American Journal of Sports Medicine最新文献

{"title":"Return to Work, Sport, and Sport- Related Activity After Distal Triceps Tendon Repair: A Systematic Review.","authors":"William L Johns, Benjamin H Miltenberg, Anthony N Baumann, Nazanin Kermanshahi, Rahul R Muchintala, Steven B Cohen","doi":"10.1177/03635465241283970","DOIUrl":"https://doi.org/10.1177/03635465241283970","url":null,"abstract":"<p><strong>Background: </strong>Distal triceps tendon injuries are relatively rare injuries, often occurring in highly active patients with physically demanding jobs or lifestyles. Information on return to work, sport, and activity is essential for patient education and counseling after a distal triceps tendon rupture.</p><p><strong>Purpose: </strong>To determine the rates of return to work, sport, and sport-related activity after distal triceps tendon repair.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 4.</p><p><strong>Methods: </strong>PubMed, CINAHL, MEDLINE, Web of Science, and SPORTDiscus were queried from the earliest record through January 12, 2024. Articles were included if they examined return to various activities (exercise, sport, work, or military duty) after distal triceps tendon repair. Data on return to sport/work/activity were collected as well as information on patient satisfaction, pre-existing medical history or medication use (ie, anabolic steroids or corticosteroids), and complications. Article quality was assessed via the Methodological Index for Non-Randomized Studies (MINORS) scale.</p><p><strong>Results: </strong>Of 164 articles initially retrieved, 10 retrospective studies were included. Patients (n = 318; 74.2% male, 25.8% female) who underwent distal triceps tendon repair had a mean age of 44.7 ± 5.5 years with a mean follow-up time of 52.6 ± 21.4 months. After distal triceps tendon repair, 93.3% of patients (112/120) returned to sport, 95.3% (81/85) returned to military duty, and 92.6% (100/108) returned to work. Of the studies that evaluated satisfaction, the majority of patients reported high satisfaction after surgery. The overall complication rate (ranging from persistent pain and wound complications to nerve injuries and reruptures) after distal triceps tendon repair was 18.0%, the rerupture rate (complete and partial) was 7.2%, and the reoperation rate was 3.9%, with all partial reruptures undergoing nonoperative care.</p><p><strong>Conclusion: </strong>A distal triceps tendon rupture is a rare but potentially challenging injury, traditionally occurring in an active population, and often requires surgical repair. Importantly, >90% of an active-duty military population, athletes, and the general workforce was able to return to sport or their respective activity after surgery. Furthermore, there was high patient satisfaction and low rates of complications and reoperations after distal triceps tendon repair.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465241283970"},"PeriodicalIF":4.2,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958718","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":"Anatomic Risk Factors for Initial and Secondary Noncontact Anterior Cruciate Ligament Injury: A Prospective Cohort Study in 880 Female Elite Handball and Soccer Players.","authors":"Yusuke Kamatsuki, Marie Synnøve Qvale, Kathrin Steffen, Arnlaug Wangensteen, Tron Krosshaug","doi":"10.1177/03635465241292755","DOIUrl":"10.1177/03635465241292755","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament (ACL) injury is one of the most severe injuries for athletes. It is important to identify risk factors because a better understanding of injury causation can help inform athletes about risk and increase their understanding of and motivation for injury prevention.</p><p><strong>Purpose: </strong>To investigate the relationship between anatomic factors and risk for future noncontact ACL injuries.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 2.</p><p><strong>Methods: </strong>A total of 870, excluding 9 players with a new contact ACL injury and a player with a new noncontact ACL injury just before the testing, female elite handball and soccer players-86 of whom had a history of ACL injury-underwent measurements of anthropometrics, alignment, joint laxity, and mobility, including leg length, knee alignment, knee anteroposterior laxity, generalized joint hypermobility, genu recurvatum, and hip anteversion. All ACL injuries among the tested players were recorded prospectively. Welch <i>t</i> tests and chi-square tests were used for comparison between the groups (new injury group, which sustained a new ACL injury in the follow-up period, and no new injury group).</p><p><strong>Results: </strong>An overall 64 new noncontact ACL injuries were registered. No differences were found between athletes with and without a new ACL injury among most of the measured variables. However, static knee valgus was significantly higher in the new injury group than in the no new injury group among all players (mean difference [MD], 0.9°; <i>P</i> = .007), and this tendency was greater in players with a previous ACL injury (MD, 2.1°; <i>P</i> = .002). Players with secondary injury also had a higher degree of knee hyperextension when compared with those previously injured who did not have a secondary injury (MD, 1.6°; <i>P</i> = .007).