The American Journal of Sports Medicine最新文献

{"title":"Anatomic Factors Influencing a Persistent J-Sign After Medial Patellofemoral Ligament Reconstruction and Distal Tibial Tubercle Osteotomy in Patients With Recurrent Patellar Dislocations and Patella Alta: A Retrospective Cohort Study.","authors":"Raimundo Vial Irarrazaval,Stefan Turkula,Marc Tompkins,Julie Agel,Elizabeth Arendt","doi":"10.1177/03635465251336162","DOIUrl":"https://doi.org/10.1177/03635465251336162","url":null,"abstract":"BACKGROUNDThe J-sign is a marker of abnormal patellar tracking and is associated with bony abnormalities. When patella alta is present, distal tibial tubercle osteotomy (dTTO) can enable the patella to engage in a more distal/deeper groove, often eliminating the J-sign.PURPOSETo determine which anatomic findings are associated with a persistent J-sign after medial patellofemoral ligament reconstruction (MPFL-R) and dTTO in patients with recurrent lateral patellar dislocations and patella alta.STUDY DESIGNCohort study; Level of evidence, 4.METHODSA retrospective cohort study of 93 knees (77 patients) with recurrent lateral patellar dislocations and the J-sign, treated by a single surgeon with MPFL-R and dTTO without trochleoplasty, was conducted. Demographic, imaging, and surgical data were obtained from medical records. The following measurements were obtained: Caton-Deschamps index (CDI), patellotrochlear index, tibial tubercle-trochlear groove (TT-TG) distance, patellar tendon-lateral trochlear ridge (PT-LTR) distance, lateral patellar tilt, tibiofemoral joint rotation (TFJR), lateral trochlear inclination (LTI), trochlear depth, sulcus angle, and sagittal bump height. The postoperative J-sign was assessed. Patients were categorized into the resolved J-sign group or persistent J-sign group. Binary logistic regression was performed to identify significant predictors of a postoperative J-sign. Cutoff values were determined by receiver operating characteristic curve analysis using the Youden index. The Fisher exact test was used to compare frequencies.RESULTSThe J-sign was not observed postoperatively in 56 cases (60.2%) and was thus considered resolved. Preoperative characteristics revealed differences between the resolved J-sign and persistent J-sign groups for mean lateral patellar tilt, PT-LTR distance, TFJR, sulcus angle, trochlear depth, TT-TG distance, sagittal bump height, and LTI. The mean amount of distalization, patellotrochlear index, and preoperative and postoperative CDI were similar between the groups. Logistic regression identified TFJR, PT-LTR distance, and LTI as significant predictors of a persistent J-sign. An increased risk of a persistent J-sign was found for a TFJR ≥6° (odds ratio [OR], 14.9 [95% CI, 5.4-41.6]), PT-LTR distance ≥13 mm (OR, 12.3 [95% CI, 4.3-35.5]), and LTI ≤10° (OR, 4.1 [95% CI, 1.6-10.4]). The frequency of a persistent J-sign was 3.8% for cases with no risk factors above the threshold value, 10.5% with 1 risk factor, 63.0% with 2 risk factors, and 87.5% with all 3 risk factors present.CONCLUSIONA persistent J-sign was associated with imaging measurements of a more lateralized extensor mechanism (greater PT-LTR distance), trochlear dysplasia (lower LTI), and increased external TFJR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"45 1","pages":"3635465251336162"},"PeriodicalIF":0.0,"publicationDate":"2025-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143893204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Morphological Risk Factors for Pediatric Anterior Cruciate Ligament Tears and Tibial Spine Fractures","authors":"Chang Ho Shin, Akbar N. Syed, Morgan E. Swanson, J. Todd R. Lawrence, Soroush Baghdadi, Aristides I. Cruz, Henry B. Ellis, Peter D. Fabricant, Daniel W. Green, Alicia Kerrigan, Julia Kirby, Mininder Kocher, Indranil V. Kushare, R. Jay Lee, James P. MacDonald, Scott D. McKay, Shital N. Parikh, Neeraj M. Patel, Yi-Meng Yen, Gregory A. Schmale, Kevin G. Shea, R. Justin Mistovich, Theodore J. Ganley","doi":"10.1177/03635465251334120","DOIUrl":"https://doi.org/10.1177/03635465251334120","url":null,"abstract":"Background: Both tibial spine fractures (TSFs) and anterior cruciate ligament (ACL) tears result in functional loss of knee stability. Nonetheless, it remains unclear why some patients sustain ACL tears, whereas others have TSFs. Purpose: To identify the common morphological risk factors for pediatric ACL tears and TSFs and to determine the morphological differences between them using multiplanar reconstruction of magnetic resonance imaging (MRI). Study Design: Cohort study; Level of evidence, 3. Methods: Age- and sex-matched participants (159 total [53 ACL tears, 53 TSFs, and 53 controls]) aged &lt;18 years who visited a pediatric tertiary-care center for ACL tears, TSFs, or anterior knee pain from March 2009 to April 2023 were included. Each group comprised 41 male and 12 female participants. Data on demographic characteristics and estimated bone age based on the knee MRI atlas were