The American Journal of Sports Medicine最新文献

{"title":"Outcomes of Surgical Interventions for Patellofemoral Instability in the Presence of Trochlear Dysplasia: A Systematic Review and Meta-analysis","authors":"Bader Majed Aljadaan, Mohammed Saad A. Alhakbani, Shahd Hamza Almonaie, Peter M.B. Cahusac","doi":"10.1177/03635465241252805","DOIUrl":"https://doi.org/10.1177/03635465241252805","url":null,"abstract":"Background:Patellar instability is frequently encountered by orthopaedic surgeons. One of the major risk factors of this condition is underlying trochlear dysplasia (TD). Recent trends have indicated the use of multiple procedures to correct patellar instability under these conditions. Medial patellofemoral ligament reconstruction (MPFLR) and trochleoplasty (TP) are surgical strategies that have demonstrated successful outcomes. However, it is unclear whether isolated MPFLR suffices for patellar instability in the presence of severe TD. Furthermore, the need for TP or a combined approach, considering its invasiveness and technical demands, to achieve better clinical outcomes and patellofemoral stability remains uncertain.Purpose:To compare the outcomes of 3 surgical interventions for addressing patellar instability due to TD: MPFLR, TP, and combined MPFLR and TP.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:Studies reporting the clinical outcomes of MPFLR, TP, and both in combination, regardless of additional procedures, were identified using the MEDLINE, PubMed, Embase, Scopus, Cochrane Library, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature databases. An important inclusion criterion was that studies should include the mean preoperative and postoperative Kujala scores and any complications. A random-effects model was used for the meta-analysis.Results:Overall, 30 studies were included: 10 describing the outcomes of TP, 13 describing the outcomes of MPFLR, and 7 describing the outcomes of combined TP and MPFLR. Furthermore, 1457 patients (1571 knees) were evaluated with a mean follow-up of 42.4 ± 32.8 months. No statistically significant differences were found between the 3 methods regarding the mean difference using the Kujala score. However, combined MPFLR and TP had the highest weighted mean difference compared with the other 2 procedures (28.5 points; P < .001). Evidential analysis revealed a robust log-likelihood ratio ( S = 3.2) supporting the superiority of the combined procedure when comparing this mean and the weighted grand mean of 23.7. The redislocation rate after patellar stabilization remained minimal, irrespective of the surgical procedure (mean, 0.7%). However, the rate of residual patellar instability was the highest in the TP group (mean, 13.5%).Conclusion:This study found no statistically significant difference between the outcomes of the 3 procedures. However, the combined approach of MPFLR and TP was associated with the most promising clinical outcomes and a low redislocation rate in patients with varying severities of TD.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"72 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925081","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":"Midterm Functional Outcomes After Retear of an Arthroscopic Rotator Cuff Repair: A Propensity Score–Matched Comparative Study","authors":"Jae Soo Kim, Su Cheol Kim, Jong Hun Park, Hyun Gon Kim, Hyoung Seok Jung, Sang Min Lee, Jae Chul Yoo","doi":"10.1177/03635465241305742","DOIUrl":"https://doi.org/10.1177/03635465241305742","url":null,"abstract":"Background:Studies are still limited on the isolated effect of retear after arthroscopic rotator cuff repair (ARCR) on functional outcomes after the midterm period.Purpose:To assess the effect of retear at midterm follow-up after ARCR and to identify factors associated with the need for revision surgery.