Publisher: Sage Publications   (Total: 1090 journals)

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Showing 1 - 200 of 1090 Journals sorted alphabetically
AADE in Practice     Hybrid Journal   (Followers: 6)
Abstracts in Anthropology     Full-text available via subscription   (Followers: 24)
Academic Pathology     Open Access   (Followers: 5)
Accounting History     Hybrid Journal   (Followers: 17, SJR: 0.527, CiteScore: 1)
Acta Radiologica     Hybrid Journal   (Followers: 1, SJR: 0.754, CiteScore: 2)
Acta Radiologica Open     Open Access   (Followers: 2)
Acta Sociologica     Hybrid Journal   (Followers: 39, SJR: 0.939, CiteScore: 2)
Action Research     Hybrid Journal   (Followers: 51, SJR: 0.308, CiteScore: 1)
Active Learning in Higher Education     Hybrid Journal   (Followers: 362, SJR: 1.397, CiteScore: 2)
Adaptive Behavior     Hybrid Journal   (Followers: 9, SJR: 0.288, CiteScore: 1)
Administration & Society     Hybrid Journal   (Followers: 14, SJR: 0.675, CiteScore: 1)
Adoption & Fostering     Hybrid Journal   (Followers: 24, SJR: 0.313, CiteScore: 0)
Adsorption Science & Technology     Open Access   (Followers: 8, SJR: 0.258, CiteScore: 1)
Adult Education Quarterly     Hybrid Journal   (Followers: 241, SJR: 0.566, CiteScore: 2)
Adult Learning     Hybrid Journal   (Followers: 44)
Advances in Dental Research     Hybrid Journal   (Followers: 9, SJR: 1.791, CiteScore: 4)
Advances in Developing Human Resources     Hybrid Journal   (Followers: 31, SJR: 0.614, CiteScore: 2)
Advances in Mechanical Engineering     Open Access   (Followers: 136, SJR: 0.272, CiteScore: 1)
Advances in Methods and Practices in Psychological Science     Full-text available via subscription   (Followers: 11)
Advances in Structural Engineering     Full-text available via subscription   (Followers: 46, SJR: 0.599, CiteScore: 1)
Advances in Tumor Virology     Open Access   (Followers: 3, SJR: 0.108, CiteScore: 0)
AERA Open     Open Access   (Followers: 10)
Affilia     Hybrid Journal   (Followers: 5, SJR: 0.496, CiteScore: 1)
Agrarian South : J. of Political Economy     Hybrid Journal   (Followers: 2)
Air, Soil & Water Research     Open Access   (Followers: 13, SJR: 0.214, CiteScore: 1)
Alexandria : The J. of National and Intl. Library and Information Issues     Full-text available via subscription   (Followers: 67)
Allergy & Rhinology     Open Access   (Followers: 4)
AlterNative : An Intl. J. of Indigenous Peoples     Full-text available via subscription   (Followers: 13, SJR: 0.194, CiteScore: 0)
Alternative Law J.     Hybrid Journal   (Followers: 11, SJR: 0.176, CiteScore: 0)
Alternatives : Global, Local, Political     Hybrid Journal   (Followers: 12, SJR: 0.351, CiteScore: 1)
American Behavioral Scientist     Hybrid Journal   (Followers: 24, SJR: 0.982, CiteScore: 2)
American Economist     Hybrid Journal   (Followers: 8)
American Educational Research J.     Hybrid Journal   (Followers: 231, SJR: 2.913, CiteScore: 3)
American J. of Alzheimer's Disease and Other Dementias     Hybrid Journal   (Followers: 19, SJR: 0.67, CiteScore: 2)
American J. of Cosmetic Surgery     Hybrid Journal   (Followers: 8)
American J. of Evaluation     Hybrid Journal   (Followers: 17, SJR: 0.646, CiteScore: 2)
American J. of Health Promotion     Hybrid Journal   (Followers: 34, SJR: 0.807, CiteScore: 1)
American J. of Hospice and Palliative Medicine     Hybrid Journal   (Followers: 43, SJR: 0.65, CiteScore: 1)
American J. of Law & Medicine     Full-text available via subscription   (Followers: 12, SJR: 0.204, CiteScore: 1)
American J. of Lifestyle Medicine     Hybrid Journal   (Followers: 6, SJR: 0.431, CiteScore: 1)
American J. of Medical Quality     Hybrid Journal   (Followers: 12, SJR: 0.777, CiteScore: 1)
American J. of Men's Health     Open Access   (Followers: 9, SJR: 0.595, CiteScore: 2)
American J. of Rhinology and Allergy     Hybrid Journal   (Followers: 9, SJR: 0.972, CiteScore: 2)
American J. of Sports Medicine     Hybrid Journal   (Followers: 216, SJR: 3.949, CiteScore: 6)
American Politics Research     Hybrid Journal   (Followers: 33, SJR: 1.313, CiteScore: 1)
American Review of Public Administration     Hybrid Journal   (Followers: 21, SJR: 2.062, CiteScore: 2)
American Sociological Review     Hybrid Journal   (Followers: 336, SJR: 6.333, CiteScore: 6)
American String Teacher     Full-text available via subscription   (Followers: 2)
Analytical Chemistry Insights     Open Access   (Followers: 26, SJR: 0.224, CiteScore: 1)
Angiology     Hybrid Journal   (Followers: 3, SJR: 0.849, CiteScore: 2)
Animation     Hybrid Journal   (Followers: 14, SJR: 0.197, CiteScore: 0)
Annals of Clinical Biochemistry     Hybrid Journal   (Followers: 10, SJR: 0.634, CiteScore: 1)
Annals of Otology, Rhinology & Laryngology     Hybrid Journal   (Followers: 17, SJR: 0.807, CiteScore: 1)
Annals of Pharmacotherapy     Hybrid Journal   (Followers: 54, SJR: 1.096, CiteScore: 2)
Annals of the American Academy of Political and Social Science     Hybrid Journal   (Followers: 49, SJR: 1.225, CiteScore: 3)
Annals of the ICRP     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Anthropocene Review     Hybrid Journal   (Followers: 8, SJR: 3.341, CiteScore: 7)
Anthropological Theory     Hybrid Journal   (Followers: 42, SJR: 0.739, CiteScore: 1)
Antitrust Bulletin     Hybrid Journal   (Followers: 13)
Antiviral Chemistry and Chemotherapy     Open Access   (Followers: 2, SJR: 0.635, CiteScore: 2)
Antyajaa : Indian J. of Women and Social Change     Hybrid Journal  
Applied Biosafety     Hybrid Journal   (Followers: 1, SJR: 0.131, CiteScore: 0)
Applied Psychological Measurement     Hybrid Journal   (Followers: 23, SJR: 1.17, CiteScore: 1)
Applied Spectroscopy     Full-text available via subscription   (Followers: 28, SJR: 0.489, CiteScore: 2)
Armed Forces & Society     Hybrid Journal   (Followers: 24, SJR: 0.29, CiteScore: 1)
Arts and Humanities in Higher Education     Hybrid Journal   (Followers: 43, SJR: 0.305, CiteScore: 1)
Asia Pacific Media Educator     Hybrid Journal   (Followers: 1, SJR: 0.23, CiteScore: 0)
Asia-Pacific J. of Management Research and Innovation     Full-text available via subscription   (Followers: 3)
Asia-Pacific J. of Public Health     Hybrid Journal   (Followers: 11, SJR: 0.558, CiteScore: 1)
Asian and Pacific Migration J.     Full-text available via subscription   (Followers: 8, SJR: 0.324, CiteScore: 1)
Asian Cardiovascular and Thoracic Annals     Hybrid Journal   (Followers: 2, SJR: 0.305, CiteScore: 0)
Asian J. of Comparative Politics     Hybrid Journal   (Followers: 5)
Asian J. of Legal Education     Full-text available via subscription   (Followers: 4)
Asian J. of Management Cases     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
ASN Neuro     Open Access   (Followers: 2, SJR: 1.534, CiteScore: 3)
Assessment     Hybrid Journal   (Followers: 17, SJR: 1.519, CiteScore: 3)
Assessment for Effective Intervention     Hybrid Journal   (Followers: 16, SJR: 0.578, CiteScore: 1)
Australasian Psychiatry     Hybrid Journal   (Followers: 18, SJR: 0.433, CiteScore: 1)
Australian & New Zealand J. of Psychiatry     Hybrid Journal   (Followers: 29, SJR: 1.801, CiteScore: 2)
Australian and New Zealand J. of Criminology     Hybrid Journal   (Followers: 532, SJR: 0.612, CiteScore: 1)
Australian J. of Career Development     Hybrid Journal   (Followers: 4)
Australian J. of Education     Hybrid Journal   (Followers: 42, SJR: 0.403, CiteScore: 1)
Australian J. of Management     Hybrid Journal   (Followers: 13, SJR: 0.497, CiteScore: 1)
Autism     Hybrid Journal   (Followers: 338, SJR: 1.739, CiteScore: 4)
Autism & Developmental Language Impairments     Open Access   (Followers: 12)
Behavior Modification     Hybrid Journal   (Followers: 12, SJR: 0.877, CiteScore: 2)
Behavioral and Cognitive Neuroscience Reviews     Hybrid Journal   (Followers: 26)
Bible Translator     Hybrid Journal   (Followers: 13)
Biblical Theology Bulletin     Hybrid Journal   (Followers: 20, SJR: 0.184, CiteScore: 0)
Big Data & Society     Open Access   (Followers: 52)
Biochemistry Insights     Open Access   (Followers: 7)
Bioinformatics and Biology Insights     Open Access   (Followers: 12, SJR: 1.141, CiteScore: 2)
Biological Research for Nursing     Hybrid Journal   (Followers: 7, SJR: 0.685, CiteScore: 2)
Biomarker Insights     Open Access   (Followers: 1, SJR: 0.81, CiteScore: 2)
Biomarkers in Cancer     Open Access   (Followers: 11)
Biomedical Engineering and Computational Biology     Open Access   (Followers: 13)
Biomedical Informatics Insights     Open Access   (Followers: 9)
Bioscope: South Asian Screen Studies     Hybrid Journal   (Followers: 3, SJR: 0.235, CiteScore: 0)
BMS: Bulletin of Sociological Methodology/Bulletin de Méthodologie Sociologique     Hybrid Journal   (Followers: 4, SJR: 0.226, CiteScore: 0)
Body & Society     Hybrid Journal   (Followers: 26, SJR: 1.531, CiteScore: 3)
Bone and Tissue Regeneration Insights     Open Access   (Followers: 2)
Brain and Neuroscience Advances     Open Access  
Breast Cancer : Basic and Clinical Research     Open Access   (Followers: 11, SJR: 0.823, CiteScore: 2)
British J. of Music Therapy     Hybrid Journal   (Followers: 8)
British J. of Occupational Therapy     Hybrid Journal   (Followers: 220, SJR: 0.323, CiteScore: 1)
British J. of Pain     Hybrid Journal   (Followers: 28, SJR: 0.579, CiteScore: 2)
British J. of Politics and Intl. Relations     Hybrid Journal   (Followers: 33, SJR: 0.91, CiteScore: 2)
British J. of Visual Impairment     Hybrid Journal   (Followers: 14, SJR: 0.337, CiteScore: 1)
British J.ism Review     Hybrid Journal   (Followers: 18)
BRQ Business Review Quarterly     Open Access   (Followers: 1)
Building Acoustics     Hybrid Journal   (Followers: 4, SJR: 0.215, CiteScore: 1)
Building Services Engineering Research & Technology     Hybrid Journal   (Followers: 3, SJR: 0.583, CiteScore: 1)
Bulletin of Science, Technology & Society     Hybrid Journal   (Followers: 8)
Business & Society     Hybrid Journal   (Followers: 13)
Business and Professional Communication Quarterly     Hybrid Journal   (Followers: 8, SJR: 0.348, CiteScore: 1)
Business Information Review     Hybrid Journal   (Followers: 17, SJR: 0.279, CiteScore: 0)
Business Perspectives and Research     Hybrid Journal   (Followers: 3)
Cahiers Élisabéthains     Hybrid Journal   (Followers: 1, SJR: 0.111, CiteScore: 0)
Calcutta Statistical Association Bulletin     Full-text available via subscription   (Followers: 1)
California Management Review     Hybrid Journal   (Followers: 32, SJR: 2.209, CiteScore: 4)
Canadian J. of Kidney Health and Disease     Open Access   (Followers: 6, SJR: 1.007, CiteScore: 2)
Canadian J. of Nursing Research (CJNR)     Hybrid Journal   (Followers: 13)
Canadian J. of Occupational Therapy     Hybrid Journal   (Followers: 142, SJR: 0.626, CiteScore: 1)
Canadian J. of Psychiatry     Hybrid Journal   (Followers: 27, SJR: 1.769, CiteScore: 3)
Canadian J. of School Psychology     Hybrid Journal   (Followers: 12, SJR: 0.266, CiteScore: 1)
Canadian Pharmacists J. / Revue des Pharmaciens du Canada     Hybrid Journal   (Followers: 3, SJR: 0.536, CiteScore: 1)
Cancer Control     Open Access   (Followers: 1)
Cancer Growth and Metastasis     Open Access   (Followers: 1)
Cancer Informatics     Open Access   (Followers: 4, SJR: 0.64, CiteScore: 1)
Capital and Class     Hybrid Journal   (Followers: 8, SJR: 0.282, CiteScore: 1)
Cardiac Cath Lab Director     Full-text available via subscription  
Cardiovascular and Thoracic Open     Open Access  
Career Development and Transition for Exceptional Individuals     Hybrid Journal   (Followers: 9, SJR: 0.44, CiteScore: 1)
Cartilage     Hybrid Journal   (Followers: 5, SJR: 0.889, CiteScore: 3)
Cell and Tissue Transplantation and Therapy     Open Access   (Followers: 2)
Cell Transplantation     Open Access   (Followers: 4, SJR: 1.023, CiteScore: 3)
Cephalalgia     Hybrid Journal   (Followers: 8, SJR: 1.581, CiteScore: 3)
Cephalalgia Reports     Open Access   (Followers: 3)
Child Language Teaching and Therapy     Hybrid Journal   (Followers: 35, SJR: 0.501, CiteScore: 1)
Child Maltreatment     Hybrid Journal   (Followers: 9, SJR: 1.22, CiteScore: 3)
Child Neurology Open     Open Access   (Followers: 6)
Childhood     Hybrid Journal   (Followers: 19, SJR: 0.894, CiteScore: 2)
Childhood Obesity and Nutrition     Open Access   (Followers: 11)
China Information     Hybrid Journal   (Followers: 7, SJR: 0.767, CiteScore: 2)
China Report     Hybrid Journal   (Followers: 11, SJR: 0.221, CiteScore: 0)
Chinese J. of Sociology     Full-text available via subscription   (Followers: 5)
Chronic Illness     Hybrid Journal   (Followers: 6, SJR: 0.672, CiteScore: 2)
Chronic Respiratory Disease     Hybrid Journal   (Followers: 9, SJR: 0.808, CiteScore: 2)
Chronic Stress     Open Access  
Citizenship, Social and Economics Education     Full-text available via subscription   (Followers: 6, SJR: 0.145, CiteScore: 0)
Cleft Palate-Craniofacial J.     Hybrid Journal   (Followers: 8, SJR: 0.757, CiteScore: 1)
Clin-Alert     Hybrid Journal   (Followers: 1)
Clinical and Applied Thrombosis/Hemostasis     Open Access   (Followers: 32, SJR: 0.49, CiteScore: 1)
Clinical and Translational Neuroscience     Open Access  
Clinical Case Studies     Hybrid Journal   (Followers: 3, SJR: 0.364, CiteScore: 1)
Clinical Child Psychology and Psychiatry     Hybrid Journal   (Followers: 45, SJR: 0.73, CiteScore: 2)
Clinical EEG and Neuroscience     Hybrid Journal   (Followers: 6, SJR: 0.552, CiteScore: 2)
Clinical Ethics     Hybrid Journal   (Followers: 11, SJR: 0.296, CiteScore: 1)
Clinical Medicine Insights : Arthritis and Musculoskeletal Disorders     Open Access   (Followers: 3, SJR: 0.537, CiteScore: 2)
Clinical Medicine Insights : Blood Disorders     Open Access   (SJR: 0.314, CiteScore: 2)
Clinical Medicine Insights : Cardiology     Open Access   (Followers: 6, SJR: 0.686, CiteScore: 2)
Clinical Medicine Insights : Case Reports     Open Access   (Followers: 1, SJR: 0.283, CiteScore: 1)
Clinical Medicine Insights : Circulatory, Respiratory and Pulmonary Medicine     Open Access   (Followers: 3, SJR: 0.425, CiteScore: 2)
Clinical Medicine Insights : Ear, Nose and Throat     Open Access   (Followers: 1)
Clinical Medicine Insights : Endocrinology and Diabetes     Open Access   (Followers: 33, SJR: 0.63, CiteScore: 2)
Clinical Medicine Insights : Oncology     Open Access   (Followers: 3, SJR: 1.129, CiteScore: 3)
Clinical Medicine Insights : Pediatrics     Open Access   (Followers: 3)
Clinical Medicine Insights : Psychiatry     Open Access   (Followers: 10)
Clinical Medicine Insights : Reproductive Health     Open Access   (Followers: 2, SJR: 0.776, CiteScore: 0)
Clinical Medicine Insights : Therapeutics     Open Access   (Followers: 1, SJR: 0.172, CiteScore: 0)
Clinical Medicine Insights : Trauma and Intensive Medicine     Open Access   (Followers: 4)
Clinical Medicine Insights : Urology     Open Access   (Followers: 3)
Clinical Medicine Insights : Women's Health     Open Access   (Followers: 4)
Clinical Nursing Research     Hybrid Journal   (Followers: 31, SJR: 0.471, CiteScore: 1)
Clinical Pathology     Open Access   (Followers: 3)
Clinical Pediatrics     Hybrid Journal   (Followers: 23, SJR: 0.487, CiteScore: 1)
Clinical Psychological Science     Hybrid Journal   (Followers: 12, SJR: 3.281, CiteScore: 5)
Clinical Rehabilitation     Hybrid Journal   (Followers: 75, SJR: 1.322, CiteScore: 3)
Clinical Risk     Hybrid Journal   (Followers: 5, SJR: 0.133, CiteScore: 0)
Clinical Trials     Hybrid Journal   (Followers: 21, SJR: 2.399, CiteScore: 2)
Clothing and Textiles Research J.     Hybrid Journal   (Followers: 26, SJR: 0.36, CiteScore: 1)
Common Law World Review     Full-text available via subscription   (Followers: 18)
Communication & Sport     Hybrid Journal   (Followers: 8, SJR: 0.385, CiteScore: 1)
Communication and the Public     Hybrid Journal   (Followers: 1)
Communication Disorders Quarterly     Hybrid Journal   (Followers: 17, SJR: 0.458, CiteScore: 1)
Communication Research     Hybrid Journal   (Followers: 21, SJR: 2.171, CiteScore: 3)
Community College Review     Hybrid Journal   (Followers: 9, SJR: 1.451, CiteScore: 1)
Comparative Political Studies     Hybrid Journal   (Followers: 264, SJR: 3.772, CiteScore: 3)
Compensation & Benefits Review     Hybrid Journal   (Followers: 8)
Competition & Change     Hybrid Journal   (Followers: 12, SJR: 0.843, CiteScore: 2)
Competition and Regulation in Network Industries     Full-text available via subscription   (Followers: 8, SJR: 0.143, CiteScore: 0)
Concurrent Engineering     Hybrid Journal   (Followers: 3, SJR: 0.642, CiteScore: 2)
Conflict Management and Peace Science     Hybrid Journal   (Followers: 40, SJR: 2.441, CiteScore: 1)
Contemporary Drug Problems     Full-text available via subscription   (Followers: 3, SJR: 0.609, CiteScore: 2)
Contemporary Education Dialogue     Hybrid Journal   (Followers: 5, SJR: 0.102, CiteScore: 0)
Contemporary Issues in Early Childhood     Full-text available via subscription   (Followers: 8, SJR: 0.766, CiteScore: 1)
Contemporary Review of the Middle East     Full-text available via subscription   (Followers: 12)
Contemporary Sociology : A J. of Reviews     Full-text available via subscription   (Followers: 35, SJR: 0.195, CiteScore: 0)
Contemporary Voice of Dalit     Full-text available via subscription   (Followers: 1)
Contexts     Hybrid Journal   (Followers: 6)