</p><p><strong>Conclusion: </strong>The anatomic factors that we investigated had a weak or no association with risk for an index noncontact ACL injury. Increased static knee valgus was associated with an increased risk for noncontact ACL injury, in particular for secondary injury. Furthermore, hyperextension of the knee was a risk factor for secondary ACL injury.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"123-131"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11689818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142649988","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":"Quantifying the Diagnostic Utility of Baseline Testing in Concussion Management: An Analysis of Collegiate Athletes From the NCAA-DoD CARE Consortium Dataset.","authors":"Himadri S Pandey, Behshad Lahijanian, Julianne D Schmidt, Robert C Lynall, Steven P Broglio, Thomas W McAllister, Michael A McCrea, Paul F Pasquina, Gian-Gabriel P Garcia","doi":"10.1177/03635465241296868","DOIUrl":"https://doi.org/10.1177/03635465241296868","url":null,"abstract":"<p><strong>Background: </strong>Although preseason baseline testing is a commonly recommended part of the concussion management process, its \"value-added\" contribution to the diagnosis of acute concussion compared with normative reference values remains in question.</p><p><strong>Purpose: </strong>This research aimed to evaluate the diagnostic benefits of baseline testing in acute concussion assessment compared with normative reference values and characterize the athletes who receive the most diagnostic utility from baseline testing.</p><p><strong>Study design: </strong>Cohort study (Diagnosis); Level of evidence, 2.</p><p><strong>Methods: </strong>The investigators selected athletes from the National Collegiate Athletic Association-Department of Defense (NCAA-DoD) Concussion Assessment, Research, and Education (CARE) Consortium with at least 2 baseline assessments and 1 concussion. Two predictive models were developed that mimic acute concussion assessment using multivariate logistic regression based on a battery of postural control, neurocognitive status, and symptom assessments. The first predictive model gives a concussion status prediction based on change scores computed using individualized baseline testing information, whereas the second model uses normative reference values. The investigators defined and computed a novel metric called the Diagnostic Utility of Baseline Testing by comparing the concussion status predicted by each of these predictive models. The Diagnostic Utility of Baseline distribution was analyzed across athlete demographic characteristics and medical history.</p><p><strong>Results: </strong>The study included 1081 collegiate athletes (43.9% female) with 1279 acute concussion assessments (24- to 48-hour postinjury assessments) and 1551 reference assessments (baseline and 6-month assessments). Both the baseline and normative models exhibited notably high area under the curve values of .89 and .90, respectively. Most athletes (86.7%) did not gain additional diagnostic benefits from baseline testing versus normative values. Those with Hispanic ethnicity (<i>P</i> = .038) or a history of psychiatric disorders (<i>P</i> < .001) or depression (<i>P</i> = .002) were more likely to be correctly identified as having acute concussion when change scores were derived from normative values instead of individualized baseline values.</p><p><strong>Conclusion: </strong>This study highlights that the additional diagnostic benefit of preseason baseline testing over normative data is limited for most collegiate student-athletes. Thus, normative data can be used for most collegiate student-athletes in the absence of baseline testing. Moreover, these results can inform decisions on the allocation of baseline tests in resource-limited athletic settings, emphasizing the need for targeted concussion assessment strategies based on individual characteristics.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":"53 1","pages":"181-191"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916092","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":"Sling Results in Better Sleep Quality and Less Anxiety Early After Arthroscopic Rotator Cuff Repair: A Randomized Single-Blinded Trial.","authors":"Xuelun Li, Wei Xu, Pengfei Liao, Junhao Feng, Dandong Wu, Wei Huang, Zhenglin Zhu, Hong Chen","doi":"10.1177/03635465241293057","DOIUrl":"10.1177/03635465241293057","url":null,"abstract":"<p><strong>Background: </strong>Sleep disturbance is commonly reported by patients wearing an abduction brace after arthroscopic rotator cuff repair (ARCR). Although a sling has been proven noninferior to an abduction brace for function and repair integrity, there is no evidence-based medical support for the advantage of the sling in improving sleep quality compared with a brace.