American Journal of Sports Medicine最新文献

{"title":"Analyzing the Association of the Area Deprivation Index on Patient-Reported Outcomes in Patients Undergoing Hip Arthroscopy.","authors":"Jordan J Cruse, Hashim J F Shaikh, James D Brodell, Mina Botros, Terrence S Daley-Lindo, Raymond J Kenney, Brian D Giordano","doi":"10.1177/03635465251316432","DOIUrl":"10.1177/03635465251316432","url":null,"abstract":"<p><strong>Background: </strong>Hip arthroscopy is a valuable tool through which intra- and extra-articular hip pathologies may be addressed, with the goal of improving pain and function while preventing osteoarthritis progression. Little data are available regarding the effect of social determinants of health on hip arthroscopy outcomes.</p><p><strong>Purpose: </strong>To determine if a patient's lived environment is associated with better or worse postoperative outcomes using the area deprivation index (ADI).</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients undergoing hip arthroscopy between January 1, 2015, and June 30, 2022, at a single institution were identified using Current Procedural Terminology codes. Patients' zip codes were utilized to identify ADI measures. Patients were divided into quartiles of ADI, and the most deprived (ADI_High) and least deprived (ADI_Low) quartiles were compared. Pre- and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores for the Pain Interference (PI), Physical Function (PF), and Depression domains were obtained. For the PF and PI domains, the minimal clinically important difference (MCID) was defined using an anchor-based approach using previously established cutoffs. For the Depression domain, the MCID was defined using a distribution-based approach and calculated as one-half of the standard deviation of the preoperative PROMIS score. Multivariable logistic regression models were estimated to characterize the association of the ADI with MCID attainment along PROMIS domains.</p><p><strong>Results: </strong>A total of 170 patients were included in the analysis of the ADI_High (n = 85) and ADI_Low (n = 85) cohorts. Age, body mass index, smoking status, and race did not significantly vary between groups. No significant differences in MCID attainment were observed at any time point in the PF, PI, or Depression domains. However, the ADI_High cohort had higher mean PI (worse) scores compared with the ADI_Low cohort at the preoperative, 1-year, and final follow-up (mean, 2.52 years) time points. In multivariable logistic regression analyses, ADI was not associated with the odds of MCID attainment.</p><p><strong>Conclusion: </strong>For patients undergoing hip arthroscopy, increased social disadvantage measured by the ADI was not associated with the odds of MCID attainment in any PROMIS domain. This information provides guidance for care providers, researchers, and policymakers to seek and identify other mechanisms that may affect outcomes after hip arthroscopy.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1133-1141"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469851","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":"Serial Changes in Muscle Strength and Dynamic Balance After Lateral Meniscal Allograft Transplantation: A Retrospective Cohort Study of 55 Patients.","authors":"Seung Ik Cho, Ji Seung Yoo, Sung Gyu Moon, Ji Hee Kang, Sang Jin Yang, Jin Goo Kim, Dhong Won Lee","doi":"10.1177/03635465251317741","DOIUrl":"10.1177/03635465251317741","url":null,"abstract":"<p><strong>Background: </strong>Despite numerous studies examining subjective clinical scores after meniscal allograft transplantation (MAT), research focusing specifically on functional measures is lacking.</p><p><strong>Purpose: </strong>To evaluate the serial changes in isokinetic muscle strength and dynamic balance during the first postoperative year after lateral MAT (LMAT).</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 55 patients who underwent LMAT underwent subjective functional assessment using the Lysholm and subjective International Knee Documentation Committee (IKDC) scores. The objective functions, evaluated using isokinetic muscle strength testing and the Y-balance test for dynamic postural stability, were recorded preoperatively and 6 and 12 months postoperatively. Magnetic resonance imaging (MRI) was performed at 2 days and 12 months postoperatively to evaluate the meniscal allograft extrusion and cartilage condition in the lateral compartment. At 12 months, patients with graft extrusion >3 mm on MRI were assigned to the extrusion group.