American Journal of Sports Medicine最新文献

{"title":"Enhancing Rotator Cuff Repair in Rabbit Osteoporosis With Chitosan Quaternary Ammonium Salt-Coated Nickel-Titanium Memory Alloy Anchors.","authors":"Mingtao Zhang, Liangna Deng, Borong Zhang, Jiaxin Liu, Chenhui Yang, Tao Liu, Zhitao Yang, Jin Jiang, Xuewen Kang, Xiangdong Yun","doi":"10.1177/03635465241302101","DOIUrl":"10.1177/03635465241302101","url":null,"abstract":"<p><strong>Background: </strong>For patients with osteoporosis and rotator cuff tears, there is still no consensus on current treatment methods. The material, structure, and number of anchors have important effects on the repair outcome.</p><p><strong>Purpose: </strong>To investigate the use of chitosan quaternary ammonium salt-coated nickel-titanium memory alloy (NTMA) anchors to treat rotator cuff injury in shoulders with osteoporosis in a rabbit osteoporosis model.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>A novel winged NTMA anchor was designed to test in normal and osteoporotic bone models in vitro. These models were assessed for maximum failure load and bone damage in various traction directions. A chitosan-sodium alginate composite was coated onto NTMA anchor surfaces using glutaraldehyde cross-linking and electrostatic layering techniques. An osteoporotic rabbit model was created using ovariectomy combined with glucocorticoid treatment. A rabbit model with acute injury to the supraspinatus muscle was established and repaired using titanium alloy anchors, NTMA anchors, and coated NTMA (CNTMA) anchors. To evaluate the efficacy of the anchors, biomechanical testing and staining with hematoxylin and eosin were performed 6 and 12 weeks after surgery. A micro-computed tomography scan was performed 12 weeks after surgery.</p><p><strong>Results: </strong>In the osteoporotic bone model, NTMA anchors exhibited greater failure loads than titanium anchors under 45° and 90° traction forces (<i>P</i> < .05). The surface-modified material showed a lower contact angle compared with unmodified material. Cell Counting Kit-8 (CCK-8) assays showed that the composite coating promoted osteoblast proliferation. The CNTMA anchor group exhibited the greatest maximum failure load at each time point. Hematoxylin and eosin staining revealed greater trabecular thickness in the CNTMA anchor group than in the other groups at 6 and 12 weeks after surgery. At 12 weeks after surgery, micro-computed tomography revealed an increased number and thickness of bone trabeculae in the NTMA anchor group, along with a widened trabecular gap (<i>P</i> < .05). After the NTMA anchor biplane unfolded, the gap between the biplane and anchor showed bone tissue growth.</p><p><strong>Conclusion: </strong>Chitosan quaternary ammonium salt-coated NTMA anchors enhanced fixation strength and promoted local osteogenesis during osteoporotic rotator cuff repair, suggesting that the use of these anchors facilitates the repair of osteoporotic rotator cuff injuries in osteoporotic bones.</p><p><strong>Clinical relevance: </strong>Innovations in anchor nailing may be effective in reducing rates of repair failure for rotator cuff tears combined with osteoporosis.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"406-417"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923961","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":"Longitudinal Changes in Medial Meniscal Extrusion After ACL Injury and Reconstruction and Its Relationship With Cartilage Degeneration Assessed Using MRI-Based T1ρ and T2 Analysis.","authors":"Shotaro Watanabe, Gabby B Joseph, Dai Sato, Drew A Lansdown, Julio Brandao Guimaraes, Thomas M Link, Chunbong Benjamin Ma","doi":"10.1177/03635465241305734","DOIUrl":"10.1177/03635465241305734","url":null,"abstract":"<p><strong>Background: </strong>Anterior cruciate ligament (ACL) injury often leads to posttraumatic osteoarthritis (PTOA), despite ACL reconstruction (ACLR). Medial meniscal extrusion (MME) is implicated in PTOA progression but remains understudied after ACL injury and ACLR.</p><p><strong>Hypothesis/purpose: </strong>It was hypothesized that MME would increase longitudinally after ACL injury and ACLR, with greater changes in the ipsilateral knee compared with the contralateral knee, leading to cartilage degeneration. The study aimed to assess MME 3 years after ACLR and its relationship with magnetic resonance imaging (MRI) T1ρ and T2 as cartilage degeneration markers.