The American Journal of Sports Medicine最新文献

{"title":"Allogenic Bioengineered Cartilage Achieves Hyaline Cartilage Repair in a Large Animal Model: A Promising Step Forward","authors":"Halah Kutaish, Laura Bengtsson, Sana Boudabbous, François Lazeyras, Sebastien Courvoisier, Vincent Braunersreuther, Sabine E. Hammer, Didier Hannouche, Jacques Ménétrey, Vannary Tieng, Philippe M. Tscholl","doi":"10.1177/03635465251331224","DOIUrl":"https://doi.org/10.1177/03635465251331224","url":null,"abstract":"Background: Chondrocyte-based cell therapy remains a promising method for cartilage repair, despite limitations faced during the last 30 years. Purpose/Hypothesis: This work presents hyaline-like bioengineered beads from donor chondrocytes as a novel treatment option for cartilage lesions. It was hypothesized that the implanted cartilage minigrafts would be able to treat cartilage lesions by complete fusion among themselves and by integration with surrounding tissue. No tissue rejection was expected because of cartilage’s reported immunological privilege. Study Design: Controlled laboratory study. Methods: Allogenic cartilage beads with hyaline characteristics were produced from frozen chondrocytes of a minipig donor. A total of 8 Göttingen minipigs underwent the implantation of bioengineered cartilage beads into 8 to 10 mm–diameter full-thickness chondral lesions (3 lesions/knee). Animals were sacrificed at 6 weeks (n = 2) and 6 months (n = 6) after implantation. The safety and efficacy of implantation were assessed by macroscopic and histological analyses as well as by magnetic resonance imaging. Results: No signs of acute or chronic rejection were observed in any study animals upon implantation. For 6 minipigs at 6 months, magnetic resonance imaging results showed better coverage of the grafted lesions compared with empty (control) lesions. When the cartilage beads were maintained in the lesion, complete integration of the minigrafts with surrounding subchondral bone and native cartilage was observed. Repair tissue in grafted lesions maintained hyaline-like quality and showed evidence of a chondral zonal arrangement at 6 months’ follow-up. Additionally, grafted lesions (n = 17) had better macroscopic repair scores than empty lesions (n = 7) (mean inverse Goebel score, 4.24 and 5.57, respectively). Graft-filled lesions showed only a slight superiority in histological repair scores (mean Bern score, 5.76 and 5.43, respectively). Conclusion: Allogenic cartilage beads hold potential as an advanced therapy medicinal product for treating cartilage lesions in 1-step surgery with established safety and efficacy. Clinical Relevance: This successful preclinical study highlights allogenic cartilage beads as a promising method for cartilage repair. Moreover, using donor chondrocytes may allow reduced patient morbidity and 1-step surgery. Hence, this advanced therapy medicinal product is suitable for treating large lesions and older patients and is currently being evaluated in a phase I/IIa clinical trial.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884313","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 Type of Lateral Hinge Fracture in Medial Open-Wedge High Tibial Osteotomy Determines Its Stability: A Biomechanical Study.","authors":"Christian Peez,Alexander Milstrey,Ivan Zderic,Adrian Deichsel,R Geoff Richards,Boyko Gueorguiev,Christoph Kittl,Michael J Raschke,Elmar Herbst","doi":"10.1177/03635465251332593","DOIUrl":"https://doi.org/10.1177/03635465251332593","url":null,"abstract":"BACKGROUNDLateral hinge fractures (LHFs) are considered risk factors for delayed union or nonunion after medial open-wedge high tibial osteotomies (MOWHTOs). However, there is limited evidence on the extent to which the morphology of the hinge fracture influences the stability of a MOWHTO.PURPOSE/HYPOTHESISThe purpose of this study was to validate the Takeuchi classification under axial and torsional loading to identify the LHF types requiring surgical treatment. It was hypothesized that (1) LHFs would reduce construct stiffness and increase interfragmentary instability across the osteotomy gap, and (2) shear displacement associated with impaired bone healing of >2 mm would be observed in Takeuchi type 2 and 3 fractures.STUDY DESIGNDescriptive laboratory study.METHODSA total of 24 fresh-frozen human cadaveric proximal tibiae underwent MOWHTO fixed with a locking compression plate. The specimens were assigned to 3 different groups so that the mean bone mineral density values were similar between the groups. Each group simulated a different type of LHF according