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review was conducted on patients who underwent ARCR between 2014 and 2018, with a minimum 5-year follow-up. The structural integrity was evaluated using magnetic resonance imaging. After propensity score matching, 65 patients for the retear group and 65 for the healed group were included. Functional outcomes, including visual analog scale for pain and function (PVAS and FVAS) and American Shoulder and Elbow Surgeons (ASES) score, were compared between the groups at 1 year and final follow-up. Multivariate analysis was conducted on the retear group to identify factors associated with the final ASES score.Results:The mean ± SD follow-up period was 6.9 ± 1.4 years. All outcomes at the final follow-up improved as compared with the preoperative status, regardless of retear (all P < .001). In the retear group, PVAS at the final follow-up showed deterioration when compared with postoperative 1 year ( P = .044). While there were no significant differences in all outcomes at 1 year postoperatively between the groups (all P > .05), the retear group demonstrated significantly worse outcomes than the healed group in scores on the PVAS (2.5 ± 1.5 vs 1.9 ± 1.5; P = .011), FVAS (7.3 ± 1.4 vs 7.8 ± 1.3; P = .020), and ASES (73.2 ± 12.7 vs 79.9 ± 15.4; P = .008) at the final follow-up. The revision rate in the retear group was 12.8%, and multivariate analysis showed that larger anteroposterior retear size ( P = .017) and retear of the subscapularis ( P = .047) were negatively associated with the final ASES score.Conclusion:Functional outcomes after ARCR improved during midterm follow-up, regardless of retear. While the effect of retear itself on functional outcomes was minimal in the short term, it became more pronounced after the midterm period. A retear involving the subscapularis or with a larger anteroposterior size was associated with a poorer functional outcome.","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":"142925078","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":"Exploring the Relationship Between Combined, Acetabular, and Femoral Version on Postoperative Outcomes 2 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome","authors":"Jordan H. Larson, Sachin Allahabadi, Daniel Kaplan, Reagan Chapman, Omair Kazi, Christopher M. Brusalis, Shane J. Nho","doi":"10.1177/03635465241303704","DOIUrl":"https://doi.org/10.1177/03635465241303704","url":null,"abstract":"Background:Many studies have examined the prevalence of acetabular version (AV) and femoral version (FV) abnormalities and their effect on patient-reported outcomes (PROs) after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), but few have explored the prevalence and influence of combined version (CV) abnormalities.Purpose:To (1) describe the distribution of AV, FV, and CV in the largest cohort to date and (2) determine the relationship between AV, FV, and CV and PROs after hip arthroscopy for FAIS.Study Design:Cohort study; Level of evidence, 3.Methods:Patients were identified who underwent primary hip arthroscopy for FAIS between 2012 and 2018 and received computed tomography containing the pelvis and transcondylar knee slices. AV and FV were assessed on computed tomography, with CV calculated as their sum. PROs were collected preoperatively and 2 years postoperatively. The distributions of AV, FV, CV, and combinations thereof were described based on published ranges. The relationships between version measurements and PROs were analyzed based on a given measurement's distance from a normative value, defined as the mean within the study population (eg, relative acetabular anteversion [AAr]). These relationships were first assessed using univariate natural (restricted) cubic regression splines to account for nonlinearity. The relationship between each relative version group (to the mean) and PROs was then assessed using multiple linear regression, with the other 2 version measurements held constant.Results:In total, 566 patients were included (66.4% female; mean age, 32.6 ± 11.9 years; mean body mass index, 25.2 ± 5.1). The mean follow-up was 28.0 months. The mean AV, FV, and CV were 17.1°± 5.2°, 12.1°± 9.2°, and 29.3°± 11°, respectively. Univariate natural cubic regression splines demonstrated that AAr had a significant negative association with 4 of 5 PROs preoperatively and 3 of 5 PROs 2 years postoperatively ( P≤ .018). All other relative version groups did not have a significant relationship with any PRO at either time point ( P > .05). The association between AAr and relatively worse PROs was maintained after controlling for relative FV and CV via multiple linear regression, particularly in patients with relative femoral retroversion.Conclusion:FV and CV, as distinct measures, are not associated with outcomes after hip arthroscopy for FAIS. AAr is associated with worse preoperative status and less improvement at 2 years postoperatively, particularly in patients with relative femoral retroversion.