American Journal of Sports Medicine最新文献

{"title":"PRP Injections for the Treatment of Knee Osteoarthritis: The Improvement Is Clinically Significant and Influenced by Platelet Concentration: A Meta-analysis of Randomized Controlled Trials.","authors":"Alessandro Bensa, Davide Previtali, Alessandro Sangiorgio, Angelo Boffa, Manuela Salerno, Giuseppe Filardo","doi":"10.1177/03635465241246524","DOIUrl":"10.1177/03635465241246524","url":null,"abstract":"<p><strong>Background: </strong>Platelet-rich plasma (PRP) has emerged as a promising therapeutic intervention for knee osteoarthritis (OA), attracting substantial clinical and research attention. However, the clinical relevance of the treatment benefit remains controversial.</p><p><strong>Purpose: </strong>To evaluate the effectiveness of PRP compared with placebo in patients with knee OA in terms of minimal clinically important difference (MCID) and to investigate the possible influence of platelet concentration on the clinical outcome.</p><p><strong>Study design: </strong>Meta-analysis. Level of evidence 1.</p><p><strong>Methods: </strong>The search was conducted on 5 databases (PubMed, Cochrane Library, Scopus, Embase, Web of Science) using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were randomized controlled trials comparing PRP and placebo injections to treat knee OA, written in the English language, with no time limitation. The effects were quantified at 1-, 3-, 6-, and 12-month follow-up points. Visual analog scale (VAS) for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were used, with subanalyses based on platelet concentration performed using a 1,000,000 ± 20% platelets/µL cutoff. The MCID values (VAS, 1.37; WOMAC, 6.4) were used to interpret clinical improvement. The articles' quality was assessed using the Revised Tool for Risk of Bias in Randomized Trials and the Grading of Recommendations Assessment, Development and Evaluation guidelines.</p><p><strong>Results: </strong>Among the 5499 articles retrieved, 18 randomized controlled trials (1995 patients) were included. PRP presented statistically superior improvements in VAS and WOMAC scores compared with placebo at all follow-up points, exceeding the MCID at 3- and 6-month follow-up points for VAS and at all follow-up points for WOMAC. The subanalysis based on platelet concentration showed that high-platelet PRP provided clinically significant pain relief with the improvement exceeding the MCID compared with placebo at 3-, 6-, and 12-month follow-up points. In contrast, low-platelet PRP failed to offer a clinically perceivable benefit in terms of VAS score. WOMAC results showed that both products provided a clinically significant improvement at 3 and 6 months of follow-up. This benefit was maintained up to the 12-month follow-up in the high-platelet group but not in the low-platelet group, where the improvement compared with placebo did not reach statistical significance.</p><p><strong>Conclusion: </strong>This meta-analysis showed that PRP offered clinically relevant functional improvement at 1-, 3-, 6-, and 12-month follow-up points and pain relief at 3- and 6-month follow-up points compared with placebo for the treatment of knee OA. Platelet concentration was found to influence treatment efficacy, with high-platelet PRP providing superior pain relief and more durable functio","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"745-754"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923974","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":"3D Muscle Volume and 3D Fat Fraction After Successful and Failed Arthroscopic Rotator Cuff Repair at 5-Year Follow-up.","authors":"Philipp Kriechling, Jethin Joshy, Stefan Klotz, Georg C Feuerriegel, Philipp Fürnstahl, Reto Sutter, Mazda Farshad, Karl Wieser","doi":"10.1177/03635465241299795","DOIUrl":"10.1177/03635465241299795","url":null,"abstract":"<p><strong>Background: </strong>The results of rotator cuff (RC) repair surgery can be influenced by the presence of muscle atrophy and fatty infiltration. Three-dimensional (3D) quantitative data regarding those degenerative muscle changes after successful or failed RC repair are rare in the current literature.