American Journal of Sports Medicine最新文献

{"title":"Comparison of Suture Versus Bony Fixation in Meniscal Allograft Transplantation Outcomes: A Meta-analysis.","authors":"Rahul Kakria, James Randolph Onggo, Iswadi Damasena","doi":"10.1177/03635465251319540","DOIUrl":"10.1177/03635465251319540","url":null,"abstract":"<p><strong>Background: </strong>Meniscal allograft transplantation replaces damaged meniscal tissue with grafts, aiming to restore knee stability and function. The method employed in the fixation of the meniscal graft-suture or bony fixation-has sparked clinical interest and ongoing discussions.</p><p><strong>Purpose: </strong>To compare suture fixation with bony fixation of the meniscal graft, with the focus on functional and clinical outcomes.</p><p><strong>Study design: </strong>Meta-analysis and systematic review; Level of evidence, 4.</p><p><strong>Methods: </strong>Meta-analyses were performed with a multidatabase search according to PRISMA guidelines on August 15, 2023. Data from published articles meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model.</p><p><strong>Results: </strong>A total of 6 studies were included consisting of 334 patients: 184 suture fixation and 150 bony fixation. No statistical analysis could be performed for clinical outcomes given the heterogeneity of raw data, but no observable trends were observed from individual studies. Suture and bony fixation showed no statistically significant difference in the risks of infection (relative risk [RR], 1.52; 95% CI, 0.29-7.80; <i>P</i> = .62), graft failure (RR, 0.86; 95% CI, 0.19-3.78; <i>P</i> = .84), graft tear (RR, 1.14; 95% CI, 0.10-13.21; <i>P</i> = .91), minor graft extrusion (RR, 0.77; 95% CI, 0.20-2.92; <i>P</i> = .70), and major graft extrusion (RR, 1.20; 95% CI, 0.28-5.07; <i>P</i> = .81).</p><p><strong>Conclusion: </strong>There was no significant difference in clinical outcomes or complications between suture and bony fixation of meniscal grafts. However, the short- to medium-term follow-up in this meta-analysis prompts the need for studies with long-term follow-up, given that meniscal allograft transplantation longevity is of utmost importance in this patient group to restore function and potentially reduce the risk of arthritis progression.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3003-3009"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12489164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Adaptations of the Shoulder in Baseball Pitchers: A Systematic Review.","authors":"Ryan W Paul, Francis R Sirch, Albi Vata, Eric Zhu, Frank G Alberta, Brandon J Erickson, Stephen J Thomas","doi":"10.1177/03635465251317202","DOIUrl":"10.1177/03635465251317202","url":null,"abstract":"<p><strong>Background: </strong>Understanding clinical and tissue adaptations to the throwing shoulder is important for optimizing injury prevention and rehabilitation programs in baseball players.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to determine the chronic clinical (range of motion [ROM] and strength) and tissue adaptations of the throwing shoulder in baseball pitchers. It was hypothesized that the throwing shoulder would have increased external rotation (ER) ROM and decreased internal rotation (IR) ROM compared with the nonthrowing shoulder, but that calculations of soft tissue glenohumeral IR deficit (GIRD) and soft tissue ER gain (ERG) would show that the true soft tissue restrictions were instead in the direction of ER ROM.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 4.</p><p><strong>Methods: </strong>This systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using various keywords related to the shoulder and baseball. Studies were included if chronic adaptations of the shoulder were evaluated bilaterally in nonrecreational baseball pitchers. Outcomes of interest collected include IR and ER ROM measured in 90° of shoulder abduction, humeral retroversion (HR), GIRD, ERG, and various structural adaptations. All other chronic adaptations were compiled and reported qualitatively because of the heterogeneity of variables assessed.</p><p><strong>Results: </strong>Overall, 1273 studies were screened and 36 met final inclusion criteria, with 24 studies (67%) evaluating professional pitchers. Across 13 studies and 1101 professional pitchers, the mean clinical GIRD was 10.0° and the mean clinical ERG was 6.5°, leading to a total arc of ROM deficit of 3.5° in the throwing shoulder. Across 498 included pitchers with HR measures, the mean bilateral difference in HR was 15.4°. After calculating soft tissue GIRD, 3 of 4 studies found that pitchers do not have any soft tissue restrictions in IR ROM. In contrast, after calculating soft tissue ERG, all 4 studies found pitchers to have soft tissue restrictions in ER ROM with a mean of 8° to 13°.