to the Takeuchi classification: (1) type 1 fracture, extension along the osteotomy plane; (2) type 2 fracture, extension distal to the proximal tibiofibular joint; and (3) type 3 fracture, proximal extension into the lateral tibial plateau. Each specimen was subjected to 10 quasi-static cycles of axial compression up to 720 N, followed by internal and external torsional loading up to 10 N·m, while the interfragmentary movements were captured with a motion tracking system.RESULTSCompared with a MOWHTO with a preserved lateral hinge, Takeuchi type 2 and 3 fractures significantly increased shear displacement and hinge rotation by 2.2 mm and 2.3°, respectively, resulting in at least 80% reduction in torsional stiffness (P < .001). In contrast, Takeuchi type 1 fractures did not significantly alter the torsional stability of a MOWHTO. Takeuchi type 2 and 3 fractures significantly increased axial displacement at the hinge site by 0.2 mm (P < .01) compared with an intact hinge MOWHTO, while axial displacement of the medial osteotomy gap remained unchanged. All Takeuchi types significantly reduced axial construct stiffness by at least 28% (P < .01).CONCLUSIONFrom a biomechanical perspective, Takeuchi type 1 LHFs did not affect the torsional stability of MOWHTO, whereas Takeuchi type 2 and 3 fractures resulted in significantly reduced torsional stiffness, increased shear displacement, and hinge rotation across the osteotomy gap. All Takeuchi fracture types resulted in reduced axial construct stiffness, while axial displacement was not significantly affected by the type of hinge fracture.CLINICAL RELEVANCEThe observed shear displacement of >2 mm for Takeuchi type 2 and 3 fractures may be indicative of impaired bone healing and may therefore qualify these fractures for hinge fixation to potentially reduce the risk of delayed union and nonunion.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"42 1","pages":"3635465251332593"},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889254","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":"Use and Effectiveness of Physical Therapy After Primary Gluteus Medius and/or Minimus Repair: A Duration- and Session-Sensitive Analysis","authors":"Ron Gilat, Michael J. Vogel, Alexander B. Alvero, Philip Malloy, Shane J. Nho","doi":"10.1177/03635465251334768","DOIUrl":"https://doi.org/10.1177/03635465251334768","url":null,"abstract":"Background: Gluteus medius and/or minimus (GM) repair has been shown to provide improved patient-reported outcomes (PROs), yet few studies have established how postoperative physical therapy (PT) after GM repair affects patient recovery. Purpose: To (1) evaluate the trajectory of patient improvement after GM repair during PT and (2) identify how the duration of PT influences minimum 2-year PROs. Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent primary GM repair between September 2012 and September 2021 were identified. The trajectory of their Lower Extremity Function Scale (LEFS) score improvement during PT was evaluated with regression modeling. The times of greatest change in LEFS improvement were identified, and the rate of improvement (ROI) per postoperative day and per PT session was recorded. Preoperative, 6-month, 1-year, and 2-year PROs were evaluated for the length of postoperative recovery. Patients were then stratified by their PT duration, and their preoperative characteristics and postoperative outcomes were compared. Correlations between LEFS scores at discharge and 2-year outcomes were evaluated. Results: In total, 69 patients were included with a mean age of 59.7 ± 9.2 years and a body mass index of 28.6 ± 6.1 kg/m <jats:sup>2</jats:sup> . The ROI was 1.89 LEFS points per session for sessions 0 to 21 and 0.04 LEFS/session after session 21. From postoperative day 0 to 81, the ROI was 0.56 LEFS/day, decreasing to 0.16 LEFS/day between days 81 and 134, and 0.03 LEFS/day after day 134. Nevertheless, significant postoperative improvements were observed until 1 year for all PROs ( <jats:italic>P</jats:italic> ≤ .023). Patients who completed between 3 and 6 months of PT showed superior 2-year Hip Outcome Score-Activities of Daily Living (HOS-ADL) and visual analog scale-pain (VAS-Pain) scores compared with patients who completed a shorter PT duration ( <jats:italic>P</jats:italic> ≤ .028). Conclusion: This study demonstrates that patients derived the greatest improvement during the first 21 PT sessions and 81 days after GM repair, with continued improvements after PT discharge up to 1 year. Patients who had &lt;3 months of PT showed worse outcomes on LEFS scores at PT discharge and on 2-year HOS-ADL and VAS-Pain scores compared with patients who completed a longer PT duration. LEFS scores at discharge showed significant moderate and strong correlations with 2-year function and satisfaction scores.