</p><p><strong>Study design: </strong>Cohort study; Level of evidence, 2.</p><p><strong>Methods: </strong>MME and relative percentage of extrusion (RPE) were measured on 3 coronal slices of 3-dimensional fast spin-echo images and the mean values were used. T1ρ and T2 sequences were obtained and cartilage compositional measurements were performed using in-house developed software with MATLAB. Mixed models were used to assess the longitudinal changes and linear regression was used to assess the relationships between RPE and T1ρ and T2 values.</p><p><strong>Results: </strong>A total of 54 participants with unilateral ACL injuries underwent preoperative bilateral knee MRI. A total of 36 participants completed MR scans at 6 months and 3 years after ACLR. MME and RPE measurements demonstrated high reliability (ICC > 0.88 and > 0.91, respectively). The predicted values of MME and RPE from the mixed models showed that the ipsilateral side had significantly greater MME and RPE than the contralateral side at all 3 time points (<i>P</i> = .023 for MME; <i>P</i> = .013 for RPE at baseline; and <i>P</i> < .001 at 6 months and <i>P</i> < .001 at 3 years for both MME and RPE). The rate of change of MME and RPE on the ipsilateral side was significantly greater than that on the contralateral side (<i>P</i> < .001). Postoperative RPE was associated with T1ρ and T2 values in the posterior medial femoral condyle.</p><p><strong>Conclusion: </strong>MME and RPE obtained pre- and postoperatively after ACLR on the ipsilateral side were significantly greater than those on the contralateral side, and the longitudinal increases on the ipsilateral side were greater than those on the contralateral side. Postoperative RPE was significantly associated with cartilage degeneration in the posterior medial femoral condyle.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"350-359"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11796289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916060","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":"Effects of Biceps Rerouting on In Vivo Glenohumeral Kinematics in the Treatment of Large-to-Massive Rotator Cuff Tears.","authors":"Chenliang Wu, Yi Qiao, Ling Zhang, Cong Wang, Jiebo Chen, Chang'an Chen, Caiqi Xu, Tsung-Yuan Tsai, Junjie Xu, Jinzhong Zhao","doi":"10.1177/03635465241301778","DOIUrl":"10.1177/03635465241301778","url":null,"abstract":"<p><strong>Background: </strong>Arthroscopic repair with the biceps rerouting (BR) technique has been determined to lead to promising clinical and biomechanical outcomes for treating large-to-massive rotator cuff tears (LMRCTs). However, the in vivo effects of BR on glenohumeral kinematics during functional shoulder movements have not been fully elucidated.</p><p><strong>Purpose: </strong>To investigate whether BR provides a better restoration of shoulder kinematics compared with conventional rotator cuff repair (RCR).</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Patients who underwent either repair with the BR technique (BR group) or RCR alone (RCR group) for treating LMRCTs between January 2021 and May 2022 were enrolled. They underwent a 1-year postoperative kinematic evaluation of bilateral shoulders by performing scapular-plane abduction with a dual fluoroscopic imaging system. Glenohumeral translation in the superior-inferior (S-I) and anterior-posterior (A-P) directions was assessed in shoulder abduction at 10° increments. Moreover, the mean, maximum, minimum, and range of glenohumeral translation were calculated throughout the entire movement.</p><p><strong>Results: </strong>A total of 9 patients were enrolled in each group for final analysis, and baseline characteristics were comparable between the groups. In the RCR group, compared with contralateral shoulders, the operative shoulders showed increased superior humeral head translation during lower abduction angles of 30° to 50° (all <i>P</i>≤ .004), with a greater maximum (<i>P</i> = .014) and a larger range (<i>P</i> = .002) for S-I translation throughout the entire movement. In the BR group, no significant differences between operative and contralateral shoulders were detected in any kinematic variables for S-I translation (all <i>P</i>≥ .132); however, the operative shoulders exhibited a larger maximum (<i>P</i> = .031), a smaller minimum (<i>P</i> = .008), and a larger range (<i>P</i> < .001) for A-P translation throughout the entire movement compared with the contralateral shoulders.