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Similar Journals
Journal Cover
American Journal of Sports Medicine
Journal Prestige (SJR): 3.949
Citation Impact (citeScore): 6
Number of Followers: 216  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0363-5465 - ISSN (Online) 1552-3365
Published by Sage Publications Homepage  [1090 journals]
  • The Influence of Lumbosacral Spine Pathology on Minimum 2-Year Outcome
           After Hip Arthroscopy: Letter to the Editor
    • Authors: Mingjin Zhong, Weimin Zhu, Kan Ouyang
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 10, Page NP45-NP45, August 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-01T12:07:40Z
      DOI: 10.1177/0363546520934749
      Issue No: Vol. 48, No. 10 (2020)
       
  • The Influence of Lumbosacral Spine Pathology on Minimum 2-Year Outcome
           After Hip Arthroscopy: Response
    • Authors: Edward C. Beck, Benedict U. Nwachukwu, Reagan Chapman, Anirudh K. Gowd, Brian R. Waterman, Shane J. Nho
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 10, Page NP45-NP46, August 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-01T12:05:52Z
      DOI: 10.1177/0363546520934757
      Issue No: Vol. 48, No. 10 (2020)
       
  • The Critical Reader—Bias
    • Authors: James L. Carey
      Pages: 2343 - 2344
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 10, Page 2343-2344, August 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-01T12:07:35Z
      DOI: 10.1177/0363546520944881
      Issue No: Vol. 48, No. 10 (2020)
       
  • Radiographic and Symptomatic Knee Osteoarthritis 32 to 37 Years After
           Acute Anterior Cruciate Ligament Rupture
    • Authors: Joanna Kvist, Stephanie Filbay, Christer Andersson, Clare L. Ardern, Håkan Gauffin
      Pages: 2387 - 2394
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 10, Page 2387-2394, August 2020.
      Background:The long-term prevalence of knee osteoarthritis (OA) after anterior cruciate ligament (ACL) injury is unknown, especially in patients without a history of ACL surgery.Purpose:To (1) describe the prevalence of radiographic OA, symptomatic OA, and knee replacement surgery 32 to 37 years after acute ACL injury and to (2) compare the prevalence of radiographic OA, symptomatic OA, and knee symptoms between patients allocated to early ACL surgery or no ACL surgery and patients who crossed over to ACL surgery.Study Design:Cohort study; Level of evidence, 2.Methods:Participants aged 15 to 40 years at the time of ACL injury were allocated to surgical (augmented or nonaugmented ACL repair) or nonsurgical ACL treatment within 14 days of injury. At 32 to 37 years after the initial injury, 153 participants were followed up with plain weightbearing radiographs and completed 4 subscales from the Knee injury and Osteoarthritis Outcome Score (KOOS). Radiographic OA was defined as Kellgren and Lawrence grade 2 or higher. Symptomatic OA was defined as radiographic OA plus knee symptoms measured with the KOOS.Results:Participants allocated to ACL surgery (n = 64) underwent surgery at a mean ± SD of 5 ± 4 days (range, 0-11 days) after injury. Of the 89 participants allocated to no ACL surgery, 53 remained nonsurgically treated, 27 had ACL surgery within 2 years, and 9 had ACL surgery between 3 and 21 years after injury. In the total sample, 95 participants (62%) had radiographic tibiofemoral OA, including 11 (7%) who had knee replacement. The prevalence of radiographic tibiofemoral OA was lower in the group allocated to ACL surgery compared with the group who never had ACL surgery (50% vs 75%; P = .005). The prevalence of symptomatic OA (50% in the total sample) and patellofemoral radiographic OA (35% in the total sample) was similar between groups.Conclusion:Patients allocated to early ACL surgery, performed a mean 5 days after injury, had a lower prevalence of tibiofemoral radiographic OA at 32 to 37 years after injury compared with patients who never had ACL surgery. The prevalences of symptomatic OA, radiographic patellofemoral OA, and knee symptoms were similar irrespective of ACL treatment. Overall, the prevalence of OA after ACL injury was high.Registration:NCT03182647 (ClinicalTrials.gov identifier)
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-01T12:08:50Z
      DOI: 10.1177/0363546520939897
      Issue No: Vol. 48, No. 10 (2020)
       
  • Allograft Donor Characteristics Significantly Influence Graft Rupture
           After Anterior Cruciate Ligament Reconstruction in a Young Active
           Population
    • Authors: Sarah Shumborski, Lucy J. Salmon, Claire Monk, Emma Heath, Justin P. Roe, Leo A. Pinczewski
      Pages: 2401 - 2407
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 10, Page 2401-2407, August 2020.
      Background:Graft selection in anterior cruciate ligament (ACL) surgery can be difficult in a young active population given their high rates of reinjury. Allografts allow for control over graft size and reduce morbidity of autograft harvest. There are mixed results about the use of allograft in the literature; however, the influence of the properties of the allograft on outcomes has not been considered.Hypothesis:ACL reconstruction with allografts from older donors will have a higher rate of graft rupture when compared with allograft from young donors.Study Design:Cohort study; Level of evidence, 3.Methods:Patients (N = 211) aged 13 to 25 years underwent primary ACL reconstruction with fresh-frozen nonirradiated allograft. Four graft types were used: patellar tendon, Achilles tendon, tibialis anterior, and tibialis posterior. Details were collected on allograft donor age and sex. At a minimum of 24 months, patients were evaluated for any further injuries and subjective analysis by International Knee Documentation Committee (IKDC) questionnaire.Results:ACL graft rupture occurred in 23.5%. When grafts were separated into single strand (patellar and Achilles tendon) and multistrand (tibialis anterior and posterior), there was a significantly higher rate of reinjury in the single-strand grafts (29.9% vs 11%; P = .014). Grafts from female donors aged ≥50 years had significantly higher rates of ACL graft rupture (52.6%; P = .003) with increased odds by 6.7 times when compared with grafts from male donors aged
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-01T12:06:17Z
      DOI: 10.1177/0363546520938777
      Issue No: Vol. 48, No. 10 (2020)
       
  • Incidence and Predictors of Subsequent Surgery After Anterior Cruciate
           Ligament Reconstruction: A 6-Year Follow-up Study
    • Authors: Jaron P. Sullivan, Laura J. Huston, Alexander Zajichek, Emily K. Reinke, Jack T. Andrish, Robert H. Brophy, Warren R. Dunn, David C. Flanigan, Christopher C. Kaeding, Robert G. Marx, Matthew J. Matava, Eric C. McCarty, Richard D. Parker, Armando F. Vidal, Brian R. Wolf, Rick W. Wright, Kurt P. Spindler
      Pages: 2418 - 2428
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 10, Page 2418-2428, August 2020.
      Background:The cause of subsequent surgery after anterior cruciate ligament (ACL) reconstruction varies, but if risk factors for specific subsequent surgical procedures can be identified, we can better understand which patients are at greatest risk.Purpose:To report the incidence and types of subsequent surgery that occurred in a cohort of patients 6 years after their index ACL reconstruction and to identify which variables were associated with the incidence of patients undergoing subsequent surgery after their index ACL reconstruction.Study Design:Cohort study; Level of evidence, 2.Methods:Patients completed a questionnaire before their index ACL surgery and were followed up at 2 and 6 years. Patients were contacted to determine whether any underwent additional surgery since baseline. Operative reports were obtained, and all surgical procedures were categorized and recorded. Logistic regression models were constructed to predict which patient demographic and surgical variables were associated with the incidence of undergoing subsequent surgery after their index ACL reconstruction.Results:The cohort consisted of 3276 patients (56.3% male) with a median age of 23 years. A 6-year follow-up was obtained on 91.5% (2999/3276) with regard to information on the incidence and frequency of subsequent surgery. Overall, 20.4% (612/2999) of the cohort was documented to have undergone at least 1 subsequent surgery on the ipsilateral knee 6 years after their index ACL reconstruction. The most common subsequent surgical procedures were related to the meniscus (11.9%), revision ACL reconstruction (7.5%), loss of motion (7.8%), and articular cartilage (6.7%). Significant risk factors for incurring subsequent meniscus-related surgery were having a medial meniscal repair at the time of index surgery, reconstruction with a hamstring autograft or allograft, higher baseline Marx activity level, younger age, and cessation of smoking. Significant predictors of undergoing subsequent surgery involving articular cartilage were higher body mass index, higher Marx activity level, reconstruction with a hamstring autograft or allograft, meniscal repair at the time of index surgery, or a grade 3/4 articular cartilage abnormality classified at the time of index ACL reconstruction. Risk factors for incurring subsequent surgery for loss of motion were younger age, female sex, low baseline Knee injury and Osteoarthritis Outcome Score symptom subscore, and reconstruction with a soft tissue allograft.Conclusion:These findings can be used to identify patients who are at the greatest risk of incurring subsequent surgery after ACL reconstruction.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-01T12:05:36Z
      DOI: 10.1177/0363546520935867
      Issue No: Vol. 48, No. 10 (2020)
       
  • Surgical Repair of Distal Musculotendinous T Junction Injuries of the
           Biceps Femoris
    • Authors: Babar Kayani, Atif Ayuob, Fahima Begum, Sandeep Singh, Fares S. Haddad
      Pages: 2456 - 2464
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 10, Page 2456-2464, August 2020.
      Background:Nonoperative management of injuries to the distal musculotendinous T junction of the biceps femoris is associated with variable periods of rehabilitation and high risk of recurrence. To our knowledge, the efficacy of operative treatment in patients with these acute injuries has not been previously reported.Hypothesis:Surgical repair of injuries to the distal musculotendinous T junction of the biceps femoris would enable return to preinjury level of sport with low risk of recurrence.Study Design:Case series; Level of evidence, 4.Methods:This prospective single-surgeon study included 34 professional athletes (mean age, 26.4 ± 3.1 years; 31 male [91.2%]; 3 female [8.8%]; body mass index, 25 ± 2.0 kg/m2) undergoing primary surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris. All study patients underwent a standardized postoperative rehabilitation program. Predefined study outcomes relating to time for return to sporting activity, patient satisfaction, range of motion, hamstring muscle strength, passive range of motion, functional progress, and complications were recorded at regular intervals after surgery. Mean follow-up time was 28.4 months (range, 24.0-36.3 months) from date of surgery.Results:All study patients returned to their preinjury level of sporting activity. Mean time from surgical repair to full sporting activity was 11.7 ± 3.6 weeks. No patients had recurrence of the primary injury. At 1-year follow-up, 18 patients (52.9%) were very satisfied and 16 patients (47.1%) were satisfied with the outcomes of their surgery. At 3 months after surgery, patients had improved mean passive straight leg raise (69.7° ± 11.7° vs 24.1° ± 7.4°; P < .001); increased mean isometric hamstring muscle strength at 0° (93.1% ± 5.4% vs 63.1% ± 7.7%; P < .001), 45° (76.8% ± 9.7% vs 24.8% ± 8.3%; P < .001), and 90° (96.4% ± 3.9% vs 85.6% ± 5.9%; P < .001); higher mean lower extremity functional scores (64.5 ± 4.5 vs 27.2 ± 5.4; P < .001); and improved mean Marx Activity Rating Scale scores (10.7 ± 2.7 vs 2.2 ± 2.1; P < .001) compared with preoperative values. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery.Conclusion:Surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris is associated with high patient satisfaction, increased muscle strength, improved functional outcome scores, and high return to preinjury level of sporting activity with low risk of recurrence at short-term follow-up.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-01T12:06:05Z
      DOI: 10.1177/0363546520938679
      Issue No: Vol. 48, No. 10 (2020)
       
  • Importance of Retaining Sufficient Acetabular Depth: Successful 2-Year
           Outcomes of Hip Arthroscopy for Patients With Pincer Morphology as
           Compared With Matched Controls
    • Authors: Claudia R. Brick, Catherine J. Bacon, Matthew J. Brick
      Pages: 2471 - 2480
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 10, Page 2471-2480, August 2020.
      Background:Patients with pincer-type femoroacetabular impingement are commonly treated with arthroscopic reduction of acetabular depth as measured by the lateral center-edge angle (LCEA). The optimal amount of rim reduction has not been established, although large resections may increase contact pressures through the hip. A recent publication demonstrated inferior surgical outcomes in patients with acetabular overcoverage as compared with normal acetabular coverage. Casual observation of our database suggested equivalent improvements, prompting a similar analysis.Purpose:To analyze patient-reported outcomes after hip arthroscopy for femoroacetabular impingement in patients with acetabular overcoverage who were matched with controls with normal coverage, as well as to analyze associations with reduction in LCEA.Study Design:Cohort study; Level of evidence, 3.Methods:Data were collected prospectively from patients with a minimum 2-year follow-up after receiving hip arthroscopy for femoroacetabular impingement by a single surgeon. Cases were reviewed to identify those with pincer-type morphology (LCEA>40°) and matched according to sex, age, chondral damage, and surgery date in a 1:1 ratio with controls with an LCEA of 25° to 40°. The surgical goal was to reduce the LCEA to the upper end of the normal range with minimal rim resection, usually 35° to 37°. Radiographic measurements of coverage, intraoperative findings, procedures, and patient-reported outcomes were recorded, including the 12-Item International Hip Outcome Tool, Non-arthritic Hip Score, Hip Disability and Osteoarthritis Outcome Score, visual analog scale for pain, rates of revision or reoperation, and conversion to total hip arthroplasty.Results:A total of 114 hips (93 patients) for the pincer group were matched 1:1 from 616 hips (541 patients) for the control group. The pincer group (mean ± SD age, 34.5 ± 12.2 years) did not differ in age, body mass index, or follow-up from controls. LCEA was reduced in both groups pre- to postoperatively: the pincer group from 44.0° ± 2.8° to 34.2° ± 3.5° and the controls from 32.9° ± 3.9° to 31.0° ± 3.0°. No differences in improvement were observed: iHOT-12 improved by 35.7 points in both groups (P = .9 for analysis of variance interaction) and Nonarthritic Hip Score by 22.3 points (P = .6). From all eligible surgical procedures, 2-year follow up rates were 2.5% and 2.6% for the pincer and control cohorts, respectively, and 1.2% and 0.3% for conversion to total hip arthroplasty.Conclusion:Arthroscopic management of acetabular overcoverage can achieve excellent results, equivalent to arthroscopy for other causes of symptomatic femoroacetabular impingement. A key finding was smaller rim resections producing a mean postoperative LCEA of 34.2° with a small standard deviation.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-01T12:07:09Z
      DOI: 10.1177/0363546520937301
      Issue No: Vol. 48, No. 10 (2020)
       
  • Distinct Pattern of Inflammation of Articular Cartilage and the Synovium
           in Early and Late Hip Femoroacetabular Impingement
    • Authors: Masahiko Haneda, Muhammad Farooq Rai, Lei Cai, Robert H. Brophy, Regis J. O’Keefe, John C. Clohisy, Cecilia Pascual-Garrido
      Pages: 2481 - 2488
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 10, Page 2481-2488, August 2020.
      Background:The molecular mechanism of how femoroacetabular impingement (FAI) morphology leads to hip osteoarthritis (OA) is yet to be determined. The expression and location of inflammation-related molecules during early- and late-stage FAI have not been previously described. Moreover, the characterization of intra-articular inflammation away from the cam deformity as well as the nature of adjacent synovial tissue have also not been extensively reported.Hypothesis:Early-stage FAI has a similar expression of inflammation-related markers in the head-neck and acetabular cartilage but less synovitis than late-stage FAI.Study Design:Controlled laboratory study.Methods:Head-neck cartilage, acetabular cartilage, and synovial samples were obtained from patients undergoing hip preservation surgery for the treatment of symptomatic cam FAI (early FAI group; n = 15) and advanced OA secondary to cam FAI (late FAI group; n = 15). Samples procured from healthy young adult donors served as the control group (n = 7). Cartilage degeneration was assessed by histology, and the expression of inflammation-related proteins (interleukin–1 beta [IL-1β], matrix metalloproteinase–13 [MMP-13], a disintegrin and metalloproteinase with thrombospondin motifs–4 [ADAMTS-4], type II collagen [COL2], and aggrecan neoepitope [NITEGE]) was measured by immunostaining. Synovial samples in the early and late FAI groups were examined for synovitis and the expression of IL-1β.Results:Head-neck cartilage in the early FAI group showed significantly more degeneration than the control group and an increased expression of inflammation-related proteins (IL-1β: 69.7% ± 18.1% vs 20.2% ± 4.9%, respectively; MMP-13: 79.6% ± 12.6% vs 25.3% ± 9.5%; ADAMTS-4: 83.9% ± 12.2% vs 24.3% ± 11.1%; NITEGE: 89.7% ± 7.7% vs 39.8% ± 20.5%) (P < .001). Head-neck and acetabular cartilage in the early and late FAI groups showed a similar degree of degeneration. Moreover, a similar expression of inflammation-related proteins was observed between the early and late FAI groups for head-neck cartilage (IL-1β: 69.7% ± 18.1% vs 72.5% ± 13.2%; MMP-13: 79.6% ± 12.6% vs 71.4% ± 18.8%; ADAMTS-4: 83.9% ± 12.2% vs 82.6% ± 12.5%; COL2: 93.6% ± 3.9% vs 92.5% ± 5.8%; NITEGE: 89.7% ± 7.7% vs 95.7% ± 4.7%) and acetabular cartilage (IL-1β: 83.3% ± 24.8% vs 80.7% ± 15.6%; MMP-13: 94.3% ± 9.7% vs 85.2% ± 12.3%; ADAMTS-4: 98.5% ± 2.3% vs 98.4% ± 3.4%; COL2: 99.8% ± 0.7% vs 99.7% ± 1.1%; NITEGE: 96.7% ± 6.7% vs 99.2% ± 2.2%). In contrast, synovitis was minimal with a low expression of IL-1β in the early FAI group compared with the late FAI group.Conclusion:Hip cartilage exhibited an OA phenotype in patients with early-stage FAI, similar to what was observed in hip OA secondary to FAI. Severe synovitis was only evident with late-stage FAI.Clinical Relevance:This study supports the concept that early hip impingement is associated with cartilage degeneration and catabolism.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-01T12:06:29Z
      DOI: 10.1177/0363546520935440
      Issue No: Vol. 48, No. 10 (2020)
       
