The American Journal of Sports Medicine最新文献

{"title":"Combining an Anterolateral Complex Procedure With Anterior Cruciate Ligament Reconstruction Reduces Graft Reinjury Without Increasing the Rate of Complications: A Systematic Review and Meta-analysis of Randomized Controlled Trials","authors":"Riccardo D’Ambrosi, Katia Corona, Simone Cerciello, Germano Guerra, Michele Mercurio, Olimpio Galasso, Federico Valli, Elisabeth Abermann, Christian Fink","doi":"10.1177/03635465241285887","DOIUrl":"https://doi.org/10.1177/03635465241285887","url":null,"abstract":"Background:Anterolateral ligament reconstruction (ALLR) or lateral extra-articular tenodesis (LET) has been used more frequently in conjunction with anterior cruciate ligament reconstruction (ACLR) in recent years. However, there are still concerns that these procedures may lead to complications such as overconstraint of the lateral compartment, stiffness, infections, tunnel convergence, and other intra- and postoperative complications because of increased surgical time and the need for additional procedures.Hypothesis/Purpose:The lateral extra-articular procedure will reduce the failure rate of reconstructed ACLs without increasing the number of complications. The purpose was to compare the complication and graft reinjury rates of 2 main anterolateral complex procedure categories described in the literature—LET and ALLR with isolated ACLR.Study Design:Systematic review and meta-analysis of randomized controlled trials (RTCs); Level of evidence, 2.Methods:The methodology followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, and Cochrane Library databases were searched on March 15, 2024, to identify RTCs comparing isolated ACLR with ACLR + LET or ALLR. The methodological index for nonrandomized studies was employed for the quality evaluation. Complications and graft reinjury rates were recorded and meta-analyzed from all included studies.Results:The initial search yielded 1411 articles. Seventeen studies that included the complication rates (5 in the ALLR group and 12 in the LET group) were included in the review. No significant differences were found in the incidence of complications between the ACLR and ACLR + ALLR groups (Mantel-Haenszel [M-H], 1.20 [95% CI, 0.05-29.30]; P = .91) or between the ACLR and ACLR + LET groups (M-H, 0.39 [95% CI, 0.05-2.98]; P = .36). Significant differences were observed in the failure rate between the ACLR + ALLR group (M-H, 6.78 [95% CI, 1.98-23.22]; P = .002) and the ACLR + LET group (M-H, 3.14 [95% CI, 1.96- 5.04]; P < .00001).Conclusion:Adding a lateral extra-articular procedure, regardless of the surgical technique, can reduce the failure rate without increasing the number of complications at the mid-term follow-up.Study Registration:PROSPERO (CRD42023458354).","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967748","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":"Knotless Versus Knotted Suture Anchors for Labral Repair of the Hip: A Systematic Review of Clinical and Biomechanical Outcomes","authors":"William L. Johns, Anthony N. Baumann, Megan E. Callaghan, Kempland C. Walley, Neel K. Patel, John Salvo","doi":"10.1177/03635465241239689","DOIUrl":"https://doi.org/10.1177/03635465241239689","url":null,"abstract":"Background:Arthroscopic labral repair of the hip is successfully performed with increasing frequency using either knotless or knotted suture anchors, each with its own risks and benefits.Purpose:To examine biomechanical and clinical outcomes for labral repair of the hip based on the use of knotted or knotless suture anchors.Study Design:Systematic review; Level of evidence, 4.Methods:A search was performed to retrieve clinical and biomechanical studies examining the use of knotless or knotted suture anchors for arthroscopic labral repair of the hip. The studied outcomes included functional outcome scores such as modified Harris Hip Score (mHHS) and Hip Outcome Score Activities of Daily Living, biomechanical outcomes, failure mechanisms, and complications such as revision/reoperation and conversion to total hip arthroplasty (THA).Results:A total of 47 articles met inclusion criteria for analysis (5 articles examining biomechanical outcomes and 42 reporting clinical outcomes). Included patients (N = 6185) who underwent hip labral repair had a mean age of 33.0 ± 8.5 years and follow-up time of 43.8 ± 18.4 months. The knotless group (n = 2719) had a mean preoperative mHHS of 63.3 ± 4.1 and postoperative mHHS of 86.3 ± 2.8 at a mean follow-up time of 47.2 ± 16.1 months. The knotted group (n = 2600) had a mean preoperative mHHS of 69.5 ± 8.3 and postoperative mHHS of 88.8 ± 5.5 with a mean follow-up time of 44.8 ± 18.1 months. The most common reason for failure of knotless anchors