American Journal of Sports Medicine最新文献

{"title":"Successful Medial Meniscal Repair Reduces Knee Pain 10 Years After Anterior Cruciate Ligament Reconstruction: Exploring the Consequences of Subsequent Surgery With Causal Mediation Analysis in the MOON Cohort.","authors":"Andrew J Sheean, Yuxuan Jin, Annunziato Amendola, Laura J Huston, Robert H Brophy, Charles L Cox, Morgan H Jones, Christopher C Kaeding, Michael W Kattan, Robert A Magnussen, Robert G Marx, Matthew J Matava, Eric C McCarty, Richard D Parker, Emily Reinke, Michelle L Wolcott, Brian R Wolf, Rick W Wright, Kurt P Spindler","doi":"10.1177/03635465251317742","DOIUrl":"https://doi.org/10.1177/03635465251317742","url":null,"abstract":"<p><strong>Background: </strong>Medial meniscal repair performed at the time of primary anterior cruciate ligament reconstruction (ACLR) has been shown to be significantly associated with subsequent surgery, and subsequent surgery has been associated with increased Knee injury and Osteoarthritis Outcome Score (KOOS) pain score and decreased patient satisfaction.</p><p><strong>Hypothesis/purpose: </strong>The purpose was to determine if medial meniscal repair decreases KOOS pain 10 years after ACLR and to assess the consequences of subsequent surgery on the development of KOOS pain. The authors hypothesized that medial meniscal repair performed at the time of primary ACLR decreases the likelihood of developing KOOS pain. It was further hypothesized that surgery performed subsequent to medial meniscal repair and primary ACLR increases KOOS pain 10 years after ACLR.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 2.</p><p><strong>Methods: </strong>Our inclusion criteria were all patients undergoing unilateral primary ACLR from 2002 to 2008 who were enrolled in the Multicenter Orthopaedic Outcomes Network without a history of medial or lateral meniscal surgery and contralateral ACLR. Causal mediation analysis using R software (Version 4.2.3) was employed to compare 2 effects on the development of significant knee pain, as represented by a KOOS pain score <80, at 10-year follow-up: (1) medial meniscal repair for longitudinal tears >10 mm in medial-to-lateral length and (2) medial meniscal excision at baseline of ACLR. A directed acyclic graph was constructed to provide a qualitative representation of the influence of known confounders that have been shown to affect the outcome of interest. Missing data were multiply imputed using multivariate imputation by chained equations. All tests were 2-sided, assuming a type I error rate of .05.</p><p><strong>Results: </strong>In total, 2387 participants (1074 female [45%]; 1313 male [55%]) were included in the final analysis. In 1502 (62.9%) cases, there was no medial meniscal tear reported. Of the 885 cases with medial meniscal tears, no treatment was performed in 109 (12.4%), meniscal excision was performed in 396 (44.7%), and meniscal repair was performed in 380 (42.9%). An overall 1825 of 2387 (76.5%) patients reported KOOS pain at 10-year follow-up: 252 (13.8%) had KOOS pain <80 and 1573 had ≥80. In the KOOS pain <80 group, 75 (29.8%) had subsequent surgery. In the KOOS pain ≥80 group, 223 (14.2%) had subsequent surgery. The step-by-step approach to causal mediation analysis demonstrated that a medial meniscal procedure (ie, no treatment for the tear, repair, or excision) significantly affected the likelihood of subsequent surgery (χ<sup>2</sup> = 28.9; <i>P</i> < .001) and subsequent surgery significantly increased the likelihood of KOOS pain <80 (χ<sup>2</sup> = 17.3; <i>P</i> < .001). However, the direct effect of a successful medial meniscal repair without subsequent surgery decre","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251317742"},"PeriodicalIF":4.2,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Evaluation and Surface Analysis of Glenoid Reconstruction Using a Subtalar Joint Allograft for Significant Glenoid Bone Loss in Recurrent Shoulder Instability: A Novel Alternative Graft Option.","authors":"Phob Ganokroj, Justin F M Hollenbeck, Marco Adriani, Ryan J Whalen, Amelia H Drumm, Alexander R Garcia, Wyatt H Buchalter, Trevor J McBride, Marco-Christopher Rupp, Matthew T Provencher","doi":"10.1177/03635465251315487","DOIUrl":"https://doi.org/10.1177/03635465251315487","url":null,"abstract":"<p><strong>Background: </strong>Glenoid and humeral head bone defects are common in chronic shoulder instability. The talus, and more specifically, the subtalar joint, has been proposed as a unique allograft from which bipolar bone loss can be addressed. However, there are few biomechanical data or joint reconstruction analyses of the glenoid using the posterior facet of a subtalar joint allograft (STA).