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925090","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":"Fixation Methods, Complications, and Outcomes After Primary Fixation of Isolated Chondral Fragments in the Knee: A Systematic Review","authors":"Sina Tartibi, Garrett R. Jackson, Tanya Boghosian, Robert H. Brophy, Matthew V. Smith, Matthew J. Matava, Derrick M. Knapik","doi":"10.1177/03635465241254520","DOIUrl":"https://doi.org/10.1177/03635465241254520","url":null,"abstract":"Background:Knee injuries resulting in purely cartilaginous defects are rare, and controversy remains regarding the reliability of chondral-only fixation.Purpose:To systematically review the literature for fixation methods and outcomes after primary fixation of chondral-only defects within the knee.Study Design:Systematic review; Level of evidence, 5.Methods:A literature search was conducted following the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using keywords and Boolean phrases in PubMed, Embase, Cochrane, and Scopus on October 10, 2023. Human studies reporting fixation methods and outcomes after primary fixation of chondral-only defects within the knee were included in this systematic review. Studies reporting subchondral bone involvement were excluded. Study quality was assessed using the Joanna Briggs Institute critical appraisal tool. Postoperative outcomes, reoperations, and return to sport/activity were evaluated. Failure was defined as chondral fragment dislodgement or failure of healing postoperatively.Results:A total of 18 studies (N = 93 patients) were identified. The mean patient age was 16 years (mean range, 11-32 years), with a mean final follow-up of 42.4 months (mean range, 5-61.2 months). Men comprised 81% (n = 59/73) of patients. Bioabsorbable implants (n = 13 studies) were the most commonly reported fixation method. Complications related to fixation of the chondral fragment occurred in 10.8% of patients (n = 10/93), with all other complications occurring in 9.8% (n = 9/93) of patients. Revision surgery directly associated with the chondral fragment was reported in 10.8% (n = 10/93) of patients. Successful return to sport/activity was observed in 90% (n = 60/67) of patients. Intact fixation was reported in 85% (n = 75/88) of patients undergoing postoperative magnetic resonance imaging, computed tomography, or second-look arthroscopy.Conclusion:Primary fixation of chondral-only defects can lead to low rates of failure and revision surgery with a high return to sport/activity in young patients, even with relatively large lesions. Bioabsorbable implants and absorbable sutures were the most common fixation methods, primarily performed via open arthrotomy after diagnostic arthroscopy. Failure of fixation and implant irritation were the most commonly reported complications related to fixation, with reoperations directly related to fragment fixation performed in 10.8% of patients. Healing of the chondral fragment as evaluated using postoperative magnetic resonance imaging, computed tomography, or second-look arthroscopy was reported in 85% of patients.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"82 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925076","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 Effects of Inaccurate Femoral Tunnel Placement During Medial Patellofemoral Ligament Reconstruction on Midterm Clinical Outcomes in Treatment of Recurrent Patellar Dislocation","authors":"Fengyi Hu, Yingying Du, Zejing Guo, Keying Zhang, Xi Gong, Cheng Wang, Jian Wang, Jianquan Wang, Qinwei Guo, Haijun Wang, Weili Shi","doi":"10.1177/03635465241303514","DOIUrl":"https://doi.org/10.1177/03635465241303514","url":null,"abstract":"Background:There is a lack of evidence and continuous debate on whether femoral tunnel displacement substantially influences the clinical efficacy of medial patellofemoral ligament reconstruction (MPFL-R) in addressing recurrent patellar dislocation.Purpose:To investigate possible associations between inaccurate femoral tunnel placement during MPFL-R and clinical outcomes, with a specific focus on proximal tunnel malpositioning.