The American Journal of Sports Medicine最新文献

{"title":"Days 7 to 14 May Represent an Optimal Window for Stem Cell–Based Treatment in a Rat Model of Anterior Cruciate Ligament Transection–Induced Posttraumatic Osteoarthritis","authors":"Zhidong Zhao, Peng Geng, Mingyang An, Yanpeng Zhao, Zheng Guo, Huayi Gao, Heng Zhu, Zhongli Li, Min Wei, Chunbao Li","doi":"10.1177/03635465251326499","DOIUrl":"https://doi.org/10.1177/03635465251326499","url":null,"abstract":"Background: The concept of early intervention at the appropriate time has been recognized for treating posttraumatic osteoarthritis (PTOA). However, the optimal intervention timing to achieve superior therapeutic efficacy remains unclear. In addition, there is a lack of direct evidence regarding therapeutic efficacies achieved at different time points. Hypothesis: The administration schedule of stem/stromal cells can significantly influence their ability to improve function and slow progression of PTOA. There may exist an appropriate time window for achieving superior therapeutic efficacy. Study Design: Controlled laboratory study. Methods: A total of 72 Sprague Dawley rats were included in this study. Anterior cruciate ligament transection (ACLT) was performed to induce PTOA. Animals in the control group underwent ACLT alone, whereas those in the sham group underwent knee articular capsulotomy alone. Bone marrow mesenchymal stem/stromal cells or phosphate-buffered saline (PBS) was intra-articularly administered on days 3, 7, 14, and 28 after ACLT (n = 6). Bioluminescence imaging was used to detect the retention of stem cells administered at different time points (n = 3). At the end of the experiment (8 weeks), gait analysis was conducted using CatWalk to compare the recovery of knee function between the 2 groups. Micro–computed tomography (CT) was performed to assess general appearance and quantify the microstructure of subchondral bone. Histological staining was used to evaluate the whole-joint pathology. Semiquantitative evaluations were conducted using Osteoarthritis Research Society International and Mankin scores. Results: PBS administration at different time points had no therapeutic effects on lower limb function or PTOA progression. Gait analysis suggested that stem cell administration significantly improved the general function of knee joints compared with the control group at all time points. However, the duty cycle was significantly higher on days 7 and 14 after ACLT. Micro-CT and histopathological staining of the knee samples suggested that although stem cell administration significantly ameliorated the progression of PTOA, the therapeutic efficacy was significantly better on days 7 and 14. After stem cell administration, the articular surface was considerably smoother with few scattered osteophytes, the deposition of cartilage extracellular matrix was more abundant, subchondral bone remodeling was significantly alleviated, and the synovium was less hyperplastic with reduced inflammatory cell infiltration. The general retention time of stem cells did not differ significantly at different administration time points. Conclusion: This study suggests that the intervention schedule is significantly correlated with the therapeutic efficacy of stem cells for PTOA, with the best effects observed on days 7 and 14 after ACLT. Clinical Relevance: Days 7 to 14 after trauma may be the appropriate intervention timing for clinical prevention and tr","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143920122","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":"Postoperative Pain and Opioid Usage With Combined Adductor Canal and IPACK Block Versus Isolated Adductor Canal Block After Anterior Cruciate Ligament Reconstruction With a Bone-Patellar Tendon-Bone Autograft: A Single-Center Randomized Controlled Trial.","authors":"Naina Rao,Jairo Triana,Amanda Avila,Kirk A Campbell,Michael J Alaia,Laith M Jazrawi,David Furiguele,Jovan Popovic,Eric J Strauss","doi":"10.1177/03635465251328609","DOIUrl":"https://doi.org/10.1177/03635465251328609","url":null,"abstract":"BACKGROUNDEfforts to decrease pain, improve