American Journal of Sports Medicine最新文献

{"title":"Kinesiophobia and High-Impact Sport Activity Are Associated With a Reduced Rate of Return to Sport After High Tibial Osteotomy: A Risk Factor Analysis of a Young and Active Population.","authors":"Gian Andrea Lucidi, Stefano Di Paolo, Federico Maria Adravanti, Nicolò Maitan, Giacomo Dal Fabbro, Filippo Naldi, Alberto Grassi, Stefano Zaffagnini","doi":"10.1177/03635465251322795","DOIUrl":"10.1177/03635465251322795","url":null,"abstract":"<p><strong>Background: </strong>High tibial osteotomy (HTO) is usually performed in patients older than 50 years with medial knee osteoarthritis. However, little is known about return-to-sport (RTS) and return-to-work (RTW) rates when HTO is performed in younger patients. Moreover, the risk factors for RTS and the impact of kinesiophobia on RTS have been poorly investigated.</p><p><strong>Purpose: </strong>To assess RTS and RTW rates, risk factors for RTS, complications, and activity levels at long-term follow-up in young and active patients after isolated HTO.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>Consecutive HTO procedures performed at a single institution with a minimum 2-year follow-up were screened. Data were collected regarding clinical scores (Lysholm score, visual analog scale for pain, Tampa Scale for Kinesiophobia, Subjective Patient Outcome for Return to Sports score, Tegner activity score, Likert scale), RTS and RTW rates, type of sport, and impact activity level. Multivariate regression analysis evaluated the effect of sex, age, body mass index, Tegner score, and Tampa score on RTS. Differences were considered statistically significant if <i>P</i> < .05.</p><p><strong>Results: </strong>A total of 60 patients with a mean age at the time of surgery of 28.9 ± 7.5 years were included at a mean follow-up of 8.8 ± 3.8 years. There were 4 (6.7%) major complications. The overall RTS rate was 86.7%, and 68.3% of patients were still participating in sports at the final follow-up (mean, 3.7 ± 2.1 h/wk). Additionally, 34.6% returned to the same sport level, 21.2% improved their status, and 44.2% decreased their sport level. Moreover, patients playing soccer had a lower RTS rate compared with the rest of the patients (72.7% vs 94.7%, respectively; <i>P</i> = .04). The overall RTW rate was 100.0%, with a mean time to RTW of 5.9 ± 6.2 months. The Tampa score was the only predictor of absolute RTS (<i>P</i> = .015; coefficient = -0.13).</p><p><strong>Conclusion: </strong>HTO performed in a young and active population resulted in high RTS rates and continuous sport participation even up to 9 years after surgery. Interestingly, the Tampa score was the only predictive factor for a reduced RTS rate. Finally, soccer participation was associated with a lower RTS rate compared with other sports.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1068-1076"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607193","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":"What Role Should Orthopaedic Journals Play in Turbulent Times for Research Funding?","authors":"David C Landy","doi":"10.1177/03635465251326851","DOIUrl":"https://doi.org/10.1177/03635465251326851","url":null,"abstract":"","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":"53 5","pages":"1025-1026"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755946","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":"No Clinically Significant Differences in Patient-Reported Outcomes and Range of Motion Between Early and Delayed Mobilization After Primary Distal Biceps Tendon Repair: A Systematic Review and Meta-analysis.","authors":"Evan R Simpson, Harkirat Jawanda, Ishani Patel, Nikhil N Verma, Kevin C Parvaresh","doi":"10.1177/03635465251317207","DOIUrl":"https://doi.org/10.1177/03635465251317207","url":null,"abstract":"<p><strong>Background: </strong>Currently, there is no uniform rehabilitation program concerning mobilization after a distal biceps tendon repair. A systematic review was conducted to investigate the effect of restrictions within the immediate postoperative period to evaluate clinical outcomes relative to mobilization after surgical repair of complete distal biceps tendon tears.</p><p><strong>Hypothesis: </strong>Early mobilization will not have a significant difference on outcomes compared with delayed mobilization.</p><p><strong>Study design: </strong>Meta-analysis; Level of evidence, 3.