American Journal of Sports Medicine最新文献

{"title":"Anatomic Drivers of J-Sign Presence and Severity: If There Is a Jump, Look for a Bump.","authors":"Navya Dandu, Mario Hevesi, Andrew R Phillips, Erik C Haneberg, Tristan J Elias, Zachary Wang, Nicholas Trasolini, Adam B Yanke","doi":"10.1177/03635465251322788","DOIUrl":"10.1177/03635465251322788","url":null,"abstract":"<p><strong>Background: </strong>Medial patellofemoral ligament reconstruction is frequently indicated for recurrent lateral patellar instability. The preoperative presence and severity of a J-sign have been associated with poorer postoperative outcomes.</p><p><strong>Purpose: </strong>To determine the underlying anatomic factors that contribute to the presence, severity, and jumping quality of the J-sign.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>All patients undergoing evaluation for patellar instability at a single institution between 2013 and 2023 and healthy controls without patellar instability were included. Patients with a history of knee osteotomies were excluded. The presence of a jumping J-sign and its relationship to patellofemoral measures including the Caton-Deschamps Index (CDI), trochlear dysplasia (Dejour grade), tibial tubercle-trochlear groove (TT-TG) distance, tibial tubercle lateralization, trochlear bump height, mechanical alignment, femoral anteversion, tibial torsion, trochlear medialization, patellar width, axial patellar/trochlear overlap, patellar height, trochlear height, and knee rotation angle (KRA) were measured using standardized 1.5-T magnetic resonance imaging (MRI). Univariate pairwise and multivariable analyses were performed to determine the factors associated with J-sign presence, severity, and quality.</p><p><strong>Results: </strong>Of the 130 knees with patellar instability, 89 (68.5%) demonstrated a J-sign on physical examination. In total, 44 (33.8%) patients demonstrated a 1-quadrant J-sign, 32 (24.6%) demonstrated a 2-quadrant smooth J-sign, and 13 (10.0%) demonstrated a jumping J-sign. A total of 22 control, noninstability cases were included. On multivariable analysis, increasing TT-TG distance (OR, 1.1 increase per millimeter; <i>P</i> = .04), external KRA (OR, 1.1 increase per degree; <i>P</i> = .02), and increasing CDI (OR, 1.3 increase per 0.1 increase in CDI; <i>P</i> = .02) were associated with J-sign presence. Increasing bump height (OR, 1.72 increase per millimeter; <i>P</i> = .007) and decreasing patellar width (OR, 0.89 decrease per millimeter; <i>P</i> = .076) were associated with a larger J-sign, when present. Increasing bump height (OR, 1.80 increase per millimeter; <i>P</i> = .018), increasing patellar width (OR, 1.33 increase per millimeter; <i>P</i> = .047), and decreasing CDI (OR, 0.009 decrease per 0.01 increase in ratio; <i>P</i> = .008) were associated with a jumping J-sign in comparison with a smooth 2-quadrant J-sign. A KRA of 10° (AUC, 0.70) and a cartilaginous bump height of 6.6 mm (AUC, 0.73) were thresholds associated with jumping J-sign presence.</p><p><strong>Conclusion: </strong>The presence of a J-sign is associated with MRI findings of relatively greater external tibiofemoral rotation, increased TT-TG distance, and increased patellar height, while J-sign severity and jumping quality are associated wi","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1119-1126"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607009","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":"When Lateral Epicondylitis Is Not Lateral Epicondylitis: Analysis of the Risk Factors for the Misdiagnosis of Lateral Elbow Pain.","authors":"Davide Blonna, Norsaga Hoxha, Valentina Greco, Carolina Rivoira, Davide Edoardo Bonasia, Roberto Rossi","doi":"10.1177/03635465251319545","DOIUrl":"10.1177/03635465251319545","url":null,"abstract":"<p><strong>Background: </strong>Lateral elbow pain, often attributed to lateral epicondylitis, presents diagnostic complexities. Lateral epicondylitis, or tennis elbow, is the most frequent cause of lateral elbow pain, but a differential diagnosis among all the potential causes of lateral elbow pain is not easy.</p><p><strong>Purpose: </strong>To evaluate the rate of misdiagnoses in patients previously diagnosed with lateral epicondylitis, identify at-risk patient profiles, and determine sensitive clinical tests for a misdiagnosis.