American Journal of Sports Medicine最新文献

{"title":"Association Between Global Overcoverage and Long-term Survivorship, Chondrolabral Junction Breakdown, and Reduced Joint Space Width: Minimum 8-Year Follow-up.","authors":"Jonathan S Lee, Stephen M Gillinov, Bilal S Siddiq, Kieran S Dowley, Michael C Dean, Nathan J Cherian, Christopher T Eberlin, Michael P Kucharik, Scott D Martin","doi":"10.1177/03635465251317738","DOIUrl":"10.1177/03635465251317738","url":null,"abstract":"<p><strong>Background: </strong>Although previous literature has established the association between femoroacetabular impingement and progressive hip osteoarthritis, there exists a paucity of studies investigating the effects of global acetabular overcoverage on chondral wear and long-term outcomes.</p><p><strong>Purpose: </strong>To compare baseline joint space width (JSW), intraoperative findings, long-term total hip arthroplasty (THA)-free survivorship, patient-reported outcome measures (PROMs), pain levels, and patient satisfaction in patients who underwent hip arthroscopy with global overcoverage (GO) to a matched-control (MC) cohort.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>In this retrospective analysis, the authors queried patients who underwent hip arthroscopy for acetabular labral tears secondary to femoroacetabular impingement. Patients with complete PROMs at a minimum 8-year follow-up, the presence of coxa profunda as indicated by an acetabular wall projecting medial to the ilioischial line, and a lateral center-edge angle >40° were matched 1:1 by sex, age, body mass index, Tönnis grade, and labral treatment to a MC cohort of patients who had normal acetabular coverage. Baseline radiographic and intraoperative findings were compared between cohorts. Collected outcomes include the modified Harris Hip Score, Nonarthritic Hip Score, Lower Extremity Functional Scale score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Specific Subscale, 33-item International Hip Outcome Tool score, pain levels, patient satisfaction, and conversion to THA.</p><p><strong>Results: </strong>In total, 38 patients with GO were 1:1 matched to a MC cohort. The GO cohort had significantly decreased baseline JSW at 50° (<i>P</i> = .002) and greater chondrolabral junction breakdown (<i>P</i> = .037). The GO and MC cohorts achieved similar outcomes for all 6 PROMs, rates of conversion to THA, pain levels, and patient satisfaction. Kaplan-Meier survival analysis demonstrated that the patients experienced a similar overall 18-year THA-free survival rate (GO: 71.1% vs MC: 84.2%; <i>P</i> = .101). To isolate the long-term effects of GO on hip arthroscopy outcomes, 6- to 18-year THA-free survivorship was examined, revealing that the GO cohort (-13.1%) experienced a significantly greater decrease compared with the MC cohort (-5.3%) (<i>P</i> = .008).</p><p><strong>Conclusion: </strong>Patients with GO had significantly lower baseline ipsilateral JSW at 50° and greater intraoperative severity of chondrolabral junction breakdown. Furthermore, the GO cohort experienced a significantly greater decrease in long-term THA-free survivorship 6 to 18 years after hip arthroscopy.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"900-910"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460806","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":"To Fix or Rebuild.","authors":"Brett D Owens","doi":"10.1177/03635465251318658","DOIUrl":"https://doi.org/10.1177/03635465251318658","url":null,"abstract":"","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":"53 3","pages":"523-524"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532217","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":"Trochlear Morphological Changes in Skeletally Immature Patients Across Consecutive MRI Studies.","authors":"Kevin J Orellana, Julianna Lee, Daniel Yang, David Kell, Jie Nguyen, J Todd Lawrence, Brendan A Williams","doi":"10.1177/03635465241312168","DOIUrl":"10.1177/03635465241312168","url":null,"abstract":"<p><strong>Background: </strong>Trochlear dysplasia is a consistent risk factor for recurrent patellofemoral instability (PFI), but there is limited understanding of how the trochlea develops during growth. The aim of this study was to evaluate serial magnetic resonance imaging (MRI) studies performed in skeletally immature patients with and without PFI to characterize changes in trochlear anatomy over time.</p><p><strong>Hypothesis: </strong>PFI leads to progressive worsening of trochlear dysplasia over time.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 3.</p><p><strong>Methods: </strong>A retrospective case-control study was conducted on pediatric patients (<18 years of age) with and without a diagnosis of PFI who had multiple ipsilateral MRI studies of the knee at least 6 months apart. Inclusion criteria were patients with open distal femoral physes at the initial MRI study and no intervening surgery between MRI studies. All patients with PFI were included, and 30 patients without PFI were identified for comparison. MRI scans were retrospectively reviewed to evaluate trochlear morphology using the Dejour and Oswestry-Bristol classifications and to measure the sulcus angle, trochlear depth index, medial condylar trochlear offset, and lateral trochlear inclination (LTI). Univariate and bivariate statistics were performed to evaluate differences in morphology between MRI studies and between groups.