The American Journal of Sports Medicine最新文献

{"title":"Posterolateral Corner Reconstruction: A Systematic Review and Meta-analysis of Biomechanical Studies","authors":"Kyle P. Zielinski, Mark D. Wieland, Sean B. Sequeira, Heath P. Gould, James C. Dreese","doi":"10.1177/03635465241266264","DOIUrl":"https://doi.org/10.1177/03635465241266264","url":null,"abstract":"Background:Surgical reconstruction is the standard treatment for injuries to the posterolateral corner (PLC) of the knee and can be performed using either a fibular-based or combined tibiofibular-based technique. Although some comparative studies have been performed, there is no consensus regarding the reconstructive approach that confers optimal biomechanical properties of the PLC.Purpose:To perform a systematic review and meta-analysis to evaluate the biomechanical properties of the knee after PLC reconstruction with fibular-based and tibiofibular-based techniques.Study Design:Meta-analysis; Level of evidence, 4.Methods:A systematic review was performed by searching the PubMed, Cochrane Library, and Embase databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify studies that analyzed the biomechanical properties of PLC reconstruction techniques. Evaluated outcomes included varus laxity and external rotation laxity. The pooled biomechanical data were analyzed by random-effects models and heterogeneity was assessed using the I<jats:sup>2</jats:sup> statistic.Results:Eleven studies met the inclusion criteria; 74 cadaveric specimens were included. Seven studies (54 specimens) evaluated the fibular-based Larson reconstruction technique, 3 studies (22 specimens) evaluated a modified fibular-based Larson reconstruction, and 1 study (7 specimens) evaluated the fibular-based Arciero reconstruction. Five studies (45 specimens) evaluated the tibiofibular-based LaPrade reconstruction technique and 2 studies (20 specimens) evaluated a modified LaPrade reconstruction. Data were pooled for fibular-based reconstructions (Larson, modified Larson, and Arciero) and tibiofibular-based reconstructions (LaPrade, modified LaPrade). Pooled analysis revealed no significant difference in varus laxity and external rotation laxity between fibular and tibiofibular reconstructions at 0°, 30°, 60°, and 90° of flexion (all P &gt; .05).Conclusion:No difference in varus laxity and external rotation laxity was observed between fibular-based and tibiofibular-based techniques for PLC reconstruction. Moreover, there was no difference in varus laxity and external rotation laxity observed between the Larson, modified Larson, and LaPrade reconstructions. These results suggest that biomechanical stability after fibular- and tibiofibular-based PLC reconstructions is similar. Further clinical investigation is warranted to validate these cadaveric findings.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935774","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":"Uncovering the State of Current Data on Quadriceps Tendon Autograft Use Versus Bone–Patellar Tendon–Bone and Hamstring Tendon Autografts in Anterior Cruciate Ligament Reconstruction at ≥5 Years After Surgery: A Systematic Review and Meta-analysis","authors":"Sarah C. Kurkowski, Michael J. Thimmesch, Meredith Murphy, Henry A. Kuechly, Andrew S. Emmert, Brian Grawe","doi":"10.1177/03635465241266628","DOIUrl":"https://doi.org/10.1177/03635465241266628","url":null,"abstract":"Background:The use of quadriceps tendon (QT) autograft for anterior cruciate ligament (ACL) reconstruction has been increasing since 2014. Studies have shown that QT is comparable to hamstring tendon (HT) and bone–patellar tendon–bone (BTB) autografts in terms of outcomes, although QT autograft has lower rates of donor site morbidity. Systematic reviews and meta-analyses have been previously conducted on this topic, although none have focused solely on data of patients at least 5 years out from surgery.Hypothesis/Purpose:The purpose of this meta-analysis was to demonstrate that QT may not be superior to BTB and HT autografts and that long-term studies must be performed before recommending QT over other graft choices. It was hypothesized that there would be less available data at ≥5 years of follow-up for patients with QT than those with HT and BTB autografts, and that patient-reported outcomes would be similar between all 3 graft choices.Study Design:Meta-analysis; Level of evidence, 4.Methods:The PubMed/MEDLINE, Scopus (Elsevier), Embase, and Cochrane Library databases were queried for studies that reported on QT, BTB, or HT outcomes at ≥5 years after ACL reconstruction (ACLR). In total, 27 studies were included; patient and outcome data were collected from each. Summary odds ratios were calculated for each outcome and compared between all graft types.Results:The sheer volume of available patient data on QT autografts at ≥5 years after ACLR is vastly