The American Journal of Sports Medicine最新文献

{"title":"Effect of Preoperative Bone Defect Severity on Results After Latarjet Procedure: A Comparative Cohort of 310 Patients With a Minimum Follow-up of 5 Years","authors":"Luciano Andrés Rossi, Rodrigo Brandariz, Santiago Bongiovanni, Matias Ramón Costa Paz, Catalina Larrague, Ignacio Tanoira, Maximiliano Ranalletta","doi":"10.1177/03635465251341451","DOIUrl":"https://doi.org/10.1177/03635465251341451","url":null,"abstract":"Background: There is a lack of studies in the literature evaluating the influence of the severity of the preoperative glenoid bone loss on the results of the Latarjet procedure. Purpose: To compare functional outcomes, return to sport, and complications in a consecutive series of athletes undergoing Latarjet surgery for glenohumeral instability by dividing patients for analysis into 3 groups according to the severity of glenoid bone loss (GBL) (group 1, GBL between 0% and 10%; group 2, GBL between 11% and 20%; group 3, GBL &gt;20%). Study Design: Case series; Level of evidence, 4. Methods: A comparative retrospective cohort study was performed in a consecutive series of competitive athletes with anterior glenohumeral instability who underwent surgery between January 2014 and January 2019. The clinical assessment included range of motion, Rowe score, American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS), Athletic Shoulder Outcome Scoring System (ASOSS), and return to sports. Graft consolidation was assessed by 3D computed tomography in all patients. All intraoperative and postoperative complications were documented. All results were compared between the 3 groups of patients. Results: A total of 310 patients were evaluated (n = 120 in group 1, n = 105 in group 2, and n = 85 in group 3). The mean follow-up was 8.3 years (range, 6.3-9.9 years) and the mean age was 22.1 ± 3.69 years. Range of motion and Rowe, ASES, VAS, and ASOSS scores showed significant improvement after surgery ( <jats:italic>P</jats:italic> &lt; .001). No statistically significant differences were found in range of motion pain or functional scores in relation to the severity of the preoperative GBL. In total, 286 patients (92%) returned to sport, and of these, 259 patients (90%) were able to return to competition at their preinjury level. The overall mean interval between surgery and return to sport was 5.4 months (range, 3-7 months). In total, 48 complications (15%) and 11 reoperations (3.5%) were noted, with no significant differences between groups. The control 3D computed tomography was performed at a mean of 3.4 months. The graft consolidated in 94.5% of patients. At the end of follow-up, 11% of patients had mild-stage osteoarthritis and 6% had moderate-stage osteoarthritis with no significant differences between groups. Conclusion: The majority of athletes with recurrent glenohumeral instability who underwent Latarjet surgery returned to sport at their preinjury level, with complete recovery of shoulder function and a similar percentage of complications regardless of the severity of the preoperative GBL.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640063","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-to-Consumer Marketing: The Ethics of Snake Oil Sales? Response","authors":"Timothy E. Foster","doi":"10.1177/03635465241277203","DOIUrl":"https://doi.org/10.1177/03635465241277203","url":null,"abstract":"","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144640058","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":"Clinical Factors Affecting Outcomes of Osteochondral Allograft Transplantation: A Multivariable Analysis of 560 Knees.","authors":"Tim Wang,Richard L Dees,Simon Görtz,Julie C McCauley,William D Bugbee","doi":"10.1177/03635465251355217","DOIUrl":"https://doi.org/10.1177/03635465251355217","url":null,"abstract":"BACKGROUNDOsteochondral allograft (OCA) transplantation is a successful treatment option for focal chondral and osteochondral lesions; however, outcomes vary by patient and intraoperative variables. Previous studies have compared outcomes of OCA transplantation using basic descriptive and surgical data; nonetheless, they do not account for possible confounding variables.HYPOTHESIS/PURPOSEThe purpose of this study was to report overall survivorship of OCA transplantation using a large, long-term registry from a specialty cartilage practice and utilize a multivariable model to identify factors that best predict treatment failure. The use of a multivariable analysis allows for the simultaneous assessment of multiple risk factors while controlling for the influence of confounding factors.STUDY DESIGNCase series; Level of evidence, 4.METHODSWe identified 527 patients (560 knees) who underwent OCA transplantation between 1997 and 2021 for focal chondral lesions by a single surgeon and had a minimum follow-up of 2 years. Treatment failure was defined as any surgery involving the removal of the allograft or conversion to arthroplasty. Variables associated with treatment failure in univariate analyses were included in a multivariable logistic regression model to identify those with the greatest effect.RESULTSThe mean age of the participants was 32.6 years, the mean follow-up was 8.2 years, and 62% were men. Treatment failure occurred in 89 knees (15.9%) at a median of 3.9 years postoperatively. Graft survivorship was 89% at 5 years, 83% at 10 years, and 75% at 15 years. Univariate analysis identified patient age, body mass index (BMI), diagnosis type, anatomic location, number of grafts, total graft size, and number of previous surgeries to be associated with treatment failure. However, in the multivariate analysis, only patient age, BMI, diagnosis, and graft size independently predicted a higher risk of treatment failure after controlling for other variables. Specifically, patients who were aged ≥30 years were 2.13 times more likely than younger patients to experience a treatment failure. Patients with a BMI of ≥30 kg/m2 were 2.24 times more likely to experience treatment failure compared with patients with a BMI of &lt;30 kg/m2. Patients with degenerative chondral lesions, avascular necrosis, or osteoarthritis were more likely to experience treatment failure compared with patients with osteochondritis dissecans. Grafts with a total surface area of &gt;8 cm2 were 2.12 times more likely to fail than those ≤8 cm2.CONCLUSIONOCA transplantation performed in all settings yielded effective long-term results, with graft survivorship of 83% at 10 years postoperatively. Patient age ≥30 years, BMI of ≥30 kg/m2, diagnosis, and graft size &gt;8 cm2 were independently associated with a higher risk of treatment failure when controlling for other variables. Understanding the effect of clinical variables in a multivariable model is useful for counseling patients on the odds of t","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"46 1","pages":"3635465251355217"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645814","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 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}