The American Journal of Sports Medicine最新文献

{"title":"Biomechanical Comparison of Transtibial Pull-out Fixation Versus Suture Anchor Fixation for Repair of Medial Meniscus Posterior Root Tears","authors":"Mark E. Cinque, Maximillian Hinz, Jason Sidrak, Justin F.M. Hollenbeck, Wyatt H. Buchalter, Ajay Kanakamedala, Justin J. Mitchell, Jonathan A. Godin, Matthew T. Provencher","doi":"10.1177/03635465251342267","DOIUrl":"https://doi.org/10.1177/03635465251342267","url":null,"abstract":"Background: Posterior medial meniscus root tears are commonly treated with a transtibial pull-out (TO) repair, but significant postoperative meniscal extrusion has been reported. Recently, knotless adjustable suture anchor fixation has been introduced to treat root tears. This anchor-based fixation demonstrates less cyclic displacement than a TO repair. However, it is unknown how meniscal extrusion and contact mechanics compare between these 2 repair techniques when the meniscus endures cyclic tibiofemoral loading. Hypothesis: Suture anchor repair will demonstrate reduced meniscal extrusion and lower medial compartment pressure at the 1000th cycle compared with the TO repair. Study Design: Controlled laboratory study. Methods: Eight pairs of cadaveric knees were used to compare extrusion and contact pressure between transtibial fixation and suture anchor repair techniques for medial meniscus posterior root tears. Each specimen underwent cyclic compressive loading (0th, 100th, 500th, and 1000th cycles). Medial meniscal extrusion was assessed with the knee at full extension using ultrasound, and medial compartment contact pressures were evaluated using pressure sensors. Statistical analyses included paired <jats:italic>t</jats:italic> tests and repeated-measures analysis of variance with an alpha level set at .05. Results: The suture anchor repair technique demonstrated significantly lower absolute and relative medial meniscal extrusion compared with transtibial fixation repair after 500 and 1000 cycles of loading ( <jats:italic>P</jats:italic> = .012 and <jats:italic>P</jats:italic> = .001, respectively). Similarly, mean medial compartment pressures were significantly lower in the suture anchor repair group compared with the transtibial fixation repair group after 1000 cycles ( <jats:italic>P</jats:italic> = .028). No significant differences were found in peak pressures between the 2 repair techniques. Conclusion: The suture anchor repair demonstrated lower medial meniscal extrusion and reduced medial compartment contact pressures after time-zero cyclic loading. This biomechanical profile may be important for increasing the likelihood of healing and may translate to improved long-term outcomes for patients undergoing meniscus root repair. Clinical Relevance: Understanding the biomechanical differences between repair techniques at time zero may be crucial for optimizing surgical outcomes and minimizing the risk of long-term joint degeneration after meniscus root tears. Future clinical studies should further investigate these findings in live patient populations to validate their effect on root healing, functional outcomes, and long-term osteoarthritis progression.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"27 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640060","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":"Musculoskeletal Injuries in National Hockey League Goaltenders.","authors":"Sam Keshen,Evan Curd,Richard Rotenberg,Sachin Raina,John Theodoropolous,Timothy Burkhart","doi":"10.1177/03635465251353229","DOIUrl":"https://doi.org/10.1177/03635465251353229","url":null,"abstract":"BACKGROUNDHockey goaltenders are exposed to unique in-game physical demands, different from those experienced by other positional players. While previous studies have identified the injuries experienced by elite goaltenders, these have been limited by the use of secondary data or data from small samples over relatively short time intervals.PURPOSETo quantify the type and number of injuries occurring in National Hockey League (NHL) goaltenders and the time lost due to these injuries.STUDY DESIGNDescriptive epidemiology study.METHODSData from the NHL's Athlete Health Management System was analyzed between the 2009-2010 and 2022-2023 seasons. The total number of each musculoskeletal injury, the total days missed (TDM) (a surrogate measure for injury severity), and the exposure-adjusted