American Journal of Sports Medicine最新文献

{"title":"Comparison of Interportal and Periportal Capsulotomies and Axial Distraction Resistance During Hip Arthroscopy: An In Vivo Propensity-Matched Cohort Study.","authors":"Joseph Featherall, Allan K Metz, Reece M Rosenthal, Ameen Z Khalil, Benjamin T Johnson, Devin L Froerer, Alexander J Mortensen, Stephen K Aoki","doi":"10.1177/03635465241311197","DOIUrl":"10.1177/03635465241311197","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative hip capsule management is increasingly recognized as an important component of hip arthroscopy for the prevention of capsular-related instability. The periportal capsulotomy, relative to the interportal capsulotomy, has been proposed as a minimally invasive technique for decreasing postarthroscopy hip instability; however, the biomechanical effects of this technique are not well established.</p><p><strong>Purpose/hypothesis: </strong>This study aimed to provide a biomechanical characterization of interportal and periportal capsulotomies, helping inform surgeon choice of capsulotomy type and repair, potentially guiding clinical practice in hip arthroscopy. The authors hypothesized that the periportal capsulotomy would demonstrate greater resistance to axial distraction in all capsular states.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients undergoing primary hip arthroscopy by a single surgeon underwent intraoperative axial distraction testing at 25-, 50-, 75-, and 100-pound force intervals, with each axial distraction distance measured by standardized fluoroscopic evaluation. Propensity matching was conducted between the periportal group and the interportal group using native state distraction, lateral center-edge angle, and sex as covariates to achieve balance between groups. Between-group comparisons of distraction distances were then conducted using the Student <i>t</i> test and Fisher exact test.</p><p><strong>Results: </strong>In total, 74 interportal capsulotomies and 124 periportal capsulotomies were identified. Propensity matching yielded 74 hips in each group. Demographic and radiographic characteristics were similar between matched cohorts (<i>P</i> > .05). An unrepaired interportal capsulotomy led to an increase in hip distraction of 2.74 mm at 100 lbf (<i>P</i> < .001) compared with the native state, whereas unrepaired periportal capsulotomy led to an increase of 2.43 mm at 100 lbf (<i>P</i> < .001). Distraction distances were similar between the interportal and periportal groups in both the capsulotomy and repair states (<i>P</i> > .05), while the periportal capsulotomy repair demonstrated decreased hip distraction distance when compared with the native state by 1.37 mm at 75 lbf and 1.45 mm at 100 lbf (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>In a propensity-matched cohort analysis, an unrepaired periportal capsulotomy and interportal capsulotomy have similar effects on increasing hip axial distraction distance intraoperatively. Performing a capsular repair restores intraoperative resistance to axial distraction in both procedures. Despite the minimal disruption of the capsule with periportal techniques, repair is required for restoration of native biomechanics.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"699-707"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043487","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 Prevalence of Tear Patterns and Their Effects on Tendon Healing After Arthroscopic Surgery in Patients With Full-Thickness Rotator Cuff Tears.","authors":"Sang-Jin Shin, Sanghyeon Lee","doi":"10.1177/03635465241311593","DOIUrl":"10.1177/03635465241311593","url":null,"abstract":"<p><strong>Background: </strong>To achieve successful anatomic rotator cuff repair with minimal tension, both the tear pattern and tear size should be considered. However, little information is available concerning the frequency of tear patterns and their effects on tendon healing.</p><p><strong>Purpose: </strong>To evaluate the distribution of tear patterns in full-thickness rotator cuff tears and whether these patterns affect tendon healing after arthroscopic repair.</p><p><strong>Study design: </strong>Case-control study; Level of evidence, 3.</p><p><strong>Methods: </strong>Between 2014 and 2021, patients who underwent arthroscopic surgery for symptomatic full-thickness rotator cuff tears with a minimum 2-year follow-up with postoperative magnetic resonance imaging or ultrasound were retrospectively reviewed. After the debridement of degenerative tendon tissue during arthroscopic surgery, the tear pattern was classified as crescent, U, or anterior or posterior L shaped. Intergroup differences in clinical and radiological characteristics were analyzed. In the subgroup analysis, patients were divided into 2 subgroups: small-to-medium or large-to-massive tears.