early rehabilitation, and reduce opioid consumption have prompted a focus on peripheral nerve blocks for pain management after anterior cruciate ligament reconstruction (ACLR). The commonly used adductor canal block (ACB) might not provide sufficient postoperative pain control because of its lack of coverage of the posterior aspect of the knee. The addition of the IPACK (interspace between the popliteal artery and the capsule of the posterior knee) block, which targets this area, to the standard ACB could potentially provide better pain control after ACLR over the current standard of care.PURPOSE/HYPOTHESISThe purpose of this study was to compare and analyze postoperative pain, satisfaction, and opioid demand between the standard ACB and a combination of an ACB and IPACK block in patients undergoing ACLR with a bone-patellar tendon-bone (BTB) autograft. It was hypothesized was that the addition of the IPACK block would substantially improve early postoperative pain control and minimize opioid use.STUDY DESIGNRandomized controlled trial; Level of evidence, 2.METHODSA total of 102 patients undergoing ACLR with a BTB autograft at a single institution were recruited. Patients were randomly assigned to receive either the ACB alone or the ACB plus IPACK block. Patients were contacted at 24 hours (postoperative day [POD] 1), 48 hours (POD 2), 72 hours (POD 3), and 1 week to assess postoperative pain scores, opioid consumption, and satisfaction with their postoperative pain control. Intergroup comparative analysis was performed using a t test or nonparametric test for continuous variables and the chi-square test for categorical variables. Opioid usage was reported as morphine milligram equivalents (MME).RESULTSThe final analysis included 96 patients, with 47 in the control group (ACB) who received only the ACB and 49 in the experimental group (IPACK) who received the ACB and an additional IPACK block. The cohort was composed of 60.4% male patients with a mean age of 28.40 ± 7.51 years (range, 18-55 years) and a mean body mass index of 25.67 ± 4.84 kg/m2. There were no statistically significant differences between the groups with respect to age, body mass index, or sex (P > .05). Patients in the IPACK group reported significantly lower opioid usage than those in the ACB group on POD 1 (mean, 6.1 [interquartile range (IQR), 4.5-7.7] vs 10.7 [IQR, 8.6-13.0] MME, respectively; P < .001), POD 2 (mean, 7.3 [IQR, 5.2-9.5] vs 12.5 [IQR, 10.0-15.0] MME, respectively; P = .001), and POD 3 (mean, 4.2 [IQR, 2.8-5.5] vs 9.4 [IQR, 7.1-12.0] MME, respectively; P < .001). The visual analog scale for pain score on POD 1 (mean, 67.7 [IQR, 62.0-73.0] vs 55.2 [IQR, 48.0-63.0], respectively; P = .024) and POD 3 (mean, 54.9 [IQR, 48.0-63.0] vs 44.4 [IQR, 37.0-51.0], respectively; P = .037) was statistically higher in the ACB group compared with the IPACK group. On POD 1, patient satisfaction was higher in the IPACK group than in the","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"13 1","pages":"1359-1367"},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143897445","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":"Orthopaedic Travel","authors":"Daniel C. Wascher","doi":"10.1177/03635465251332900","DOIUrl":"https://doi.org/10.1177/03635465251332900","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"134 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143898245","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":"Identifying Independent Predictors of Achieving Clinically Significant Outcomes After Contemporary Hip Arthroscopic Surgery for Femoroacetabular Impingement Syndrome at a Minimum 10-Year Follow-up.","authors":"Ron Gilat,Michael J Vogel,Omair Kazi,Richard M Danilkowicz,Shane J Nho","doi":"10.1177/03635465251336181","DOIUrl":"https://doi.org/10.1177/03635465251336181","url":null,"abstract":"BACKGROUNDPatients undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS) have been shown to achieve clinically significant outcomes (CSOs) at high rates. However, limited studies, to date, have identified independent predictors of achieving CSOs at a minimum 10-year