</p><p><strong>Purpose/hypothesis: </strong>This study aimed to compare the effects of a sling and an abduction brace on sleep quality and clinical outcomes after ARCR. It was hypothesized that immobilization in a sling would result in better sleep quality while not deteriorating clinical outcomes and bone-tendon healing compared with an abduction brace.</p><p><strong>Study design: </strong>Randomized controlled trial; Level of evidence, 1.</p><p><strong>Methods: </strong>A total of 142 consecutive patients with rotator cuff tears were randomly assigned to 2 groups: (1) the brace group, receiving abduction brace immobilization for 6 weeks, and (2) the sling group, receiving sling immobilization after ARCR for 6 weeks. The primary outcome was the Pittsburgh Sleep Quality Index at 6 weeks postoperatively. Secondary outcomes-American Shoulder and Elbow Surgeons score, Self-rating Anxiety Scale, pain, satisfaction, and tendon healing (using ultrasonography)-were evaluated until 1 year postoperatively.</p><p><strong>Results: </strong>Complete outcome measurements were obtained for 131 patients. The Pittsburgh Sleep Quality Index at 6 weeks was 11.1 ± 2.7 for the brace group and 9.2 ± 2.3 for the sling group (<i>P</i> < .001), indicating a statistically significant advantage for the sling group. The sling group also reported significantly lower Self-rating Anxiety Scale, lower pain level, and higher satisfaction scores at 6 weeks. No significant difference was observed in outcome measures between groups at 1 year. The tendon healing rates (91% vs 88%, respectively) were comparable between the brace and sling groups within the first 1 year (risk ratio, 1.03 [95% CI, 0.92-1.16]; <i>P</i> = .59).</p><p><strong>Conclusion: </strong>The use of a sling resulted in better sleep quality, less anxiety, and higher satisfaction compared with an abduction brace in the first 6 weeks after ARCR; nevertheless, functional outcomes and repair integrity were similar at 1 year postoperatively between the 2 groups. These findings indicate that a sling is appropriate for the postoperative care of ARCR. However, caution should be used when interpreting these results because the clinical relevance of sling-related benefits warrants further investigation.</p><p><strong>Registration: </strong>ChiCTR2200059967 (Chinese Clinical Trial Registry).</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"39-45"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644818","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":"Distal Tibial Allograft for the Treatment of Anterior Shoulder Instability With Glenoid Bone Loss: A Systematic Review and Meta-analysis.","authors":"Manjot Singh, Rory Byrne, Kenny Chang, Akash Nadella, Michael Kutschke, Tucker Callanan, Brett D Owens","doi":"10.1177/03635465231223124","DOIUrl":"10.1177/03635465231223124","url":null,"abstract":"<p><strong>Background: </strong>The use of a distal tibial allograft (DTA) for reconstruction of a glenoid defect in anterior shoulder instability has grown significantly over the past decade. However, few large-scale clinical studies have investigated the clinical and radiographic outcomes of the DTA procedure.</p><p><strong>Purpose: </strong>To conduct a systematic review and meta-analysis of clinical studies with data on outcomes and complications in patients who underwent the DTA procedure for recurrent anterior shoulder instability with glenoid bone loss.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 4.</p><p><strong>Methods: </strong>A comprehensive search of major bibliographic databases was conducted for articles pertaining to the use of a DTA for the management of anterior shoulder instability with associated glenoid bone loss. Postoperative complications and outcomes were extracted and compiled in a meta-analysis.</p><p><strong>Results: </strong>Of the 8 included studies with 329 total participants, the mean patient age was 28.1 ± 10.8 years, 192 (83.8%) patients were male, and the mean follow-up was 38.4 ± 20.5 months. The overall complication rate was 7.1%, with hardware complications (3.8%) being the most common. Partial graft resorption was observed in 36.5% of the participants. Recurrent subluxation was reported in 1.2% of the participants, and recurrent dislocation prompting a reoperation was noted in 0.3% of the participants. There were significant improvements in clinical outcomes, including American Shoulder and Elbow Surgeons score (40.9-point increase; <i>P</i> < .01), Single Assessment Numeric Evaluation (47.2-point increase; <i>P</i> < .01), Western Ontario Shoulder Instability Index (49.4-point decrease; <i>P</i> < .01), Disabilities of the Arm, Shoulder and Hand (20.0-point decrease; <i>P</i> = .03), and visual analog scale (2.1-point decrease; <i>P</i> = .05). Additionally, postoperative shoulder range of motion significantly increased from baseline values.</p><p><strong>Conclusion: </strong>The DTA procedure was associated with a low complication rate, good clinical outcomes, and improved range of motion among patients with anterior shoulder instability and associated glenoid defects.