The American Journal of Sports Medicine最新文献

{"title":"Ten-Year Outcomes in Patients Aged 40 Years and Older After Primary Arthroscopic Treatment of Femoroacetabular Impingement With Labral Repair","authors":"Benjamin G. Domb, Jade S. Owens, Ajay C. Lall, W. Taylor Harris, Benjamin D. Kuhns","doi":"10.1177/03635465241270291","DOIUrl":"https://doi.org/10.1177/03635465241270291","url":null,"abstract":"Background:Arthroscopic labral repair has been shown to result in favorable short- and midterm outcomes; however, the durability of outcomes specifically in older patients remains underreported.Purpose:To (1) report prospectively collected hip preservation rates and patient-reported outcome measures (PROMs) at a minimum 10-year follow-up in patients aged ≥40 years after primary hip arthroscopy with labral repair and (2) perform a matched analysis comparing patients aged ≥40 years with patients aged <40 years.Study Design:Cohort study; Level of evidence, 3.Methods:Data were prospectively collected and retrospectively reviewed on all patients who underwent primary hip arthroscopy between February 2008 and December 2011. Patients aged ≥40 years who underwent labral repair were included. Preoperative and minimum 10-year follow-up scores were collected for multiple PROMs. Propensity score matching was utilized to compare these patients with a cohort of patients <40 years.Results:Of the 113 hips eligible, 91 hips (80.5%) on 85 patients (6 bilateral) had a minimum 10-year follow-up. There were 58 women (68%) and 27 men (32%) with a mean age and body mass index of 47.8 years and 25.8, respectively. The hip preservation rate for patients aged ≥40 years was 78%, with 20 patients requiring arthroplasty during the study period. There was significant improvement in all PROMs from baseline to minimum 10-year follow-up with high rates of achieving the minimal clinically important difference and Patient Acceptable Symptom State clinical outcome thresholds. In total, 69 patients aged ≥40 years were propensity matched to 107 patients <40 years. Patients ≥40 tended to have a lower hip preservation rate (81.2% vs 91.6%; P = .06), while patients in the younger cohort had significantly higher rates of secondary hip arthroscopy (14% vs 3%; P = .02). Improvement in PROMs was comparable between the groups.Conclusion:Patients ≥40 years who underwent primary hip arthroscopy with labral repair demonstrated a hip preservation rate of 78%, significant and durable improvement in PROMs, and high rates of satisfaction at a minimum 10-year follow-up. Matched analysis with patients <40 years revealed comparable improvement in patient-reported outcomes between the 2 groups, with a tendency to a higher level of arthroplasty in patients ≥40 years.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100830","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":"Load Distribution After Serial Resection of the Posterior Horn of the Lateral Meniscus and Subsequent Meniscal Allograft Transplant: A Biomechanical Study","authors":"Luiz Felipe Ambra, Alexandre Barbieri Mestriner, Jakob Ackermann, Enzo S. Mameri, Andreas H. Gomoll","doi":"10.1177/03635465241264211","DOIUrl":"https://doi.org/10.1177/03635465241264211","url":null,"abstract":"Background:Data are lacking as to when a meniscal allograft transplant (MAT) may be biomechanically superior to a partially resected lateral meniscus.Hypothesis:Lateral MAT using a bone bridge technique would restore load distribution and contact pressures in the tibiofemoral joint to levels superior to those of a partial lateral meniscectomy.Study Design:Controlled laboratory study.Methods:Eleven fresh-frozen human cadaveric knees were evaluated in 5 lateral meniscal testing conditions (native, one-third posterior horn meniscectomy, two-thirds posterior horn meniscectomy, total meniscectomy, MAT) at 3 flexion angles (0°, 30°, and 60°) under a 1600-N axial load. Pressure sensors were used to acquire contact pressure, contact area, and peak contact pressure within the tibiofemoral joint.Results:Limited (one-third and two-thirds) partial lateral posterior horn meniscectomy showed no significant increase in mean and peak contact pressures as well as no significant decrease in contact area compared with the intact state. Total meniscectomy significantly increased mean contact pressure at 0° and 30° ( P = .008 and P < .001, respectively), increased peak contact pressure at 30° ( P = .04), and decreased mean contact area in all flexion angles compared with the native condition ( P < .01). Lateral MAT significantly improved mean contact pressure