American Journal of Sports Medicine最新文献

{"title":"The Effect of a Supratrochlear Spur on Patellofemoral Cartilage in Patients With Trochlear Dysplasia.","authors":"Jakob Ackermann, Berfin Caliskan, Martin Hartmann, Lazaros Vlachopoulos, Sandro F Fucentese","doi":"10.1177/03635465251323806","DOIUrl":"https://doi.org/10.1177/03635465251323806","url":null,"abstract":"<p><strong>Background: </strong>The presence of a supratrochlear spur has been shown to influence outcomes in patients with trochlear dysplasia and is thought to accelerate cartilage wear. However, the current literature does not provide an evidence-based threshold for a relevant supratrochlear spur height.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to establish a clinically significant supratrochlear spur height associated with patellofemoral chondral damage to guide surgeons in surgical decision-making. It was hypothesized that a supratrochlear spur negatively affects patellofemoral articular cartilage, with large spurs having the greatest effect.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>This study evaluated 363 knees with trochlear dysplasia that were scheduled to undergo surgery for the treatment of patellar instability at a single institution. All patients underwent preoperative true lateral radiography and magnetic resonance imaging (MRI). There were 2 independent reviewers who analyzed the supratrochlear spur height by measuring the distance between a tangent at the anterior femoral cortex and the most prominent point of the trochlea on sagittal MRI as well as other common patellofemoral parameters. All MRI scans were assessed for full-thickness cartilage lesions.</p><p><strong>Results: </strong>Of the included 363 knees, 91 (25.1%) showed full-thickness cartilage defects on the patella, while 21 (5.8%) had full-thickness trochlear cartilage damage. Patellar defects were significantly correlated with patient's age (<i>r</i> = 0.237; <i>P</i> < .001), body mass index (<i>r</i> = 0.148; <i>P</i> = .005), and supratrochlear spur height (<i>r</i> = 0.196; <i>P</i> < .001). Trochlear defects were significantly associated with patient's age (<i>r</i> = 0.160; <i>P</i> = .002), patellar tilt (<i>r</i> = 0.202; <i>P</i> < .001), tibial tubercle-trochlear groove distance (<i>r</i> = 0.128; <i>P</i> = .014), and supratrochlear spur height (<i>r</i> = 0.151; <i>P</i> < .004). Trochlear dysplasia types B and D showed a trend toward a higher prevalence in patellar defects (<i>P</i> = .082), while they were significantly associated with a higher prevalance of trochlear defects (<i>P</i> = .003) compared with types A and C. Knees with patellar (5.1 ± 2.0 vs 4.3 ± 1.7 mm, respectively; <i>P</i> = .001) and trochlear (5.3 ± 2.1 vs 4.4 ± 1.8 mm, respectively; <i>P</i> = .015) cartilage defects had a significantly larger supratrochlear spur height than knees without patellar and trochlear defects. A supratrochlear spur height ≥6 mm had adjusted odds ratios of 2.7 (95% CI, 1.6-4.5; <i>P</i> < .001) and 3.4 (95% CI, 1.3-8.8; <i>P</i> = .014) for developing patellar and trochlear cartilage damage, respectively.</p><p><strong>Conclusion: </strong>A supratrochlear spur was significantly associated with patellofemoral cartilage damage. Large supratrochlear spurs demonstrat","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251323806"},"PeriodicalIF":4.2,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544692","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":"Greater Cognitive-Motor Interference Among Patients After Anterior Cruciate Ligament Reconstruction Compared With Controls.","authors":"Andrew Strong, Carl-Johan Boraxbekk, Jonas L Markström","doi":"10.1177/03635465251322947","DOIUrl":"https://doi.org/10.1177/03635465251322947","url":null,"abstract":"<p><strong>Background: </strong>Chaotic sporting environments require the performance of concurrent cognitive and motor tasks. A reduced capacity for either or both of the tasks when performed concurrently is known as cognitive-motor interference (CMi) and is believed to increase the injury risk. A greater susceptibility to CMi after a rupture of the anterior cruciate ligament (ACL) has been suggested to be caused by central nervous system adaptations, thus possibly contributing to high secondary ACL injury rates.</p><p><strong>Purpose: </strong>To investigate whether patients after ACL reconstruction (ACLR) demonstrate greater CMi than noninjured controls when adding secondary cognitive tasks to the drop vertical jump (DVJ) and explore the potential influence of sex on CMi.