injury rate (EAIR) was quantified. For each individual diagnosis, the total number of injuries, mean, median, standard deviation, and minimum and maximum (range) TDM were calculated.RESULTSThere were 1585 musculoskeletal injuries recorded over 14 NHL seasons resulting in 31,406 TDM. The number of total injuries per year was stable across the data collection period. The EAIR was higher in the preseason (69.4) and postseason (46.8) compared with the regular season (17.1). The majority of the injuries occurred during games (n = 904), followed by practice and off-ice activities (n = 681). The most common mechanisms were noncontact (n = 673), incidental contact (n = 252), and \"unknown/other\" (n = 374). Proximal adductor injuries accounted for the largest number of injuries (n = 371), leading to the highest total TDM (n = 6126). Concussions (n = 110) and MCL sprains (n = 95) were the second and third most common injuries, respectively.CONCLUSIONThe most common injuries to NHL goaltenders are proximal adductor injuries, concussions, and MCL sprains. Attention should be paid to the significant number of injuries occurring in the preseason and practice periods.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"47 1","pages":"3635465251353229"},"PeriodicalIF":0.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622117","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":"Direct Comparison of Modified Jobe and Docking Reconstructions With Ulnar Collateral Ligament Repair With Suture Augmentation at Midterm Follow-up.","authors":"Steve H Bayer,Justin W Arner,Benjamin B Rothrauff,James P Bradley","doi":"10.1177/03635465251352186","DOIUrl":"https://doi.org/10.1177/03635465251352186","url":null,"abstract":"BACKGROUNDThe modified Jobe and docking techniques are the most utilized ulnar collateral ligament (UCL) reconstruction techniques, with previous research demonstrating successful and equivalent outcomes at midterm follow-up. However, these techniques have not been compared with UCL repair with suture augmentation (SA), nor has longer-term follow-up been reported.PURPOSETo directly compare clinical outcomes at midterm follow-up of these 3 surgical techniques: the modified Jobe, docking, and repair with SA.STUDY DESIGNCohort study; Level of evidence, 3.METHODSTwenty-four surgical procedures for UCL repair with SA were performed by a single surgeon, each with a minimum 2-year follow-up. Patients were matched by age, gender, and handedness to patients from previously published modified Jobe and docking cohorts. The following were compared among groups: Conway Scale, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score, years played, gender, handedness, sport, position, graft type (for reconstructive techniques), future upper extremity injury, need for additional surgery, rates of ulnar nerve symptoms, and return-to-play time.RESULTSPatients were similar with respect to age (P = .54), gender (P = .66), handedness (P = .29), sport (P = .23), years played (P = .72), level of competition (P = .08), type of pathology (P = .23), future shoulder surgery (P = .71), and future elbow surgery (P = .61). The mean ± SD follow-up was 6.2 ± 3.9, 7.3 ± 4.6, and 5.2 ± 1.1 years in the modified Jobe, docking, and repair + SA groups, respectively (P = .66). The reconstruction groups had a greater proportion of pitchers than the repair + SA group (P = .02). Tear locations in the SA cohort were proximal in 18 (75%) and distal in 6 (25%). In the SA cohort, 13 (54%) were partial tears, 10 (42%) were complete tears, and 1 (4%) was attenuated. The repair + SA cohort had a significantly greater proportion of proximal tears than the docking cohort (P = .03). No difference was identified among techniques in results on the Kerlan-Jobe Orthopaedic Clinic score (P = .70) or Conway Scale (P = .06). The UCL repair + SA cohort returned to sports 4 months earlier than the reconstruction cohorts (P = .0001).CONCLUSIONNo differences in outcomes scores or return-to-play rates were found when the modified Jobe and docking UCL reconstruction techniques were compared with the UCL repair + SA technique at >5-year mean follow-up; however, the SA group returned to sport 4 months earlier on average. Given the similar outcomes among groups, all 3 techniques are viable treatment options for UCL injuries.