in biomechanical studies was suture breakage or pullout, and for knotted anchors it was anchor pullout. Of the articles reporting on revisions and/or conversion to THA after labral repair, the knotless group had 225 reoperations (8.1%) and 123 cases of conversion to THA (4.4%). The knotted group had 101 reoperations (6.2%) and 31 cases of conversion to THA (1.9%).Conclusion:Arthroscopic management of labral repairs of the hip using either knotless or knotted suture anchors appears to be both safe and effective in reducing pain and improving function. Biomechanical evaluation suggests differing failure mechanisms in knotted versus knotless anchors. The rates of revision and conversion to THA are low overall, irrespective of knotted or knotless anchors.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962796","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":"Where Are All the Female Participants in Sports and Exercise Medicine Research? A Decade Later","authors":"Benjamin M. Ose, Jake Eisenhauer, Isaiah Roepe, Ashley A. Herda, Bryan G. Vopat, Lisa M. Vopat","doi":"10.1177/03635465241278350","DOIUrl":"https://doi.org/10.1177/03635465241278350","url":null,"abstract":"Background:In 2014, Costello and colleagues published a sentinel paper spotlighting the large disparity of female versus male representation within sports science and sports medicine (SSSM) research.Purpose:To (1) revisit the method published by Costello et al a decade later to evaluate female representation and (2) ascertain whether study designs account for menstrual status.Study Design:Systematic Review; Level of evidence, 4.Methods:All original and epidemiologic research of live human participants from the journals Medicine and Science in Sports and Exercise, British Journal of Sports Medicine, and the American Journal of Sports Medicine were included from January 2021 to August 2023. Number of male and female participants for each study was analyzed. A menstrual-status tiering system published by Smith et al was used to classify the consideration of female participants’ menstrual status in study design.Results:A total of 1441 studies and 40,152,860 participants were included in this analysis. This included 17,648,509 (43.95%) female participants. The mean proportion of female participants per study was 40.22%, and 103 (7.15%) studies included only female participants compared with 268 (18.6%) male-only studies. A total of 66 (5.6%) studies included menstrual-status considerations in their study design with 7.7 (0.7%) and 5.5 (0.5%) receiving a silver or gold classification, respectively, for design considerations.Conclusion:Our investigation into the representation of female athletes in SSSM research found an increase in female participation from 39% to 43.95% of total participants over the past decade. While the overall number of female participants rose in the years 2021 to 2023, there remains a significant disparity in female representation in SSSM research compared with male participants. Additionally, we found that the inclusion of menstrual status in study designs has been limited, with few studies considering this crucial variable.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936705","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":"Malpractice Liability Exposure and the Sports Medicine Team Physician: Caring for Professional Athletes in the National Football League, Major League Baseball, and National Hockey League","authors":"Michael Pang, Sayyida S. Hasan, Joshua J. Woo, Reena J. Olsen, Prem N. Ramkumar","doi":"10.1177/03635465241306742","DOIUrl":"https://doi.org/10.1177/03635465241306742","url":null,"abstract":"Background:Orthopaedic surgeons play a critical role in ensuring the health and safety of professional athletes. Despite the privilege of treating elite athletes, there exists great financial exposure to individual physicians in the event of a malpractice lawsuit.Hypothesis/Purpose:The purpose of this study was to evaluate and model malpractice liability exposure of the sports medicine surgeon caring for athletes in the National Football League (NFL), Major League Baseball (MLB), and National Hockey League (NHL) with respect to player position and additional supplemental malpractice insurance needs. It was hypothesized that routine liability coverage cannot adequately address the demands of caring for elite athletes in professional sports leagues.Study Design:Economic and Decision Analysis; Level of evidence, 3.Methods:In total, 2447 NFL, 992 MLB, and 980 NHL player contracts from the 2022-2023 season were aggregated from a publicly available online database. Position, team, total contract value, and mean yearly salary were noted. Risk ratios were calculated with respect to 1 million