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>A total of 40 (50% male) sports-active patients who had undergone ACLR (mean, 24.9 ± 16.1 months after surgery) and 40 (50% male) sports-active noninjured controls performed DVJs with and without secondary cognitive tasks targeting short-term memory, attention, fast decision-making, and inhibitory control. Outcomes included a letter position recall task and 3 motor variables: (1) correct action (landing or landing with a subsequent vertical jump), (2) relative jump height (relative between DVJs), and (3) relative peak vertical ground-reaction force (relative between DVJs). Participants also completed isolated cognitive tests (CANTAB) included as covariates in multivariate analysis.</p><p><strong>Results: </strong>Multivariate analysis of variance revealed that the ACLR group had greater CMi than the control group (<i>P</i> < .001), as manifested by more incorrect answers for the cognitive letter recall task (mean difference [MD], -13.3% [95% CI, -20.8% to -5.9%]; <i>P</i> < .001), more incorrect motor actions (MD, -7.5% [95% CI, -12.4% to -2.6%]; <i>P</i> = .003), and a reduced relative jump height (MD, -4.5% [95% CI, -7.9% to -1.2%]; <i>P</i> = .010). No difference in relative peak vertical ground-reaction force was found (MD, 2.8% [95% CI, -7.7% to 13.3%]; <i>P</i> = .59). Isolated cognitive outcomes did not affect these results, and there were no significant differences between male and female participants.</p><p><strong>Conclusion: </strong>Patients after ACLR showed greater CMi than noninjured controls, which was unrelated to isolated cognitive outcomes, thus indicating aberrant neurocognitive function.</p><p><strong>Clinical relevance: </strong>Clinicians should consider cognitive and dual-task training and screening during ACL rehabilitation to better prepare patients for chaotic and uncontrolled sporting environments in which dual tasking is prevalent. Such interventions may help to reduce the risk of secondary ACL injuries.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251322947"},"PeriodicalIF":4.2,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544688","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 Revision Elbow Medial Ulnar Collateral Ligament Reconstruction in Professional Baseball Players: An Analysis of 191 Pitchers From 2010 to 2023.","authors":"Brandon J Erickson, Christopher L Camp, Peter N Chalmers, Timothy B Griffith, Karissa N Simon, Elizabeth Hebert, Keith Meister","doi":"10.1177/03635465251322780","DOIUrl":"https://doi.org/10.1177/03635465251322780","url":null,"abstract":"<p><strong>Background: </strong>The number of medial ulnar collateral ligament (MUCL) reconstructions is increasing. The epidemiology surrounding revision MUCL reconstructions in professional baseball players has not been well defined.</p><p><strong>Purpose/hypothesis: </strong>The purpose was to report the epidemiology of revision MUCL reconstruction in professional baseball players. The authors hypothesized that the number of revision MUCL reconstructions has increased over time and that the rate of return to sport at the same level of play is <70%.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>All professional baseball pitchers who underwent revision MUCL reconstruction between 2010 and 2023 were identified using the Major League Baseball Health and Injury Tracking System. Rates of return to play, time to return to play, and return to same level of play were recorded and analyzed for pitchers with a minimum follow-up of 2 years. Surgical variables, including technique and graft choice, were also recorded.</p><p><strong>Results: </strong>Overall 191 pitchers (mean age, 26.0 years) underwent revision MUCL reconstruction. The mean time between primary and revision surgery was 1381 days (45 months). Of these players, 130 (68%) were Minor League Baseball pitchers. Hamstring tendon autograft was the most commonly used graft source (n = 90; 47%) when compared with palmaris longus autograft (n = 67; 35%). In terms of tunnel configuration, the modified Jobe and docking techniques were used in equal occurrence (n = 70; 37%). After revision MUCL reconstruction, only 72% of professional baseball pitchers were able to return to play at any level at a mean 556 days (18 months), and only 58% were able to return to the same level of play at a mean 604 days (20 months). The mean time between primary and revision MUCL reconstruction was 45 months (3.75 years).