American Journal of Sports Medicine最新文献

{"title":"Correlation of Player and Imaging Characteristics With Severity and Missed Time in National Football League Professional Athletes With Hamstring Strain Injury: A Retrospective Review.","authors":"Molly A Day, Lee H Karlsson, Mackenzie M Herzog, Leigh J Weiss, Shane J McGonegle, Harry G Greditzer, Vivek Kalia, Asheesh Bedi, Scott A Rodeo","doi":"10.1177/03635465241270281","DOIUrl":"https://doi.org/10.1177/03635465241270281","url":null,"abstract":"<p><strong>Background: </strong>Hamstring strain injuries (HSIs) are prevalent in US National Football League (NFL) players, but there is a paucity of information regarding imaging characteristics, injury severity, and player factors associated with time missed and risk of recurrent injury.</p><p><strong>Purpose: </strong>To describe player, football activity, clinical, and imaging characteristics of NFL players with HSIs, as well as determine player characteristics, clinical examination results, and magnetic resonance imaging (MRI) findings associated with injury occurrence, severity, and missed time.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>A retrospective cohort of NFL players with acute HSI (n = 180) during the 2018-2019 season was identified. Injury data were collected prospectively through a league-wide electronic health record system. Three musculoskeletal radiologists graded MRI muscle injury parameters using the British Athletics Muscle Injury Classification (BAMIC) system. Player, football, clinical, and imaging characteristics were correlated with HSI incidence and severity and with missed time from sport.</p><p><strong>Results: </strong>Of the 1098 HSIs identified during the 2018-2019 season, 416 (37.9%) were randomly sampled, and 180 (43.3%) had diagnostic imaging available. Game activity, preseason period, and wide receiver and defensive secondary positions disproportionately contributed to HSI. The biceps femoris was the most commonly injured muscle (n = 132, 73.3%), followed by the semimembranosus (n = 24, 13.3%) and semitendinosus (n = 17, 9.4%) muscles. The most common injury site was the distal third of the biceps femoris and semitendinosus muscles (n = 60, 45.5% and n = 10, 58.8%, respectively) and central part of the semimembranosus muscle (n = 17, 70.8%). Nearly half of the injuries (n = 83, 46.1%) were BAMIC grade 2; 25.6% (n = 46), grade 3; and 17.8% (n = 32), grade 4. MRI showed sciatic nerve abnormality in 30.6% (n = 55) of all HSIs and 81.3% (n = 26) of complete tendon injuries. BAMIC grade correlated with both median days and games missed. Combined biceps femoris and semitendinosus injuries resulted in the highest median days missed (27 days).</p><p><strong>Conclusion: </strong>Among NFL players with acute HSIs, the most common injury was a moderate-severity injury of the distal biceps femoris. BAMIC grade was associated with missed time.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037794","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":"Effect of Preoperative Lipidemic Control on Retear Rates After Rotator Cuff Repair in Patients With Hyperlipidemia.","authors":"Myung-Seo Kim, Gi-Young Jang, Nam-Su Cho","doi":"10.1177/03635465241264818","DOIUrl":"https://doi.org/10.1177/03635465241264818","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;In patients with hyperlipidemia, the risk of retear increases after rotator cuff repair (RCR). In particular, it has been reported that preoperative low-density lipoprotein cholesterol (LDL-C) level affects cuff integrity. However, there are no studies assessing whether lipidemic control affects cuff healing.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate the effect of preoperative lipidemic control on cuff integrity after arthroscopic RCR across cardiovascular disease risk groups in patients with hyperlipidemia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Case-control study; Level of evidence, 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The authors retrospectively reviewed the charts of patients with hyperlipidemia who underwent arthroscopic double-row suture bridge RCR between 2014 and 2019. The included patients had LDL-C tested within 1 month before surgery. Magnetic resonance imaging was conducted 6 months after surgery to evaluate the integrity of the repaired cuff tendon. Patients were divided into groups of low, moderate, high, and very high risk according to the 4th Korean Dyslipidemia Guidelines. On the basis of the target LDL-C set in each risk group, patients were categorized into 2 groups: group C (controlled hyperlipidemia, less than target LDL-C) and group U (uncontrolled hyperlipidemia, target LDL-C or greater). The correlation between serum lipid profile, lipidemic control, and post-RCR integrity was evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 148 patients were analyzed, 51 in group U and 97 in group C. The retear rate was significantly higher in group U than in group C (23/51 [45.1%] vs 18/97 [18.6%], respectively; &lt;i&gt;P&lt;/i&gt; = .001). The proportion of group U was significantly higher in the retear group than in the healing group (56.1% vs 26.2%; &lt;i&gt;P&lt;/i&gt; = .001). In addition, the proportions of patients with uncontrolled diabetes mellitus (DM) (19.5% vs 3.7%; &lt;i&gt;P&lt;/i&gt; = .002) and mediolateral (2.6 ± 1.2 cm vs 1.7 ± 1.1 cm; &lt;i&gt;P&lt;/i&gt; &lt; .001) and anteroposterior (2.2 ± 1.1 cm vs 1.6 ± 0.8 cm; &lt;i&gt;P&lt;/i&gt; = .003) tear sizes were significantly different between the retear and healing groups, respectively. No significant difference in serum lipid profile, including LDL-C level (119.6 ± 31.3 vs 116.7 ± 37.2; &lt;i&gt;P&lt;/i&gt; = .650), was observed between the retear and healing groups. Multivariate regression analysis identified uncontrolled hyperlipidemia (OR, 4.005; &lt;i&gt;P&lt;/i&gt; = .001), uncontrolled DM (OR, 5.096; &lt;i&gt;P&lt;/i&gt; = .022), and mediolateral tear size (OR, 1.764; &lt;i&gt;P&lt;/i&gt; = .002) as independent risk factors for retear. The 2.0-cm mediolateral size cutoff and the 3 independent risk factors had significant associations with retear.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Poor preoperative lipidemic control was significantly associated with poor healing after RCR. In addition to large mediolateral tear size, uncontrolled hyperlipidemia and DM were significant risk factors for retear. Moreover, poor lipidemic control compared wi","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010018","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":"Influence of Increased Joint Line Obliquity on Survivorship After Lateral Closing-Wedge High Tibial Osteotomy.","authors":"Tianshun Xie, Astrid J de Vries, Hugo C van der Veen, Reinoud W Brouwer","doi":"10.1177/03635465241270292","DOIUrl":"https://doi.org/10.1177/03635465241270292","url":null,"abstract":"<p><strong>Background: </strong>Although high tibial osteotomy (HTO) has emerged as a powerful intervention for treating symptomatic medial osteoarthritis and varus malalignment, it can result in an increase in knee joint line obliquity (KJLO) in the frontal plane. Limited current evidence hinders understanding of the effect of increased KJLO on HTO survivorship.</p><p><strong>Purpose: </strong>To investigate the influence of KJLO and other potential risk factors on the survivorship of lateral closing-wedge HTO.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients with symptomatic medial knee osteoarthritis and varus malalignment treated with lateral closing-wedge HTO at a single hospital were screened with a minimum follow-up of 5 years. HTO survival rate was assessed using Kaplan-Meier survival analysis. The influence of postoperative increased KJLO (medial proximal tibial angle ≥95°), age (≥55 years), sex (female), preoperative malalignment (hip-knee-ankle angle ≥10° of varus), postoperative untargeted alignment (hip-knee-ankle angle <2° or >6° of valgus), and preoperative osteoarthritis severity (Kellgren-Lawrence grade ≥3) on survivorship of HTO was evaluated using Cox regression analysis. A failure of HTO was defined as a conversion to total knee arthroplasty (TKA).</p><p><strong>Results: </strong>A total of 410 patients (463 knees) were included, with a mean follow-up of 13.0 years (range, 5.0-18.1 years) and a mean survival time of 11.2 years (range, 1.2-18.1 years) for patients who reached the endpoint of TKA. HTO survival rates at 5, 10, and 15 years postoperatively were 91%, 78%, and 60%, respectively. Multivariate Cox regression analysis showed no significant difference in survivorship between patients with increased KJLO and those with acceptable KJLO (178 vs 285 knees; hazard ratio [HR], 0.8; 95% CI, 0.6-1.1; <i>P</i> = .148), with no significant between-group difference observed in the mean follow-up length (12.9 ± 3.0 years vs 13.1 ± 3.3 years; <i>P</i> = .105). Female sex (HR, 2.0; <i>P</i> < .001) and postoperative untargeted alignment (HR, 1.6; <i>P</i> = .003) were risk factors for a conversion to TKA.