</p><p><strong>Hypothesis/purpose: </strong>The purpose of this study was to analyze muscle volume and fatty infiltration of the supraspinatus muscle after successful and failed arthroscopic RC tendon repair, with a minimum follow-up of 5 years. It was hypothesized that RC muscle volume and fatty infiltration would improve after successful repair and only to a limited extent after failed repair.</p><p><strong>Study design: </strong>Cohort study; Level of evidence 2.</p><p><strong>Methods: </strong>A total of 115 patients (mean age, 59 ± 8 years; 33% women) with RC repair for full-thickness supraspinatus tendon tear were prospectively followed at 3 and 12 months. Of them, 18 patients with unsuccessful RC repairs were matched to 21 patients with successful repairs and reevaluated at a minimum follow-up of 60 months. All patients underwent quantitative 2-point Dixon magnetic resonance imaging at all time points to evaluate full 3D muscle volume and 3D fatty infiltration. The clinical examination included the full Constant-Murley score (CS) and subjective shoulder value.</p><p><strong>Results: </strong>The relative changes in supraspinatus muscle volume were statistically significant between the 2 groups over time (<i>P</i> < .01). Successful repairs showed a mean volume increase of 18% (<i>P</i> < .001) and 23% (<i>P</i> < .001) from preoperatively and the 3-month follow-up, respectively, and failed repairs were remodeled by 3% (<i>P</i> = .586) and 12% (<i>P</i> = .001), respectively. However, a direct comparison of the volumes revealed comparable results at the latest follow-up with 43 cm<sup>3</sup> (95% CI, 38-47 cm<sup>3</sup>) and 40 cm<sup>3</sup> (95% CI, 33-46 cm<sup>3</sup>) for successful and failed repairs (<i>P</i> = .494), respectively. The supraspinatus 3D fatty infiltration also showed lower fat content for the successful repair preoperatively (6.9% [95% CI, 4.7%-9.2%] vs 9.1% [95% CI, 7.2%-11.1%]; <i>P</i> < .01), at 3 months (7.9% [95% CI, 5.5%-10.4%] vs 12.8% [95% CI, 9.1%-16.5%]; <i>P</i> < .01), at 12 months (7.5% [95% CI, 4.8%-10.1%] vs 11.6% [95% CI, 9.4%-13.8%]; <i>P</i> < .01), and at 60 months (7.4% [95% CI, 4.7%-10.2%] vs 15.5% [95% CI, 11%-20%]; <i>P</i> < .01) postoperatively. Fatty infiltration remained unchanged between preoperatively and from 3-month follow-up in the successful group. However, it increased by 70% (<i>P</i> < .01) from preoperative and by 21% (<i>P</i> = .065) from 3-months follow-up in the failed group. The clinical outcome was similar for successful and failed repairs with an absolute CS of 81 ± 6 versus 72 ± 15 (<i>P</i> = .069) and a relative CS of 94% ± 7% versus 85% ± 17% (<i>P</i> = .078)","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":"53 3","pages":"571-582"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532191","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":"Biomechanical Evaluation and Surface Analysis of Glenoid Reconstruction Using a Subtalar Joint Allograft for Significant Glenoid Bone Loss in Recurrent Shoulder Instability: A Novel Alternative Graft Option.","authors":"Phob Ganokroj, Justin F M Hollenbeck, Marco Adriani, Ryan J Whalen, Amelia H Drumm, Alexander R Garcia, Wyatt H Buchalter, Trevor J McBride, Marco-Christopher Rupp, Matthew T Provencher","doi":"10.1177/03635465251315487","DOIUrl":"10.1177/03635465251315487","url":null,"abstract":"<p><strong>Background: </strong>Glenoid and humeral head bone defects are common in chronic shoulder instability. The talus, and more specifically, the subtalar joint, has been proposed as a unique allograft from which bipolar bone loss can be addressed. However, there are few biomechanical data or joint reconstruction analyses of the glenoid using the posterior facet of a subtalar joint allograft (STA).</p><p><strong>Purpose: </strong>To compare the contact mechanics of an STA versus a coracoid graft (Latarjet procedure) versus a distal tibial allograft (DTA) for anatomic glenoid reconstruction.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>A total of 8 fresh-frozen, unpaired cadaveric specimens underwent repeated-measures biomechanical testing in 5 stages: native (intact) state, bone loss (30% glenoid bone defect), Latarjet procedure, glenoid reconstruction using a DTA, and glenoid reconstruction using an STA. A compressive load of 440 N was applied to the glenohumeral joint when the humerus was mounted to a dynamic tensile testing machine in 3 shoulder positions: 30° of abduction, 60° of abduction, and 60° of abduction with 90° of external rotation (ER). Average contact pressure, contact area, and peak contact pressure were determined from the sensors. Surface area and surface congruency were calculated using a custom script. Data were analyzed using analysis of variance.