</p><p><strong>Conclusion: </strong>When isolating for soft tissue restrictions through calculation of soft tissue GIRD and ERG, previously reported IR ROM deficits are currently not as prevalent, and soft tissue restrictions in ER ROM are now being observed. Clinicians should focus on better isolating soft tissue restrictions to evaluate whether an athlete has deficits in IR or ER ROM.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2984-2994"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544683","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":"Corrigendum to \"Biomechanical Comparison of Transtibial Pull-out Fixation Versus Suture Anchor Fixation for Repair of Medial Meniscus Posterior Root Tears\".","authors":"","doi":"10.1177/03635465251378346","DOIUrl":"10.1177/03635465251378346","url":null,"abstract":"","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"NP25"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979791","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":"Concomitant Cartilage Procedures With Meniscal Allograft Transplantation Do Not Substantially Alter Failure or Survival Rates Relative to Meniscal Allograft Transplantation Without Cartilage Procedures: A Systematic Review.","authors":"Lika Dzidzishvili, Sachin Allahabadi, Garrett R Jackson, Salvador Gonzalez Ayala, Divesh Sachdev, Julie Mekhail, Brian J Cole, Jorge Chahla","doi":"10.1177/03635465241305410","DOIUrl":"10.1177/03635465241305410","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Timely recognition and addressing of concomitant cartilage damage at the time of meniscal allograft transplantation (MAT) is critical to warrant future success. However, there remains a scarcity of data comparing outcomes between MAT with and without cartilage procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare patient-reported outcomes and rates of complications, failures, reoperations, and graft survivorship after MAT with concomitant cartilage procedures (MAT/Cart) and MAT without (MAT/NoCart).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review; Level of evidence, 4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A literature search was performed according to the 2020 PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) using the Scopus, PubMed, and Embase computerized databases from inception to January 7, 2024. Human clinical studies with levels of evidence 1 to 4 were included that evaluated patient-reported outcomes, postoperative complications, failures, reoperations, and graft survivorship with a minimum mean follow-up of 2 years. Study quality was assessed using the Methodological Index for Non-randomized Studies criteria and Modified Coleman Methodology Score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-six studies from 2006 to 2024 consisting of 1031 patients were included. Thirteen studies (n = 367) reported on MAT/Cart with a mean patient age of 37.6 years and mean follow-up of 72.9 months. Thirteen studies (n = 665) reported on MAT/NoCart procedures in patients with a mean age of 33.6 years and mean follow-up of 58.6 months. Postoperatively, both study groups had improved clinical outcomes, with International Knee Documentation Committee scores ranging from 55.3 to 74.4 in the MAT/Cart group versus 61.7 to 89.8 in the MAT/NoCart group and Lysholm scores from 62.5 to 85.9 versus 72 to 92.4, respectively. The incidence of failure ranged from 0% to 33% after MAT/Cart versus 3.8% to 43.7% after MAT/NoCart. All included patients either had well-aligned lower extremities in the coronal plane, within 3° to 5° of neutral on the affected side, or underwent correction via an osteotomy before or during the MAT procedure. Subsequent surgery not related to failure was higher in the MAT/Cart group (range, 11.8%-83.3%) as compared with the MAT/NoCart group (range, 4.3%-30.8%). The mean survival rates after MAT/Cart ranged from 86.2% to 100% at 2 years, 75% to 97.9% at 5 years, and 70% to 85% at 10 years. The mean survival rates after MAT/NoCart ranged from 83.5% to 93% at 2 years, 82.6% to 85% at 5 years, and 55% to 90% at 10 years. Decreased range of motion and arthrofibrosis were the most frequently reported complications in each group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In patients with normal lower limb coronal plane alignment, performing cartilage restoration procedures in combination with MAT does not substantially alter clinical outcomes or complication, failure, and survival rates relat","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3010-3024"},"PeriodicalIF":4.