</p><p><strong>Conclusion: </strong>Increased postoperative KJLO (medial proximal tibial angle ≥95°) had no significant influence on the survivorship of lateral closing-wedge HTO. Men demonstrated superior survival outcomes compared with women, and it was important to achieve a targeted postoperative alignment (HKA 2°-6° of valgus) to ensure favorable HTO survivorship.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009979","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":"Cryo-Pneumatic Compression Results in a Significant Decrease in Opioid Consumption After Shoulder Surgery: A Multicenter Randomized Controlled Trial.","authors":"Moin Khan, Steven A Phillips, Paul Mathew, Vikram Venkateswaran, John Haverstock, Danielle Dagher, Darryl Yardley, David Dick, Mohit Bhandari","doi":"10.1177/03635465241270138","DOIUrl":"https://doi.org/10.1177/03635465241270138","url":null,"abstract":"<p><strong>Background: </strong>The management of pain after shoulder surgery typically includes the use of cryotherapy and the prescription of opioid analgesics. Much focus has been placed lately on the opioid epidemic, which in part is fueled by excessive prescription of opioid medication. Previous studies have found a combination of cryotherapy and compression effective at reducing analgesic consumption and increasing recovery in patients undergoing knee and spine surgery; however, efficacy in patients undergoing shoulder surgery has not been evaluated.</p><p><strong>Purpose: </strong>To evaluate the effectiveness of a cryo-pneumatic compression device on postoperative shoulder pain, narcotic use, and quality of life when compared with standard care cryotherapy.</p><p><strong>Study design: </strong>Randomized controlled trial; Level of evidence, 2.</p><p><strong>Methods: </strong>In total, 200 patients older than 18 years scheduled for unilateral shoulder surgery were enrolled. Patients were randomized to receive either postoperative cryo-pneumatic compression or standard care. The intervention group received a cryo-pneumatic device, while the standard care group received the treating surgeon's preferred method of postoperative care, including standard cryotherapy. Narcotic use was evaluated by the number of oral morphine milligram equivalents consumed during the postoperative period, as well as the time to cessation of narcotic use. Patient-reported outcome measures consisted of a numeric rating scale pain score, 36-item Short Form Survey, patient experience assessed using the net promoter score, and adverse events. Outcomes were evaluated at 2, 6, and 12 weeks postoperatively.</p><p><strong>Results: </strong>Patients receiving cryo-pneumatic compression reported a significant decrease in opioid consumption when compared with standard care (oral morphine milligram equivalents median, 56.1 vs 112; <i>P</i> = .02468). A significant increase in self-reported function was seen in the cryo-pneumatic compression group at 2 weeks when compared with standard care (mean, 61.2 vs 54.2; <i>P</i> = .0412).</p><p><strong>Conclusion: </strong>In patients undergoing unilateral shoulder surgery, the use of cryotherapy with pneumatic compression, when compared with standard care, resulted in significantly decreased opioid consumption as well as increased function at 2 weeks.</p><p><strong>Registration: </strong>NCT04185064 (ClinicalTrials.gov identifier).</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010017","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":"How to Best Identify Acetabular Retroversion on Radiographs: Thresholds to Guide Clinical Practice.","authors":"Jeroen C F Verhaegen, Camille Vorimore, Claudia Galletta, Kawan Rakhra, Pablo A Slullitel, Paul E Beaule, George Grammatopoulos","doi":"10.1177/03635465241265087","DOIUrl":"https://doi.org/10.1177/03635465241265087","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Acetabular retroversion is associated with impingement and instability. An adequate interpretation of acetabular version and coverage on radiographs is essential to determine the optimal treatment strategy (periacetabular osteotomy vs hip arthroscopic surgery). The crossover sign (COS) has been associated with the presence of acetabular retroversion, and the anterior wall index (AWI) and posterior wall index (PWI) assess anteroposterior acetabular coverage. However, the radiographic appearance of the acetabulum is sensitive to anterior inferior iliac spine (AIIS) morphology and pelvic tilt (PT), which differs between the supine and standing positions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To (1) identify differences in the acetabular appearance between the supine and standing positions among patients presenting with hip pain; (2) determine factors (acetabular version, AIIS morphology, and spinopelvic characteristics) associated with the crossover ratio (COR), AWI, and PWI; and (3) define relevant clinical thresholds to guide management.