The American Journal of Sports Medicine最新文献

{"title":"Assessing Glenoid Defects in Anterior Shoulder Instability: Comparison of a Simple Linear Formula Method With Traditional Methods Using 3-Dimensional Computed Tomography.","authors":"Long Pang,Peng Zeng,Pengcheng Li,Zhengfeng Pan,Songyun Yang,Chunsen Zhang,Jiapeng Wang,Lei Yao,Yinghao Li,Tao Li,Xin Tang","doi":"10.1177/03635465241309307","DOIUrl":"https://doi.org/10.1177/03635465241309307","url":null,"abstract":"BACKGROUNDAnterior glenoid bone defects significantly influence surgical outcomes in shoulder instability cases. Various measurement methods based on 3-dimensional computed tomography (3D-CT) have been developed. Recently, the simple linear formula method, which establishes a correlation between glenoid height and width, has emerged as a promising technique.PURPOSEThis study aimed to assess the differences in glenoid morphology between patients with anterior shoulder instability and healthy controls within a specific East Asian population (Han Chinese). The objectives included establishing linear formulas specific to both groups and comparing the efficacy of the simple linear formula method with traditional methods for measuring glenoid defects using 3D-CT.STUDY DESIGNCohort study (diagnosis); Level of evidence, 3.METHODS3D-CT images of both the affected and unaffected shoulders of patients with anterior shoulder instability, as well as one shoulder of healthy controls, were analyzed. Glenoid height and width were measured, and linear formulas were established for this specific Han Chinese population. P values were determined using linear regression analysis to assess the statistical significance of the relationship between glenoid height (H) and width (W). A P value <.05 indicated a statistically significant relationship. R2 values were calculated to determine the strength of the relationship, with higher values (closer to 1) indicating a stronger correlation. The glenoid defect ratio was calculated using the simple linear formula method and compared with traditional methods: the Griffith, linear-based best-fit circle, and area-based best-fit circle methods. Interrater agreement was assessed using intraclass correlation coefficients (ICCs).RESULTSThere were 206 patients in the patient group and 206 participants in the healthy control group. In the patient group, the mean glenoid height and width of the unaffected shoulders were 35.21 ± 3.39 and 24.26 ± 2.74 mm, respectively (formula: W = 0.75H - 2.12; R2 = 0.86; P < .001). In the male patient subgroup, they were 37.57 ± 1.35 and 26.23 ± 0.91 mm, respectively (formula: W = 0.47H + 8.60; R2 = 0.79; P < .001). In the female patient subgroup, they were 31.63 ± 2.21 and 21.26 ± 1.65 mm, respectively (formula: W = 0.52H + 4.78; R2 = 0.74; P < .001). In the healthy control group, the mean glenoid height and width were 33.48 ± 3.32 and 24.18 ± 3.02 mm, respectively (formula: W = 0.86H - 4.58; R2 = 0.89; P < .001). In the male healthy control subgroup, they were 36.43 ± 1.35 and 26.89 ± 1.17 mm, respectively (formula: W = 0.67H + 2.63; R2 = 0.58; P < .001). In the female healthy control subgroup, they were 30.54 ± 1.70 and 21.47 ± 1.49 mm, respectively (formula: W = 0.61H + 2.90; R2 = 0.69; P < .001). The actual glenoid defect in the entire patient cohort averaged 12.3% ± 5.9%. The simple linear formula method demonstrated an ICC of 0.82, with a glenoid defect ratio averaging 15.7% ± 6.9%. The Griffith m","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"32 1","pages":"3635465241309307"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991801","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 Statistical Fragility of Functional Outcomes for Arthroscopic Rotator Cuff Repair With and Without Acromioplasty: A Systematic Review and Meta-analysis.","authors":"David S Clark,Benjamin C Tingey,Jeffrey L Shi,Jeremy S Somerson","doi":"10.1177/03635465241302797","DOIUrl":"https://doi.org/10.1177/03635465241302797","url":null,"abstract":"BACKGROUNDViews surrounding acromioplasty at the time of arthroscopic rotator cuff repair (RCR) have shifted dramatically over time. In recent years, various studies have argued against acromioplasty, citing equivocal functional outcomes after arthroscopic RCR with or without