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884300","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 Level Maintenance at 10-Year Minimum Follow-up Among Active Patients Undergoing Periacetabular Osteotomy","authors":"Deniz C. Ince, Cecilia Pascual-Garrido, Kyle P. O’Connor, Katherine L. Mistretta, Jeffrey J. Nepple, Perry L. Schoenecker, John C. Clohisy","doi":"10.1177/03635465251334770","DOIUrl":"https://doi.org/10.1177/03635465251334770","url":null,"abstract":"Background: Periacetabular osteotomy (PAO) can treat pain, dysfunction, and decreased activity secondary to hip dysplasia. Patients’ pre- and postoperative activity can be measured using the University of California Los Angeles (UCLA) activity score, a validated questionnaire. Understanding return to and maintenance of activity at long-term follow-up after PAO is a priority for active patients. Purpose: To provide long-term follow-up of a previously published cohort that will help examine maintenance of activity after PAO, guide treatment decision-making, and inform patient counseling. Study Design: Case series; Level of evidence, 4. Methods: This prospective longitudinal cohort consisted of patients undergoing PAO between 2006 and 2013. Inclusion criteria included lateral center-edge angle &lt;25°, highly active individuals (UCLA score ≥7), and 10-year minimum follow-up. UCLA, modified Harris Hip Score, and Western Ontario and McMaster Universities Osteoarthritis Index scores and descriptive information were obtained. <jats:italic>P</jats:italic> values &lt;.05 were considered significant. Results: The cohort included 68 hips (86.1% follow-up; 61 patients), with 7 (10.3%) having additional surgery (4 total hip arthroplasty, 3 osteochondroplasty) at a mean 9.8 years (range, 6.0-15.8). Reoperated hips were excluded; the remaining 61 were analyzed. Mean age at PAO was 24.7 years (range, 14.7-44.8) with female predominance (74.1%). Mean follow-up was 12.5 years (range, 10.2-17.1). Of 61 hips, 54 (88.5%) either maintained high activity with a UCLA score ≥7 (n = 43; 70.5%) or had lower activity unrelated to the surgical hip (n = 11; 18.0%). When compared with preoperative values, the mean UCLA score decreased from 8.9 to 8.1 ( <jats:italic>P</jats:italic> = .009); the modified Harris Hip Score improved from 64.6 to 88.8 ( <jats:italic>P</jats:italic> &lt; .001), with 49 of 61 hips (80.3%) achieving the minimal clinically important difference; and the Western Ontario and McMaster Universities Osteoarthritis Index pain score improved from 68.2 to 89.0 ( <jats:italic>P</jats:italic> &lt; .001), with 35 of 51 hips (68.7%) achieving the minimal clinically important difference. Hips with PAO before age 25 years were more likely to be in higher activity groups at follow-up ( <jats:italic>P</jats:italic> = .030). Conclusion: Patients with hip dysplasia can be treated with PAO to help maintain activity and preserve the native hip. At long-term follow-up (mean, 12.5 years), 54 of 68 (79.4%) hips did not have additional surgery and either remained in the high activity group or had lower activity levels unrelated to the hip. PAO appears to be a durable hip preservation technique at 12.5-year follow-up for highly active patients.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143876319","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":"Validation of a Composite Outcome Score for Assessing Return to Sports After Achilles Tendon Repair.","authors":"Ronny Lopes,Kinan Freiha,Michael R Carmont,Eugénie Valentin,Kylian Alvino,Mohamed Mousa,Gauthier Rauline,François Fourchet,Brice Picot,Alexandre Hardy","doi":"10.1177/03635465251333142","DOIUrl":"https://doi.org/10.1177/03635465251333142","url":null,"abstract":"BACKGROUNDThe Ankle-GO is a composite outcome score based on 4 functional tests and 2 patient-reported outcome measures. It was initially described and validated for its ability to predict return to sports (RTS) at the same level of play after lateral ankle sprains.PURPOSE/HYPOTHESISThe main aim of this study was to assess the psychometric properties of the Ankle-GO in patients after Achilles tendon repair. The second objective was to evaluate its ability to predict RTS at the same level of play. It was hypothesized that this composite outcome score is a valid and reliable tool that is able to discriminate and predict the