</p><p><strong>Results: </strong>Significant improvements were observed in the Lysholm and subjective IKDC scores at 12 months postoperatively (both <i>P</i> < .001). The joint space width did not significantly increase (<i>P</i> = .054). Coronal graft extrusion increased significantly (<i>P</i> < .001). At 6 months postoperatively, isokinetic muscle strength tests indicated no significant reduction in the peak torque for knee extension (<i>P</i> = .911). However, at 12 months, the peak torque was significantly increased (<i>P</i> = .001), with the deficits improving from 38.3% to 18.1% (<i>P</i> < .001). No significant changes were noted in the knee flexion strength. Dynamic postural stability showed a significant decrease in the Limb Symmetry Index (LSI) for the anterior reach at 6 months (<i>P</i> = .004), but significant improvements were seen by 12 months, with the LSI values for the anterior, posteromedial, and posterolateral reaches all exceeding 90% (<i>P</i> < .001). No significant differences in muscle strength or dynamic balance were found between the nonextrusion (n = 41) and extrusion (n = 14) groups at 12 months.</p><p><strong>Conclusion: </strong>The significant improvements in isokinetic muscle strength and dynamic postural stability achieved only by 12 months after LMAT underscores the necessity of a comprehensive rehabilitation program and caution against premature sports resumption.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1101-1111"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460897","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":"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":"1041-1049"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951357/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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":"10.1177/03635465251323806","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose/hypothesis: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Case series; Level of evidence, 4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;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.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;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 (&lt;i&gt;r&lt;/i&gt; = 0.237; &lt;i&gt;P&lt;/i&gt; &lt; .001), body mass index (&lt;i&gt;r&lt;/i&gt; = 0.148; &lt;i&gt;P&lt;/i&gt; = .005), and supratrochlear spur height (&lt;i&gt;r&lt;/i&gt; = 0.196; &lt;i&gt;P&lt;/i&gt; &lt; .001). Trochlear defects were significantly associated with patient's age (&lt;i&gt;r&lt;/i&gt; = 0.160; &lt;i&gt;P&lt;/i&gt; = .002), patellar tilt (&lt;i&gt;r&lt;/i&gt; = 0.202; &lt;i&gt;P&lt;/i&gt; &lt; .001), tibial tubercle-trochlear groove distance (&lt;i&gt;r&lt;/i&gt; = 0.128; &lt;i&gt;P&lt;/i&gt; = .014), and supratrochlear spur height (&lt;i&gt;r&lt;/i&gt; = 0.151; &lt;i&gt;P&lt;/i&gt; &lt; .004). Trochlear dysplasia types B and D showed a trend toward a higher prevalence in patellar defects (&lt;i&gt;P&lt;/i&gt; = .082), while they were significantly associated with a higher prevalance of trochlear defects (&lt;i&gt;P&lt;/i&gt; = .003) compared with types A and C. Knees with patellar (5.1 ± 2.0 vs 4.3 ± 1.7 mm, respectively; &lt;i&gt;P&lt;/i&gt; = .001) and trochlear (5.3 ± 2.1 vs 4.4 ± 1.8 mm, respectively; &lt;i&gt;P&lt;/i&gt; = .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; &lt;i&gt;P&lt;/i&gt; &lt; .001) and 3.4 (95% CI, 1.3-8.8; &lt;i&gt;P&lt;/i&gt; = .014) for developing patellar and trochlear cartilage damage, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;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":"1127-1132"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951347/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Controlled Release of Platelet-Rich Plasma-Loaded Alginate Repairs Muscle Damage With Less Fibrosis.","authors":"William Kenzo Felipone, Luana de Mambro, Beatrice Rodrigues Ranieri, Giovana Zaneti Ivanov, Robert Meves, Leonardo Martins, Roberta Sessa Stilhano","doi":"10.1177/03635465251321108","DOIUrl":"10.1177/03635465251321108","url":null,"abstract":"<p><strong>Background: </strong>Muscle injuries often result in dysfunctional muscle repair and reduced muscle strength. While platelet-rich plasma (PRP) has emerged as a new treatment option in orthopaedics, its use for muscle injuries remains controversial.</p><p><strong>Hypothesis: </strong>Encapsulating PRP within alginate hydrogels will achieve a localized and sustained release of growth factors at the site of the muscle injury, thereby enhancing skeletal muscle repair and reducing fibrosis.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Bimodal blends of hydrogels were formulated using 1% oxidized high- and low-molecular weight alginate. There were 2 types of PRP prepared: leukocyte-rich PRP (L-PRP) and pure PRP (P-PRP). These PRP types were loaded onto 75L25H alginate hydrogels, and the release of TGF-β1 was quantified over time. A laceration injury was induced in mice, which was then treated with various agents: alginate only, L-PRP, L-PRP-loaded alginate (L-PRPA), P-PRP, and P-PRP-loaded alginate (P-PRPA). An additional 2 groups were formed: injury with no treatment and control with no treatment or injury.