American Journal of Sports Medicine最新文献

{"title":"Arthroscopy Is at Least as Effective as Arthrotomy for Treatment of Septic Arthritis in Adults: A Systematic Review of Large and Intermediate Joints.","authors":"Brandon M Nudelman, Amit S Piple, Richard D Ferkel","doi":"10.1177/03635465241285878","DOIUrl":"10.1177/03635465241285878","url":null,"abstract":"<p><strong>Background: </strong>Surgical options for septic arthritis include open arthrotomy or an arthroscopic procedure. The optimal surgical technique remains a matter of debate as acceptable results have been reported for both.</p><p><strong>Purpose: </strong>To evaluate the efficacy of arthroscopy versus arthrotomy for the treatment of septic arthritis in large and intermediate-sized joints.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 3.</p><p><strong>Methods: </strong>A literature search was performed of the PubMed and Cochrane online databases through September 2023 identifying articles comparing arthroscopy with arthrotomy for the treatment of septic arthritis. Eligible articles included retrospective or prospective comparative studies investigating reoperation, perioperative complications, or clinical outcomes after arthroscopic or open treatment for septic arthritis of the shoulder, elbow, wrist, hip, knee, or ankle in adults.</p><p><strong>Results: </strong>In total, 23 articles with 34,248 patients met the inclusion criteria comparing arthroscopy with arthrotomy. In 14 of the 20 (70%) studies that reported on reoperation rates, there was no significant difference in arthroscopic versus open surgical management for septic arthritis. Four (20%) studies reported lower reoperation rates when arthroscopy was utilized compared with open arthrotomy. One single-institution study found arthrotomy to be more effective for shoulder septic arthritis, and another favored open surgery only in the presence of erosions. In 11 of 23 (47.8%) studies, no difference in complications or clinical outcomes was found. However, 11 of 23 (47.8%) studies comprising the shoulder, wrist, hip, knee, and ankle reported a significant benefit to arthroscopy for improved outcomes.</p><p><strong>Conclusion: </strong>Arthroscopic surgery for the treatment of septic arthritis involving the shoulder, wrist, hip, knee, and ankle appears to be safe and effective. Reoperation rates, short-term complications, and functional outcomes tend to be similar or in favor of arthroscopy when compared with arthrotomy.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2007-2012"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967387","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":"Best-Fit Circle Missing Area Method Shows Good Accuracy and Interrater Reliability When Assessing Glenoid Bone Loss.","authors":"Cortez L Brown, Clarissa M LeVasseur, Devon Scott, Jonathan D Hughes, Albert Lin, William J Anderst","doi":"10.1177/03635465251346838","DOIUrl":"10.1177/03635465251346838","url":null,"abstract":"<p><strong>Background: </strong>The amount of glenoid bone loss (GBL) in anterior shoulder instability helps determine management options. Unfortunately, there is no consensus on how to accurately measure GBL.</p><p><strong>Hypothesis: </strong>The best-fit circle missing area method has better accuracy and interrater reliability than the ratio and diameter methods.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Three-dimensional computed tomography shoulder scans were collected and segmented on 4 healthy male participants (mean age, 22.5 ± 3.4 years). For each scapula, 5 GBL models were created with known levels of GBL (5%-30%) in the anteroinferior glenoid rim. Ground-truth GBL was determined using the glenoid fossa edge and best-fit circle of the anteroinferior edge. Six blinded reviewers with varying expertise measured GBL for 20 randomized models using 3 different best-fit circle methods (missing area, ratio, and diameter). Accuracy was assessed by root mean square error and obtained by comparing measured and ground truth for bone loss for each model. Interrater reliability was assessed using intraclass correlation coefficients (ICCs) with a 2-way random-effects model with consistency.