</p><p><strong>Conclusion: </strong>Revision MUCL surgery continues to be a challenging problem, where the procedure is complex, rehabilitation timelines are prolonged, and outcomes are not always optimal. Accordingly, the authors recommend that these procedures be performed by surgeons with high levels of experience.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251322780"},"PeriodicalIF":4.2,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544690","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":"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":"https://doi.org/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":"3635465251319540"},"PeriodicalIF":4.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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":"https://doi.org/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":"3635465251317202"},"PeriodicalIF":4.2,"publicationDate":"2025-03-03","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":"The Biomechanical Importance of Bone Block Positioning in Glenoid Augmentation: Every Millimeter Matters.","authors":"Sebastian Oenning, Jens Wermers, Alina Köhler, Julia Sußiek, Mats Wiethölter, Michael J Raschke, J Christoph Katthagen","doi":"10.1177/03635465251322796","DOIUrl":"https://doi.org/10.1177/03635465251322796","url":null,"abstract":"<p><strong>Background: </strong>In the presence of anterior glenoid bone loss (aGBL), options for bony glenoid augmentation include Latarjet procedures and free bone block transfers. Bone graft placement is challenging, and malposition causes complications, such as recurrent instability or osteoarthritis.</p><p><strong>Hypothesis: </strong>With minimal changes in bone block positioning, osteochondral shoulder stability cannot be restored sufficiently.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>In a robotic test setup, 14 human cadaveric scapulae were included. Soft tissue was resected, and matching artificial humeri were selected for each specimen. Testing was performed in 60° of glenohumeral abduction with 50 N of glenohumeral compression and anterior-directed translational force to the humerus. Application of 20% aGBL and screw fixation of artificial bone blocks (artBBs) with different buildup shells allowed the following testing stages: (1) intact, (2) 20% aGBL, (3) flush artBB, (4) 1-mm medialized artBB, and (5) 1-mm lateralized artBB. The stability ratio (SR) and medial-lateral humeral head starting position were assessed.</p><p><strong>Results: </strong>Specimens with 20% aGBL provided lower mean SRs than native joints (20.6% [SD, 4.7%] vs 27.8% [SD, 6.7%]; <i>P</i> < .0001). Flush artBB placement (mean, 35.4%; SD, 7.7%) led to an increased SR compared with both native joints (<i>P</i> = .002) and 20% aGBL (<i>P</i> < .0001). The mean SR in 1-mm medialized artBBs (21.5%; SD, 5.7%) did not differ compared with that for 20% aGBL (<i>P</i> = .908). One-millimeter lateralized artBBs (mean, 40.8%; SD, 5%) provided higher SR and more lateral humeral head starting positions compared with flush artBB (<i>P</i> = .003 and <i>P</i> = .003, respectively).</p><p><strong>Conclusion: </strong>In the presence of aGBL, flush bone block placement restores osteochondral glenohumeral stability, while a 1-mm medialized bone block fails to increase stability. Bone block lateralization of 1 mm provides higher stability but is associated with humeral head lateralization.</p><p><strong>Clinical relevance: </strong>Glenoid bone block augmentations are established in patients with glenohumeral instability and aGBL. In the case of bone block malposition, complications like recurrent instability or the development of osteoarthritis can occur. This study underlines the importance of accurate bone block placement since only minimum bone block malposition relevantly affects osteochondral shoulder biomechanics.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251322796"},"PeriodicalIF":4.2,"publicationDate":"2025-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538126","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":"Long-term Recurrence Rates After Isolated Arthroscopic Bankart Repair in Selected Patients Without Preoperative Bone Loss Versus Open Latarjet Procedure: A Matched-Pair Analysis.","authors":"Clémentine Rieussec, Juan Enrique Cassinelli, Matias Hoffman, Clément Horteur, Johannes Barth","doi":"10.1177/03635465241309330","DOIUrl":"10.1177/03635465241309330","url":null,"abstract":"<p><strong>Background: </strong>Clinical studies have shown that the open Latarjet procedure (OLP) has lower recurrence rates than the isolated arthroscopic Bankart (IAB) procedure for recurrent anterior shoulder instability, but no long-term comparative studies exist for IAB in patients without bone loss.