</p><p><strong>Results: </strong>Our in vitro experiments showed that after an initial burst, TGF-β1 was released in a sustained manner for approximately 1 week after the encapsulation of both PRP preparations. The in vivo experiments showed that the groups treated with bolus injections of L-PRP or P-PRP did not show significant changes in the fibrotic area. However, the L-PRPA and P-PRPA groups demonstrated a 50% reduction in the fibrotic area (<i>P</i> < .05), resulting in a higher ratio of regenerating myofibers and higher levels of myogenic markers (myogenin and MyHC-emb) compared with all the other groups (<i>P</i> < .05). The L-PRPA group demonstrated significantly improved performance on the rotarod test; interestingly, this group also had more type I collagen than type III collagen.</p><p><strong>Conclusion: </strong>The administration of L-PRP and P-PRP after a muscle injury did not reduce fibrosis. However, when loaded onto alginate hydrogels, they led to benefits, resulting in a smaller area of fibrosis and greater tissue regeneration.</p><p><strong>Clinical relevance: </strong>The encapsulation of different preparations of PRP by alginate hydrogels was more effective in treating muscle lacerations than injections of PRP alone. This information is relevant for future clinical studies of PRP.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1152-1163"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494647","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 Chance to Become an Elite Athlete After Pediatric And Adolescent Anterior Cruciate Ligament Reconstruction.","authors":"Baldur Thorolfsson, Philipp W Winkler, Ramana Piussi, Thorkell Snaebjörnsson, Rebecca Hamrin Senorski, Jon Karlsson, Kristian Samuelsson, Eric Hamrin Senorski","doi":"10.1177/03635465251320415","DOIUrl":"10.1177/03635465251320415","url":null,"abstract":"<p><strong>Background: </strong>An anterior cruciate ligament (ACL) injury is a severe condition that may affect the career of young athletes. There is limited evidence on the rate and level of return to sport (RTS) after pediatric and adolescent ACL reconstruction.</p><p><strong>Purpose: </strong>To evaluate clinical outcomes, the level and rate of RTS, and predictive factors for RTS after pediatric and adolescent ACL reconstruction.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients aged between 10 and 18 years at the time of primary ACL reconstruction were screened for eligibility. Based on age at the time of ACL reconstruction, patients were divided into the pediatric (female: 11-13 years; male: 11-15 years) and adolescent (female: 14-18 years; male: 16-18 years) groups. Patient-specific, injury-related, and treatment-specific data, as well as subscores of the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline and 1-, 2-, 5-, and 10-year follow-up, were obtained. A survey consisting of 3 patient-specific and 30 knee-related questions was developed by experts in the management of ACL injuries and was sent to all patients to determine sport-specific variables and RTS rates.</p><p><strong>Results: </strong>Overall, 1392 patients (total response rate: 24%) were included in this study. There were 81 pediatric patients (mean age at ACL reconstruction, 13.7 ± 1.4 years) and 1311 adolescent patients (mean age at ACL reconstruction, 16.5 ± 1.2 years). Significant improvements in KOOS subscores were observed after both pediatric and adolescent ACL reconstruction at each follow-up time point. After ACL reconstruction, 74% of pediatric patients and 68% of adolescent patients returned to their previous type of sport (<i>P</i> = .23). Moreover, 31% of pediatric patients and 23% of adolescent patients became elite athletes (highest national level of junior sport or higher) after ACL reconstruction (<i>P</i> = .13). A cartilage injury at the time of ACL reconstruction was found to lower the odds of pediatric and adolescent patients returning to their previous type of sport (odds ratio, 0.60; <i>P</i> = .001). A second ACL injury occurred in 25% and 31% of pediatric and adolescent patients, respectively (<i>P</i> = .29).</p><p><strong>Conclusion: </strong>Long-lasting clinical improvements and high RTS rates can be expected after pediatric and adolescent ACL reconstruction. Moreover, young athletes still have the chance to compete at an elite level of sport after ACL reconstruction.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1027-1033"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Glycogen Synthase Kinase-3 Inhibitor CHIR99021 Reduces Fatty Infiltration and Muscle Atrophy After Rotator Cuff Tears: An In Vitro Experiment and In Vivo Mouse Model.","authors":"Pu Zhang, Meng Zhou, Yiming Zhu, Jianhao Xie, Ziqi Huo, Dan Zhang, Pinxue Li, Jianxun Guo, Guangping Li, Xu Li, Renxian Wang, Chunyan Jiang","doi":"10.1177/03635465251319549","DOIUrl":"10.1177/03635465251319549","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff tears (RCTs) can cause inflammation, muscle atrophy, and irreversible fatty infiltration, resulting in poor clinical outcomes. Effective therapeutic approaches to inhibit fatty infiltration in rotator cuff muscles remain limited.