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who were diagnosed with recurrent patellar dislocation and underwent MPFL-R were retrospectively analyzed. A true lateral view on 3-dimensional computed tomography was obtained, and the distance from the center of the femoral tunnel to the Schöttle point (D<jats:sub>F-to-S</jats:sub>) was measured. Accordingly, femoral tunnels were divided into the suboptimal group (D<jats:sub>F-to-S</jats:sub> &gt; 10 mm) and the optimal group (D<jats:sub>F-to-S</jats:sub>≤ 10 mm). Patient data were collected and pathoanatomic risk factors were evaluated. Clinical assessments included patient-reported outcome measures, including the International Knee Documentation Committee (IKDC), Kujala, Lysholm, and Tegner scores; subjective satisfaction; and postoperative complications. A subgroup analysis was performed between proximally malpositioned tunnels and tunnels lying in other directions.Results:A total of 112 patients (112 knees) were included, with 34 in the suboptimal group and 78 in the optimal group. Patient characteristics and pathoanatomic abnormalities were comparable between the 2 arms, with mean follow-ups of 52.90 ± 23.80 months and 60.14 ± 27.88 months in the suboptimal and optimal groups, respectively ( P = .259). At the final follow-up, inferior IKDC (76.3 ± 12.8 vs 85.9 ± 6.3; P &lt; .001), Kujala (87.7 ± 9.3 vs 93.8 ± 4.9; P = .001), and Lysholm (87.0 ± 11.8 vs 94.5 ± 5.3; P = .001) scores and subjective satisfaction (8.2 ± 1.4 vs 9.3 ± 0.9; P &lt; .001) were observed in the suboptimal group compared with the optimal group. Lower proportions of patients met the minimal clinically important difference for the IKDC (82.4% vs 100.0%; P = .001) and Lysholm (79.4% vs 98.7%; P = .001) scores in the suboptimal group compared with the optimal group. Subgroup analysis demonstrated that the final IKDC ( P = .002), Kujala ( P = .001), and Lysholm ( P = .001) scores and subjective satisfaction ( P = .031) were statistically worse in the proximally located group, with insignificant improvements compared with preoperative levels. The suboptimal group showed a higher rate of overall complications, and anterior knee pain was more often reported in the proximally located subgroup.Conclusion:Inaccurate femoral tunnel positioning was associated with inferior midterm subjective functional scores and a higher rate of postoperative complications after MPFL-R. Proximal displacement in particular was associated with adverse clinical outcomes.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924512","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":"Isolated ACL Reconstruction Versus Combined ACL and Anterolateral Ligament Reconstruction: Functional Outcomes, Return to Sport, and Survivorship: An Updated Meta-analysis of Comparative Studies","authors":"Michele Mercurio, Erminia Cofano, Giorgio Gasparini, Olimpio Galasso, Filippo Familiari, Valentina Sanzo, Gianluca Ciolli, Katia Corona, Simone Cerciello","doi":"10.1177/03635465241251467","DOIUrl":"https://doi.org/10.1177/03635465241251467","url":null,"abstract":"Background:Failure, persistent knee instability, and reinjury rates after anterior cruciate ligament (ACL) reconstruction are still concerns. Biomechanical investigations have highlighted the role of the anterolateral ligament (ALL) as a crucial knee stabilizer, and clinical outcomes after combined ACL and ALL reconstruction appear to indicate the success of the procedure.Purpose:To compare the functional outcomes, return-to-sport (RTS) rate, and complications between combined ACL and ALL reconstruction and isolated ACL reconstruction.Study Design:Meta-analysis; Level of evidence, 4.Methods:The PubMed/MEDLINE, Scopus, and Cochrane Central databases were used to search keywords, and a total of 16 studies were included. The data extracted for quantitative analysis included the Tegner activity scale score, Lysholm knee score, International Knee Documentation Committee (IKDC) score, laxity measured using the KT-1000 knee arthrometer, number and types of complications, RTS rate, and survival rate. Random- and fixed-effects models were used for the meta-analysis of pooled mean differences and odds ratios.Results:A total of 2329 patients were identified, 1116 of whom underwent combined ACL and ALL reconstruction and 1213 of whom underwent isolated ACL reconstruction. The mean ages were 25.4 ± 7.2 years and 26.5 ± 7.8 years for