</p><p><strong>Results: </strong>There was a significantly higher surface area with glenoid reconstruction using the DTA (859 ± 78 mm<sup>2</sup>; <i>P</i> = .005) than with glenoid reconstruction using the STA (806 ± 88 mm<sup>2</sup>; <i>P</i> < .001) and the Latarjet procedure (692 ± 91 mm<sup>2</sup>). Surface congruency was significantly better with reconstruction using the DTA (2.0 ± 0.3 mm; <i>P</i> = .003) or the STA (1.9 ± 0.3 mm; <i>P</i> = .004) than with the Latarjet procedure (2.6 ± 0.4 mm). In all shoulder positions, the average contact pressure in the bone loss state was significantly higher than that in the native state (<i>P</i> < .05). All repair states restored average contact pressure to the native state at 60° of abduction and 60° of abduction with 90° of ER. There was less contact area after the Latarjet procedure than in the native state at 30° and 60° of abduction (<i>P</i> = .009 and <i>P</i> = .040, respectively). There was no significant difference in contact area and peak contact pressure after reconstruction with the DTA or STA compared with the native state.</p><p><strong>Conclusion: </strong>Anatomic glenoid reconstruction using a DTA or STA restored average contact pressure, peak contact pressure, and contact area at 60° of abduction and 60° of abduction with 90° of ER in a cadaveric model. In addition, surface congruency and surface area improved over the traditional Latarjet procedure.</p><p><strong>Clinical relevance: </strong>The STA showed comparable contact mechanics and surface geometry ","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"935-943"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392249","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 Open Arthrotomy and Arthroscopic Surgery for Primary Synovial Chondromatosis of the Hip: A Comparative Study With Propensity Score Matching.","authors":"Han Soul Kim, Cha Hyeong Ok, Jae Suk Chang, Ji Wan Kim, Chul-Ho Kim","doi":"10.1177/03635465251316312","DOIUrl":"10.1177/03635465251316312","url":null,"abstract":"<p><strong>Background: </strong>Despite the widespread use of arthroscopic surgery for hip synovial chondromatosis, its postoperative outcomes remain uncertain. A head-to-head comparison between open arthrotomy and arthroscopic surgery is lacking.</p><p><strong>Purpose: </strong>To compare the treatment outcomes of open arthrotomy, particularly with surgical dislocation, and arthroscopic surgery for hip synovial chondromatosis.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>All patients who were surgically treated for symptomatic synovial chondromatosis in a tertiary university referral hospital between April 1996 and February 2023 were investigated via 1:1 propensity score matching to compare open arthrotomy and arthroscopic surgery. The primary outcome was chondromatosis recurrence. Secondary outcomes were patient-reported outcome scores, reoperations, and complications.</p><p><strong>Results: </strong>A total of 73 patients were enrolled, and after matching, 28 patients in each group were investigated. The mean age and mean follow-up period were 40.5 ± 13.7 years and 4.0 ± 3.1 years, respectively. Clinical and radiological recurrence rates did not differ between groups (clinical recurrence: 7.1% for open arthrotomy vs 25.0% for arthroscopic surgery [<i>P</i> = .143]; radiological recurrence: 14.3% for open arthrotomy vs 32.1% for arthroscopic surgery [<i>P</i> = .205]). However, all patient-reported outcomes at final follow-up were in favor of open arthrotomy compared with arthroscopic surgery (visual analog scale for pain: 1.6 for open arthrotomy vs 3.1 for arthroscopic surgery [<i>P</i> = .002]; quality of life scale: 80.4 for open arthrotomy vs 65.4 for arthroscopic surgery [<i>P</i> < .001]; and modified Harris Hip Score: 84.4 for open arthrotomy vs 75.9 for arthroscopic surgery [<i>P</i> = .001]). The symptom dissatisfaction rate at final follow-up was significantly higher with arthroscopic surgery than with open arthrotomy (35.7% vs 7.1%, respectively; <i>P</i> = .020). There was no difference in reoperation and complication rates between the 2 groups.