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"9 1","pages":"3635465251352186"},"PeriodicalIF":0.0,"publicationDate":"2025-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144622116","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":"A Higher Thigh Muscle Injury Incidence in Professional Male Soccer Players Returning to Play After Anterior Cruciate Ligament Reconstruction: Analysis of 110 Cases From the UEFA Elite Club Injury Study.","authors":"Francesco Della Villa,Håkan Bengtsson,Martin Hägglund,Romain Seil,Eric Hamrin Senorski,Jan Ekstrand,Markus Waldén","doi":"10.1177/03635465251353213","DOIUrl":"https://doi.org/10.1177/03635465251353213","url":null,"abstract":"BACKGROUNDPrevious literature has suggested an important association between a history of anterior cruciate ligament (ACL) reconstruction (ACLR) and future thigh muscle injuries, but more and larger studies are needed, particularly for quadriceps muscle injuries.PURPOSETo determine the incidence of hamstring and quadriceps muscle injuries after return to play (RTP) from ACLR using patellar tendon (PT) and hamstring tendon (HT) autografts in professional male soccer players.STUDY DESIGNCohort study; Level of evidence, 3.METHODSA total of 5447 players from 74 clubs were followed prospectively from July 2001 to May 2022. The injury incidence (number of injuries per 1000 hours) was compared between players with ACLR and those without ACL injuries as well as for players with ACLR between a 2-year period before the ACL injury and a 2-year period after RTP. The rate ratio (RR) was calculated with the 95% confidence interval (CI) and examined for significance with Z statistics.RESULTSThere were 110 ACLR cases (76 PT and 34 HT grafts) in 107 players included. Players with ACLR had a 60% higher thigh muscle injury incidence (RR, 1.6 [95% CI, 1.3-2.0]) within 2 years after RTP compared with players without ACL injuries. Players with ACLR had a doubled thigh muscle injury incidence (RR, 2.0 [95% CI, 1.4-2.9]) in the 2 years after RTP compared with 2 years before their ACL injury. Players with a PT autograft had a higher quadriceps muscle injury incidence (RR, 3.5 [95% CI, 1.4-8.8]) in the 2 years after RTP compared with 2 years before their ACL injury, whereas there was no difference in the hamstring muscle injury incidence in players with an HT autograft (RR, 1.7 [95% CI, 0.5-5.8]).CONCLUSIONACLR in professional male soccer players was associated with an increased thigh muscle injury incidence, particularly quadriceps muscle injuries in players with a PT autograft.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"81 1","pages":"3635465251353213"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578629","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":"Coronal Alignment Patterns in Primary Anterior Cruciate Ligament Tears: The Influence of Tibial Dominance on Both Varus and Valgus Alignment.","authors":"Adam B Thompson,Luke V Tollefson,Nicholas I Kennedy,Evan P Shoemaker,Christopher M LaPrade,Robert F LaPrade","doi":"10.1177/03635465251354972","DOIUrl":"https://doi.org/10.1177/03635465251354972","url":null,"abstract":"BACKGROUNDWhile the effect of increased posterior tibial slope on the anterior cruciate ligament (ACL)-deficient knee is increasingly recognized, the specific patterns of coronal alignment and their effects on concomitant knee abnormalities remain relatively underappreciated.PURPOSE/HYPOTHESISThe purpose of this study was to evaluate overall coronal-plane alignment in patients with primary ACL tears, identifying individual mechanical femoral and tibial angles, and whether secondary concomitant injuries associated with ACL tears were related to overall or individual mechanical femoral and tibial alignment. Our null hypothesis was that there would be no differences in the tibial or femoral influence among the coronal alignment groups.STUDY DESIGNCase series; Level of evidence, 4.METHODSThe preoperative coronal alignment of patients undergoing primary ACL reconstructions were assessed retrospectively between June 2019 and July 2024. Patients were categorized into neutral, varus, and valgus groups based on their long-limb coronal mechanical axis. Coronal measurements were obtained, including the mechanical lateral distal femoral angle (mLDFA) and mechanical medial proximal tibial angle (mMPTA), to determine individual alignment of the femur and the tibia. The neutral mLDFA and mMPTA were defined by a range within 1 standard deviation from the mean mLDFA and mMPTA values of the