  • Society News and Announcements
    • Pages: 2586 - 2587
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 10, Page 2586-2587, August 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-01T12:07:21Z
      DOI: 10.1177/0363546520946745
      Issue No: Vol. 48, No. 10 (2020)
       
  • The Hip Suction Seal, Part I: The Role of Acetabular Labral Height on Hip
           Distractive Stability
    • Authors: Hunter W. Storaci, Hajime Utsunomiya, Bryson R. Kemler, Samuel I. Rosenberg, Grant J. Dornan, Alex W. Brady, Marc J. Philippon
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The acetabular labrum has been found to provide a significant contribution to the distractive stability of the hip. However, the influence of labral height on hip suction seal biomechanics is not known.Hypothesis:The smaller height of acetabular labrum is associated with decreased distractive stability.Study Design:Descriptive laboratory study.Methods:A total of 23 fresh-frozen cadaveric hemipelvises were used in this study. Hips with acetabular dysplasia or femoroacetabular impingement–related bony morphologic features, intra-articular pathology, or no measurable suction seal were excluded. Before testing, each specimen’s hip capsule was removed, a pressure sensor was placed intra-articularly, and the hip was fixed in a heated saline bath. Labral size was measured by use of a digital caliper. Maximum distraction force, distance to suction seal rupture, and peak negative pressure were recorded while the hip underwent distraction at a rate of 0.5 mm/s. Correlations between factors were analyzed using the Spearman rho, and differences between groups were detected using Mann-Whitney U test.Results:Of 23 hips, 12 satisfied inclusion criteria. The maximum distraction force and peak negative pressure were significantly correlated (R = −0.83; P = .001). Labral height was largely correlated with all suction seal parameters (maximum distraction force, R = 0.69, P = .013; distance to suction seal rupture, R = 0.55, P = .063; peak negative pressure, R = −0.62, P = .031). Labral height less than 6 mm was observed in 5 hips, with a mean height of 6.48 mm (SD, 2.65 mm; range, 2.62-11.90 mm; 95% CI, 4.80-8.17 mm). Compared with the 7 hips with larger labra (>6 mm), the hips with smaller labra had significantly shorter distance to suction seal rupture (median, 2.3 vs 7.2 mm; P = .010) and significantly decreased peak negative pressure (median, −59.3 vs −66.9 kPa; P = .048).Conclusion:Smaller height (
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-07T11:23:48Z
      DOI: 10.1177/0363546520941855
       
  • The Hip Suction Seal, Part II: The Effect of Rim Trimming, Chondrolabral
           Junction Separation, and Labral Repair/Refixation on Hip Distractive
           Stability
    • Authors: Hajime Utsunomiya, Hunter W. Storaci, Samuel I. Rosenberg, Bryson R. Kemler, Grant J. Dornan, Alex W. Brady, Marc J. Philippon
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The acetabular labrum contains free nerve endings, and an unstable labrum can result in increased femoral head movement during hip motion. This can be caused by chondrolabral junction (CLJ) separation, especially in association with pincer-type femoroacetabular impingement, and may contribute to hip pain.Hypothesis:Rim resection alone has no effect on suction seal biomechanics. Further, separation of the CLJ changes hip suction seal biomechanics when compared with those of the native state, whereas repair and refixation with suture anchors restore these biomechanical parameters.Study Design:Controlled laboratory study.Methods:A total of 12 fresh-frozen human cadaveric hips were used in this study. Hips were mounted in a saline bath on a dynamic tensile testing machine and were distracted at a rate of 0.5 mm/s from neutral position. A total of 3 parameters (force, displacement, and intra-articular pressure) were measured throughout testing. Before testing, hips were randomly allocated to 1 of 2 groups: 1 that included the CLJ separation (CLJ Cut group) and 1 that did not (CLJ Intact group). Hips were tested in the following states: (1) native, (2) rim trimming, (3) separated CLJ (CLJ Cut group only), and (4) labral repair/refixation. For each group a linear mixed-effects model was used to compare biomechanical parameters between states.Results:Rim trimming did not affect any suction seal parameters relative to those of the native state. In the CLJ Cut group, no significant difference in distance to break the suction seal was observed for any states compared with that of the native state. In the CLJ Intact group, the distance to break the suction seal was significantly shorter in the labral refixation state (1.8 mm) than the native state (5.6 mm; P = .002). The maximum distraction force (62.1 ± 54.1 N) and the peak negative pressure (−36.6 ± 24.2 kPa) of the labral repair/refixation state were significantly lower than those of the native state in both groups (93.4 ± 41.7 N, P = .01; –60.7 ± 20.4 kPa, P = .02).Conclusion:Rim trimming did not change the biomechanical properties of the labral suction seal. Labral refixation resulted in a shorter distance to break the labral suction seal. This indicates that labral mobility is reduced by the labral refixation procedure, which could be beneficial in postoperative pain relief and labral healing.Clinical Relevance:The labral refixation reduced labral mobility, which could be beneficial for both pain relief and labral healing to the acetabulum after pincer-type femoroacetabular impingement resection.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-07T11:23:19Z
      DOI: 10.1177/0363546520941859
       
  • Patellofemoral Cartilage Degeneration After Closed- and Open-Wedge High
           Tibial Osteotomy With Large Alignment Correction
    • Authors: Sang Jun Song, Kyoung Ho Yoon, Cheol Hee Park
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Previous studies have reported patellofemoral cartilage degeneration and analyzed the factors affecting degeneration after open-wedge high tibial osteotomy (OWHTO). However, no studies have evaluated patellofemoral cartilage degeneration or examined the factors affecting degeneration after closed-wedge high tibial osteotomy (CWHTO).Purpose:To investigate and compare patellofemoral cartilage degeneration after CWHTO and OWHTO via arthroscopic evaluation and to analyze the factors affecting the degeneration.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 54 CWHTOs and 50 OWHTOs were performed with first-look arthroscopy between 2013 and 2017 at one institution. Hardware removal and second-look arthroscopy were performed, on average, 30.2 months after CWHTO and 26.8 months after OWHTO (P = .178). Patient characteristics did not differ significantly between the groups. Radiographically, the mechanical axis, posterior tibial slope, and modified Blackburne-Peel ratio were evaluated. Arthroscopically, the percentage of patient with patellofemoral cartilage degeneration was evaluated according to the International Cartilage Repair Society grading system. Logistic regression analysis was used to identify the factors affecting patellofemoral cartilage degeneration in terms of demographics and the change of mechanical axis (correction angle), tibial posterior slope angle, and modified Blackburne-Peel ratio. The Anterior Knee Pain Scale was used for clinical comparison between the patellofemoral degenerative and nondegenerative groups.Results:No significant differences were observed in pre- and postoperative radiographic results between the CWHTO and OWHTO groups, except that the postoperative modified Blackburne-Peel ratio was significantly smaller among the OWHTOs. The percentage of patients with patellofemoral cartilage degeneration were 29.6% in the CWHTO group and 44% in the OWHTO group (P = .156) at second-look arthroscopy. The correction angle was the only significant factor affecting cartilage degeneration in the CWHTO group (odds ratio, 2.324; P = .013; cutoff value, 9.6°) and the OWHTO group (odds ratio, 1.440; P = .041; cutoff value, 10.1°). The postoperative Anterior Knee Pain Scale score was significantly lower in the patellofemoral degenerative group as compared with the nondegenerative group among the OWHTO group (81.6 vs 76.4; P = .039); among the CWHTO group, there was a lower tendency in the degenerative group, but this was without significance (81.1 vs 79.6; P = .367).Conclusion:Patellofemoral cartilage degeneration progressed after CWHTO and OWHTO with large alignment correction. High tibial osteotomy should be selected with careful consideration of the osteoarthritic status of the patellofemoral joint and required correction angle, regardless of applying a closed- or open-wedge technique.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-07T04:47:17Z
      DOI: 10.1177/0363546520943872
       
  • 3D-Printed Extracellular Matrix/Polyethylene Glycol Diacrylate Hydrogel
           Incorporating the Anti-inflammatory Phytomolecule Honokiol for
           Regeneration of Osteochondral Defects
    • Authors: Shouan Zhu, Pengfei Chen, Yang Chen, Muzhi Li, Can Chen, Hongbin Lu
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Osteoarthritis is the leading cause of disability worldwide; cartilage degeneration and defects are the central features. Significant progress in tissue engineering holds promise to regenerate damaged cartilage tissue. However, a formidable challenge is to develop a 3-dimensional (3D) tissue construct that can regulate local immune environment to facilitate the intrinsic osteochondral regeneration.Purpose:This study is to evaluate efficacy of a 3D-printed decellularized cartilage extracellular matrix (ECM) and polyethylene glycol diacrylate (PEGDA) integrated novel scaffold (PEGDA/ECM) together with the natural compound honokiol (Hon) for regenerating osteochondral defect.Study Design:Controlled laboratory study.Methods:We used a stereolithography-based 3D printer for PEGDA/ECM bioprinting. A total of 36 Sprague-Dawley rats with cylindrical osteochondral defect in the trochlear groove of the femur were randomly assigned into 3 different treatments: no scaffold implantation (Defect group), 3D printed PEGDA/ECM scaffold alone (PEGDA/ECM group), or Hon suspended in a 3D-printed PEGDA/ECM scaffold (PEGDA/ECM/Hon group). 12 rats that underwent only medial parapatellar incision surgery were used as normal controls. The femur specimens were postoperatively harvested at 4 and 8 weeks for gross, micro-CT, and histological evaluations. The efficacy of PEGDA/ECM/Hon scaffold on the release of proinflammatory cytokines from the macrophages stimulated by lipopolysaccharide (LPS) was evaluated in-vitro.Results:In-vitro results determined that PEGDA/ECM/Hon scaffold could suppress the release of proinflammatory cytokines from macrophages that were stimulated by LPS. Macroscopic images showed that the PEGDA/ECM/Hon group had significantly higher ICRS scoring than that of defect and PEGDA/ECM groups. Micro-CT evaluation demonstrated that much more bony tissue was formed in the defect sites implanted with the PEGDA/ECM scaffold or PEGDA/ECM/Hon scaffold compared with the untreated defects. Histological analysis showed that the PEGDA/ECM/Hon group had a significant enhancement in osteochondral regeneration at 4 and 8 weeks after surgery in comparison with the ECM/PEGDA or defect group.Conclusion:This study demonstrated that 3D printing of PEGDA/ECM hydrogel incorporating the anti-inflammatory phytomolecule honokiol could provide a promising scaffold for osteochondral defect repair.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-07T04:32:41Z
      DOI: 10.1177/0363546520941842
       
  • Prospective Single-Blinded Randomized Controlled Trial Comparing
           Pericapsular Injection Versus Lumbar Plexus Peripheral Nerve Block for Hip
           Arthroscopy
    • Authors: John P. Scanaliato, Daniel Christensen, Michael M. Polmear, Catherine Salfiti, Patrick S. Gaspar, Andrew B. Wolff
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Hip arthroscopy has become the standard for the operative treatment of symptomatic femoroacetabular impingement. Given the high levels of postoperative pain associated with hip arthroscopy, optimal analgesia is critical to ensure patient comfort and safety after discharge.Purpose/Hypothesis:Our purpose was to perform a single-blinded randomized controlled trial comparing the use of pericapsular injection versus lumbar plexus blockade for postoperative pain control after arthroscopic surgery on the hip. We hypothesized that pericapsular injection would provide equivalent pain relief to that of lumbar plexus blockade while minimizing adverse effects and alleviating the dependence on a qualified individual to administer.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 64 consecutive patients undergoing hip arthroscopy were prospectively assessed over a 6-month period between 2017 and 2018. Patients were randomly allocated to 1 of 2 groups: 32 patients received a lumbar plexus blockade by a single anesthesiologist, while 32 patients received a pericapsular injection of 30 mL of ropivacaine and 12 mg of morphine. Postoperative pain in the postanesthesia care unit (PACU) as measured using the numeric rating scale, time to discharge, PACU morphine equivalents, and adverse effects were collected by PACU staff. Postoperative day 1 and 2 narcotic use was obtained through a telephone call with the patient on postoperative day 3.Results:We found no statistically significant difference in PACU pain scores at all time points, although there was a trend toward lower pain for patients receiving a pericapsular injection. PACU and short-term narcotic demand did not vary across the 2 arms. Time to discharge from the PACU did not differ. There were no major adverse events reported for either intervention.Conclusion:Pericapsular injection provides equivalent analgesia when compared with lumbar plexus blockade. It is a safe intervention that allows for efficient postoperative analgesia for patients undergoing hip arthroscopy.Registration:ClinicalTrials.gov ID: NCT03244631.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-06T08:20:16Z
      DOI: 10.1177/0363546520943580
       
  • Operative Treatment of Acute Patellar Tendon Ruptures
    • Authors: James A. O’Dowd, David M. Lehoang, Rebecca R. Butler, David O. Dewitt, Raffy Mirzayan
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The gold standard for patellar tendon repair is a transosseous technique. Suture anchor repair has gained popularity, with recent biomechanical studies demonstrating significantly less gap formation during cyclic loading and significantly higher ultimate failure loads as compared with transosseous repair. These findings have not been substantiated in a large clinical cohort.Purpose:To report demographic and epidemiologic data, clinical and surgical findings, and outcomes and complications of anchor and transosseous suture repairs of acute patellar tendon ruptures.Study Design:Cohort study; Level of evidence, 3.Methods:All patients who underwent a primary repair of a traumatic patellar tendon rupture within 45 days of injury between 2006 and 2016 were retrospectively reviewed. Surgery was performed at a multisurgeon (120 surgeons) multicenter (14 centers) community-based integrated health care system. Patient demographic information, repair type, complications, and time from surgery to release from medical care were recorded.Results:A total of 361 patients (374 knees) met our inclusion criteria. The mean age was 39.8 years (range, 9-86 years), and 91.7% were male. There were 321 transosseous and 53 anchor repairs. There was no significant difference in the mean age (P = .27), sex (P = .79), tourniquet time (P = .93), or body mass index (P = .78) between the groups. There was a significant difference in rerupture rate between transosseous and anchor repairs (7.5% vs 0%, respectively; P = .034). Based on logistic regression, transosseous repair had 3.24 times the odds of reoperation verseus anchor repair (95% CI, 0.757-13.895; P = .1129). The infection rate was 1.6% for transosseous repair and 7.5% for anchor repair (P = .160). There was no difference in time to release from medical care: 18.4 weeks for anchor and 17.1 weeks for transosseous repairs (P = .92).Conclusion:Anchor repair demonstrated a significant decrease in rerupture rate when compared with transosseous repair. There was no difference in reoperation rate, infection rate, or time to release from medical care.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-06T07:45:03Z
      DOI: 10.1177/0363546520943879
       
  • Can We Eliminate Opioid Medications for Postoperative Pain Control' A
           Prospective, Surgeon-Blinded, Randomized Controlled Trial in Knee
           Arthroscopic Surgery
    • Authors: Matthew J. Hartwell, Ryan S. Selley, Michael A. Terry, Vehniah K. Tjong
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Orthopaedic surgeons have a responsibility to develop responsible opioid practices. Growing evidence has helped define an optimal number of opioids to prescribe after surgical procedures, but little evidence-based guidance exists to support specific practice patterns to decrease opioid utilization.Hypothesis:After knee arthroscopic surgery with partial meniscectomy, patients who were provided a prescription for opioids and instructed to only fill the prescription if absolutely necessary for pain control would take fewer opioids than patients with opioids automatically included as part of a multimodal approach to pain control prescribed at discharge.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:Patients undergoing arthroscopic partial meniscectomy were provided multimodal pain control with aspirin, acetaminophen, and naproxen and randomized to receive oxycodone as either included with their multimodal pain medications (group 1) or given an optional prescription to fill (group 2). Patients were contacted at time points up to 1 month after surgery to assess opioid utilization and medication side effects. The mean number of tablets utilized was the primary outcome measure, with a 50% reduction defined as a successful outcome.Results:A total of 105 patients were initially enrolled, and 95 (91%; 48 in group 1 and 47 in group 2) successfully completed the study. There was no significant reduction in the number of tablets utilized between groups 1 and 2 (3.5 vs 4.5, respectively; P = .45), days that opioids were required (2.2 vs 3.2, respectively; P = .20), or postoperative pain at any time point. The group with the option to fill their prescription had significantly fewer unused tablets remaining than the group with opioids included as part of the multimodal pain control regimen (75% of potentially prescribed tablets vs 82% of prescribed tablets; P < .001). Overall, 37% of patients did not require any opioids after surgery, and 86% used ≤8 tablets.Conclusion:Patients required a minimal number of opioids after knee arthroscopic surgery with partial meniscectomy. There was no difference in the number of tablets utilized whether the opioid prescription was included in a multimodal pain control regimen or patients were given an option to fill the prescription. Offering optional opioid prescriptions in the setting of a multimodal approach to pain control can significantly reduce the number of unused opioids circulating in the community.Registration:NCT03876743 (ClinicalTrials.gov identifier)
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-05T10:05:45Z
      DOI: 10.1177/0363546520941861
       