</p><p><strong>Results: </strong>Among the 1037 patients with a full-thickness rotator cuff tear, the most common tear pattern was crescent shaped (39.6%), followed by posterior L, U, and anterior L shaped (26.0%, 21.4%, and 12.9%, respectively). In the subgroup analysis, 713 patients (68.8%) had small-to-medium tears, while 324 (31.2%) had large-to-massive tears. The proportion of large-to-massive tears was significantly higher for the anterior L-shaped tear pattern than for the other tear patterns (24.8%, 28.8%, 52.2%, and 32.6% for crescent, U, and anterior and posterior L shaped, respectively; <i>P</i> < .001). The anterior L-shaped tear pattern had a significantly higher retear rate than the other tear patterns in small-to-medium tears (7.8%, 13.0%, 28.0%, and 10.6% for crescent, U, and anterior and posterior L shaped, respectively; <i>P</i> < .001). The rate of revision surgery because of a symptomatic retear within 2 years after primary surgery was significantly higher for the anterior L-shaped tear pattern than for the other tear patterns (3.8%, 7.5%, 21.6%, and 0.0% for crescent, U, and anterior and posterior L shaped, respectively; <i>P</i> = .002).</p><p><strong>Conclusion: </strong>The prevalence of tear patterns varied depending on the tear size. In small-to-medium tears, the anterior L-shaped tear pattern had the lowest incidence among the tear patterns; however, it had a significantly higher retear rate. Furthermore, the anterior L-shaped tear pattern had a higher incidence of retears requiring early revision surgery than the other tear patterns.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"583-591"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030317","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":"Successful Medial Meniscal Repair Reduces Knee Pain 10 Years After Anterior Cruciate Ligament Reconstruction: Exploring the Consequences of Subsequent Surgery With Causal Mediation Analysis in the MOON Cohort.","authors":"Andrew J Sheean, Yuxuan Jin, Annunziato Amendola, Laura J Huston, Robert H Brophy, Charles L Cox, Morgan H Jones, Christopher C Kaeding, Michael W Kattan, Robert A Magnussen, Robert G Marx, Matthew J Matava, Eric C McCarty, Richard D Parker, Emily Reinke, Michelle L Wolcott, Brian R Wolf, Rick W Wright, Kurt P Spindler","doi":"10.1177/03635465251317742","DOIUrl":"10.1177/03635465251317742","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Medial meniscal repair performed at the time of primary anterior cruciate ligament reconstruction (ACLR) has been shown to be significantly associated with subsequent surgery, and subsequent surgery has been associated with increased Knee injury and Osteoarthritis Outcome Score (KOOS) pain score and decreased patient satisfaction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis/purpose: &lt;/strong&gt;The purpose was to determine if medial meniscal repair decreases KOOS pain 10 years after ACLR and to assess the consequences of subsequent surgery on the development of KOOS pain. The authors hypothesized that medial meniscal repair performed at the time of primary ACLR decreases the likelihood of developing KOOS pain. It was further hypothesized that surgery performed subsequent to medial meniscal repair and primary ACLR increases KOOS pain 10 years after ACLR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Cohort study; Level of evidence, 2.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Our inclusion criteria were all patients undergoing unilateral primary ACLR from 2002 to 2008 who were enrolled in the Multicenter Orthopaedic Outcomes Network without a history of medial or lateral meniscal surgery and contralateral ACLR. Causal mediation analysis using R software (Version 4.2.3) was employed to compare 2 effects on the development of significant knee pain, as represented by a KOOS pain score &lt;80, at 10-year follow-up: (1) medial meniscal repair for longitudinal tears &gt;10 mm in medial-to-lateral length and (2) medial meniscal excision at baseline of ACLR. A directed acyclic graph was constructed to provide a qualitative representation of the influence of known confounders that have been shown to affect the outcome of interest. Missing data were multiply imputed using multivariate imputation by chained equations. All tests were 2-sided, assuming a type I error rate of .05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 2387 participants (1074 female [45%]; 1313 male [55%]) were included in the final analysis. In 1502 (62.9%) cases, there was no medial meniscal tear reported. Of the 885 cases with medial meniscal tears, no treatment was performed in 109 (12.4%), meniscal excision was performed in 396 (44.7%), and meniscal repair was performed in 