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>A prospective analysis was conducted on 189 consecutive patients with a previous diagnosis of lateral epicondylitis and failed nonoperative treatment. According to medical history and a physical examination, patients were preliminarily classified into the typical or atypical lateral epicondylitis group. Atypical epicondylitis was defined as one of the following: atypical lateral pain location, history of trauma, limited range of motion (ROM), elbow swelling, negative Cozen test finding, and physical examination findings suggesting a misdiagnosis. Patients in the atypical group were further investigated for a potential lateral epicondylitis misdiagnosis using magnetic resonance imaging, computed tomography, and/or analysis of intraoperative samples according to suspected underlying abnormalities. Univariate and logistic regression analyses were conducted to assess the risk of a misdiagnosis. A standardized diagnostic analysis was performed to evaluate the clinical tests used during the physical examination to identify misdiagnosed patients.</p><p><strong>Results: </strong>A misdiagnosis occurred in 21 of 189 (11%) patients. The most common misdiagnoses were posterolateral elbow instability in 6 patients; radial nerve compression and inflammatory osteoarthritis in 3 patients each; and osteochondritis dissecans, posterolateral plica, and primary osteoarthritis in 2 patients each. The variables associated with a misdiagnosis were young age (≤30 years; odds ratio [OR], 66.90; <i>P</i> < .001), history of trauma (OR, 17.85; <i>P</i> = .0027), history of a limitation of ROM and/or mechanical symptoms (OR, 16.68; <i>P</i> = .0278), history of elbow swelling (OR, 14.32; <i>P</i> = .0032), and number of corticosteroid injections (OR, 2.00; <i>P</i> = .0007). Atypical lateral pain location highly predicted a misdiagnosis, with a sensitivity of 90.5%.</p><p><strong>Conclusion: </strong>A misdiagnosis can occur in patients affected by longstanding lateral elbow pain. Young patients and patients with a history of elbow trauma, a limitation of ROM, swelling, corticosteroid injections, and atypical lateral pain should be highly suspected for a misdiagnosis.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1195-1201"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484711","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":"Primary Fixation and Cyclic Performance of Posterior Horn Medial Meniscus Root Repair With Knotless Adjustable Suture Anchor-Based Fixation: A Human Biomechanical Evaluation Over 100,000 Loading Cycles.","authors":"Samuel Bachmaier, Aaron J Krych, Patrick A Smith, Clayton W Nuelle, Peter E Müller, Asheesh Bedi, Coen A Wijdicks","doi":"10.1177/03635465251317210","DOIUrl":"10.1177/03635465251317210","url":null,"abstract":"<p><strong>Background: </strong>Recent biomechanical evidence for adjustable suture anchor (ASA)-based posterior medial meniscus root (PMMR) fixation has shown promising results compared with conventional transtibial pull-out repair (TPOR). However, ASA fixation has not been evaluated in human tissue to 100,000 cycles.</p><p><strong>Hypothesis: </strong>ASA repair would lead to increased primary fixation strength and less cyclic displacement than conventional TPORs.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>A total of 32 human medial menisci were used, 8 of which were intact specimens and served as native controls. For the others, PMMR tears were created and repaired using 3 different techniques (n = 8 group). Two conventional PMMR repairs were prepared consisting of two No. 2 simple sutures (TSS) and two No. 2 sutures in a Mason-Allen (MA) configuration, all tied over a cortical button. The knotless ASA repair was fixed in MA with repair sutures tensioned at 120 N (MA-120). The repairs' initial force, stiffness, and relief displacement from the tensioned state toward repair unloading (2 N) were measured after fixation. All repair constructs were loaded for 100,000 cycles, with displacement and stiffness measured, and finally were pulled to failure.</p><p><strong>Results: </strong>The TPORs demonstrated similar primary fixation and cyclic loading behavior except for initial cyclic displacement (cycle 10). The ASA repair provided a higher initial repair load (<i>P</i> < .001) and stiffness (<i>P</i> < .001) with relief displacement similar to conventional TPORs. Lower initial cyclic displacement (<i>P</i> < .011; cycle 10) with overall higher repair stiffness (<i>P</i> < .011) resulted in significantly lower displacement (<i>P</i> < .001) throughout testing for ASA repair. Although both TPORs were completely loose after 100,000 cycles, the ASA repair achieved near-native dynamic meniscal stabilization. The TSS repair had lower overall ultimate load (<i>P</i> < .001) and ultimate stiffness (<i>P</i> < .023) compared with the ASA repair. All repairs had lower ultimate stiffness and loads than the native meniscus (<i>P</i> < .001).