compared with total meniscectomy at 0° and 30° ( P = .002 and P = .003, respectively) and increased contact area at 30° and 60° ( P = .003 and P = .009, respectively), although contact area was still significantly smaller (24.1%) after MAT relative to the native meniscus (P = 0.015). However, allograft transplant did not result in better tibiofemoral contact biomechanics compared with limited partial meniscectomy ( P > .05).Conclusion:The peripheral portion of the lateral meniscus provided the most important contribution to the distribution of contact pressure across the tibiofemoral joint in the cadaveric model. Total meniscectomy significantly increased mean and peak contact pressure in the cadaveric model and decreased contact area. Lateral MAT restored contact biomechanics close to normal but was not superior to the partially meniscectomized status.Clinical Relevance:Surgeons should attempt to preserve a peripheral rim of the posterior lateral meniscus. Meniscal allograft transplant appears to improve but not normalize mean contact pressure and contact area relative to total lateral meniscectomy.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100831","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":"Alpha-2-Macroglobulin Attenuates Posttraumatic Osteoarthritis Cartilage Damage by Inhibiting Inflammatory Pathways With Modified Intra-articular Drilling in a Yucatan Minipig Model","authors":"Changqi Sun, Kenny Chang, Braden C. Fleming, Brett D. Owens, Jillian E. Beveridge, Yu Zhao, Guoxuan Peng, Lei Wei","doi":"10.1177/03635465241272401","DOIUrl":"https://doi.org/10.1177/03635465241272401","url":null,"abstract":"Background:Posttraumatic osteoarthritis (PTOA) arises secondarily to joint trauma and is driven by catabolic inflammatory pathways. Alpha-2-macroglobulin (α<jats:sub>2</jats:sub>M) is a naturally occurring proteinase inhibitor found in human serum and synovial fluid that binds proteases as well as proinflammatory cytokines involved in the pathogenesis of PTOA.Purpose:(1) To investigate the therapeutic potential of intra-articular α<jats:sub>2</jats:sub>M injections during the acute stages of PTOA by inhibiting inflammatory pathways driven by the cytokines expressed by the synovium in a large preclinical Yucatan minipig model and (2) to determine if 3 intra-articular α<jats:sub>2</jats:sub>M injections have greater chondroprotective effects compared with 1 intra-articular injection.Study Design:Controlled laboratory study.Methods:A total of 48 Yucatan minipigs were randomized into 4 groups (n = 12 each): (1) modified intra-articular drilling (mIAD) and saline (mIAD + saline), (2) mIAD and 1 intra-articular α<jats:sub>2</jats:sub>M injection (mIAD +α<jats:sub>2</jats:sub>M-1), (3) mIAD and 3 α<jats:sub>2</jats:sub>M injections (mIAD +α<jats:sub>2</jats:sub>M-3), and (4) sham control. Surgical hindlimbs were harvested at 15 weeks after surgery. Cartilage degeneration, synovial changes, inflammatory gene expression, and matrix metalloproteinase levels were evaluated. Gait asymmetry was measured before and after surgery using a pressure-sensing walkway system.Results:Macroscopic lesion areas and microscopic cartilage degeneration scores were lower in the mIAD +α<jats:sub>2</jats:sub>M-1 and mIAD +α<jats:sub>2</jats:sub>M-3 groups compared with the mIAD + saline group ( P < .05) and similar to those in the sham group ( P > .05). Synovial membrane scores of the mIAD +α<jats:sub>2</jats:sub>M-1 and mIAD +α<jats:sub>2</jats:sub>M-3 groups were lower than that of the mIAD + saline group ( P < .05) and higher than that of the sham group ( P < .05). Interleukin-1 beta, nuclear factor kappa B, and tumor necrosis factor alpha mRNA expression in the synovium and matrix metalloproteinase-1 levels in synovial fluid were significantly lower in the mIAD +α<jats:sub>2</jats:sub>M-1 and mIAD +α<jats:sub>2</jats:sub>M-3 groups compared with the mIAD + saline group ( P < .05). No significant differences were observed between the mIAD +α<jats:sub>2</jats:sub>M-1 and mIAD +α<jats:sub>2</jats:sub>M-3 groups for all measured outcomes. There were early changes in gait ( P < .05) between preoperative and postoperative time points for the mIAD + saline, mIAD +α<jats:sub>2</jats:sub>M-1, and mIAD +α<jats:sub>2</jats:sub>M-3 groups that normalized by 15 weeks.Conclusion:Animals receiving early α<jats:sub>2</jats:sub>M treatment exhibited less cartilage damage, milder synovitis, and lower inflammation compared with animals with no α<jats:sub>2</jats:sub>M treatment. These results exemplify the early anti-inflammatory effects of