</p><p><strong>Purpose: </strong>To compare the contact mechanics of an STA versus a coracoid graft (Latarjet procedure) versus a distal tibial allograft (DTA) for anatomic glenoid reconstruction.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>A total of 8 fresh-frozen, unpaired cadaveric specimens underwent repeated-measures biomechanical testing in 5 stages: native (intact) state, bone loss (30% glenoid bone defect), Latarjet procedure, glenoid reconstruction using a DTA, and glenoid reconstruction using an STA. A compressive load of 440 N was applied to the glenohumeral joint when the humerus was mounted to a dynamic tensile testing machine in 3 shoulder positions: 30° of abduction, 60° of abduction, and 60° of abduction with 90° of external rotation (ER). Average contact pressure, contact area, and peak contact pressure were determined from the sensors. Surface area and surface congruency were calculated using a custom script. Data were analyzed using analysis of variance.</p><p><strong>Results: </strong>There was a significantly higher surface area with glenoid reconstruction using the DTA (859 ± 78 mm<sup>2</sup>; <i>P</i> = .005) than with glenoid reconstruction using the STA (806 ± 88 mm<sup>2</sup>; <i>P</i> < .001) and the Latarjet procedure (692 ± 91 mm<sup>2</sup>). Surface congruency was significantly better with reconstruction using the DTA (2.0 ± 0.3 mm; <i>P</i> = .003) or the STA (1.9 ± 0.3 mm; <i>P</i> = .004) than with the Latarjet procedure (2.6 ± 0.4 mm). In all shoulder positions, the average contact pressure in the bone loss state was significantly higher than that in the native state (<i>P</i> < .05). All repair states restored average contact pressure to the native state at 60° of abduction and 60° of abduction with 90° of ER. There was less contact area after the Latarjet procedure than in the native state at 30° and 60° of abduction (<i>P</i> = .009 and <i>P</i> = .040, respectively). There was no significant difference in contact area and peak contact pressure after reconstruction with the DTA or STA compared with the native state.</p><p><strong>Conclusion: </strong>Anatomic glenoid reconstruction using a DTA or STA restored average contact pressure, peak contact pressure, and contact area at 60° of abduction and 60° of abduction with 90° of ER in a cadaveric model. In addition, surface congruency and surface area improved over the traditional Latarjet procedure.</p><p><strong>Clinical relevance: </strong>The STA showed comparable contact mechanics and surface geometry ","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251315487"},"PeriodicalIF":4.2,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Structural Adaptations of the Shoulder and Elbow Are Correlated in Professional Baseball Pitchers.","authors":"Ryan W Paul, Alim Osman, Levon N Nazarian, Michael G Ciccotti, Steven B Cohen, Brandon J Erickson, Paul Buchheit, Joseph Rauch, Daryl C Osbahr, Stephen J Thomas","doi":"10.1177/03635465251317509","DOIUrl":"https://doi.org/10.1177/03635465251317509","url":null,"abstract":"<p><strong>Background: </strong>Pitchers with deficits in total shoulder rotation range of motion (ROM) are 2.6 times more likely to experience an elbow injury. Despite the effects of shoulder ROM on elbow injury, it is currently unclear whether specific tissue adaptations of the shoulder relate to the tissue adaptations of the elbow in baseball pitchers.