neutral group. Varus and valgus alignment were assessed, including if the variation originated from the tibia, the femur, or both. Comparisons to posterior tibial slope, sex, and concomitant injuries were analyzed.RESULTSThe study consisted of 250 patients (116 female). The mean mLDFA was 86.3° ± 1.7°, and the mean mMPTA was 87.3° ± 2.2°. The mean mechanical hip-knee-ankle angle and joint line convergence angle were 179.9° ± 2.9° and 1.3° ± 1.0°, respectively. On the basis of the mechanical axis, 113 patients were classified as having neutral alignment, 77 as having varus alignment, and 60 as having valgus alignment. The mMPTA was the primary cause of overall alignment in both the varus (54.5%) and valgus (65.0%) groups. Female patients had a significantly higher mMPTA than male patients (88.1° vs 86.7°, respectively), indicating less overall tibial varus alignment (P < .001), and there were significantly more female patients in the valgus group (P < .001). Concomitant meniscal, chondral, and ligament injuries displayed no significant associations between each coronal alignment group.CONCLUSIONThe present study found that overall varus and valgus alignment were influenced more often by the tibia, or the mMPTA, than by the femur, especially for valgus alignment. Additionally, female patients exhibited significantly more overall valgus alignment than male patients, with the tibia being the primary determinant of valgus alignment. Finally, coronal alignment did not influence concomitant meniscal, chondral, or ligament injuries.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"63 1","pages":"3635465251354972"},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144586470","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":"Patient and Operative Risk Factors for Subsequent Knee Arthroplasty After Primary Anterior Cruciate Ligament Reconstruction: A Cohort Study of 52,222 Patients","authors":"David Y. Ding, Heather A. Prentice, Chelsea Reyes, Elizabeth W. Paxton, Foster Chen, Gregory B. Maletis","doi":"10.1177/03635465251352180","DOIUrl":"https://doi.org/10.1177/03635465251352180","url":null,"abstract":"Background: Knee arthroplasty in patients who have undergone anterior cruciate ligament reconstruction (ACLR) has been associated with a high risk of infection, arthrofibrosis, and longer operative time due in part to difficulty with exposure and retained hardware. Patients who undergo ACLR are at a higher risk of undergoing knee arthroplasty and are at risk earlier than the general population. As patients with ACLR age and as ACLR surgery becomes more prevalent in the older athlete, the rates of knee arthroplasty after ACLR will only increase. Purpose: To determine the incidence of knee arthroplasty after ACLR, as well as identify patient and operative risk factors for knee arthroplasty after ACLR. Study Design: Cohort study; Level of evidence 3. Methods: Data from Kaiser Permanente’s ACLR Registry and Total Joint Replacement Registry were used to conduct a cohort study. Patients with primary ACLR were identified (2005-2022). Patient factors considered included age, body mass index (BMI), sex, race/ethnicity, smoking status, American Society of Anesthesiologists classification, activity at the time of injury, and medical comorbidities. Time from injury to ACLR, concomitant meniscal or chondral injuries, multiligament injury, graft type, and drilling technique were procedure factors evaluated. Postoperative factors included revision surgery, ipsilateral reoperation, and contralateral operation during follow-up. The outcome of interest was a subsequent knee arthroplasty. Patients were followed until the outcome of interest unless censored for membership disenrollment, death, or study end date (December 31, 2022). Multivariable Cox proportional hazards regression was used to determine factors associated with knee arthroplasty after ACLR using a &lt;jats:italic&gt;P&lt;/jats:italic&gt; value &lt;.05 as the threshold for statistical significance. Results: The study sample included 52,222 primary ACLRs. The mean age was 28.6 years, and more patients were male (60.2%). The incidence of knee arthroplasty after ACLR was 1.60% at 15 years of follow-up. The mean age of patients undergoing knee arthroplasty after ACLR was 56 years, which was 12 years younger than the mean age of patients undergoing primary knee arthroplasty in general. Risk factors for knee arthroplasty