α<jats:sub>2</jats:sub>M and prov","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100832","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":"Differences in Graft Tear Configurations in Medial and Lateral Meniscal Allograft Transplantation: Objective Evaluations Using Magnetic Resonance Imaging","authors":"Jongjin Lee, Jong-Min Kim, Bum-Sik Lee, Seong-Il Bin, Taehyeon Jeon, Kinam Bae, Donghyok Kim","doi":"10.1177/03635465241271592","DOIUrl":"https://doi.org/10.1177/03635465241271592","url":null,"abstract":"Background:Few studies have compared the characteristics of meniscal allograft tears between medial and lateral meniscal allograft transplantation (MAT) using bone fixation.Purpose:To investigate the prevalence, location, and patterns of allograft tears after MAT with the bone fixation technique and compare tear patterns between medial and lateral compartments according to the time elapsed after surgery.Study Design:Cohort study; Level of evidence, 3.Methods:The charts of consecutive patients who underwent primary medial or lateral MAT between December 1996 and June 2019 were retrospectively reviewed. The location, pattern, and postoperative periods during which allograft tears occurred were evaluated by reviewing all series of follow-up magnetic resonance imaging (MRI) scans, which were performed at 6 weeks, 3 months, 6 months, and 1 year postoperatively and every 2 years thereafter with the patient's agreement. Postoperative periods for allograft tears were defined as the time between surgery and the follow-up MRI scan in which the meniscal tear was first confirmed. Allograft tears were compared between the medial and lateral MAT groups.Results:A total of 327 consecutive patients who underwent MAT (55 medial, 272 lateral) with a minimum 2-year follow-up were retrospectively reviewed. The incidences of allograft tears after medial and lateral MATs were 32.7% and 30.9%, respectively. The mean times for tears were 80.1 ± 81.1 months and 48.9 ± 46.3 months in the medial and lateral MAT groups, respectively ( P = .130). In both the medial and lateral MAT groups, allograft tears were observed mainly in the posterior horn, with complex tears being the most commonly identified tear type. In medial MATs, root tears were the second most common at 27.8%, with a significantly higher proportion than the lateral MATs ( P = .014). On the other hand, in lateral MATs, meniscocapsular separation and radial tears were the second most common at 15.5% each, albeit not significantly more common than in medial MATs ( P = .123 and P = .454, respectively). All root tears in medial MATs and meniscocapsular separations in lateral MATs were observed within 1 year postoperatively.Conclusion:Significant differences in allograft tear patterns were identified between the medial and lateral MAT groups. The proportion of root tears in medial MATs was higher than that in lateral MATs; conversely, the proportion of meniscocapsular separation was more common in lateral MATs. Such tear patterns, which may require surgical repair or graft resection, were observed only within 1 year of surgery. Therefore, close observation and regular follow-up in the earlier postoperative period are necessary after medial or lateral MATs.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100833","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":"Isokinetic Strength and Balance Analyses for Predicting Return to Sports After the Latarjet Procedure: A Prospective Cross-sectional Study","authors":"Mohamad K. Moussa, Badr El Hariri, Nicolas Lefèvre, Olivier Grimaud, Pierre Alban Bouché, Yoann Bohu, Zeinab Khalaf, Jean-David Werthel, Antoine Gerometta, Alexandre Hardy","doi":"10.1177/03635465241271518","DOIUrl":"https://doi.org/10.1177/03635465241271518","url":null,"abstract":"Background:Isokinetic torque in shoulder internal rotation (IR) and external rotation (ER) can be considered as potential indicators for dynamic stability of the glenohumeral joint.Purpose:To assess the efficacy of 4-month isokinetic testing in predicting the 6-month return-to-sports (RTS) status after Latarjet surgery, explore its correlations with testing parameters, and identify optimal thresholds to ensure a safe RTS.Study Design:Cohort study; Level of evidence, 2.Methods:The study assessed athletes who underwent the Latarjet stabilization procedure between January 2022 and June 2023. The primary outcome was RTS at 6 months after surgery. The primary examined predictors were isokinetic testing metrics at 4 months postoperatively. Secondary outcomes comprised the modified Closed Kinetic Chain