380 (42.9%). An overall 1825 of 2387 (76.5%) patients reported KOOS pain at 10-year follow-up: 252 (13.8%) had KOOS pain &lt;80 and 1573 had ≥80. In the KOOS pain &lt;80 group, 75 (29.8%) had subsequent surgery. In the KOOS pain ≥80 group, 223 (14.2%) had subsequent surgery. The step-by-step approach to causal mediation analysis demonstrated that a medial meniscal procedure (ie, no treatment for the tear, repair, or excision) significantly affected the likelihood of subsequent surgery (χ&lt;sup&gt;2&lt;/sup&gt; = 28.9; &lt;i&gt;P&lt;/i&gt; &lt; .001) and subsequent surgery significantly increased the likelihood of KOOS pain &lt;80 (χ&lt;sup&gt;2&lt;/sup&gt; = 17.3; &lt;i&gt;P&lt;/i&gt; &lt; .001). However, the direct effect of a successful medial meniscal repair without subsequent surgery decre","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"769-776"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411697","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 Concavity Restoration on Glenohumeral Stability in a Glenoid Bone Loss Model: Comparing Distal Tibial Allograft Reconstruction to Classic Latarjet.","authors":"Matthew S Fury, Carl M Cirino, Amirhossein Jahandar, Ryan C Rauck, Lawrence V Gulotta, David M Dines, Joshua S Dines, Theodore A Blaine, Michael C Fu, Russell F Warren, Andreas Kontaxis, Samuel A Taylor","doi":"10.1177/03635465251318337","DOIUrl":"10.1177/03635465251318337","url":null,"abstract":"<p><strong>Background: </strong>Distal tibial allograft (DTA) reconstruction for glenoid bone loss (GBL) has gained popularity. While recent studies have demonstrated that glenoid concavity is an important factor in native glenohumeral stability, there remains a paucity of data regarding concavity restoration during reconstructive procedures for GBL and its biomechanical effect.</p><p><strong>Purpose: </strong>To compare the restoration of anterior glenohumeral stability and glenoid concavity after DTA and classic Latarjet procedures.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Nine human cadaveric specimens (mean age, 62.2 years; range, 52-69 years) underwent pretesting computed tomography (CT) to assess native glenoid concavity as determined by the glenoid depth and bony shoulder stability ratio (BSSR). GBL was created so the DTA and Latarjet graft could restore 100% of the native glenoid width. The rotator cuff tendons were loaded, and anterior stability testing was performed using a KUKA robot to apply a controlled anterior force with the shoulder in 90° of abduction and neutral external rotation. A motion capture system recorded humeral head translation. The following conditions were tested: intact, soft tissue Bankart lesion; bone loss model with DTA reconstruction; classic Latarjet procedure without conjoint tendon loaded; and classic Latarjet procedure with conjoint tendon loaded (sling effect). All specimens underwent posttesting CT to measure the BSSR of the DTA and Latarjet reconstructions. A repeated-measures analysis of variance was performed to compare the BSSR and anterior translations between the DTA and Latarjet reconstructions.</p><p><strong>Results: </strong>DTA produced greater concavity than the Latarjet procedure (BSSR: 0.45 vs 0.35; <i>P</i> < .001). There was no difference in anterior translation between the DTA and Latarjet procedures with the sling effect (5.1 mm vs 4.7 mm; <i>P</i> > .999). However, maximum anterior translation was decreased after the DTA procedure when compared with the Latarjet technique without the sling effect (5.1 mm vs 10.3 mm; <i>P</i> = .045).</p><p><strong>Conclusion: </strong>DTA produces a more concave reconstruction and decreased anterior translation compared with the flatter reconstruction produced by the classic Latarjet procedure without the sling effect. DTA and the classic Latarjet procedure with conjoint tendon loading, however, yielded equivalent reductions in anterior translation.</p><p><strong>Clinical relevance: </strong>Distal tibial allograft reconstruction is a biomechanically equivalent alternative to the classic Latarjet due to the restoration of glenoid concavity in addition to glenoid width. Surgeons should consider the role of concavity when addressing glenohumeral instability with bone loss.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"928-934"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Structural Adaptations of the Shoulder and Elbow Are Correlated in Professional Baseball Pitchers.","authors":"Ryan W Paul, Alim Osman, Levon N Nazarian, Michael G Ciccotti, Steven B Cohen, Brandon J Erickson, Paul Buchheit, Joseph Rauch, Daryl C Osbahr, Stephen J Thomas","doi":"10.1177/03635465251317509","DOIUrl":"10.1177/03635465251317509","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Pitchers with deficits in total shoulder rotation range of motion (ROM) are 2.6 times more likely to experience an elbow injury. Despite the effects of shoulder ROM on elbow injury, it is currently unclear whether specific tissue adaptations of the shoulder relate to the tissue adaptations of the elbow in baseball pitchers.