US dollars (USD) and 3 million USD of annual occurrence-based malpractice liability awards and used to generate a “covered-to-treat” analysis. Supplemental malpractice liability insurance was quantified.Results:Assuming 1 million and 3 million USD occurrence-based awards covered by malpractice liability insurance, team physicians can fully treat 17.3% and 50.0% of NFL players, 43.2% and 59.7% of MLB players, and 13.6% and 41.0% of NHL players, without incurring additional personal financial risk, from a risk-based medicolegal model. Liability policies of 52.6 million, 108.1 million, and 64.1 million USD are required to treat 95% of NFL, MLB, and NHL players, respectively. Positions carrying the greatest risk ratios are quarterback (QB) (9.9) in the NFL, right field (15.1) in the MLB, and center (5.7) in the NHL.Conclusion:Sports medicine specialists caring for elite athletes face potential personal financial risk due to insufficient medicolegal coverage. While coverage may vary among different practice settings including private, academic, or public state institutions, medical malpractice risk is crucial in partnerships between sports franchises, hospitals, players, agents, and physicians to protect sports medicine physicians and offer the highest-quality care.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940349","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":"Osteochondral Allograft Transplantation as a Salvage Procedure After Failed Index Cartilage Surgery of the Knee: A Systematic Review","authors":"Varun Gopinatth, Sina Tartibi, Matthew V. Smith, Matthew J. Matava, Robert H. Brophy, Derrick M. Knapik","doi":"10.1177/03635465241238466","DOIUrl":"https://doi.org/10.1177/03635465241238466","url":null,"abstract":"Background:Osteochondral allograft transplantation (OCA) is well established as a viable chondral restoration procedure for the treatment of symptomatic, focal chondral defects of the knee. The efficacy of secondary OCA in the setting of failed index cartilage repair or restoration is poorly understood.Purpose:To evaluate radiographic and clinical outcomes, failures, and reoperations after OCA after failed index cartilage repair or restoration of the knee.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review was conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search was conducted by querying PubMed, MEDLINE, Scopus, the Cochrane Database for Systematic Reviews, and the Cochrane Central Register for Controlled Trials databases from inception through September 2023 to identify studies reporting on outcomes of patients undergoing OCA after failed index chondral repair or restoration.Results:A total of 6 studies, entailing 349 patients, met inclusion criteria. The mean patient age was 34.6 ± 10.2 years. The mean chondral defect size at the time of secondary OCA was 5.8 cm<jats:sup>2</jats:sup> (range, 4.0-9.5 cm<jats:sup>2</jats:sup>), and the most common defect location was the medial femoral condyle (53.6%; n = 171/319). The most common index chondral procedures were marrow stimulation (73.8%; n = 256/347 patients), OCA (11.8%; n = 41/347), and autologous chondrocyte implantation (4.9%; n = 17/347). The overall failure rate after secondary OCA was 16.6% (95% CI, 8.8%-24.4%). The overall reoperation rate was 42.8% (95% CI, 31.7%-53.9%). Failure and reoperation rates were associated with increasing chondral defect size ( P &lt; .01). Defects 9-10 cm<jats:sup>2</jats:sup> had a reoperation rate of 67% and a failure rate of 39%. The 5-year survival rate after secondary OCA was 79% to 87.8%, and the 10-year survival rate was 61% to 82%. A total of 42 clinical outcome scores were reported, and 71.0% (n = 22/31) of patient-reported outcome measures yielded significant improvement from preoperative to postoperative levels for patients undergoing secondary OCA.Conclusion:After index chondral surgery, the overall failure rate after secondary OCA was 16.6%, with an overall reoperation rate of 42.8%. The majority of clinical outcomes reported suggest improvement when compared with preoperative values. Larger chondral defects may be associated with higher rates of failure and reoperation.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142940356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Outcomes of Glenoid Bone Graft Fixation Techniques: A Systematic Review","authors":"Joseph C. Brinkman, Eugenia A. Lin, M. Lane Moore, Nikhil N. Verma, John M. Tokish","doi":"10.1177/03635465241278328","DOIUrl":"https://doi.org/10.1177/03635465241278328","url":null,"abstract":"Background:The Latarjet and other bony augmentation procedures are commonly used to treat anterior shoulder instability in the setting of significant glenoid bone loss. Although several fixation strategies have been reported, the biomechanical strength of these techniques remains poorly understood.Purpose:To perform a systematic review of the biomechanical strength of glenoid bony augmentation procedures for anterior shoulder instability.