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"210-216"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934440","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":"Association Between Insufficient Restoration of Meniscal Tension During Surgical Repair of Medial Meniscus Root Tear and Surgical Outcomes: Clinical Implication of Curtain-Cliff Sign.","authors":"Hyun-Soo Moon, Chong-Hyuk Choi, Min Jung, Kwangho Chung, Se-Han Jung, Junwoo Byun, Jin-Gyu Kim, Sung-Hwan Kim","doi":"10.1177/03635465241293733","DOIUrl":"10.1177/03635465241293733","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Despite the clinical benefits over nonoperative treatment or meniscectomy, the clinical outcomes of surgical repair for medial meniscus posterior root tear (MMRT) remain suboptimal, which may be attributed to the insufficient restoration of meniscal hoop tension during surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To analyze the clinical outcomes of surgical repair of MMRT based on the appearance of the meniscal tension observed immediately after surgery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cohort study; Level of evidence, 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Electronic medical records of patients who underwent arthroscopic transtibial pull-out repair of MMRT between 2010 and 2021 were retrospectively reviewed. Patients with at least a 2-year follow-up and whose overall meniscal status after the surgical repair could be evaluated via arthroscopic images or videos were eligible to be included. Patients were classified based on the presence of the curtain-cliff sign, potentially implying insufficient postoperative meniscal hoop tension (group 1, patients without the curtain-cliff sign; group 2, patients with the curtain-cliff sign). Regression analysis was performed to evaluate whether the curtain-cliff sign reflects postoperative meniscal extrusion. Subsequently, comparative analyses were conducted between the 2 groups regarding baseline demographic data, clinical scores, intraoperative data, and radiologic parameters.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 79 patients were included (group 1, 59 patients; group 2, 20 patients). Regression analysis revealed a significant association between the curtain-cliff sign and postoperative meniscal extrusion, suggesting its potential to reflect the postoperative meniscal tension. In the between-group comparisons, there were no differences in baseline demographic data, preoperative clinical scores, and preoperative radiologic variables. However, at the final follow-up, group 2 showed a significantly lower International Knee Documentation Committee subjective score compared with group 1 (group 1, 61.7 ± 14.4; group 2, 52.9 ± 12.5; &lt;i&gt;P&lt;/i&gt; = .017), while no significant differences were found in the visual analog scale for pain score and Lysholm score. Additionally, group 2 exhibited significantly higher postoperative meniscal extrusion compared with group 1, which was measured at both the midpoint of the medial femoral condyle (group 1, 4.0 ± 1.1 mm; group 2, 5.1 ± 1.5 mm, &lt;i&gt;P&lt;/i&gt; = .004) and the posterior border of the medial collateral ligament (group 1, 4.4 ± 1.2 mm; group 2, 5.7 ± 1.5 mm; &lt;i&gt;P&lt;/i&gt; = .004), with more pronounced progression compared with the preoperative status at these sites. Consistently, the progression of both the osteoarthritis grade and the hip-knee-ankle angle compared with preoperatively was significantly greater in group 2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In patients in whom the restoration of meniscal tension appears insufficient immediately after","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"163-171"},"PeriodicalIF":4.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644806","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":"Subscapularis Muscle Radiographic Integrity and Patient-Reported Outcomes Following Arthroscopic Anatomic Glenoid Reconstruction With Distal Tibial Allograft.","authors":"Jose Castillo de la Peña, Peter N Chalmers, Jie Ma, Ivan Wong","doi":"10.1177/03635465241291843","DOIUrl":"10.1177/03635465241291843","url":null,"abstract":"<p><strong>Background: </strong>Shoulder stabilization surgery has evolved over time, and bony augmentation procedures on the glenoid side are being performed more often. The Latarjet procedure modifies subscapularis anatomy because the conjoined tendon divides the subscapularis muscle fibers through a split/takedown, which has structural and functional implications. Arthroscopic anatomic glenoid reconstruction (AAGR) re-creates anatomy. This technique uses the Halifax portal to deploy and fix a distal tibial allograft (DTA) through the rotator interval, thus preserving the subscapularis anatomy.</p><p><strong>Purpose/hypothesis: </strong>The purpose was to analyze the radiographic properties of the subscapularis muscle after AAGR. It was hypothesized that the subscapularis muscle structure remains preserved postoperatively.