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose/hypothesis: &lt;/strong&gt;The purpose was to evaluate the relationship between chronic structural adaptations of the shoulder (humeral retroversion [HR], posterior capsule thickness [PCT], infraspinatus/teres minor pennation angle, and muscle thickness) and chronic structural adaptations of the elbow (ulnar collateral ligament [UCL] thickness, ulnohumeral joint laxity with valgus stress, and ulnar nerve cross-sectional area) in professional baseball pitchers. It was hypothesized that chronic adaptations of HR and PCT would relate to structural adaptations of the elbow.&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;Healthy minor league right-handed baseball pitchers from a single professional baseball organization were enrolled during 2022 preseason medical evaluations. Enrolled pitchers underwent bilateral shoulder ultrasound examination of HR, PCT, and posterior rotator cuff pennation angle and muscle thickness as well as bilateral elbow ultrasound examination of the ulnar nerve, UCL thickness, and ulnohumeral joint gapping using the Telos device. The difference in ulnohumeral joint gapping from stressed (150 N) to unstressed (ie, delta value) was calculated. Bilateral differences in every included measure were calculated and used for analysis to more closely isolate chronic adaptations. Multivariate stepwise regressions were performed to determine whether the chronic structural and clinical (strength and ROM) shoulder adaptations were related to structural adaptations of the elbow.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, 40 right-handed professional baseball pitchers with a mean age of 22 ± 3 years were included. A significant positive relationship was observed between preseason structural adaptations of UCL thickness and PCT (&lt;i&gt;R&lt;/i&gt; = 0.344; &lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.118; &lt;i&gt;P&lt;/i&gt; = .030) as well as between chronic structural adaptations of ulnar nerve cross-sectional area and teres minor muscle thickness (&lt;i&gt;R&lt;/i&gt; = 0.387; &lt;i&gt;R&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0.150; &lt;i&gt;P&lt;/i&gt; = .020). No statistically significant relationships were found between chronic structural adaptations of the shoulder and delta ulnohumeral joint gapping (all &lt;i&gt;P&lt;/i&gt; &gt; .05) or between chronic adaptations in clinical measures (strength and ROM) of the shoulder and chronic structural adaptations of the elbow (all &lt;i&gt;P&lt;/i&gt; &gt; .05).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Positive relationships between chronic adaptations of UCL thickness and PCT, as well as between ulnar nerve cross-sectional area and teres minor MT, were observed in asymptomatic minor lea","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"944-951"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384150","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":"Clinical Outcomes of Fully Arthroscopic Versus Arthroscopically Assisted Latissimus Dorsi Transfer for Irreparable Subscapularis Tear.","authors":"Bo Taek Kim, Luis Alfredo Miranda, Chang Hee Baek, Jung Gon Kim, Luis Leoncio Temoche Diaz, Gyu Rim Baek, Jean Kany","doi":"10.1177/03635465251314057","DOIUrl":"10.1177/03635465251314057","url":null,"abstract":"<p><strong>Background: </strong>Untreated chronic subscapularis (SSC) tears pose a challenging problem to treat owing to the resultant tendon retraction, atrophy, fatty infiltration, and changes in humeral head position, which complicate surgical options. Anterior latissimus dorsi (LD) transfer has shown effective results in treating these tears without glenohumeral arthritis.</p><p><strong>Purpose/hypothesis: </strong>This study introduces and evaluates fully arthroscopic and arthroscopically assisted anterior LD transfer techniques for reconstructing irreparable SSC tears. The authors hypothesize that both methods will yield promising and comparable clinical outcomes.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>This retrospective study reviewed patients who underwent anterior LD tendon transfer between February 2014 and April 2022. Indications for surgery included persistent shoulder pain and functional limitations unresponsive to nonoperative treatment, irreparable SSC tears (Lafosse grade ≥4), significant fatty infiltration (Goutallier grade ≥3), and minimal glenohumeral arthritis (Hamada stage <3). Patients were excluded if they had <2 years of follow-up or if data were lost. For comparison, the study divided patients into 2 groups based on the surgical methods: fully arthroscopic LD tendon transfer and arthroscopically assisted LD tendon transfer. Clinical assessments included pain levels (visual analog scale), Constant score, Subjective Shoulder Value score, and range of motion. Radiologic measurement and complications were assessed.