</p><p><strong>Conclusion: </strong>The ASA repair resulted in improved primary PMMR fixation that was stiffer with less cyclic displacement than conventional TPORs and approached that of the human meniscal function after 100,000 load cycles in a cadaveric model. However, all repair techniques had lower ultimate strength than the native human PMMR.</p><p><strong>Clinical relevance: </strong>Knotless ASA meniscus root fixation resulted in higher tissue compression and less displacement in a cadaveric model; however, future clinical series with surveillance imaging will define the overall significance of healing rates.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1093-1100"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460741","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 Biomechanical Importance of Bone Block Positioning in Glenoid Augmentation: Every Millimeter Matters.","authors":"Sebastian Oenning, Jens Wermers, Alina Köhler, Julia Sußiek, Mats Wiethölter, Michael J Raschke, J Christoph Katthagen","doi":"10.1177/03635465251322796","DOIUrl":"10.1177/03635465251322796","url":null,"abstract":"<p><strong>Background: </strong>In the presence of anterior glenoid bone loss (aGBL), options for bony glenoid augmentation include Latarjet procedures and free bone block transfers. Bone graft placement is challenging, and malposition causes complications, such as recurrent instability or osteoarthritis.</p><p><strong>Hypothesis: </strong>With minimal changes in bone block positioning, osteochondral shoulder stability cannot be restored sufficiently.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>In a robotic test setup, 14 human cadaveric scapulae were included. Soft tissue was resected, and matching artificial humeri were selected for each specimen. Testing was performed in 60° of glenohumeral abduction with 50 N of glenohumeral compression and anterior-directed translational force to the humerus. Application of 20% aGBL and screw fixation of artificial bone blocks (artBBs) with different buildup shells allowed the following testing stages: (1) intact, (2) 20% aGBL, (3) flush artBB, (4) 1-mm medialized artBB, and (5) 1-mm lateralized artBB. The stability ratio (SR) and medial-lateral humeral head starting position were assessed.</p><p><strong>Results: </strong>Specimens with 20% aGBL provided lower mean SRs than native joints (20.6% [SD, 4.7%] vs 27.8% [SD, 6.7%]; <i>P</i> < .0001). Flush artBB placement (mean, 35.4%; SD, 7.7%) led to an increased SR compared with both native joints (<i>P</i> = .002) and 20% aGBL (<i>P</i> < .0001). The mean SR in 1-mm medialized artBBs (21.5%; SD, 5.7%) did not differ compared with that for 20% aGBL (<i>P</i> = .908). One-millimeter lateralized artBBs (mean, 40.8%; SD, 5%) provided higher SR and more lateral humeral head starting positions compared with flush artBB (<i>P</i> = .003 and <i>P</i> = .003, respectively).</p><p><strong>Conclusion: </strong>In the presence of aGBL, flush bone block placement restores osteochondral glenohumeral stability, while a 1-mm medialized bone block fails to increase stability. Bone block lateralization of 1 mm provides higher stability but is associated with humeral head lateralization.</p><p><strong>Clinical relevance: </strong>Glenoid bone block augmentations are established in patients with glenohumeral instability and aGBL. In the case of bone block malposition, complications like recurrent instability or the development of osteoarthritis can occur. This study underlines the importance of accurate bone block placement since only minimum bone block malposition relevantly affects osteochondral shoulder biomechanics.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1164-1170"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538126","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":"Analyzing the Association of the Area Deprivation Index on Patient-Reported Outcomes in Patients Undergoing Hip Arthroscopy.","authors":"Jordan J Cruse, Hashim J F Shaikh, James D Brodell, Mina Botros, Terrence S Daley-Lindo, Raymond J Kenney, Brian D Giordano","doi":"10.1177/03635465251316432","DOIUrl":"10.1177/03635465251316432","url":null,"abstract":"<p><strong>Background: </strong>Hip arthroscopy is a valuable tool through which intra- and extra-articular hip pathologies may be addressed, with the goal of improving pain and function while preventing osteoarthritis progression. Little data are available regarding the effect of social determinants of health on hip arthroscopy outcomes.