follow-up, and even fewer studies have reported on patients treated with contemporary hip arthroscopic techniques, including chondrolabral preservation, surgical correction of FAIS morphology, and capsular repair.PURPOSETo identify independent predictors of achieving minimum 10-year CSOs after contemporary hip arthroscopic surgery for FAIS with chondrolabral preservation, surgical correction of FAIS morphology, and capsular repair.STUDY DESIGNCase series; Level of evidence, 4.METHODSPatients undergoing primary contemporary hip arthroscopic surgery for FAIS between January 2012 and November 2013 with a minimum 10-year follow-up were identified. Patient-reported outcomes (PROs) collected included scores for the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale, International Hip Outcome Tool-12, modified Harris Hip Score, and visual analog scale for pain. Cohort-specific thresholds for the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) were determined, and achievement rates were recorded. Patients achieving and not achieving each CSO for any PRO measure were compared. Stepwise multivariate logistic regression was used to identify independent predictors of achieving the MCID, PASS, and SCB for any PRO measure, with the odds ratio (OR) recorded.RESULTSA total of 294 patients with a minimum 10-year follow-up were included in this study. The mean age was 33.8 ± 12.3 years, and the mean body mass index was 25.0 ± 4.8 kg/m2. Most patients were female (60.2%). The reoperation-free survivorship rate was 85.0%. Achievement rates for the MCID, PASS, and SCB were 91.4%, 77.6%, and 71.6%, respectively. Independent predictors of achieving CSOs were age (OR, 0.97-0.98; P ≤ .039), sport participation (OR, 1.84-2.18; P ≤ .042), psychiatric history (OR, 0.46-0.47; P ≤ .041), and high-grade chondral defects (OR, 0.25-0.39; P ≤ .019).CONCLUSIONIndependent predictors of achieving 10-year CSOs after contemporary hip arthroscopic surgery with chondrolabral preservation, surgical correction of FAIS morphology, and capsular repair were younger age, the presence of sport participation, the absence of a psychiatric history, and the absence of chondral defects.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"20 1","pages":"3635465251336181"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893288","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":"Fresh Meniscal Allograft Transplantation Is Associated With Superior Functional Outcomes for Acetabular Labral Reconstruction in a Preclinical Canine Model.","authors":"Brent A Prenger,John R Baumann,James L Cook,Chantelle C Bozynski,Cristi R Cook,Aaron M Stoker,Keiichi Kuroki,Brett D Crist,Steven F DeFroda","doi":"10.1177/03635465251334132","DOIUrl":"https://doi.org/10.1177/03635465251334132","url":null,"abstract":"BACKGROUNDIrreparable acetabular labral defects often require acetabular labral reconstruction (ALR) to restore hip joint health and function. Optimal graft choices for ALR have not been fully delineated.HYPOTHESISFresh meniscal allograft transplantation (MAT) will be associated with cellular, extracellular matrix, geometric, and integration characteristics that mimic native acetabular labrum, which results in superior functional, diagnostic imaging, gross, and histologic outcomes as compared with fresh-frozen tendon allograft transplantation (TAT) for ALR.STUDY DESIGNControlled laboratory study.METHODSWith Institutional Animal Care and Use Committee approvals, canine fresh-frozen tendon allografts and fresh meniscal allografts were recovered. Acetabular labral resection was performed in 1 hip of research hounds (n = 12). Based on random assignment, TAT (n = 4) or MAT (n = 4) ALR was performed or the resected labrums were left untreated (resected, n = 4). Contralateral hips served as healthy controls (n = 12). Preoperatively and at 1, 3, and 6 months postoperatively, dogs were assessed for pain, function, and hip range of motion. Six-month endpoint magnetic resonance imaging (MRI), gross, and histologic assessments were performed. Cohorts were compared for statistically significant differences (P < .05).RESULTSThe