level of RTS at 9 months after Achilles tendon repair.STUDY DESIGNCase-control study; Level of evidence, 3.METHODSThis was a prospective multicenter study. Patients who were active in sports and underwent primary acute Achilles tendon repair between April 2021 and December 2022 were included. A control group comprising 30 participants with no history of lower limb injuries was also evaluated. After standard rehabilitation for the first 2 months, the Ankle-GO was administered at 6 and 9 months after repair by the same experienced physical therapist. During testing, the patients were asked whether they were able to practice their main sport again and, if so, whether at the same or a lower level of play. A comparison between control participants and patients at 9 months after surgery was performed.RESULTSA total of 50 patients (24 women and 26 men), with a mean age of 38.3 ± 10.1 years, were included. No patients were lost to follow-up at 9 months. The Ankle-GO score at 6 months was 10.7 ± 4.8. At 9 months, the score had risen by 4.8 points. All participants scored above the minimum threshold. The minimum score achieved was 3 points (n = 5 [10%]). Only 1 patient (2%) obtained the maximum score (25 points). There was a significant difference in the Ankle-GO score between patients at 6 and 9 months and between control participants and patients at 9 months after Achilles tendon repair. Of the 50 patients included in the study, 14 (28%) returned to their preinjury level of sport at 9 months. The ability of the Ankle-GO score at 6 months to predict RTS at the preinjury level at 9 months was good (area under the curve = 0.71 [95% CI, 0.56-0.85]; P < .01). A Youden index of 0.42 was observed for a cut-off score of 8 points, which corresponds to a sensitivity of 81.8% and a specificity of 41.2%.CONCLUSIONThe Ankle-GO is a valid tool to evaluate and discriminate patients during the RTS continuum after Achilles tendon repair and to predict RTS at the same level at 9 months after surgery. This composite outcome score assesses ankle function and the patient's psychological readiness to avoid premature RTS and worsening of the injury. Further studies are needed to assess its value in identifying and predicting patients at risk of a recurrence.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"219 1","pages":"3635465251333142"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone Bruise Patterns After Noncontact Anterior Cruciate Ligament Tears Differ Between Alpine Skiers and Pivoting Sports Athletes.","authors":"Steffen T Ubl,Romed P Vieider,Jesse Seilern Und Aspang,Steffen F Siemoneit,Thomas R Pfeiffer,Christian Gaebler,Hannes Platzgummer","doi":"10.1177/03635465251332272","DOIUrl":"https://doi.org/10.1177/03635465251332272","url":null,"abstract":"BACKGROUNDConcomitant injuries after an anterior cruciate ligament (ACL) tear differ between sports, which may be related to divergent loading patterns. Bone bruises (BBs) can provide insight into the biomechanical injury mechanism.PURPOSE/HYPOTHESISThe purpose of this study was to compare BB patterns and concomitant injuries after noncontact ACL tears between pivoting sports athletes and alpine skiers. It was hypothesized that pivoting sports athletes would have a higher prevalence and depth of BBs and a higher prevalence of concomitant injuries.STUDY DESIGNCohort study; Level of evidence, 3.METHODSA total of 446 consecutive patients with ACL injuries between December 2016 and November 2020 were retrospectively analyzed. Patients with contact injuries, an injury mechanism other than alpine skiing or pivoting sports, missing magnetic resonance imaging, failed previous nonoperative treatment, open physes, or incomplete ACL tears were excluded. Magnetic resonance imaging was used to classify BB location and depth as well as concomitant meniscal and collateral ligament injuries. There were 2 groups (alpine skiers vs pivoting sports athletes) that were propensity score matched for age, body mass index, and sex. Chi-square and Mann-Whitney U tests were used to detect differences, with significance set at P < .05. The Fleiss kappa (κ) was used to assess observer agreement.RESULTSPropensity score matching of 122 included patients resulted in 27 patients per group. Pivoting sports athletes showed a higher prevalence of BBs in the lateral femoral condyle than alpine skiers (85.2% vs 51.9%, respectively; P = .008). No significant differences were found for BB prevalence in other anatomic locations, BB depth, and concomitant meniscal and collateral ligament injuries. Post hoc power analysis showed a power of 75%. Observer agreement was almost perfect for BB prevalence (κ = 0.95-1.00), substantial for BB depth (κ = 0.68-0.75), and substantial to almost perfect for concomitant injuries (κ = 0.64-0.94).CONCLUSIONThe prevalence of BBs in the lateral femoral condyle was higher in pivoting sports athletes than in alpine skiers after acute noncontact ACL tears. This suggests that ACL injuries in pivoting sports are associated with higher lateral compression forces in a pivot-shift mechanism, whereas anterior tibial translation and tibial rotation may be the predominant loading pattern in alpine skiing.