acromioplasty.PURPOSETo assess the statistical fragility of functional outcomes after arthroscopic RCR with and without acromioplasty using the reverse continuous fragility index (RCFI).STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 3.METHODSA systematic review and meta-analysis was performed including all randomized controlled trials through February 5, 2024 investigating arthroscopic RCR with and without acromioplasty. The RCFI, defined as the number of qualifying data points required to be moved from the lower mean group to the higher mean group to alter the significance, was calculated for the Welch t test, Student t test, and Wilcoxon rank-sum test under various data assumptions. The reverse continuous fragility quotient (RCFQ) was determined by dividing the RCFI by the sample size.RESULTSA total of 6 clinical trials consisting of 609 patients with functional outcome scores were analyzed. Using the Welch t test, the median RCFI across all study outcomes was 20 (interquartile range [IQR], 17-24). For the Student t test, the median RCFI across all study outcomes was 14 (IQR, 13-19), with a median RCFQ of 0.18 (IQR, 0.15-0.20). For the Wilcoxon rank-sum test, the median RCFI was 14 (IQR, 13-17), with a median RCFQ of 0.17 (IQR, 0.13-0.19). While using the Welch t test, 64% of study outcomes had an RCFI greater than the loss to follow-up (LTFU). When using the other tests, 32% of study outcomes had an RCFI greater than the LTFU.CONCLUSIONThe fragility of these studies was largely dependent on the statistical test used to analyze the results. The Wilcoxon rank-sum test and Student t test appeared to be most appropriate to find differences in treatment arms. When using these tests, we found the results to be fragile. This, in combination with a small number of studies and the LTFU close to or exceeding 20%, indicates an overall lack of strong evidence to support previously accepted conclusions.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"32 1","pages":"3635465241302797"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991685","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 and Graft Failure Rates After Primary Anterior Cruciate Ligament Reconstruction With a Bone-Patellar Tendon-Bone Versus Hamstring Tendon Autograft: A Systematic Review and Meta-analysis.","authors":"John Patrick Connors,Antonio Cusano,Jayson Saleet,Kevin A Hao,Kristian Efremov,Robert L Parisien,Romain Seil,Xinning Li","doi":"10.1177/03635465241295713","DOIUrl":"https://doi.org/10.1177/03635465241295713","url":null,"abstract":"BACKGROUNDAnterior cruciate ligament (ACL) tears are frequent injuries in athletes that often require surgical reconstruction so that patients may return to their previous levels of performance. While existing data on patient-reported outcomes are similar between bone-patellar tendon-bone (BTB) and hamstring tendon (HT) autografts, the literature regarding return to sport (RTS), return to previous levels of sport activity, and graft failure rate remains limited.PURPOSETo compare rates of RTS, return to previous activity levels, and graft retears among athletes undergoing primary ACL reconstruction using a BTB versus HT autograft.STUDY DESIGNSystematic review and meta-analysis; Level of evidence, 4.METHODSThe MEDLINE, Embase, and Cochrane Library databases were queried, and studies reporting on RTS after primary ACL reconstruction using a BTB or HT autograft were included. Exclusion criteria included revision reconstruction, ACL repair, quadriceps tendon autografts, allografts, graft augmentation, or double-bundle autografts. Rates of RTS, return to previous levels of activity, and retears were extracted and analyzed across included studies.RESULTSA total of 33 articles met inclusion criteria, with a patient cohort of 4810 athletes. The overall RTS rate for all athletes was 80.4% (95% CI, 75.3%-84.6%) at a mean follow-up of 35.7 months, with 54.6% (95% CI, 48.5%-60.6%) returning to preinjury levels of activity. No significant difference was found between BTB and HT autografts with respect to rates of RTS, return to preinjury activity levels, or reruptures. The overall RTS rate in patients after primary ACL reconstruction with a BTB autograft was 83.3% (95% CI, 77.0%-88.2%), with 56.1% (95% CI, 