</p><p><strong>Conclusion: </strong>BR successfully reduced residual superior humeral head translation compared with conventional RCR and restored normal S-I glenohumeral kinematics in the treatment of LMRCTs. However, A-P glenohumeral kinematics was not fully restored after BR, and its effect on long-term clinical outcomes requires further investigation.</p><p><strong>Clinical relevance: </strong>BR can be a promising technique to treat LMRCTs. However, its potential adverse effects on A-P glenohumeral kinematics should not be ignored, requiring further clinical evidence to determine long-term outcomes.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"427-436"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923956","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":"Arthroscopic Repair of Bursal-Sided Partial-Thickness Rotator Cuff Tears: Literature Review and Meta-analysis.","authors":"Yoann Dalmas, Kevin A Hao, Hugo Barret, Pierre Mansat, Nicolas Bonnevialle","doi":"10.1177/03635465241239883","DOIUrl":"10.1177/03635465241239883","url":null,"abstract":"<p><strong>Background: </strong>The surgical management of bursal-sided partial-thickness rotator cuff tendon tears is controversial. The 2 methods used are in situ repair (ISR), preserving the contingent of intact articular tendon fiber, or tear completion before repair (TCBR) according to the operating surgeon's usual technique. No study with sufficient power has demonstrated a superior technique.</p><p><strong>Hypothesis: </strong>The 2 techniques are equivalent in terms of clinical outcome and tendon healing.</p><p><strong>Study design: </strong>Systematic literature review and meta-analysis; Level of evidence, 4.</p><p><strong>Methods: </strong>A systematic review was carried out in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations on the PubMed, Embase, and Cochrane Library databases from January 2003 through March 2023. Only articles dealing with Ellman grade 3 bursal-sided tears with a minimum follow-up of 1 year were included. Primary endpoints were American Shoulder and Elbow Surgeons and Constant-Murley scores, pain on a visual analog scale, and retear rate. The secondary endpoint was recovery of active mobility.</p><p><strong>Results: </strong>Twelve studies were included with overlap of 3, leaving 8 ISR studies (360 patients; mean follow-up, 30 months) and 7 TCBR studies (224 patients; mean follow-up, 51 months) for statistical analysis. No significant clinical differences were found when comparing mean American Shoulder and Elbow Surgeons (92.2 [95% CI, 88.1-96.2] vs 88.9 [95% CI, 85.8-92.0]; <i>P</i> = .21), Constant-Murley (86.3 [95% CI, 81.5-91.0] vs 91.8 [95% CI, 88.1-95.6]; <i>P</i> = .07), and visual analog scale (0.8 [95% CI, 0.2-1.4] vs 1.0 [95% CI, 0.5-1.4]; <i>P</i> = .63) scores in the TCBR and ISR groups, respectively. The retear rate was 6.8% (95% CI, 3.1%-14.3%) in the TCBR group and 9.5% (95% CI, 6.1%-14.3%) in the ISR group (<i>P</i> = .46). Active mobility was also comparable.</p><p><strong>Conclusion: </strong>This meta-analysis suggests that ISR and TCBR provide comparable results in the surgical management of Ellman grade 3 bursal-sided partial-thickness rotator cuff tears.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"501-507"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959487","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":"Adequate Failure Loads for Modified Lemaire Lateral Extra-articular Tenodesis Are Achieved With an Interference Screw, Staple, and Suture Anchor: A Biomechanical Study of Structural Properties.","authors":"Luke V Tollefson, Evan P Shoemaker, Erik L Slette, Mitchell Carlson, Robert F LaPrade, Lars Engebretsen, Gilbert Moatshe, Andrew G Geeslin","doi":"10.1177/03635465241305739","DOIUrl":"10.1177/03635465241305739","url":null,"abstract":"<p><strong>Background: </strong>A lateral extra-articular tenodesis (LET) is increasingly being utilized to augment an anterior cruciate ligament reconstruction because it has been shown to reduce the risk of postreconstruction graft failure or recurrent rotatory instability. Various femoral fixation techniques are available, including the use of an interference screw, staple, or suture anchor.</p><p><strong>Purpose: </strong>To determine and compare the biomechanical properties of an LET graft when using an interference screw, staple, or suture anchor for the femoral fixation for a modified Lemaire LET.