</p><p><strong>Results: </strong>On average, the missing area method overestimated GBL by 1%, while the ratio method and diameter method overestimated GBL by 2.4% and 6.3%, respectively. The interrater reliabilities of the missing area (ICC, 0.89), ratio (ICC, 0.91), and diameter (ICC, 0.90) methods were good, excellent, and good, respectively. For all reviewers, the overall root mean square error of the missing area method (3.6%) was better than that of the ratio (5%) and diameter (7.9%) methods. When stratifying reviewer accuracy by level of training, the missing area method remained superior at all levels when compared with the ratio and diameter methods (attending [3.1% vs 3.8% and 8.9%], fellow [4.2% vs 6.3% and 8.4%], and resident [3.5% vs 4.6% and 6.3%]).</p><p><strong>Conclusion: </strong>The best-fit circle missing area method was reliable and more accurate at measuring GBL than the other methods. This held true at all levels of surgical experience (resident, fellow, and attending).</p><p><strong>Clinical relevance: </strong>The best-fit circle missing area method is accurate, has good reliability, and is simple. This can enhance preoperative planning for shoulder surgeons.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2060-2065"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276785","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":"Magnetic Resonance Imaging Characteristics of the Iliocapsularis in Hip Microinstability: A Comparative Analysis.","authors":"Yazdan Raji, Kinsley J Pierre, Sagar Wagle, Nicole S Pham, Robert D Boutin, Marc R Safran","doi":"10.1177/03635465251344600","DOIUrl":"10.1177/03635465251344600","url":null,"abstract":"<p><strong>Background: </strong>Iliocapsularis (IC) muscle hypertrophy in borderline developmental dysplasia of the hip (BDDH) and developmental dysplasia of the hip (DDH) suggests a possible role as a dynamic hip stabilizer. However, its significance in hip microinstability (MI) without acetabular undercoverage remains unclear.</p><p><strong>Purpose: </strong>To compare IC muscle dimensions and fatty infiltration between patients with MI, BDDH, and mixed-type femoroacetabular impingement (mFAI), and assess the association between IC muscle morphology and hip pathology.</p><p><strong>Study design: </strong>Case-control study; Level of evidence, 4.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients undergoing arthroscopic surgery for hip pathology between January 2014 and December 2022. Patients were categorized based on lateral center-edge angle (LCEA) into BDDH (18° to <25°), MI (25° to 39°), and mFAI (>39°) groups. Preoperative radiographs and magnetic resonance imaging (MRI) scans were reviewed, and IC muscle dimensions, including width, depth, cross-sectional area (CSA), IC fatty infiltration, and combined IC and iliopsoas (IP) (IC+IP) CSA, were measured by 3 independent observers. A priori power analysis was performed. Statistical analyses included parametric and nonparametric comparative tests, interobserver correlation coefficients, and receiver operating characteristic analysis.</p><p><strong>Results: </strong>A total of 95 hips were included in this study. IC depth, width, and CSA and IC+IP CSA were significantly smaller in the MI group (<i>P</i> < .05 for all). Interobserver agreement was good to excellent for IC width (IRC, 0.87), IC CSA (IRC, 0.87), and IC+IP CSA (IRC, 0.96), but poor for IC depth (IRC, 0.26). The alpha angle did not significantly differ among groups (<i>P</i> = .093). The MI group had a higher proportion of female patients (<i>P</i> = .003). No significant differences were noted in radiographic markers, including the ischial spine sign (<i>P</i> = .083), crossover sign (<i>P</i> = .130), and posterior wall sign (<i>P</i> = .41).</p><p><strong>Conclusion: </strong>No detectable IC hypertrophy was observed in the MI group compared with the BDDH and mFAI groups, with patients with MI showing smaller IC width, depth, and CSA. The study offers a reproducible measurement technique with good interobserver agreement. IC muscle mass has limited prognostic value in predicting hip MI.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2181-2188"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276787","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":"Return to Work, Sport, and Sport- Related Activity After Distal Triceps Tendon Repair: A Systematic Review.","authors":"William L Johns, Benjamin H Miltenberg, Anthony N Baumann, Nazanin Kermanshahi, Rahul R Muchintala, Steven B Cohen","doi":"10.1177/03635465241283970","DOIUrl":"10.1177/03635465241283970","url":null,"abstract":"<p><strong>Background: </strong>Distal triceps tendon injuries are relatively rare injuries, often occurring in highly active patients with physically demanding jobs or lifestyles. Information on return to work, sport, and activity is essential for patient education and counseling after a distal triceps tendon rupture.