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic search of the Medline, Embase, Web of Science, and Cochrane Library databases was performed to identify biomechanical studies evaluating various fixation strategies for coracoid and other bone transfer procedures for anterior shoulder instability. Biomechanical results included load to failure with both compression and traction forces, stiffness, and cyclic displacement. The quality of included articles was assessed based on the Quality Appraisal for Cadaveric Studies (QUACS) scale.Results:A total of 21 biomechanical studies comprising 486 specimens were included. The number of screws used and the addition of washers were found to significantly increase rigidity and load to failure. The comparison of fixation techniques demonstrated mixed results in load to failure between screw and alternative constructs including suture buttons and suture anchors. However, studies that tested graft displacement consistently found more graft displacement in buttons compared with screws. The median and mean of the QUACS scale were both 12, with a range of 10-13.Conclusion:Biomechanical studies consistently demonstrated that when glenoid bone grafts were fixed with screws, the number of screws and use of washers significantly increased construct rigidity and load to failure. Different metal screw materials and sizes did not consistently demonstrate a significant difference in biomechanical strength. There are mixed results when comparing suture buttons to screw fixation. The evaluated studies revealed that all double metal screw constructs and the majority of suture button and anchor constructs were able to withstand the glenohumeral load reflective of activities of daily living using a 150-N threshold.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"67 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936872","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 Association Between Delaying Anterior Cruciate Ligament Reconstruction in Adolescents and Increasing Meniscal and Chondral Pathology: A Cohort Study of 2740 Adolescents","authors":"Kirsten L. Hickie, Lucy J. Salmon, Benjamin R. Gooden, Matthew C. Lyons, Keran Sundaraj, David Carmody, Phil Huang, Leo A. Pinczewski, Justin P. Roe","doi":"10.1177/03635465241306759","DOIUrl":"https://doi.org/10.1177/03635465241306759","url":null,"abstract":"Background:A growing body of evidence surrounds secondary meniscal and cartilage pathology after delay to anterior cruciate ligament (ACL) reconstruction (ACLR). Many of these studies focus on or include an adult population.Purpose:To elucidate the prevalence of secondary meniscal and chondral pathology with delay to ACLR in the adolescent population as well as examine the influence of sex, skeletal maturity, and trends over the years.Study Design:Cohort study; Level of evidence, 3.Methods:A prospective database was used to identify all patients younger than 19 years who underwent ACLR at the authors’ center between January 1993 and April 2023. Operative data including meniscal and chondral injury and treatment were prospectively recorded at the time of ACLR. A retrospective analysis was performed assessing the relationship between meniscal treatment and chondral injury at ACLR and the time from injury to ACLR, controlling for age, sex, and decade of surgery with multiple regression analysis. Prevalence of meniscal and chondral surgery at ACLR was examined over time and compared between sexes and age groups.Results:A total of 2740 patients were identified with a median age of 17 years (range, 7-19 years). Surgical delay of 5 to 12 months increased the risk of medial meniscal tear requiring surgery by 1.6 (95% CI, 1.1-2.2; P = .007). Surgical delay &gt;12 months increased the risk of medial meniscal tear requiring surgery by 4.2 (95% CI, 3.1-5.8; P = .001) and medial chondral injury by 3.4 (95% CI, 2.2-5.1; P = .001). The repairability of medial meniscal tears decreased with greater delay to reconstruction (57% before 5 months vs 19% after 12 months; P = .001). Lateral meniscal tear repairability followed a similar trend. More male than female participants had secondary pathology (46% vs 39%; P = .001). Patients aged 14-19 years had more meniscal surgery and chondral pathology compared with those younger than 14 years (45% vs 30%, P = .001).Conclusion:Surgical delay &gt;4 months from injury is associated with a steady increase in the prevalence of medial meniscal and chondral pathology in adolescents with ACL rupture. If ACL surgery is delayed &gt;12 months, the odds of requiring medial meniscal surgery is increased by a factor of 4 and the odds of having a chondral lesion is increased by a factor of 3. Timely diagnosis of ACL injury and early surgical referral are important for reducing the odds of meniscal and chondral pathology in adolescents.