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048893","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":"Player Tracking Metrics to Predict Risk of Anterior Cruciate Ligament Injuries During Change-of-Direction Scenarios in the National Football League.","authors":"Cody M O'Cain, Paul M Inclan, E Meade Spratley, Kristy B Arbogast, David J Lessley, W Britt Evans, Ben Stollberg, Robert H Brophy","doi":"10.1177/03635465251361138","DOIUrl":"10.1177/03635465251361138","url":null,"abstract":"<p><strong>Background: </strong>National Football League (NFL) athletes face a substantial risk for anterior cruciate ligament (ACL) injuries, particularly during special team plays. ACL injuries commonly occur during change-of-direction (CoD) scenarios. Player tracking is standardized for all NFL games and can be used to quantify player motion intensity during CoD injury scenarios.</p><p><strong>Purpose: </strong>The purpose was to identify ACL injuries during CoD scenarios in the NFL. We investigated whether player tracking metrics derived from on-field play can predict an increased ACL injury risk during CoD scenarios.</p><p><strong>Study design: </strong>Descriptive epidemiology study.</p><p><strong>Methods: </strong>For all ACL injuries (n = 216) occurring in games during the 2018 to 2022 NFL seasons, the injury timing and injury scenario were identified through a video review. Motion characteristics of ACL injuries during CoD scenarios were identified from player tracking data, and a generalized linear mixed model (GLMM) was developed to quantify whether player tracking metrics were predictive of the ACL injury risk during CoD scenarios.</p><p><strong>Results: </strong>Among the ACL injuries reviewed, 32% were noncontact, 42% were indirect contact, and 46% were classified as CoD scenarios. Of the athletes involved in a CoD scenario, 98% were decelerating at the time of their ACL injury. Maximum speed (odds ratio, 1.52 per 1-m/s increase in maximum speed) and normalized maximum deceleration power (odds ratio, 1.08 per 1-W/kg increase in maximum deceleration power) were both significant predictors of the CoD ACL injury risk. Punt and kickoff returns had a significantly increased CoD ACL injury risk only when maximum speed and normalized maximum deceleration power metrics were excluded from the GLMM.</p><p><strong>Conclusion: </strong>ACL injuries in NFL games primarily occurred during CoD scenarios. Player tracking data analyzed for CoD ACL injuries demonstrated a consistent movement pattern involving high speeds and deceleration at the time of the injury. Both a player's maximum speed and normalized maximum deceleration power were significant predictors of an increased CoD ACL injury risk. The inclusion of these metrics in a GLMM helped to explain the variation in CoD ACL injury rates observed across different play types.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2523-2532"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144884339","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":"Early Meniscal Repair Leads to Higher Success Rates Than Delayed Meniscal Repair: A Systematic Review and Meta-analysis.","authors":"Jelle P van der List, Stef Daniel, Ingmar Blom, Joyce L Benner","doi":"10.1177/03635465241298619","DOIUrl":"10.1177/03635465241298619","url":null,"abstract":"<p><strong>Background: </strong>There has been an increased interest in meniscus preservation over the last decade. Several risk factors for the failure of meniscal repair have been identified. However, the timing of meniscal repair has not been extensively assessed in the literature, and there is currently no high-quality evidence on the optimal timing of performing meniscal repair after an injury with regard to outcomes.</p><p><strong>Purpose: </strong>To assess the role of the timing of meniscal repair on outcomes in the literature.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 4.</p><p><strong>Methods: </strong>The databases of PubMed, Embase, and the Cochrane Library were searched in October 2023 for studies comparing the outcomes of early versus delayed meniscal repair. Studies were eligible for inclusion if they reported outcomes within and after a time threshold (eg, within and after 3 weeks). Random-effects models were used.