</p><p><strong>Conclusion: </strong>For treating primary synovial chondromatosis, particularly when it is distributed across both the central and peripheral zones, arthroscopic surgery should be chosen with caution, and open arthrotomy with surgical dislocation should be actively considered.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"911-920"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143384152","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":"Remplissage May Decrease the Redislocation Rate After Arthroscopic Bankart Repair in Patients With an Engaging Hill-Sachs Defect: A Systematic Review and Meta-analysis of Studies With Minimal 2-Year Follow-up.","authors":"Natalia Pawłuś, Michał Kanak, Andrzej Frankiewicz, Joanna Piwnik, Ion-Andrei Popescu, Andrzej Borowski, Adam Kwapisz","doi":"10.1177/03635465241249492","DOIUrl":"10.1177/03635465241249492","url":null,"abstract":"<p><strong>Background: </strong>The redislocation rate after arthroscopic Bankart repair (BR) among patients with a Hill-Sachs lesion (HSL) may be reduced with the use of remplissage.</p><p><strong>Purpose: </strong>To investigate the outcomes of adding remplissage to an arthroscopic BR in patients with concomitant HSL.</p><p><strong>Study design: </strong>Meta-analysis; Level of evidence, 3.</p><p><strong>Methods: </strong>PubMed and ScienceDirect databases were searched between February 2022 and April 2023 with the terms \"remplissage\" and \"shoulder instability\" according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The inclusion criteria were formed using the population, intervention, control, and outcome method; the investigation included studies that compared BR with and without remplissage and had ≥24 months of follow-up.</p><p><strong>Results: </strong>From 802 articles found during the initial search, 7 studies with a total of 837 patients-558 receiving isolated BR (BR group) and 279 receiving BR with remplissage (BR+REMP)-were included. The probability of recurrence of instability among patients with an engaging HSL was significantly diminished in the BR+REMP group compared with the BR group (odds ratio, 0.11; 95% CI, 0.05 to 0.24; <i>P</i> < .001). Regarding shoulder range of motion, the BR+REMP group achieved increased forward flexion (mean difference [MD], 1.97°; 95% CI, 1.49° to 2.46°; <i>P</i> < .001) and decreased external rotation in adduction (MD, -1.43°; 95% CI, -2.40° to -0.46°; <i>P</i> = .004) compared with the BR group. Regarding patient-reported outcome measures, the BR+REMP group had Rowe (MD, 2.53; 95% CI, -1.48 to 6.54; <i>P</i> = .21) and Western Ontario Shoulder Instability Index (WOSI) (MD, -61.60; 95% CI, -148.03 to 24.82; <i>P</i> = .162) scores that were comparable with those of the BR group.</p><p><strong>Conclusion: </strong>Remplissage resulted in a 9-fold decrease in the recurrence of instability after arthroscopic BR in patients with HSL. Remplissage not only led to an increase in forward flexion but also only slightly limited patients' external rotation in adduction. WOSI and Rowe scores after remplissage at the final 24-month follow-up were comparable with those obtained after isolated Bankart repair.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"717-726"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140924058","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":"Rate and Timing of Progression to Total Knee Arthroplasty After Anterior Cruciate Ligament Reconstruction in Patients With Systemic Inflammatory Disease: A Long-term Propensity-Matched Cohort Study.","authors":"Xuankang Pan, Allen S Wang, Quinn J Johnson, Sean C Clark, Christopher L Camp, Kelechi R Okoroha, Daniël B F Saris, Adam J Tagliero, Mario Hevesi, Aaron J Krych","doi":"10.1177/03635465241310520","DOIUrl":"10.1177/03635465241310520","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Anterior cruciate ligament reconstruction (ACLR) is one of the most common orthopaedic procedures and one of the most well studied. Despite extensive research dedicated to ACLR, there is limited understanding of how chronic inflammatory systemic diseases (CIDs) such as rheumatoid arthritis and systemic lupus erythematosus affect outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the outcomes of ACLR in cohorts of patients with and without CID.