  • Beneficial Therapeutic Approach of Acellular PLGA Implants Coupled With
           Rehabilitation Exercise for Osteochondral Repair: A Proof of Concept Study
           in a Minipig Model
    • Authors: Chih-Chan Lin, Chih-Jou Chu, Pei-Hsi Chou, Chun-Hao Liang, Peir-In Liang, Nai-Jen Chang
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Osteochondral (OC) repair presents a significant challenge to clinicians. However, whether the use of acellular spongy poly(lactic-co-glycolic acid) (PLGA) scaffolding plus treadmill exercise as a rehabilitation program regenerates OC defects in a large-animal model has yet to be determined.Hypothesis:PLGA scaffolding plus treadmill exercise may offer improved OC repair for both high and low weightbearing regions in a minipig model.Study Design:Controlled laboratory study.Methods:A total of 9 mature minipigs (18 knees) were randomly divided into the treadmill exercise (TRE) group or sedentary (SED) group. All pigs received critically sized OC defects in a higher weightbearing region of the medial condyle and a lower weightbearing region of the trochlear groove. In each minipig, a PLGA scaffold was placed in the defect of the right knee (PLGA subgroup), and the defect of the left knee was untreated (empty defect [ED] subgroup). The TRE group performed exercises in 3 phases: warm-up, 3 km/h for 5 minutes; main exercise, 4 km/h for 20 minutes; and cool-down, 3 km/h for 5 minutes. The total duration was about 30 minutes whenever possible. The SED group was allowed free cage activity.Results:At 6 months, the TRE-PLGA group showed the highest gross morphology scores and regenerated a smooth articular surface covered with new hyaline-like tissue, while the defects of the other groups remained and contained nontransparent tissue. Histologically, the TRE-PLGA group also revealed sound OC integration, chondrocyte-like cells embedded in lacunae, abundant glycosaminoglycans, a sound collagen structure, and modest inflammatory cells with an inflammatory response (ie, tumor necrosis factor–α, interleukin-6). In addition, in the medial condyle region, the TRE-PLGA group (31.80 ± 3.03) had the highest total histological scores (TRE-ED: 20.20 ± 5.76; SED-PLGA: 10.25 ± 6.24; SED-ED: 11.75 ± 6.50; P = .004). In the trochlear groove region, the TRE-PLGA group (30.20 ± 6.42) displayed significantly higher total histological scores (TRE-ED: 19.60 ± 7.00; SED-PLGA: 10.00 ± 5.42; SED-ED: 11.25 ± 5.25; P = .006). In contrast, the SED-PLGA and SED-ED groups revealed an irregular surface with abrasion, fibrotic tissue with an empty void and inflammatory cells, disorganized collagen fibers, and less glycosaminoglycan deposition. Micro–computed tomography analysis revealed that the TRE-PLGA group had integrated OC interfaces with continued remodeling in the subchondral bone. Furthermore, comparing the 2 defect regions, no statistically significant differences in cartilage regeneration were detected, indicating the suitability of this regenerative approach for both high and low weightbearing regions.Conclusion:Implanting an acellular PLGA scaffold plus treadmill exercise promoted articular cartilage regeneration for both high and low weightbearing regions in minipigs.Clinical Relevance:This study suggests the use of a cell-free porous PLGA scaffold and treadmill exercise rehabilitation as an alternative therapeutic strategy for OC repair in a large-animal knee joint model. This combined effect may pave the way for biomaterials and exercise regimens in the application of OC repair.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-08-04T04:50:50Z
      DOI: 10.1177/0363546520940306
       
  • Diagnostic Imaging of Ulnar Collateral Ligament Injury: A Systematic
           Review
    • Authors: Richard E. Campbell, Alexa N. McGhee, Kevin B. Freedman, Fotios P. Tjoumakaris
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Ulnar collateral ligament (UCL) injuries can be debilitating in overhead athletes. Accurate diagnosis is important; however, several imaging modalities are available for the assessment of UCL injuries.Purpose:To provide a comprehensive review of published literature regarding the diagnostic capabilities of different imaging modalities for UCL tears.Methods:PubMed, Medline, and Embase were queried for peer-reviewed literature published between January 1947 and June 4, 2019, pertaining to diagnostic imaging of UCL tears. Articles assessing static and stress radiography, ultrasound, magnetic resonance imaging (MRI), MRI with arthrography (MRA), and computed tomography arthrography of the UCL were included. Studies were excluded if imaging results were not compared with intraoperative diagnosis, as intraoperative findings are generally considered the gold standard for diagnostic comparison. The articles were assessed per the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines and reviewed with the Quality Assessment of Diagnostic Accuracy Studies, version 2 (QUADAS-2) assessment.Results:The literature search yielded 2478 articles, of which 15 were included in this review. Potential bias was noted in each QUADAS-2 subsection. Multiple studies demonstrate an association between UCL tears and osseous abnormalities identified on static radiographs; however, the use of static or nonstressed radiographs is not recommended for specific evaluation of UCL injuries. Conventional ultrasound was 81% sensitive and 91% specific, as compared with 96% and 81% for stress ultrasound, respectively. The sensitivity and specificity of MRI ranged from 57% to 100% and 89% to 100%. The sensitivity of computed tomography arthrography ranged from 63% to 86%. The sensitivity and specificity of MRA ranged from 81% to 100% and 91% to 100%.Conclusion:Of the currently available imaging modalities, MRA provides the best combination of sensitivity and specificity of the evaluation of the UCL. Further research comparing ultrasound with MRA is needed.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-31T06:01:19Z
      DOI: 10.1177/0363546520937302
       
  • Early Surgical Repair of Medial Meniscus Posterior Root Tear Minimizes the
           Progression of Meniscal Extrusion: 2-Year Follow-up of Clinical and
           Radiographic Parameters After Arthroscopic Transtibial Pull-out Repair
    • Authors: Hyun-Soo Moon, Chong-Hyuk Choi, Min Jung, Dae-Young Lee, Seung-Pyo Hong, Sung-Hwan Kim
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Conflicting results have been reported concerning the progression of medial meniscal extrusion (MME) after arthroscopic transtibial pull-out repair of medial meniscus posterior root tear (MMRT), and no study has evaluated the relevant factors affecting the progression of MME.Purpose:To (1) evaluate the subjective and objective surgical outcomes of arthroscopic transtibial pull-out repair of MMRT and (2) identify relevant factors affecting the progression of MME after surgery.Study Design:Case-control study; Level of evidence, 3.Methods:A total of 63 patients who underwent isolated arthroscopic transtibial pull-out repair of MMRT between January 2010 and June 2017 were evaluated retrospectively. Clinical scores and various radiographic parameters were evaluated to assess the surgical outcomes. The patients were classified into 2 groups according to the change in medial meniscal extrusion ratio (MMER) at 1 year after surgery compared with before surgery (group 1 consisted of 21 patients with reduced or maintained MMER; group 2 consisted of 42 patients with increased MMER). Variables including baseline demographics, radiographic parameters, and arthroscopic findings were compared to identify relevant factors affecting the progression of MME after surgery.Results:In the overall cohort, clinical outcomes at postoperative 2 years improved significantly (P < .001 for visual analog scale score, International Knee Documentation Committee subjective score, and Lysholm score), whereas radiographic parameters showed an overall deterioration compared with the preoperative level. In subgroup comparisons, a significant difference was seen in the time from the onset of symptoms until surgery (P < .001), defined as preoperative symptom duration, which a subsequent logistic regression analysis revealed to be a relevant factor associated with the progression of MMER (P = .015). Both groups showed progression of radiographic osteoarthritis, but the progression was significantly higher in group 2 compared with group 1 at postoperative 2 years (P = .032). On receiver operating characteristic curve analysis, the cutoff point for preoperative symptom duration associated with the progression of MMER was 13 weeks (sensitivity, 52.4%; specificity, 76.2%; accuracy, 72.4%).Conclusion:The arthroscopic transtibial pull-out repair of MMRT showed clinical improvement but did not prevent the progression of knee osteoarthritis, MME, or MMER. Although the preservation of MMER was not capable of completely preventing the progression of knee degeneration, MMER still has a potential clinical value in delaying the rate of progression of knee degeneration. Early surgical repair of MMRT, within 13 weeks from the onset of symptoms, might be helpful to prevent the progression of MME.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-30T11:55:16Z
      DOI: 10.1177/0363546520940715
       
  • Human Rotator Cuff Tears Have an Endogenous, Inducible Stem Cell Source
           Capable of Improving Muscle Quality and Function After Rotator Cuff Repair
           
    • Authors: Brian T. Feeley, Mengyao Liu, C. Benjamin Ma, Obiajulu Agha, Mya Aung, Carlin Lee, Xuhui Liu
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The muscle quality of the rotator cuff (RC), measured by atrophy and fatty infiltration (FI), is a key determinant of outcomes in RC injury and repair. The ability to regenerate muscle after repair has been shown to be limited.Purpose:To determine if there is a source of resident endogenous stem cells, fibroadipogenic progenitor cells (FAPs), within RC injury patients, and if these cells are capable of adipogenic, fibrogenic, and pro-myogenic differentiation.Study Design:Controlled laboratory study.Methods:A total of 20 patients between the ages of 40 and 75 years with partial- or full-thickness RC tears of the supraspinatus and evidence of atrophy and FI Goutallier grade 1, 2, or 3 were selected from 2 surgeons at an orthopaedic center. During the surgical repair procedure, supraspinatus muscle biopsy specimens were obtained for analysis as were deltoid muscle biopsy specimens to serve as the control. FAPs and satellite cells were quantified using fluorescence-activated cell sorting. Muscle FI and fibrosis was quantified using Oil Red O and Masson trichrome staining. FAP differentiation and gene expression profiles were compared across tear sizes after culture in adipogenic, fibrogenic, and beta-3 agonist (amibegron) conditions. Analysis of variance was used for statistical comparisons between groups, with P < .05 as statistically significant.Results:Histologic analysis confirmed the presence of fat in biopsy specimens from patients with full-thickness tears. There were more FAPs in the full-thickness tear group compared with the partial-thickness tear group (9.43% ± 4.25% vs 3.84% ± 2.54%; P < .01). Full-thickness tears were divided by tear size, with patients with larger tears having significantly more FAPs than those with smaller tears. FAPs from muscles with full-thickness tendon tears had more adipogenic and fibrogenic potential than those with partial tears. Induction of a beige adipose tissue (BAT) phenotype in FAPs was possible, as demonstrated by increased expression of BAT markers and pro-myogenic genes including insulin-like growth factor 1 and follistatin.Conclusion:Endogenous FAPs are present within the RC and likely are the source of FI. These FAPs were increased in muscles with in larger tears but are capable of adopting a pro-myogenic BAT phenotype that could be utilized to improve muscle quality and patient function after RC repair.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-30T11:46:10Z
      DOI: 10.1177/0363546520935855
       
  • Return to Golf After Shoulder Arthroplasty: A Systematic Review
    • Authors: Hytham S. Salem, Do H. Park, Stephen G. Thon, Jonathan T. Bravman, Adam J. Seidl, Eric C. McCarty, Rachel M. Frank
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The number of golfers aged ≥65 years has increased in recent years, and shoulder arthritis is prevalent in this age group. Guidelines for return to golf (RTG) after shoulder arthroplasty have not been fully established.Purpose:To review the data available in the current literature on RTG after shoulder arthroplasty.Study Design:Systematic review.Methods:A systematic review based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. Two independent reviewers searched PubMed, Embase, and the Cochrane Library using the terms “shoulder,”“arthroplasty,”“replacement,” and “golf.” The authors sought to include all studies investigating RTG after total shoulder arthroplasty (TSA), shoulder hemiarthroplasty (HA), and reverse shoulder arthroplasty (RSA). Outcomes of interest included indications for shoulder arthroplasty, surgical technique, rehabilitation protocol, amount of time between surgery and resumption of golf activity, and patient-reported outcome measures.Results:A total of 10 studies were included, 2 of which reported on golf performance after shoulder arthroplasty. The other 8 studies described return to sports after shoulder arthroplasty with golf-specific data for our analysis. Three studies that included patients who underwent TSA reported RTG rates ranging from 89% to 100% after mean follow-up periods of 5.1 to 8.4 months. Two studies included patients who underwent TSA and HA and reported RTG rates of 77% and 100% after mean intervals of 5.8 and 4.5 months, respectively. Two studies included patients who underwent RSA, with RTG rates of 50% and 79% after mean postoperative intervals of 5.3 and 6 months, respectively. One study included only patients undergoing HA, with an RTG rate of 54% and a mean RTG time of 6.5 months. Varying surgical procedures and baseline patient characteristics precluded our ability to draw conclusions regarding surgical technique, rehabilitation protocol, or patient-reported outcome measures among studies reporting these data.Conclusion:Most patients who undergo a shoulder arthroplasty procedure can expect to resume playing golf approximately 6 months after the index procedure. The rate of return may be lower after RSA and HA as compared with anatomic TSA. The data presented in our review can help physicians counsel patients who wish to continue golf participation after a shoulder arthroplasty procedure.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-17T08:47:19Z
      DOI: 10.1177/0363546520923070
       
  • Outcomes of 1- Versus 2-Stage Revision Anterior Cruciate Ligament
           Reconstruction: A Systematic Review and Meta-analysis
    • Authors: Matthew Colatruglio, David C. Flanigan, Joseph Long, Alex C. DiBartola, Robert A. Magnussen
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Anterior cruciate ligament reconstruction (ACLR) is a common orthopaedic sports medicine procedure, but graft failure is not uncommon and often leads to revision ACLR. Revision surgery can be performed in a 1- or 2-stage fashion.Hypothesis:Graft failure risk, patient-reported outcomes, and anterior knee laxity are similar after 1- and 2-stage revision ACLR.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed to evaluate patient outcomes after 1- versus 2-stage revision ACLR. A search was performed with the phrase “revision anterior cruciate ligament reconstruction” across Embase, PubMed, Scopus, and SportDiscus from the beginning of their archives through July 12, 2019.Results:Thirteen studies met inclusion criteria and included 524 patients: 319 patients who underwent 1-stage revision ACLR and 205 patients who underwent 2-stage revision ACLR. Two studies compared outcomes of 1- versus 2-stage revision ACLR; 4 studies reported outcomes after 2-stage revision ACLR; and the remaining 7 studies documented outcomes after 1-stage ACLR. The mean follow-up was 4.1 years. The 2 studies that compared 1- versus 2-stage ACLR reported no differences in functional, radiologic, or patient-reported outcomes or failure risk. Overall, 9 studies reported subjective International Knee Documentation Committee (IKDC) scores; 4 studies, Knee injury and Osteoarthritis Outcome Score values; 8 studies, Lysholm scores; and 7 studies, Tegner scores; 8 studies measured anterior laxity with a KT-1000 arthrometer. The mean weighted subjective IKDC score for all studies including this outcome at final follow-up was 66.6 for 1-stage revisions and 65.9 for 2-stage revisions.Conclusion:The available evidence comparing 1- versus 2-stage revision ACLR is retrospective and limited. The results of each approach are similar in appropriately selected patients.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-16T05:09:17Z
      DOI: 10.1177/0363546520923090
       
  • Hip Arthroscopy in Smokers: A Systematic Review of Patient-Reported
           Outcomes and Complications in 18,585 Cases
    • Authors: Ahmed K. Emara, Daniel Grits, Linsen T. Samuel, Alexander J. Acuña, James T. Rosneck, Atul F. Kamath
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Although the negative effects of smoking have been documented for other types of arthroscopic procedures, there is limited information regarding its influence on hip arthroscopy outcomes.Purpose:To examine the effect of smoking on the following outcomes after hip arthroscopy: patient-reported outcomes (PROs), the degree of improvement in PROs relative to baseline, complication rates, and rates of revision arthroscopy and/or conversion to total hip arthroplasty (THA).Study Design:Systematic review.Methods:The PubMed, Embase, and Cochrane Library databases were queried for studies published between January 1, 1985, and January 14, 2020, comparing the outcomes of hip arthroscopy between smokers and nonsmokers. Case reports, basic science studies, and studies investigating pediatric patients or lacking a description of outcomes were excluded. Included outcome tools were the modified Harris Hip Score, the visual analog scale (VAS) for pain and satisfaction, and the Hip Outcome Score (HOS)–Sports Specific and HOS–Activities of Daily Living. Preoperative characteristics and operative indications were also recorded.Results:Postoperative combined means (± SD) were better in nonsmokers versus smokers for the modified Harris Hip Score (75.67 ± 20.88 vs 82.32 ± 15.5; P = .001), the VAS pain (3.13 ± 2.79 vs 2.13 ± 2.21; P < .001), and the HOS–Sports Specific (62.54 ± 25.38 vs 71.7 ± 23.3; P < .001). There was no difference between groups in VAS satisfaction (P = .23) or HOS–Activities of Daily Living (P = .13). The extent of PRO score improvement relative to baseline values was similar in smokers and nonsmokers in all PRO measures (P> .05 for all). Smokers demonstrated higher rates of postoperative thromboembolic (P = .0177) and infectious (P = .006) complications. There was no difference between rates of revision arthroscopy (P = .47) and THA conversion (P = .31).Conclusion:Smoking adversely affects certain postoperative PROs and is associated with higher postoperative complication rates. Further studies are required investigating the degree of PRO improvement and long-term arthroscopy revision and THA conversion rates.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-06T07:54:44Z
      DOI: 10.1177/0363546520922854
       
  • Iliopsoas Tenotomy During Hip Arthroscopy: A Systematic Review of
           Postoperative Outcomes
    • Authors: Kyle Gouveia, Ajay Shah, Jeffrey Kay, Muzammil Memon, Nicole Simunovic, Josip N. Cakic, Anil S. Ranawat, Olufemi R. Ayeni
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Arthroscopic iliopsoas tendon release is a surgical treatment option for painful snapping hips, although it has been associated with controversy surrounding potential complications including decreased hip flexion strength, iatrogenic hip instability, and iliopsoas atrophy.Purpose:To systematically assess the efficacy and safety of arthroscopic iliopsoas tenotomy during hip arthroscopic surgery as an intervention for painful snapping hips.Study Design:Systematic review; Level of evidence, 4.Methods:A total of 3 online databases (Embase, PubMed, and MEDLINE) were searched from database inception until September 2019 for studies investigating iliopsoas tenotomy during hip arthroscopic surgery. Studies were screened by 2 reviewers independently and in duplicate, and studies investigating arthroscopic iliopsoas tendon release were included. Demographic data as well as data on treatment success, functional outcome scores, and radiological outcomes were recorded. A risk of bias assessment was performed for all included studies.Results:Overall, 21 studies were identified with a total of 824 patients (875 hips). These patients were 82.5% female (680/824), with a mean age of 28.1 years (range, 12-62 years) and mean follow-up of 32.1 months (range, 3-73 months). Arthroscopic iliopsoas tenotomy was performed at the level of the labrum in 811 hips (92.7%) or the lesser trochanter in 64 hips (7.3%). The overall reported success rate of the procedure in resolving snapping hips was 93.0% (266/286), and all studies reported an improvement in functional outcome scores. Only 6 studies (93 hips) discussed postoperative hip flexion strength, with complete recovery of strength reported in 4 studies (47 hips) and mild decreases reported in the other 2 studies (46 hips). Iliopsoas atrophy was evaluated radiologically (3 studies; 66 hips) and was found postoperatively in 92.4% (61/66) of hips. No major complications were reported.Conclusion:Arthroscopic release of the iliopsoas tendon was effective in alleviating pain and persistent clicking associated with a snapping hip. Although patients demonstrated some early postoperative weakness and iliopsoas atrophy on radiological imaging, the results from studies to date showed satisfactory clinical function and return to sports/activities. High-quality comparative studies are needed to further assess arthroscopic iliopsoas tendon release to determine the optimal technique and location of tendon release.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-06T07:45:03Z
      DOI: 10.1177/0363546520922551
       