retrospectively collected, and various knee morphological parameters were evaluated using multiplanar reconstruction of MRI. Parameters showing significant differences among the 3 groups were selected as independent variables for multivariable multinomial logistic regression analysis, with the groups as dependent variables. Results: The mean chronological age at the time of MRI was 13.2 ± 2.3 years. Height, weight, body mass index, bone age, articular medial tibial slope, and bony medial tibial slope did not differ among the groups. Articular lateral tibial slope was independently associated with the occurrence of both ACL tears (relative risk ratio [RRR], 1.42 [95% confidence interval (CI), 1.16-1.74]; <jats:italic>P</jats:italic> = .001) and TSFs (RRR, 1.33 [95% CI, 1.10-1.62]; <jats:italic>P</jats:italic> = .004). A high notch width index was a protective factor against ACL tears (RRR, 0.86 [95% CI, 0.77-0.96]; <jats:italic>P</jats:italic> = .006) but not against TSFs (RRR, 1.01 [95% CI, 0.91-1.12]; <jats:italic>P</jats:italic> = .848). Conclusion: A high articular lateral tibial slope was a common risk factor for ACL tears and TSFs. Patients with ACL tears had a narrower intercondylar notch than those with TSFs and controls.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143880655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sagittal Slope-Reducing High Tibial Osteotomy Decreases Anterior Cruciate Ligament Force and Coupled Internal Tibial Rotation Under Pivoting Loads: A Computational Modeling Study","authors":"Mark J. Amirtharaj, Reza Pourmodheji, Mitchell G.A. Wheatley, Julien Leluc, Andrew E. Pechstein, Jacob M. Hirth, Michael K. Parides, Thomas L. Wickiewicz, Andrew D. Pearle, Matthieu Ollivier, Carl W. Imhauser, Danyal H. Nawabi","doi":"10.1177/03635465251334649","DOIUrl":"https://doi.org/10.1177/03635465251334649","url":null,"abstract":"Background: Sagittal-plane slope-reducing high tibial osteotomy (HTO) can reduce the risk of anterior cruciate ligament (ACL) injury in knees with a high posterior tibial slope. The biomechanical effect of slope-reducing HTO on tibiofemoral kinematics and force carried by the ACL remains less well understood. Hypothesis: Decreased tibial slope will be associated with decreased ACL force, coupled internal tibial rotation (ITR), and anterior tibial translation (ATT) under both compressive and combined compressive and valgus loads. Study Design: Descriptive laboratory study. Methods: Computational models of 10 cadaveric knees were created using magnetic resonance imaging– and computed tomography–based 3-dimensional renderings of the bones, articular cartilage, and menisci. Virtual slope-reducing HTO was performed on each tibial geometry in 1° increments, creating tibial slopes spanning −5° to 15°. All knees were flexed to 15°, and loads consisting of (1) axial compression (100 N) and (2) combined axial compression (100 N) and valgus torque (8 N·m) were then applied to each knee at each tibial slope. The outcome measures were ACL force, coupled ITR, and ATT. Relationships between tibial slope and each outcome measure were assessed via linear regression (α = .05), and the effects of 10° slope-reducing HTO, from 15° to 5°, on each outcome measure were reported. Results: A 10° slope-reducing HTO decreased ACL force by 53% under compression (1.7 N of ACL force per degree decrease in tibial slope; <jats:italic>P</jats:italic> &lt; .001) and 47% under combined compression and valgus (4.7 N of ACL force per degree decrease in tibial slope; <jats:italic>P</jats:italic> &lt; .001). Regarding kinematics, a 10° slope-reducing HTO decreased coupled ITR by 64% under combined compression and valgus (0.99° of coupled ITR per degree decrease in tibial slope; <jats:italic>P</jats:italic> &lt; .001). Finally, a 10° slope-reducing HTO decreased ATT by 54% under compression (0.14 mm of ATT per degree decrease in tibial slope; <jats:italic>P</jats:italic> &lt; .001). Conclusion: Slope-reducing HTO decreased ACL force linearly by reducing ATT with compression and also by decreasing coupled ITR with combined compression and valgus. Clinical Relevance: Slope-reducing HTO decreased ATT and coupled ITR, dampening movements known to load the ACL. These findings may provide a further biomechanical basis for the ability of slope-reducing HTO to decrease the risk of ACL injury.