</p><p><strong>Purpose: </strong>To determine the rates of return to work, sport, and sport-related activity after distal triceps tendon repair.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 4.</p><p><strong>Methods: </strong>PubMed, CINAHL, MEDLINE, Web of Science, and SPORTDiscus were queried from the earliest record through January 12, 2024. Articles were included if they examined return to various activities (exercise, sport, work, or military duty) after distal triceps tendon repair. Data on return to sport/work/activity were collected as well as information on patient satisfaction, pre-existing medical history or medication use (ie, anabolic steroids or corticosteroids), and complications. Article quality was assessed via the Methodological Index for Non-Randomized Studies (MINORS) scale.</p><p><strong>Results: </strong>Of 164 articles initially retrieved, 10 retrospective studies were included. Patients (n = 318; 74.2% male, 25.8% female) who underwent distal triceps tendon repair had a mean age of 44.7 ± 5.5 years with a mean follow-up time of 52.6 ± 21.4 months. After distal triceps tendon repair, 93.3% of patients (112/120) returned to sport, 95.3% (81/85) returned to military duty, and 92.6% (100/108) returned to work. Of the studies that evaluated satisfaction, the majority of patients reported high satisfaction after surgery. The overall complication rate (ranging from persistent pain and wound complications to nerve injuries and reruptures) after distal triceps tendon repair was 18.0%, the rerupture rate (complete and partial) was 7.2%, and the reoperation rate was 3.9%, with all partial reruptures undergoing nonoperative care.</p><p><strong>Conclusion: </strong>A distal triceps tendon rupture is a rare but potentially challenging injury, traditionally occurring in an active population, and often requires surgical repair. Importantly, >90% of an active-duty military population, athletes, and the general workforce was able to return to sport or their respective activity after surgery. Furthermore, there was high patient satisfaction and low rates of complications and reoperations after distal triceps tendon repair.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2240-2247"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparable Mid- to Long-term Outcomes of Semitendinosus and Semitendinosus/Gracilis Grafts in ACL Reconstruction: Median 8-Year (Range, 5-10 Years) Results From a Randomized Controlled Study.","authors":"Ingunn Fleten Mo, Thomas Harlem, Anne Gro Heyn Faleide, Torbjørn Strand, Søren Vindfeld, Eirik Solheim, Per Henrik Randsborg, Eivind Inderhaug","doi":"10.1177/03635465251344106","DOIUrl":"10.1177/03635465251344106","url":null,"abstract":"<p><strong>Background: </strong>The hamstring tendon autograft used for anterior cruciate ligament reconstruction commonly entails both the semitendinosus and gracilis (ST/G) tendons for sufficient graft thickness, but they may impair function. To mitigate this, a tendon-sparing ST-only graft has been explored. However, less is known of the mid- to long-term outcomes comparing these configurations.</p><p><strong>Purpose/hypothesis: </strong>The purpose was to investigate differences between the quadrupled ST tendon graft and the doubled ST/G graft configuration. The primary hypothesis was that there would be no difference in the International Knee Documentation Committee 2000 Subjective Knee Form (IKDC-SF) outcomes between groups. The secondary hypothesis was that there would be no differences in knee flexion strength, KT-1000 arthrometer side-to-side measurements, or need for secondary surgery (including revision) between the 2 techniques.</p><p><strong>Study design: </strong>Randomized controlled trial; Level of evidence, 1.</p><p><strong>Methods: </strong>At baseline, 98 patients were randomized to receive either the quadrupled ST tendon graft or the doubled ST/G graft configuration. Preoperatively and after 2 and median 8 years (range, 5-10 years) postoperatively, the investigators collected results for the IKDC-SF, Knee injury and Osteoarthritis Outcome Score, Tegner Activity Scale, a sports and activity participation questionnaire, knee laxity (KT-1000 arthrometer) side-to-side measurements, Lachman test, and flexion rotation drawer test. Need for secondary knee surgery was evaluated 5 to 10 years postoperatively.