including body mass and pitch velocity, significantly predicted peak shoulder distraction force ( P &lt; .001), accounting for 49.9% of the variance. Of the predictors, the isometric drive hip rotation strength ratio was able to significantly predict peak shoulder distraction force beyond the effects of body mass and pitch velocity ( P = .015), resulting in a 6.3% increase in variability accounted for (56.2% of the variance of shoulder distraction force).Conclusion:The isometric drive hip rotation strength ratio is related to shoulder distraction force and can be used as a low-cost screening measure for collegiate softball pitchers. However, pitch velocity and body mass should also be considered, as these measures accounted for the majority of the variance in shoulder distraction force.Clinical Relevance:It is important that screening measures used for softball pitchers consider the multisegment synergy required for pitching and therefore evaluate imbalances and deficiencies associated with the high forces acting on the shoulder. The current study found that collegiate softball pitchers can be proactively screened for greater shoulder distraction forces using isometric hip rotation strength. These findings emphasize to coaches and clinicians the importance of evaluating lower extremity risk factors in upper extremity athletes, and support using a low-cost, low-technology screening measure to identify softball pitchers who are more likely to experience high shoulder distraction forces.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020745","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":"Patients With a Quadriceps Tendon Autograft Demonstrate Greater Asymmetry in Landing Kinetics Than Patients With a Bone–Patellar Tendon–Bone Autograft 6 Months After Anterior Cruciate Ligament Reconstruction","authors":"Rachel E. Cherelstein, Christopher M. Kuenze, Michelle C. Walaszek, Emily R. Brumfield, Jennifer N. Lewis, Garrison A. Hughes, Edward S. Chang","doi":"10.1177/03635465241310400","DOIUrl":"https://doi.org/10.1177/03635465241310400","url":null,"abstract":"Background:Asymmetric landing kinetics 6 months after anterior cruciate ligament reconstruction (ACLR) are associated with higher risk of second anterior cruciate ligament injury. Little is known about landing kinetics after ACLR with an all–soft tissue quadriceps tendon (QT) autograft despite its increasingly common use in young, active patients.Purpose/Hypothesis:The purpose of this study was to compare landing kinetics during a bilateral drop vertical jump (DVJ) 6 months after ACLR in participants who had undergone primary ACLR with a QT or bone–patellar tendon–bone (BTB) autograft. The hypothesis was that patients with a QT autograft will experience more asymmetry during a bilateral DVJ than patients with a BTB autograft 6 months after ACLR. In addition, greater impact force asymmetry will be associated with worse patient-reported outcome measures.Study Design:Controlled laboratory study.Methods:Participants who underwent primary unilateral ACLR with a QT or BTB autograft between May 2022 and December 2023 were prospectively recruited to undergo DVJ assessment and patient-reported outcome measures 6 months after ACLR. DVJ assessment was completed using force-sensing insoles. Peak impact force, average loading rate, and impulse data were collected at 100 Hz.Results:Forty-four participants (22 BTB, 22 QT) completed DVJ assessment and International Knee Documentation Committee (IKDC) and Anterior Cruciate Ligament–Return to Sport After Injury (ACL-RSI) surveys at 6 ± 1 months after ACLR. Graft source groups did not differ by age ( P = .884), sex ( P = .531), mass ( P = .872), height ( P = .572), months since surgery ( P = .683), or lateral ( P = .637) or medial ( P = .416) meniscal tear treatment rate. On average, participants with a QT autograft demonstrated 26.2% greater contralateral limb peak impact force ( P = .004), 18.4% lower peak impact force limb symmetry index ( P = .009), 18.5% lower involved limb impulse ( P &lt; .001), and 15.1% lower impulse limb symmetry index ( P &lt; .001) when compared with participants with a BTB autograft. Graft source groups did not differ in IKDC score ( P = .333) or ACL-RSI score ( P = .070). Neither IKDC nor ACL-RSI score was strongly associated with any kinetic variables.Conclusion/Clinical Relevance:Participants with a QT autograft exhibit greater asymmetry in landing kinetics when compared with participants with a BTB autograft 6 months after ACLR, and landing kinetics were not associated with IKDC or ACL-RSI score.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"92 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143020750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to Sport After Distal Biceps Tendon Repair: A Systematic Review.","authors":"Peter Boufadel,Mohammad Daher,Ryan Lopez,Mohamad Y Fares,Jad Lawand,Adam Z Khan,Joseph A Abboud","doi":"10.1177/03635465241295618","DOIUrl":"https://doi.org/10.1177/03635465241295618","url":null,"abstract":"BACKGROUNDRuptures of the distal biceps tendon (DBT) can affect the range of motion and strength of the elbow, raising concerns for patients seeking to restore normal function and engage in their regular activities, particularly returning to previous levels of sport participation.PURPOSETo characterize and assess the rate and timing of return to sport (RTS) after DBT repair.STUDY DESIGNSystematic review; Level of evidence, 4.METHODSPubMed, Embase, and Google Scholar (pages 1-20) were searched from database inception to December 6, 2023 for clinical studies reporting RTS outcomes after DBT repair. The extracted data consisted of patient characteristics; information on the incision approach, fixation method, and rehabilitation protocol; and outcome data including RTS rates, patient-reported outcome measure scores, and complications.RESULTSA total of 42 studies, including 1093 patients (1100 elbows), met the inclusion criteria. The mean age of patients was 44.9 years, and 99.2% of patients were male. The mean follow-up time was 31.5 months. Ruptures were acute in 87.6% of cases, the dominant arm was injured in 64.9%, and the cause of the injury was sport related in 43.5%. The overall RTS rate was 91.5%, with 85.2% of patients returning to preinjury levels or higher, at a mean time of 6.3 months. Patients had excellent functional outcomes, irrespective of the incision approach or fixation method, although trends associated with a higher RTS rate were observed with bone tunnel fixation, ≤2 weeks of postoperative immobilization, early initiation of active range of motion postoperatively, and initiation of strengthening at ≤10 weeks. Single-incision repair had higher rates of nerve-related complications and reruptures compared with double-incision repair, and cortical button fixation had a higher rate of nerve-related complications among the fixation methods.CONCLUSIONThere was a high rate of RTS after DBT repair at 6 months postoperatively. A positive trend for RTS was observed with respect to rehabilitation protocols favoring earlier active mobility.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"15 1","pages":"3635465241295618"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991802","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}