resected cohort was associated with significantly worse hip pain (P = .028) and function (P = .036) when compared with controls and the MAT cohort at 3 and 6 months. Only the MAT cohort was superior to the resected cohort and not significantly different from controls for pain (P = .044) and function (P = .031) at all time points. MAT was judged to have superior MRI (P = .039) and histologic characteristics of joint health and labral graft integrity, integration, and healing (P < .0005) as compared with the TAT and resected cohorts, whereas TAT was superior to the resected cohort. No treatment was judged to fully restore MRI or histologic characteristics of controls.CONCLUSIONThis preclinical study suggests that ALR using allografts should be considered over labral resection for treatment of irreparable acetabular labral deficiency. When allograft-based ALR was performed, fresh MAT was associated with functional measures that were superior to fresh-frozen TAT and were attributed to cellular, extracellular matrix, geometric, and material property differences between the tissues.CLINICAL RELEVANCEThese preclinical data suggest that this canine model can help delineate mechanisms underlying acetabular labral pathology and related treatment options for clinically relevant translational application to patients.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":"3635465251334132"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893205","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":"Anatomic Factors Influencing a Persistent J-Sign After Medial Patellofemoral Ligament Reconstruction and Distal Tibial Tubercle Osteotomy in Patients With Recurrent Patellar Dislocations and Patella Alta: A Retrospective Cohort Study.","authors":"Raimundo Vial Irarrazaval,Stefan Turkula,Marc Tompkins,Julie Agel,Elizabeth Arendt","doi":"10.1177/03635465251336162","DOIUrl":"https://doi.org/10.1177/03635465251336162","url":null,"abstract":"BACKGROUNDThe J-sign is a marker of abnormal patellar tracking and is associated with bony abnormalities. When patella alta is present, distal tibial tubercle osteotomy (dTTO) can enable the patella to engage in a more distal/deeper groove, often eliminating the J-sign.PURPOSETo determine which anatomic findings are associated with a persistent J-sign after medial patellofemoral ligament reconstruction (MPFL-R) and dTTO in patients with recurrent lateral patellar dislocations and patella alta.STUDY DESIGNCohort study; Level of evidence, 4.METHODSA retrospective cohort study of 93 knees (77 patients) with recurrent lateral patellar dislocations and the J-sign, treated by a single surgeon with MPFL-R and dTTO without trochleoplasty, was conducted. Demographic, imaging, and surgical data were obtained from medical records. The following measurements were obtained: Caton-Deschamps index (CDI), patellotrochlear index, tibial tubercle-trochlear groove (TT-TG) distance, patellar tendon-lateral trochlear ridge (PT-LTR) distance, lateral patellar tilt, tibiofemoral joint rotation (TFJR), lateral trochlear inclination (LTI), trochlear depth, sulcus angle, and sagittal bump height. The postoperative J-sign was assessed. Patients were categorized into the resolved J-sign group or persistent J-sign group. Binary logistic regression was performed to identify significant predictors of a postoperative J-sign. Cutoff values were determined by receiver operating characteristic curve analysis using the Youden index. The Fisher exact test was used to compare frequencies.RESULTSThe J-sign was not observed postoperatively in 56 cases (60.2%) and was thus considered resolved. Preoperative characteristics revealed differences between the resolved J-sign and persistent J-sign groups for mean lateral patellar tilt, PT-LTR distance, TFJR, sulcus angle, trochlear depth, TT-TG distance, sagittal bump height, and LTI. The mean amount of distalization, patellotrochlear index, and preoperative and postoperative CDI were similar between the groups. Logistic regression identified TFJR, PT-LTR distance, and LTI as significant predictors of a persistent J-sign. An increased risk