</p><p><strong>Results: </strong>The study included 34 patients (mean ± SD age, 62.4 ± 7.5 years; follow-up, 35.4 ± 15.9 months). Significant improvements were observed in all patient-reported outcomes (pre- to posttest visual analog scale, 7.5 ± 1.2 to 1.2 ± 1.6; Constant score, 28.3 ± 6.0 to 68.8 ± 15.8; Subjective Shoulder Value, 23.2 ± 8.7 to 65.3 ± 22.0; all <i>P</i> < .001), range of motion in all directions, and internal rotation strength. Fully arthroscopic (n = 18) and arthroscopically assisted (n = 16) LD tendon transfers produced comparable clinical outcomes. Complications included 3 retears, 3 infections, and 5 cases of arthritis progression.</p><p><strong>Conclusion: </strong>Fully arthroscopic and arthroscopically assisted anterior LD transfers significantly reduce pain, enhance range of motion, and strengthen internal rotation in patients with irreparable SSC tears, with no significant differences in complications. These techniques offer comparable clinical outcomes, providing different options for surgeons.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"961-970"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191380","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":"Regional Patellar Tendon Strain in the Short- and Long-term After ACL Reconstruction Using Bone-Patellar Tendon-Bone Autograft.","authors":"João Luiz Quaglioti Durigan, Naoaki Ito, Rodrigo Scattone Silva, Karin Grävare Silbernagel","doi":"10.1177/03635465241310152","DOIUrl":"10.1177/03635465241310152","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament reconstruction (ACLR) often involves harvesting a bone-patellar tendon-bone (BPTB) autograft. How graft harvest affects tendon strain across the 3 distinct regions (medial, lateral, and central) is not known.</p><p><strong>Purpose: </strong>To (1) quantify strain in the 3 regions of the patellar tendon during 60% of maximum voluntary isometric contraction (MVIC) in 90° of knee flexion and (2) assess how effort level in 2 different knee joint angles (60° and 90°) impacts strain in the medial and lateral regions of the patellar tendon, in 2 cohorts of patients after ACLR using a BPTB autograft (one group <24 months after surgery and another group ≥24 months after surgery).</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>Effort levels ranging from 20% to 100% of MVIC were performed at 90° and 60° of knee flexion on an isokinetic dynamometer, with simultaneous ultrasound imaging of tendon length to calculate regional strain. Linear mixed-effects models were used to evaluate regional strain at 60% of MVIC in 90° of knee flexion. The fixed effects of percentage of MVIC, joint angles, and time from surgery groups on patellar tendon strain were evaluated using separate models for the medial and lateral regions.</p><p><strong>Results: </strong>Fourteen participants in the short-term group (7.5 ± 1.9 months from surgery) and 15 participants in the long-term group (71.5 ± 16.5 months from surgery) were included. At 60% of MVIC in 90° of knee flexion, the short-term group demonstrated lower patellar tendon strain than the long-term group regardless of region (<i>P</i> < .01). The central region also had lower strain than the medial and lateral regions regardless of group (both <i>P</i> < .01). Finally, the rate at which strain increased with increasing effect levels differed between time from surgery groups in both medial and lateral regions.</p><p><strong>Conclusion: </strong>The short-term group had lower strain in all regions of the patellar tendon after ACLR using BPTB autograft. The medial and lateral regions showed varying strain based on time from surgery and effort level. Varying knee joint angles and effort levels for graft site rehabilitation may have to be considered to target specific regions of the patellar tendon.</p><p><strong>Clinical relevance: </strong>Clinicians should consider the time elapsed since surgery and the manipulation of knee angle as factors that can exert varying levels of strain on different regions of the patellar tendon after ACLR. Accelerating quadriceps strengthening to enhance strain distribution across the patellar tendon to promote tendon healing may be of benefit for optimizing postsurgery rehabilitation.