</p><p><strong>Purpose: </strong>To determine if a patient's lived environment is associated with better or worse postoperative outcomes using the area deprivation index (ADI).</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients undergoing hip arthroscopy between January 1, 2015, and June 30, 2022, at a single institution were identified using Current Procedural Terminology codes. Patients' zip codes were utilized to identify ADI measures. Patients were divided into quartiles of ADI, and the most deprived (ADI_High) and least deprived (ADI_Low) quartiles were compared. Pre- and postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores for the Pain Interference (PI), Physical Function (PF), and Depression domains were obtained. For the PF and PI domains, the minimal clinically important difference (MCID) was defined using an anchor-based approach using previously established cutoffs. For the Depression domain, the MCID was defined using a distribution-based approach and calculated as one-half of the standard deviation of the preoperative PROMIS score. Multivariable logistic regression models were estimated to characterize the association of the ADI with MCID attainment along PROMIS domains.</p><p><strong>Results: </strong>A total of 170 patients were included in the analysis of the ADI_High (n = 85) and ADI_Low (n = 85) cohorts. Age, body mass index, smoking status, and race did not significantly vary between groups. No significant differences in MCID attainment were observed at any time point in the PF, PI, or Depression domains. However, the ADI_High cohort had higher mean PI (worse) scores compared with the ADI_Low cohort at the preoperative, 1-year, and final follow-up (mean, 2.52 years) time points. In multivariable logistic regression analyses, ADI was not associated with the odds of MCID attainment.</p><p><strong>Conclusion: </strong>For patients undergoing hip arthroscopy, increased social disadvantage measured by the ADI was not associated with the odds of MCID attainment in any PROMIS domain. This information provides guidance for care providers, researchers, and policymakers to seek and identify other mechanisms that may affect outcomes after hip arthroscopy.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1133-1141"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serial Changes in Muscle Strength and Dynamic Balance After Lateral Meniscal Allograft Transplantation: A Retrospective Cohort Study of 55 Patients.","authors":"Seung Ik Cho, Ji Seung Yoo, Sung Gyu Moon, Ji Hee Kang, Sang Jin Yang, Jin Goo Kim, Dhong Won Lee","doi":"10.1177/03635465251317741","DOIUrl":"10.1177/03635465251317741","url":null,"abstract":"<p><strong>Background: </strong>Despite numerous studies examining subjective clinical scores after meniscal allograft transplantation (MAT), research focusing specifically on functional measures is lacking.</p><p><strong>Purpose: </strong>To evaluate the serial changes in isokinetic muscle strength and dynamic balance during the first postoperative year after lateral MAT (LMAT).</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A total of 55 patients who underwent LMAT underwent subjective functional assessment using the Lysholm and subjective International Knee Documentation Committee (IKDC) scores. The objective functions, evaluated using isokinetic muscle strength testing and the Y-balance test for dynamic postural stability, were recorded preoperatively and 6 and 12 months postoperatively. Magnetic resonance imaging (MRI) was performed at 2 days and 12 months postoperatively to evaluate the meniscal allograft extrusion and cartilage condition in the lateral compartment. At 12 months, patients with graft extrusion >3 mm on MRI were assigned to the extrusion group.</p><p><strong>Results: </strong>Significant improvements were observed in the Lysholm and subjective IKDC scores at 12 months postoperatively (both <i>P</i> < .001). The joint space width did not significantly increase (<i>P</i> = .054). Coronal graft extrusion increased significantly (<i>P</i> < .001). At 6 months postoperatively, isokinetic muscle strength tests indicated no significant reduction in the peak torque for knee extension (<i>P</i> = .911). However, at 12 months, the peak torque was significantly increased (<i>P</i> = .001), with the deficits improving from 38.3% to 18.1% (<i>P</i> < .001). No significant changes were noted in the knee flexion strength. Dynamic postural stability showed a significant decrease in the Limb Symmetry Index (LSI) for the anterior reach at 6 months (<i>P</i> = .004), but significant improvements were seen by 12 months, with the LSI values for the anterior, posteromedial, and posterolateral reaches all exceeding 90% (<i>P</i> < .001). No significant differences in muscle strength or dynamic balance were found between the nonextrusion (n = 41) and extrusion (n = 14) groups at 12 months.