  • Modified Jobe Versus Docking Technique for Elbow Ulnar Collateral Ligament
           Reconstruction: A Systematic Review and Meta-analysis of Clinical Outcomes
           
    • Authors: Austin M. Looney, David X. Wang, Christine M. Conroy, Jake E. Israel, Blake M. Bodendorfer, Caroline M. Fryar, Mark A. Pianka, Nathan P. Fackler, Michael G. Ciccotti, Edward S. Chang
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The modified Jobe and docking techniques are the most common techniques used for elbow ulnar collateral ligament (UCL) reconstruction. Previous systematic reviews have suggested that the docking technique results in superior outcomes as compared with the Jobe (figure-of-8) technique. However, these included results from earlier studies in which the flexor-pronator mass (FPM) was detached and an obligatory submuscular ulnar nerve transposition was performed.Purpose/Hypothesis:The purpose was to compare the outcomes and return-to-play (RTP) time between the docking and figure-of-8 techniques for UCL reconstruction. We hypothesized that there would be no significant difference in the proportion of excellent outcomes between techniques when the FPM was preserved and no obligatory submuscular ulnar nerve transposition was performed. We also hypothesized that there would be no significant difference in RTP time between techniques.Study Design:Systematic review and meta-analysis.Methods:This study was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. In the primary analysis, techniques were compared in random effects models by using the restricted maximum likelihood method, with weighted effect sizes calculated as the Freeman-Tukey double-arcsine transformed proportion of excellent outcomes for variance stabilization and with summary effects estimated from the inverse double-arcsine transformation per the harmonic mean of the sample sizes. Mean RTP times for techniques were compared in a separate model.Results:There were 21 eligible articles identified, with results for 1842 UCL reconstructions (n = 320, docking; n = 1466, figure-of-8). Without controlling for the effects of flexor-pronator detachment and submuscular ulnar nerve transposition, a significantly larger proportion of excellent outcomes was observed with docking reconstruction (86.58%; 95% CI, 80.42%-91.85%) than with figure-of-8 reconstruction (76.76%; 95% CI, 69.65%-83.25%; P = .031); however, there was no significant difference between techniques when controlling for FPM preservation or detachment with submuscular nerve transposition (P = .139). There was no significant difference between techniques in time to return to sports (P = .729), although no reconstructions with FPM detachment and submuscular ulnar nerve transposition were available for RTP time analysis.Conclusion:There was no significant difference in the proportion of excellent Conway Scale outcomes or RTP time between the docking and modified Jobe techniques for UCL reconstruction when the FPM was preserved and routine submuscular ulnar nerve transposition was not performed.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-06-29T10:46:21Z
      DOI: 10.1177/0363546520921160
       
  • Biceps Tenodesis for Superior Labrum Anterior-Posterior Tear in the
           Overhead Athlete: A Systematic Review
    • Authors: Travis L. Frantz, Andrew G. Shacklett, Adam S. Martin, Jonathan D. Barlow, Grant L. Jones, Andrew S. Neviaser, Gregory L. Cvetanovich
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Superior labrum anterior-posterior (SLAP) lesion is a common shoulder injury, particularly in overhead athletes. While surgical management has traditionally consisted of SLAP repair, high rates of revision and complications have led to alternative techniques, such as biceps tenodesis (BT). While BT is commonly reserved for older nonoverhead athletes, indications for its use have expanded in recent years.Purpose:To determine functional outcomes and return-to-sport rates among overhead athletes after BT for SLAP tear.Study Design:Systematic review.Methods:A systematic review was performed for any articles published before July 2019. The search phrase “labral tear” was used to capture maximum results, followed by keyword inclusion of “SLAP tear” and “biceps tenodesis.” Inclusion criteria included outcome studies of BT for isolated SLAP tear in athletes participating in any overhead sports, not limited to throwing alone. Abstracts and manuscripts were independently reviewed to determine eligibility. When clearly delineated, outcome variables from multiple studies were combined.Results:After full review, 8 articles met inclusion criteria (99 athletes; mean age, 19.8-47 years), with baseball and softball players the most common among them (n = 62). Type II SLAP tear was the most common diagnosis, and 0% to 44% of athletes had a failed previous SLAP repair before undergoing BT. Only 1 study included patients with concomitant rotator cuff repair. Open subpectoral BT was most commonly used, and complication rates ranged from 0% to 14%, with wound erythema, traumatic biceps tendon rupture, brachial plexus neurapraxia, and adhesive capsulitis being reported. Combined reported postoperative functional scores were as follows: American Shoulder and Elbow Surgeons, 81.7 to 97; 12-Item Short Form Health Survey physical, 50 to 54; visual analog scale for pain, 0.8-1.5; Kerlan Jobe Orthopaedic Clinic, 66 to 79; and satisfaction, 80% to 87%. The overall return-to-sports rate for overhead athletes was 70% (60 of 86). For studies that clearly delineated outcomes based on level of play/athlete, the combined return-to-sports rate was 69% (11 of 16) for recreational overhead athletes, 80% (4 of 5) for competitive/collegiate athletes, and 60% (18 of 30) for professionals.Conclusion:BT in the overhead athlete offers encouraging functional outcomes and return-to-sports rates, particularly in the recreational athlete. It can be successfully performed as an index operation rather than SLAP repair, as well as in a younger patient population. Careful consideration should be given to elite overhead athletes, particularly pitchers, who tend to experience poorer outcomes.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-06-24T09:51:26Z
      DOI: 10.1177/0363546520921177
       
  • Platelet-Rich Plasma Injection for the Treatment of Hamstring Injuries: A
           Systematic Review and Meta-analysis With Best-Worst Case Analysis
    • Authors: Dexter Seow, Yoshiharu Shimozono, Tengku Nazim B. Tengku Yusof, Youichi Yasui, Andrew Massey, John G. Kennedy
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Hamstring injuries are common and account for considerable time lost to play in athletes. Platelet-rich plasma has potential as a means to accelerate healing of these injuries.Purpose:(1) To present the evidence of platelet-rich plasma injection in the treatment of hamstring injuries, (2) evaluate the “best-case scenario” in dichotomous outcomes, and (3) evaluate the “worst-case scenario” in dichotomous outcomes.Study Design:Systematic review and meta-analysis.Methods:Two authors systematically reviewed the PubMed, Embase, and Cochrane Library databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with any discrepancies resolved by mutual consensus. The level of evidence was assessed per the criteria of the Oxford Centre for Evidence-Based Medicine and the quality of evidence by the Coleman Methodology Score. Meta-analysis by fixed effects models was used if heterogeneity was low (I2 < 25%) and random effects models if heterogeneity was moderate to high (I2≥ 25%). P values
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-05-19T04:43:49Z
      DOI: 10.1177/0363546520916729
       
  • Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Osteoarthritis: A
           Systematic Review and Meta-analysis of Randomized Controlled Trials
    • Authors: John W. Belk, Matthew J. Kraeutler, Darby A. Houck, Jesse A. Goodrich, Jason L. Dragoo, Eric C. McCarty
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Platelet-rich plasma (PRP) and hyaluronic acid (HA) are 2 nonoperative treatment options for knee osteoarthritis (OA) that are supposed to provide symptomatic relief and help delay surgical intervention.Purpose:To systematically review the literature to compare the efficacy and safety of PRP and HA injections for the treatment of knee OA.Study Design:Meta-analysis of level 1 studies.Methods:A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify level 1 studies that compared the clinical efficacy of PRP and HA injections for knee OA. The search phrase used was platelet-rich plasma hyaluronic acid knee osteoarthritis randomized. Patients were assessed via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analog scale (VAS) for pain, and Subjective International Knee Documentation Committee (IKDC) scale. A subanalysis was also performed to isolate results from patients who received leukocyte-poor and leukocyte-rich PRP.Results:A total of 18 studies (all level 1) met inclusion criteria, including 811 patients undergoing intra-articular injection with PRP (mean age, 57.6 years) and 797 patients with HA (mean age, 59.3 years). The mean follow-up was 11.1 months for both groups. Mean improvement was significantly higher in the PRP group (44.7%) than the HA group (12.6%) for WOMAC total scores (P < .01). Of 11 studies based on the VAS, 6 reported PRP patients to have significantly less pain at latest follow-up when compared with HA patients (P < .05). Of 6 studies based on the Subjective IKDC outcome score, 3 reported PRP patients to have significantly better scores at latest follow-up when compared with HA patients (P < .05). Finally, leukocyte-poor PRP was associated with significantly better Subjective IKDC scores versus leukocyte-rich PRP (P < .05).Conclusion:Patients undergoing treatment for knee OA with PRP can be expected to experience improved clinical outcomes when compared with HA. Additionally, leukocyte-poor PRP may be a superior line of treatment for knee OA over leukocyte-rich PRP, although further studies are needed that directly compare leukocyte content in PRP injections for treatment of knee OA.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-04-17T04:21:30Z
      DOI: 10.1177/0363546520909397
       
  • Regional Interdependence and the Role of the Lower Body in Elbow Injury in
           Baseball Players: A Systematic Review
    • Authors: Matthew Jordan Deal, Bradley P. Richey, Cyrus Anthony Pumilia, Ibrahim Mamdouh Zeini, Charles Wolf, Todd Furman, Daryl Christopher Osbahr
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Elbow injuries are exceedingly common in baseball players. Previous studies have identified that upper extremity strength and range of motion deficits pose a risk for these injuries, but few studies have examined the effect of lower extremity deficits. Given the role of the lower extremity in the kinetic chain of the baseball throwing motion, lower body deficits may affect the kinematics of the upper extremity and play a role in the elbow injury of baseball players.Purpose:To systematically review the current literature investigating the association of trunk and lower extremity deficits with elbow pain or injury in baseball players.Study Design:Systematic review.Methods:A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines to identify and analyze all previous studies focused on the association of elbow pain and/or injury with functional deficits of the trunk and lower extremities.Results:A total of 14 studies met inclusion criteria, examining a range of baseball players extending from youth to professional athletes. One of the 14 studies examined other types of overhead throwing athletes alongside baseball players. Lower extremity–related risk factors for elbow pain and injury in these athletes were found and stratified per level of play. Factors included specific hip range of motion, lower extremity injury or pain, balance, and foot arch posture. Associations were also found with lower extremity injury and noncompliance with primary prevention programs.Conclusion:Specific lower extremity deficits were found to be independent risk factors for elbow pain and injury in throwing athletes at certain levels of play. Additionally, prevention programs designed to correct deficits in identified risk factors were effective in reducing the incidence of elbow injury in youth athletes. These results highlight the potential of screening and subsequent intervention to reduce the incidence of elbow injury in certain subsets of baseball players.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-04-16T07:35:31Z
      DOI: 10.1177/0363546520910138
       
  • All-Inside Repair of Bucket-Handle Meniscal Tears: Clinical Outcomes and
           Prognostic Factors
    • Authors: Carolyn A. Ardizzone, Darby A. Houck, Derek W. McCartney, Armando F. Vidal, Rachel M. Frank
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:There is no consensus on technique of choice for repair of bucket-handle meniscal tears (BHMTs).Purpose:To determine factors that affect patient outcomes and failure rates in patients undergoing all-inside repairs of BHMTs.Study Design:Systematic review.Methods:A systematic review of 3 databases using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed. All English-language literature from 1993 to 2019 describing clinical outcomes for patients undergoing all-inside BHMT repair with ≥12-month follow-up was reviewed by 2 independent reviewers. Patient characteristics (patient sex, age), intraoperative factors (laterality, concomitant procedures, surgical technique, implants utilized), and postoperative outcomes (failure rates) were analyzed. Study quality was evaluated with the Modified Coleman Methodology Score (MCMS).Results:Fifteen studies (1 level 1, 4 level 3, 10 level 4) with 763 total patients (64% male; average age, 26.4 years [range, 9-58 years]; average follow-up, 39.8 months [range, 12-120 months]) including 396 all-inside BHMT repairs were included. Six devices were used for repair including the Meniscal Repair System, FasT-Fix, Meniscus Arrow, Biofix Arrow, RapidLoc device, and PDS II suture, with failure rates of 13.5%, 22.4%, 27.1%, 42.9%, 45.2%, and 0%, respectively. The overall repair failure rate was 29.3% at an average of 13.0 months (range, 5.0-32.4 months), but 19.0% for devices still in use. The RapidLoc and Biofix Arrow had higher failure rates than other devices (P = .0003). Women (31%) were less likely to experience a failure than were men (69%) (P = .03). Longer follow-up duration resulted in higher failure rates (>30 months, 34.4%; .05 for all). The overall average MCMS was 54.4 ± 12.Conclusion:The overall failure rate after all-inside repair of BHMTs is 29.3% at an average of 13.0 months, with no difference in failure rates between medial and lateral meniscal repairs. The variables shown to negatively affect the failure rates were the RapidLoc and Biofix Arrow, male sex, and longer follow-up duration.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-03-20T03:33:29Z
      DOI: 10.1177/0363546520906141
       
  • Superior Capsule Reconstruction for Irreparable Massive Rotator Cuff
           Tears: Does It Make Sense' A Systematic Review of Early Clinical
           Evidence
    • Authors: Burak Altintas, Michael Scheidt, Victor Kremser, Robert Boykin, Sanjeev Bhatia, Kaveh R. Sajadi, Scott Mair, Peter J. Millett
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Treatment of irreparable massive rotator cuff tears (MRCTs) in patients without advanced glenohumeral osteoarthritis remains a challenge. Arthroscopic superior capsule reconstruction (SCR) represents a newer method for treatment with increasing popularity and acceptance.Purpose:To analyze the clinical evidence surrounding SCR and determine the current clinical outcomes postoperatively.Study Design:Systematic review.Methods:A systematic review of the literature was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Electronic databases of PubMed, MEDLINE, Cochrane, and Google Scholar were used for the literature search. The study quality was evaluated according to the Modified Coleman Methodology Score. Studies in English evaluating SCR outcomes were included.Results:Seven studies were reviewed, including 352 patients (358 shoulders) treated with arthroscopic SCR with the mean duration of follow-up ranging from 15 to 48 months (range, 12-88 months). Fourteen patients were lost to follow-up, leaving 338 patients (344 shoulders) with clinical outcome data. Graft types included dermal allografts (n = 3 studies), fascia lata autografts (n = 3), or both (n = 1). Most commonly, a double-row technique was utilized for humeral graft fixation. The most common complication included graft tears in 13% of patients, resulting in 15 SCR revisions and 7 reverse shoulder arthroplasties. Postoperatively, improvements in visual analog scale (2.5 to 5.9), American Shoulder and Elbow Surgeons (20 to 56), Japanese Orthopaedic Association (38.0), Subjective Shoulder Value (37.0 to 41.3), and Constant (11.6 to 47.4) scores were observed. Three studies reported respective satisfaction rates of 72.9%, 85.7% and 90%. Increases in external rotation, internal rotation, and abduction with improved strength in external rotation were observed postoperatively. Improvement of pseudoparalysis was also observed in 3 studies. One study reported return to sports in 100% of patients (2 competitively, 24 recreationally) with no adverse outcomes.Conclusion:SCR showed good to excellent short-term clinical outcomes with adequate pain relief and functional improvement. The current evidence suggests that the procedure is an alternative for symptomatic patients with irreparable MRCT; however, the included studies were fair to poor in quality, and there were some notable complications. Long-term follow-up will determine the longevity and ultimate role of this new method in the treatment of irreparable MRCT.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-03-19T05:45:00Z
      DOI: 10.1177/0363546520904378
       
  • Adjunct Analgesia Reduces Pain and Opioid Consumption After Hip
           Arthroscopy: A Systematic Review of Randomized Controlled Trials
    • Authors: Kyle N. Kunze, Evan M. Polce, Daniel T. Lilly, Flavio L. Garcia, Matthew R. Cohn, Shane J. Nho, Jorge Chahla
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Patients who undergo hip arthroscopy inevitably experience pain postoperatively; however, the efficacy and safety of adjunct analgesia to prevent or reduce pain are not well-understood.Purpose:To perform a comprehensive qualitative synthesis of available randomized controlled trials evaluating the effect of adjunct analgesia on postoperative (1) pain, (2) opioid use, and (3) length of stay (LOS) in patients undergoing hip arthroscopy.Study Design:Systematic review.Methods:PubMed, OVID/MEDLINE, and Cochrane Controlled Register of Trials were queried for studies pertaining to analgesia interventions for patients undergoing hip arthroscopy. Two authors independently assessed article bias and eligibility. Data pertaining to changes in pain scores, additional analgesia requirements, length of hospital stay, and complications were extracted and qualitatively reported. Network meta-analyses were constructed to depict mean pain, opioid use, and LOS among the 3 analgesia categories (blocks, local infiltration analgesia, and celecoxib).Results:Fourteen level 1 studies were included; 12 (85.7%) reported pain reductions in the immediate and perioperative period after hip arthroscopy. Of the 7 studies that assessed an intervention (2 celecoxib, 1 fascia iliaca block, 1 lumbar plexus block, 1 femoral nerve block, 1 intra-articular bupivacaine, 1 extracapsular bupivacaine) versus placebo, more than half reported that patients who received an intervention consumed significantly fewer opioids postoperatively than patients who received placebo (lowest P value = .0006). Of the same 7 studies, 2 reported significantly shortened LOS with interventions, while 4 reported no statistically significant difference in LOS and 1 did not report LOS as an outcome.Conclusion:The majority of studies concerning adjunct analgesia for patients undergoing hip arthroscopy suggest benefits in pain reduction early in the postoperative period. There is mild evidence that adjunct analgesia reduces postoperative opioid use and currently inconclusive evidence that it reduces length of hospital stay. Furthermore, it appears that local infiltration analgesia may provide the greatest benefits in reductions in pain and opioid consumption. We recommend the use of adjunct analgesia in appropriately selected patients undergoing hip arthroscopy without contraindication who are at a high risk of severe postoperative pain.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-03-02T09:28:09Z
      DOI: 10.1177/0363546520905884
       