</p><p><strong>Purpose/hypothesis: </strong>The purpose was to evaluate the relationship between chronic structural adaptations of the shoulder (humeral retroversion [HR], posterior capsule thickness [PCT], infraspinatus/teres minor pennation angle, and muscle thickness) and chronic structural adaptations of the elbow (ulnar collateral ligament [UCL] thickness, ulnohumeral joint laxity with valgus stress, and ulnar nerve cross-sectional area) in professional baseball pitchers. It was hypothesized that chronic adaptations of HR and PCT would relate to structural adaptations of the elbow.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>Healthy minor league right-handed baseball pitchers from a single professional baseball organization were enrolled during 2022 preseason medical evaluations. Enrolled pitchers underwent bilateral shoulder ultrasound examination of HR, PCT, and posterior rotator cuff pennation angle and muscle thickness as well as bilateral elbow ultrasound examination of the ulnar nerve, UCL thickness, and ulnohumeral joint gapping using the Telos device. The difference in ulnohumeral joint gapping from stressed (150 N) to unstressed (ie, delta value) was calculated. Bilateral differences in every included measure were calculated and used for analysis to more closely isolate chronic adaptations. Multivariate stepwise regressions were performed to determine whether the chronic structural and clinical (strength and ROM) shoulder adaptations were related to structural adaptations of the elbow.</p><p><strong>Results: </strong>Overall, 40 right-handed professional baseball pitchers with a mean age of 22 ± 3 years were included. A significant positive relationship was observed between preseason structural adaptations of UCL thickness and PCT (<i>R</i> = 0.344; <i>R</i><sup>2</sup> = 0.118; <i>P</i> = .030) as well as between chronic structural adaptations of ulnar nerve cross-sectional area and teres minor muscle thickness (<i>R</i> = 0.387; <i>R</i><sup>2</sup> = 0.150; <i>P</i> = .020). No statistically significant relationships were found between chronic structural adaptations of the shoulder and delta ulnohumeral joint gapping (all <i>P</i> > .05) or between chronic adaptations in clinical measures (strength and ROM) of the shoulder and chronic structural adaptations of the elbow (all <i>P</i> > .05).</p><p><strong>Conclusion: </strong>Positive relationships between chronic adaptations of UCL thickness and PCT, as well as between ulnar nerve cross-sectional area and teres minor MT, were observed in asymptomatic minor lea","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251317509"},"PeriodicalIF":4.2,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of Open Arthrotomy and Arthroscopic Surgery for Primary Synovial Chondromatosis of the Hip: A Comparative Study With Propensity Score Matching.","authors":"Han Soul Kim, Cha Hyeong Ok, Jae Suk Chang, Ji Wan Kim, Chul-Ho Kim","doi":"10.1177/03635465251316312","DOIUrl":"https://doi.org/10.1177/03635465251316312","url":null,"abstract":"<p><strong>Background: </strong>Despite the widespread use of arthroscopic surgery for hip synovial chondromatosis, its postoperative outcomes remain uncertain. A head-to-head comparison between open arthrotomy and arthroscopic surgery is lacking.</p><p><strong>Purpose: </strong>To compare the treatment outcomes of open arthrotomy, particularly with surgical dislocation, and arthroscopic surgery for hip synovial chondromatosis.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>All patients who were surgically treated for symptomatic synovial chondromatosis in a tertiary university referral hospital between April 1996 and February 2023 were investigated via 1:1 propensity score matching to compare open arthrotomy and arthroscopic surgery. The primary outcome was chondromatosis recurrence. Secondary outcomes were patient-reported outcome scores, reoperations, and complications.