different from what is available on HT and BTB autografts (which have almost 3 times the amount of patient data as compared with QT). HT had the highest failure rate (12.7%), followed by QT (9.1%) and BTB (6.4%); summary odds ratios favored BTB over both QT and HT in terms of failure rate. Patient-reported outcomes were comparable between graft types, although some comparisons were not adequately powered.Conclusion:This meta-analysis reveals critical information on the current state of the literature surrounding QT use in ACLR. Most notably, additional mid-term and long-term patient data are needed on those undergoing ACLR with QT autograft. There is not enough long-term outcome data on QT to recommend it over HT or BTB for primary ACLR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935772","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":"Intra-articular Injections of CXCR4-Overexpressing Human Cartilage–Derived Progenitor Cells Improve Meniscus Healing and Protect Against Posttraumatic Osteoarthritis in Immunocompetent Rabbits","authors":"Jay Trivedi, Salomi Desai, Janine Molino, Brett D. Owens, Chathuraka T. Jayasuriya","doi":"10.1177/03635465241309305","DOIUrl":"https://doi.org/10.1177/03635465241309305","url":null,"abstract":"Background:Meniscal injuries that fail to heal instigate catabolic changes in the knee's microenvironment, posing a high risk for developing posttraumatic osteoarthritis (PTOA). Previous research has suggested that human cartilage–derived progenitor cells (hCPCs) can stimulate meniscal repair in a manner that depends on stromal cell–derived factor 1 (SDF-1) pathway activity.Hypothesis:Overexpressing the SDF-1 receptor CXCR4 in hCPCs will increase cell trafficking and further improve the repair efficacy of meniscal injuries.Study Design:Controlled laboratory study.Methods:hCPCs were genetically modified to overexpress CXCR4 (CXCR4-overexpressing [OE] hCPCs) using lentivirus. In vitro characterization was performed using cell viability assay, cell migration assay, and immunoblotting. These cells were then used to treat a meniscal injury in rabbits. A medial meniscal tear was surgically created in the right knees of New Zealand White rabbits, followed by 2 intra-articular injections (5.0 × 10<jats:sup>6</jats:sup> cells each) of either CXCR4-OE hCPCs, wild-type hCPCs, or saline alone. A histological assessment of menisci and cartilage was performed using safranin O/fast green staining. Joints were assessed for PTOA changes using the modified Osteoarthritis Research Society International scoring system. Fluorescence imaging and DNA analysis were performed to examine tissue for human cells.Results:SDF-1 inhibited NF-κB and ERK pathways in both wild-type and CXCR4-OE hCPCs. CXCR4 overexpression increased hCPC trafficking toward sources of SDF-1, including injured meniscal fibrocartilage and an SDF-1–presoaked collagen scaffold. Intra-articular injections of CXCR4-OE hCPCs significantly improved meniscus healing, as evidenced by the complete absence of tears in 5 of 6 (83%) animals that received CXCR4-OE hCPCs compared with only 3 of 6 (50%) wild-type hCPC–treated animals and 2 of 6 (33%) animals in the saline control group. CXCR4-OE hCPC–treated animals also showed significantly less erosion in their knee cartilage compared with control animals.Conclusion:Overall, CXCR4 overexpression inhibited catabolic pathway signaling in hCPCs and increased cell migration. Evidence suggests that intra-articular injections of these cells into the injured knee allow them to home in on sites of fibrocartilage injuries and ultimately result in meniscal tear healing and PTOA inhibition in immunocompetent animals.Clinical Relevance:This study demonstrated that cartilage progenitors with elevated CXCR4 expression have the potential to be a potent therapeutic tool for stimulating meniscal tear healing.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935770","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 Presence of a Trochlear Bump and Patella Alta May Predict the Risk of Recurrent Instability After Isolated Medial Patellofemoral Ligament Reconstruction: A Systematic Review and Meta-analysis","authors":"Navya Dandu, Tristan J. Elias, Mario Hevesi, Nicholas A. Trasolini, Athan G. Zavras, Erik Haneberg, Adam B. Yanke","doi":"10.1177/03635465241266594","DOIUrl":"https://doi.org/10.1177/03635465241266594","url":null,"abstract":"Background:Medial patellofemoral ligament reconstruction (MPFLR) is an excellent surgical option for patients with recurrent patellar instability. This technique has demonstrated significant improvements in patient-reported outcomes, high rates of return to sport, and low rates of failure. However, there is debate regarding the use of isolated MPFLR in the setting of concomitant pathoanatomic features such as patella alta, trochlear dysplasia, or a lateralized tibial