  • Relationship of the Medial Patellofemoral Ligament Origin on the Distal
           Femur to the Distal Femoral Physis: A Systematic Review
    • Authors: Kyle R. Sochacki, Kevin G. Shea, Kunal Varshneya, Marc R. Safran, Geoffrey D. Abrams, Joseph Donahue, Seth L. Sherman
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The relationship between the medial patellofemoral ligament (MPFL) and the distal femoral physis has been reported in multiple studies.Purpose:To determine the distance from the MPFL central origin on the distal femur to the medial distal femoral physis in skeletally immature participants.Study Design:Systematic review.Methods:A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Multiple databases were searched for studies investigating the anatomic origin of the MPFL on the distal femur and its relationship to the medial distal femoral physis in skeletally immature participants. Study methodological quality was analyzed with the Anatomical Quality Assessment tool, with studies categorized as low risk, high risk, or unclear risk of bias. Continuous variable data were reported as mean ± SD. Categorical variable data were reported as frequency with percentage.Results:Seven articles were analyzed (298 femurs, 53.7% male patients; mean age, 11.7 ± 3.4 years). There was low risk of bias based on the Anatomical Quality Assessment tool. The distance from the MPFL origin to the distal femoral physis ranged from 3.7 mm proximal to the physis to 10.0 mm distal to the physis in individual studies. Six of 7 studies reported that the MPFL origin on the distal femur lies distal to the medial distal femoral physis in the majority of specimens. The MPFL originated distal to the medial distal femoral physis in 92.8% of participants at a mean distance of 6.9 ± 2.4 mm.Conclusion:The medial patellofemoral ligament originates distal to the medial distal femoral physis in the majority of cases at a mean proximal-to-distal distance of 7 mm distal to the physis. However, this is variable in the literature owing to study design and patient age and sex.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-02-28T07:05:53Z
      DOI: 10.1177/0363546520904685
       
  • Treatment of Pectoralis Major Tendon Tears: A Systematic Review and
           Meta-analysis of Repair Timing and Fixation Methods
    • Authors: Blake M. Bodendorfer, David X. Wang, Brian P. McCormick, Austin M. Looney, Christine M. Conroy, Caroline M. Fryar, Joshua A. Kotler, William J. Ferris, William F. Postma, Edward S. Chang
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Repair of torn pectoralis major tendons is generally considered superior to nonoperative management, but there is a paucity of comparative data to demonstrate ideal repair timing and fixation methods.Purpose/Hypothesis:The purpose was to compare the outcomes between acute and chronic repair and among the various methods of fixation (transosseous tunnels, cortical buttons, suture anchors, screws with washers, and direct repair). It was hypothesized that acute repair would have superior outcomes and there would be similar outcomes among the various methods of fixation.Study Design:Meta-analysis.Methods:In accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic review of the literature was completed through MEDLINE, SPORTDiscus, CINAHL, Cochrane, Embase, and Web of Science databases. English-language studies were included with a minimum of 6 months’ mean follow-up and 5 cases per study. MINORS (Methodological Index for Nonrandomized Studies) was utilized to assess the quality of the existing literature. Analysis of mechanisms of injury and meta-analysis of pooled outcomes were completed. Pooled effect sizes were calculated from random effects models. Continuous variables were assessed via mixed model analysis, with the individual study designated as a random effect and the desired treatment for comparison as a fixed effect. Bivariate frequency data were transformed through Freeman-Tukey log-linear transformation for variance stabilization and then assessed through a mixed model with a study-level random effect and subsequently back-transformed. Significance was set at P < .05.Results:Twenty articles with 384 injuries met the inclusion criteria for comparison. All patients were male, with 61.9% of injuries occurring during weight training, at a mean age of 31.53 years, and with a mean follow-up of 30.12 months. Included studies scored a mean (SD) 15.53 ± 4.26 (range, 7.0-23.3) by MINORS criteria. Acute repair was significantly superior to chronic repair, with a relative improvement of functional outcome by 0.85 (P = .004) and satisfaction with cosmesis by 20.50% (P = .003). There was a trend toward acute repair having a higher proportion of patients who were pain-free (34.47%, P = .064). There were no significant differences among the methods of fixation for repair.Conclusion:Acute repair of pectoralis major tendon tears resulted in significantly superior functional outcomes and cosmesis satisfaction with a trend toward a higher proportion of patients who were pain-free. There were no significant differences among the methods of fixation for repair.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-02-28T05:16:21Z
      DOI: 10.1177/0363546520904402
       
  • Efficacy of Nonaugmented, Static Augmented, and Dynamic Augmented Suture
           Repair of the Ruptured Anterior Cruciate Ligament: A Systematic Review of
           the Literature
    • Authors: Roy A.G. Hoogeslag, Reinoud W. Brouwer, Astrid J. de Vries, Barbara C. Boer, Rianne Huis in ‘t Veld
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Anterior cruciate ligament suture repair (ACLSR) was abandoned late last century in favor of anterior cruciate ligament (ACL) reconstruction (ACLR) because of overall disappointing results. However, in recent years there has been renewed and increasing interest in ACLSR for treatment of ACL ruptures. Several contemporary ACLSR techniques are being used, but any difference in effectiveness is unclear.Hypothesis:Contemporary nonaugmented (NA), static augmented (SA), and dynamic augmented (DA) ACLSR leads to (1) comparable outcomes overall and (2) comparable outcomes between proximal third, middle third, and combined ACL rupture locations (a) within and (b) between ACLSR technique categories.Study Design:Systematic review.Methods:An electronic search was performed in the MEDLINE and Embase databases for the period between January 1, 2010, and August 7, 2019. All articles describing clinical and patient-reported outcomes for ACLSR were identified and included, and outcomes for NA, SA, and DA ACLSR categories were compared.Results:A total of 31 articles and 2422 patients were included. The majority of articles (65%) and patients (89%) reported outcomes of DA ACLSR. Overall, there was high heterogeneity in study characteristics and level as well as quality of evidence (19 level 4; 7 level 3; 3 level 2; and 2 level 1). Most studies indicated excellent patient-reported outcomes. Overall, the variability in (and the maximum of) the reported failure rate was high within all ACLSR categories. The variability in (and the maximum of) the reported rate of all other complications was highest for DA ACLSR. Regarding ACL rupture location, the failure rate was highest in proximal ACL ruptures within the SA and DA ACLSR categories; rates of all other reported complications were highest in combined ACL ruptures within the DA ACLSR category. However, no studies in the NA category and only 1 study in the SA ACLSR category evaluated combined ACL ruptures. The majority of studies comparing ACLSR and ACLR found no differences in outcomes.Conclusion:The amount of high-quality evidence for contemporary ACLSR is poor. This makes it difficult to interpret differences among ACLSR categories and among ACL rupture locations and, though promising, to establish the role of ACLSR in the treatment of ACL ruptures. More high-quality large randomized clinical trials with longer follow-up comparing ACLSR and ACLR are needed.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-02-26T10:09:24Z
      DOI: 10.1177/0363546520904690
       
  • Complications After Distal Biceps Tendon Repair: A Systematic Review
    • Authors: Melanie Amarasooriya, Gregory Ian Bain, Tom Roper, Kimberley Bryant, Karim Iqbal, Joideep Phadnis
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Distal biceps tendon injuries typically occur in the dominant arm of men in their fourth decade of life. Surgical repair restores flexion and supination strength, resulting in good functional outcome. The complication profile of each surgical approach and fixation technique has not been widely studied in the literature.Purpose:To report the rate of complications after repair of complete distal biceps ruptures, to classify them according to surgical approach and fixation technique, and to analyze risk factors and outcomes of the individual complications.Study Design:Systematic review.Methods:Studies published in English on primary repair of the distal biceps between January 1998 and January 2019 were identified. Data on complications were extracted and classified as major and minor for analysis. A quantitative synthesis of data was done to compare the complication rates between (1) limited anterior incision, extensile anterior incision, and double incision and (2) 4 fixation methods.Results:Seventy-two articles including 3091 primary distal biceps repairs were identified. The overall complication rate was 25% (n = 774). The major complication rate was 4.6% (n = 144) and included a 1.6% (n = 51) rate of posterior interosseous nerve injury; 0.3% (n = 10), median nerve injury; 1.4% (n = 43), rerupture; and a 0.1% (n = 4), synostosis. Brachial artery injury, ulnar nerve injury, compartment syndrome, proximal radius fracture, and chronic regional pain syndrome occurred at a rate of
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-02-24T07:33:25Z
      DOI: 10.1177/0363546519899933
       
  • Ischemic Therapy in Musculoskeletal Medicine
    • Authors: Austin J. Ramme, Brennan J. Rourke, Christopher M. Larson, Asheesh Bedi
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The competitive environment of athletics has promoted the exploration of any technology application that may offer an edge with performance and recovery from injury. Ischemic therapy is one such technology that has rapidly been incorporated into training rooms and physical therapy clinics worldwide. This therapy modality is reported to increase an athlete’s ability to improve muscle mass, strength, and endurance.Purpose:To provide the sports medicine physician with an understanding of the current state of ischemic therapy technology, including treatment specifications, known physiological effects, hypothesized mechanisms, biochemical effects, athletic applications, medical applications, animal models, and future research recommendations.Study Design:Literature review.Methods:A computer-based search of the PubMed database was used to perform a comprehensive literature review on musculoskeletal ischemic therapy.Results:The current research on ischemic therapy is largely composed of case series with varying equipment, methods, and therapy specifications. The publication of case series has value in identifying this technology for future research, but the results of these studies should not be justification for application to athletes without validation of safety and effectiveness.Conclusion:To date, ischemic therapy remains unvalidated, and the mechanism by which it improves muscle performance is not clear.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-02-11T07:38:32Z
      DOI: 10.1177/0363546520901539
       
  • Effect of Normal Saline Injections on Lateral Epicondylitis Symptoms: A
           Systematic Review and Meta-analysis of Randomized Clinical Trials
    • Authors: Carlos Alberto Acosta-Olivo, Juan Manuel Millán-Alanís, Luis Ernesto Simental-Mendía, Neri Álvarez-Villalobos, Félix Vilchez-Cavazos, Víctor Manuel Peña-Martínez, Mario Simental-Mendía
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Lateral epicondylitis, or tennis elbow, is a painful degenerative disorder that commonly occurs in adults between 40 and 60 years of age. Normal saline (NS) injections have been used as placebo through a large number of randomized controlled trials (RCTs) focused on the treatment of lateral epicondylitis.Purpose:This meta-analysis of RCTs aimed to assess the therapeutic effect of NS injections on lateral epicondylitis symptoms and compare results with established minimal clinically important difference criteria.Study Design:Systematic review and meta-analysis.Methods:MEDLINE, Embase, Web of Science, and Scopus databases were searched for clinical trials reporting pain and joint function with the visual analog scale, Patient-Rated Tennis Elbow Evaluation, and Disabilities of the Arm, Shoulder and Hand in patients with lateral epicondylitis. The meta-analysis was conducted with a random effects model and generic inverse variance method. Heterogeneity was tested with the I2 statistic index.Results:A total of 15 RCTs included in this meta-analysis revealed a significant improvement in pain (mean difference, 3.61 cm [95% CI, 2.29-4.92 cm]; P < .00001; I2 = 88%; visual analog scale) and function (mean difference, 25.65 [95% CI, 13.30-37.99]; P < .0001; I2 = 82%; Patient-Rated Tennis Elbow Evaluation / Disabilities of the Arm, Shoulder and Hand) after NS injection (≥6 months).Conclusion:NS injections yielded a statistically significant and clinically meaningful improvement in pain and functional outcomes in patients with lateral epicondylitis. New research should focus on better methods to diminish the potential confounders that could lead to this effect because NS injections could mask the real effect of an active therapeutic intervention in RCT.Registration:CRD42019127547 (PROSPERO).
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-02-11T07:23:50Z
      DOI: 10.1177/0363546519899644
       
  • The Concept of Sport Sampling Versus Sport Specialization: Preventing
           Youth Athlete Injury: A Systematic Review and Meta-analysis
    • Authors: Seth L. Carder, Nicolas E. Giusti, Lisa M. Vopat, Armin Tarakemeh, Jordan Baker, Bryan G. Vopat, Mary K. Mulcahey
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The prevalence of youth athletes specializing in 1 sport has been increasing over the past decade. Subsequently, the rate of youth athlete injury has also been increasing. It is possible that an association exists between youth specialization and sports injury rate.Purpose:To determine if sport sampling is associated with a lower sports injury rate in youths compared with youths who specialize in 1 sport.Study Design:Systematic review and meta-analysis.Methods:A systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using PubMed, Embase, and the Cochrane library. Inclusion criteria included studies written in the English language, studies with athletes between 7 and 18 years of age, studies that report injury rates, and studies that specify if athletes were sport samplers or specialized in a sport. Data relevant to this study, including injuries and patient characteristics, were extracted and statistically analyzed.Results:The initial search identified 324 studies, 6 of which met inclusion criteria. From these 6 studies, the total participant number was 5736. Of those, 2451 (42.7%) were “sport samplers,” 1628 (28.4%) were “sport specializers,” and 1657 (28.9%) were considered “others” (ie, could not be classified as true samplers or true specializers). The average age of all the athletes was 14.6 years (range, 7-18 years). Sport specializers had a significantly higher injury risk than the sport samplers (RR, 1.37; 95% CI, 1.19-1.57; P < .0001). There was a higher risk of injury in the “others” group when compared with the “sport sampler” group (RR, 1.21; 95% CI, 1.14-1.29; P < .0001). There was a higher risk of injury in the “sport specializer” group over the “others” group (RR, 1.09; 95% CI, 1.04-1.14; P < .005).Conclusion:Sport sampling is associated with a decreased risk of sports injury in youth athletes when compared with those who specialize in 1 sport. Injury rates increase as a youth athlete becomes increasingly specialized. Youth athletes would benefit substantially from participating in sport sampling.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-21T06:33:22Z
      DOI: 10.1177/0363546519899380
       
  • Traumatic Meniscal Tears Are Associated With Meniscal Degeneration
    • Authors: Marinus A. Wesdorp, Susanne M. Eijgenraam, Duncan E. Meuffels, Sita M.A. Bierma-Zeinstra, Gert-Jan Kleinrensink, Yvonne M. Bastiaansen-Jenniskens, Max Reijman
      First page: 2345
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Meniscal tears are traditionally classified into traumatic versus degenerative tears. Although this classification plays a major role in clinical decision making, no consensus exists on the exact definition of a traumatic or degenerative tear, and the histopathological basis for this classification is unclear.Purpose:To assess the histological degree of meniscal degeneration in patients with a traumatic meniscal tear, as compared with intact meniscal tissue and osteoarthritic meniscal tissue.Study Design:Descriptive laboratory study.Methods:Traumatically torn meniscal tissue was collected during arthroscopic partial meniscectomy. As a control group, intact meniscal tissue was used from transfemoral amputations or direct postmortem dissections. Meniscal tissue from osteoarthritic knees was obtained during total knee replacement surgery. Meniscal tissue was processed, stained, and histologically analyzed with the Pauli scoring system (range, 0-18), comprising the subdomains surface integrity, cellularity, collagen organization, and matrix staining. Scoring was performed by 2 independent observers, blinded to condition, region, and patient data of the meniscus.Results:The traumatic meniscal tear group contained 43 patients (34 men; median age, 29 years; median body mass index [BMI], 24 kg/m2); the intact meniscal tissue group, 8 patients (3 men; median age, 58 years; median BMI, 30 kg/m2); and the osteoarthritic group, 14 patients (4 men; median age, 66 years; median BMI, 28 kg/m2). After adjustment for sex, age, and BMI, patients with a traumatic meniscal tear had a significantly higher histological score than patients with intact meniscal tissue (2.7-point difference; P = .035). Histological score between the traumatic and osteoarthritic groups was not different.Conclusion:Traumatically torn menisci possess a higher degree of degeneration than intact menisci. Our results suggest that patients with a traumatic meniscal tear may already have had a certain degree of meniscal degeneration. These findings potentially challenge the classic view of traumatic versus degenerative meniscal tears.Clinical Relevance:Our findings provide a better understanding of the tissue condition of a torn meniscus. This knowledge may help clinicians decide on choice of treatment and may lead to new perspectives to prevent knee osteoarthritis in patients with a torn meniscus.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-14T04:44:28Z
      DOI: 10.1177/0363546520934766
       
  • Comparing Meniscectomy and Meniscal Repair: A Matched Cohort Analysis
           Utilizing a National Insurance Database
    • Authors: Kyle R. Sochacki, Kunal Varshneya, Jacob G. Calcei, Marc R. Safran, Geoffrey D. Abrams, Joseph Donahue, Seth L. Sherman
      First page: 2353
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Meniscal repair leads to improved patient outcomes compared with meniscectomy in small case series.Purpose:To compare the reoperation rates, 30-day complication rates, and cost differences between meniscectomy and meniscal repair in a large insurance database.Study Design:Cohort study; Level of evidence, 3.Methods:A national insurance database was queried for patients who underwent meniscectomy (Current Procedural Terminology [CPT] code 29880 or 29881) or meniscal repair (CPT code 29882 or 29883) in the outpatient setting and who had a minimum 2-year follow-up. Patients without confirmed laterality and patients who underwent concomitant ligament reconstruction were excluded. Reoperation was defined by ipsilateral knee procedure after the index surgery. The 30-day postoperative complication rates were assessed using the International Classification of Diseases, 9th Revision, Clinical Modification codes. The cost of the procedures per patient was calculated. Propensity score matching was utilized to create matched cohorts with similar characteristics. Statistical comparisons of cohort characteristics, reoperations, postoperative complications, and payments were made. All P values were reported with significance set at P < .05.Results:A total of 27,580 patients (22,064 meniscectomy and 5516 meniscal repair; mean age, 29.9 ± 15.1 years; 41.2% female) were included in this study with a mean follow-up of 45.6 ± 21.0 months. The matched groups were similar with regard to characteristics and comorbidities. There were significantly more patients who required reoperation after index meniscectomy compared with meniscal repair postoperatively (5.3% vs 2.1%; P < .001). Patients undergoing meniscectomy were also significantly more likely to undergo any ipsilateral meniscal surgery (P < .001), meniscal transplantation (P = .005), or total knee arthroplasty (P = .001) postoperatively. There was a significantly higher overall 30-day complication rate after meniscal repair (1.2%) compared with meniscectomy (0.82%; P = .011). The total day-of-surgery payments was significantly higher in the repair group compared with the meniscectomy group ($7094 vs $5423; P < .001).Conclusion:Meniscal repair leads to significantly lower rates of reoperation and higher rates of early complications with a higher total cost compared with meniscectomy in a large database study.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-15T05:17:35Z
      DOI: 10.1177/0363546520935453
       