</p><p><strong>Results: </strong>A total of 73 patients were enrolled, and after matching, 28 patients in each group were investigated. The mean age and mean follow-up period were 40.5 ± 13.7 years and 4.0 ± 3.1 years, respectively. Clinical and radiological recurrence rates did not differ between groups (clinical recurrence: 7.1% for open arthrotomy vs 25.0% for arthroscopic surgery [<i>P</i> = .143]; radiological recurrence: 14.3% for open arthrotomy vs 32.1% for arthroscopic surgery [<i>P</i> = .205]). However, all patient-reported outcomes at final follow-up were in favor of open arthrotomy compared with arthroscopic surgery (visual analog scale for pain: 1.6 for open arthrotomy vs 3.1 for arthroscopic surgery [<i>P</i> = .002]; quality of life scale: 80.4 for open arthrotomy vs 65.4 for arthroscopic surgery [<i>P</i> < .001]; and modified Harris Hip Score: 84.4 for open arthrotomy vs 75.9 for arthroscopic surgery [<i>P</i> = .001]). The symptom dissatisfaction rate at final follow-up was significantly higher with arthroscopic surgery than with open arthrotomy (35.7% vs 7.1%, respectively; <i>P</i> = .020). There was no difference in reoperation and complication rates between the 2 groups.</p><p><strong>Conclusion: </strong>For treating primary synovial chondromatosis, particularly when it is distributed across both the central and peripheral zones, arthroscopic surgery should be chosen with caution, and open arthrotomy with surgical dislocation should be actively considered.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251316312"},"PeriodicalIF":4.2,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Concavity Restoration on Glenohumeral Stability in a Glenoid Bone Loss Model: Comparing Distal Tibial Allograft Reconstruction to Classic Latarjet.","authors":"Matthew S Fury, Carl M Cirino, Amirhossein Jahandar, Ryan C Rauck, Lawrence V Gulotta, David M Dines, Joshua S Dines, Theodore A Blaine, Michael C Fu, Russell F Warren, Andreas Kontaxis, Samuel A Taylor","doi":"10.1177/03635465251318337","DOIUrl":"https://doi.org/10.1177/03635465251318337","url":null,"abstract":"<p><strong>Background: </strong>Distal tibial allograft (DTA) reconstruction for glenoid bone loss (GBL) has gained popularity. While recent studies have demonstrated that glenoid concavity is an important factor in native glenohumeral stability, there remains a paucity of data regarding concavity restoration during reconstructive procedures for GBL and its biomechanical effect.</p><p><strong>Purpose: </strong>To compare the restoration of anterior glenohumeral stability and glenoid concavity after DTA and classic Latarjet procedures.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Nine human cadaveric specimens (mean age, 62.2 years; range, 52-69 years) underwent pretesting computed tomography (CT) to assess native glenoid concavity as determined by the glenoid depth and bony shoulder stability ratio (BSSR). GBL was created so the DTA and Latarjet graft could restore 100% of the native glenoid width. The rotator cuff tendons were loaded, and anterior stability testing was performed using a KUKA robot to apply a controlled anterior force with the shoulder in 90° of abduction and neutral external rotation. A motion capture system recorded humeral head translation. The following conditions were tested: intact, soft tissue Bankart lesion; bone loss model with DTA reconstruction; classic Latarjet procedure without conjoint tendon loaded; and classic Latarjet procedure with conjoint tendon loaded (sling effect). All specimens underwent posttesting CT to measure the BSSR of the DTA and Latarjet reconstructions. A repeated-measures analysis of variance was performed to compare the BSSR and anterior translations between the DTA and Latarjet reconstructions.</p><p><strong>Results: </strong>DTA produced greater concavity than the Latarjet procedure (BSSR: 0.45 vs 0.35; <i>P</i> < .001). There was no difference in anterior translation between the DTA and Latarjet procedures with the sling effect (5.1 mm vs 4.7 mm; <i>P</i> > .999). However, maximum anterior translation was decreased after the DTA procedure when compared with the Latarjet technique without the sling effect (5.1 mm vs 10.3 mm; <i>P</i> = .045).</p><p><strong>Conclusion: </strong>DTA produces a more concave reconstruction and decreased anterior translation compared with the flatter reconstruction produced by the classic Latarjet procedure without the sling effect. DTA and the classic Latarjet procedure with conjoint tendon loading, however, yielded equivalent reductions in anterior translation.