&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;A retrospective query of a regional data set was conducted for all patients who underwent ACLR from 1990 to 2021 for traumatic ACL rupture. All patients with CID were identified and propensity matched to non-CID controls. Baseline characteristics and clinical outcomes were identified through retrospective chart review, and patients were contacted for subjective outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 30 patients with ACLR and a diagnosis of CID were identified. These patients were propensity matched to 120 non-CID controls. Baseline demographic and surgical characteristics demonstrated no statistical differences. Follow-up duration was similar between the CID and non-CID groups (mean, 14.6 vs 14.2 years; &lt;i&gt;P&lt;/i&gt; = .868). The CID cohort had a higher arthrofibrosis rate (16.7% vs 4.3%; &lt;i&gt;P&lt;/i&gt; = .031), higher osteoarthritis rate (33.3% vs 16.7%; &lt;i&gt;P&lt;/i&gt; = .041), higher total knee arthroplasty (TKA) rate (16.7% vs 3.3%; &lt;i&gt;P&lt;/i&gt; = .016), and earlier time to TKA (14.7 vs 23.5 years; &lt;i&gt;P&lt;/i&gt; = .032). Knee range of motion, infection rate, retear rate, time to retear, and time to osteoarthritis were not statistically different between the cohorts. The CID cohort had higher visual analog scale pain scores (mean, 2.00 vs 1.20; &lt;i&gt;P&lt;/i&gt; = .043) but slightly higher satisfaction (mean, 3.92 vs 3.39; &lt;i&gt;P&lt;/i&gt; = .043). There were no differences in preinjury Tegner, postoperative Tegner, change in Tegner, or IKDC score. In a univariate Cox regression model, the CID cohort had a retear hazard ratio of 1.43 (95% CI, 0.46-4.51; &lt;i&gt;P&lt;/i&gt; = .537). Kaplan-Meier survival revealed no significant differences in retear-free survival between the CID and non-CID cohorts at 25 years (85.7% vs 87.3%; &lt;i&gt;P&lt;/i&gt; = .53). The CID cohort had a TKA hazard ratio of 3.94 (95% CI, 1.05-14.8; &lt;i&gt;P&lt;/i&gt; = .042). Kaplan-Meier survival demonstrated significantly decreased TKA-free survival at 25 years in the CID cohort (64.9% vs 91.2%; &lt;i&gt;P&lt;/i&gt; = .029).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;CID increases the incidence of arthrofibrosis, osteoarthritis, and TKA in those undergoing ACLR. Patients with CID also undergo TKA significantly sooner than non-CID counterparts. Notably, the majority of patient-reported outcome measures are no worse in patients who have a CID diagnosis. Thus, ACLR constructs themselves may not necessarily fare worse in patients with CID. Nonetheless, these patients need to be ca","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"649-657"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030314","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":"Medial Meniscotibial Ligament Deficiency Increases Medial Meniscus Extrusion and Posterior Root Forces.","authors":"Matthew J J Anderson, Justin F M Hollenbeck, Amelia H Drumm, Emily A Whicker, Justin R Brown, Alexander R Garcia, John M Apostolakos, Wyatt H Buchalter, Natalie Cortes, Ryan J Whalen, Armando F Vidal, Matthew T Provencher","doi":"10.1177/03635465241309671","DOIUrl":"10.1177/03635465241309671","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;There is growing evidence that medial meniscotibial ligament (MTL) deficiency and medial meniscus extrusion may precede the development of some medial meniscus posterior root (MMPR) tears. However, no study has investigated the biomechanical consequences of MTL deficiency on the MMPR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Hypothesis: &lt;/strong&gt;(1) MTL deficiency leads to increased medial meniscus extrusion, (2) increased medial meniscus extrusion is correlated with increased compression and shear forces at the MMPR, and (3) MTL repair restores medial meniscus extrusion and MMPR forces to native levels.