included increasing age compared with those &lt;40 years (40-49 years: hazard ratio [HR], 8.03 [95% CI, 4.83-13.34]; 50-59 years: HR, 18.24 [95% CI, 10.56-31.52]; ≥60 years: HR, 53.77 [95% CI, 26.24-110.22]), increasing BMI (HR, 1.07 [95% CI, 1.04-1.10]), female sex (HR, 1.60 [95% CI, 1.21-2.12]), trauma-associated anterior cruciate ligament (ACL) injury (HR, 1.71 [95% CI, 1.07-2.74]), a history of hypertension (HR, 1.69 [95% CI, 1.14-2.51]) or other neurological disorders at the time of ACLR (HR, 5.08 [95% CI, 2.15-12.02]), chondral injuries reported during the ACLR (HR, 1.43 [95% CI, 1.04-1.97]), and allograft selection (HR, 2.16 [95% CI, 1.17-4.00]). Revision surgery (HR, 2.19 [95% CI, 1.18-4.08]), i","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"109 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144578373","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 Outcomes of a Contemporary Arthroscopic Bankart Repair Technique in Patients With Traumatic Anterior Shoulder Instability: A Minimum 10-Year Follow-up.","authors":"Anh Do,Markus Scheibel,Philipp Moroder,Agahan Hayta,Isil Akgun Demir,Alp Paksoy,Doruk Akgün","doi":"10.1177/03635465251351293","DOIUrl":"https://doi.org/10.1177/03635465251351293","url":null,"abstract":"BACKGROUNDThe long-term results of arthroscopic Bankart repair are poorly reported in the literature and show recurrence rates as high as 37%. However, this high failure rate is based on historical studies of patients with critical defects stabilized using older techniques.PURPOSETo evaluate the long-term clinical outcomes of arthroscopic Bankart repair using a contemporary technique with a minimum of 3 suture anchors in patients with traumatic anterior instability and to assess possible risk factors for recurrent instability.STUDY DESIGNCase series; Level of evidence, 4.METHODSA total of 181 patients (182 shoulders), who underwent arthroscopic Bankart repair because of traumatic anterior instability between 2005 and 2014, were included in this study and evaluated at a minimum follow-up of 10 years. Exclusion criteria were previous shoulder surgery, additional stabilization procedures, use of &lt;3 anchors, multidirectional instability, and indications for bony reconstruction (critical bony defects: glenoid defect &gt;20%, off-track Hill-Sachs lesion). The primary outcome was recurrent instability. Secondary outcomes were the Subjective Shoulder Value (SSV), visual analog scale (VAS), Constant score, Western Ontario Shoulder Instability Index (WOSI), and Rowe score as well as sports activity level and return to sports. Risk factors for recurrent instability were analyzed.RESULTSThe overall recurrence rate was 20.9% at a mean follow-up of 13.8 ± 2.8 years. Age ≤20 years at the time of surgery was associated with a higher risk of recurrence (P = .007). The failure rate was lower in patients who underwent surgery after the first-time dislocation (8/58 [13.8%]) compared with patients who underwent surgery after multiple instability events (30/124 [24.2%]), although this was not statistically significant (P = .108). Patients without recurrent instability had statistically significant better scores on the SSV (P &lt; .001), VAS for pain during movements (P = .016), Constant score (P = .011), WOSI (P = .001), and Rowe score (P &lt; .001) compared with patients with recurrence without revision surgery. A shorter interval between the first dislocation and surgery was associated with better shoulder outcomes, despite a consistent recurrence rate. Of all patients, 97.6% returned to sports, with 69.6% returning to 90% to 100% of their preoperative sports activity.CONCLUSIONArthroscopic Bankart repair resulted in a relatively high recurrence rate, despite the use of a contemporary technique, particularly in patients with &gt;1 dislocation before surgery. While younger age and a higher number of preoperative dislocations were potential risk factors for recurrence, a shorter interval between the first dislocation and surgery was associated with improved clinical outcomes. Therefore, patients with a high risk of redislocations should be considered for early soft tissue stabilization, while additional procedures such as remplissage should be performed for those with nonmodifiab","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"20 1","pages":"3635465251351293"},"PeriodicalIF":0.0,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Focal