</p><p><strong>Results: </strong>A total of 128 patients were identified (98 in the PFI group, 30 in the non-PFI group) with a mean age of 12.3 ± 2.4 years and mean time between MRI studies of 2.3 ± 1.5 years (range, 0.5-6.5 years). Among patients with PFI, rates of moderate to severe (Dejour grades B-D and Oswestry-Bristol classification flat or convex) trochlear dysplasia increased from the initial to most recent imaging study (67% vs 89%; <i>P</i> < .001), and statistically significantly more dysplastic LTI and sulcus angle were observed on follow-up (<i>P</i> < .05). Among the non-PFI group, the percentage of patients with normal trochlear morphology increased from 53% to 87% (<i>P</i> < .001), and less dysplastic measures of trochlear depth index, LTI, and sulcus angle were seen on follow-up imaging (<i>P</i> < .05). When comparing rates of change, trochlear metrics changed toward a more shallow and dysplastic direction in the PFI cohort and toward a deeper and less dysplastic direction in the non-PFI group.</p><p><strong>Conclusion: </strong>Skeletally immature patients with untreated PFI have trochlear dysplasia that progressively worsens over time. Conversely, those without PFI have trochlear characteristics that appear to normalize with growth.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"690-698"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030321","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: Response.","authors":"Sophia Y Kim-Wang, Charles E Spritzer, Jefferson R Bercaw, Kwadwo Owusu-Akyaw, James A Coppock, Adam P Goode, Jocelyn R Wittstein, Louis E DeFrate","doi":"10.1177/03635465241311246","DOIUrl":"https://doi.org/10.1177/03635465241311246","url":null,"abstract":"","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":"53 3","pages":"NP7-NP13"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532214","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 Revision and Primary Osteochondral Allograft Transplantation at Midterm Follow-up: Patient Reported Outcomes, Survivorship, and Reoperation Rates.","authors":"Zachary D Meeker, Derrick M Knapik, Kyle R Wagner, Ron Gilat, Eric J Cotter, Allen A Yazdi, Alexander C Weissman, Nolan B Condron, Adam B Yanke, Brian J Cole","doi":"10.1177/03635465251316475","DOIUrl":"10.1177/03635465251316475","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Previous studies have observed promising short-term outcomes after revision osteochondral allograft (OCA) transplantation. However, few studies have examined midterm outcomes after revision OCA transplantation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To examine midterm outcomes after revision OCA transplantation of the femoral condyle and evaluate reoperation and survivorship compared with a matched cohort of patients who underwent primary OCA transplantation.&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 review of prospectively collected data identified patients undergoing revision OCA transplantation to the femoral condyle between 1999 and 2018 (minimum 5-year follow-up). A 1:2 cohort of patients who underwent revision OCA transplantation to patients who underwent primary OCA transplantation, matched by defect size, age, sex, and body mass index, was created. Patient-reported outcome measures and the incidence of reoperations or graft failures were collected. Failure was defined as subchondral collapse of the OCA transplantation as confirmed via second-look arthroscopy, revision OCA transplantation, or conversion to knee arthroplasty.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Fifteen patients who underwent revision OCA transplantation were matched to 30 patients who underwent primary OCA transplantation. The mean follow-up in the revision OCA transplantation group was 9.3 ± 3.0 years (range, 5.1-14.7 years), with a mean age of 31.4 ± 10.0 years (range, 19.9-52.7 years) and a mean body mass index of 25.9 ± 3.4 (range, 20.8-30.4). Revision OCA transplantation was performed to the lateral condyle in 53% of cases (8/15). A concomitant procedure was performed in 73% of patients (11/15), most commonly involving meniscal allograft transplantation (73% [8/11]), followed by realignment osteotomy (27% [3/11]). The Patient Acceptable Symptom State was achieved by a majority of patients who underwent revision OCA transplantation for all patient-reported outcome measures examined (International Knee Documentation Committee, 70%; Lysholm, 83%; Knee injury and Osteoarthritis Outcome Score [KOOS] Pain, 100%; KOOS Symptoms, 70%, KOOS Sport, 90%; KOOS Activities of Daily Living, 80%; KOOS Quality of Life, 80%), and there was no difference in the proportion of patients the Patient Acceptable Symptom State when compared with those undergoing primary OCA transplantation (&lt;i&gt;P&lt;/i&gt;≥ .070) (see Table 3). Eight patients (53%) underwent revision OCA transplantation reoperation at a mean time of 3.9 ± 3.7 