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"31 1","pages":"3635465251332272"},"PeriodicalIF":0.0,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143866319","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":"Outcomes of Latissimus Dorsi Tendon Transfer for Posterosuperior Massive Rotator Cuff Tears and Failed Rotator Cuff Repair.","authors":"Jean Kany,Luis Alfredo Miranda,Quentin Duerinckx,Luis Leoncio Temoche,Floris van Rooij,Jean Grimberg","doi":"10.1177/03635465251330882","DOIUrl":"https://doi.org/10.1177/03635465251330882","url":null,"abstract":"BACKGROUNDAlthough a recent systematic review found that latissimus dorsi tendon transfer (LDTT) granted comparable outcomes in shoulders with massive rotator cuff tears (mRCTs) versus those with failed rotator cuff repair (RCR), some studies found inferior outcomes after failed RCR.PURPOSETo compare the clinical and functional outcomes, as well as complication rates, of patients who underwent LDTT for the treatment of mRCTs or failed RCR.STUDY DESIGNCase series; Level of evidence, 4.METHODSThe authors retrieved the records of a consecutive series of 258 patients (n = 150, arthroscopically assisted; n = 108, all-arthroscopic) who underwent LDTT by the same senior surgeon between 2014 and 2021. A total of 136 patients underwent LDTT for irreparable posterosuperior mRCTs without previous RCR, whereas 122 underwent LDTT for failed RCR. All intra- and postoperative complications were noted, as well as whether patients required conversion to reverse shoulder arthroplasty. At a minimum follow-up of 24 months, an independent observer collected the range of motion and clinical scores including the Constant score, Subjective Shoulder Value (SSV), Simple Shoulder Test, Activities of Daily Living requiring Active External Rotation (ADLER) score, American Shoulder and Elbow Surgeons (ASES) score, and pain on visual analog scale (VAS).RESULTSAt a minimum follow-up of 2 years after LDTT, no significant differences were noted between shoulders treated for mRCTs versus failed RCR in terms of rates of conversion to reverse shoulder arthroplasty (3% vs 3%, respectively), LDTT tear (8% vs 10%), or other complications (10% vs 11%). Shoulders treated for mRCTs had significantly better outcomes than those treated for failed RCR, in terms of ASES score (75.8 ± 19.5 vs 65.6 ± 24.2, respectively; P = .002), ADLER score (26.3 ± 5.7 vs 24.8 ± 6.4; P = .003), SSV (72.3 ± 19.8 vs 63.6 ± 24.0; P = .004), and pain on VAS (1.8 ± 2.0 vs 2.7 ± 2.7; P = .018) but not in terms of Constant score (69.2 ± 13.4 vs 66.4 ± 16.3, P = .520) and range of motion (P = .360-.700). Multivariable analysis confirmed that ASES score was worse for shoulders with previous RCR (β, -9.90; 95% CI, -15.94 to 3.86; P = .001) and that Constant score was better for men (β, 3.91; 95% CI, -0.06 to 7.88; P = .044).CONCLUSIONAt a minimum follow-up of 24 months, LDTT granted better outcomes for the treatment of mRCTs than of failed RCR, notably in terms of activity and pain.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"41 1","pages":"3635465251330882"},"PeriodicalIF":0.0,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143849506","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-Specific Advanced Analytic and Pitch-Tracking Risk Factors for Ulnar Collateral Ligament Injuries in Major League Baseball Pitchers.","authors":"Michael A Mastroianni,Jennifer A Kunes,John D Mueller,Kyle K Obana,Jamie Confino,Andrew J Luzzi,Alexander J Rondon,David P Trofa,Charles A Popkin,Charles M Jobin,William N Levine,Christopher S Ahmad","doi":"10.1177/03635465251330564","DOIUrl":"https://doi.org/10.1177/03635465251330564","url":null,"abstract":"BACKGROUNDThe utilization of new pitch-tracking metrics has driven player development and provides more predictive pitch-specific data on physical characteristics and performance. Given the differences in each pitcher's arsenal, these pitch-specific metrics provide new potential variables to investigate ulnar