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"632-639"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11871995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016768","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":"Revision Anterior Cruciate Ligament Reconstruction: Surgeon-Reported Causes of Failure From the Norwegian Knee Ligament Register.","authors":"Søren Vindfeld, Andreas Persson, Line Lindanger, Anne Marie Fenstad, Håvard Visnes, Eivind Inderhaug","doi":"10.1177/03635465251316308","DOIUrl":"10.1177/03635465251316308","url":null,"abstract":"<p><strong>Background: </strong>Failed anterior cruciate ligament reconstruction (ACLR) leads to reduced quality of life and sometimes the need for repeat surgery. The reason for failure can be multifactorial and difficult to determine. Reports on failure leading to revision are few with limited generalizability. Also, no studies have investigated the reasons for early (<2 years) versus late (≥2 years) revision.</p><p><strong>Purpose: </strong>To describe patients undergoing revision surgery, the surgeon's reported cause of failure, and the risk of undergoing early versus late revision surgery.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Primary ACLR cases without concomitant ligament injuries or surgery, registered in the Norwegian Knee Ligament Register from 2004 throughout 2023, were eligible. Descriptive analyses were conducted on intraoperative findings and procedures, time from injury to surgery, activity at the time of injury, revision surgery, surgeon-reported cause of revision, and reporting method. The Kaplan-Meier method was used to calculate revision rates. A multivariable Cox regression model, adjusted for confounders, was used to calculate the hazard ratio of early and late revision surgery.</p><p><strong>Results: </strong>A total of 30,035 primary ACLR cases were analyzed, of which 1599 resulted in revision surgery. The overall revision rate was 7.1% at 15 years. Female patients were younger at the time of both primary and revision surgery (23.8 and 22.5 years, respectively) compared with male patients (28.2 and 22.2 years, respectively). Age at the time of primary surgery was significantly lower for patients who underwent revision (20.4 years) compared with those who did not undergo revision (26.5 years). Male sex, lower age, hamstring tendon graft, and no cartilage injury at the time of primary reconstruction were all associated with a higher risk of early revision. Lower age, hamstring tendon graft, and no meniscal injury were associated with a higher risk of late revision. New trauma (38.1%) was found to be the most common cause of failure leading to revision.</p><p><strong>Conclusion: </strong>In the current study, representing one of the largest cohorts to date investigating failed primary ACLR leading to revision, the overall 15-year revision rate was estimated as 7.1%. Patients receiving hamstring tendon grafts were at a particular risk for early revision during the first 2 years after primary reconstruction. New trauma was the most common reported cause of failure leading to revision ACLR.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"801-808"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143371298","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":"Mesenchymal Stem Cell Exosome and Fibrin Sealant Composite Enhances Rabbit Anterior Cruciate Ligament Repair.","authors":"Keng Lin Wong, Kristeen Ye Wen Teo, Gin Way Law, Shipin Zhang, Tianqi Wang, Hassan Afizah, Chee Jian Pua, Barry Wei Loong Tan, James Hoi Po Hui, Wei Seong Toh","doi":"10.1177/03635465241313142","DOIUrl":"10.1177/03635465241313142","url":null,"abstract":"<p><strong>Background: </strong>The anterior cruciate ligament (ACL) fails to heal after rupture, leading to joint instability and an increased risk of osteoarthritis. Mesenchymal stem/stromal cell (MSC) exosomes have reported wide-ranging therapeutic efficacy; however, their potential for augmenting ACL repair remains to be investigated.</p><p><strong>Purpose: </strong>To evaluate the use of MSC exosomes with fibrin sealant on biological augmentation of ACL healing after suture repair and their effects on ACL fibroblast functions.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Twelve rabbit knees underwent ACL transection and suture repair. MSC exosome and fibrin composite (Exosome+Fibrin) or fibrin (Fibrin) alone was used to supplement the suture repair in 6 knees. ACL repair was assessed by magnetic resonance imaging at 6 and 12 weeks postoperatively and by histologic and immunohistochemical analyses at 12 weeks. To investigate the mechanisms through which MSC exosomes augment ACL repair, metabolic activity, proliferation, migration, and matrix synthesis assays were performed using the primary ACL fibroblasts. RNA sequencing was also performed to assess global gene expression changes in exosome-treated ACL fibroblasts.