</p><p><strong>Study design: </strong>Controlled laboratory study.</p><p><strong>Methods: </strong>Eighteen fresh-frozen cadaveric knees were obtained and randomly assigned via a random group generator to undergo a modified Lemaire LET using either an interference screw, a staple, or a suture anchor for femoral fixation. The specimen underwent load-to-failure testing at 20 mm/min until graft failure. The maximum failure load, stiffness, and failure mode for each specimen were recorded.</p><p><strong>Results: </strong>The mean failure load was highest for the interference screw (252.7 ± 131.2 N), followed by the staple (151.8 ± 34.1 N) and the suture anchor (105.7 ± 16.4 N). There was a significant difference in failure load between the interference screw and the suture anchor (<i>P</i> = .015). There was no significant difference between the staple and the interference screw (<i>P</i> = .101) or the suture anchor (<i>P</i> = .577). There was no significant difference in graft stiffness across all fixation methods (<i>P</i> = .089).</p><p><strong>Conclusion: </strong>All 3 femoral fixation methods achieved adequate failure loads, although the interference screw had a greater failure load than the suture anchor and there was no significant difference between these implants and the staple. There were no significant differences in stiffness between the fixation methods.</p><p><strong>Clinical relevance: </strong>The maximum failure load occurred with an interference screw for femoral fixation of a modified Lemaire LET; however, because of socket size, this implant may be at greater risk of anterior cruciate ligament reconstruction tunnel collision compared to a smaller-diameter suture anchor drill hole. The failure load of the suture anchor was the lowest; however, it appears sufficient for stable fixation based on the force experienced by an LET graft reported in the literature.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"327-332"},"PeriodicalIF":4.2,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933719","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 Effect of Sex Hormones on Joint Ligament Properties: A Systematic Review and Meta-analysis.","authors":"Gabrielle Gilmer, Nikitha Crasta, Miho J Tanaka","doi":"10.1177/03635465241310145","DOIUrl":"https://doi.org/10.1177/03635465241310145","url":null,"abstract":"<p><strong>Background: </strong>Sex differences exist in injury rates, and one contributing factor may be sex hormone effects on the musculoskeletal system.</p><p><strong>Purpose/hypothesis: </strong>The goal of this systematic review and meta-analysis was to understand the effects of sex hormones on ligaments in females as determined by preclinical and clinical studies. The hypothesis was that sex hormones would affect ligament mechanical properties, histological features, cellular function, and clinically measurable outcomes.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 4.</p><p><strong>Methods: </strong>A literature search of PubMed, PEDro, CINAHL, and CENTRAL was performed to identify preclinical and clinical studies assessing sex hormone effects on ligament properties. Overall, 2 independent reviewers performed title, abstract, and full-text screening. Rigor and reproducibility were assessed using the ARRIVE guidelines and the modified Downs and Black checklist. Meta-analyses were also performed.</p><p><strong>Results: </strong>There were 54 articles included in this review. The majority of studies focused on the anterior cruciate ligament (ACL; n = 27), the menstrual cycle (n = 23), and 17β-estradiol (n = 35). Meta-analyses revealed that there was no effect of the menstrual cycle on knee laxity or anterior tibial translation but that 17β-estradiol decreased the production of types I and III procollagen in ACL fibroblasts in vitro. In examining other ligaments, data suggest that sex hormone changes may affect the mechanical and cellular properties of the medial collateral ligament, intrapubic ligaments, hip ligaments, and ligamentum flavum. Additionally, the literature suggests that hormonal shifts that occur with oral contraceptive pill use, pregnancy, and menopause can affect ligament properties. These effects appear to be mediated, at least in part, by the hormone relaxin.