of a persistent J-sign was found for a TFJR ≥6° (odds ratio [OR], 14.9 [95% CI, 5.4-41.6]), PT-LTR distance ≥13 mm (OR, 12.3 [95% CI, 4.3-35.5]), and LTI ≤10° (OR, 4.1 [95% CI, 1.6-10.4]). The frequency of a persistent J-sign was 3.8% for cases with no risk factors above the threshold value, 10.5% with 1 risk factor, 63.0% with 2 risk factors, and 87.5% with all 3 risk factors present.CONCLUSIONA persistent J-sign was associated with imaging measurements of a more lateralized extensor mechanism (greater PT-LTR distance), trochlear dysplasia (lower LTI), and increased external TFJR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"45 1","pages":"3635465251336162"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893204","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":"Morphological Risk Factors for Pediatric Anterior Cruciate Ligament Tears and Tibial Spine Fractures","authors":"Chang Ho Shin, Akbar N. Syed, Morgan E. Swanson, J. Todd R. Lawrence, Soroush Baghdadi, Aristides I. Cruz, Henry B. Ellis, Peter D. Fabricant, Daniel W. Green, Alicia Kerrigan, Julia Kirby, Mininder Kocher, Indranil V. Kushare, R. Jay Lee, James P. MacDonald, Scott D. McKay, Shital N. Parikh, Neeraj M. Patel, Yi-Meng Yen, Gregory A. Schmale, Kevin G. Shea, R. Justin Mistovich, Theodore J. Ganley","doi":"10.1177/03635465251334120","DOIUrl":"https://doi.org/10.1177/03635465251334120","url":null,"abstract":"Background: Both tibial spine fractures (TSFs) and anterior cruciate ligament (ACL) tears result in functional loss of knee stability. Nonetheless, it remains unclear why some patients sustain ACL tears, whereas others have TSFs. Purpose: To identify the common morphological risk factors for pediatric ACL tears and TSFs and to determine the morphological differences between them using multiplanar reconstruction of magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 3. Methods: Age- and sex-matched participants (159 total [53 ACL tears, 53 TSFs, and 53 controls]) aged &lt;18 years who visited a pediatric tertiary-care center for ACL tears, TSFs, or anterior knee pain from March 2009 to April 2023 were included. Each group comprised 41 male and 12 female participants. Data on demographic characteristics and estimated bone age based on the knee MRI atlas were retrospectively collected, and various knee morphological parameters were evaluated using multiplanar reconstruction of MRI. Parameters showing significant differences among the 3 groups were selected as independent variables for multivariable multinomial logistic regression analysis, with the groups as dependent variables. Results: The mean chronological age at the time of MRI was 13.2 ± 2.3 years. Height, weight, body mass index, bone age, articular medial tibial slope, and bony medial tibial slope did not differ among the groups. Articular lateral tibial slope was independently associated with the occurrence of both ACL tears (relative risk ratio [RRR], 1.42 [95% confidence interval (CI), 1.16-1.74]; <jats:italic>P</jats:italic> = .001) and TSFs (RRR, 1.33 [95% CI, 1.10-1.62]; <jats:italic>P</jats:italic> = .004). A high notch width index was a protective factor against ACL tears (RRR, 0.86 [95% CI, 0.77-0.96]; <jats:italic>P</jats:italic> = .006) but not against TSFs (RRR, 1.01 [95% CI, 0.91-1.12]; <jats:italic>P</jats:italic> = .848). Conclusion: A high articular lateral tibial slope was a common risk factor for ACL tears and TSFs. Patients with ACL tears had a narrower intercondylar notch than those with TSFs and controls.