  • Long-term Outcomes and Survivorship of Fresh-Frozen Meniscal Allograft
           Transplant With Soft Tissue Fixation: Minimum 10-Year Follow-up Study
    • Authors: Alberto Grassi, Luca Macchiarola, Gian Andrea Lucidi, Vito Coco, Iacopo Romandini, Giuseppe Filardo, Maria Pia Neri, Maurilio Marcacci, Stefano Zaffagnini
      First page: 2360
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Meniscal allograft transplant (MAT) is considered an effective procedure for reducing pain and improving knee function. Nevertheless, the current knowledge regarding the results of MAT is limited to short- to mid-term follow-up studies, especially for arthroscopic techniques.Purpose:To evaluate the long-term clinical outcomes, reoperations, and failures with a minimum follow-up of 10 years after fresh-frozen MAT performed arthroscopically with soft tissue fixation.Study Design:Case series; Level of evidence, 4.Methods:A total of 46 patients (age, 36.6 ± 10.6 years; 36 male, 10 female) who underwent medial MAT (n = 27) or lateral MAT (n = 19) with a minimum 10-year follow-up were evaluated with the Lysholm score, Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale for pain, and Tegner score. Surgical failure was defined as the need for partial or total graft removal (meniscectomy or knee replacement), and clinical failure was defined as the need for partial or total graft removal in addition to a poor Lysholm score (
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-06T08:07:04Z
      DOI: 10.1177/0363546520932923
       
  • Meniscal Allograft Transplantation After Anterior Cruciate Ligament
           Reconstruction Can Improve Knee Stability: A Comparison of Medial and
           Lateral Procedures
    • Authors: Kyoung Ho Yoon, Hyun Woo Lee, Soo Yeon Park, Raymond D.K. Yeak, Jung-Suk Kim, Jae-Young Park
      First page: 2370
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The purpose of this study was to evaluate the clinical score and stability after meniscal allograft transplantation (MAT) after a previous anterior cruciate ligament (ACL) reconstruction.Hypothesis:Medial MAT would improve anteroposterior stability, and lateral MAT would improve rotational stability.Study Design:Cohort study; Level of evidence, 3.Method:We retrospectively investigated 31 cases of MAT after a previous total or nearly total meniscectomy and ACL reconstruction between November 2008 and June 2017. Cases were divided into medial (16 cases) and lateral (15 cases) MAT groups. The patients were assessed preoperatively and at the 2-year follow-up.Results:In the medial MAT group, the International Knee Documentation Committee, Lysholm, Lysholm instability, and Tegner scores improved significantly at the 2-year follow-up, and there were also significant improvements in the anterior drawer, Lachman, and pivot-shift tests. In the lateral MAT group, the Lysholm and Tegner scores improved significantly at the 2-year follow-up, as had the anterior drawer and Lachman tests but not the pivot-shift test. The medial MAT group showed significant improvement in side-to-side difference on Telos stress radiographs, from 6.5 mm (preoperatively) to 3.6 mm (2-year follow-up) (P = .001), while the lateral MAT group showed no significant change. There was no progression of arthritis in either group.Conclusion:Medial MAT improved not only anteroposterior stability but also rotational stability in the meniscus-deficient ACL-reconstructed knee. Lateral MAT showed improvements in the anterior drawer and Lachman tests but not in the pivot-shift test or side-to-side difference on Telos stress radiographs in meniscus-deficient ACL-reconstructed knees. Instability and pain are indications for MAT in meniscus-deficient ACL-reconstructed knees.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-21T09:31:47Z
      DOI: 10.1177/0363546520938771
       
  • Preoperative Medial Meniscal Extrusion Is Associated With Patient-Reported
           Outcomes After Medial Opening Wedge High Tibial Osteotomy
    • Authors: Man Soo Kim, In Jun Koh, Chul Kyu Kim, Keun Young Choi, Ki Ho Kang, Yong In
      First page: 2376
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Although the medial compartment continues to sustain some loading after medial opening wedge high tibial osteotomy (MOWHTO) in varus-deformed knees, no studies have examined the relationship between medial meniscal extrusion (MME) and patient-reported outcome measures after MOWHTO.Purpose:To examine whether compartmental baseline MME was associated with patient-reported outcome measures after MOWHTO.Study Design:Cohort study; Level of evidence, 3.Methods:This retrospective study was composed of 149 MOWHTOs in 147 patients with clinical and radiological assessments. Patients were grouped according to severity of MME in the medial compartment at the time of surgery. MME was categorized into 4 groups according to MOAKS (MRI [magnetic resonance imaging] Osteoarthritis Knee Score) criteria and relative value of MME. We compared preoperative characteristics, including Kellgren-Lawrence (KL) grading scale, meniscal tear pattern, and postoperative Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) subscores. Associations between extent of MME and WOMAC subscores at postoperative 1 and 2 years were assessed with generalized linear models.Results:Pattern of meniscal tear (P < .05) and KL grade (P < .05) were associated with MME. Patients with KL grades 3 and 4 at the time of surgery had significantly greater MME than those with KL grade 2 (P < .05). When patients were divided into 4 groups according to MOAKS criteria at the time of surgery, there were significant differences in WOMAC pain scores among groups at 1 and 2 years after the operation (all P < .05). The WOMAC function score also differed among groups at postoperative 1 year (P < .05) but not postoperative 2 years (P> .05). When patients were divided into 4 groups according to relative MME at the time surgery, the WOMAC pain score differed significantly among groups at postoperative 1 and 2 years (all P < .05). Analysis of WOMAC pain score as the dependent variable in multivariate analyses revealed that severity of absolute and relative MME and KL grade were independent predictors of worse WOMAC pain score at postoperative 1 and 2 years (all P < .05).Conclusion:Greater preoperative MME at the time of surgery was associated with inferior patient-reported outcomes, especially pain, in patients with MOWHTO at 1 and 2 years after surgery.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-06T08:54:46Z
      DOI: 10.1177/0363546520933834
       
  • An In-Depth Analysis of Graft Rupture and Contralateral Anterior Cruciate
           Ligament Rupture Rates After Pediatric Anterior Cruciate Ligament
           Reconstruction
    • Authors: Christopher J. DeFrancesco, Brendan M. Striano, Joshua T. Bram, Keith D. Baldwin, Theodore J. Ganley
      First page: 2395
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Reported rates of graft rupture and contralateral anterior cruciate ligament (ACL) rupture after ACL reconstruction (ACLR) are higher among pediatric patients than adults. Previous series may have underestimated postoperative event risk because of small sample sizes and high proportions of dropouts.Purpose:To calculate rates of graft rupture and contralateral ACL rupture after ACLR in a large pediatric series.Study Design:Case series; Level of evidence, 4.Methods:ACLRs performed in our tertiary care children’s hospital system over a period of>7 years were identified through billing review. Cases were sorted based on operative technique, with all-epiphyseal ACLRs considered separately. Transphyseal ACLRs were divided into 2 groups based on patient age, with a cutoff of 16 years. Clinic follow-up data as well as prospectively collected survey data were used to note graft rupture and contralateral ACL rupture events. Rates of graft rupture and contralateral ACL rupture were calculated using Kaplan-Meier survival analysis.Results:The final data set included 996 patients. A total of 161 patients underwent all-epiphyseal ACLR. Of the remaining transphyseal surgeries, 504 patients were
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-15T05:08:16Z
      DOI: 10.1177/0363546520935437
       
  • Risk Factors for Grade 3 Pivot Shift in Knees With Acute Anterior Cruciate
           Ligament Injuries: A Comprehensive Evaluation of the Importance of Osseous
           and Soft Tissue Parameters From the SANTI Study Group
    • Authors: Andrea Ferretti, Edoardo Monaco, Edoardo Gaj, Valerio Andreozzi, Alessandro Annibaldi, Alessandro Carrozzo, Thais Dutra Vieira, Bertrand Sonnery-Cottet, Adnan Saithna
      First page: 2408
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Preoperative grade 3 pivot shift has been reported to be associated with higher rates of anterior cruciate ligament (ACL) failure, persistent instability, and inferior patient-reported outcomes. The etiology of a high-grade pivot shift is multifactorial, and numerous factors have been suggested to be responsible. More attention has recently been focused on injury to the anterolateral structures (ALS) as a risk factor for a grade 3 pivot shift.Purpose:To determine risk factors for grade 3 pivot shift, including soft tissue and osseous parameters.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A prospective evaluation was undertaken of 200 consecutive patients undergoing acute ACL reconstruction (within 10 days of injury). An open exploration of the lateral side of the injured knee was performed at the time of the index procedure. Details regarding patient and injury characteristics were recorded, as were details of soft tissue injuries, including meniscal tears, ALS lesions, medial collateral ligament tears, and chondral injuries. Osseous parameters (tibial slope and condylar ratios) were determined per established magnetic resonance imaging protocols. A multivariate logistic regression with penalized maximum likelihood was used to identify risk factors associated with International Knee Documentation Committee (IKDC) grade 3 pivot shift.Results:The mean ± SD age of the population was 28.3 ± 9.8 years; 67.5% of patients were male. Among patients, 35 (17.5%) had a high-grade pivot shift (IKDC grade 3), and 165 (82.5%) had a low-grade pivot shift (IKDC grades 1 and 2). Univariate and multivariate logistic regression analysis demonstrated that injury to the ALS was the only significant risk factor for grade 3 pivot shift (odds ratio, 13.49; 95% CI, 1.80-1725.53).Conclusion:This comprehensive evaluation of soft tissue and osseous factors has identified that injury to the ALS is the most important risk factor for grade 3 pivot shift in acute ACL-injured knees.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-06T08:15:24Z
      DOI: 10.1177/0363546520935866
       
  • Utility of Neuromuscular Electrical Stimulation to Preserve Quadriceps
           Muscle Fiber Size and Contractility After Anterior Cruciate Ligament
           
    • Authors: Michael J. Toth, Timothy W. Tourville, Thomas B. Voigt, Rebecca H. Choquette, Bradley M. Anair, Michael J. Falcone, Mathew J. Failla, Jennifer E. Stevens-Lapslaey, Nathan K. Endres, James R. Slauterbeck, Bruce D. Beynnon
      First page: 2429
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Anterior cruciate ligament (ACL) injuries and reconstruction (ACLR) promote quadriceps muscle atrophy and weakness that can persist for years, suggesting the need for more effective rehabilitation programs. Whether neuromuscular electrical stimulation (NMES) can be used to prevent maladaptations in skeletal muscle size and function is unclear.Purpose:To examine whether early NMES use, started soon after an injury and maintained through 3 weeks after surgery, can preserve quadriceps muscle size and contractile function at the cellular (ie, fiber) level in the injured versus noninjured leg of patients undergoing ACLR.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:Patients (n = 25; 12 men/13 women) with an acute, first-time ACL rupture were randomized to NMES (5 d/wk) or sham (simulated microcurrent electrical nerve stimulation; 5 d/wk) treatment to the quadriceps muscles of their injured leg. Bilateral biopsies of the vastus lateralis were performed 3 weeks after surgery to measure skeletal muscle fiber size and contractility. Quadriceps muscle size and strength were assessed 6 months after surgery.Results:A total of 21 patients (9 men/12 women) completed the trial. ACLR reduced single muscle fiber size and contractility across all fiber types (P < .01 to P < .001) in the injured compared with noninjured leg 3 weeks after surgery. NMES reduced muscle fiber atrophy (P < .01) through effects on fast-twitch myosin heavy chain (MHC) II fibers (P < .01 to P < .001). NMES preserved contractility in slow-twitch MHC I fibers (P < .01 to P < .001), increasing maximal contractile velocity (P < .01) and preserving power output (P < .01), but not in MHC II fibers. Differences in whole muscle strength between groups were not discerned 6 months after surgery.Conclusion:Early NMES use reduced skeletal muscle fiber atrophy in MHC II fibers and preserved contractility in MHC I fibers. These results provide seminal, cellular-level data demonstrating the utility of the early use of NMES to beneficially modify skeletal muscle maladaptations to ACLR.Clinical Relevance:Our results provide the first comprehensive, cellular-level evidence to show that the early use of NMES mitigates early skeletal muscle maladaptations to ACLR.Registration:NCT02945553 (ClinicalTrials.gov identifier)
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-06T08:35:24Z
      DOI: 10.1177/0363546520933622
       
  • A Cross-sectional Examination of Quadriceps Strength, Biomechanical
           Function, and Functional Performance From 9 to 24 Months After Anterior
           Cruciate Ligament Reconstruction
    • Authors: Michael T. Curran, Asheesh Bedi, Megan Kujawa, Riann Palmieri-Smith
      First page: 2438
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Patients who undergo anterior cruciate ligament reconstruction (ACLR) have deficiencies in strength, functional performance, and biomechanical function at return to activity. Patients who have abnormal strength and function after ACLR may be at a greater risk for secondary injury and posttraumatic osteoarthritis.Purpose:To examine quadriceps strength, functional performance, and knee biomechanics in patients who are 9, 12, 18, and 24 months after ACLR.Study Design:Cross-sectional study; Level of evidence, 3.Methods:We recruited 82 participants (45 female) who underwent ACLR and were cleared to return to activity . Participants were assigned to 1 of 4 groups based on their time from ACLR: 9 months (285.26 ± 8.16 days), 12 months (373.59 ± 8.81 days), 18 months (557.50 ± 11.96 days), and 24 months postoperative (741.05 ± 11.86 days). Quadriceps strength was measured concentrically at 60 deg/s. Functional performance was assessed by measuring maximal hop distances or heights during dynamic hopping/jumping tests (single-leg hop, triple hop, crossover hop, and single-leg vertical hop). Biomechanical function was evaluated during the dynamic hop tests by using peak sagittal plane knee flexion angles recorded during landings. Strength, performance, and biomechanics data were collected for both limbs and reported as symmetry scores ([injured/uninjured] × 100). Self-perceived function was measured using the International Knee Documentation Committee subjective knee form.Results:Quadriceps strength in the 9-month (77.61 ± 16.73) and 12-month (77.80 ± 13.99) groups was significantly lower (P < .01) compared with the 24-month group (92.40 ± 15.55). Self-perceived function for the 9-month group (79.33 ± 10.40) was significantly lower (P < .01) when compared with 12-month (87.58 ± 10.29), 18-month (89.81 ± 8.36), and 24-month (91.59 ± 5.70) groups. Single-leg hop distance symmetry was significantly lower (P < .01) for the 9-month group (90.01 ± 9.46) when compared with the 18-month (96.24 ± 6.47) and 24-month (96.30 ± 6.46) groups; triple hop symmetry was significantly lower (P < .05) for the 9-month group (90.26 ± 10.03) when compared with the 18-month (96.83 ± 9.60) and 24-month (95.91 ± 6.36) groups; and crossover hop was significantly lower (P < .05) for the 9-month group (88.35 ± 13.53) when compared with the 18-month (95.85 ± 8.63) and 24-month (97.10 ± 4.12) groups.Conclusion:Quadriceps strength, self-perceived function, and functional performance improve 9 to 24 months after ACLR, indicating that recovery is ongoing after return to activity. Return-to-activity criteria after ACLR should objectively account for strength and function.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-21T09:58:55Z
      DOI: 10.1177/0363546520940310
       
  • Linear Discriminant Analysis Successfully Predicts Knee Injury Outcome
           From Biomechanical Variables
    • Authors: Nathan D. Schilaty, Nathaniel A. Bates, Sydney Kruisselbrink, Aaron J. Krych, Timothy E. Hewett
      First page: 2447
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The most commonly damaged structures of the knee are the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and menisci. Given that these injuries present as either isolated or concomitant, it follows that these events are driven by specific mechanics versus coincidence. This study was designed to investigate the multiplanar mechanisms and determine the important biomechanical and demographic factors that contribute to classification of the injury outcome.Hypothesis:Linear discriminant analysis (LDA) would accurately classify each injury type generated by the mechanical impact simulator based on biomechanical input variables (ie, ligament strain and knee kinetics).Study Design:Controlled laboratory study.Methods:In vivo kinetics and kinematics of 42 healthy, athletic participants were measured to determine stratification of injury risk (ie, low, medium, and high) in 3 degrees of knee forces/moments (knee abduction moment, anterior tibial shear, and internal tibial rotation). These stratified kinetic values were input into a cadaveric impact simulator to assess ligamentous strain and knee kinetics during a simulated landing task. Uniaxial and multiaxial load cells and implanted strain sensors were used to collect mechanical data for analysis. LDA was used to determine the ability to classify injury outcome by demographic and biomechanical input variables.Results:From LDA, a 5-factor model (Entropy R2 = 0.26) demonstrated an area under the receiver operating characteristic curve (AUC) for all 5 injury outcomes (ACL, MCL, ACL+MCL, ACL+MCL+meniscus, ACL+meniscus) of 0.74 or higher, with “good” prediction for 4 of 5 injury classifications. A 10-factor model (Entropy R2 = 0.66) improved the AUC to 0.86 or higher, with “excellent” prediction for 5 injury classifications. The 15-factor model (Entropy R2 = 0.85), produced 94.1% accuracy with the AUC 0.98 or higher for all 5 injury classifications.Conclusion:Use of LDA accurately predicted the outcome of knee injury from kinetic data from cadaveric simulations with the use of a mechanical impact simulator at 25° of knee flexion. Thus, with clinically relevant kinetics, it is possible to determine clinical risk of injury and also the likely presentation of singular or concomitant knee injury.Clinical Relevance:LDA demonstrates that injury outcomes are largely characterized by specific mechanics that can distinguish ACL, MCL, and medial meniscal injury. Furthermore, as the mechanics of injury are better understood, improved interventional prehabilitation can be designed to reduce these injuries.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-21T09:59:24Z
      DOI: 10.1177/0363546520939946
       
  • Hip Arthroscopy in the High-Level Athlete: Does Capsular Closure Make a
           Difference'
    • Authors: Jeffrey D. Hassebrock, Justin L. Makovicka, Anikar Chhabra, Matthew B. Anastasi, Heather M. Menzer, Justin G. Wilcox, Kostas J. Economopoulos
      First page: 2465
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Hip arthroscopy has been shown to be effective in athletes who have femoral acetabular impingement and labral tearing. The effect of complete capsular closure versus nonclosure on return to play is unknown.Hypothesis:Complete capsular closure after hip arthroscopy would lead to a higher rate and faster return to sports in high-level athletes.Study Design:Cohort study; Level of evidence, 3.Methods:A nonrandomized retrospective review was performed of high school, collegiate, and professional athletes undergoing hip arthroscopy by a single high-volume hip arthroscopic surgeon. Athletes were divided into those undergoing complete capsular closure (CC group) and non–capsular closure (NC group) after hip arthroscopy. Rate and time to return to play were determined between the 2 groups. Patient-reported outcomes including modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL), and Hip Outcome Score Sport-Specific Subscale (HOS-SSS) were obtained at a minimum of 2 years.Results:A total of 111 athletes with a minimum 2-year follow-up were included in the study. There were 62 in the CC group and 49 in the NC group. A higher percentage of athletes in the CC group returned to play compared with that in the NC group (90.3% vs 75.5%, respectively; P = .03). The CC group returned to play at a mean ± SD of 4.7 ± 1.9 months compared with 5.8 ± 2.6 months in the NC group (P < .001). Patients in the CC group met the minimal clinically important difference for the mHHS, HOS-ADL, and HOS-SSS patient-reported outcomes at higher percentages: mHHS, 98.3% vs 87.7% for CC vs NC, respectively (P = .02); HOS-ADL, 98.3% vs 87.7% (P = .02); and HOS-SSS, 96.7% vs 89.7% (P = .13). The difference between groups was statistically significant for mHHS and HOS-ADL.Conclusion:Complete capsular closure after hip arthroscopy was associated with faster return to play and a higher rate of return compared with that of nonclosure of the capsule in this sample population of high-level athletes. At a minimum 2-year follow-up, complete capsular closure was associated with significantly higher patient-reported outcomes compared with those of nonclosure in athletes who underwent hip arthroscopy.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-15T05:31:56Z
      DOI: 10.1177/0363546520936255
       