years (range, 0.6-11.2 years). Failures were observed in 20% (3/15) of patients who underwent revision OCA transplantation at a mean of 4.3 ± 1.9 years (range, 1.7-6.4 years). Graft survivorship free from reoperation (&lt;i&gt;P&lt;/i&gt; = .905; revision 53% [8/15], primary 43% [13/30]) and failure (&lt;i&gt;P&lt;/i&gt; = .577; revision 13% [2/15], primary 20% [6/30]) was not significantly different betwe","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"863-870"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460740","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":"Microfragmented Adipose Tissue Has No Advantage Over Platelet-Rich Plasma and Bone Marrow Aspirate Injections for Symptomatic Knee Osteoarthritis: A Systematic Review and Meta-analysis.","authors":"Erik Hohmann, Natalie Keough, Rachel M Frank, Scott A Rodeo","doi":"10.1177/03635465241249940","DOIUrl":"10.1177/03635465241249940","url":null,"abstract":"<p><strong>Background: </strong>Microfragmented adipose tissue has been proposed for intra-articular treatment of knee osteoarthritis. There are little data comparing the outcomes of treatment between microfragmented adipose tissue and other biological treatments.</p><p><strong>Purpose: </strong>To perform a systematic review and meta-analysis comparing microfragmented aspirated fat injections to other orthobiologics, hyaluronic acid, and corticosteroid injections for symptomatic knee osteoarthritis.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 2.</p><p><strong>Methods: </strong>A systematic review of the literature was performed to identify pertinent publications in the MEDLINE, Embase, Scopus, and Google Scholar databases, including all level 1 to 3 studies from 2000 to 2023. Validated knee scores (visual analog scale [VAS] for pain, Knee injury and Osteoarthritis Outcome Score [KOOS], Lysholm, International Knee Documentation Committee) were included as outcome measures. Risk of bias was assessed using Cochrane tools. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of the body of evidence and the modified Coleman Methodology Score was used to assess study quality. Heterogeneity was assessed using χ² and <i>I</i>² statistics.</p><p><strong>Results: </strong>Five studies were included in the analysis. One study had a high risk of bias; 4 studies had some risk of bias. The overall study quality was fair, and the certainty of evidence was low. The pooled estimate for VAS scores did not demonstrate significant differences at 3, 6, and 12 months. The pooled estimate for the KOOS Pain, Symptoms, Activities of Daily Living, Sport and Recreation, and Quality of Life subscales did not demonstrate significant differences at 3, 6, and 12 months.</p><p><strong>Conclusion: </strong>The results of this systematic review and meta-analysis demonstrated that there were no statistically significant differences for both the clinical outcomes and pain scores between microfragmented adipose tissue and other orthobiologics for the treatment of knee osteoarthritis. However, modest study quality, some risk of bias, and low certainty of evidence reduce external validity, and these results must be viewed with some caution.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"988-998"},"PeriodicalIF":4.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923968","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":"Increased Tibial Tubercle-Trochlear Groove Distance and Sulcus Angle Are Associated With Patellar Osteochondritis Dissecans in Pediatric Patients.","authors":"Emilie Lijesen, Akshitha Adhiyaman, Olivia C Tracey, Joshua T Bram, Nnaoma M Oji, Danielle E Chipman, Shae K Simpson, Douglas N Mintz, Peter D Fabricant, Daniel W Green","doi":"10.1177/03635465251320117","DOIUrl":"https://doi.org/10.1177/03635465251320117","url":null,"abstract":"<p><strong>Background: </strong>Osteochondritis dissecans (OCD) lesions in the knee are most commonly found in the medial femoral condyle (MFC). However, a paucity of literature has explored the characteristics or morphology of patellar OCD lesions.</p><p><strong>Purpose/hypothesis: </strong>The purpose of this study was to analyze patellar tracking and patellofemoral measurements of pediatric patients with patellar OCD compared with patients with MFC OCD. It was hypothesized that the patients with patellar OCD would demonstrate an increased bony sulcus angle, cartilaginous sulcus angle, and tibial tubercle-trochlear groove (TT-TG) distance compared with patients with MFC OCD.</p><p><strong>Study design: </strong>Case series; Level of evidence, 3.</p><p><strong>Methods: </strong>Patients aged ≤18 years diagnosed with either a patellar or MFC OCD lesion at a single tertiary care hospital between January 2016 and May 2023 were analyzed. Patients with a history of patellar instability were excluded. The Caton-Deschamps index, cartilaginous bony height, trochlear depth, patellar tilt, lateral patellar displacement, cartilaginous sulcus angle, bony sulcus angle, and TT-TG distance were assessed on magnetic resonance imaging (MRI). Patients were matched 1:2 based on sex and chronological age within 2 years between the patellar and MFC OCD groups.