the combined ACL and ALL reconstruction and isolated ACL reconstruction groups, respectively. The mean follow-ups were 40.3 ± 21.4 months and 42.5 ± 21.6 months, respectively. Comparable Tegner activity scale ( P = .16), Lysholm knee ( P = .13), and IKDC ( P = .83) scores were found between groups. Significantly greater postoperative knee laxity was found in the isolated ACL reconstruction group (mean difference, –0.44; 95% CI, –0.85 to −0.04; P = .03). The combined ACL and ALL reconstruction group showed a significantly lower rate of graft failure (odds ratio [OR], 0.37; 95% CI, 0.18-0.77; P = .008), a higher RTS rate (OR, 1.41; 95% CI, 1.11-1.80; P = .005), and a higher survival rate (OR, 2.94; 95% CI, 1.97-4.37; P &lt; .001).Conclusion:Compared with isolated ACL reconstruction, combined ACL and ALL reconstruction yielded comparable functional outcomes but significantly less residual knee laxity and a lower graft failure rate. Patients who underwent combined ACL and ALL reconstruction also had higher RTS and survival rates.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925080","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":"Association of Smokeless Tobacco Use With Perioperative Complications and Revision Surgery After Anterior Cruciate Ligament Reconstruction","authors":"Alejandro M. Holle, Sailesh V. Tummala, Jelena Pejic, Paul R. Van Schuyver, Anikar Chhabra, Kostas J. Economopoulos","doi":"10.1177/03635465241303487","DOIUrl":"https://doi.org/10.1177/03635465241303487","url":null,"abstract":"Background:Tobacco use is a known modifiable risk factor for postoperative complications and revision surgery after anterior cruciate ligament reconstruction (ACLR). Previous studies focus on tobacco as a broad categorization of traditional smoking, smokeless tobacco, and other forms of nicotine use. It is unclear if differences in the type of nicotine used lead to similar adverse outcomes after ACLR.Purposes:To (1) assess the incidence of postoperative complications among ACLR patients who use smokeless tobacco and (2) compare these outcomes with those of patients who do not use tobacco and those who smoke tobacco.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective cohort study utilizing the PearlDiver database was conducted. Patients undergoing primary ACLR with a minimum 2-year follow-up were included. Smokeless tobacco users (n = 898), cigarette smokers (n= 22,062), and non–tobacco users (n= 207,462) were matched based on patient variables and comorbidities. Postoperative complications within 90 days of surgery and subsequent knee surgery within 2 years were compared among groups. Multivariable logistic regressions were used to control for confounding variables.Results:Compared with nonusers, smokeless tobacco users demonstrated an increased risk of pneumonia (odds ratio [OR], 3.36; 95% CI, 1.41-7.90), acute kidney injury (OR, 12.7; 95% CI, 3.77-52.8), and emergency department (ED) utilization (OR, 6.29; 95% CI, 3.70-10.9) within 90 days of the ACLR. Additionally, smokeless tobacco users had an increased risk of ACLR (OR, 4.75; 95% CI, 3.60-6.26) and meniscal surgery (OR, 2.89; 95% CI, 2.23-3.73) within 2 years. When compared with cigarette smokers, smokeless tobacco users showed an increased risk of pneumonia (OR, 3.25; 95% CI, 1.33-7.78), acute kidney injury (OR, 7.63; 95% CI, 2.72-22.5), and ED visits (OR, 1.55; 95% CI, 1.26-1.90) within 90 days and subsequent ACLR (OR, 4.81; 95% CI, 3.58-6.47) and meniscal surgery (OR, 3.23; 95% CI, 2.45-4.26) within 2 years.Conclusion:Smokeless tobacco use was associated with an increased risk of medical complications, ED utilization, and subsequent procedures compared with nonuser controls and traditional smokers. These findings highlight the importance of considering specific forms of tobacco use in preoperative screening for patients undergoing ACLR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924547","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":"Correlation of Increased Lateral Tibial Slope With Baseline Tibial Position in Intact Knees and Side-to-Side Anterior Tibial Translation for Knees With ACL Tears","authors":"Luke V. Tollefson, Jace R. Otremba, Claire J. Knowlan, Nicholas I. Kennedy, Christopher M. Larson, Christopher M. LaPrade, Robert