Upper Extremity Stability Test (mCKCUEST) and several patient-reported outcome measures, including the Walch-Duplay score, the Western Ontario Shoulder Instability Index (WOSI), and the Shoulder Instability–Return to Sports after Injury scale. To assess the predictors, patients were divided into those who returned to any level of sports compared with those who did not return to sports. The correlation between isokinetic testing results and other outcome scores was also analyzed.Results:A total of 71 patients (mean age, 27.43 ± 9.09 years) were included in the study. Of these, 23.61% did not return to sports, 38.89% returned at a lower level, and 37.50% returned to the same level. Significant rotational strength disparities were noted. Patients who did not return to sports at 6 months demonstrated inferior strength in concentric ER at 60 deg/s, concentric ER at 240 deg/s, concentric IR at 240 deg/s, and eccentric IR at 30 deg/s ( P < .05). Similar trends appeared for all studied patient-reported outcome measures and the mCKCUEST ( P < .05). Receiver operating characteristic analysis emphasized the significance of isokinetic testing in concentric ER at 240 deg/s (area under the curve = 0.759; P = .001; cutoff = 0.32 N·m/kg; sensitivity = 100.0%; specificity = 49.1%) and eccentric ER at 30 deg/s (area under the curve = 0.760; P = .001; cutoff = 0.51 N·m/kg; sensitivity = 94.1%; specificity = 49.1%) for RTS prediction. Additionally, ER strength moderately correlated with the Walch-Duplay score across all examined velocities ( r = 0.26-0.34; P < .05). The modified WOSI score was weakly linked to ER strength at 240 deg/s and 30 deg/s ( r = 0.24-0.25; P < .05) as well as moderately linked to the limb symmetry index in ER at 60 deg/s and 30 deg/s ( r = 0.30-0.38; P < .05).Conclusion:Isokinetic testing can act as an independent predictor of successful RTS after Latarjet surgery, with concentric ER at 240 deg/s, concentric IR at 240 deg/s, eccentric ER at 30 deg/s, and eccentric IR at 30 deg/s showing the most accuracy. Strength recovery in ER was associated with better Walch-Duplay and modified WOSI scores.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100834","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 Development and Execution of An Orthopaedic Sports Medicine Fellowship Surgical Skills Assessment","authors":"Ryan R. Thacher, Alexander E. White, Christopher L. Camp, Matthew J. Matava, Jeffrey R. Dugas, Anil S. Ranawat","doi":"10.1177/03635465241270160","DOIUrl":"https://doi.org/10.1177/03635465241270160","url":null,"abstract":"Background:Assessment of orthopaedic surgery trainees is traditionally based on subjective evaluation by faculty. The recent push for value-based health care has placed a premium on improving patient outcomes. As a result, surgical training evaluations for orthopaedic trainees are evolving to include more objective measures to evaluate competency.Purpose:To develop and subsequently demonstrate the efficacy of a novel surgical skills assessment for orthopaedic sports medicine fellows.Study Design:Case series; Level of evidence, 4.Methods:A team of 14 fellowship-trained orthopaedic sports medicine surgeons developed objective scoring rubrics for anterior cruciate ligament reconstruction (ACLR) and rotator cuff repair (RCR) using a modified Delphi process. Rubrics were designed based on 10 surgical steps with a grading scale (1-5) based on core competencies with a maximum summative score of 50. Fourteen orthopaedic fellows across a regionally diverse group of sports medicine–accredited fellowship programs were invited to complete both an ACLR and RCR in a surgical skills laboratory at the beginning and end of their fellowship year. Individual surgical steps, overall performance, and total procedure time were evaluated by a single sports medicine surgeon for both sessions.Results:Thirteen of 14 fellows completed both pre- and post-fellowship assessments. For the ACLR procedure, the pre-fellowship mean summative score was 25.4 (SD, 4.4) and the post-fellowship mean summative score was 38.6 (SD, 4.1), which was a statistically significant improvement ( P < .001). For the RCR procedure, the pre-fellowship mean summative score was 26.6 (SD, 5.4) and the post-fellowship mean summative score was 38.8 (SD, 4.3), which was also a statistically significant improvement ( P < .001). The mean time to completion for the ACLR procedure was 82.3 minutes (SD, 4.3 minutes) pre-fellowship, which improved to 69.7 minutes (SD, 11.6 minutes) post-fellowship ( P = .002). The mean time to completion for the RCR procedure was 85.5 minutes (SD, 5.0 minutes) pre-fellowship, which improved to 76.4 minutes (SD, 7.0 minutes) post-fellowship ( P < .001).Conclusion:This surgical skills program represents the first standardized and reproducible instrument for the evaluation of 2 arthroscopic sports medicine procedures in the United States. Orthopaedic sports medicine fellows improved significantly in aggregate over their fellowship year with regard to the ACLR and RCR. The described program has the potential to serve as both a training tool and formal orthopaedic sports medicine fellow assessment.