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cross-sectional study; Level of evidence, 3.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients who presented to a hip preservation surgical unit (n = 134) were included (mean age, 35 ± 8 years; 58% female; mean body mass index, 27 ± 6). All participants underwent supine and standing anteroposterior pelvic radiography to assess the COS, COR, AWI, and PWI as well as standing lateral radiography to determine standing PT. Computed tomography was used to measure supine PT, acetabular version, and AIIS morphology. Acetabular version was measured at 3 transverse levels, corresponding to the 1-, 2-, and 3-o'clock positions. The correlation between radiographic characteristics (COR, AWI, and PWI) and acetabular version, AIIS morphology, and PT was calculated using the Spearman correlation coefficient. Receiver operating characteristic curve analysis was performed to define thresholds for the COR, AWI, and PWI to identify retroversion (version thresholds: &lt;10°, &lt;5°, and &lt;0°).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The COS was present in 55% of hips when supine and 30% when standing, with a mean difference in the COR of 12%. The supine COR (rho = -0.661) and AWI/PWI ratio (rho = -0.618) strongly correlated with acetabular version. The COS was more prevalent among patients with type 2 AIIS morphology (71%) than among those with type 1 AIIS morphology (43%) (&lt;i&gt;P&lt;/i&gt; = .003). COR thresholds of 23% and 28% were able to identify acetabular version &lt;5° (sensitivity = 81%; specificity = 80%) and &lt;0° (sensitivity = 88%; specificity = 85%), respectively. An AWI/PWI ratio &gt;0.6 was able to reliably identify acetabular version &lt;0° (sensitivity = 83%; specificity = 84%). In the presence of a COR &gt;30% and an AWI/PWI ratio &gt;0.6, the specificity to detect retroversion was significantly increased (&gt;90%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The presence of the COS was very common among patients ","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142010019","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":"Surgical Treatment of Proximal Hamstring Avulsion Injuries Compared With Nonsurgical Treatment: A Matched Comparative Study With a Mean Follow-up of >4 Years From the Proximal Hamstring Avulsion Surgery Cohort Study.","authors":"Nicolas Lefèvre, Mohamad K Moussa, Laila El Otmani, Eugénie Valentin, Alain Meyer, Olivier Grimaud, Yoann Bohu, Alexandre Hardy","doi":"10.1177/03635465241270139","DOIUrl":"10.1177/03635465241270139","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Surgical outcomes for proximal hamstring avulsion injury (PHAI) are well documented, yet comparative analyses with nonsurgical approaches remain scarce.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the functional outcomes between surgical and nonsurgical interventions for PHAI.&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;This comparative study, conducted at a sports surgery center between January 2012 and July 2021, focused on patients with primary PHAI. The study was a retrospective analysis of prospectively collected data. Group selection involved utilizing propensity score matching to compare an arm of patients who were surgically treated (indications included patients with complete injury, patients with partial injury with &gt;2 cm of retraction, and patients for whom 6 months of nonsurgical treatment failed) with another arm of patients who refused surgery. The primary outcome was evaluated using the Parisian Hamstring Avulsion Score (PHAS). The secondary outcomes included the Tegner Activity Scale (TAS) score; University of California, Los Angeles (UCLA) score; rate and quality of return to sport (RTS); and patient satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study included 32 patients (mean age, 55.8 years [SD, 8.4 years]) in the nonsurgical treatment arm and 95 patients in the surgical treatment arm (mean age, 53.4 years [SD, 7.7 years]) (&lt;i&gt;P&lt;/i&gt; &gt; .05). The interval from injury to treatment was 5.7 months (SD, 9.6 months) for the surgical group and 12.7 months (SD, 25.9 months) for the nonsurgical group (&lt;i&gt;P&lt;/i&gt; &gt; .05). At the final follow-up (nonsurgical group: mean, 56.5 months [SD, 28.2 months]; surgical group: mean, 50.7 months [SD, 33.1 