</p><p><strong>Conclusion: </strong>Of the sex hormones examined in this body of literature, 17β-estradiol and relaxin appear to have the most effect on both the mechanical and cellular properties of ligaments in females. The ACL, medial collateral ligament, intrapubic ligaments, hip ligaments, and ligamentum flavum may be impacted by changes in sex hormone concentrations. The menstrual cycle does not likely affect ligament laxity in a clinically meaningful way, but pregnancy, oral contraceptive pill use, and menopause may.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465241310145"},"PeriodicalIF":4.2,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069881","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":"Concomitant Cartilage Procedures With Meniscal Allograft Transplantation Do Not Substantially Alter Failure or Survival Rates Relative to Meniscal Allograft Transplantation Without Cartilage Procedures: A Systematic Review.","authors":"Lika Dzidzishvili, Sachin Allahabadi, Garrett R Jackson, Salvador Gonzalez Ayala, Divesh Sachdev, Julie Mekhail, Brian J Cole, Jorge Chahla","doi":"10.1177/03635465241305410","DOIUrl":"https://doi.org/10.1177/03635465241305410","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Timely recognition and addressing of concomitant cartilage damage at the time of meniscal allograft transplantation (MAT) is critical to warrant future success. However, there remains a scarcity of data comparing outcomes between MAT with and without cartilage procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare patient-reported outcomes and rates of complications, failures, reoperations, and graft survivorship after MAT with concomitant cartilage procedures (MAT/Cart) and MAT without (MAT/NoCart).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;Systematic review; Level of evidence, 4.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A literature search was performed according to the 2020 PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses) using the Scopus, PubMed, and Embase computerized databases from inception to January 7, 2024. Human clinical studies with levels of evidence 1 to 4 were included that evaluated patient-reported outcomes, postoperative complications, failures, reoperations, and graft survivorship with a minimum mean follow-up of 2 years. Study quality was assessed using the Methodological Index for Non-randomized Studies criteria and Modified Coleman Methodology Score.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Twenty-six studies from 2006 to 2024 consisting of 1031 patients were included. Thirteen studies (n = 367) reported on MAT/Cart with a mean patient age of 37.6 years and mean follow-up of 72.9 months. Thirteen studies (n = 665) reported on MAT/NoCart procedures in patients with a mean age of 33.6 years and mean follow-up of 58.6 months. Postoperatively, both study groups had improved clinical outcomes, with International Knee Documentation Committee scores ranging from 55.3 to 74.4 in the MAT/Cart group versus 61.7 to 89.8 in the MAT/NoCart group and Lysholm scores from 62.5 to 85.9 versus 72 to 92.4, respectively. The incidence of failure ranged from 0% to 33% after MAT/Cart versus 3.8% to 43.7% after MAT/NoCart. All included patients either had well-aligned lower extremities in the coronal plane, within 3° to 5° of neutral on the affected side, or underwent correction via an osteotomy before or during the MAT procedure. Subsequent surgery not related to failure was higher in the MAT/Cart group (range, 11.8%-83.3%) as compared with the MAT/NoCart group (range, 4.3%-30.8%). The mean survival rates after MAT/Cart ranged from 86.2% to 100% at 2 years, 75% to 97.9% at 5 years, and 70% to 85% at 10 years. The mean survival rates after MAT/NoCart ranged from 83.5% to 93% at 2 years, 82.6% to 85% at 5 years, and 55% to 90% at 10 years. Decreased range of motion and arthrofibrosis were the most frequently reported complications in each group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;In patients with normal lower limb coronal plane alignment, performing cartilage restoration procedures in combination with MAT does not substantially alter clinical outcomes or complication, failure, and survival rates relat","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465241305410"},"PeriodicalIF":4.