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>A retrospective review was performed comprising a consecutive series of patients treated with AAGR with DTA between November 2012 and April 2021 for traumatic anterior shoulder instability with glenoid bone loss. Patients were excluded if they had posterior instability, glenoid fracture, missing pre- or postoperative computed tomography (CT) scans, or only CT arthrogram available. Radiographic variables measured on CT scans included estimates of subscapularis muscle volume, subscapularis/infraspinatus muscle ratio, and fatty infiltration according to the Goutallier classification. Pre- and postoperative Western Ontario Shoulder Instability index scores were collected as a secondary outcome of this study.</p><p><strong>Results: </strong>Ninety-three patients were included in the study with a clinical follow-up of 2.3 ± 1.5 years (mean ± SD). The subscapularis volume increased from 185.91 ± 45.85 mL preoperatively to 194.1 ± 49.0 mL postoperatively (<i>P</i> = .006). The subscapularis to infraspinatus muscle ratio showed a significant increase from 0.96 ± 0.27 to 1.05 ± 0.30 after surgery (<i>P</i> = .002). All patients had a Goutallier stage of 0 before and after surgery. The Western Ontario Shoulder Instability scores showed a significant improvement from 64.8 ± 15.5 preoperatively to 28.2 ± 24.0 postoperatively (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>Patients who undergo AAGR with DTA for traumatic shoulder instability with glenoid bone loss have a preserved subscapularis muscle volume with no fatty infiltration, while showing a significant improvement in clinical outcomes.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3480-3487"},"PeriodicalIF":4.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11608513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632928","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":"Evaluation of Preoperative Factors That Affect the Alpha Angle of Screw Insertion After the Open Latarjet Procedure.","authors":"Hee Dong Lee, Su Cheol Kim, Yun Seong Choi, Dae Yeung Kim, Jae Chul Yoo","doi":"10.1177/03635465241290818","DOIUrl":"10.1177/03635465241290818","url":null,"abstract":"<p><strong>Background: </strong>The open Latarjet procedure yields excellent results as a treatment for anterior shoulder instability. The position of the bony fragment and the insertion angle of the screw (the alpha angle) are critical factors for a successful procedure. The alpha angle is considered overangulated at >25°, which is associated with poor bone fixation and healing.</p><p><strong>Purpose: </strong>To assess preoperative patient anatomic factors that affect the alpha angle in the Latarjet procedure for anterior shoulder instability.</p><p><strong>Study design: </strong>Case-control study; Level of evidence, 3.</p><p><strong>Methods: </strong>In this retrospective study, 76 patients who underwent the open Latarjet procedure between October 2009 and December 2023 were included. Postoperative computed tomography scans were reviewed for the alpha angle, and patients were classified into 2 groups: group 1 (alpha angle ≥25°) and group 2 (alpha angle <25°). Preoperative patient characteristics and radiological parameters obtained from preoperative computed tomography scans were analyzed and compared between groups 1 and 2. We developed a novel method to measure the depth of the chest and the angle between the deltopectoral interval and the plane of screw insertion. We also measured the thickness of the pectoralis major and subscapularis muscles.</p><p><strong>Results: </strong>Of the 76 patients in this study, 41 and 35 patients were included in groups 1 and 2, respectively. The mean alpha angles of groups 1 and 2 were 36° and 12°, respectively, and the body mass index was significantly higher in group 1 (<i>P</i> < .001). In addition, group 1 had a significantly longer distance from the anterior edge of the glenoid to the skin margin of the deltopectoral interval (<i>P</i> < .001). The angle between the deltopectoral interval and the plane of screw insertion (traction angle) was significantly larger in group 1 (<i>P</i> < .001), and the pectoralis major and subscapularis muscles were thicker in group 1 (<i>P</i> = .017 and <i>P</i> = .032, respectively).</p><p><strong>Conclusion: </strong>The alpha angle after the Latarjet procedure was strongly related to the patient's weight, body mass index, depth of the chest, and the angle between the deltopectoral interval and the plane of screw insertion. To our knowledge, this is the first study in which the preoperative factors that facilitate proper screw fixation in the Latarjet procedure are reported.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3488-3494"},"PeriodicalIF":4.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640394","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":"Tranexamic Acid for Rotator Cuff Repair: A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Eoghan T Hurley, Kaitlyn Rodriguez, Mark P Karavan, Jay M Levin, Joshua Helmkamp, Oke Anakwenze, Michael J Alaia, Christopher S Klifto","doi":"10.1177/03635465231216336","DOIUrl":"10.1177/03635465231216336","url":null,"abstract":"<p><strong>Background: </strong>Several randomized controlled trials (RCTs) have been conducted to assess the use of tranexamic acid (TXA) in the setting of arthroscopic rotator cuff repair (ARCR). However, these studies have shown mixed results, with some showing improved intraoperative visualization, subsequent operative times, and pain levels, and others finding no difference.