</p><p><strong>Results: </strong>A total of 35 studies with 3556 patients and 3767 menisci were included (mean age, 27.5 years; 66% male; mean follow-up, 4.5 years). Most studies were level 3 or 4 evidence, and the overall quality was low. The failure rates of meniscal repair were 11.3% versus 24.1% within versus after 2 weeks, respectively (7 studies, 511 patients; odds ratio [OR], 0.50 [95% CI, 0.22-1.16]; <i>P</i> = .11); 7.2% versus 15.3% within versus after 3 weeks, respectively (5 studies, 556 patients; OR, 0.28 [95% CI, 0.10-0.79]; <i>P</i> = .02); 15.7% versus 21.3% within versus after 6 weeks, respectively (7 studies, 746 patients; OR, 0.63 [95% CI, 0.33-1.18]; <i>P</i> = .15); and 10.2% versus 18.7% within versus after 8 weeks, respectively (7 studies, 652 patients; OR, 0.47 [95% CI, 0.26-0.87]; <i>P</i> = .02); these were significant for 3 and 8 weeks. No differences were seen for within versus after 3 months (7 studies, 1305 patients; 22.4% vs 18.5%, respectively; OR, 1.04 [95% CI, 0.47-2.33]; <i>P</i> = .92).</p><p><strong>Conclusion: </strong>The timing of meniscal surgery was correlated with the likelihood of success, and meniscal repair should preferably be performed within 8 weeks of the injury, with the earliest benefit at 3 weeks. Clinicians should take this into consideration when recommending operative treatment or initial nonoperative treatment.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2761-2770"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025467","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":"Posterior Shoulder Stability Can Be Restored by Posterior Acromial Bone Grafting (Scapinelli) in a Cadaveric Biomechanical Model With Normal Glenoid Anatomy.","authors":"Bettina Hochreiter, Nhi Nguyen, Anna-Katharina Calek, Bastian Sigrist, David C Ackland, Lukas Ernstbrunner, Eugene T Ek, Christian Gerber","doi":"10.1177/03635465251362854","DOIUrl":"10.1177/03635465251362854","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;A high and flat acromion seems to be a risk factor for posterior shoulder instability. Biomechanically, the surgical correction of acromial malalignment can restore glenohumeral joint stability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose/hypothesis: &lt;/strong&gt;The purpose was to assess (1) the stabilizing effect of a posterior acromial bone graft (PABG) in moderate and severe acromial malalignment (high and flat) and (2) contact patterns under posterior humeral head displacement. It was hypothesized that a PABG would significantly (1) increase resistance to posterior humeral head displacement, (2) restore stability, and (3) increase acromiohumeral contact pressure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Controlled laboratory study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 8 fresh-frozen human cadaveric shoulders, with normal glenoid anatomy, were examined in a shoulder simulator in the load and shift and jerk test positions. Each specimen underwent 5 testing conditions using 3-dimensional printed cutting and reduction guides, with the joint left intact for each condition: (1) severe acromial malalignment, (2) severe acromial malalignment + PABG, (3) moderate acromial malalignment, (4) moderate acromial malalignment + PABG, and (5) corrected acromial alignment. The humeral head was translated posteriorly until reaching either a peak force of 150 N or a maximum posterior displacement of 50% of the glenoid width. Force, displacement, and acromiohumeral contact pressure were recorded.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;At 30° of flexion, the force needed to displace the humeral head 50% increased by 659% when a PABG was added to a moderately malaligned acromion and by 1249% when a PABG was added to a severely malaligned acromion. At 60° of flexion, it increased by 293% and 348%, respectively. This stabilizing effect increased progressively with increasing displacement (&lt;i&gt;P&lt;/i&gt; &lt; .05 for all comparisons after ≥5% of displacement). Compared with acromial correction, a PABG allowed comparable posterior displacement but required different amounts of force, depending on the scenario. At 30° of flexion after 30% of displacement, a PABG provided significantly greater stability (&lt;i&gt;P&lt;/i&gt; &lt; .05 for all comparisons). Mean contact pressure was significantly reduced on the rotator cuff and significantly increased on the acromial undersurface in moderate and severe acromial malalignment, whereas a PABG restored acromiohumeral contact pressure comparable with corrective osteotomy, particularly at 30° of flexion.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The study provides quantitative evidence showing that a PABG significantly enhanced resistance to displacement and compensated for deficient posterolateral acromial coverage by extending the natural mechanical buttress.