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"204 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936876","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Return to Sport After Treatment of Stable Osteochondritis Dissecans Lesions of the Knee in Adolescents: A Systematic Review","authors":"Rahul Muchintala, Carlo Coladonato, Andres Perez, Alec Kellish, Shiraz Mumtaz, William Sutton, Sean Wilson, Steven Cohen, Fotios P. Tjoumakaris, Kevin B. Freedman","doi":"10.1177/03635465241272464","DOIUrl":"https://doi.org/10.1177/03635465241272464","url":null,"abstract":"Background:Treatment of stable osteochondritis dissecans (OCD) lesions of the knee in young patients poses the challenge of abstaining from competitive sports for months. Outcomes relevant to this patient population additionally include successful return to sport (RTS), return to the same level of sport, and the time needed to achieve both.Purpose:To evaluate the adolescent population for RTS outcomes after treatment of stable OCD lesions of the knee and to compare RTS outcomes between patients treated nonoperatively and those who required surgery.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic search of the literature was conducted using the terms “knee,”“return to play,”“return to sport,”“osteochondritis dissecans,”“articular cartilage,”“arthroscopic drilling,”“open drilling,” and “arthroscopic fixation” between inception and May 31, 2023 using PubMed, CINAHL, SPORTDiscus, and Ovid MEDLINE databases. Articles reporting RTS outcomes with a minimum of 6 months’ follow-up were included. Articles were excluded if they were abstracts, editorials, letters, or reviews; were in languages other than English; had &lt;6 months of follow-up, on average; had no data specific to the knee; had no RTS outcomes; consisted of skeletally mature patients; or involved only unstable OCD lesions.Results:Available data were collected from 13 articles, consisting of level 3 and 4 evidence, which met inclusion criteria with a total of 710 patients and 783 knees. Ages ranged from 8 to 18 years, and the mean follow-up time ranged from 9.5 to 48 months. Nonoperative treatment consisted of activity modification, bracing, casting, and physical therapy to allow for healing of the subchondral bone. All patients attempted at least 6 weeks of nonoperative treatment. Operative treatment consisted of surgical drilling or internal fixation. The rate of successful nonoperative management for adolescents with stable OCD of the knee ranged from 40.3% to 87.5%. Of those treated successfully with nonoperative treatment, RTS rates ranged from 84.7% to 100%. Patients treated operatively had RTS rates of 100% and rates of return to the same level of sport ranging from 77.8% to 100% at 6 months’ follow-up. Rates of return to the same level of sport varied between operative techniques used. Patients who underwent operative management demonstrated improvements in Lysholm and Tegner scores, and most knees were rated excellent or good according to the Hughston rating scale.Conclusion:The current literature demonstrates favorable short-term RTS outcomes after the nonoperative and operative management of stable OCD lesions of the knee in young athletes. When successful, nonoperative management demonstrated high RTS rates, and further research should investigate prognostic factors for successful nonoperative management. The operative management of stable OCD lesions resulted in high rates of RTS and return to the same level of sport, improvements in patient-reported outco","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936875","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":"Evaluation of Spin in Clinical Trials of Mesenchymal Stromal Cells for the Treatment of Knee Osteoarthritis: A Systematic Review","authors":"Katherine Woolley, Nesa Milan, Zubin Master, Brian T. Feeley","doi":"10.1177/03635465241274155","DOIUrl":"https://doi.org/10.1177/03635465241274155","url":null,"abstract":"Background:The regenerative potential of mesenchymal stromal cells (MSCs) has sparked interest in their use for knee osteoarthritis. Concurrently, there have been investigations on how data in scientific journals are reported and how they may influence readers’ interpretations, or “spin bias.” These studies are at risk for bias, given the limited number of patients and inconsistent blinding or controls. The risk of spin bias also complicates