</p><p><strong>Purpose: </strong>To identify pathways associated with fatty infiltration through RNA sequencing and to evaluate the therapeutic potential of the glycogen synthase kinase-3 (GSK-3) inhibitor CHIR99021 based on enrichment of the Akt/GSK-3 pathway identified by RNA sequencing.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Supraspinatus muscle biopsy specimens from 6 patients with chronic full-thickness RCTs were analyzed by RNA sequencing. Fibro-adipogenic progenitors (FAPs) or C2C12 myoblasts were cultured with different doses of CHIR99021 to assess their effects on adipogenic or myogenic differentiation, respectively. RNA sequencing identified cellular pathways in FAPs treated with or without CHIR99021. A mouse RCT model was established by detaching the supraspinatus tendon, followed by treatment with or without CHIR99021 administered intraperitoneally. Muscle atrophy and fatty infiltration were assessed histologically and through gene expression analysis at 1 and 4 weeks after surgery.</p><p><strong>Results: </strong>RNA sequencing analysis identified a marked upregulation of the Akt/GSK-3 signaling pathway specifically in patients' samples and FAPs with minimal fat accumulation. CHIR99021 suppressed adipogenic differentiation in FAPs and promoted myogenic differentiation in C2C12 cells. In the mouse RCT model, CHIR99021-treated mice exhibited reduced Oil Red O staining, a larger cross-sectional area, and less muscle weight loss in the supraspinatus muscle compared with the vehicle-treated mice. Gene expression analysis indicated increased myogenesis and reduced fatty infiltration at 1 and 4 weeks after surgery as well as increased expression levels of IL-6 and IL-15 in the CHIR99021 group compared with the control group at 1 week after surgery.</p><p><strong>Conclusion: </strong>The Akt/GSK-3 pathway was enriched in supraspinatus muscle samples and FAPs with low fat accumulation, highlighting its potential as a therapeutic target. The GSK-3 inhibitor CHIR99021 was shown to alleviate fatty infiltration and muscle atrophy after RCTs in vitro and in vivo in a mouse model.</p><p><strong>Clinical relevance: </strong>The GSK-3 inhibitor CHIR99021 shows potential for treating muscle degeneration after RCTs.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1184-1194"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484709","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":"Complications, Reoperations, and Readmissions After Common Arthroscopic Sports Medicine Procedures of the Knee: An Analysis of the ABOS Part II Oral Examination Case List Database.","authors":"Jack T Bragg, J Alex McIntyre, Richard N Puzzitiello, Matthew J Salzler","doi":"10.1177/03635465251321007","DOIUrl":"10.1177/03635465251321007","url":null,"abstract":"<p><strong>Background: </strong>Arthroscopic knee surgeries are among the most commonly performed orthopaedic surgeries, yet complications of these procedures are relatively understudied.</p><p><strong>Purpose: </strong>To determine the rate of complications, reoperations, and readmissions for arthroscopic knee surgeries by procedure, patient characteristics, and physician fellowship training status using a large national database.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>Data were collected from the American Board of Orthopaedic Surgery (ABOS) database for early-career orthopaedic surgeons taking the ABOS Part II Oral Examination between 2003 and 2022. We queried the type and frequency of complications, unexpected 90-day reoperations, and readmissions for patients undergoing sports medicine knee arthroscopy. Chi-square test and analysis of variance were used to determine the effect of fellowship training status, geographic region of practice, patient age, and patient sex on outcomes of interest.</p><p><strong>Results: </strong>Of 138,823 knee arthroscopic procedures, 10,450 complications were self-reported, making for an overall complication rate of 7.53%. Unexpected 90-day reoperation and readmission rates were calculated to be 1.16% and 0.91%, respectively. Posterior cruciate ligament reconstruction had the highest complication rate (26.38%). Sports medicine fellowship-trained physicians had a significantly higher rate of complications (<i>P</i> < .001) compared with their non-sports medicine fellowship-trained peers (8.43% and 7.06%, respectively). Female patients had a higher complication rate (7.72%) than males (7.40%) (<i>P</i> = .02). Patients aged 20 to 29 had the highest rate of complications and reoperations (10.29% and 1.56%, respectively), whereas patients aged 70 to 79 had the highest rate of readmission (1.47%). Geographic regions of practice had significantly different complication and reoperation rates (<i>P</i> < .01). The rate of deep venous thrombus was 0.57%, and the rate of pulmonary embolism was 0.12%. Forty-two patients died, for an overall 0.03% mortality rate.