Cartilage Lesions on Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction: A 10-Year Nationwide Cohort Study of 7040 Patients","authors":"Stian Kjennvold, Svend Ulstein, Asbjørn Årøen, Magnus Forssblad, Lars Engebretsen, Jan Harald Røtterud","doi":"10.1177/03635465251350398","DOIUrl":"https://doi.org/10.1177/03635465251350398","url":null,"abstract":"Background: Focal cartilage lesions are commonly associated with anterior cruciate ligament injuries. The long-term effect of these lesions on patient-reported outcomes after anterior cruciate ligament reconstruction (ACLR) remains unclear. Purpose: To determine the effect of cartilage lesions—partial thickness (International Cartilage Regeneration and Joint Preservation Society grades 1 and 2) and full thickness (grades 3 and 4)—on patient-reported outcomes 10 years after ACLR. Study Design: Cohort study; Level of evidence, 3. Methods: The study included all patients with primary unilateral ACLR enrolled in the Norwegian Knee Ligament Registry and Swedish Knee Ligament Registry from 2005 through 2008 (n = 15,783). At a mean follow-up of 10.1 years (SD, 0.2), 7040 (45%) patients completed the Knee injury and Osteoarthritis Outcome Score (KOOS). Multiple linear regression analyses were used to evaluate any associations between concomitant cartilage lesions and KOOS outcomes 10 years after ACLR. Results: Of the 7040 patients available at 10-year follow-up, 1425 (20.3%) had partial-thickness cartilage lesions at the time of ACLR, and 495 (7.0%) had full-thickness cartilage lesions. Multiple linear regression analyses revealed that partial- and full-thickness cartilage lesions were associated with significantly inferior scores across all KOOS subscales as compared with patients without cartilage lesions. Patients with full-thickness lesions had less postoperative improvement after ACLR in all KOOS subscales as compared with patients with partial-thickness lesions. Conclusion: Patients with concomitant partial- or full-thickness cartilage lesions reported significantly worse outcomes in all KOOS subscales 10 years after ACLR as compared with patients without cartilage lesions.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565764","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":"Comparison of Snowman and Single-Plug Circular Osteochondral Allograft Transplantation Techniques for Similarly Sized Defects: A Matched Cohort Analysis","authors":"Yusuf N. Mufti, Jared P. Sachs, Chloe H. Franzia, Fatima Bouftas, Kyle Wagner, Eric J. Cotter, Brian J. Cole","doi":"10.1177/03635465251352172","DOIUrl":"https://doi.org/10.1177/03635465251352172","url":null,"abstract":"Background: Multiplug “snowman” osteochondral allograft transplantation (OCA) is an effective treatment method for large, irregularly shaped osteochondral defects of the knee. No existing literature directly compares the effectiveness of this technique with traditional single-plug circular OCA. Purpose: To compare failure rates, reoperation rates, and relevant patient-reported outcome (PRO) scores at 2-year follow-up between patients undergoing snowman OCA and patients undergoing single-plug OCA. Study Design: Case series; Level of evidence, 3. Methods: Patients who underwent snowman or single-plug OCA between 2001 and 2021 with a minimum 2-year follow-up were identified. Propensity score matching at 1:2 was performed based on age, sex, body mass index, defect location, and defect size. The PRO measures assessed included the International Knee Documentation Committee subjective score, Lysholm score, Knee Injury and Osteoarthritis Outcome Score, and 12-Item Short Form Health Survey. Failure was defined as conversion to arthroplasty, revision OCA, or graft degeneration on second-look arthroscopic examination. Additionally, rates of achieving the minimal clinically important difference (MCID) or patient acceptable symptom state (PASS) for PRO measures were determined. Results: There were 26 patients (mean age, 33.3 ± 9.3 years; 65.4% male) who underwent snowman OCA with a mean follow-up of 5.8 ± 4.1 years. No significant differences in baseline variables were identified compared with a matched control group of 52 patients who underwent single-plug OCA. No differences were detected in the rate of achieving the MCID or PASS between the groups for any PRO measure. Overall, 5 patients (19.2%) in the snowman group experienced graft failure at a mean 1.7 ± 1.0 