months]), the PHAS was significantly higher in the surgical group (mean, 86.3 [SD, 13.7]) compared with the nonsurgical group (mean, 69.8 [SD, 15.1]) (&lt;i&gt;P&lt;/i&gt; &lt; .0001). Higher activity scores were also observed in the surgical group for the TAS and UCLA scores (&lt;i&gt;P&lt;/i&gt; = .0224 and &lt;i&gt;P&lt;/i&gt; = .0026, respectively). A higher percentage of the surgical group (68.4%) returned to sports compared with the nonsurgical group (46.9%) (&lt;i&gt;P&lt;/i&gt; = .0354), with a greater proportion in the surgical group returning at the same or higher level (67.7% vs 26.7%) (&lt;i&gt;P&lt;/i&gt; = .0069). Additionally, a higher satisfaction level was reported by patients in the surgical group (89.5%) in contrast to the nonsurgical group (25%) (&lt;i&gt;P&lt;/i&gt; &lt; .0001). Three patients in the surgical group experienced complications (2 reruptures and 1 hyperesthesia at the pudendal nerve territories). Odds ratios (ORs) indicated that patients in the surgical group were significantly more likely to achieve or exceed median scores for the PHAS (OR, 6.79; &lt;i&gt;P&lt;/i&gt; &lt; .001), TAS score (OR, 2.29; &lt;i&gt;P&lt;/i&gt; = .045), and UCLA score (OR, 3.63; &lt;i&gt;P&lt;/i&gt; = .003), as well as to RTS at any level (OR, 2.46; &lt;i&gt;P&lt;/i&gt; = .031) or at the preinjury level or higher (OR, 6.04;","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009980","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":"Career Length After Surgically Treated ACL Plus Collateral Ligament Injury in Elite Athletes.","authors":"Vitor Hugo Pinheiro, Mitzi Laughlin, Kyle A Borque, Dylan Ngo, Madison R Kent, Mary Jones, Nuno Neves, Fernando Fonseca, Andy Williams","doi":"10.1177/03635465241262440","DOIUrl":"10.1177/03635465241262440","url":null,"abstract":"<p><strong>Background: </strong>Limited data are available regarding career length and competition level after combined anterior cruciate ligament (ACL) and medial- or lateral-sided surgeries in elite athletes.</p><p><strong>Purpose: </strong>To evaluate career length after surgical treatment of combined ACL plus medial collateral ligament (MCL) and ACL plus posterolateral corner (PLC) injuries in elite athletes and, in a subgroup analysis of male professional soccer players, to compare career length and competition level after combined ACL+MCL or ACL+PLC surgeries with a cohort who underwent isolated ACL reconstruction (ACLR).</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A consecutive cohort of elite athletes undergoing combined ACL+MCL and ACL+PLC surgery was analyzed between February 2001 and October 2019. A subgroup of male elite soccer players from this population was compared with a previously identified cohort having had isolated primary ACLR without other ligament surgery. A minimum 2-year follow-up was required. Outcome measures were career length and competition level.</p><p><strong>Results: </strong>A total of 98 elite athletes met the inclusion criteria, comprising 50 ACL+PLC and 48 ACL+MCL surgeries. The mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Return-to-play (RTP) time was significantly longer for ACL+PLC injuries (12.8 months; <i>P</i> = .019) than for ACL+MCL injuries (10.9 months). In the subgroup analysis of soccer players, a significantly lower number of players with combined ACL+PLC surgery were able to RTP (88%; <i>P</i> = .003) compared with 100% for ACL+MCL surgery and 97% for isolated ACLR, as well as requiring an almost 3 months longer RTP timeline (12.9 months; <i>P</i> = .002) when compared with the isolated ACL (10.2 months) and combined ACL+MCL (10.0 months) groups. However, career length and competition level were not significantly different between groups.</p><p><strong>Conclusion: </strong>Among elite athletes, the mean career length after surgical treatment of combined ACL+MCL and ACL+PLC injuries was 4.5 years. Professional soccer players with combined ACL+PLC surgery returned at a lower rate and required a longer RTP time when compared with the players with isolated ACL or combined ACL+MCL injuries. However, those who did RTP had the same career longevity and competition level.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891053","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":"Effect of Preoperative Anterolateral Ligament Injury on Outcomes After Isolated Acute ACL Reconstruction With Hamstring Graft: A Prospective Study With Minimum 5-Year Follow-up.","authors":"Marcel Faraco Sobrado, Andre Giardino Moreira da Silva, Paulo Victor Partezani Helito, Camilo Partezani Helito","doi":"10.1177/03635465241263599","DOIUrl":"10.1177/03635465241263599","url":null,"abstract":"<p><strong>Background: </strong>The potential influence of a preoperative anterolateral ligament (ALL) lesion seen on magnetic resonance imaging (MRI) on the mid- and long-term surgical outcomes of anterior cruciate ligament (ACL) reconstruction is still controversial.