</p><p><strong>Clinical relevance: </strong>Distal tibial allograft reconstruction is a biomechanically equivalent alternative to the classic Latarjet due to the restoration of glenoid concavity in addition to glenoid width. Surgeons should consider the role of concavity when addressing glenohumeral instability with bone loss.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251318337"},"PeriodicalIF":4.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revision Anterior Cruciate Ligament Reconstruction: Surgeon-Reported Causes of Failure From the Norwegian Knee Ligament Register.","authors":"Søren Vindfeld, Andreas Persson, Line Lindanger, Anne Marie Fenstad, Håvard Visnes, Eivind Inderhaug","doi":"10.1177/03635465251316308","DOIUrl":"https://doi.org/10.1177/03635465251316308","url":null,"abstract":"<p><strong>Background: </strong>Failed anterior cruciate ligament reconstruction (ACLR) leads to reduced quality of life and sometimes the need for repeat surgery. The reason for failure can be multifactorial and difficult to determine. Reports on failure leading to revision are few with limited generalizability. Also, no studies have investigated the reasons for early (<2 years) versus late (≥2 years) revision.</p><p><strong>Purpose: </strong>To describe patients undergoing revision surgery, the surgeon's reported cause of failure, and the risk of undergoing early versus late revision surgery.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Primary ACLR cases without concomitant ligament injuries or surgery, registered in the Norwegian Knee Ligament Register from 2004 throughout 2023, were eligible. Descriptive analyses were conducted on intraoperative findings and procedures, time from injury to surgery, activity at the time of injury, revision surgery, surgeon-reported cause of revision, and reporting method. The Kaplan-Meier method was used to calculate revision rates. A multivariable Cox regression model, adjusted for confounders, was used to calculate the hazard ratio of early and late revision surgery.</p><p><strong>Results: </strong>A total of 30,035 primary ACLR cases were analyzed, of which 1599 resulted in revision surgery. The overall revision rate was 7.1% at 15 years. Female patients were younger at the time of both primary and revision surgery (23.8 and 22.5 years, respectively) compared with male patients (28.2 and 22.2 years, respectively). Age at the time of primary surgery was significantly lower for patients who underwent revision (20.4 years) compared with those who did not undergo revision (26.5 years). Male sex, lower age, hamstring tendon graft, and no cartilage injury at the time of primary reconstruction were all associated with a higher risk of early revision. Lower age, hamstring tendon graft, and no meniscal injury were associated with a higher risk of late revision. New trauma (38.1%) was found to be the most common cause of failure leading to revision.</p><p><strong>Conclusion: </strong>In the current study, representing one of the largest cohorts to date investigating failed primary ACLR leading to revision, the overall 15-year revision rate was estimated as 7.1%. Patients receiving hamstring tendon grafts were at a particular risk for early revision during the first 2 years after primary reconstruction. New trauma was the most common reported cause of failure leading to revision ACLR.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251316308"},"PeriodicalIF":4.2,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371298","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cadaveric Study of the Sagittal Patellar Insertion of the Medial Patellofemoral Ligament in Children: Implications for Reconstruction.","authors":"Amin Alayleh, Ian Hollyer, Thomas Johnstone, Bryan Khoo, Chiamaka Obilo, Kelly McFarlane, Wills Baird, Calvin Chan, Marc Tompkins, Henry Ellis, Matthew Schmitz, Yi-Meng Yen, Theodore Ganley, Seth L Sherman, Kevin G Shea","doi":"10.1177/03635465241313239","DOIUrl":"https://doi.org/10.1177/03635465241313239","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral instability is a common problem, and medial patellofemoral ligament (MPFL) reconstruction is a standard treatment approach for recurrent instability. The accurate restoration of anatomy in MPFL reconstruction is essential. While coronal-plane anatomy of the MPFL patellar insertion has been previously reported, sagittal-plane anatomy has not been widely studied.