49.3%-62.7%) returning to preinjury levels of activity. Conversely, the overall RTS rate in patients after primary ACL reconstruction with an HT autograft was 77.9% (95% CI, 70.3%-84.0%), with 53.5% (95% CI, 42.8%-63.9%) returning to preinjury levels of activity. The overall graft rerupture rate for the entire patient cohort was 3.6% (95% CI, 2.5%-5.1%), for patients with BTB grafts was 3.2% (95% CI, 1.9%-5.3%), and for patients with HT grafts was 4.4% (95% CI, 2.8%-6.8%).CONCLUSIONPrimary ACL reconstruction using BTB autografts demonstrated similar rates of RTS, return to previous activity levels, and reruptures compared with reconstruction using HT autografts.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"8 1","pages":"3635465241295713"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991643","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":"Pitch Types and Their Influence on Elbow Varus Torque and Spin Rate in Professional Baseball Pitchers.","authors":"Alexander J Hodakowski,Brittany Dowling,John T Streepy,Bjorn Olmanson,Logan Schmitt,Marc J Richard,Nikhil N Verma,Grant E Garrigues","doi":"10.1177/03635465241309316","DOIUrl":"https://doi.org/10.1177/03635465241309316","url":null,"abstract":"BACKGROUNDElbow injuries are prevalent among professional baseball pitchers as nearly 25% undergo ulnar collateral ligament reconstruction. Pitch type, ball velocity, and spin rate have been previously hypothesized to influence elbow varus torque and subsequent risk of injury, but existing research is inconclusive.PURPOSETo examine elbow varus torque, cumulative torque, and loading rate within professional pitchers throwing fastball, curveball, change-up, and slider pitches, as well as to identify potential influences of ball spin on the elbow.STUDY DESIGNDescriptive laboratory study.METHODSA total of 31 professional pitchers (mean height, 189.0 ± 5.7 cm; mean weight, 91.7 ± 8.2 kg) were analyzed using motion capture (480 Hz) and TrackMan while throwing a full bullpen of pitches consisting of fastballs, curveballs, change-ups, and sliders. Elbow varus torque, loading rate, cumulative torque, and spin rate were calculated and analyzed using linear regression to establish within-player and mixed-effects models to establish between-player differences in pitch types.RESULTSAnalyzed by individual pitcher, fastballs exhibited significantly higher mean ball velocity and elbow varus torque (40.4 ± 0.6 m/s; 90.1 ± 3.5 N·m) (all P < .001) and peak elbow varus torque compared with curveballs (33.4 ± 0.6 m/s; 87.5 ± 2.7 N·m), change-ups (36.4 ± 0.6 m/s; 81.3 ± 2.4 N·m), and sliders (36.2 ± 0.7 m/s; 87.7 ± 2.7 N·m). Fastball pitches had a significantly greater cumulative elbow varus torque and loading rate compared to all pitch types within a pitcher (P < .001). Despite the lower peak elbow varus torque and loading rate, the change-up pitch had the second highest cumulative torque. Curveballs were found to have the lowest cumulative elbow varus torque. No significant relationship was found between spin rates and elbow varus torque across pitch types.CONCLUSIONFastballs produced the greatest ball velocity, peak elbow varus torque, loading rate, and cumulative torque among the 4 pitch types analyzed in professional pitchers. Although spin rate has become a popular topic in modern pitching strategies and analyses, this study found no significant relationship between spin rate and elbow varus torque across pitch types, suggesting that spin rate alone may not be a reliable predictor of elbow torque or injury.CLINICAL RELEVANCEThese findings suggest that pitch type, rather than spin rate, should be considered when assessing risk of elbow injuries in professional pitchers.