tubercle.Purpose:To estimate the overall relative effect sizes as well as strength of evidence supporting described risk factors for recurrent instability after isolated MPFLR.Study Design:Systematic review and meta-analysis.Methods:A systematic review was performed in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Embase, Cochrane, and Ovid/MEDLINE databases were queried. Clinical studies for outcomes of isolated MPFLR reporting recurrent instability and associated risk factors were included. Data for each risk factor analyzed by at least 2 studies were extracted, and the heterogeneity of studies was determined by I<jats:sup>2</jats:sup> value. For variables evaluated in studies determined to have fair homogeneity, defined as I<jats:sup>2</jats:sup> &lt;25%, DerSimonian-Laird random-effects models were generated and effect sizes were represented as mean differences or odds ratios.Results:Nine studies examining risk for recurrent instability after isolated MPFLR were identified, with 5 overlapping risk factors with low heterogeneity between studies: age, sex, tibial tubercle to trochlear groove (TT-TG) distance, Caton-Deschamps Index (CDI), and trochlear dysplasia. There was strong evidence to support the risk of recurrent instability associated with CDI &gt;1.3 (OR, 2.72; P = .02) and dysplasia with a trochlear bump (DeJour type B or D; OR, 3.28; P &lt;.001). Age, sex, and TT-TG distance did not cause an increased risk of recurrent instability with currently available aggregate data.Conclusion:There are signs of increased risk of failure of isolated MPFLR in the setting of DeJour type B and D trochlear dysplasia and patella alta (CDI, &gt;1.3). Currently available data suggest that age, sex, and TT-TG distance do not cause a higher risk of recurrence for patients undergoing isolated MPFLR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935771","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":"Immunophenotyping of Synovial Tissue in Adolescents Undergoing ACL Reconstruction: What Is the Role of Synovial Inflammation in Arthrofibrosis?","authors":"Sarah M. Romereim, Matthew R. Smykowski, Elaina K. Ball, Edward Grant Carey, Mario Cuadra, Alicia Williams, Kate Hickson, Kara Haim, Meera Sumith, Ziqing Yu, Guangxu Jin, David Foureau, Nury Steuerwald, Susan Odum, Bailey V. Fearing, Jonathan C. Riboh","doi":"10.1177/03635465241305411","DOIUrl":"https://doi.org/10.1177/03635465241305411","url":null,"abstract":"Background:Loss of motion and arthrofibrosis after anterior cruciate ligament (ACL) reconstruction (ACLR) can be devastating complications for athletes. The cellular and molecular pathogenesis of arthrofibrosis is poorly understood, limiting prevention and treatment options. Synovial inflammation may contribute to post-ACLR arthrofibrosis.Hypothesis:Higher synovial immune cell infiltration and inflammatory/catabolic gene expression patterns at the time of ACLR would correlate with poorer motion-related outcomes.Study Design:Case series; Level of evidence, 4.Methods:Patients aged 10 to 18 years undergoing primary ACLR were enrolled in a prospective pilot study, and synovial tissue biopsy specimens were obtained during ACLR. Flow cytometry and single-cell RNA sequencing explored synovial cell types/frequencies and gene expression. Principal component analysis was performed, followed by clustering which grouped patients into distinct immunophenotypes based on their synovial cell composition. Clinical follow-up data with knee range of motion (ROM), need for lysis of adhesions, and patient-reported outcome measures were collected and compared between immunophenotypes.Results:Enrolled patients (n = 17) underwent ACLR at a median of 37 days after injury. Analysis revealed 3 distinct immunophenotypes. Type 1 consisted of patients with the longest time between injury and surgery and the lowest hematopoietic and T-cell infiltration. Types 2 and 3 had similar times between injury and surgery; type 2 had intermediate while type 3 had the highest hematopoietic and T-cell percentages. Type 3 was associated with worse ROM at 2 and 6 weeks postoperatively; T-cell prevalence and ROM were inversely correlated at those time points. The only patient requiring lysis of adhesions for arthrofibrosis had a type 3 immunophenotype.Conclusion:Synovial immune infiltration after ACL injury shows variability between patients that clusters into 3 immunophenotypes correlating with early ROM and the risk of arthrofibrosis. T-cell recruitment and infiltration were the strongest factors correlated with ROM outcomes and present an exciting venue for future research on post-ACLR arthrofibrosis.