American Journal of Sports Medicine最新文献

{"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":"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":"1184-1194"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12084656/pdf/","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":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Role Should Orthopaedic Journals Play in Turbulent Times for Research Funding?","authors":"David C Landy","doi":"10.1177/03635465251326851","DOIUrl":"https://doi.org/10.1177/03635465251326851","url":null,"abstract":"","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":"53 5","pages":"1025-1026"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complications, Reoperations, and Readmissions After Common Arthroscopic Sports Medicine Procedures of the Knee: An Analysis of the ABOS Part II Oral Examination Case List Database.","authors":"Jack T Bragg, J Alex McIntyre, Richard N Puzzitiello, Matthew J Salzler","doi":"10.1177/03635465251321007","DOIUrl":"10.1177/03635465251321007","url":null,"abstract":"<p><strong>Background: </strong>Arthroscopic knee surgeries are among the most commonly performed orthopaedic surgeries, yet complications of these procedures are relatively understudied.</p><p><strong>Purpose: </strong>To determine the rate of complications, reoperations, and readmissions for arthroscopic knee surgeries by procedure, patient characteristics, and physician fellowship training status using a large national database.</p><p><strong>Study design: </strong>Cross-sectional study; Level of evidence, 3.</p><p><strong>Methods: </strong>Data were collected from the American Board of Orthopaedic Surgery (ABOS) database for early-career orthopaedic surgeons taking the ABOS Part II Oral Examination between 2003 and 2022. We queried the type and frequency of complications, unexpected 90-day reoperations, and readmissions for patients undergoing sports medicine knee arthroscopy. Chi-square test and analysis of variance were used to determine the effect of fellowship training status, geographic region of practice, patient age, and patient sex on outcomes of interest.</p><p><strong>Results: </strong>Of 138,823 knee arthroscopic procedures, 10,450 complications were self-reported, making for an overall complication rate of 7.53%. Unexpected 90-day reoperation and readmission rates were calculated to be 1.16% and 0.91%, respectively. Posterior cruciate ligament reconstruction had the highest complication rate (26.38%). Sports medicine fellowship-trained physicians had a significantly higher rate of complications (<i>P</i> < .001) compared with their non-sports medicine fellowship-trained peers (8.43% and 7.06%, respectively). Female patients had a higher complication rate (7.72%) than males (7.40%) (<i>P</i> = .02). Patients aged 20 to 29 had the highest rate of complications and reoperations (10.29% and 1.56%, respectively), whereas patients aged 70 to 79 had the highest rate of readmission (1.47%). Geographic regions of practice had significantly different complication and reoperation rates (<i>P</i> < .01). The rate of deep venous thrombus was 0.57%, and the rate of pulmonary embolism was 0.12%. Forty-two patients died, for an overall 0.03% mortality rate.</p><p><strong>Conclusion: </strong>The overall rate of self-reported complications was 7.53%, and the 90-day rate of unexpected reoperation and unexpected readmission was 1.16% and 0.91%, respectively. Patient sex, patient age, sports medicine fellowship training status, and geographic region of practice all affected rates of complications, reoperations, and readmissions. Knee arthroscopy carries many risks of which patients should be aware before undergoing these procedures.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1085-1092"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484705","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 Revision Elbow Medial Ulnar Collateral Ligament Reconstruction in Professional Baseball Players: An Analysis of 191 Pitchers From 2010 to 2023.","authors":"Brandon J Erickson, Christopher L Camp, Peter N Chalmers, Timothy B Griffith, Karissa N Simon, Elizabeth Hebert, Keith Meister","doi":"10.1177/03635465251322780","DOIUrl":"10.1177/03635465251322780","url":null,"abstract":"<p><strong>Background: </strong>The number of medial ulnar collateral ligament (MUCL) reconstructions is increasing. The epidemiology surrounding revision MUCL reconstructions in professional baseball players has not been well defined.</p><p><strong>Purpose/hypothesis: </strong>The purpose was to report the epidemiology of revision MUCL reconstruction in professional baseball players. The authors hypothesized that the number of revision MUCL reconstructions has increased over time and that the rate of return to sport at the same level of play is <70%.