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"74 1","pages":"3635465241309316"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991799","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":"A Descriptive Analysis of the Seasonal Patterns of Bone Stress Injury Incidence in Division I Collegiate Distance Runners.","authors":"Axel Wolff,Lianne M Kurina,Kristin L Sainani,Adam S Tenforde,Aurelia Nattiv,Michael Fredericson","doi":"10.1177/03635465241307231","DOIUrl":"https://doi.org/10.1177/03635465241307231","url":null,"abstract":"BACKGROUNDA bone stress injury (BSI) is a common overuse injury in collegiate athletes, particularly cross-country and track and field runners. Limited work describes the seasonality of BSIs or the differences in rates and anatomic locations of BSIs in collegiate runners.PURPOSETo describe seasonally related trends in anatomic locations of BSIs in National Collegiate Athletic Association (NCAA) Division I male and female middle- and long-distance runners.STUDY DESIGNDescriptive epidemiological study.METHODSData from a 7-year prospective study of 2 NCAA Division I cross-country and track and field programs characterized BSIs over the years 2013 to 2020. Femoral neck, pelvic, sacral, lumbar spine, and calcaneal BSIs were considered trabecular-rich. All remaining BSIs were classified as cortical-rich. Total athlete-years of follow-up were calculated by subtracting the number of days an athlete was unable to run from the number of total study participation days. Annual incidence rates were calculated by dividing the number of BSIs by the total athlete-years of follow-up for that year, and monthly incidence rates were calculated by dividing the number of BSIs in a given month by the total athlete-years of follow-up for that month.RESULTSParticipants included 221 collegiate distance runners (114 female, 107 male). There were 154 BSIs across 482 total athlete-years, resulting in an incidence rate of 32 BSIs per 100 athlete-years. The female BSI rate was more than double that of the male BSI rate: 45 versus 20 BSIs per 100 athlete-years, respectively. The highest monthly BSI rates occurred during competitive months, with the lowest monthly BSI rates occurring during noncompetitive months. Tibial and femoral shaft BSI rates peaked during the early competitive phases of each season, whereas metatarsal BSI rates remained relatively constant. Cortical-rich BSI rates varied by sex and seasonal phase, whereas trabecular-rich BSI rates remained relatively consistent.CONCLUSIONBSIs were common in collegiate distance runners, especially among female athletes, with higher rates during the competitive phases of the running season. Tibial and femoral shaft BSI rates were highest during the competitive phases and lowest during the noncompetitive phases, while metatarsal BSI rates remained consistent throughout the season. Cortical-rich BSI rates varied by seasonal phase and sex, whereas trabecular-rich BSI rates were relatively constant.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"10 1","pages":"3635465241307231"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991800","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 On-Snow Performance in Ski Racing After Anterior Cruciate Ligament Reconstruction.","authors":"Nathaniel Morris,Ricardo da Silva Torres,Mark Heard,Patricia Doyle Baker,Walter Herzog,Matthew J Jordan","doi":"10.1177/03635465241307212","DOIUrl":"https://doi.org/10.1177/03635465241307212","url":null,"abstract":"BACKGROUNDThe individual variation in on-snow performance outcomes after anterior cruciate ligament (ACL) reconstruction (ACLR) in elite alpine ski racers has not been reported and may be influenced by specific injury characteristics.PURPOSETo report the performance statistics of elite ski racers before and after ACLR and to identify surgical and athlete-specific factors that may be associated with performance recovery.STUDY DESIGNDescriptive epidemiological study.METHODSInternational Ski and Snowboard Federation (FIS) points, FIS ranking, average placing, and average percentage behind the winning time in each race were calculated for 30 national and provincial team ski racers at 1 year before and 3 years after ACLR. Injury characteristics were obtained from operative reports and clinical notes.RESULTSThe mean age at the time of primary ACLR was 21.6 ± 3.5 years. Overall, 27 of 30 (90%) ski racers returned to the same preinjury competition level. Yet, only 16 of 30 (53%) improved in FIS points, and 13 of 30 (43%) improved in FIS ranking, in one of the speed or technical disciplines by 3 years after surgery. Of the skiers who improved in FIS points, 36% sustained multiligamentous injuries, 45% sustained meniscal tears, and 45% sustained chondral lesions. Of those who failed to improve in FIS points, 50% sustained multiligamentous injuries, 50% sustained meniscal tears, and 60% sustained chondral lesions. Meniscal tears and chondral lesions occurred mostly on the lateral side. The medial collateral ligament was involved in 8 of 9 multiligamentous injuries.CONCLUSIONThese findings suggest significant individual variation in the recovery of on-snow performance of ski racers after ACLR, despite returning to the same competition circuit. The pattern of secondary injuries alongside primary ACL ruptures showed little association with improved performance.