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Controlled laboratory study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Fifteen pairs of fresh-frozen cadaveric knees were tested. Specimens were organized into 3 groups according to a balanced incomplete block design: (1) native, (2) MTL deficiency, and (3) MTL repair. For the MTL deficiency group, a 3-cm deficiency in the MTL was developed under direct arthroscopic visualization. Specimens in the MTL repair group underwent a 2-anchor repair that compressed the joint capsule to the proximal tibia. All specimens were biomechanically tested in full extension with a tensile testing machine. The specimens underwent cyclic loading for 10,000 cycles at 1 Hz and compression of 20 to 500 N, with a 500-N compressive force applied for 30 seconds after the 0th, 100th, 1000th, and 10,000th cycles. Ultrasound was used to measure medial meniscus extrusion. Shear and compressive forces at the MMPR were measured with a 3-axis sensor installed inferior to the MMPR tibial attachment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Medial meniscus extrusion was significantly increased in the MTL deficiency group compared with the native group (0th: 1.6 ± 0.1 mm vs 1.2 ± 0.1 mm, &lt;i&gt;P&lt;/i&gt; &lt; .05; 100th: 2.2 ± 0.2 mm vs 1.5 ± 0.2 mm, &lt;i&gt;P&lt;/i&gt; &lt; .05; 1000th: 2.8 ± 0.2 mm vs 1.8 ± 0.2 mm, &lt;i&gt;P&lt;/i&gt; &lt; .05; 10,000th: 3.5 ± 0.3 mm vs 2.1 ± 0.2 mm, &lt;i&gt;P&lt;/i&gt; &lt; .05). Compression root force was significantly increased in the MTL deficiency group compared with the native group at all cyclic loading points (0th: 21.7 ± 12.8 N vs 13.6 ± 2.4 N, &lt;i&gt;P&lt;/i&gt; &lt; .05; 100th: 18.9 ± 11.0 N vs 12.1 ± 7.5 N, &lt;i&gt;P&lt;/i&gt; &lt; .05; 1000th: 16.5 ± 9.9 N vs 11.2 ± 7.5 N, &lt;i&gt;P&lt;/i&gt; &lt; .05; 10,000th: 12.6 ± 8.6 N vs 9.0 ± 6.9 N, &lt;i&gt;P&lt;/i&gt; &lt; .05). Root shear force was significantly increased in the MTL deficiency group compared with the native group at the 0th (17.5 ± 2.5 N vs 13.6 ± 2.4 N, &lt;i&gt;P&lt;/i&gt; &lt; .001) and 100th (16.2 ± 2.6 N vs 12.1 ± 2.2 N, &lt;i&gt;P&lt;/i&gt; &lt; .001) cycles. Medial meniscus extrusion, root shear force, and compression root force of the MTL repair group were not significantly different from the native group for all cyclic loading points.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Medial MTL deficiency led to increased medial meniscus extrusion as well as greater compression and shear forces at the MMPR compared with the intact and repaired MTL states, suggesting that MTL deficiency may pr","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"666-672"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016834","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 Play After Arthroscopic Superior Labral Repair: A Systematic Review.","authors":"Dana G Rowe, Eoghan T Hurley, Mikhail A Bethell, Samuel G Lorentz, Alex M Meyer, Christopher S Klifto, Brian C Lau, Dean C Taylor, Jonathan F Dickens","doi":"10.1177/03635465241246122","DOIUrl":"10.1177/03635465241246122","url":null,"abstract":"<p><strong>Background: </strong>Superior labral tears are common shoulder injuries among athletes, and for athletes undergoing surgical intervention, one of the main priorities is to return to preinjury levels of activity in a timely manner. However, the literature surrounding return to play after superior labral repair presents inconsistent results, with limited studies evaluating the timing of return to play.</p><p><strong>Purpose: </strong>To systematically review the rate and timing of return to play in athletes after arthroscopic superior labral repair.</p><p><strong>Study design: </strong>Systematic review; Level of evidence, 4.</p><p><strong>Methods: </strong>A systematic literature search was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the PubMed, EMBASE, and Cochrane Library databases. Eligible for inclusion were clinical studies reporting on return to play after arthroscopic superior labral repair. Subgroup analysis was conducted for overhead and collision athletes as well as for return to duty among military personnel. Meta-analysis was performed using Review Manager to compare superior labral repair to biceps tenodesis in the subset of studies comparing these treatments directly. A <i>P</i> value <.05 was considered to be statistically significant.</p><p><strong>Results: </strong>This review identified 42 studies including 1759 unique cases meeting the inclusion criteria. The majority of patients were male (76.7%), with a mean age of 31.5 years (range, 15-75 years) and a mean follow-up of 50.4 months. The overall rate of return to sport was 77.5%, with 68.2% returning to the same level at a mean of 8.2 months. In overhead athletes, the overall rate of return to play was 69.9% and the rate of return to preinjury level was 55.5%. In collision and contact athletes, the overall rate of return to play was 77.2% and the rate of return to preinjury level was 70.2%. Among military personnel, the overall rate of return to duty was 83.4%, and 81.7% returned to preinjury level at a mean of 4.4 months. In the studies comparing return to play after superior labral repair and biceps tenodesis, a nonsignificant difference was found (risk ratio, 0.92; 95% CI, 0.85-1.00; <i>I</i>² = 13%; <i>P</i> = .05).