</p><p><strong>Conclusion: </strong>The significant improvements in isokinetic muscle strength and dynamic postural stability achieved only by 12 months after LMAT underscores the necessity of a comprehensive rehabilitation program and caution against premature sports resumption.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1101-1111"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Greater Cognitive-Motor Interference Among Patients After Anterior Cruciate Ligament Reconstruction Compared With Controls.","authors":"Andrew Strong, Carl-Johan Boraxbekk, Jonas L Markström","doi":"10.1177/03635465251322947","DOIUrl":"10.1177/03635465251322947","url":null,"abstract":"<p><strong>Background: </strong>Chaotic sporting environments require the performance of concurrent cognitive and motor tasks. A reduced capacity for either or both of the tasks when performed concurrently is known as cognitive-motor interference (CMi) and is believed to increase the injury risk. A greater susceptibility to CMi after a rupture of the anterior cruciate ligament (ACL) has been suggested to be caused by central nervous system adaptations, thus possibly contributing to high secondary ACL injury rates.</p><p><strong>Purpose: </strong>To investigate whether patients after ACL reconstruction (ACLR) demonstrate greater CMi than noninjured controls when adding secondary cognitive tasks to the drop vertical jump (DVJ) and explore the potential influence of sex on CMi.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>A total of 40 (50% male) sports-active patients who had undergone ACLR (mean, 24.9 ± 16.1 months after surgery) and 40 (50% male) sports-active noninjured controls performed DVJs with and without secondary cognitive tasks targeting short-term memory, attention, fast decision-making, and inhibitory control. Outcomes included a letter position recall task and 3 motor variables: (1) correct action (landing or landing with a subsequent vertical jump), (2) relative jump height (relative between DVJs), and (3) relative peak vertical ground-reaction force (relative between DVJs). Participants also completed isolated cognitive tests (CANTAB) included as covariates in multivariate analysis.</p><p><strong>Results: </strong>Multivariate analysis of variance revealed that the ACLR group had greater CMi than the control group (<i>P</i> < .001), as manifested by more incorrect answers for the cognitive letter recall task (mean difference [MD], -13.3% [95% CI, -20.8% to -5.9%]; <i>P</i> < .001), more incorrect motor actions (MD, -7.5% [95% CI, -12.4% to -2.6%]; <i>P</i> = .003), and a reduced relative jump height (MD, -4.5% [95% CI, -7.9% to -1.2%]; <i>P</i> = .010). No difference in relative peak vertical ground-reaction force was found (MD, 2.8% [95% CI, -7.7% to 13.3%]; <i>P</i> = .59). Isolated cognitive outcomes did not affect these results, and there were no significant differences between male and female participants.</p><p><strong>Conclusion: </strong>Patients after ACLR showed greater CMi than noninjured controls, which was unrelated to isolated cognitive outcomes, thus indicating aberrant neurocognitive function.</p><p><strong>Clinical relevance: </strong>Clinicians should consider cognitive and dual-task training and screening during ACL rehabilitation to better prepare patients for chaotic and uncontrolled sporting environments in which dual tasking is prevalent. Such interventions may help to reduce the risk of secondary ACL injuries.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1041-1049"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544688","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of a Supratrochlear Spur on Patellofemoral Cartilage in Patients With Trochlear Dysplasia.","authors":"Jakob Ackermann, Berfin Caliskan, Martin Hartmann, Lazaros Vlachopoulos, Sandro F Fucentese","doi":"10.1177/03635465251323806","DOIUrl":"10.1177/03635465251323806","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The presence of a supratrochlear spur has been shown to influence outcomes in patients with trochlear dysplasia and is thought to accelerate cartilage wear. However, the current literature does not provide an evidence-based threshold for a relevant supratrochlear spur height.