</p><p><strong>Methods: </strong>The authors performed a systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines of studies reporting outcomes of the distal biceps tendon repair. The early mobilization cohort included studies with no restrictions beyond 2 weeks after surgery, and the delayed mobilization cohort included studies with continued restrictions beyond 2 weeks after surgery.</p><p><strong>Results: </strong>A total of 26 studies with 1114 patients (643 in the delayed mobilization cohort and 471 in the early mobilization cohort) met the inclusion criteria, with a weighted mean patient age of 45.14 years (range, 18-76 years) and a mean follow-up of 27.9 months (range, 3-120 months). Meta-analysis at the 24-month follow-up found that range of motion (ROM) was not significantly different across early and delayed mobilization cohorts for flexion (mean, 137.38° vs 140.42°; <i>P</i> = .34) and extension (mean, 3.23° vs 1.5°; <i>P</i> = .91). Early mobilization was found to be significantly associated with less pronation (mean, 75.68° vs 83.18°; <i>P</i> = .0019) and supination (mean, 76.38° vs 83.93°; <i>P</i> = .0049). Analysis of patient-reported outcomes (PROs) found that Disabilities of the Arm, Shoulder and Hand scores (mean, 3.93 vs 4.21; <i>P</i> = .77) and Mayo Elbow Performance Score values (mean, 96.33 vs 97.11;<i>P</i> = .65) were not significantly different across cohorts. Failure analysis found a significant difference when comparing proportion (mean, 0.0006 vs 0.0185; <i>P</i> = .0029) but no difference when comparing incidence rate (mean, 0.0001 vs 0.0001; <i>P</i> = .647). Complication analysis found no statistical difference in proportion (mean, 0.2181 vs 0.1918; <i>P</i> = .7388) or incidence rate (mean, 0.0012 vs 0.008; <i>P</i> = .344).</p><p><strong>Conclusion: </strong>These results suggest there may be no clinically significant difference in failure rates, complications, ROM, or PROs for early versus delayed mobilization after primary distal biceps tendon repair.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251317207"},"PeriodicalIF":4.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665511","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":"Mechanisms of Action of Intra-articular Hyaluronic Acid Injections for Knee Osteoarthritis: A Targeted Review of the Literature.","authors":"Seth L Sherman, Andrew S Gudeman, John D Kelly, Robert J Dimeff, Jack Farr","doi":"10.1177/03635465241302820","DOIUrl":"https://doi.org/10.1177/03635465241302820","url":null,"abstract":"<p><strong>Background: </strong>The knee is the most commonly afflicted joint in osteoarthritis (OA). Injection of intra-articular of hyaluronic acid (IAHA) is a frequently used therapy for the management of knee OA with varying product characteristics.</p><p><strong>Purpose: </strong>To describe and characterize the mechanism of action (MoA) of IAHA products concerning nociception, chondroprotection, and anti-inflammatory properties via a targeted literature review.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 2.</p><p><strong>Methods: </strong>We followed the standard methodologies for conducting and reporting targeted reviews as recommended by the <i>Cochrane Handbook for Systematic Reviews of Interventions</i>, adapted for conducting a targeted literature review. Relevant studies were identified by searching the Embase database using predefined search strategies via the Ovid platform. The results of the review were reported according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses).</p><p><strong>Results: </strong>A total of 182 studies were included in this targeted literature review. Of these, 107 reported chondroprotective action, 59 anti-inflammatory activity, 18 analgesic properties, 30 proteoglycan or glycosaminoglycan synthesis, 8 subchondral bone effects, 2 mechanical effects, and 1 other effects of IAHA. These MoAs were studied through diverse types of studies: in vitro biochemistry, animal physiological studies, or human physiological and clinical studies. The chondroprotective effect was the most studied MoA and showed an increase in anabolic biomarkers, such as collagen types II, IX, and XI, and a reduction in catabolic biomarkers, such as matrix metalloproteinases, which play a primary role in the downstream signaling pathways in OA and cartilage degradation in the synovial fluid. IAHA was widely reported by studies to reduce soluble inflammatory mediators, such as interleukins 1β and 6 and tumor necrosis factor α, thereby decreasing the production of degradative enzymes (eg, matrix metalloproteinases, aggrecanases). IAHA was also reported to enhance the synthesis of intrinsic proteoglycan (eg, aggrecan) and glycosaminoglycans, thus delaying the progression of OA. IAHA also reported improvement in the mechanical function of the knee by increasing the viscosity of the synovial fluid, reducing the coefficient of friction, and improving its lubrication. Overall, a significant decrease in knee pain was observed after IAHA treatments.