</p><p><strong>Results: </strong>Seventy-seven patients completed median 8-year follow-up (range, 5-10 years): 38 patients in the ST group and 39 patients in the ST/G group. No statistically significant differences were observed between the ST and ST/G groups in IKDC-SF scores (81.7 vs 82.1; <i>P</i> = .93), knee stability, or revision rates. Both groups demonstrated statistically significant improvements in self-reported function (<i>P</i> < .001) until final follow-up. The overall anterior cruciate ligament revision rate was 10.4%, and no increased risk of graft failure or excessive residual laxity was associated with the ST-only graft.</p><p><strong>Conclusion: </strong>No statistically significant differences were found between the ST group and the ST/G group in terms self-reported function, knee laxity, or need for secondary surgery at median 8 years (range, 5-10 years) after surgery. The ST-only graft configuration did not increase the risk of graft failure or excessive residual laxity compared with the ST/G graft configuration.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2145-2153"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236002","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 Reverse Total Shoulder Arthroplasty After Failed Rotator Cuff Repair, Superior Capsular Reconstruction, and Tendon Transfer.","authors":"Rodrigo Saad Berreta, Juan Bernardo Villarreal-Espinosa, William Harkin, Jared Rubin, Cadence Lee, Stephanie Boden, Salvador Ayala, Johnathon P Scanaliato, Grant E Garrigues, Brian J Cole, Gregory P Nicholson, Nikhil N Verma","doi":"10.1177/03635465251346163","DOIUrl":"10.1177/03635465251346163","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is limited evidence describing the effect of failed rotator cuff repair (RCR), superior capsular reconstruction (SCR), or tendon transfer (TT) before reverse total shoulder arthroplasty (RTSA) on postoperative outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;(1) To compare patient-reported outcome measure scores, range of motion, and complication rates in patients with previous ipsilateral shoulder surgery to those without previous surgery undergoing RTSA and (2) to compare the outcomes of patients with failed SCR or TT to those with failed RCR.&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;Patients who underwent RTSA from 2016 to 2021 were retrospectively identified through an institutional database. Patients who underwent RTSA after failed RCR, SCR, or TT (prior surgery [PS] group) were matched by age, sex, body mass index, and concomitant latissimus dorsi TT to patients who underwent RTSA for rotator cuff arthropathy with no prior surgery (NPS group). Primary outcome measures included rates of achieving the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and Patient Acceptable Symptom State (PASS) for the American Shoulder and Elbow Surgeons (ASES) score and Single Assessment Numeric Evaluation (SANE). Secondary outcome measures included Veterans RAND 12-Item Health Survey scores, complication rates, and postoperative range of motion. A subanalysis compared outcomes in patients with prior failed RCR to patients with prior failed SCR or TT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 150 patients (PS: n = 60; NPS: n = 90) met inclusion criteria. The PS group consisted of 33 cases (55.0%) of primary RCR, 10 cases (16.7%) of revision RCR, 10 cases (16.7%) of SCR, and 7 cases (11.7%) of TT. Adjusted analysis showed that the NPS group had higher rates of achieving the MCID (93.3% vs 73.3%, respectively; &lt;i&gt;P&lt;/i&gt; = .007), SCB (88.3% vs 56.7%, respectively; &lt;i&gt;P&lt;/i&gt; &lt; .001), and PASS (73.3% vs 26.7%, respectively; &lt;i&gt;P&lt;/i&gt; &lt; .001) for the ASES and higher rates of achieving the SCB (56.7% vs 20.0%, respectively; &lt;i&gt;P&lt;/i&gt; &lt; .001) and PASS (76.7% vs 35.0%, respectively; &lt;i&gt;P&lt;/i&gt; &lt; .001) for the SANE. The NPS group had greater forward flexion (&lt;i&gt;P&lt;/i&gt; &lt; .001) at final follow-up. The PS group had higher rates of overall complications (30.0% vs 13.3%, respectively; &lt;i&gt;P&lt;/i&gt; = .022) and prosthetic instability or dislocations (10.0% vs 1.1%, respectively; &lt;i&gt;P&lt;/i&gt; = .033). Subanalysis showed that the SCR/TT subgroup had significantly lower rates of achieving the SCB (ASES: &lt;i&gt;P&lt;/i&gt; = .004; SANE: &lt;i&gt;P&lt;/i&gt; = .034) and PASS (ASES: &lt;i&gt;P&lt;/i&gt; = .014; SANE: &lt;i&gt;P&lt;/i&gt; = .009) compared with the RCR subgroup.