collateral ligament (UCL) injury risk.PURPOSETo evaluate the association of several pitch-specific advanced analytic and pitch-tracking metrics on UCL surgery rates in Major League Baseball (MLB) pitchers.STUDY DESIGNCase-control study; Level of evidence, 3.METHODSWe performed a retrospective case-control study on all MLB pitchers who underwent primary UCL reconstruction or repair from April 2018 to November 2023. Exclusion criteria included pitchers without 2 qualifying seasons of preoperative pitch-tracking data or who previously underwent UCL surgery. Matched controls were identified in a 2:1 manner by using season, age, position, handedness, and pitch count as covariates. Pitch-specific advanced analytic and pitch-tracking metrics used commonly in the evaluation of MLB players were collected from public web sources sponsored by MLB. Statistical analysis consisted of unpaired t tests comparing preinjury metrics between the case and control groups, along with binary logistic regression.RESULTSA total of 115 MLB pitchers who underwent UCL reconstruction or repair were compared with 230 matched controls. Increased velocity for fastballs, changeups, and sinkers were all associated with UCL surgery. A decreased horizontal release point for fastballs, curveballs, and sinkers were also associated with UCL surgery, along with an increased horizontal approach angle above average for fastballs and sinkers. An increased spin rate for sliders and an increased release extension for cutters were also associated with surgery. Large statistically significant differences in Pitching+ and Location+ for fastballs, changeups, and sinkers, and in Stuff+ for changeups, were associated with surgery. There were no differences in pitch-specific pitch count, active spin, spin axis, vertical release point or approach angle, or overall pitch movement between cases and controls. Binary logistic regression showed that higher velocity fastballs, sliders, and changeups were all associated with UCL surgery, along with sliders with a higher spin rate and cutters with a longer release extension.CONCLUSIONThis study demonstrated that pitch-specific associations with UCL surgery exist compared with matched controls. Specifically, higher velocity fastballs, sliders, and changeups were all associated with UCL surgery, along with sliders with a higher spin rate and cutters with a longer release extension. Fastballs, changeups, and sinkers with superior ability (Pitching+) and command (Location+) were also associated with UCL surgery. While fastball velocity appears to play a role in the rise of UCL injuries, recent trends in decreased fastball usage and improved secondary pitch","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"3 1","pages":"3635465251330564"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836505","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":"Joint Position and General Hypermobility Affect Elbow Joint Congruence on Magnetic Resonance Imaging: A Prospective Cohort Study.","authors":"Stephanie Geyer,Maximilian Hinz,Pavel Kadantsev,Sebastian Lappen,Philipp W Winkler,Jan Neumann,Benedikt J Schwaiger,Sebastian Siebenlist","doi":"10.1177/03635465251330152","DOIUrl":"https://doi.org/10.1177/03635465251330152","url":null,"abstract":"BACKGROUNDPatients with posterolateral rotational instability (PLRI) of the elbow exhibit a higher degree of joint incongruence on magnetic resonance imaging (MRI) than patients without PLRI. However, the influence of joint hypermobility and position of the elbow in healthy participants is yet unknown.PURPOSETo analyze the influence of general hypermobility and elbow joint position on joint congruence in healthy participants via MRI.STUDY DESIGNCase-control study; Level of evidence, 4.METHODSTwenty participants with Beighton score <5 (normal group) and 20 with Beighton score ≥5 (hypermobile group) who had healthy elbows underwent bilateral MRI in full extension and supination, full extension and pronation, and 30° of flexion in both supination and pronation. Sagittal radiocapitellar joint incongruence and ulnohumeral joint incongruence (in sagittal, coronal, and axial planes) were measured according to a standardized protocol.RESULTSRadiocapitellar congruence increased in pronation (P < .001) but did not change between flexion and extension (P > .05). Coronal ulnohumeral congruence increased significantly from extension and supination to pronation (P = .010) and to combined flexion and pronation (P = .011). Sagittal and axial ulnohumeral joint congruence did not change significantly between different elbow joint positions (P > .05). Significant differences between the normal and hypermobile groups were observed in 3 of the 4 evaluated joint positions. Overall, the hypermobile group showed an increased joint incongruence except in extension and pronation (P > .05).CONCLUSIONIn MRI examination of healthy elbows, joint congruence increased significantly from supination to pronation. In combined extension and pronation, the elbow joint was equally congruent in the normal and hypermobile groups. When MRI scans in supination or combined flexion and pronation are evaluated, increased joint incongruence in hypermobile individuals is physiological and should not be confused with PLRI.