</p><p><strong>Purpose: </strong>To evaluate the sagittal patellar insertion of the MPFL in pediatric specimens to guide future anatomic reconstruction.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>A total of 11 pediatric cadaveric knee specimens were dissected. The patella and sagittal MPFL insertion were evaluated. The maximal anterior-posterior patellar width, distance from the posterior patella to the posterior MPFL insertion, distance from the medial patellar articular cartilage edge to the MPFL insertion, maximal MPFL thickness, and distance from the anterior MPFL insertion to the anterior patella were measured. The proportion of patellar coverage by the sagittal MPFL insertion footprint was calculated.</p><p><strong>Results: </strong>The pediatric knee specimens had a mean age of 9.3 ± 1.4 years (range, 6-11 years). The mean maximal transverse patellar width was 19.0 ± 2.7 mm (range, 13.7-22.7 mm). The mean posterior patella-to-posterior MPFL distance was 10.5 ± 1.6 mm (range, 7.7-12.6 mm). The mean patellar articular cartilage edge-to-MPFL distance was 2.3 ± 0.6 mm (range, 1.5-3.5 mm). The mean maximal MPFL thickness was 4.0 ± 0.9 mm (range, 2.6-5.5 mm). The mean anterior MPFL-to-anterior patella distance was 4.4 ± 1.1 mm (range, 2.6-5.8 mm). The sagittal MPFL insertion footprint spanned a mean of 21.0% (range, 16.1%-29.7%) of the medial patella.</p><p><strong>Conclusion: </strong>This study, utilizing skeletally immature cadaveric specimens, demonstrated that the sagittal MPFL insertion consistently resided in the anterior third of the patella, averaging 21% of the total sagittal patellar width. Additionally, the distance from the MPFL insertion to the medial patellar articular cartilage edge showed minimal variation, representing a consistent intraoperative landmark for MPFL graft placement.</p><p><strong>Clinical relevance: </strong>This research characterized MPFL insertion anatomy on the medial patella in the sagittal plane. This knowledge provides a clear target area for anatomic graft placement during MPFL reconstruction.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465241313239"},"PeriodicalIF":4.2,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Fully Arthroscopic Versus Arthroscopically Assisted Latissimus Dorsi Transfer for Irreparable Subscapularis Tear.","authors":"Bo Taek Kim, Luis Alfredo Miranda, Chang Hee Baek, Jung Gon Kim, Luis Leoncio Temoche Diaz, Gyu Rim Baek, Jean Kany","doi":"10.1177/03635465251314057","DOIUrl":"https://doi.org/10.1177/03635465251314057","url":null,"abstract":"<p><strong>Background: </strong>Untreated chronic subscapularis (SSC) tears pose a challenging problem to treat owing to the resultant tendon retraction, atrophy, fatty infiltration, and changes in humeral head position, which complicate surgical options. Anterior latissimus dorsi (LD) transfer has shown effective results in treating these tears without glenohumeral arthritis.</p><p><strong>Purpose/hypothesis: </strong>This study introduces and evaluates fully arthroscopic and arthroscopically assisted anterior LD transfer techniques for reconstructing irreparable SSC tears. The authors hypothesize that both methods will yield promising and comparable clinical outcomes.