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical relevance: &lt;/strong&gt;Experimentally, a PABG provided comparable or superior stability to that after surgical acromial reorientation while representing a technically simpler and","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2684-2694"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12381383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms of Action of Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis: A Targeted Review of the Literature.","authors":"Seth L Sherman, Andrew S Gudeman, John D Kelly, Robert J Dimeff, Jack Farr","doi":"10.1177/03635465241302820","DOIUrl":"10.1177/03635465241302820","url":null,"abstract":"<p><strong>Background: </strong>The knee is the most commonly afflicted joint in osteoarthritis (OA). Injection of intra-articular of hyaluronic acid (IAHA) is a frequently used therapy for the management of knee OA with varying product characteristics.</p><p><strong>Purpose: </strong>To describe and characterize the mechanism of action (MoA) of IAHA products concerning nociception, chondroprotection, and anti-inflammatory properties via a targeted literature review.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 2.</p><p><strong>Methods: </strong>We followed the standard methodologies for conducting and reporting targeted reviews as recommended by the <i>Cochrane Handbook for Systematic Reviews of Interventions</i>, adapted for conducting a targeted literature review. Relevant studies were identified by searching the Embase database using predefined search strategies via the Ovid platform. The results of the review were reported according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses).</p><p><strong>Results: </strong>A total of 182 studies were included in this targeted literature review. Of these, 107 reported chondroprotective action, 59 anti-inflammatory activity, 18 analgesic properties, 30 proteoglycan or glycosaminoglycan synthesis, 8 subchondral bone effects, 2 mechanical effects, and 1 other effects of IAHA. These MoAs were studied through diverse types of studies: in vitro biochemistry, animal physiological studies, or human physiological and clinical studies. The chondroprotective effect was the most studied MoA and showed an increase in anabolic biomarkers, such as collagen types II, IX, and XI, and a reduction in catabolic biomarkers, such as matrix metalloproteinases, which play a primary role in the downstream signaling pathways in OA and cartilage degradation in the synovial fluid. IAHA was widely reported by studies to reduce soluble inflammatory mediators, such as interleukins 1β and 6 and tumor necrosis factor α, thereby decreasing the production of degradative enzymes (eg, matrix metalloproteinases, aggrecanases). IAHA was also reported to enhance the synthesis of intrinsic proteoglycan (eg, aggrecan) and glycosaminoglycans, thus delaying the progression of OA. IAHA also reported improvement in the mechanical function of the knee by increasing the viscosity of the synovial fluid, reducing the coefficient of friction, and improving its lubrication. Overall, a significant decrease in knee pain was observed after IAHA treatments.</p><p><strong>Conclusion: </strong>Preclinical and clinical studies established evidence for varied MoAs by which IAHA preparations may produce a desired effect in patients with knee OA.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2771-2782"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12381393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the Addition of a Lateral Extra-articular Procedure to a Primary Anterior Cruciate Ligament Reconstruction Result in Superior Functional and Clinical Outcomes? A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Adrian Kan, Tayla English, Allanah Penny, Jordan Franc-Smith, Francois Tudor, Larissa Sattler","doi":"10.1177/03635465241304781","DOIUrl":"10.1177/03635465241304781","url":null,"abstract":"<p><strong>Background: </strong>Current research focused on clinical outcomes suggests that lateral extra-articular procedures (LEAPs) can reduce rotational instability and graft failure rates in primary anterior cruciate ligament reconstructions (ACLRs). Limited studies have investigated the functional outcomes after LEAPs, including patient-reported outcome measures, sports participation, and physical performance.</p><p><strong>Purpose: </strong>To conduct a systematic literature review and meta-analysis to determine whether the addition of a LEAP to an ACLR results in superior functional and clinical outcomes as compared with an isolated ACLR.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 1.