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose/hypothesis: &lt;/strong&gt;The purpose of this study was to establish a clinically significant supratrochlear spur height associated with patellofemoral chondral damage to guide surgeons in surgical decision-making. It was hypothesized that a supratrochlear spur negatively affects patellofemoral articular cartilage, with large spurs having the greatest effect.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Case series; Level of evidence, 4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This study evaluated 363 knees with trochlear dysplasia that were scheduled to undergo surgery for the treatment of patellar instability at a single institution. All patients underwent preoperative true lateral radiography and magnetic resonance imaging (MRI). There were 2 independent reviewers who analyzed the supratrochlear spur height by measuring the distance between a tangent at the anterior femoral cortex and the most prominent point of the trochlea on sagittal MRI as well as other common patellofemoral parameters. All MRI scans were assessed for full-thickness cartilage lesions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the included 363 knees, 91 (25.1%) showed full-thickness cartilage defects on the patella, while 21 (5.8%) had full-thickness trochlear cartilage damage. Patellar defects were significantly correlated with patient's age (&lt;i&gt;r&lt;/i&gt; = 0.237; &lt;i&gt;P&lt;/i&gt; &lt; .001), body mass index (&lt;i&gt;r&lt;/i&gt; = 0.148; &lt;i&gt;P&lt;/i&gt; = .005), and supratrochlear spur height (&lt;i&gt;r&lt;/i&gt; = 0.196; &lt;i&gt;P&lt;/i&gt; &lt; .001). Trochlear defects were significantly associated with patient's age (&lt;i&gt;r&lt;/i&gt; = 0.160; &lt;i&gt;P&lt;/i&gt; = .002), patellar tilt (&lt;i&gt;r&lt;/i&gt; = 0.202; &lt;i&gt;P&lt;/i&gt; &lt; .001), tibial tubercle-trochlear groove distance (&lt;i&gt;r&lt;/i&gt; = 0.128; &lt;i&gt;P&lt;/i&gt; = .014), and supratrochlear spur height (&lt;i&gt;r&lt;/i&gt; = 0.151; &lt;i&gt;P&lt;/i&gt; &lt; .004). Trochlear dysplasia types B and D showed a trend toward a higher prevalence in patellar defects (&lt;i&gt;P&lt;/i&gt; = .082), while they were significantly associated with a higher prevalance of trochlear defects (&lt;i&gt;P&lt;/i&gt; = .003) compared with types A and C. Knees with patellar (5.1 ± 2.0 vs 4.3 ± 1.7 mm, respectively; &lt;i&gt;P&lt;/i&gt; = .001) and trochlear (5.3 ± 2.1 vs 4.4 ± 1.8 mm, respectively; &lt;i&gt;P&lt;/i&gt; = .015) cartilage defects had a significantly larger supratrochlear spur height than knees without patellar and trochlear defects. A supratrochlear spur height ≥6 mm had adjusted odds ratios of 2.7 (95% CI, 1.6-4.5; &lt;i&gt;P&lt;/i&gt; &lt; .001) and 3.4 (95% CI, 1.3-8.8; &lt;i&gt;P&lt;/i&gt; = .014) for developing patellar and trochlear cartilage damage, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;A supratrochlear spur was significantly associated with patellofemoral cartilage damage. Large supratrochlear spurs demonstrat","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1127-1132"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Controlled Release of Platelet-Rich Plasma-Loaded Alginate Repairs Muscle Damage With Less Fibrosis.","authors":"William Kenzo Felipone, Luana de Mambro, Beatrice Rodrigues Ranieri, Giovana Zaneti Ivanov, Robert Meves, Leonardo Martins, Roberta Sessa Stilhano","doi":"10.1177/03635465251321108","DOIUrl":"10.1177/03635465251321108","url":null,"abstract":"<p><strong>Background: </strong>Muscle injuries often result in dysfunctional muscle repair and reduced muscle strength. While platelet-rich plasma (PRP) has emerged as a new treatment option in orthopaedics, its use for muscle injuries remains controversial.</p><p><strong>Hypothesis: </strong>Encapsulating PRP within alginate hydrogels will achieve a localized and sustained release of growth factors at the site of the muscle injury, thereby enhancing skeletal muscle repair and reducing fibrosis.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Bimodal blends of hydrogels were formulated using 1% oxidized high- and low-molecular weight alginate. There were 2 types of PRP prepared: leukocyte-rich PRP (L-PRP) and pure PRP (P-PRP). These PRP types were loaded onto 75L25H alginate hydrogels, and the release of TGF-β1 was quantified over time. A laceration injury was induced in mice, which was then treated with various agents: alginate only, L-PRP, L-PRP-loaded alginate (L-PRPA), P-PRP, and P-PRP-loaded alginate (P-PRPA). An additional 2 groups were formed: injury with no treatment and control with no treatment or injury.