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>This retrospective study reviewed patients who underwent anterior LD tendon transfer between February 2014 and April 2022. Indications for surgery included persistent shoulder pain and functional limitations unresponsive to nonoperative treatment, irreparable SSC tears (Lafosse grade ≥4), significant fatty infiltration (Goutallier grade ≥3), and minimal glenohumeral arthritis (Hamada stage <3). Patients were excluded if they had <2 years of follow-up or if data were lost. For comparison, the study divided patients into 2 groups based on the surgical methods: fully arthroscopic LD tendon transfer and arthroscopically assisted LD tendon transfer. Clinical assessments included pain levels (visual analog scale), Constant score, Subjective Shoulder Value score, and range of motion. Radiologic measurement and complications were assessed.</p><p><strong>Results: </strong>The study included 34 patients (mean ± SD age, 62.4 ± 7.5 years; follow-up, 35.4 ± 15.9 months). Significant improvements were observed in all patient-reported outcomes (pre- to posttest visual analog scale, 7.5 ± 1.2 to 1.2 ± 1.6; Constant score, 28.3 ± 6.0 to 68.8 ± 15.8; Subjective Shoulder Value, 23.2 ± 8.7 to 65.3 ± 22.0; all <i>P</i> < .001), range of motion in all directions, and internal rotation strength. Fully arthroscopic (n = 18) and arthroscopically assisted (n = 16) LD tendon transfers produced comparable clinical outcomes. Complications included 3 retears, 3 infections, and 5 cases of arthritis progression.</p><p><strong>Conclusion: </strong>Fully arthroscopic and arthroscopically assisted anterior LD transfers significantly reduce pain, enhance range of motion, and strengthen internal rotation in patients with irreparable SSC tears, with no significant differences in complications. These techniques offer comparable clinical outcomes, providing different options for surgeons.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251314057"},"PeriodicalIF":4.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"fMRI Activation in Sensorimotor Regions at 6 Weeks After Anterior Cruciate Ligament Reconstruction.","authors":"Adam M Culiver, Dustin R Grooms, Jaclyn B Caccese, Scott M Hayes, Laura C Schmitt, James A Oñate","doi":"10.1177/03635465251313808","DOIUrl":"https://doi.org/10.1177/03635465251313808","url":null,"abstract":"<p><strong>Background: </strong>Brain activity during knee movements is altered throughout the sensorimotor network after anterior cruciate ligament reconstruction (ACLR). Patients at 2 to 5 years after surgery appear to require greater neural activity to perform basic knee movement patterns, but it is unclear if brain activity differences within sensorimotor regions are present early after surgery. It is also unknown whether uninvolved knee movements elicit similar or unique activity compared with involved knee movements.</p><p><strong>Purpose: </strong>To examine brain activity in sensorimotor regions during involved and uninvolved knee movements in patients at 6 weeks after ACLR compared with control participants.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 2.</p><p><strong>Methods: </strong>A total of 15 patients who underwent ACLR (mean age, 21.9 ± 4.3 years [range, 17-29 years]; 8 female) and 15 control participants performed 30-second blocks of repeated knee flexion and extension, followed by 30 seconds of rest, during functional magnetic resonance imaging. Regions of interest included the right and left primary motor cortex (M1), right and left primary somatosensory cortex (S1), supplementary motor area (SMA), precuneus, and lingual gyrus. Activity from task-relevant voxels (move > rest) was extracted, and generalized estimating equations evaluated the main effect of group and group-by-limb interaction. Effect sizes were calculated using the Cohen <i>d</i>.</p><p><strong>Results: </strong>Reduced brain activity during knee flexion and extension was observed in the ACLR group in the ipsilateral M1 and S1, contralateral S1, SMA, and precuneus during movements of the involved and uninvolved knees. There were no group-by-limb interaction effects, indicating no significant differences between the involved knee and uninvolved knee in the ACLR group. Medium to large effect sizes were identified for between-group differences in all regions.