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"147 4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142935773","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 Use of Liposomal Bupivacaine for Pain Control After Shoulder Surgery: A Systematic Review and Meta-analysis","authors":"Mohamad Y. Fares, Mohammad Daher, Peter Boufadel, Adam Z. Khan, Joseph A. Abboud","doi":"10.1177/03635465241260255","DOIUrl":"https://doi.org/10.1177/03635465241260255","url":null,"abstract":"Background:Liposomal bupivacaine (LB) is a relatively novel anesthetic agent used in the management of postoperative pain in patients who have undergone shoulder surgery.Purpose:To explore the literature on LB in the setting of shoulder surgery and assess its efficacy and utility in managing postoperative pain.Study Design:Systematic review and meta-analysis; Level of evidence, 1.Methods:PubMed, Cochrane, and Google Scholar (pp 1-20) were searched for articles published up to November 2023. Inclusion criteria consisted of randomized controlled trials comparing anesthetic modalities using LB with other anesthetic modalities using alternative drugs in patients who underwent shoulder surgery. Complications, pain levels in the first 24 hours postoperatively, and opioid consumption intraoperatively and in the first, second, and third 24 hours postoperatively were assessed.Results:A total of 15 randomized controlled trials were included in the meta-analysis. In 4 studies comparing periarticular injections of LB (196 patients) with nerve blocks of other anesthetic agents (201 patients), there was no significant difference in pain levels ( P = .74) and complication rates ( P = .37); however, intraoperative opioid consumption was significantly greater in patients with periarticular injections of LB ( P = .005). In 3 studies comparing single-injection LB nerve blocks (83 patients) with interscalene nerve block catheters (102 patients) and in 8 studies comparing single-injection LB nerve blocks (311 patients) with other nerve blocks (308 patients), single-injection LB nerve blocks demonstrated clinical superiority. Single-injection LB nerve blocks resulted in significantly lower pain levels and lower opioid consumption in the first, second, and third 24 hours postoperatively compared with other single-injection nerve blocks and both single-injection nerve blocks and interscalene catheters combined.Conclusion:LB is a promising anesthetic component with efficacy in providing analgesia after shoulder surgery. Single-injection LB nerve blocks were found to be superior in reducing pain levels and opioid consumption compared with other anesthetic modalities.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142929399","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":"Long-term Complications From Peripheral Nerve Blocks After Pediatric Orthopaedic Lower Extremity Procedures: A Systematic Review","authors":"Sunny M. Trivedi, Charlotte F. Wahle, Yifan V. Mao, Dimpy Wraich, Kevin G. Shea, Kesavan Sadacharam, Zachary Stinson, Matthew Ellington, Emily Niu, Brendan Williams, Neeraj Patel, Henry Ellis, Allison Crepeau, Kelly Vanderhave, Sasha Carsen, Stephanie Mayer, Andy Pennock, Curtis Vandenberg, Jennifer J. Beck","doi":"10.1177/03635465241255606","DOIUrl":"https://doi.org/10.1177/03635465241255606","url":null,"abstract":"Background:Peripheral nerve blocks (PNBs) are frequently utilized as a regional anesthetic in pediatric orthopaedic surgery for postoperative pain control and reduced time to discharge; however, short- and long-term complications after these procedures are variably reported.Purpose:To identify the frequency of long-term complications in pediatric patients who received regional anesthesia for a lower extremity orthopaedic procedure.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic literature search was performed using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were collected on pediatric patients, which included the following: block type, block location, procedure type, patient age, experimental design, and reported outcomes. Full texts were then thoroughly examined to determine whether the article made specific references to long-term (≥6 weeks) complications in pediatric patients who received PNBs.Results:A total of 158 studies were assessed for eligibility. There were 16 of 158 (10%) studies that met inclusion criteria of having a discussion on follow-up to evaluate for long-term complications (≥6 weeks) from pediatric PNBs. Of these 16 studies, 9 documented long-term complications, while 7 reported no complications. The most common complications were motor deficits, chronic pain, reduced range of motion, and neurological paresthesia. Of the 9 studies reporting long-term complications related to PNBs, 16 of 352 patients across 2 studies (5%) reported chronic pain, 45 of 466 patients across 4 studies (10%) reported strength deficits, 16 of 135 patients across 2 studies (12%) reported reduced range of motion, and 11 of 15,387 patients across 4 studies (0.07%) reported sensory deficits.Conclusion:Persistent complications occurred in pediatric orthopaedic patients undergoing lower extremity procedures with PNBs; however, reports in the current literature were rare.