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>All professional baseball pitchers who underwent revision MUCL reconstruction between 2010 and 2023 were identified using the Major League Baseball Health and Injury Tracking System. Rates of return to play, time to return to play, and return to same level of play were recorded and analyzed for pitchers with a minimum follow-up of 2 years. Surgical variables, including technique and graft choice, were also recorded.</p><p><strong>Results: </strong>Overall 191 pitchers (mean age, 26.0 years) underwent revision MUCL reconstruction. The mean time between primary and revision surgery was 1381 days (45 months). Of these players, 130 (68%) were Minor League Baseball pitchers. Hamstring tendon autograft was the most commonly used graft source (n = 90; 47%) when compared with palmaris longus autograft (n = 67; 35%). In terms of tunnel configuration, the modified Jobe and docking techniques were used in equal occurrence (n = 70; 37%). After revision MUCL reconstruction, only 72% of professional baseball pitchers were able to return to play at any level at a mean 556 days (18 months), and only 58% were able to return to the same level of play at a mean 604 days (20 months). The mean time between primary and revision MUCL reconstruction was 45 months (3.75 years).</p><p><strong>Conclusion: </strong>Revision MUCL surgery continues to be a challenging problem, where the procedure is complex, rehabilitation timelines are prolonged, and outcomes are not always optimal. Accordingly, the authors recommend that these procedures be performed by surgeons with high levels of experience.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1210-1215"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544690","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":"Kinesiophobia and High-Impact Sport Activity Are Associated With a Reduced Rate of Return to Sport After High Tibial Osteotomy: A Risk Factor Analysis of a Young and Active Population.","authors":"Gian Andrea Lucidi, Stefano Di Paolo, Federico Maria Adravanti, Nicolò Maitan, Giacomo Dal Fabbro, Filippo Naldi, Alberto Grassi, Stefano Zaffagnini","doi":"10.1177/03635465251322795","DOIUrl":"10.1177/03635465251322795","url":null,"abstract":"<p><strong>Background: </strong>High tibial osteotomy (HTO) is usually performed in patients older than 50 years with medial knee osteoarthritis. However, little is known about return-to-sport (RTS) and return-to-work (RTW) rates when HTO is performed in younger patients. Moreover, the risk factors for RTS and the impact of kinesiophobia on RTS have been poorly investigated.</p><p><strong>Purpose: </strong>To assess RTS and RTW rates, risk factors for RTS, complications, and activity levels at long-term follow-up in young and active patients after isolated HTO.</p><p><strong>Study design: </strong>Case series; Level of evidence, 4.</p><p><strong>Methods: </strong>Consecutive HTO procedures performed at a single institution with a minimum 2-year follow-up were screened. Data were collected regarding clinical scores (Lysholm score, visual analog scale for pain, Tampa Scale for Kinesiophobia, Subjective Patient Outcome for Return to Sports score, Tegner activity score, Likert scale), RTS and RTW rates, type of sport, and impact activity level. Multivariate regression analysis evaluated the effect of sex, age, body mass index, Tegner score, and Tampa score on RTS. Differences were considered statistically significant if <i>P</i> < .05.</p><p><strong>Results: </strong>A total of 60 patients with a mean age at the time of surgery of 28.9 ± 7.5 years were included at a mean follow-up of 8.8 ± 3.8 years. There were 4 (6.7%) major complications. The overall RTS rate was 86.7%, and 68.3% of patients were still participating in sports at the final follow-up (mean, 3.7 ± 2.1 h/wk). Additionally, 34.6% returned to the same sport level, 21.2% improved their status, and 44.2% decreased their sport level. Moreover, patients playing soccer had a lower RTS rate compared with the rest of the patients (72.7% vs 94.7%, respectively; <i>P</i> = .04). The overall RTW rate was 100.0%, with a mean time to RTW of 5.9 ± 6.2 months. The Tampa score was the only predictor of absolute RTS (<i>P</i> = .015; coefficient = -0.13).</p><p><strong>Conclusion: </strong>HTO performed in a young and active population resulted in high RTS rates and continuous sport participation even up to 9 years after surgery. Interestingly, the Tampa score was the only predictive factor for a reduced RTS rate. Finally, soccer participation was associated with a lower RTS rate compared with other sports.