F. LaPrade","doi":"10.1177/03635465241303158","DOIUrl":"https://doi.org/10.1177/03635465241303158","url":null,"abstract":"Background:Anterior cruciate ligament (ACL) stress techniques—including single-leg stress radiographs, Telos, and KT-1000 arthrometer—are highly accessible and can provide additional diagnostic information to assess ACL and ACL graft integrity. The degree of anterior tibial translation (ATT) may be useful in guiding treatment when a diagnosis on magnetic resonance imaging is not conclusive or for judging if additional treatments, such as anterolateral complex augmentation, may be necessary.Purpose/Hypothesis:The purpose of this study was to evaluate the effect of increasing posterior tibial slope (PTS) on baseline tibial position (BTP) and side-to-side differences (SSD) in ATT. A secondary purpose was to perform a subgroup analysis of SSD in ATT for patients with a PTS of ≥12° versus &lt;12°, as well as for acute (&lt;6 weeks from injury) versus chronic (≥6 weeks from injury or ACL graft tear) ACL tears. It was hypothesized that the BTP in normal intact knees would increase linearly with the PTS and there would be an increased SSD in ATT when comparing ACL-injured and ACL-intact knees.Study Design:Case-control study; Level of evidence, 3.Methods:Bilateral ACL stress radiographs were assessed from patients with primary ACL and ACL graft tears between March 2023 and March 2024. Bilateral stress views were obtained by single-leg full-length lateral weightbearing radiograph in 20° of knee flexion. The BTP and ATT were measured using a perpendicular line drawn between the posterior position of the lateral femoral condyle and the lateral tibial plateau. PTS measurements were assessed by the anatomic tibial axis. Statistical analysis using linear regression— r &gt; 0.6 was considered strong, r between 0.4 and 0.6 moderate, and r &lt; 0.4 weak—and t tests were used to compare the PTS with BTP and SSD in ATT.Results:A total of 72 patients were analyzed using ACL stress radiographs. The results found a significant positive correlation between increased PTS and increased BTP for the ACL-intact knees ( P &lt; .001; r = 0.476). A significant increase was found in the SSD in ATT of 1.73 mm with a positive correlation between increased PTS and increased SSD in ATT of ACL-deficient knees ( P &lt; .001; r = 0.397). A subgroup analysis reported significant increases in SSD in ATT for both ACL-injured knees with a PTS ≥12° ( P = .008) and for chronic ACL tears ( P &lt; .001) and no significant differences in SSD in ATT for ACL-injured knees with a PTS of &lt;12° ( P = .650) and for acute ACL tears ( P = .745).Conclusion:This study found a significant positive correlation between PTS and the BTP in ACL-intact knees and for the SSD in ATT between ACL-injured and ACL-intact knees. Moreover, the SSD in ATT was significantly increased for ACL-injured knees with a PTS of ≥12° and for chronic ACL tears. No significant difference in SSD in ATT was found for ACL-injured knees with a PTS of &lt;12° and for acute ACL tears.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"66 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924548","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":"Lower ACLR Failure Rates in Bone–Soft Tissue Versus Soft Tissue–Only Allografts in Adults: A Systematic Review and Meta-analysis","authors":"Ameer Tabbaa, Myles Atkins, Alicia M. Montalvo, Camryn B. Petit, Mia S. White, Erich J. Petushek, Jed A. Diekfuss, Gregory D. Myer, Joseph D. Lamplot","doi":"10.1177/03635465241250016","DOIUrl":"https://doi.org/10.1177/03635465241250016","url":null,"abstract":"Background:While allografts are commonly used for anterior cruciate ligament reconstruction (ACLR), evidence to guide specific allograft selection is lacking.Purpose:To compare clinical and graft failure rates after ACLR using soft tissue–only allografts and bone–soft tissue allografts in adults.