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142101955","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":"Implications for Femoral Tunnel Placement in Medial Patellofemoral Ligament Reconstruction Considering the Sagittal Trochlear Groove Curvature in Severe Trochlear Dysplasia Before and After Deepening Trochleoplasty","authors":"Peter Balcarek, Alexander Zimmerer, Georgi I. Wassilew, Sebastian Gebhardt","doi":"10.1177/03635465241271900","DOIUrl":"https://doi.org/10.1177/03635465241271900","url":null,"abstract":"Background:Medial patellofemoral ligament reconstruction (MPFL-R) aims to restore proper ligament function with minimal changes in length during range of motion, yet the ideal area for femoral fixation of the graft remains controversial.Purpose:To determine the region where the isometric circular path of a simulated MPFL graft (best-fit circle) follows the sagittal radius curvature of the trochlea in normal (nontrochlear dysplastic) knees and to evaluate the best-fit circle coverage of different femoral fixation points in knees with severe trochlear dysplasia (TD) and after deepening trochleoplasty.Study Design:Controlled laboratory study.Methods:Twelve patients (4 male, 8 female; mean age, 24 ± 8 years) who underwent surgical treatment for recurrent lateral patellar instability due to severe TD were prospectively enrolled in this study. Four previously defined reference points for the femoral MPFL-R (Schöttle, Fujino, Stephen, and Oka) were identified, and the best-fit circle was drawn along the sagittal trochlear groove curvature. The divergence between each best-fit circle and the trochlear groove was calculated, with negative values indicating relative slackening and positive values indicating relative tightening of the simulated MPFL graft. Measurements were made on true-lateral fluoroscopic images before and after deepening trochleoplasty and compared with those of a sex-matched control group.Results:The best-fit circle of the Schöttle point followed the sagittal curvature of the trochlea most closely in both the control and trochlear dysplastic knees, followed by the Fujino, Stephen, and Oka points. As the radius of the trochlear groove curvature increased, the divergence of all best-fit circles to the trochlear groove became negative (all P < .05). This effect was most pronounced at the Stephen and Oka points, followed by the Fujino and Schöttle points (all P < .05). After deepening trochleoplasty, the divergence of the Schöttle point changed toward positive values (11.6% at 40°; P < .001). Concurrently, the best-fit circle divergence of all other reference points improved toward baseline (all P < .05).Conclusion:The isometric circle of the Schöttle point provides the best congruence with the sagittal trochlear groove curvature in both the normal trochlea and the dysplastic trochlea. After trochleoplasty, the best-fit circles of more distal femoral fixation points resulted in better congruence with the deepened trochlear groove, whereas the best-fit circle of Schöttle indicated graft tension during flexion.Clinical Relevance:According to the present study, different femoral fixation points should be considered depending on whether the TD is corrected.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142100835","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":"Association of Mechanical Axis With Osteochondritis Dissecans of the Femoral Condyle","authors":"Michael P. Klueh, Bryan O. Ren, Stefano R. Muscatelli, John A. Grant","doi":"10.1177/03635465241255331","DOIUrl":"https://doi.org/10.1177/03635465241255331","url":null,"abstract":"Background:Osteochondritis dissecans (OCD) is a condition characterized by abnormal subchondral bone with disturbance of overlying articular cartilage. The role of weightbearing alignment in the pathophysiology of OCD lesion development is not fully understood.Hypothesis:Lower extremity mechanical axis would be concordant with femoral condylar OCD lesion location.