</p><p><strong>Conclusion: </strong>Preclinical and clinical studies established evidence for varied MoAs by which IAHA preparations may produce a desired effect in patients with knee OA.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465241302820"},"PeriodicalIF":4.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665510","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 Use of Customized 3D-Printed Guides in Anterior Cruciate Ligament Reconstruction Compared With Conventional Techniques: A Systematic Review and Meta-analysis.","authors":"Abdulrahman O Al-Naseem, Abdullah Almehandi, Khalaf M Ebrahim, Abdulaziz Al-Naseem, Yousef Marwan, Naser Alnusif","doi":"10.1177/03635465251315165","DOIUrl":"https://doi.org/10.1177/03635465251315165","url":null,"abstract":"<p><strong>Background: </strong>Accurate femoral tunnel positioning is essential for successful anterior cruciate ligament (ACL) reconstruction. Tunnel malposition can happen due to limited arthroscopic visibility as well as anatomic variance. The use of customized patient-specific guides can optimize surgical planning and enhance accuracy.</p><p><strong>Purpose: </strong>To compare femoral tunnel positioning in 3-dimensional (3D)-assisted ACL reconstruction versus conventional surgery.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 3.</p><p><strong>Methods: </strong>This systematic review and meta-analysis was performed in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with a search of the following databases: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. All randomized controlled trials (RCTs) and observational studies comparing the 2 interventions were included. Primary outcomes included tunnel positioning time (minutes) and accuracy rates (%). Secondary outcomes were Lysholm and International Knee Documentation Committee (IKDC) functional scores. Random effects modeling was used for analysis.</p><p><strong>Results: </strong>Four RCTs and 1 retrospective study were included, enrolling a total of 299 patients. The 3D group had significantly shorter tunnel positioning times (mean difference, -2.80; 95% CI, -4.13 to -1.46; <i>P</i> < .0001) with significantly greater tunnel positioning accuracy (odds ratio, 4.62; 95% CI, 1.02 to 20.89; <i>P</i> = .05). No significant difference was noted in postoperative functional scores, including Lysholm and IKDC scores (<i>P</i> > .05).</p><p><strong>Conclusion: </strong>The use of 3D guides helps reduce tunnel positioning time and increases tunnel positioning accuracy with comparable postoperative functional outcomes.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251315165"},"PeriodicalIF":4.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chronic Adaptations of the Shoulder in Baseball Pitchers: A Systematic Review.","authors":"Ryan W Paul, Francis R Sirch, Albi Vata, Eric Zhu, Frank G Alberta, Brandon J Erickson, Stephen J Thomas","doi":"10.1177/03635465251317202","DOIUrl":"https://doi.org/10.1177/03635465251317202","url":null,"abstract":"<p><strong>Background: </strong>Understanding clinical and tissue adaptations to the throwing shoulder is important for optimizing injury prevention and rehabilitation programs in baseball players.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to determine the chronic clinical (range of motion [ROM] and strength) and tissue adaptations of the throwing shoulder in baseball pitchers. It was hypothesized that the throwing shoulder would have increased external rotation (ER) ROM and decreased internal rotation (IR) ROM compared with the nonthrowing shoulder, but that calculations of soft tissue glenohumeral IR deficit (GIRD) and soft tissue ER gain (ERG) would show that the true soft tissue restrictions were instead in the direction of ER ROM.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 4.</p><p><strong>Methods: </strong>This systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using various keywords related to the shoulder and baseball. Studies were included if chronic adaptations of the shoulder were evaluated bilaterally in nonrecreational baseball pitchers. Outcomes of interest collected include IR and ER ROM measured in 90° of shoulder abduction, humeral retroversion (HR), GIRD, ERG, and various structural adaptations. All other chronic adaptations were compiled and reported qualitatively because of the heterogeneity of variables assessed.