</p><p><strong>Purpose/hypothesis: </strong>This study aimed to compare the outcomes of IAB in selected patients without bone loss versus OLP. The hypothesis was that OLP would be more successful in preventing recurrence, even in carefully selected patients for IAB.</p><p><strong>Study design: </strong>Cohort study; Level of evidence 3.</p><p><strong>Methods: </strong>An overall 774 patients who underwent surgical stabilization for recurrent anterior instability between January 2007 and December 2021 were analyzed. A total of 685 shoulders were followed up (89 patients were lost of follow-up: 11,4%), including 582 OLP, 45 IAB, and 58 other techniques (Trillat procedure, Arthroscopic Latarjet procedure, and revision Eden Hybinette procedure). The patients who underwent primary IAB were matched with patients who underwent OLP in a 1:1 ratio using propensity matching, resulting in 45 patients in each group. The main objective was to identify new episodes of instability, with a recurrence rate <5% considered acceptable. Kaplan-Meier analysis was used to evaluate patient survivorship, and logistic regression was performed to consider potential factors affecting recurrence rates. Data were collected on return-to-sport rate, Walch and Duplay score, visual analog scale score, and external rotation.</p><p><strong>Results: </strong>The mean follow-up was 9 years and 3 months. A new episode of instability occurred in 2% of the OLP group and 20% of the IAB group (<i>P</i> = .04; odds ratio, 11; 95% CI, 1.91-63.4, Miettinen method). Regarding the rest of our analyses, there was no significant difference. Patients maintained good external rotation with low pain: 68° in the OLP group as compared with 72° in the IAB group (<i>P</i> = .325), with 1.2 out of 10 on the visual analog scale in the OLP group versus 1.5 in the IAB group (<i>P</i> = .433), respectively. Walch and Duplay score reached 79.9 in the OLP group and 78.9 in the IAB group (<i>P</i> = .496), and 89% of the OLP group returned to its previous sport level as compared with 73% of the IAB group (<i>P</i> = .104).</p><p><strong>Conclusion: </strong>Patients who underwent an OLP had better long-term survivorship without recurrence when compared with those who underwent an IAB, even without bone loss. The odds of experiencing a new episode of instability recurrence was 11 times higher for patients who underwent IAB, with a mean follow-up of 9 years and 3 months.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"549-555"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016831","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":"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":"826-831"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","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":"Partial Avulsion Patterns in the Pediatric Humeral Medial Epicondyle.","authors":"Richard C Lee, Akbar N Syed, Margaret A Bowen, J Todd R Lawrence","doi":"10.1177/03635465241310407","DOIUrl":"10.1177/03635465241310407","url":null,"abstract":"<p><strong>Background: </strong>The anterior oblique bundle of the medial ulnar collateral ligament (UCL) inserts on the anteroinferior aspect of the humeral medial epicondyle, while the flexor pronator mass (FPM) originates superficial and proximal to the UCL. With valgus stress, these distinct footprints may produce injury patterns that affect only focal areas of the medial epicondyle.</p><p><strong>Hypothesis: </strong>The proximal UCL can act on the medial epicondyle either in isolation or in conjunction with the FPM to form partial avulsion fracture patterns within the pediatric medial epicondyle, and the predominant pattern involves only the proximal UCL footprint.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>A retrospective review was performed of medial epicondyle injuries from a single tertiary care institution documented from 2012 to 2022. Inclusion criteria consisted of (1) patients <18 years of age with a diagnosis of medial epicondyle fracture, (2) availability of radiographs within 3 weeks of injury date, and (3) no history of acute medial epicondyle fracture. Data collection included demographics, imaging, mechanisms of injury, associated injuries, and procedural details if operative notes were available.