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1068-1076"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Restriction of Posterior Tibial Translation During the Posterior Drawer Test in Internal or External Rotation Is Dependent on Peripheral Stabilizers of the Knee: A Biomechanical Robotic Investigation.","authors":"Adrian Deichsel, Christian Peez, Wenke Liu, Michael J Raschke, Alina Albert, Thorben Briese, Elmar Herbst, Christoph Kittl","doi":"10.1177/03635465251317209","DOIUrl":"10.1177/03635465251317209","url":null,"abstract":"<p><strong>Background: </strong>The posteromedial and posterolateral structures of the knee have previously been shown to be secondary restraints to posterior tibial translation (PTT). The effect of these structures may increase when performing the posterior drawer test in internal or external rotation.</p><p><strong>Purpose/hypothesis: </strong>The purpose was to investigate the influence of the posteromedial and posterolateral structures on restricting PTT in neutral, external, and internal rotation. It was hypothesized that the posteromedial structures restrict PTT in internal rotation, while the posterolateral structures restrict PTT in external rotation.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>A sequential cutting study was performed on 24 fresh-frozen human knee specimens utilizing a 6 degrees of freedom robotic test setup. After determining the native knee kinematics from 0° to 90° of knee flexion, an 89-N posterior drawer test in neutral, internal, and external rotation was performed at 0°, 30°, 60°, and 90° of knee flexion. In 8 knees, a motion-controlled protocol was applied, replicating the native motion while the force was measured. The reduction of the restraining force represented the percentage contribution of each cut. In 16 knees, a force-controlled protocol was applied, determining the increase in PTT after each cut. After calculating the native knee kinematics, the posterior cruciate ligament (PCL) was cut, followed by randomized sectioning of the posteromedial (medial collateral ligament, posterior oblique ligament) and posterolateral (lateral collateral ligament, popliteus complex) structures. Mixed linear models with the post hoc Dunn test were used for statistical analysis.</p><p><strong>Results: </strong>During motion-controlled testing, performing the posterior drawer test in internal or external rotation significantly decreased the contribution of the PCL in restraining PTT. The PCL was the primary restraint to PTT during the posterior drawer test in neutral rotation at all flexion angles (24.4%-61.2% contribution). The primary restraint to PTT during the posterior drawer test in internal rotation was the posterior oblique ligament at 0° (24.2% ± 14.1%), the medial collateral ligament at 30° (33.6% ± 11.4%), and the PCL at 60° and 90° (46.2%-57.8%). In external rotation, the primary restraint was the lateral collateral ligament at 0° (24.7% ± 10.5%) and the popliteus complex at 30° to 90° (56.4%-65.2%). During force-controlled testing, PTT in the PCL-deficient knee was significantly decreased when performing the posterior drawer test in internal or external rotation. Insufficiency of the posterolateral or posteromedial structures, in addition to insufficiency of the PCL, during the posterior drawer test in neutral rotation led to an additional significant increase in PTT of up to 7.6 mm (95% confidence interval [CI], 3.6-11.7). Insufficiency of the posterolateral ","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"1077-1084"},"PeriodicalIF":4.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460814","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":"No Clinically Significant Differences in Patient-Reported Outcomes and Range of Motion Between Early and Delayed Mobilization After Primary Distal Biceps Tendon Repair: A Systematic Review and Meta-analysis.","authors":"Evan R Simpson, Harkirat Jawanda, Ishani Patel, Nikhil N Verma, Kevin C Parvaresh","doi":"10.1177/03635465251317207","DOIUrl":"https://doi.org/10.1177/03635465251317207","url":null,"abstract":"<p><strong>Background: </strong>Currently, there is no uniform rehabilitation program concerning mobilization after a distal biceps tendon repair. A systematic review was conducted to investigate the effect of restrictions within the immediate postoperative period to evaluate clinical outcomes relative to mobilization after surgical repair of complete distal biceps tendon tears.</p><p><strong>Hypothesis: </strong>Early mobilization will not have a significant difference on outcomes compared with delayed mobilization.</p><p><strong>Study design: </strong>Meta-analysis; Level of evidence, 3.