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"121 1","pages":"3635465241307212"},"PeriodicalIF":0.0,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991648","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":"Sex-Based Differences in the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: 10-Year Outcomes With a Nested Propensity-Matched Comparison","authors":"Benjamin G. Domb, Allison Y. Kufta, Yasemin E. Kingham, Payam W. Sabetian, W. Taylor Harris, Paulo A. Perez-Padilla","doi":"10.1177/03635465241302806","DOIUrl":"https://doi.org/10.1177/03635465241302806","url":null,"abstract":"Background:Sex has been associated with different pathologic characteristics in painful hips undergoing hip arthroscopic surgery.Purpose:To compare minimum 10-year patient-reported outcomes (PROs) and survivorship in patients who underwent primary hip arthroscopic surgery for femoroacetabular impingement syndrome and labral tears according to sex.Study Design:Cohort study; Level of evidence, 3.Methods:Data from patients who underwent primary hip arthroscopic surgery between March 2009 and May 2011 were reviewed. Patients with minimum 10-year PROs for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain were eligible. Exclusion criteria included previous ipsilateral hip conditions or surgical procedures, Tönnis grade &gt;1, or dysplasia (lateral center-edge angle &lt;25°). In the subanalysis, female patients were matched to male patients using a 1:1 ratio by age, sex, and body mass index.Results:A total of 375 hips had a minimum 10-year follow-up. There were 249 female (mean age, 36.8 ± 13.1 years) and 126 male (mean age, 38.9 ± 13.1 years) hips. Survivorship was defined as no conversion to total hip arthroplasty. Female and male hips exhibited similarly high rates of survivorship (80.3% vs 72.2%, respectively; P = .076). Female hips underwent secondary arthroscopic surgery at a statistically higher rate of 14.5% ( P = .021) and had higher rates of capsular repair and iliopsoas fractional lengthening ( P &lt; .0001 and P &lt; .001, respectively). Male hips had a significantly higher rate of acetabular labrum articular disruption/Outerbridge grade 3 and 4 damage at 54.0% compared with female hips (both P &lt; .001) and underwent femoroplasty and acetabular microfracture at significantly higher rates of 88.1% versus 51.0%, respectively, and 16.7% versus 4.8%, respectively (both P &lt; .001). In the subanalysis, both groups showed significant improvements in all PROs from baseline (all P &lt; .001). Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher self-reported mean satisfaction score of 9.0 compared with 8.4 ( P = .003) and a greater magnitude of improvement in 10-year PROs (ΔmHHS: 29.3 ± 17.5 vs 23.1 ± 19.8, respectively [ P = .036]; ΔNAHS: 33.2 ± 21.3 vs 25.1 ± 19.5, respectively [ P = .012]; ΔHOS-SSS: 47.0 ± 32.0 vs 32.7 ± 31.9, respectively [ P = .008]; and ΔVAS: –4.6 ± 2.7 vs −3.5 ± 2.0, respectively [ P = .009]). However, all PROs at a minimum 10-year follow-up were similar between the groups.Conclusion:After undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome, both female and male patients reported significant improvements in all PROs at a minimum 10-year follow-up and high patient satisfaction, with similar final functional scores. Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher satisfaction","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988885","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":"Kinetics During the Tuck Jump Assessment and Biomechanical Deficits in Female Athletes 12 Months After ACLR Surgery","authors":"Lucy S. Kember, Christopher D. Riehm, Andrew Schille, Jake A. Slaton, Jon L. Oliver, Gregory D. Myer, Rhodri S. Lloyd","doi":"10.1177/03635465241308579","DOIUrl":"https://doi.org/10.1177/03635465241308579","url":null,"abstract":"Background:Residual interlimb deficits after anterior cruciate ligament reconstruction (ACLR) can lead to functional maladaptation and increase the risk of reinjury. The tuck jump assessment (TJA) may offer a more effective evaluation of ACLR status as compared with traditional tasks owing to increased risk of altered landing mechanics, asymmetrical landing, and increased knee valgus attributed to the cyclical nature of the task. However, it remains unclear whether altered TJA kinetics resolve over time or persist through return-to-play phases of rehabilitation.Purpose:To examine longitudinal kinetics, asymmetries, and functional performance deficits during TJA at 9 and 12 months after ACLR in female athletes at high risk of reinjury.Study Design:Cohort study; Level of evidence, 2.Methods:Female athletes (ACLR, n = 24; controls, n = 19; total, N = 43) performed a single trial of TJA on dual-force plates at 2 time points. The ACLR group (mean ± SD age, 16.8 ± 1.9 years) was tested at 9 and 12 months after surgery, and the control group (16.5 ± 3.6 years) was tested at similar time points. All athletes participated in similar sports and had comparable activity levels. Discrete time point analysis and statistical parametric mapping were used to identify deficits within each group.Results:At 9 months after surgery, the ACLR group exhibited significant interlimb differences in all kinetic variables ( P &lt; .05), which persisted at 12 months with only small reductions in magnitude. As compared with controls, the ACLR group demonstrated a persistent offloading strategy in the involved limb by exhibiting larger interlimb asymmetries for a range of kinetic variables and a greater vertical ground-reaction force in the uninvolved limb during most of the stance phase at both time points ( P &lt; .001). Distinct differences in functional performance of TJA were evident at both time points, characterized by lower peak vertical ground-reaction force, peak center of mass displacement, and relative vertical leg stiffness and longer ground contact times ( P &lt; .001).Conclusion:This study revealed that young female athletes after ACLR exhibit persistent interlimb deficits and functional maladaptations up to 12 months after surgery. The TJA identified significant biomechanical impairments to both limbs, resulting in asymmetrical loading and altered movement strategies as compared with healthy controls. Despite some improvements, athletes with ACLR continued to demonstrate offloading to the uninvolved limb, indicating incomplete neuromuscular recovery.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"98 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142988835","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 Continuous Fragility Index of Statistically Significant Findings in Studies Based on High Levels of Evidence Comparing Interventions for Femoroacetabular Impingement Syndrome","authors":"Juan Bernardo Villarreal-Espinosa, Zeeshan A. Khan, Kyleen Jan, Rodrigo Saad Berreta, Michael J. Murray, Felicitas Allende, Shane J. Nho, Jorge Chahla","doi":"10.1177/03635465241283967","DOIUrl":"https://doi.org/10.1177/03635465241283967","url":null,"abstract":"Background:Critical analysis of studies with high level of evidence has relied on the significance set by the reported P values. However, this strategy steers readers toward categorical interpretation of the data; therefore, a more comprehensive approach of data analysis is warranted. The continuous fragility index (CFI) allows for frailty interpretation of any given study's continuous outcome results.Purpose:To calculate the CFI of high-level quality studies reporting significant continuous outcomes on comparison of treatment modalities for management of femoroacetabular impingement syndrome.Study Design:Meta-analysis; Level of evidence, 2.Methods:Three databases (PubMed, Embase, Cochrane) were queried from inception to February 2024 utilizing Boolean operators to combine variations of the following search terms: “femoroacetabular impingement, randomized controlled trials or prospective cohort.” Studies were included if level of evidence 1 or 2, and a statistically