</p><p><strong>Results: </strong>Of the 1951 patients screened, 709 were diagnosed with any form of medial epicondyle fracture. Of these patients, 15.9% (n = 113; mean ± SD age, 11.15 ± 2.56 years; 70% male; 40% throwing mechanism) had radiographic evidence of fragmentation of the inferior aspect of the medial epicondyle, suggesting a partial avulsion fracture/injury. Seventy-eight patients (69%) were noted to have a small, well-corticated fragment off the inferior pole of the medial epicondyle on radiographs, defined as a \"proximal UCL avulsion fracture.\" Magnetic resonance imaging in 24 patients in this group confirmed attachment of the UCL to the avulsed fragment. This configuration was also confirmed by 2 operative reports. Thirty-five patients had a well-defined cortical shell or an indistinct radio-opaque body off the inferomedial aspect of the medial epicondyle on radiographs, defined as a \"cortical sleeve avulsion.\" Magnetic resonance imaging in 8 patients in this group demonstrated the UCL in addition to the FPM origin still attached to the avulsed cortical sleeve. This was confirmed by 2 operative reports.</p><p><strong>Conclusion: </strong>The 2 injury patterns seen in this study-proximal UCL avulsion fracture and cortical sleeve avulsion-represented 15.9% of the patients with a medial epicondyle fracture. The proximal UCL avulsion fracture pattern was the more common of the 2 injury patterns. Accurate identification of these injury patterns and their underlying pathology is likely to be important in ultimately understanding the natural history of these injuries and the outcomes of different treatment strategies.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"537-542"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025468","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 Patient Characteristics and the Depth of Microvascular Penetration Into the Adult Human Meniscus.","authors":"Thies J N van der Lelij, Peter van Schie, Amber Weekhout, Marta Fiocco, Roelina Munnik-Hagewoud, Stijn Keereweer, Hans Marten Hazelbag, Ewoud R A van Arkel, Pieter B A A van Driel","doi":"10.1177/03635465241307216","DOIUrl":"10.1177/03635465241307216","url":null,"abstract":"<p><strong>Background: </strong>Current knowledge on the microvascular anatomy of adult human menisci is based on cadaveric studies. However, considerable interindividual variation in meniscal microvascularization has been reported in recent studies with small sample sizes.</p><p><strong>Purpose: </strong>To assess the association between patient characteristics and the depth of microvascularization of the meniscus.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>Menisci from 174 patients who received total knee replacement between March 2021 and December 2023 were collected. A total of 174 lateral and 102 medial menisci were included. Three sections were made from each meniscus: the anterior horn, midbody, and posterior horn. Immunohistochemical staining (CD-31) was used to visualize the microvasculature. The 4 primary outcome measures were the correlation between the depth of microvascular penetration into the lateral meniscus (0%-100%) and (1) age, (2) smoking, (3) degree of osteoarthritis, and (4) history of cardiovascular disease. To account for repeated measurements within each patient, a linear mixed-effects model was estimated to study the association between microvascularization and the patient's characteristics previously introduced.</p><p><strong>Results: </strong>The depth of vascular penetration ranged from 0% to 78% into the lateral menisci and from 0% to 67% into the medial menisci. No significant correlations were found between age, smoking, degree of osteoarthritis, or history of cardiovascular disease and the degree of vascular penetration into the lateral meniscus. The linear mixed-effects model analysis, adjusted for location within the meniscus (anterior horn, midbody, or posterior horn) and meniscal side (lateral or medial), showed no significant associations between the same patient characteristics and meniscal microvascularization.</p><p><strong>Conclusion: </strong>The degree of microvascular penetration into the meniscus has a wide range among adults >50 years. However, the depth of microvascularization was not associated with age, smoking, degree of osteoarthritis, or history of cardiovascular disease.</p><p><strong>Clinical relevance: </strong>Because no associations were found between depth of microvascular penetration into the meniscus and patient characteristics, the latter cannot be used to estimate the vascular status of a meniscal tear in clinical practice.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"658-665"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048879","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}