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Patients with a history of failed RCR, SCR, or TT to address rotator cuff insufficiency before RTSA had greater range of motion deficits, higher complication rates, and lower rates of achieving clinically ","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2084-2093"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276789","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":"Return to Preoperative Level of Sporting Function after Surgical Repair of the Pyramidalis-Anterior Pubic Ligament-Adductor Longus Complex in Professional Athletes.","authors":"Fahima A Begum, Babar Kayani, Shwan Ali Ahmad, Andreas Fontalis, Ricci Plastow, Fares S Haddad","doi":"10.1177/03635465251342117","DOIUrl":"10.1177/03635465251342117","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The outcomes of surgical repair for traumatic avulsions of the pyramidalis, anterior pubic ligament, adductor longus complex (PLAC) remain unknown.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To report how surgical repair for PLAC injuries in professional athletes affected return to preinjury level of sporting activity, injury recurrence, patient satisfaction, functional performance, and complications.&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 retrospective, single-surgeon study included 62 professional athletes. Inclusion criteria for study participation were professional athletes, primary injury within 28 days of surgical intervention, magnetic resonance imaging scan confirming complete avulsion of the proximal adductor longus tendon fibrocartilaginous entheses, patient symptomatic with groin pain and adductor weakness, and surgical intervention undertaken by the senior author. Exclusion criteria were chronic and recurrent adductor injuries; concomitant chronic conditions including osteoarthritis, inguinal hernia, and chronic groin pain; and patient living abroad or not available for follow-up. All study participants underwent surgical repair with suture anchor fixation. A standard rehabilitation protocol was followed postoperatively. The Lower Extremity Functional Scale (LEFS), Marx Activity Rating Scale (MARS), patient satisfaction levels, and time to return to previous level of sport were the primary outcome measures used in this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The mean follow-up time was 4.2 years (range, 2.1-8.1 years) from the date of surgery. The study included 62 professional athletes (52 male, 10 female) with a mean age of 27.2 years (range, 18-36 years) with acute traumatic avulsions of the proximal adductor longus tendon involving the PLAC: type I, 28 patients (45.2%); type II, 24 patients (38.7%); type III, 2 patients (3.3%); type IV, 2 patients (3.3%); type V, 6 patients (9.7%); and type VI, 0 patients (0%). All 62 patients (100%) returned to their preinjury level of sporting activity. The specific level of each sport at which the individuals were performing was not recorded; however, all participants were professional athletes who returned to professional play. The mean time from surgical intervention to return to full sporting activity was 12.3 ± 2.2 weeks (range, 9-18 weeks) with no injury recurrence at 2 years after surgery. Overall, 46 patients (74.2%) were highly satisfied and 16 patients (25.8%) were satisfied with the outcomes of their surgery. Improvements were observed in the mean LEFS (from 49.7 ± 5.2 points preoperatively to 80.2 ± 4.2 points at 2-year follow-up; &lt;i&gt;P&lt;/i&gt; &lt; .001). In addition, 48 patients (77.4%) had a LEFS of 75 points, and 12 patients (19.4%) achieved the maximum LEFS score of 80 points at 2-year follow-up. Improvements were also seen in MARS scores (from 3.1 ± 1.2 points preoperatively to 12.8 ± 1.8 points a","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1878-1884"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144180466","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 Effect of Previous Lumbar Spine Surgery on Primary Hip Arthroscopic Surgery: A Minimum 5-Year Follow-up.","authors":"Roger Quesada-Jimenez, Andrew R Schab, Ady H Kahana-Rojkind, Elizabeth G Walsh, Benjamin G Domb","doi":"10.1177/03635465251345833","DOIUrl":"10.1177/03635465251345833","url":null,"abstract":"<p><strong>Background: </strong>Previous lumbar spine surgery (LSS) may restrict spinal mobility, impacting pelvic mechanics and potentially increasing hip motion demands.</p><p><strong>Purpose: </strong>To evaluate the effect of previous LSS on the outcomes of primary hip arthroscopic surgery at a minimum 5-year follow-up.