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048893","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":"Does the Addition of a Lateral Extra-articular Procedure to a Primary Anterior Cruciate Ligament Reconstruction Result in Superior Functional and Clinical Outcomes? A Systematic Review and Meta-analysis of Randomized Controlled Trials.","authors":"Adrian Kan, Tayla English, Allanah Penny, Jordan Franc-Smith, Francois Tudor, Larissa Sattler","doi":"10.1177/03635465241304781","DOIUrl":"https://doi.org/10.1177/03635465241304781","url":null,"abstract":"<p><strong>Background: </strong>Current research focused on clinical outcomes suggests that lateral extra-articular procedures (LEAPs) can reduce rotational instability and graft failure rates in primary anterior cruciate ligament reconstructions (ACLRs). Limited studies have investigated the functional outcomes after LEAPs, including patient-reported outcome measures, sports participation, and physical performance.</p><p><strong>Purpose: </strong>To conduct a systematic literature review and meta-analysis to determine whether the addition of a LEAP to an ACLR results in superior functional and clinical outcomes as compared with an isolated ACLR.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 1.</p><p><strong>Methods: </strong>Five databases were searched to identify randomized controlled trials comparing clinical and functional outcomes after the addition of LEAPs to an isolated primary ACLR. Study selection was performed in accordance with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-analyses). Assessment of methodological quality for included studies was undertaken using the Cochrane Risk of Bias 2 tool for randomized controlled trials. Studies were eligible for meta-analysis if an outcome measure utilizing similar time points was present across ≥2 studies and reported in mean difference or standard deviation.</p><p><strong>Results: </strong>Meta-analysis of 10 studies showed that the addition of LEAPs to an ACLR can reduce rates of rotatory instability (risk ratio, 1.45 [95% CI, 1.17-1.79]; <i>P</i> = .0006; <i>I</i>² = 0%) and graft rupture (risk ratio, 0.21 [95% CI, 0.08-0.55]; <i>P</i> < .001; <i>I</i>² = 0%). As supported by studies eligible for meta-analysis, this review showed that the addition of LEAPs to an ACLR can reduce rotatory instability. Short-term morbidity, including increased pain, joint stiffness, and muscle weakness, as compared with isolated ACLRs was resolved by 12 months after surgery.</p><p><strong>Conclusion: </strong>ACLR in combination with a LEAP results in superior clinical outcomes when compared with an isolated ACLR. Despite early postoperative outcomes concerning pain and function favoring isolated ACLRs, any negative effects were not still observed 6 months after surgery. A conclusion around the correlation between LEAPs and accelerated knee osteoarthritis could not be drawn, owing to the lack of long-term prospective studies available.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465241304781"},"PeriodicalIF":4.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048895","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":"Platelet Concentration Explains Variability in Outcomes of Platelet-Rich Plasma for Lateral Epicondylitis: A High Dose Is Critical for a Positive Response: A Systematic Review and Meta-analysis With Meta-regression.","authors":"Jacob F Oeding, Nathan H Varady, Caden J Messer, Joshua S Dines, Riley J Williams, Scott A Rodeo","doi":"10.1177/03635465241303716","DOIUrl":"https://doi.org/10.1177/03635465241303716","url":null,"abstract":"<p><strong>Background: </strong>Randomized controlled trials (RCTs) evaluating the efficacy of platelet-rich plasma (PRP) for the management of lateral epicondylitis (LE) have been characterized by substantial variability in reported outcomes. The source of this heterogeneity is uncertain.</p><p><strong>Purpose: </strong>To determine the effect of estimated platelet concentration on the efficacy of PRP for the management of LE.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 2.</p><p><strong>Methods: </strong>All RCTs evaluating the efficacy of PRP in managing LE were identified. RCTs were classified according to whether the study documented a platelet concentration factor of PRP representing a greater than 3-fold increase over whole blood or a supraphysiological platelet dose (high-dose vs low-dose PRP). The primary outcome was the mean difference (MD) in the visual analog scale (VAS) score at latest follow-up. Random-effects and mixed-effects meta-analyses were performed, and meta-regression was used to evaluate whether differences in outcomes after treatment with PRP could be explained by differences in the concentration of PRP used.