  • Gastrocnemius Injuries in Professional Baseball Players: An
           Epidemiological Study
    • Authors: Kristi Hultman, Patrick F. Szukics, Adrienne Grzenda, Frank C. Curriero, Steven B. Cohen
      First page: 2489
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Gastrocnemius injuries are a common lower extremity injury in elite baseball players. There are no current epidemiological studies focused on gastrocnemius injuries in professional baseball players that provide information on the timing, distribution, and characteristics of such injuries.Hypothesis:Gastrocnemius injury in professional baseball players is a common injury that is influenced by factors such as age, player position, and time of season.Study Design:Descriptive epidemiological study.Methods:Based on Major League Baseball’s (MLB’s) Health and Injury Tracking System (HITS) database, gastrocnemius injuries that caused time out of play for MLB and Minor League Baseball (MiLB) players during the 2011-2016 seasons were identified. Player characteristics, including age, level of play, and position at time of injury, were collected. Injury-specific factors analyzed included date of injury, time of season, days missed, and activity leading to injury.Results:A total of 402 gastrocnemius injuries (n = 145, MLB; n = 257, MiLB) occurred during the 2011-2016 seasons. MLB players were significantly older at the time of injury (30.1 years, MLB; 23.9 years, MiLB; P < .001). Base running (36.1%) was the most common activity causing the injury, followed by fielding (23.6%), with 50.3% of base-running injuries sustained on the way to first base. In MLB players, gastrocnemius injuries were most common in infielders (48.3%), followed by pitchers (27.6%) and then outfielders (17.9%), while for MiLB players the injuries were more evenly distributed (33.5%, 28.8%, and 30.7%, respectively). The frequency of injuries in MLB players dropped off after the start of the regular season, whereas MiLB players had a consistent injury rate throughout the year.Conclusion:Gastrocnemius injuries are a common cause of lower extremity injury in professional baseball players, resulting in significant time out of play. Base running, particularly to first base, was the most common activity during injury. Outfielders had the fewest injuries; however, they required the longest time to recover. This study provides the first investigation to date with the HITS database to examine the characteristics and distribution of gastrocnemius injuries in professional baseball players, offering insight into risk factors, injury prevention, and recovery expectations.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-21T06:28:13Z
      DOI: 10.1177/0363546520938759
       
  • Tendon Regeneration After Partial-Thickness Peroneus Longus Tendon
           Harvesting: Magnetic Resonance Imaging Evaluation and In Vivo Animal Study
           
    • Authors: Ho Won Lee, Chenyu Wang, Tae Soo Bae, Ik Yang, Yuxuan Liu, Chang Won Park, Hyong Nyun Kim
      First page: 2499
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:In recent years, the use of the anterior half of the peroneus longus tendon (AHPLT) as an autograft source for ligament reconstruction has gained popularity. However, no reports are available regarding tendon regeneration after harvesting of the AHPLT.Hypothesis:When half of the tendon is preserved during tendon harvesting, the quality of the regenerated tendon is better than that of the regenerated tendon after full-thickness harvesting.Study Design:Case series; Level of evidence, 4; controlled laboratory study.Methods:A total of 21 patients who underwent AHPLT harvesting for lower extremity ligament reconstruction participated in the magnetic resonance imaging (MRI) study to evaluate tendon regeneration 1 year after the harvesting. An in vivo animal study was performed to compare the quality of the regenerated tendon after partial-thickness and full-thickness tendon harvesting. A total of 30 adult female Sprague-Dawley rats were allocated to 2 groups—15 rats underwent partial-thickness Achilles tendon harvesting (partial-thickness harvesting [PTH] group), and 15 rats underwent full-thickness Achilles tendon harvesting (full-thickness harvesting [FTH] group). The quality of the regenerated tendons was compared 180 days after tendon harvesting.Results:All 21 patients showed regeneration of the peroneus longus tendon (PLT) (homogeneously dark on both T1- and T2-weighted sequences). The cross-sectional area of the regenerated tendon divided by that of the preoperative tendon was 92.6% and 84.5% at 4 cm and 9 cm proximal to the tip of the distal fibula, respectively. In the animal study, the mean histologic score was better for the PTH group compared with the FTH group (9.17 ± 1.35 vs 14.72 ± 0.74; P < .001). The ultimate strength and the stiffness of the regenerated Achilles tendon were significantly higher for the PTH group compared with the FTH group (35.5 ± 8.3 vs 22.4 ± 8.3 N, P = .004; and 31.6 ± 7.7 vs 23.5 ± 4.8 N/mm, P = .016).Conclusion:The PLT was found to regenerate after partial-thickness harvesting on MRI. In the animal study, the quality of the regenerated tendon when half of the tendon was preserved during tendon harvesting was better than that after full-thickness tendon harvesting.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-06T08:45:26Z
      DOI: 10.1177/0363546520933628
       
  • Repair Integrity and Retear Pattern After Arthroscopic Medial Knot-Tying
           After Suture-Bridge Lateral Row Rotator Cuff Repair
    • Authors: Yasutaka Takeuchi, Hiroyuki Sugaya, Norimasa Takahashi, Keisuke Matsuki, Morihito Tokai, Takeshi Morioka, Yusuke Ueda, Shota Hoshika
      First page: 2510
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Type 2 failure is a big issue after suture-bridge rotator cuff repair, which may be because of stress concentration at the medial row stitches. We have been performing medial knot-tying after suture-bridge lateral row repair to avoid the stress concentration. This study aimed to evaluate clinical and radiological outcomes after arthroscopic rotator cuff repair using this technique.Hypothesis:This technique would yield better radiological outcomes with a reduced type 2 failure rate compared with reported outcomes after conventional suture-bridge repair.Study Design:Case series; Level of evidence, 4.Methods:The inclusion criteria of this study were (1) full-thickness tears, (2) primary surgery, and (3) minimum 2-year follow-up with pre- and postoperative magnetic resonance imaging (MRI). We investigated active ranges of motion (forward elevation and external rotation), as well as the Japanese Orthopaedic Association (JOA) and University of California, Los Angeles (UCLA), scores preoperatively and at the final follow-up.Results:This study included 384 shoulders in 373 patients (205 men and 168 women) with a mean age of 65 years (range, 24-89 years) at the time of surgery. The mean follow-up was 29 months (range, 24-60 months). There were 91 small, 137 medium, 121 large, and 35 massive tears. Postoperative MRI scans demonstrated successful repair in 324 shoulders (84.4%, group S) and retear in 60 shoulders (15.6%). Among 60 retears, 40 shoulders (67%) had type 1 failure (group F1) and 20 shoulders (33%) had type 2 failure (group F2). Forward elevation and external rotation significantly improved after surgery (P < .001 for both). Postoperative JOA and UCLA scores in group F2 were significantly lower than those in the other groups.Conclusion:The medial knot-tying after suture-bridge lateral row repair demonstrated excellent functional and radiological outcomes after surgery, with a retear rate of 15.6%. The type 2 failure showed significantly inferior functional outcomes; however, the rate of type 2 failure was less relative to previous studies using conventional suture-bridge techniques. Our technique could be a good alternative to conventional suture-bridging rotator cuff repair because it may reduce the rate of postoperative type 2 failure.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-14T04:51:48Z
      DOI: 10.1177/0363546520934786
       
  • Dyslipidemia With Perioperative Statin Usage Is Not Associated With Poorer
           24-Month Functional Outcomes After Arthroscopic Rotator Cuff Surgery
    • Authors: Gerald Joseph ShengXiang Zeng, Merrill Jian Hui Lee, Jerry Yongqiang Chen, Benjamin Fu Hong Ang, Ying Hao, Denny Tjiauw Tjoen Lie
      First page: 2518
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Current literature suggests a higher rate of rotator cuff disease development in patients with dyslipidemia (DL). Moderate to high levels of DL are associated with higher rates of retear and revision surgery after arthroscopic rotator cuff repair. Statins protect against development of rotator cuff disease and mitigate the need for rotator cuff repair.Purpose:We aimed to investigate the influence of DL and statin use on postoperative functional outcomes.Study Design:Cohort study; Level of evidence, 3.Methods:Between 2010 and 2016, 266 patients underwent arthroscopic double-row rotator cuff repair for atraumatic full-thickness tears. Evaluation was conducted preoperatively and at 3, 6, 12, and 24 months postoperatively. Three functional outcome measures were used (Constant Shoulder Score [CSS], Oxford Shoulder Score [OXF], and University of California, Los Angeles, Shoulder Rating Scale [UCLASS]), as well as a visual analog scale (VAS) for pain. DL and non-DL were classified through screening of health and assessment of lipid levels within 6 months of surgery (triglycerides, total cholesterol, low-density lipoprotein, and high-density lipoprotein). Patients with DL were divided into statin users and nonusers. Types and dosages of statins were recorded, and intensity and equivalency charts were employed for standardization. Mann-Whitney U test and Pearson chi-square test were used for analysis. Generalized estimating equations and linear mixed models were used to examine the influence of DL and statin dosage, respectively on percentage change of postoperative outcome scores.Results:Increased age was associated with a higher incidence of DL (P < .001), and 86% of the DL group was taking statins. The DL group also exhibited poorer scores preoperatively (CSS, P = .001; OXF, P = .032). No significant difference in scores was elicited between the DL and non-DL groups at 24 months. However, patients with DL experienced greater percentage improvement of CSS and OXF from preoperative baseline than did patients without DL (P = .008 and P = .034, respectively) at 24 months. There was no significant difference in 24-month functional outcomes between statin users and nonusers. No statistically significant change of CSS; OXF; UCLASS; or VAS was noted with increasing statin doses at 24 months.Conclusion:Patients with DL with perioperative statin usage did not have poorer 24-month functional outcomes after arthroscopic rotator cuff surgery compared with those in patients without DL.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-21T08:44:35Z
      DOI: 10.1177/0363546520937266
       
  • Posterior Rotational and Translational Stability in Acromioclavicular
           Ligament Complex Reconstruction: A Comparative Biomechanical Analysis in
           Cadaveric Specimens
    • Authors: Daichi Morikawa, Joel B. Huleatt, Lukas N. Muench, Cameron Kia, Daniel P. Berthold, Mark P. Cote, Elifho Obopilwe, Denis Kelolli, Bastian Scheiderer, Augustus D. Mazzocca
      First page: 2525
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Persistent posterior instability of the acromioclavicular (AC) joint is a reported complication after isolated coracoclavicular (CC) reconstruction. Thus, multiple techniques have been proposed attempting to restore biomechanics of the AC ligament complex (ACLC).Purpose/Hypothesis:The purpose was to evaluate the posterior translational and rotational stability of an ACLC reconstruction with a dermal allograft (ACLC patch) as compared with 3 suture brace constructs. It was hypothesized that the ACLC patch would better restore AC joint posterior stability.Study Design:Controlled laboratory study.Methods:A total of 28 cadaveric shoulders (mean ± SD age, 57.6 ± 8.3 years) were randomly assigned to 1 of 4 surgical techniques: ACLC patch, oblique brace, anterior brace, and x-frame brace. The force and torque to achieve 10 mm of posterior translation and 20° of posterior rotation of the AC joint were recorded in the following conditions: intact, transected ACLC, ACLC patch/brace repair, ACLC patch/brace repair with dissected CC ligaments, and ACLC patch/brace repair with CC ligament repair.Results:For posterior translation, transection of the ACLC reduced resistance to 16.7% of the native. With the native CC ligaments intact, the ACLC patch (59.1%), oblique brace (54.1%), and anterior brace (60.7%) provided significantly greater stability than the x-frame brace (33.2%; P < .001, P = .008, P < .001, respectively). ACLC patch, oblique brace, and anterior brace continued to have significantly higher posterior translational resistance than the x-frame (35.1%; P < .001, P = .003, P < .001) after transection and subsequent CC ligament repair. For posterior rotation, transection of the ACLC decreased the resistance to 5.4% of the intact state. With the CC ligaments intact, the ACLC patch (77.1%) better restored posterior rotational stability than the oblique (35.3%), anterior (48.5%), and x-frame (23.0%) brace repairs (P < .001, P = .002, P < .001). CC ligament transection and subsequent repair demonstrated the ACLC patch (41.0%) to have improved stability when compared with the oblique (16.0%), anterior (14.0%), and x-frame (12.7%) repairs (P = .006, P = .003, P = .002).Conclusion:ACLC reconstruction with a dermal allograft better restored native posterior rotational stability than other brace constructs, with translational stability similar to the oblique and anterior brace technique at the time of surgery.Clinical Relevance:Horizontal stability of the AC joint is primarily controlled by the ACLC. Inability to restore AC joint biomechanics can result in persistent posterior instability and lead to functional impairment.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-21T09:45:53Z
      DOI: 10.1177/0363546520939882
       
  • Association Between Concussion History and Factors Relating to Cognitive,
           Behavioral, and Emotional Health Among American High School Athletes: A
           Cross-sectional Analysis
    • Authors: Gregory Knell, Scott O. Burkhart, Todd J. Caze, John D. Polousky, Harold W. Kohl, Sarah E. Messiah
      First page: 2534
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The cognitive, behavioral, and emotional deficits that may be associated with sports-related concussions among adolescents are unclear.Purpose:We examined the association between reported concussion history and factors relating to cognitive, behavioral, and emotional health among a population-based sample of US high school–aged adolescents.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Participants included a representative sample of US high school student-athletes who reported a concussion history (in the past 12 months) and relevant behaviors/outcomes within 3 domains: cognitive (academics, difficulty concentrating), behavioral (drinking and driving, carrying a weapon, physically fighting, tobacco use, marijuana use, binge drinking), and emotional (symptoms of depression, suicidal thoughts/actions). The adjusted relative odds of experiencing 0 and at least 1, 2, 3, or ≥4 concussions were modeled while mutually adjusting for the behaviors of interest in addition to age, race/ethnicity, and sleep problems. Data were reported in sex stratum.Results:A total of 13,268 participants were included in the unweighted data set. Overall, 14.5% (95% CI, 12.9%-16.2%) of female and 18.1% (95% CI, 16.4%-19.8%) of male student-athletes had at least 1 concussion in the past 12 months. As compared with those who reported not engaging in any of the behaviors deleterious to health or having had any of the negative health outcomes (composite score of 0), female athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 1.94 (95% CI, 1.55-2.43), 3.13 (95% CI, 2.30-4.33), and 6.05 (95% CI, 3.75-9.75) times more likely to have a recent history of concussions after accounting for relevant factors. As compared with those having a composite score of 0, male athletes with composite scores of 1 to 4, 5 to 7, and 8 to 11 were 2.03 (95% CI, 1.58-2.59), 3.80 (95% CI, 2.71-5.34), and 8.23 (95% CI, 4.91-13.77) times more likely to have a recent history of concussions after accounting for relevant factors.Conclusion:Self-reported concussions among US high school athletes is related to several deleterious health behaviors and outcomes. These associations should be confirmed in longitudinal analyses.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-21T09:39:36Z
      DOI: 10.1177/0363546520938776
       
  • Concussion Symptom Cutoffs for Identification and Prognosis of
           Sports-Related Concussion: Role of Time Since Injury
    • Authors: Shawn R. Eagle, Melissa N. Womble, R.J. Elbin, Raymond Pan, Michael W. Collins, Anthony P. Kontos
      First page: 2544
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Symptom reporting with scales such as the Post-Concussion Symptom Scale (PCSS) is one of the most sensitive markers of concussed status and/or recovery time, It is known that time from injury until initial clinic visit affects symptom presentation and recovery outcomes, but no study to date has evaluated changes in clinical cutoff scores for the PCSS based on earlier versus later clinical presentation postconcussion.Purpose:To evaluate if time since injury after sports-related concussion (SRC) affects clinical cutoff scores for total PCSS and PCSS factors in differentiating athletes with SRC from healthy controls and predicting prolonged recovery (>30 days) after SRC.Study Design:Cohort study; Level of evidence, 3.Methods:A chart review was conducted of clinical data from patients with SRC (age, 13-25 years; n = 588; female, n = 299) who presented to concussion specialty clinics. Participants were categorized on the basis of time from injury: early (≤7 days; n = 348) and late (8-21 days; n = 240). Outcomes were total symptom severity (ie, total PCSS score) and total score for each of 4 symptom factors (cognitive/migraine/fatigue [CMF], affective, sleep, and somatic). Area under the curve (AUC) analyses were conducted using the Youden index to optimize sensitivity and specificity cutoffs.Results:In the early group, the CMF factor (cutoff, ≥7; AUC = 0.944), affective factor (cutoff, ≥1; AUC = 0.614), and total PCSS (cutoff, ≥7; AUC = 0.889) differentiated athletes with SRC from controls. In the late group, the CMF factor cutoff was reduced (cutoff, ≥4; AUC = 0.945), while the total PCSS score (cutoff, ≥7; AUC = 0.892), affective factor (cutoff, ≥1; AUC = 0.603), and sleep factor (cutoff, ≥1; AUC = 0.609) remained the same. In the early cohort, the CMF factor was the strongest predictor of protracted recovery (cutoff, ≥23; AUC = 0.717), followed by the total PCSS (cutoff, ≥39; AUC = 0.695) and affective factor (cutoff, ≥2; AUC = 0.614). The affective factor (cutoff, ≥1; AUC = 0.642) and total PCSS (cutoff, ≥35; AUC = 0.592) were significant predictors in the late cohort, but the cutoff threshold was reduced.Conclusion:The findings indicate that PCSS symptom clinical cutoffs for identifying injury and recovery prognosis change on the basis of time since injury. Specifically, the combination of CMF, affective, and sleep factors is the best differentiator of athletes with SRC from controls regardless of time since injury. Furthermore, the CMF factor is the most robust predictor of prolonged recovery if the patient is within 1 week of SRC, whereas the affective factor is the most robust predictor of prolonged recovery if the patient is within 2 to 3 weeks of SRC.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-07-21T08:55:49Z
      DOI: 10.1177/0363546520937291
       
 
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