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142929404","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 Revision Cartilage Restoration Surgery for Failed Primary Treatment of Chondral or Osteochondral Defects of the Knee: A Systematic Review","authors":"Kyle N. Kunze, Steven Persaud, Juan Briano, Scott A. Rodeo, Russell F. Warren, Thomas L. Wickiewicz, Riley J. Williams","doi":"10.1177/03635465241260271","DOIUrl":"https://doi.org/10.1177/03635465241260271","url":null,"abstract":"Background:Failure of primary cartilage restoration procedures of the knee that proceed to necessitating revision cartilage procedures represent a challenging clinical scenario with variable outcomes reported in previous literature.Purpose:To perform a systematic review and meta-analysis of clinical outcomes and adverse events after revision cartilage restoration procedures of the knee for failed primary cartilage procedures.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:The PubMed, OVID/MEDLINE, and Cochrane databases were queried in August 2023 for trials reporting on the outcomes of revision cartilage restoration procedures of the knee. Information pertaining to rates of failure, reoperations, graft-related complications, and patient-reported outcome measures were extracted. A meta-analysis using inverse-variance proportion models using Freeman-Tukey double-arcsine transformations and DerSimonian-Laird random-effects estimators was constructed to quantitatively describe the cumulative incidence of adverse events.Results:Sixteen studies (1361 patients; mean age, 35.7 ± 9.3 years) were included. The most frequently performed revision cartilage procedure was autologous chondrocyte implantation (ACI; n = 755 [55.5%]). The overall rate of failure was 25.1% (95% CI, 14.4%-37.3%) at a mean 6.5 years (range, 2-26 years). The majority of studies (n = 9) reported a failure rate exceeding 20%. A significant reduction in failure was observed in favor of the revision osteochondral allograft cohort (19.0% [75/395] vs 35.7% [273/764]; relative risk, 0.63; P &lt; .0001) compared with the revision ACI cohort. The pooled all-cause reoperation event rate was 40.8%, which ranged between 18.2% and 71.4% (13 studies). Of these studies, 12 reported reoperation rates exceeding 20%, and 7 reported rates exceeding 40%. The pooled graft-related complication event rate was 27.2%, which ranged between 5.4% and 56.6% (11 studies). Notably, all analyses demonstrated considerable or moderate heterogeneity, potentially influencing the observed variability in pooled effect estimates.Conclusion:One of every 4 patients may experience a secondary failure after undergoing a revision cartilage procedure. Revision using an osteochondral allograft may confer a meaningful reduction in the risk of failure relative to revision using ACI. High rates of graft-related complications and reoperations are also frequently observed in this population, highlighting the challenge of treating patients with failed primary treatment of chondral or osteochondral defects of the knee.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142929403","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":"No Association Between Donor Variables and Clinically Significant Outcomes, Reoperations, and Failure After Osteochondral Allograft Transplantation","authors":"Mario Hevesi, Kyle R. Wagner, Ryan A. Quigley, Zach D. Meeker, Allen A. Yazdi, Alexander C. Weissman, Sara A. Muth, Nate S. Cohen, Adam B. Yanke, Brian J. Cole","doi":"10.1177/03635465241305419","DOIUrl":"https://doi.org/10.1177/03635465241305419","url":null,"abstract":"Background:Mismatch between osteochondral allograft (OCA) donor and recipient sex has been shown to negatively affect outcomes. This study accounts for additional donor variables and clinically relevant outcomes.Purpose:To evaluate whether donor sex, age, donor-recipient sex mismatch, and duration of graft storage affect clinical outcomes and failure rates after knee OCA transplantation.Study Design:Cohort study; Level of evidence, 3.Methods:Patients undergoing knee OCA transplantation between 2003 and 2018 were prospectively followed. Inclusion criteria consisted of primary OCA transplantation and minimum 2-year follow-up. Patient descriptive data and allograft donor sex, age, and graft storage time before implantation were collected. Patients were evaluated for reoperation, failure, and achievement of clinically significant outcomes for International Knee Documentation Committee scores. Reoperation was defined as subsequent surgical intervention of the transplanted allograft, including second-look arthroscopy for graft evaluation, debridement, and loose body removal. Failure was defined as revision of the primary OCA transplantation