</p><p><strong>Study design: </strong>Case control; Level of evidence, 4.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on patients who underwent hip arthroscopic surgery with previous LSS. Patients had completed a minimum of 5-year follow-up. A subanalysis based on the type of LSS was also conducted. Patients were matched to a control group that underwent hip arthroscopic surgery without previous LSS in a 1:3 ratio based on age at surgery, sex, acetabular Outerbridge grade, and body mass index. Comparisons of patient-reported outcome (PRO) scores, clinically relevant outcome thresholds, complications, revision hip arthroscopic surgery, and conversion to total hip arthroplasty (THA) were performed.</p><p><strong>Results: </strong>A total of 424 hips were included in the study: 106 hips with previous LSS and 318 control hips. Patients with previous LSS displayed improvements across all PRO measures. There were no differences in improvements in PRO scores or the percentage of patients reaching clinically relevant outcome thresholds based on the type of LSS. Compared with the control group, the LSS group started with significantly lower preoperative PRO scores. Yet, both groups experienced equivalent improvements in all PRO scores. Furthermore, the LSS group had worse postoperative scores for all PRO measures. Additionally, the LSS group reached the Patient Acceptable Symptom State at significantly lower rates for the mHHS (modified Harris Hip Score), NAHS (Non-Arthritic Hip Score), and HOS-SSS (Hip Outcome Score-Sports-Specific Subscale). There was no difference in the rates of complications and secondary surgery, but the LSS group converted to THA sooner, with the LSS and control groups converting to THA at 27.43 ± 24.32 and 48.02 ± 37.61 months, respectively (<i>P</i> < .05).</p><p><strong>Conclusion: </strong>Hip arthroscopic surgery for the treatment of femoroacetabular impingement and labral tears in patients with previous LSS yielded significant improvements at midterm follow-up, which were equivalent to those of a matched control group with no history of lumbar abnormalities. However, the LSS group had lower postoperative PRO scores and met the Patient Acceptable Symptom State for PRO measures at lower rates. Importantly, LSS did not influence the risk of revision arthroscopic surgery and conversion to THA. However, the LSS group converted to THA sooner than the control group.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2231-2239"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276790","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":"Proinflammatory Synovial Fluid Biomarkers Predict Poor Long-term Outcomes in Chronic Meniscal Injuries.","authors":"Emily Berzolla, Vishal Sundaram, Mark Pianka, Daniel J Kaplan, Thorsten Kirsch, Eric Strauss","doi":"10.1177/03635465251343306","DOIUrl":"10.1177/03635465251343306","url":null,"abstract":"<p><strong>Background: </strong>Synovial fluid (SF) biomarkers demonstrate time-dependent variation after acute knee injury, and it is postulated that persistently elevated inflammatory markers may mediate worse long-term outcomes.</p><p><strong>Purpose: </strong>This study investigated the relationship between biomarkers in SF at the time of meniscectomy and long-term patient-reported outcomes in patients with acute versus chronic meniscal injuries.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>This retrospective analysis included patients who underwent knee SF aspiration on the day of arthroscopic meniscectomy between October 2011 and October 2020 with minimum 4-year follow-up. SF aspirated from the operative knee was analyzed for 10 pro- and anti-inflammatory biomarkers. Patients completed the visual analog scale for pain, Lysholm Knee Questionnaire, Tegner Activity Scale, and Knee injury and Osteoarthritis Outcome Score-Physical Function Short-form (KOOS-PS) before surgery and at follow-up. Patients were categorized as having acute (<6 weeks) or chronic (>1 year) symptoms. K-means clustering analysis was performed using biomarker levels to group patients into distinct cohorts.