</p><p><strong>Results: </strong>Based on magnetic resonance imaging findings, 5 of 6 Exosome+Fibrin-treated ACLs were completely or partially healed, as opposed to 5 of 6 Fibrin-treated ACLs appearing torn at 6 and 12 weeks postoperatively. Additionally, 4 of 6 Exosome+Fibrin-treated ACLs were isointense, as compared with 5 of 6 Fibrin-treated ACLs that were hyperintense, indicating improved remodeling and maturation of the repaired ACLs with Exosome+Fibrin treatment. Histologically, Exosome+Fibrin-treated ACLs showed more organized collagen fibers and abundant collagen deposition, with a high amount of collagen I and relatively lower amount of collagen III, which are consistent with the matrix structure and composition of the normal ACL. Cell culture studies using ACL fibroblasts showed that MSC exosomes enhanced proliferation, migration, and collagen synthesis and deposition, which are cellular processes relevant to ACL repair. Further gene set enrichment analysis revealed key pathways mediated by MSC exosomes in enhancing proliferation and migration while reducing matrix degradation of ACL fibroblasts.</p><p><strong>Conclusion: </strong>The combination of MSC exosomes and fibrin sealant (Exosome+Fibrin) applied to a suture repair enhanced the morphologic and histologic properties of the ACL in a rabbit model, and these improvements could be attributed to the augmented functions of ACL fibroblasts with exosome treatment.</p><p><strong>Clinical relevance: </strong>This work supports the use of MSC exosomes in biological augmentation of ACL healing after suture repair.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"871-884"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469856","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":"Midterm to Long-term Follow-up After Limited Saucerization of a Discoid Lateral Meniscus: Radiological and Functional Outcomes With Age-Dependent Variations.","authors":"Taha Aksoy, Ibrahim Mehmet Goymen, Gazi Huri, Egemen Turhan, Mininder S Kocher, Ozgur Ahmet Atay","doi":"10.1177/03635465241313137","DOIUrl":"10.1177/03635465241313137","url":null,"abstract":"<p><strong>Background: </strong>A discoid lateral meniscus (DLM) is the most common meniscus variant and is commonly treated with arthroscopic saucerization. There are mixed data regarding long-term results after surgery, especially in terms of radiological parameters.</p><p><strong>Purpose/hypothesis: </strong>The aim was to evaluate the functional and radiological results of patients who underwent arthroscopic saucerization for a symptomatic DLM. It was hypothesized that successful outcomes can be achieved by avoiding excessive resection while reshaping only to an extent that prevents mechanical symptoms.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>This study retrospectively analyzed pediatric and adult patients who had a symptomatic discoid meniscus between 2000 and 2018, who underwent arthroscopic saucerization with at least 10 mm of peripheral length, and who had at least 5 years of follow-up. Radiological parameters were measured on both preoperative and follow-up radiographs. Patient-reported outcome measure scores were recorded at follow-up.</p><p><strong>Results: </strong>The study included 57 knees of 53 patients (mean age, 27.6 years [range, 6-65 years]). The mean follow-up duration was 12.1 years (range, 5.0-23.1 years). There were 31 knees in the pediatric group and 26 knees in the adult group. No significant difference was found between the groups or between preoperative and follow-up values for the femorotibial angle (<i>P</i> > .05). When the preoperative and follow-up Kellgren-Lawrence grades were compared, no change was observed in the pediatric group (<i>P</i> = .125), while grades were shown to progress in the adult group (<i>P</i> < .001). The mean Lysholm score was 94.61 ± 7.61 and 84.23 ± 14.90 for the pediatric and adult groups, respectively (<i>P</i> = .001). Overall, 2 patients underwent arthroscopic surgery because of a symptomatic recurrence of symptoms, and 2 patients underwent arthroplasty because of osteoarthritis. The 10-year survival rate was 90.6%.</p><p><strong>Conclusion: </strong>Limited saucerization of a DLM helped to preserve coronal-plane knee joint alignment. Functional and radiological results were superior in the pediatric patients. Even when alignment was more varus in older patients, preoperative and follow-up femorotibial angles were not statistically significant. This outcome may be used to guide treatment in appropriately selected cases.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"817-825"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11894862/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069878","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}