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Saline Irrigation Mitigates Chondrocyte Viability Changes During Trochleoplasty","authors":"Andrew R. Phillips, Erik C. Haneberg, Thomas E. Moran, Zachary R. Oppenheim, Adam B. Yanke","doi":"10.1177/03635465251334655","DOIUrl":"https://doi.org/10.1177/03635465251334655","url":null,"abstract":"Background: Trochleoplasty aims to correct trochlear dysplasia, an osseous cause of patellar instability. The procedure involves the use of a high-speed bur directly under femoral articular cartilage, which may place chondrocytes at risk of thermal necrosis. Purpose/Hypothesis: The purpose of this study was to investigate the effect of irrigation and offset used during a trochleoplasty procedure on trochlear chondrocyte viability. It was hypothesized that thermal necrosis would be induced by burring and would be mitigated with saline irrigation. Study Design: Controlled laboratory study. Methods: Cadaveric trochlea were obtained and sectioned into 4 quadrants. Trochleoplasty was performed in each quadrant under one of the following randomized conditions: 3-mm offset with saline irrigation (3Wet), 3-mm offset without irrigation (3Dry), 5-mm offset with irrigation (5Wet), or 5-mm offset without irrigation (5Dry). A 3 × 8-mm strip of cartilage was obtained from the center of each quadrant and from an 8-mm control area. Cartilage samples underwent chondrocyte viability staining with calcein-acetoxymethyl and ethidium homodimer-1. Confocal imaging was performed, and viability across treatment and control groups was compared. Results: Eight cadaveric trochlea were obtained from 5 male and 2 female donors (mean age, 26.4 ± 5.6 years). Trochleoplasty was performed at a mean of 25.3 ± 1.3 days from donor death on 5 right and 3 left trochlea. On analysis, control cartilage viability (75.3% ± 12.9%) was greater than those for 5Dry (60.4% ± 9.3%; <jats:italic>P</jats:italic> = .001) and 3Dry (63.2% ± 13.4%; <jats:italic>P</jats:italic> = .002). Cartilage viabilities for 5Wet (70.5% ± 11.0%; <jats:italic>P</jats:italic> = .15) and 3Wet (66.1% ± 10.9%; <jats:italic>P</jats:italic> = .09) were not significantly different from that of the control. No other intergroup differences were seen. Conclusion: Saline irrigation mitigates chondrocyte-induced thermal necrosis when performing trochleoplasty in this cadaveric model. Clinical Relevance: Saline irrigation should be used when performing a trochleoplasty, while offset of the trochleoplasty bur does not have an effect on cartilage viability.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"221 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pectoralis Minor–Repairing Latarjet: A Modified Technique to Prevent Postoperative Scapular Dyskinesis After the Latarjet Procedure","authors":"Vittorio Candela, Marco Scacchi, Daniele De Meo, Yuri Piccolo, Claudio Ascani, Stefano Gumina","doi":"10.1177/03635465251332270","DOIUrl":"https://doi.org/10.1177/03635465251332270","url":null,"abstract":"Background: Latarjet is the gold standard procedure for treating anterior shoulder instability associated with significant bone loss. However, concerns arise regarding associated anatomic and mechanical changes, including release of the pectoralis minor tendon and alteration of the conjoint tendon vector. Recent studies have investigated alterations in scapular position and motion after Latarjet, with conflicting findings. Purpose: To evaluate the clinical outcomes and scapular position and motion in patients treated with the pectoralis minor–repairing Latarjet (PMRL) compared with traditional Latarjet (TL) after midterm follow-up. Study Design: Case-control study; Level of evidence, 3. Methods: A case-control study included 41 consecutive patients (27 men and 14 women; mean age, 37.4 years; mean body mass index, 26.4) with anterior recurrent shoulder instability. Patients underwent TL (21 patients) or PMRL (20 patients). Clinical evaluation, including Western Ontario Shoulder Instability Index (WOSI), Rowe score, and Subjective Shoulder Value (SSV), was performed preoperatively and at various postoperative intervals. Scapular position and motion were assessed using established protocols. Statistical analyses were conducted. Results: The mean follow-up was 34 months. No significant differences were observed in surgical time, clinical scores, or patient satisfaction between groups. Recurrence of dislocation occurred in 1 TL patient and persistent apprehension in 1 PMRL patient. Postoperative hematoma occurred in 1 TL patient. The rate of return to preoperative sport activity for the TL and PMRL groups was 93% and 95%, respectively ( <jats:italic>P</jats:italic> &gt; .05). Scapular dyskinesis occurred in 5 TL patients (25%) and 0 PMRL patients; in all cases, a type III dyskinesis was present. Four of 5 cases resolved with 6 months of a specific rehabilitation protocol. A significance difference was found between patients with and without dyskinesis, according to the WOSI, Rowe score, and SSV ( <jats:italic>P</jats:italic> &lt; .05). Scapular malposition was observed in 2 TL patients with dyskinesis. Conclusion: The study confirmed that postoperative scapular dyskinesis occurred frequently (25%) after the Latarjet procedure. A simple modification of the original technique, which consists of repairing the pectoralis minor to the coracoid stump, prevented the risk of postoperative dyskinesis, maintaining the stabilizing benefits of the TL procedure.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143884310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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}