</p><p><strong>Methods: </strong>The authors performed a systematic review in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines of studies reporting outcomes of the distal biceps tendon repair. The early mobilization cohort included studies with no restrictions beyond 2 weeks after surgery, and the delayed mobilization cohort included studies with continued restrictions beyond 2 weeks after surgery.</p><p><strong>Results: </strong>A total of 26 studies with 1114 patients (643 in the delayed mobilization cohort and 471 in the early mobilization cohort) met the inclusion criteria, with a weighted mean patient age of 45.14 years (range, 18-76 years) and a mean follow-up of 27.9 months (range, 3-120 months). Meta-analysis at the 24-month follow-up found that range of motion (ROM) was not significantly different across early and delayed mobilization cohorts for flexion (mean, 137.38° vs 140.42°; <i>P</i> = .34) and extension (mean, 3.23° vs 1.5°; <i>P</i> = .91). Early mobilization was found to be significantly associated with less pronation (mean, 75.68° vs 83.18°; <i>P</i> = .0019) and supination (mean, 76.38° vs 83.93°; <i>P</i> = .0049). Analysis of patient-reported outcomes (PROs) found that Disabilities of the Arm, Shoulder and Hand scores (mean, 3.93 vs 4.21; <i>P</i> = .77) and Mayo Elbow Performance Score values (mean, 96.33 vs 97.11;<i>P</i> = .65) were not significantly different across cohorts. Failure analysis found a significant difference when comparing proportion (mean, 0.0006 vs 0.0185; <i>P</i> = .0029) but no difference when comparing incidence rate (mean, 0.0001 vs 0.0001; <i>P</i> = .647). Complication analysis found no statistical difference in proportion (mean, 0.2181 vs 0.1918; <i>P</i> = .7388) or incidence rate (mean, 0.0012 vs 0.008; <i>P</i> = .344).</p><p><strong>Conclusion: </strong>These results suggest there may be no clinically significant difference in failure rates, complications, ROM, or PROs for early versus delayed mobilization after primary distal biceps tendon repair.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251317207"},"PeriodicalIF":4.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Use of Customized 3D-Printed Guides in Anterior Cruciate Ligament Reconstruction Compared With Conventional Techniques: A Systematic Review and Meta-analysis.","authors":"Abdulrahman O Al-Naseem, Abdullah Almehandi, Khalaf M Ebrahim, Abdulaziz Al-Naseem, Yousef Marwan, Naser Alnusif","doi":"10.1177/03635465251315165","DOIUrl":"https://doi.org/10.1177/03635465251315165","url":null,"abstract":"<p><strong>Background: </strong>Accurate femoral tunnel positioning is essential for successful anterior cruciate ligament (ACL) reconstruction. Tunnel malposition can happen due to limited arthroscopic visibility as well as anatomic variance. The use of customized patient-specific guides can optimize surgical planning and enhance accuracy.</p><p><strong>Purpose: </strong>To compare femoral tunnel positioning in 3-dimensional (3D)-assisted ACL reconstruction versus conventional surgery.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 3.</p><p><strong>Methods: </strong>This systematic review and meta-analysis was performed in line with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines with a search of the following databases: MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. All randomized controlled trials (RCTs) and observational studies comparing the 2 interventions were included. Primary outcomes included tunnel positioning time (minutes) and accuracy rates (%). Secondary outcomes were Lysholm and International Knee Documentation Committee (IKDC) functional scores. Random effects modeling was used for analysis.</p><p><strong>Results: </strong>Four RCTs and 1 retrospective study were included, enrolling a total of 299 patients. The 3D group had significantly shorter tunnel positioning times (mean difference, -2.80; 95% CI, -4.13 to -1.46; <i>P</i> < .0001) with significantly greater tunnel positioning accuracy (odds ratio, 4.62; 95% CI, 1.02 to 20.89; <i>P</i> = .05). No significant difference was noted in postoperative functional scores, including Lysholm and IKDC scores (<i>P</i> > .05).</p><p><strong>Conclusion: </strong>The use of 3D guides helps reduce tunnel positioning time and increases tunnel positioning accuracy with comparable postoperative functional outcomes.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465251315165"},"PeriodicalIF":4.2,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143607196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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

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