significant outcome was reported for any continuous outcome. CFI calculation was performed for all significant outcomes to obtain a study-specific mean CFI and also for the primary outcome of each study. Mean CFI was also calculated for outcomes reported to be significant in &gt;3 studies. Additionally, multivariable linear regression was utilized for assessment of variables associated with achievement of a higher CFI.Results:Thirteen studies totaling 1316 patients were included for analysis: 11 level of evidence 1 and 2 level of evidence 2 studies. A total of 48 outcomes reaching significance were extracted, with 8 representing primary outcomes. Study-specific mean (SD) CFI was 8 (9.3), whereas primary outcome mean CFI was 12.5 (12). In 4 of the 13 studies, the number of hips lost to follow-up was greater than the study CFI. Outcome-specific mean CFI was obtained for 5 outcomes reported in &gt;3 studies. Multivariable linear regression revealed that larger sample size and greater journal impact factor had a significant positive association with a higher overall CFI value ( P &lt; .05).Conclusion:The mean (SD) number of patient outcome events needed to reverse the significance of a continuous outcome (ie, CFI) was 8.0 (9.3). Nearly one-third of studies had a CFI less than the reported loss to follow-up, reflecting the need for better patient compliance to attain less fragile statistical results. Larger sample size and greater journal impact factor were both predictive of a higher CFI.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967749","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":"Biomechanical Properties of Meniscal Repair Versus Meniscectomy for Horizontal Meniscal Tears: A Systematic Review","authors":"Christian A. Pearsall, Sohil S. Desai, Christian Athanasian, Dana P. Piasecki, Bryan M. Saltzman, Hasani Swindell, David P. Trofa","doi":"10.1177/03635465241279844","DOIUrl":"https://doi.org/10.1177/03635465241279844","url":null,"abstract":"Background:Limited biomechanical evidence exists describing how horizontal meniscus tears (HMTs), meniscal repair (MR), and meniscectomy alter the knee's biomechanical environment.Purpose:To evaluate changes in knee contact mechanics following HMTs, MR, and meniscectomy.Study Design:Systematic review; Level of evidence, 5.Methods:PubMed, EMBASE, and CINAHL databases were systematically searched for biomechanical cadaveric studies of HMTs up to January 16, 2023, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that (1) did not examine MRs or meniscectomies, (2) did not report contact area (CA) or pressure, (3) involved concomitant injuries (eg, anterior cruciate ligament tear), (4) were nonbiomechanical studies (eg, review, technique, and clinical), and (5) were non-English language articles were excluded. The endpoints were peak contact pressure (PCP) and mean CA.Results:Out of 1526 initial results, 6 studies were included for final review. PCP and CA were measured in 59 intact menisci, 59 HMTs, 59 partial meniscectomies (PM), 59 complete meniscectomies (CM), and 33 MR. Among all HMTs versus the intact state, pooled PCP increased by 14.2%, and pooled CA decreased by 7.1%. Among all PMs versus the intact state, 4 of 6 studies found significantly increased PCP (27.1%), and 5 found significantly reduced CA (22.1%). Among all CMs versus the intact state, all 6 studies found significantly increased PCP (54.5%), and 5 found significantly reduced CA (33%). Among the 3 studies directly comparing PM to CM, 2 studies found PM to have significantly smaller increases in PCP (23.3% vs 52.4%) and significantly smaller reductions in CA (16.7% vs 28.1%) from the intact state.) The 3 studies evaluating MR versus the intact state found no significant difference in PCP or CA.Conclusion:After an HMT, MR had the smallest deviations in contact mechanics; only MR restored contact mechanics to the uninjured state. These findings support MR's superiority, illustrate that maintaining contact mechanics requires preserving meniscal tissue, and are consistent with clinical evidence. More clinical comparisons are needed to understand the differences among treatments.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967750","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}