</p><p><strong>Results: </strong>Our in vitro experiments showed that after an initial burst, TGF-β1 was released in a sustained manner for approximately 1 week after the encapsulation of both PRP preparations. The in vivo experiments showed that the groups treated with bolus injections of L-PRP or P-PRP did not show significant changes in the fibrotic area. However, the L-PRPA and P-PRPA groups demonstrated a 50% reduction in the fibrotic area (<i>P</i> < .05), resulting in a higher ratio of regenerating myofibers and higher levels of myogenic markers (myogenin and MyHC-emb) compared with all the other groups (<i>P</i> < .05). The L-PRPA group demonstrated significantly improved performance on the rotarod test; interestingly, this group also had more type I collagen than type III collagen.</p><p><strong>Conclusion: </strong>The administration of L-PRP and P-PRP after a muscle injury did not reduce fibrosis. However, when loaded onto alginate hydrogels, they led to benefits, resulting in a smaller area of fibrosis and greater tissue regeneration.</p><p><strong>Clinical relevance: </strong>The encapsulation of different preparations of PRP by alginate hydrogels was more effective in treating muscle lacerations than injections of PRP alone. This information is relevant for future clinical studies of PRP.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1152-1163"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143494647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Chance to Become an Elite Athlete After Pediatric And Adolescent Anterior Cruciate Ligament Reconstruction.","authors":"Baldur Thorolfsson, Philipp W Winkler, Ramana Piussi, Thorkell Snaebjörnsson, Rebecca Hamrin Senorski, Jon Karlsson, Kristian Samuelsson, Eric Hamrin Senorski","doi":"10.1177/03635465251320415","DOIUrl":"10.1177/03635465251320415","url":null,"abstract":"<p><strong>Background: </strong>An anterior cruciate ligament (ACL) injury is a severe condition that may affect the career of young athletes. There is limited evidence on the rate and level of return to sport (RTS) after pediatric and adolescent ACL reconstruction.</p><p><strong>Purpose: </strong>To evaluate clinical outcomes, the level and rate of RTS, and predictive factors for RTS after pediatric and adolescent ACL reconstruction.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients aged between 10 and 18 years at the time of primary ACL reconstruction were screened for eligibility. Based on age at the time of ACL reconstruction, patients were divided into the pediatric (female: 11-13 years; male: 11-15 years) and adolescent (female: 14-18 years; male: 16-18 years) groups. Patient-specific, injury-related, and treatment-specific data, as well as subscores of the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline and 1-, 2-, 5-, and 10-year follow-up, were obtained. A survey consisting of 3 patient-specific and 30 knee-related questions was developed by experts in the management of ACL injuries and was sent to all patients to determine sport-specific variables and RTS rates.</p><p><strong>Results: </strong>Overall, 1392 patients (total response rate: 24%) were included in this study. There were 81 pediatric patients (mean age at ACL reconstruction, 13.7 ± 1.4 years) and 1311 adolescent patients (mean age at ACL reconstruction, 16.5 ± 1.2 years). Significant improvements in KOOS subscores were observed after both pediatric and adolescent ACL reconstruction at each follow-up time point. After ACL reconstruction, 74% of pediatric patients and 68% of adolescent patients returned to their previous type of sport (<i>P</i> = .23). Moreover, 31% of pediatric patients and 23% of adolescent patients became elite athletes (highest national level of junior sport or higher) after ACL reconstruction (<i>P</i> = .13). A cartilage injury at the time of ACL reconstruction was found to lower the odds of pediatric and adolescent patients returning to their previous type of sport (odds ratio, 0.60; <i>P</i> = .001). A second ACL injury occurred in 25% and 31% of pediatric and adolescent patients, respectively (<i>P</i> = .29).</p><p><strong>Conclusion: </strong>Long-lasting clinical improvements and high RTS rates can be expected after pediatric and adolescent ACL reconstruction. Moreover, young athletes still have the chance to compete at an elite level of sport after ACL reconstruction.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1027-1033"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}