</p><p><strong>Conclusion: </strong>At 6 weeks after ACLR, patients exhibited bilateral reductions in brain activity during knee movements in multiple sensorimotor regions. These identified regions are associated with motor planning, motor execution, somatosensory function, and sensorimotor integration. These data indicate that ACLR affected sensorimotor brain activity in both limbs during the early postoperative phase of rehabilitation.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251313808"},"PeriodicalIF":4.2,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Clinical Significance of Using PASS Thresholds When Administering Patient-Reported Outcome Instruments After Anterior Cruciate Ligament Reconstruction.","authors":"Julian Mobley, Devin K Kelly, Bradley J Lauck, Gabrielle M DelBiondo, Xavier D Thompson, Joe M Hart, Amelia S Bruce Leicht","doi":"10.1177/03635465241298917","DOIUrl":"10.1177/03635465241298917","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Patient-reported outcome (PROs) instruments of knee function quality of life are routinely administered to patients after anterior cruciate ligament reconstruction (ACLR). The Patient Acceptable Symptom State (PASS), an evidence-based threshold defining perceived outcomes, may be a useful indicator of strength and functional performance.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare strength and functional performance between patients recovering from ACLR who did and did not meet PASS thresholds on associated PROs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cross-sectional study; Level of evidence, 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 223 patients who had undergone ACLR (106 women, 117 men; 7.62 ± 1.71 months after ACLR) completed isokinetic knee extensor and flexor strength at 90 deg/s, hop performance (single-limb hop for distance [SLHD], triple hop for distance [THD], 6-m timed hop [6MH]), and PROs (International Knee Documentation Committee Subjective Form [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], and Anterior Cruciate Ligament Return to Sport After Injury [ACL-RSI]) assessments in a controlled laboratory setting at an academic institution. Independent-samples &lt;i&gt;t&lt;/i&gt; tests compared strength and hop measures between patients who did and did not achieve a PASS on the PROs. Limb symmetry index (LSI) was calculated as (ACLR Limb ÷ Contralateral Limb) × 100%. Strength and hop performance LSI outcomes were converted into indicator variables, categorized as either a \"pass\" or \"fail\" based on the operational definition of having an LSI value ≥90%. Chi-square tests compared strength and hop LSI PASS status measures to PRO PASS status.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Patients who achieved IKDC&lt;sub&gt;PASS&lt;/sub&gt; were significantly stronger and had more symmetric limbs than those who did not achieve IKDC&lt;sub&gt;PASS&lt;/sub&gt;. Values for IKDC&lt;sub&gt;PASS&lt;/sub&gt; were as follows: knee extension ACLR limb 1.72 ± 0.47 N·m/kg, contralateral limb 2.40 ± 0.45 N·m/kg, LSI 71.64% ± 15.23%; knee flexion ACLR limb 1.04 ± 0.29 N·m/kg, contralateral limb 1.05 ± 0.26 N·m/kg, LSI 99.12% ± 17.22%. Values for IKDC&lt;sub&gt;FAIL&lt;/sub&gt; were knee extension ACLR limb 1.47 ± 0.52 N·m/kg, contralateral limb 2.25 ± 0.47 N·m/kg, LSI 64.66% ± 17.07%; knee flexion ACLR limb 0.88 ± 0.28 N·m/kg, contralateral limb 0.97 ± 0.28 N·m/kg, LSI 90.46% ± 17.41%. Effect sizes ranged from small to moderate (&lt;i&gt;P&lt;/i&gt; &lt; .001; &lt;i&gt;d&lt;/i&gt; = 0.3-0.55). IKDC&lt;sub&gt;PASS&lt;/sub&gt; status was significantly associated with an LSI ≥90% for knee flexion peak torque (χ&lt;sup&gt;2&lt;/sup&gt; = 9.66; &lt;i&gt;P&lt;/i&gt; = .002), SLHD (χ&lt;sup&gt;2&lt;/sup&gt; = 9.61; &lt;i&gt;P&lt;/i&gt; = .002), and THD (χ&lt;sup&gt;2&lt;/sup&gt; = 3.97; &lt;i&gt;P&lt;/i&gt; = .02), with a moderate effect size (&lt;i&gt;P&lt;/i&gt; &lt; .05; &lt;i&gt;d&lt;/i&gt; = 0.41-0.73). Significant relationships were found with KOOS&lt;sub&gt;PASS&lt;/sub&gt; (Pain, Activities of Daily Living [ADL], and Sport) and LSI ≥90% for peak knee flexion torque with a moderate effect size (Pain and ADL, &lt;i&gt;P&lt;/i&gt; &lt; .001; Sp","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"299-307"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}