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":"3635465251330152"},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143836516","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":"Effect of Slope-Reducing Tibial Osteotomy With Primary Anterior Cruciate Ligament Reconstruction on Clinical and Radiological Results in Patients With a Steep Posterior Tibial Slope and Excessive Anterior Tibial Subluxation: Propensity Score Matching With a Minimum 2-Year Follow-up","authors":"Daofeng Wang, Menglinqian Di, Tong Zheng, Chengcheng Lv, Yang Liu, Guanyang Song, Hui Zhang","doi":"10.1177/03635465251330976","DOIUrl":"https://doi.org/10.1177/03635465251330976","url":null,"abstract":"Background: A steep posterior tibial slope (PTS) and excessive anterior tibial subluxation of the lateral compartment (ASLC) have been considered to be associated with inferior graft outcomes in primary anterior cruciate ligament (ACL) reconstruction (ACLR). Case series studies have demonstrated that combined slope-reducing tibial osteotomy can greatly improve knee functional scores and stability in revision ACLR. However, there is currently no comparative study evaluating the clinical benefits of osteotomy procedures in primary ACLR. Purpose: To assess the feasibility of combined slope-reducing tibial osteotomy and primary ACLR in patients with a steep PTS and excessive ASLC and to explore the suitable threshold for osteotomy. Study Design: Case series; Level of evidence, 4. Methods: Between 2016 and 2022, of the 108 patients with ACL injuries who had a steep PTS (≥15°) and a follow-up ≥2 years, 30 patients with excessive ASLC (≥6 mm) underwent concomitant slope-reducing tibial osteotomy and ACLR (osteotomy group), and 78 patients underwent isolated ACLR (control group). Propensity score matching at a 1:2 ratio was used to match preoperative variables between the 2 groups. After matching preoperative variables, 25 and 48 patients underwent combined surgery and isolated ACLR, respectively. The primary outcome was ACL graft status (failure and laxity rates). The secondary outcomes were ASLC and anterior tibial subluxation of the medial compartment (ASMC), KT-1000 arthrometer side-to-side difference (SSD), pivot-shift grade, and second-look arthroscopic findings. Stratified analysis was performed with 1° PTS increments to explore the osteotomy threshold. Results: Both groups were comparable in terms of age, sex, side, body mass index, PTS, graft diameter, time from injury to surgery, ASLC, ASMC, KT-1000 arthrometer SSD, pivot-shift grade, and meniscal injuries (all &lt;jats:italic&gt;P&lt;/jats:italic&gt; &gt; .05). The mean PTS significantly decreased from 18.2° to 6.7° ( &lt;jats:italic&gt;P&lt;/jats:italic&gt; &lt; .001) in the osteotomy group. The 2-year rate of ACL graft laxity was 12.0% in the osteotomy group and 35.4% in the control group, with a statistically significant difference ( &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .033). There was no significant difference in the 2-year rate of ACL graft failure between the 2 groups (8.0% vs 12.5%, respectively; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .559). The final follow-up data showed that improvements in ASLC (4.5 vs 6.4 mm, respectively; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .012) and ASMC (2.8 vs 4.5 mm, respectively; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .014) were more significant in the osteotomy group compared with the control group. On the second-look arthroscopic examination, the incidence of graft roof impingement in the control group was significantly higher than that in the osteotomy group (22.9% vs 4.0%, respectively; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .039). No significant differences were observed between the 2 groups in terms of KT-1000","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143832275","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}