</p><p><strong>Methods: </strong>Five databases were searched to identify randomized controlled trials comparing clinical and functional outcomes after the addition of LEAPs to an isolated primary ACLR. Study selection was performed in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Assessment of methodological quality for included studies was undertaken using the Cochrane Risk of Bias 2 tool for randomized controlled trials. Studies were eligible for meta-analysis if an outcome measure utilizing similar time points was present across ≥2 studies and reported in mean difference or standard deviation.</p><p><strong>Results: </strong>Meta-analysis of 10 studies showed that the addition of LEAPs to an ACLR can reduce rates of rotatory instability (risk ratio, 1.45 [95% CI, 1.17-1.79]; <i>P</i> = .0006; <i>I</i>² = 0%) and graft rupture (risk ratio, 0.21 [95% CI, 0.08-0.55]; <i>P</i> < .001; <i>I</i>² = 0%). As supported by studies eligible for meta-analysis, this review showed that the addition of LEAPs to an ACLR can reduce rotatory instability. Short-term morbidity, including increased pain, joint stiffness, and muscle weakness, as compared with isolated ACLRs was resolved by 12 months after surgery.</p><p><strong>Conclusion: </strong>ACLR in combination with a LEAP results in superior clinical outcomes when compared with an isolated ACLR. Despite early postoperative outcomes concerning pain and function favoring isolated ACLRs, any negative effects were not still observed 6 months after surgery. A conclusion around the correlation between LEAPs and accelerated knee osteoarthritis could not be drawn, owing to the lack of long-term prospective studies available.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2749-2760"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12381392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Sex Hormones on Joint Ligament Properties: A Systematic Review and Meta-analysis.","authors":"Gabrielle Gilmer, Nikitha Crasta, Miho J Tanaka","doi":"10.1177/03635465241310145","DOIUrl":"10.1177/03635465241310145","url":null,"abstract":"<p><strong>Background: </strong>Sex differences exist in injury rates, and one contributing factor may be sex hormone effects on the musculoskeletal system.</p><p><strong>Purpose/hypothesis: </strong>The goal of this systematic review and meta-analysis was to understand the effects of sex hormones on ligaments in females as determined by preclinical and clinical studies. The hypothesis was that sex hormones would affect ligament mechanical properties, histological features, cellular function, and clinically measurable outcomes.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 4.</p><p><strong>Methods: </strong>A literature search of PubMed, PEDro, CINAHL, and CENTRAL was performed to identify preclinical and clinical studies assessing sex hormone effects on ligament properties. Overall, 2 independent reviewers performed title, abstract, and full-text screening. Rigor and reproducibility were assessed using the ARRIVE guidelines and the modified Downs and Black checklist. Meta-analyses were also performed.</p><p><strong>Results: </strong>There were 54 articles included in this review. The majority of studies focused on the anterior cruciate ligament (ACL; n = 27), the menstrual cycle (n = 23), and 17β-estradiol (n = 35). Meta-analyses revealed that there was no effect of the menstrual cycle on knee laxity or anterior tibial translation but that 17β-estradiol decreased the production of types I and III procollagen in ACL fibroblasts in vitro. In examining other ligaments, data suggest that sex hormone changes may affect the mechanical and cellular properties of the medial collateral ligament, intrapubic ligaments, hip ligaments, and ligamentum flavum. Additionally, the literature suggests that hormonal shifts that occur with oral contraceptive pill use, pregnancy, and menopause can affect ligament properties. These effects appear to be mediated, at least in part, by the hormone relaxin.</p><p><strong>Conclusion: </strong>Of the sex hormones examined in this body of literature, 17β-estradiol and relaxin appear to have the most effect on both the mechanical and cellular properties of ligaments in females. The ACL, medial collateral ligament, intrapubic ligaments, hip ligaments, and ligamentum flavum may be impacted by changes in sex hormone concentrations. The menstrual cycle does not likely affect ligament laxity in a clinically meaningful way, but pregnancy, oral contraceptive pill use, and menopause may.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2738-2748"},"PeriodicalIF":4.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069881","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}