</p><p><strong>Results: </strong>Overall, 1273 studies were screened and 36 met final inclusion criteria, with 24 studies (67%) evaluating professional pitchers. Across 13 studies and 1101 professional pitchers, the mean clinical GIRD was 10.0° and the mean clinical ERG was 6.5°, leading to a total arc of ROM deficit of 3.5° in the throwing shoulder. Across 498 included pitchers with HR measures, the mean bilateral difference in HR was 15.4°. After calculating soft tissue GIRD, 3 of 4 studies found that pitchers do not have any soft tissue restrictions in IR ROM. In contrast, after calculating soft tissue ERG, all 4 studies found pitchers to have soft tissue restrictions in ER ROM with a mean of 8° to 13°.</p><p><strong>Conclusion: </strong>When isolating for soft tissue restrictions through calculation of soft tissue GIRD and ERG, previously reported IR ROM deficits are currently not as prevalent, and soft tissue restrictions in ER ROM are now being observed. Clinicians should focus on better isolating soft tissue restrictions to evaluate whether an athlete has deficits in IR or ER ROM.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251317202"},"PeriodicalIF":4.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Suture Versus Bony Fixation in Meniscal Allograft Transplantation Outcomes: A Meta-analysis.","authors":"Rahul Kakria, James Randolph Onggo, Iswadi Damasena","doi":"10.1177/03635465251319540","DOIUrl":"https://doi.org/10.1177/03635465251319540","url":null,"abstract":"<p><strong>Background: </strong>Meniscal allograft transplantation replaces damaged meniscal tissue with grafts, aiming to restore knee stability and function. The method employed in the fixation of the meniscal graft-suture or bony fixation-has sparked clinical interest and ongoing discussions.</p><p><strong>Purpose: </strong>To compare suture fixation with bony fixation of the meniscal graft, with the focus on functional and clinical outcomes.</p><p><strong>Study design: </strong>Meta-analysis and systematic review; Level of evidence, 4.</p><p><strong>Methods: </strong>Meta-analyses were performed with a multidatabase search according to PRISMA guidelines on August 15, 2023. Data from published articles meeting inclusion criteria were extracted and analyzed with an inverse variance statistical model.</p><p><strong>Results: </strong>A total of 6 studies were included consisting of 334 patients: 184 suture fixation and 150 bony fixation. No statistical analysis could be performed for clinical outcomes given the heterogeneity of raw data, but no observable trends were observed from individual studies. Suture and bony fixation showed no statistically significant difference in the risks of infection (relative risk [RR], 1.52; 95% CI, 0.29-7.80; <i>P</i> = .62), graft failure (RR, 0.86; 95% CI, 0.19-3.78; <i>P</i> = .84), graft tear (RR, 1.14; 95% CI, 0.10-13.21; <i>P</i> = .91), minor graft extrusion (RR, 0.77; 95% CI, 0.20-2.92; <i>P</i> = .70), and major graft extrusion (RR, 1.20; 95% CI, 0.28-5.07; <i>P</i> = .81).</p><p><strong>Conclusion: </strong>There was no significant difference in clinical outcomes or complications between suture and bony fixation of meniscal grafts. However, the short- to medium-term follow-up in this meta-analysis prompts the need for studies with long-term follow-up, given that meniscal allograft transplantation longevity is of utmost importance in this patient group to restore function and potentially reduce the risk of arthritis progression.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251319540"},"PeriodicalIF":4.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544685","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Cadaveric Study of the Sagittal Patellar Insertion of the Medial Patellofemoral Ligament in Children: Implications for Reconstruction.","authors":"Amin Alayleh, Ian Hollyer, Thomas Johnstone, Bryan Khoo, Chiamaka Obilo, Kelly McFarlane, Wills Baird, Calvin Chan, Marc Tompkins, Henry Ellis, Matthew Schmitz, Yi-Meng Yen, Theodore Ganley, Seth L Sherman, Kevin G Shea","doi":"10.1177/03635465241313239","DOIUrl":"10.1177/03635465241313239","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral instability is a common problem, and medial patellofemoral ligament (MPFL) reconstruction is a standard treatment approach for recurrent instability. The accurate restoration of anatomy in MPFL reconstruction is essential. While coronal-plane anatomy of the MPFL patellar insertion has been previously reported, sagittal-plane anatomy has not been widely studied.