</p><p><strong>Conclusion: </strong>Overall, nearly a quarter of athletes were unable to return to play after arthroscopic superior labral repair. However, a high rate of return to duty was found among the military population treated with arthroscopic superior labral repair.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"727-733"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923980","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 Predicted Position of the Knee Near the Time of ACL Rupture Is Similar Between 2 Commonly Observed Patterns of Bone Bruising on MRI: Letter to the Editor.","authors":"Piero Agostinone, Stefano Di Paolo, Alberto Grassi, Stefano Zaffagnini","doi":"10.1177/03635465241311245","DOIUrl":"https://doi.org/10.1177/03635465241311245","url":null,"abstract":"","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":"53 3","pages":"NP6-NP7"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532210","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":"fMRI Activation in Sensorimotor Regions at 6 Weeks After Anterior Cruciate Ligament Reconstruction.","authors":"Adam M Culiver, Dustin R Grooms, Jaclyn B Caccese, Scott M Hayes, Laura C Schmitt, James A Oñate","doi":"10.1177/03635465251313808","DOIUrl":"10.1177/03635465251313808","url":null,"abstract":"<p><strong>Background: </strong>Brain activity during knee movements is altered throughout the sensorimotor network after anterior cruciate ligament reconstruction (ACLR). Patients at 2 to 5 years after surgery appear to require greater neural activity to perform basic knee movement patterns, but it is unclear if brain activity differences within sensorimotor regions are present early after surgery. It is also unknown whether uninvolved knee movements elicit similar or unique activity compared with involved knee movements.</p><p><strong>Purpose: </strong>To examine brain activity in sensorimotor regions during involved and uninvolved knee movements in patients at 6 weeks after ACLR compared with control participants.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 2.</p><p><strong>Methods: </strong>A total of 15 patients who underwent ACLR (mean age, 21.9 ± 4.3 years [range, 17-29 years]; 8 female) and 15 control participants performed 30-second blocks of repeated knee flexion and extension, followed by 30 seconds of rest, during functional magnetic resonance imaging. Regions of interest included the right and left primary motor cortex (M1), right and left primary somatosensory cortex (S1), supplementary motor area (SMA), precuneus, and lingual gyrus. Activity from task-relevant voxels (move > rest) was extracted, and generalized estimating equations evaluated the main effect of group and group-by-limb interaction. Effect sizes were calculated using the Cohen <i>d</i>.</p><p><strong>Results: </strong>Reduced brain activity during knee flexion and extension was observed in the ACLR group in the ipsilateral M1 and S1, contralateral S1, SMA, and precuneus during movements of the involved and uninvolved knees. There were no group-by-limb interaction effects, indicating no significant differences between the involved knee and uninvolved knee in the ACLR group. Medium to large effect sizes were identified for between-group differences in all regions.</p><p><strong>Conclusion: </strong>At 6 weeks after ACLR, patients exhibited bilateral reductions in brain activity during knee movements in multiple sensorimotor regions. These identified regions are associated with motor planning, motor execution, somatosensory function, and sensorimotor integration. These data indicate that ACLR affected sensorimotor brain activity in both limbs during the early postoperative phase of rehabilitation.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"791-800"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191383","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}