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:English-language studies with clinical outcome data on primary and revision ACLR in adults with nonirradiated soft tissue–only and bone–soft tissue grafts were identified in the search. Data extracted included allograft type, patient characteristics, follow-up time, and failure rates. The cumulative failure rate was defined as International Knee Documentation Committee grade C/D, graft retear, grade ≥2+ Lachman, grade ≥2+ pivot shift, and/or side-to-side KT-1000 laxity of &gt;5 mm. The graft rupture rate was defined solely by the proportion of patients who had a graft rupture. Meta-analyses using the inverse variance method were used to estimate the pooled rates with 95% CIs. Subgroup analysis was conducted to compare allograft types and determine whether age, sex, and follow-up time influenced the estimates.Results:A total of 14 studies met the inclusion criteria: 7 investigated bone–soft tissue allografts, 6 investigated soft tissue–only allografts, and 1 investigated both. The comparative study showed a difference in the cumulative failure rate between bone–patellar tendon–bone and soft tissue–only allografts. The pooled cumulative failure rates for bone–soft tissue and soft tissue–only allografts were 11% (95% CI, 7-17) and 20% (95% CI, 14-29), respectively ( P = .05). The pooled graft rupture rates for bone–soft tissue and soft tissue–only allografts were 6% (95% CI, 4-9) and 13% (95% CI, 7-23), respectively ( P = .07).Conclusion:The meta-analysis results showed that bone–soft tissue allografts have lower cumulative failure rates than soft tissue–only allografts. Bone–soft tissue allografts may be the preferred allograft choices for ACLR.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142925079","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":"Systematic Review of Randomized Controlled Trials Evaluating the Use of Platelet-Rich Plasma for Knee Osteoarthritis: Adherence to Minimum Information for Studies Evaluating Biologics in Orthopaedics","authors":"Hirotaka F. Nakagawa, James Kim, Joseph Rinaldi, Judy Rabinowitz, Ken Mautner, Ariana DeMers, Seth Sherman, Joanne Borg-Stein, Walter I. Sussman","doi":"10.1177/03635465241249996","DOIUrl":"https://doi.org/10.1177/03635465241249996","url":null,"abstract":"Background:The Minimum Information for Studies Evaluating Biologics in Orthopedics (MIBO) guidelines were developed in May 2017 to encourage improved reporting standards, promote increased transparency and reproducibility, and enhance clinical evaluation capabilities. The MIBO guidelines consist of 23 checklist items considered necessary to critically appraise clinical studies evaluating platelet-rich plasma (PRP).Purpose:To assess randomized controlled trials that evaluated PRP for the treatment of knee osteoarthritis in order to systematically review their adherence to the MIBO guidelines.Study Design:Systematic review. Level 1a.Methods:A search was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were randomized controlled trials reporting on knee osteoarthritis treated with intra-articular PRP. The studies were categorized into pre-, peri-, and post-MIBO groups based on the start date of data collection. The overall MIBO scores, defined as percentage of checklist items out of the 23 checklist items reported in 1 study, individual item scores, defined as percentage of studies reporting the checklist item within a specified group, and overall item score defined as the average of the individual item scores from all the included studies were calculated.Results:The review included 87 studies (7925 patients; 8118 knees). Of these, 51 studies were assigned to the pre-MIBO group, 19 studies to the peri-MIBO group, and 17 studies to the post-MIBO group. The overall MIBO score was 72%. No statistically significant differences in MIBO scores were found among the 3 MIBO groups ( P = .345). The majority of the studies (62 studies; 71%) had MIBO scores &lt;80%. MIBO items with particularly low item scores included reporting of whole-blood characteristics (20%), platelet recovery rate (22%), PRP analysis (30%), and PRP activation (47%). No significant difference among the 3 MIBO groups was found for the item scores except for the reporting of the recipient details ( P = .012).Conclusion:This study highlights the deficiencies in adherence to the MIBO guidelines, particularly in reporting key variables such as whole-blood characteristics, platelet recovery rate, PRP analysis, and PRP activation. These findings suggest that the publication of the MIBO guidelines has not resulted in improved reporting practices in studies investigating intra-articular PRP for the treatment of knee osteoarthritis.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142924546","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}