</p><p><strong>Purpose: </strong>To evaluate the sagittal patellar insertion of the MPFL in pediatric specimens to guide future anatomic reconstruction.</p><p><strong>Study design: </strong>Descriptive laboratory study.</p><p><strong>Methods: </strong>A total of 11 pediatric cadaveric knee specimens were dissected. The patella and sagittal MPFL insertion were evaluated. The maximal anterior-posterior patellar width, distance from the posterior patella to the posterior MPFL insertion, distance from the medial patellar articular cartilage edge to the MPFL insertion, maximal MPFL thickness, and distance from the anterior MPFL insertion to the anterior patella were measured. The proportion of patellar coverage by the sagittal MPFL insertion footprint was calculated.</p><p><strong>Results: </strong>The pediatric knee specimens had a mean age of 9.3 ± 1.4 years (range, 6-11 years). The mean maximal transverse patellar width was 19.0 ± 2.7 mm (range, 13.7-22.7 mm). The mean posterior patella-to-posterior MPFL distance was 10.5 ± 1.6 mm (range, 7.7-12.6 mm). The mean patellar articular cartilage edge-to-MPFL distance was 2.3 ± 0.6 mm (range, 1.5-3.5 mm). The mean maximal MPFL thickness was 4.0 ± 0.9 mm (range, 2.6-5.5 mm). The mean anterior MPFL-to-anterior patella distance was 4.4 ± 1.1 mm (range, 2.6-5.8 mm). The sagittal MPFL insertion footprint spanned a mean of 21.0% (range, 16.1%-29.7%) of the medial patella.</p><p><strong>Conclusion: </strong>This study, utilizing skeletally immature cadaveric specimens, demonstrated that the sagittal MPFL insertion consistently resided in the anterior third of the patella, averaging 21% of the total sagittal patellar width. Additionally, the distance from the MPFL insertion to the medial patellar articular cartilage edge showed minimal variation, representing a consistent intraoperative landmark for MPFL graft placement.</p><p><strong>Clinical relevance: </strong>This research characterized MPFL insertion anatomy on the medial patella in the sagittal plane. This knowledge provides a clear target area for anatomic graft placement during MPFL reconstruction.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"826-831"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143257479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Recurrence Rates After Isolated Arthroscopic Bankart Repair in Selected Patients Without Preoperative Bone Loss Versus Open Latarjet Procedure: A Matched-Pair Analysis.","authors":"Clémentine Rieussec, Juan Enrique Cassinelli, Matias Hoffman, Clément Horteur, Johannes Barth","doi":"10.1177/03635465241309330","DOIUrl":"10.1177/03635465241309330","url":null,"abstract":"<p><strong>Background: </strong>Clinical studies have shown that the open Latarjet procedure (OLP) has lower recurrence rates than the isolated arthroscopic Bankart (IAB) procedure for recurrent anterior shoulder instability, but no long-term comparative studies exist for IAB in patients without bone loss.</p><p><strong>Purpose/hypothesis: </strong>This study aimed to compare the outcomes of IAB in selected patients without bone loss versus OLP. The hypothesis was that OLP would be more successful in preventing recurrence, even in carefully selected patients for IAB.</p><p><strong>Study design: </strong>Cohort study; Level of evidence 3.</p><p><strong>Methods: </strong>An overall 774 patients who underwent surgical stabilization for recurrent anterior instability between January 2007 and December 2021 were analyzed. A total of 685 shoulders were followed up (89 patients were lost of follow-up: 11,4%), including 582 OLP, 45 IAB, and 58 other techniques (Trillat procedure, Arthroscopic Latarjet procedure, and revision Eden Hybinette procedure). The patients who underwent primary IAB were matched with patients who underwent OLP in a 1:1 ratio using propensity matching, resulting in 45 patients in each group. The main objective was to identify new episodes of instability, with a recurrence rate <5% considered acceptable. Kaplan-Meier analysis was used to evaluate patient survivorship, and logistic regression was performed to consider potential factors affecting recurrence rates. Data were collected on return-to-sport rate, Walch and Duplay score, visual analog scale score, and external rotation.