years, while 10 patients (19.2%) in the single-plug group met the criteria for failure at a mean 6.6 ± 3.5 years. No differences were detected in the rate of failure or reoperations between the 2 groups. Conclusion: Multiplug “snowman” and single-plug circular OCA techniques yielded comparable clinical outcomes and graft survivorship for defects of a similar size in a matched cohort analysis. Defect shape, rather than size alone, should guide the selection of a technique. The snowman technique is advantageous for longer or oval-shaped defects not easily treated with a single plug, as it minimizes the removal of healthy cartilage while maintaining optimal outcomes.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144565786","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":"Arthroscopic Bankart Repair Versus Immobilization for a First Episode of an Anterior Shoulder Dislocation Before the Age of 25 Years: A Randomized Controlled Trial With 6-Year Follow-up","authors":"Cécile Pougès, Marie Boutry, Carlos Maynou, Christophe Chantelot, Thomas Vervoort, Thomas Amouyel, Clément Lalanne, Pascal Malandri-Ghipponi","doi":"10.1177/03635465251350151","DOIUrl":"https://doi.org/10.1177/03635465251350151","url":null,"abstract":"Background: The risk of recurrence after a first episode of an anterior shoulder dislocation (ASD) is high with nonoperative treatment in younger patients. In a previous study, arthroscopic labral repair (Bankart repair) reduced the risk of secondary shoulder dislocations and improved functional outcomes versus nonoperative treatment at 2-year follow-up. Purpose/Hypothesis: The aim of this study was to compare the results of arthroscopic Bankart repair and nonoperative treatment at a minimum of 6 years’ follow-up in patients aged ≤25 years. The hypothesis was that acute surgery would decrease the risk of recurrence and improve functional outcomes. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: We included patients aged between 18 and 25 years after a first episode of an ASD and divided them into 2 groups. The first group was treated surgically with arthroscopic Bankart repair in the initial 2 weeks after the dislocation, and the second group was treated nonoperatively. Both groups were immobilized for 3 weeks in internal rotation and followed the same physical therapy protocol. Follow-up was performed at a minimum of 6 years. The primary outcome measure was the recurrence of instability, defined as another ASD requiring closed reduction or a subluxation. Secondary outcome measures included the need for stabilization surgery; return to sport; and functional outcomes according to the quick version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH), Walch-Duplay score, and Western Ontario Shoulder Instability Index (WOSI). Results: There were 20 patients included in each group. The mean age at the time of inclusion was 21.4 ± 1.8 years. A total of 37 patients were evaluated at a mean follow-up of 81.4 months (6.8 years). In the surgical group, the recurrence of instability (dislocation or subluxation) was significantly lower compared with the nonoperative group (n = 5 [27.8%] vs 17 [89.5%], respectively; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &lt; .0005), and the rate increased in both groups compared with 2-year results (n = 2 [10%] vs 13 [65%], respectively; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .003). Fewer patients had another episode of a dislocation in the surgical group compared with the nonoperative group (n = 4 [22.2%] vs 15 [79.0%], respectively; &lt;jats:italic&gt;P&lt;/jats:italic&gt; &lt; .003). In the surgical group, all dislocations occurred after 2 years’ follow-up, while 6 patients in the nonoperative group already had dislocations at 2 years. The Walch-Duplay score (93.24 vs 76.05 points, respectively; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .0004), WOSI score (12.12 vs 20.95 points, respectively; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .009), and QuickDASH score (4.84 vs 16.14 points, respectively; &lt;jats:italic&gt;P&lt;/jats:italic&gt; = .0088) were significantly better in the surgical group than in the nonoperative group. The rate of return to the same or better level of sport was 82% in the surgical group compared with 21% in the nonoperative gro","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144547014","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}