</p><p><strong>Purpose: </strong>To perform a systematic review of the RCTs in the literature to evaluate the use of TXA on ARCR.</p><p><strong>Study design: </strong>Meta-analysis; Level of evidence, 1.</p><p><strong>Methods: </strong>Two independent reviewers performed the literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with a third author resolving any discrepancies. RCTs comparing TXA with a control in ARCR were included. Visualization, postoperative pain, operative time, pump pressures, and shoulder swelling were evaluated. A <i>P</i> value < .05 was deemed statistically significant.</p><p><strong>Results: </strong>Six RCTs with 450 patients were included in this review. Overall, 5 studies evaluated intraoperative visualization, with 3 studies finding a significant difference in favor of TXA. With TXA, patients had a lower mean postoperative visual analog scale (VAS) score of 3.3, and with the control, patients had a mean VAS score of 4.1, which was statistically significant (<i>P</i> = .001). With TXA, the mean weighted operation time was 79.3 minutes, and with the control, the mean operation time was 88.8 minutes, which was statistically significant (<i>P</i> = .001). No study found any difference in intraoperative pump pressures or swelling.</p><p><strong>Conclusion: </strong>TXA improved visualization, operative time, and subsequent postoperative pain levels in patients undergoing ARCR.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3673-3679"},"PeriodicalIF":4.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725094","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":"Comparing Clinical Outcomes and Knee Stability in Remnant-Preserving ACL Reconstruction Versus Standard ACL Reconstruction: A Systematic Review and Meta-analysis.","authors":"Felicitas Allende, Sachin Allahabadi, Divesh Sachdev, Varun Gopinatth, Rodrigo Saad Berreta, Robert F LaPrade, Jorge Chahla","doi":"10.1177/03635465231225984","DOIUrl":"10.1177/03635465231225984","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament reconstruction (ACLR) is one of the most frequently performed procedures in sports medicine, and undesirable outcomes still may range from 3-18%. One technique that has been explored to improve outcomes is preservation of the ACL remnant tibial stump, as opposed to stump debridement, at the time of reconstruction.</p><p><strong>Purpose: </strong>To review current high-level evidence and compare remnant-preserving anterior cruciate ligament reconstruction (ACLR) versus standard ACLR in terms of clinical outcomes and measures of knee stability.</p><p><strong>Hypothesis: </strong>ACLR with remnant preservation would result in improved clinical outcomes and knee stability measures.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 2.</p><p><strong>Methods: </strong>A systematic review of randomized controlled trials (RCTs) and cohort studies comparing remnant-preserving ACLR with standard ACLR with a minimum level of evidence of 2 was performed. Extracted data were summarized as general information, surgical characteristics, postoperative clinical outcomes, knee stability, graft evaluation, tunnel assessment, and postoperative complications. When feasible, a meta-analysis was performed.</p><p><strong>Results: </strong>Seven RCTs and 5 cohort studies met the inclusion criteria. In total, 518 patients underwent remnant-preserving ACLR and 604 patients underwent standard ACLR. Ten studies performed the reconstruction with hamstring tendon (HT) autografts, 1 study with HT and bone-patellar tendon-bone autografts, and 1 study with HT and tibialis anterior allografts. On meta-analysis, remnant-preserving ACLR provided comparable outcomes with respect to International Knee Documentation Committee grades or Tegner scores. Even though there was a significant improvement in Lysholm scores (mean difference, -1.9; 95% CI, -2.89 to -0.91; <i>P</i> = .0002) with the remnant-preserving technique, this did not exceed previously reported minimal clinically important difference values. Remnant-preserving ACLR demonstrated superior knee stability in terms of patients achieving negative pivot shift when compared with the control group (88.89% vs 79.92%; <i>P</i> = .006). Although there was a significant improvement in the side-to-side difference in anterior tibial translation favoring remnant preservation (<i>P</i> = .004), the mean difference was 0.51 mm.</p><p><strong>Conclusion: </strong>Remnant-preserving ACLR, primarily with HT autografts, results in comparable clinical outcome scores and significantly improved knee stability relative to standard ACLR without remnant preservation without increasing the complication rate. Further studies will help clarify if remnant-preserving ACLR also has benefits in terms of enhancing graft integration and maturation, improving proprioception, limiting tunnel enlargement, and reducing complications.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3651-3661"},"PeriodicalIF":4.2,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140319959","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}