</p><p><strong>Results: </strong>The mean follow-up was 9 years and 3 months. A new episode of instability occurred in 2% of the OLP group and 20% of the IAB group (<i>P</i> = .04; odds ratio, 11; 95% CI, 1.91-63.4, Miettinen method). Regarding the rest of our analyses, there was no significant difference. Patients maintained good external rotation with low pain: 68° in the OLP group as compared with 72° in the IAB group (<i>P</i> = .325), with 1.2 out of 10 on the visual analog scale in the OLP group versus 1.5 in the IAB group (<i>P</i> = .433), respectively. Walch and Duplay score reached 79.9 in the OLP group and 78.9 in the IAB group (<i>P</i> = .496), and 89% of the OLP group returned to its previous sport level as compared with 73% of the IAB group (<i>P</i> = .104).</p><p><strong>Conclusion: </strong>Patients who underwent an OLP had better long-term survivorship without recurrence when compared with those who underwent an IAB, even without bone loss. The odds of experiencing a new episode of instability recurrence was 11 times higher for patients who underwent IAB, with a mean follow-up of 9 years and 3 months.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"549-555"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Partial Avulsion Patterns in the Pediatric Humeral Medial Epicondyle.","authors":"Richard C Lee, Akbar N Syed, Margaret A Bowen, J Todd R Lawrence","doi":"10.1177/03635465241310407","DOIUrl":"10.1177/03635465241310407","url":null,"abstract":"<p><strong>Background: </strong>The anterior oblique bundle of the medial ulnar collateral ligament (UCL) inserts on the anteroinferior aspect of the humeral medial epicondyle, while the flexor pronator mass (FPM) originates superficial and proximal to the UCL. With valgus stress, these distinct footprints may produce injury patterns that affect only focal areas of the medial epicondyle.</p><p><strong>Hypothesis: </strong>The proximal UCL can act on the medial epicondyle either in isolation or in conjunction with the FPM to form partial avulsion fracture patterns within the pediatric medial epicondyle, and the predominant pattern involves only the proximal UCL footprint.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>A retrospective review was performed of medial epicondyle injuries from a single tertiary care institution documented from 2012 to 2022. Inclusion criteria consisted of (1) patients <18 years of age with a diagnosis of medial epicondyle fracture, (2) availability of radiographs within 3 weeks of injury date, and (3) no history of acute medial epicondyle fracture. Data collection included demographics, imaging, mechanisms of injury, associated injuries, and procedural details if operative notes were available.</p><p><strong>Results: </strong>Of the 1951 patients screened, 709 were diagnosed with any form of medial epicondyle fracture. Of these patients, 15.9% (n = 113; mean ± SD age, 11.15 ± 2.56 years; 70% male; 40% throwing mechanism) had radiographic evidence of fragmentation of the inferior aspect of the medial epicondyle, suggesting a partial avulsion fracture/injury. Seventy-eight patients (69%) were noted to have a small, well-corticated fragment off the inferior pole of the medial epicondyle on radiographs, defined as a \"proximal UCL avulsion fracture.\" Magnetic resonance imaging in 24 patients in this group confirmed attachment of the UCL to the avulsed fragment. This configuration was also confirmed by 2 operative reports. Thirty-five patients had a well-defined cortical shell or an indistinct radio-opaque body off the inferomedial aspect of the medial epicondyle on radiographs, defined as a \"cortical sleeve avulsion.\" Magnetic resonance imaging in 8 patients in this group demonstrated the UCL in addition to the FPM origin still attached to the avulsed cortical sleeve. This was confirmed by 2 operative reports.</p><p><strong>Conclusion: </strong>The 2 injury patterns seen in this study-proximal UCL avulsion fracture and cortical sleeve avulsion-represented 15.9% of the patients with a medial epicondyle fracture. The proximal UCL avulsion fracture pattern was the more common of the 2 injury patterns. Accurate identification of these injury patterns and their underlying pathology is likely to be important in ultimately understanding the natural history of these injuries and the outcomes of different treatment strategies.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"537-542"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}