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Cases were identified from a single, large academic institutional database using International Classification of Diseases, Ninth Revision and Tenth Revision and Current Procedural Terminology codes associated with OCD. Patients were included if they had a magnetic resonance imaging scan demonstrating the OCD lesion and lower extremity alignment radiographs. OCD lesion location was identified using Cahill and Berg zones. The primary outcome was the association of OCD lesion location with weightbearing mechanical axis. Secondary outcomes included the association of mechanical axis with skeletal maturity, OCD lesion stability, and treatment. For unilateral OCD lesions, mechanical axis was compared between affected and unaffected lower extremities.Results:A total of 86 patients (95 knees) with an OCD lesion of the femoral condyle were identified. The population was 74% male, and the mean age was 21 years. In total, 65% of knees had closed physes, 82% of lesions were unstable, and 85% underwent a surgical procedure. Mechanical axis was located in the same zone as the OCD lesion in 48% of cases and within the same compartment in 56% of cases. Spearman correlation coefficient demonstrated a moderate positive correlation (r<jats:sub>s</jats:sub> = 0.59). No significant differences were found in the association of mechanical axis and OCD lesion location in subgroup analysis of medial versus lateral femoral condylar OCD lesions, skeletal maturity, stability of the lesion, or treatment group. For patients with varus alignment and medial femoral condylar OCD lesions, the mean lateral distal femoral angle was 89.9°, and medial proximal tibial angle was 85.4°; for valgus alignment and lateral femoral condylar lesions, the lateral distal femoral angle was 84.8°, and medial proximal tibial angle was 88.8°. Patients with unilateral medial femoral condylar OCD lesions were more likely to have varus alignment of the affected extremity compared with the contralateral extremity (59% vs 36%; P = .01).Conclusion:This study demonstrated a relationship between lower extremity mechanical weightbearing axis and femoral condylar OCD location. Patients with unilateral medial femoral condylar OCD lesions frequently had asymmetric varus alignment in the affected extremity.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141755238","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":"Activity-Dependent Compensation at the Hip and Ankle at 8 Years After the Reconstruction of Isolated and Combined Posterior Cruciate Ligament Injuries","authors":"Alison N. Agres, Nicholas M. Brisson, Georg N. Duda, Tobias M. Jung","doi":"10.1177/03635465241248819","DOIUrl":"https://doi.org/10.1177/03635465241248819","url":null,"abstract":"Background:After posterior cruciate ligament reconstruction (PCLR), functional deficits at the knee can persist. It remains unclear if neighboring joints compensate for the knee during demanding activities of daily living.Purpose:To assess long-term alterations in lower limb mechanics in patients after PCLR.Study Design:Descriptive laboratory study.Methods:A total of 28 patients who had undergone single-bundle unilateral isolated or combined PCLR performed stair navigation, squat, sit-to-stand, and stand-to-sit tasks at 8.2 ± 2.2 years after surgery. Motion capture and force plates were used to collect kinematic and kinetic data. Then, 3-dimensional hip, knee, and ankle kinematic data of the reconstructed limb were compared with those of the contralateral limb using statistical parametric mapping.Results:Side-to-side differences at the knee were primarily found during upward-driven movements at 8 years after surgery. The reconstructed knee exhibited lower internal rotation during the initial loading phase of stair ascent versus the contralateral knee ( P = .005). During the sit-to-stand task, higher flexion angles during the midcycle ( P = .017) and lower external rotation angles ( P = .049) were found in the reconstructed knee; sagittal knee ( P = .001) and hip ( P = .016) moments were lower in the reconstructed limb than the contralateral limb. In downward-driven movements, side-to-side differences were minimal at the knee but prominent at the ankle and hip: during stair descent, the reconstructed ankle exhibited lower dorsiflexion and lower external rotation during the midcycle versus the contralateral ankle ( P = .006 and P = .040, respectively). Frontal hip moments in the reconstructed limb were higher than those in the contralateral limb during the stand-to-sit task ( P = .010); during squats, sagittal