</p><p><strong>Purpose: </strong>To evaluate the clinical outcomes and failure rate of isolated ACL reconstruction at a minimum 5-year follow-up in patients with and without ALL injury diagnosed preoperatively using MRI.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 2.</p><p><strong>Methods: </strong>A prospective cohort of patients with acute ACL injury was divided into 2 groups based on the presence (ALL injury group) or absence (control group) of ALL injury on preoperative MRI. This is a longer-term follow-up study of a previously published study that had a minimum 2-year follow-up. Both groups underwent anatomic isolated reconstruction of the ACL. The Lysholm and subjective International Knee Documentation Committee scores, KT-1000 arthrometer and pivot-shift tests, reconstruction failure rate, incidence of contralateral ACL injury, presence of associated meniscal injury, and presence of knee hyperextension were evaluated. The evaluation at the 5-year follow-up was also compared with the same patient's evaluation at 2 years of follow-up.</p><p><strong>Results: </strong>A total of 156 patients were evaluated. No significant differences were found between the groups in the preoperative evaluation. In the postoperative evaluation, patients in the ALL injury group had a higher reconstruction failure rate (14.3% vs 4.6% for the control group; <i>P</i> = .049) and worse clinical outcomes according to the Lysholm scores (85.0 ± 10.3 vs 92.3 ± 6.6; <i>P</i> < .00001). Although the pivot-shift test results were similar, anteroposterior translation using the KT-1000 arthrometer revealed worse results for the ALL injury group (2.8 ± 1.4 mm vs 1.9 ± 1.3 mm; <i>P</i> = .00018). Patients in the ALL injury group also had an increase in KT-1000 arthrometer values from 2 to 5 years (2.4 ± 1.6 vs 2.8 ± 1.4; <i>P</i> = .038). Patients in the control group had no differences in outcomes from 2 to 5 years of follow-up.</p><p><strong>Conclusion: </strong>Combined ACL and ALL injuries were associated with significantly less favorable outcomes than were isolated ACL injuries at a minimum follow-up of 5 years after isolated ACL reconstruction with hamstring autograft. Patients with concomitant ALL injury showed a higher failure rate and worse functional scores. Also, knee stability tended to slightly worsen from 2 to 5 years in cases of associated ALL injury.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891055","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":"Investigating the Bone Bruise Patterns in Pediatric Patients With Contact and Noncontact Acute Anterior Cruciate Ligament Tears: A Multicenter Study.","authors":"Jay Moran, Jason Z Amaral, Michael Lee, Ruth H Jones, Preston Gross, Lee D Katz, Annie Wang, John A Carrino, Andrew Esteban Jimenez, Barkha N Chhabra, J Herman Kan, Brian G Smith, Aharon Z Gladstein, Scott D McKay, Robert F LaPrade, Peter D Fabricant, Michael J Medvecky","doi":"10.1177/03635465241264282","DOIUrl":"10.1177/03635465241264282","url":null,"abstract":"<p><strong>Background: </strong>In adults with anterior cruciate ligament (ACL) tears, bone bruises on magnetic resonance imaging (MRI) scans provide insight into the underlying mechanism of injury. There is a paucity of literature that has investigated these relationships in children with ACL tears.</p><p><strong>Purpose: </strong>To examine and compare the number and location of bone bruises between contact and noncontact ACL tears in pediatric patients.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Boys ≤14 years and girls ≤12 years of age who underwent primary ACL reconstruction surgery between 2018 and 2022 were identified at 3 separate institutions. Eligibility criteria required detailed documentation of the mechanism of injury and MRI performed within 30 days of the initial ACL tear. Patients with congenital lower extremity abnormalities, concomitant fractures, injuries to the posterolateral corner and/or posterior cruciate ligament, previous ipsilateral knee injuries or surgeries, or closed physes evident on MRI scans were excluded. Patients were stratified into 2 groups based on a contact or noncontact mechanism of injury. Preoperative MRI scans were retrospectively reviewed for the presence of bone bruises in the coronal and sagittal planes using fat-suppressed T2-weighted images and a grid-based mapping technique of the tibiofemoral joint.