</p><p><strong>Results: </strong>Of 85 patients meeting inclusion criteria, 55 had chronic and 30 had acute meniscal pathology, with 62 (72.9%) completing patient-reported outcome surveys at a mean follow-up of 8.66 years (SD, 2.27). K-means clustering identified 2 distinct biomarker profiles: a high-inflammation cluster and a low-inflammation cluster. The high-inflammation cluster had higher levels of 7 proinflammatory biomarkers as compared with the low-inflammation cluster (<i>P</i> = .015). The low-inflammation cluster predominantly comprised chronic meniscal injuries (89.2%), whereas the high-inflammation cluster was divided between acute and chronic cases. There were no differences in postoperative outcomes between clusters in the overall cohort. However, within the chronic cohort, the high-inflammation cluster exhibited worse postoperative scores on the visual analog scale for pain (<i>P</i> = .035), Lysholm questionnaire (<i>P</i> = .007), KOOS-PS (<i>P</i> = .038), and Tegner scale (<i>P</i> = .049) and had a higher rate of postoperative injections (<i>P</i> = .020) than the low-inflammation cohort.</p><p><strong>Conclusion: </strong>In patients with chronic meniscal injury, those with a more proinflammatory SF biomarker profile at the time of meniscectomy had worse outcomes than those who had a low inflammatory profile. In acute meniscal injuries, most patients demonstrate a high inflammatory profile, which was not associated with a difference in long-term outcomes.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1960-1968"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144200862","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":"Risk Factors for Subchondral Insufficiency Fracture of the Knee in the Setting of Medial Meniscus Posterior Root Tear.","authors":"Jose Rafael Garcia, Stephanie A Boden, Zeeshan A Khan, Myles A Atkins, Felicitas Allende, Michael J Murray, Trevor A Poulson, Michael Ralls, Adam B Yanke, Brian J Cole, Nikhil N Verma, Jorge Chahla","doi":"10.1177/03635465251346952","DOIUrl":"10.1177/03635465251346952","url":null,"abstract":"<p><strong>Background: </strong>Subchondral insufficiency fracture of the knee (SIFK) is commonly associated with medial meniscus posterior root tears (MMPRTs). However, there is limited research investigating risk factors for SIFK in patients with MMPRTs.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this investigation was to identify the risk factors for SIFK in patients with MMPRTs. It was hypothesized that age, body mass index, and extent of meniscal extrusion would emerge as significant risk factors for SIFK.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>Patients with a primary isolated MMPRT confirmed via magnetic resonance imaging were included. Data on patient demographics, medical and surgical history, and imaging parameters were assessed for associations with SIFK. Imaging parameters included mechanical axis, medial tibial slope, tibiofemoral joint space, and meniscal extrusion. Patients were identified and divided into 2 groups based on the presence or absence of findings of SIFK on magnetic resonance imaging. Continuous variable distribution normality was assessed using the Shapiro-Wilk test. Demographic comparisons were made by <i>t</i> tests and chi-square tests. Multivariable logistic regression was used to identify SIFK risk factors. The threshold of joint space for predicting SIFK was determined through receiver operating characteristic analysis. The optimal threshold was determined with the Youden index.</p><p><strong>Results: </strong>A total of 153 patients were included (mean ± SD age, 56.2 ± 9.1 years): 90 patients (26 male, 64 female) in the non-SIFK group and 63 patients (16 male, 47 female) in the SIFK group. There were no differences in patient demographics between the cohorts. Patients with SIFK had a greater incidence of previous knee injections (<i>P</i> = .047), a significantly smaller tibiofemoral joint space (<i>P</i> < .001), and a significantly greater degree of meniscal extrusion (<i>P</i> = .041). Multivariable logistic regression analysis identified diminished joint space as the only independent predictor of SIFK (odds ratio, 0.41; <i>P</i> = .017). Receiver operating characteristic analysis determined a predictive threshold for joint space <3.93 mm, yielding an acceptable area under the curve of 0.766.</p><p><strong>Conclusion: </strong>The development of SIFK is likely multifactorial; however, decreased tibiofemoral joint space is a significant independent risk factor for SIFK in patients with MMPRTs, with a greater risk in patients with a tibiofemoral joint space <3.93 mm.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"2118-2127"},"PeriodicalIF":4.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236005","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}