</p><p><strong>Conclusion: </strong>The overall rate of self-reported complications was 7.53%, and the 90-day rate of unexpected reoperation and unexpected readmission was 1.16% and 0.91%, respectively. Patient sex, patient age, sports medicine fellowship training status, and geographic region of practice all affected rates of complications, reoperations, and readmissions. Knee arthroscopy carries many risks of which patients should be aware before undergoing these procedures.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1085-1092"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484705","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":"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":"1210-1215"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","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":"Restriction of Posterior Tibial Translation During the Posterior Drawer Test in Internal or External Rotation Is Dependent on Peripheral Stabilizers of the Knee: A Biomechanical Robotic Investigation.","authors":"Adrian Deichsel, Christian Peez, Wenke Liu, Michael J Raschke, Alina Albert, Thorben Briese, Elmar Herbst, Christoph Kittl","doi":"10.1177/03635465251317209","DOIUrl":"10.1177/03635465251317209","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The posteromedial and posterolateral structures of the knee have previously been shown to be secondary restraints to posterior tibial translation (PTT). The effect of these structures may increase when performing the posterior drawer test in internal or external rotation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose/hypothesis: &lt;/strong&gt;The purpose was to investigate the influence of the posteromedial and posterolateral structures on restricting PTT in neutral, external, and internal rotation. It was hypothesized that the posteromedial structures restrict PTT in internal rotation, while the posterolateral structures restrict PTT in external rotation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Controlled laboratory study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A sequential cutting study was performed on 24 fresh-frozen human knee specimens utilizing a 6 degrees of freedom robotic test setup. After determining the native knee kinematics from 0° to 90° of knee flexion, an 89-N posterior drawer test in neutral, internal, and external rotation was performed at 0°, 30°, 60°, and 90° of knee flexion. In 8 knees, a motion-controlled protocol was applied, replicating the native motion while the force was measured. The reduction of the restraining force represented the percentage contribution of each cut. In 16 knees, a force-controlled protocol was applied, determining the increase in PTT after each cut. After calculating the native knee kinematics, the posterior cruciate ligament (PCL) was cut, followed by randomized sectioning of the posteromedial (medial collateral ligament, posterior oblique ligament) and posterolateral (lateral collateral ligament, popliteus complex) structures. Mixed linear models with the post hoc Dunn test were used for statistical analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;During motion-controlled testing, performing the posterior drawer test in internal or external rotation significantly decreased the contribution of the PCL in restraining PTT. The PCL was the primary restraint to PTT during the posterior drawer test in neutral rotation at all flexion angles (24.4%-61.2% contribution). The primary restraint to PTT during the posterior drawer test in internal rotation was the posterior oblique ligament at 0° (24.2% ± 14.1%), the medial collateral ligament at 30° (33.6% ± 11.4%), and the PCL at 60° and 90° (46.2%-57.8%). In external rotation, the primary restraint was the lateral collateral ligament at 0° (24.7% ± 10.5%) and the popliteus complex at 30° to 90° (56.4%-65.2%). During force-controlled testing, PTT in the PCL-deficient knee was significantly decreased when performing the posterior drawer test in internal or external rotation. Insufficiency of the posterolateral or posteromedial structures, in addition to insufficiency of the PCL, during the posterior drawer test in neutral rotation led to an additional significant increase in PTT of up to 7.6 mm (95% confidence interval [CI], 3.6-11.7). Insufficiency of the posterolateral ","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1077-1084"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460814","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}