or conversion to arthroplasty. A Kaplan-Meier curve determined cumulative survivability of OCA transplantations, and log-rank testing was used to compare survivorship between groups. Stepwise regression analysis was utilized to evaluate associations between donor variables and achievement of clinically significant outcomes, reoperation, and failure.Results:A total of 372 patients undergoing OCA transplantation were included and followed for a mean 5.4 years (SD, 2.7; range, 2.0-16.3). Isolated OCA transplantation was performed in 45% of cases (169/372). A mismatch in donor and recipient sex was present for more female patients (90%) than male patients (10%; P &lt; .001). Those who had a sex-mismatched graft more frequently underwent concomitant tibial tubercle osteotomy ( P = .034). When controlling for patient sex, no other differences were seen between groups matched and mismatched by sex. Univariable and multivariable analysis found no significant difference in survival free from reoperation or failure on the basis of donor-recipient sex mismatch, donor age, or graft storage time before implantation.Conclusion:In contrast to previous historical data, no donor variables were associated with inferior clinical outcomes in patients who underwent OCA transplantation. These data can help inform graft selection, expedient recipient selection, and outcome optimization after OCA transplantation.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925077","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":"Athlete Selective Androgen Receptor Modulators Abuse: A Systematic Review","authors":"Nikhil Vasireddi, Henrik A. Hahamyan, Heath P. Gould, Andrew J.M. Gregory, Elizabeth B. Gausden, Christopher C. Dodson, James E. Voos, Jacob G. Calcei","doi":"10.1177/03635465241252435","DOIUrl":"https://doi.org/10.1177/03635465241252435","url":null,"abstract":"Background:Selective androgen receptor modulators (SARMs) are small-molecule compounds that exert agonist and antagonist effects on androgen receptors in a tissue-specific fashion. Because of their performance-enhancing implications, SARMs are increasingly abused by athletes. To date, SARMs have no Food and Drug Administration approved use, and recent case reports associate the use of SARMs with deleterious effects such as drug-induced liver injury, myocarditis, and tendon rupture.Purpose:(1) To provide a comprehensive synthesis of the literature pertaining to SARMs from a sports medicine perspective and (2) to provide a better understanding of the clinical effects, treatment protocols, prevalence, and potential contamination associated with athlete-consumed SARMs.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the English-language literature from PubMed, Cochrane, and Embase databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Articles relevant to SARM clinical outcomes, elimination profiles, contamination, safety profiles, prevalence, and doping control were included.Results:A total of 72 articles from 2003 to 2022 were identified for inclusion. The prevalence of SARM use among athletes is estimated to be 1% to 3%. SARM preclinical and clinical studies reported significant increases in lean body mass and side effects—including bone remodeling, testosterone suppression, and kidney, liver, and prostate enlargement. Thirteen case reports described 15 cases of SARM abuse. All described patients were men, with a median age of 32 years (range, 19-52 years), more than half were identified as athletes (8/15), and all ingested SARMs orally for a mean course of 8 weeks. Five patients described in the case reports explicitly denied “illicit drug use,” implying patients may believe their use to be legal. Athletes most commonly purchased SARMs online, and most of these compounds have been shown to be contaminated with other substances, contributing to adverse effects. Athletes reported consuming SARMs at much higher doses than clinically studied, which may increase the risk of the reported side effects, such as liver injury, impaired insulin sensitivity, cardiovascular events, and tendon damage.Conclusion:The results of this systematic review serve to educate sports medicine clinicians and researchers on how to better identify, diagnose, and treat athlete SARM abuse. SARM use is associated with increased muscle mass, hepatotoxicity, cardiotoxicity, tendon damage, and androgenic side effects throughout the body—including prostate enlargement and serum testosterone suppression. Identifying and treating SARM abuse requires taking a thorough substance and supplement use history with open communication, providing literature-supported patient education, negotiating SARM discontinuation, and performing multidisciplinary treatment of adverse events. Athle","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925075","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}