</p><p><strong>Results: </strong>A total of 40 extremities in 34 patients with patellar OCD were matched to 80 extremities in 73 patients with MFC OCD. The mean age at the time of MRI was 14.1 ± 2.3 years, and 23% were female. Compared with patients with MFC OCD, patients with patellar OCD had a significantly greater TT-TG distance (11.55 ± 4.15 vs 13.35 ± 4.07 mm, respectively; <i>P</i> = .03). The cartilaginous sulcus angle (150.63°± 7.20° vs 128.09°± 14.07°, respectively; <i>P</i> < .001) and bony sulcus angle (144.70°± 7.78° vs 137.37°± 9.62°, respectively; <i>P</i> < .001) were higher in the patellar OCD group compared with the MFC OCD group. Of patients with patellar OCD, 40% had a TT-TG distance >15 mm, and of patients with MFC OCD, 20% had a TT-TG distance >15 mm. The patellar OCD group had 3.7 times the risk of having a patellar dislocation compared with the MFC OCD group.</p><p><strong>Conclusion: </strong>An increased TT-TG distance and sulcus angle were associated with patellar OCD in pediatric patients. Patients with abnormal patellofemoral morphology who undergo treatment for a patellar OCD lesion may subsequently develop a patellar dislocation; in this study, patients with patellar OCD without a history of patellar dislocations demonstrated a nearly 4-fold higher dislocation rate compared with an age- and sex-matched group of patients with MFC OCD.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251320117"},"PeriodicalIF":4.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484707","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":"https://doi.org/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":"3635465251319545"},"PeriodicalIF":4.2,"publicationDate":"2025-02-24","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":"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":"https://doi.org/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":"3635465251321108"},"PeriodicalIF":4.2,"publicationDate":"2025-02-24","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 Glycogen Synthase Kinase-3 Inhibitor CHIR99021 Reduces Fatty Infiltration and Muscle Atrophy After Rotator Cuff Tears: An In Vitro Experiment and In Vivo Mouse Model.","authors":"Pu Zhang, Meng Zhou, Yiming Zhu, Jianhao Xie, Ziqi Huo, Dan Zhang, Pinxue Li, Jianxun Guo, Guangping Li, Xu Li, Renxian Wang, Chunyan Jiang","doi":"10.1177/03635465251319549","DOIUrl":"https://doi.org/10.1177/03635465251319549","url":null,"abstract":"<p><strong>Background: </strong>Rotator cuff tears (RCTs) can cause inflammation, muscle atrophy, and irreversible fatty infiltration, resulting in poor clinical outcomes. Effective therapeutic approaches to inhibit fatty infiltration in rotator cuff muscles remain limited.</p><p><strong>Purpose: </strong>To identify pathways associated with fatty infiltration through RNA sequencing and to evaluate the therapeutic potential of the glycogen synthase kinase-3 (GSK-3) inhibitor CHIR99021 based on enrichment of the Akt/GSK-3 pathway identified by RNA sequencing.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Supraspinatus muscle biopsy specimens from 6 patients with chronic full-thickness RCTs were analyzed by RNA sequencing. Fibro-adipogenic progenitors (FAPs) or C2C12 myoblasts were cultured with different doses of CHIR99021 to assess their effects on adipogenic or myogenic differentiation, respectively. RNA sequencing identified cellular pathways in FAPs treated with or without CHIR99021. A mouse RCT model was established by detaching the supraspinatus tendon, followed by treatment with or without CHIR99021 administered intraperitoneally. Muscle atrophy and fatty infiltration were assessed histologically and through gene expression analysis at 1 and 4 weeks after surgery.</p><p><strong>Results: </strong>RNA sequencing analysis identified a marked upregulation of the Akt/GSK-3 signaling pathway specifically in patients' samples and FAPs with minimal fat accumulation. CHIR99021 suppressed adipogenic differentiation in FAPs and promoted myogenic differentiation in C2C12 cells. In the mouse RCT model, CHIR99021-treated mice exhibited reduced Oil Red O staining, a larger cross-sectional area, and less muscle weight loss in the supraspinatus muscle compared with the vehicle-treated mice. Gene expression analysis indicated increased myogenesis and reduced fatty infiltration at 1 and 4 weeks after surgery as well as increased expression levels of IL-6 and IL-15 in the CHIR99021 group compared with the control group at 1 week after surgery.</p><p><strong>Conclusion: </strong>The Akt/GSK-3 pathway was enriched in supraspinatus muscle samples and FAPs with low fat accumulation, highlighting its potential as a therapeutic target. The GSK-3 inhibitor CHIR99021 was shown to alleviate fatty infiltration and muscle atrophy after RCTs in vitro and in vivo in a mouse model.</p><p><strong>Clinical relevance: </strong>The GSK-3 inhibitor CHIR99021 shows potential for treating muscle degeneration after RCTs.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251319549"},"PeriodicalIF":4.2,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484709","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}