the interpretation, as results may be presented in a way that favors a particular outcome.Purpose:To quantify and characterize spin bias in clinical trials of MSCs for knee osteoarthritis.Study Design:Systematic review.Methods:PubMed and Embase searches were conducted using the terms “mesenchymal stem cells” or “MSCs” and “knee arthritis” or “osteoarthritis” and “therapy” or “treatment” or “regeneration.” Overall, 2 independent reviewers classified spin as high, moderate, or low and as 1 of 3 types: (1) emphasizing statistically significant results, (2) interpreting nonsignificant results as treatment effectiveness, and (3) claiming treatment benefits despite nonsignificant results. Journals were categorized as orthopaedic or nonorthopaedic. Descriptive statistics, the chi-square test, and the Fisher exact test were used to analyze the data, with alpha set at P &lt; .05.Results:Among the 54 studies, spin was found in 80.0% of articles, with 14.5% having high, 25.5% moderate, and 40.0% low levels of spin. Type 1 was found in 54.5% of articles, type 2 in 18.2%, and type 3 in 29.1%. Spin was less frequently observed in the Methods section of articles compared with the abstract (17.52; P = .003). Reports on adipose-derived MSCs were associated with a higher frequency and level of spin compared with reports on MSCs from other sources (18.92; P = .026). There was no difference in the frequency of spin between orthopaedic and nonorthopaedic journals (0.48; P = .49) and no association with the impact factor (5.34; P = .07). There was no association between spin and financial disclosures (0.02; P = .577).Conclusion:Spin bias was present in most MSC-related trials for knee osteoarthritis, with a higher frequency among those that utilized adipose-derived MSCs. Understanding the prevalence and strategies of spin can mitigate any potential misinterpretations of study outcomes.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936873","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":"Risk Factors for Recurrent Instability After Arthroscopic Bankart Repair in Pediatric and Adolescent Patients: A Systematic Review","authors":"Tyler Warner, Jeffrey Kay, Shane McInnis, Benton E. Heyworth","doi":"10.1177/03635465241267022","DOIUrl":"https://doi.org/10.1177/03635465241267022","url":null,"abstract":"Background:While risk factors for recurrent instability (RI) after arthroscopic Bankart repair (ABR) for anterior glenohumeral instability (aGHI) have been well established in adult populations, there is much less evidence in pediatric and adolescent patients, despite being the most affected epidemiologic subpopulation.Purpose:To identify the clinical, demographic, radiologic, and operative risk factors for RI after ABR for aGHI in pediatric and adolescent patients.Study Design:Systematic review; Level of evidence, 4.Methods:This systematic review was performed according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Three databases (PubMed, Embase, and Ovid [MEDLINE]) were searched from data inception to July 5, 2023, using the terms “pediatric,”“shoulder instability,” and “Bankart repair,” allowing data on patients with age up to 19 years. The Methodological Index for Non-randomized Studies tool was used to assess the quality of included studies.Results:Eleven studies met the criteria, with 767 patients (770 shoulders) with a mean age of 16.4 years (range, 12-19; 18% female). The pooled RI rate was 28%, and the revision aGHI surgery rate was 20%. The following risk factors were identified for RI after ABR, in descending order of frequency of identification, in terms of number of studies: younger age and greater glenoid bone loss, as well as the presence and/or greater size of a Hill-Sachs lesion (HSL) (2 studies each), followed by off-track HSL, &gt;1 dislocation before index surgery, overhead and/or contact sports participation, larger anterior labral tear size, loss of glenoid retroversion, greater number of anchors used, lower postoperative patient-reported outcome scores (PROs), nonunion after bony Bankart repair, and absence of concomitant remplissage (1 study each).Conclusion:In pediatric and adolescent patients with aGHI, the most common risk factors identified for RI after ABR were younger age, greater glenoid bone loss, and the presence and greater size of an HSL. Other risk factors included &gt;1 dislocation before index surgery, participation in overhead and/or contact sports, larger anterior labral tear size, loss of glenoid retroversion, greater number of anchors used, lower postoperative PROs, nonunion after bony Bankart repair, and absence of concomitant remplissage.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142936874","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}