</p><p><strong>Results: </strong>Overall, 13 RCTs with a total of 791 patients were included in this analysis, with 5 that utilized low-dose PRP and 8 that used high-dose PRP. Meta-analysis of VAS scores reported by studies that used high-dose PRP resulted in an MD of -1.31 (95% CI, -1.87 to -0.75) in favor of PRP over all alternative treatment strategies (<i>P</i> < .001). Meta-analysis of VAS scores reported by studies that used low-dose PRP resulted in an MD of 0.08 (95% CI, -0.51 to 0.68), suggesting no difference in the effect between PRP and all alternative treatment strategies (<i>P</i> = .79). The platelet concentration factor of PRP used in each RCT was found to be strongly predictive of the VAS score at final follow-up in meta-regression (<i>P</i> < .001), with 58.5% of the heterogeneity in the outcomes of PRP between studies explained by the platelet concentration factor alone.</p><p><strong>Conclusion: </strong>The platelet concentration of PRP may play a significant role in the outcomes of patients with LE. A direct linear relationship was observed between the platelet concentration factor of PRP used and the magnitude of patient-reported symptom relief after the management of LE with PRP. Clinicians should ensure a supraphysiological platelet concentration when preparing PRP for the management of LE.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465241303716"},"PeriodicalIF":4.2,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048897","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":"Early Meniscal Repair Leads to Higher Success Rates Than Delayed Meniscal Repair: A Systematic Review and Meta-analysis.","authors":"Jelle P van der List, Stef Daniel, Ingmar Blom, Joyce L Benner","doi":"10.1177/03635465241298619","DOIUrl":"https://doi.org/10.1177/03635465241298619","url":null,"abstract":"<p><strong>Background: </strong>There has been an increased interest in meniscus preservation over the last decade. Several risk factors for the failure of meniscal repair have been identified. However, the timing of meniscal repair has not been extensively assessed in the literature, and there is currently no high-quality evidence on the optimal timing of performing meniscal repair after an injury with regard to outcomes.</p><p><strong>Purpose: </strong>To assess the role of the timing of meniscal repair on outcomes in the literature.</p><p><strong>Study design: </strong>Systematic review and meta-analysis; Level of evidence, 4.</p><p><strong>Methods: </strong>The databases of PubMed, Embase, and the Cochrane Library were searched in October 2023 for studies comparing the outcomes of early versus delayed meniscal repair. Studies were eligible for inclusion if they reported outcomes within and after a time threshold (eg, within and after 3 weeks). Random-effects models were used.</p><p><strong>Results: </strong>A total of 35 studies with 3556 patients and 3767 menisci were included (mean age, 27.5 years; 66% male; mean follow-up, 4.5 years). Most studies were level 3 or 4 evidence, and the overall quality was low. The failure rates of meniscal repair were 11.3% versus 24.1% within versus after 2 weeks, respectively (7 studies, 511 patients; odds ratio [OR], 0.50 [95% CI, 0.22-1.16]; <i>P</i> = .11); 7.2% versus 15.3% within versus after 3 weeks, respectively (5 studies, 556 patients; OR, 0.28 [95% CI, 0.10-0.79]; <i>P</i> = .02); 15.7% versus 21.3% within versus after 6 weeks, respectively (7 studies, 746 patients; OR, 0.63 [95% CI, 0.33-1.18]; <i>P</i> = .15); and 10.2% versus 18.7% within versus after 8 weeks, respectively (7 studies, 652 patients; OR, 0.47 [95% CI, 0.26-0.87]; <i>P</i> = .02); these were significant for 3 and 8 weeks. No differences were seen for within versus after 3 months (7 studies, 1305 patients; 22.4% vs 18.5%, respectively; OR, 1.04 [95% CI, 0.47-2.33]; <i>P</i> = .92).</p><p><strong>Conclusion: </strong>The timing of meniscal surgery was correlated with the likelihood of success, and meniscal repair should preferably be performed within 8 weeks of the injury, with the earliest benefit at 3 weeks. Clinicians should take this into consideration when recommending operative treatment or initial nonoperative treatment.</p>","PeriodicalId":55528,"journal":{"name":"American Journal of Sports Medicine","volume":" ","pages":"3635465241298619"},"PeriodicalIF":4.2,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143025467","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}