hip angles in the reconstructed limb were higher than those in the contralateral limb ( P &lt; .001).Conclusion:Patients after PCLR exhibited compensations at the hip and ankle during downward-driven movements, such as stair descent, squats, and stand-to-sit. Conversely, residual long-term side-to-side differences at the knee were detected during upward-driven movements such as stair ascent and sit-to-stand.Clinical Relevance:After PCLR, side-to-side differences in biomechanical function were activity-dependent and occurred either at the knee or neighboring joints. When referring to the contralateral limb to assess knee function in the reconstructed limb, concentric, upward-driven movements should be prioritized. Compensations at the hip and ankle during downward-driven movements lead to biases in long-term functional assessments.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140954665","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":"Indirect Head of the Rectus Femoris Tendon as a Graft for Segmental Hip Labral Reconstruction: An Anatomic, Radiographical, and Biomechanical Study in Comparison With Iliotibial Labral Reconstruction","authors":"Safa Gursoy, Felipe Bessa, Navya Dandu, Zeeshan A. Khan, Hailey P. Huddleston, Brady T. Williams, Amar S. Vadhera, Ian M. Clapp, Philip Malloy, Elizabeth F. Shewman, Shane J. Nho, Jorge Chahla","doi":"10.1177/03635465241251824","DOIUrl":"https://doi.org/10.1177/03635465241251824","url":null,"abstract":"Background:The indirect head of the rectus femoris (IHRF) tendon has been used as an autograft for segmental labral reconstruction. However, the biomechanical properties and anatomic characteristics of the IHRF, as they relate to surgical applications, have yet to be investigated.Purpose:To (1) quantitatively and qualitatively describe the anatomy of IHRF and its relationship with surrounding arthroscopically relevant landmarks; (2) detail radiographic findings pertinent to IHRF; (3) biomechanically assess segmental labral reconstruction with IHRF, including restoration of the suction seal and contact pressures in comparison with iliotibial band (ITB) reconstruction; and (4) assess potential donor-site morbidity caused by graft harvesting.Study Design:Descriptive laboratory study.Methods:A cadaveric study was performed using 8 fresh-frozen human cadaveric full pelvises and 7 hemipelvises. Three-dimensional anatomic measurements were collected using a 3-dimensional coordinate digitizer. Radiographic analysis was accomplished by securing radiopaque markers of different sizes to the evaluated anatomic structures of the assigned hip.Suction seal and contact pressure testing were performed over 3 trials on 6 pelvises under 4 different testing conditions for each specimen: intact, labral tear, segmental labral reconstruction with ITB, and segmental labral reconstruction with IHRF. After IHRF tendon harvest, each full pelvis had both the intact and contralateral hip tested under tension along its anatomic direction to assess potential site morbidity, such as tendon failure or bony avulsion.Results:The centroid and posterior apex of the indirect rectus femoris attachment are respectively located 10.3 ± 2.6 mm and 21.0 ± 6.5 mm posteriorly, 2.5 ± 7.8 mm and 0.7 ± 8.0 mm superiorly, and 5.0 ± 2.8 mm and 22.2 ± 4.4 mm laterally to the 12:30 labral position. Radiographically, the mean distance of the IHRF to the following landmarks was determined as follows: anterior inferior iliac spine (8.8 ± 2.5 mm), direct head of the rectus femoris (8.0 ± 3.9 mm), 12-o’clock labral position (14.1 ± 2.8 mm), and 3-o’clock labral position (36.5 ± 4.4 mm). During suction seal testing, both the ITB and the IHRF reconstruction groups had significantly lower peak loads and lower energy to peak loads compared with both intact and tear groups ( P = .01 to .02 for all comparisons). There were no significant differences between the reconstruction groups for peak loads, energy, and displacement at peak load. In 60° of flexion, there were no differences in normalized contact pressure and contact area between ITB or IHRF reconstruction groups ( P &gt; .99). There were no significant differences between intact and harvested specimen groups in donor-site morbidity testing.Conclusion:The IHRF tendon is within close anatomic proximity to arthroscopic acetabular landmarks. In the cadaveric model, harvesting of the IHRF tendon as an autograft does not lead to significant donor-site morbid","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140954668","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}