</p><p><strong>Results: </strong>A total of 109 patients were included, with 76 (69.7%) patients sustaining noncontact injuries and 33 (30.3%) patients sustaining contact injuries. There were no significant differences between the contact and noncontact groups in terms of age (11.8 ± 2.0 vs 12.4 ± 1.3 years; <i>P</i> = .12), male sex (90.9% vs 88.2%; <i>P</i> > .99), time from initial injury to MRI (10.3 ± 8.1 vs 10.4 ± 8.9 days; <i>P</i> = .84), the presence of a concomitant medial meniscus tear (18.2% vs 14.5%; <i>P</i> = .62) or lateral meniscus tear (69.7% vs 52.6%; <i>P</i> = .097), and sport-related injuries (82.9% vs 81.8%; <i>P</i> = .89). No significant differences were observed in the frequency of combined lateral tibiofemoral (lateral femoral condyle + lateral tibial plateau) bone bruises (87.9% contact vs 78.9% noncontact; <i>P</i> = .41) or combined medial tibiofemoral (medial femoral condyle [MFC] + medial tibial plateau) bone bruises (54.5% contact vs 35.5% noncontact; <i>P</i> = .064). Patients with contact ACL tears were significantly more likely to have centrally located MFC bruising (odds ratio, 4.3; 95% CI, 1.6-11; <i>P</i> = .0038) and less likely to have bruising on the anterior aspect of the lateral tibial plateau (odds ratio, 0.27; 95% CI, 0.097-0.76; <i>P</i> = .013).</p><p><strong>Conclusion: </strong>Children with contact ACL tears were 4 times more likely to present with centrally located MFC bone bruises on preoperative MRI scans compared with children who sustained noncontact ACL tears. Future studies should inves","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891057","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":"Midterm Outcomes After Simultaneous Hip Arthroscopic Surgery for Bilateral Femoroacetabular Impingement.","authors":"Eric Marty, Carson Keeter, Kaleigh Henry, Matthew J Kraeutler, Jessica H Lee, Omer Mei-Dan","doi":"10.1177/03635465241263597","DOIUrl":"10.1177/03635465241263597","url":null,"abstract":"<p><strong>Background: </strong>Bilateral hip arthroscopic surgery for the treatment of femoroacetabular impingement (FAI) has demonstrated good outcomes at short-term follow-up, with significant improvements in pain, hip function, and patient-reported outcomes, coupled with a complication rate similar to that of unilateral surgery.</p><p><strong>Purpose: </strong>To investigate whether, in patients with bilateral symptomatic FAI, simultaneous bilateral hip arthroscopic surgery is an efficacious option that produces effective midterm outcomes.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A prospective database of patients who underwent primary hip arthroscopic surgery between August 2012 and October 2020 was used to collect clinical data on 2 groups. Group 1 consisted of patients who underwent simultaneous bilateral hip arthroscopic surgery for the treatment of FAI. Group 2 represented a matched-pair control group of patients selected based on sex and age with signs and symptoms of unilateral FAI and in whom a single side was evaluated and treated. Differences in the International Hip Outcome Tool-12 and Non-Arthritic Hip Score scores were evaluated up to 5 years postoperatively.</p><p><strong>Results: </strong>In total, 171 patients (235 hips) were included, of whom 64 underwent simultaneous bilateral hip arthroscopic surgery (128 hips) and a control group of 107 patients (107 hips) underwent unilateral hip arthroscopic surgery. No significant differences were observed in International Hip Outcome Tool-12 scores between the 2 groups at 6 weeks, 3 months, 1 year, 2 years, and 5 years postoperatively. No significant differences were observed in Non-Arthritic Hip Score scores between the simultaneous bilateral and control groups at 6 weeks, 3 months, 6 months, 1 year, 2 years, and 5 years postoperatively. Overall, 18% of hips in the simultaneous bilateral group reported lateral femoral cutaneous nerve palsy at 2-week follow-up in comparison to 16% of hips in the control group.</p><p><strong>Conclusion: </strong>Simultaneous bilateral hip arthroscopic surgery for the treatment of FAI represents a safe treatment option, producing effective midterm outcomes in appropriately selected patients.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":null,"pages":null},"PeriodicalIF":4.2,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141891058","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}