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880655","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":"Sagittal Slope-Reducing High Tibial Osteotomy Decreases Anterior Cruciate Ligament Force and Coupled Internal Tibial Rotation Under Pivoting Loads: A Computational Modeling Study","authors":"Mark J. Amirtharaj, Reza Pourmodheji, Mitchell G.A. Wheatley, Julien Leluc, Andrew E. Pechstein, Jacob M. Hirth, Michael K. Parides, Thomas L. Wickiewicz, Andrew D. Pearle, Matthieu Ollivier, Carl W. Imhauser, Danyal H. Nawabi","doi":"10.1177/03635465251334649","DOIUrl":"https://doi.org/10.1177/03635465251334649","url":null,"abstract":"Background: Sagittal-plane slope-reducing high tibial osteotomy (HTO) can reduce the risk of anterior cruciate ligament (ACL) injury in knees with a high posterior tibial slope. The biomechanical effect of slope-reducing HTO on tibiofemoral kinematics and force carried by the ACL remains less well understood. Hypothesis: Decreased tibial slope will be associated with decreased ACL force, coupled internal tibial rotation (ITR), and anterior tibial translation (ATT) under both compressive and combined compressive and valgus loads. Study Design: Descriptive laboratory study. Methods: Computational models of 10 cadaveric knees were created using magnetic resonance imaging– and computed tomography–based 3-dimensional renderings of the bones, articular cartilage, and menisci. Virtual slope-reducing HTO was performed on each tibial geometry in 1° increments, creating tibial slopes spanning −5° to 15°. All knees were flexed to 15°, and loads consisting of (1) axial compression (100 N) and (2) combined axial compression (100 N) and valgus torque (8 N·m) were then applied to each knee at each tibial slope. The outcome measures were ACL force, coupled ITR, and ATT. Relationships between tibial slope and each outcome measure were assessed via linear regression (α = .05), and the effects of 10° slope-reducing HTO, from 15° to 5°, on each outcome measure were reported. Results: A 10° slope-reducing HTO decreased ACL force by 53% under compression (1.7 N of ACL force per degree decrease in tibial slope; <jats:italic>P</jats:italic> &lt; .001) and 47% under combined compression and valgus (4.7 N of ACL force per degree decrease in tibial slope; <jats:italic>P</jats:italic> &lt; .001). Regarding kinematics, a 10° slope-reducing HTO decreased coupled ITR by 64% under combined compression and valgus (0.99° of coupled ITR per degree decrease in tibial slope; <jats:italic>P</jats:italic> &lt; .001). Finally, a 10° slope-reducing HTO decreased ATT by 54% under compression (0.14 mm of ATT per degree decrease in tibial slope; <jats:italic>P</jats:italic> &lt; .001). Conclusion: Slope-reducing HTO decreased ACL force linearly by reducing ATT with compression and also by decreasing coupled ITR with combined compression and valgus. Clinical Relevance: Slope-reducing HTO decreased ATT and coupled ITR, dampening movements known to load the ACL. These findings may provide a further biomechanical basis for the ability of slope-reducing HTO to decrease the risk of ACL injury.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884302","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":"Saline Irrigation Mitigates Chondrocyte Viability Changes During Trochleoplasty","authors":"Andrew R. Phillips, Erik C. Haneberg, Thomas E. Moran, Zachary R. Oppenheim, Adam B. Yanke","doi":"10.1177/03635465251334655","DOIUrl":"https://doi.org/10.1177/03635465251334655","url":null,"abstract":"Background: Trochleoplasty aims to correct trochlear dysplasia, an osseous cause of patellar instability. The procedure involves the use of a high-speed bur directly under femoral articular cartilage, which may place chondrocytes at risk of thermal necrosis. Purpose/Hypothesis: The purpose of this study was to investigate the effect of irrigation and offset used during a trochleoplasty procedure on trochlear chondrocyte viability. It was hypothesized that thermal necrosis would be induced by burring and would be mitigated with saline irrigation. Study Design: Controlled laboratory study. Methods: Cadaveric trochlea were obtained and sectioned into 4 quadrants. Trochleoplasty was performed in each quadrant under one of the following randomized conditions: 3-mm offset with saline irrigation (3Wet), 3-mm offset without irrigation (3Dry), 5-mm offset with irrigation (5Wet), or 5-mm offset without irrigation (5Dry). A 3 × 8-mm strip of cartilage was obtained from the center of each quadrant and from an 8-mm control area. Cartilage samples underwent chondrocyte viability staining with calcein-acetoxymethyl and ethidium homodimer-1. Confocal imaging was performed, and viability across treatment and control groups was compared. Results: Eight cadaveric trochlea were obtained from 5 male and 2 female donors (mean age, 26.4 ± 5.6 years). Trochleoplasty was performed at a mean of 25.3 ± 1.3 days from donor death on 5 right and 3 left trochlea. On analysis, control cartilage viability (75.3% ± 12.9%) was greater than those for 5Dry (60.4% ± 9.3%; <jats:italic>P</jats:italic> = .001) and 3Dry (63.2% ± 13.4%; <jats:italic>P</jats:italic> = .002). Cartilage viabilities for 5Wet (70.5% ± 11.0%; <jats:italic>P</jats:italic> = .15) and 3Wet (66.1% ± 10.9%; <jats:italic>P</jats:italic> = .09) were not significantly different from that of the control. No other intergroup differences were seen. Conclusion: Saline irrigation mitigates chondrocyte-induced thermal necrosis when performing trochleoplasty in this cadaveric model. Clinical Relevance: Saline irrigation should be used when performing a trochleoplasty, while offset of the trochleoplasty bur does not have an effect on cartilage viability.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"221 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884306","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 Pectoralis Minor–Repairing Latarjet: A Modified Technique to Prevent Postoperative Scapular Dyskinesis After the Latarjet Procedure","authors":"Vittorio Candela, Marco Scacchi, Daniele De Meo, Yuri Piccolo, Claudio Ascani, Stefano Gumina","doi":"10.1177/03635465251332270","DOIUrl":"https://doi.org/10.1177/03635465251332270","url":null,"abstract":"Background: Latarjet is the gold standard procedure for treating anterior shoulder instability associated with significant bone loss. However, concerns arise regarding associated anatomic and mechanical changes, including release of the pectoralis minor tendon and alteration of the conjoint tendon vector. Recent studies have investigated alterations in scapular position and motion after Latarjet, with conflicting findings. Purpose: To evaluate the clinical outcomes and scapular position and motion in patients treated with the pectoralis minor–repairing Latarjet (PMRL) compared with traditional Latarjet (TL) after midterm follow-up. Study Design: Case-control study; Level of evidence, 3. Methods: A case-control study included 41 consecutive patients (27 men and 14 women; mean age, 37.4 years; mean body mass index, 26.4) with anterior recurrent shoulder instability. Patients underwent TL (21 patients) or PMRL (20 patients). Clinical evaluation, including Western Ontario Shoulder Instability Index (WOSI), Rowe score, and Subjective Shoulder Value (SSV), was performed preoperatively and at various postoperative intervals. Scapular position and motion were assessed using established protocols. Statistical analyses were conducted. Results: The mean follow-up was 34 months. No significant differences were observed in surgical time, clinical scores, or patient satisfaction between groups. Recurrence of dislocation occurred in 1 TL patient and persistent apprehension in 1 PMRL patient. Postoperative hematoma occurred in 1 TL patient. The rate of return to preoperative sport activity for the TL and PMRL groups was 93% and 95%, respectively ( <jats:italic>P</jats:italic> &gt; .05). Scapular dyskinesis occurred in 5 TL patients (25%) and 0 PMRL patients; in all cases, a type III dyskinesis was present. Four of 5 cases resolved with 6 months of a specific rehabilitation protocol. A significance difference was found between patients with and without dyskinesis, according to the WOSI, Rowe score, and SSV ( <jats:italic>P</jats:italic> &lt; .05). Scapular malposition was observed in 2 TL patients with dyskinesis. Conclusion: The study confirmed that postoperative scapular dyskinesis occurred frequently (25%) after the Latarjet procedure. A simple modification of the original technique, which consists of repairing the pectoralis minor to the coracoid stump, prevented the risk of postoperative dyskinesis, maintaining the stabilizing benefits of the TL procedure.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884310","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}