Subjects -> MEDICAL SCIENCES (Total: 8359 journals)
    - ALLERGOLOGY AND IMMUNOLOGY (210 journals)
    - ANAESTHESIOLOGY (119 journals)
    - CARDIOVASCULAR DISEASES (329 journals)
    - CHIROPRACTIC, HOMEOPATHY, OSTEOPATHY (21 journals)
    - COMMUNICABLE DISEASES, EPIDEMIOLOGY (228 journals)
    - DENTISTRY (288 journals)
    - DERMATOLOGY AND VENEREOLOGY (162 journals)
    - EMERGENCY AND INTENSIVE CRITICAL CARE (119 journals)
    - ENDOCRINOLOGY (148 journals)
    - FORENSIC SCIENCES (41 journals)
    - GASTROENTEROLOGY AND HEPATOLOGY (182 journals)
    - GERONTOLOGY AND GERIATRICS (132 journals)
    - HEMATOLOGY (153 journals)
    - HYPNOSIS (4 journals)
    - INTERNAL MEDICINE (164 journals)
    - LABORATORY AND EXPERIMENTAL MEDICINE (98 journals)
    - MEDICAL GENETICS (58 journals)
    - MEDICAL SCIENCES (2268 journals)
    - NURSES AND NURSING (356 journals)
    - OBSTETRICS AND GYNECOLOGY (202 journals)
    - ONCOLOGY (377 journals)
    - OPHTHALMOLOGY AND OPTOMETRY (136 journals)
    - ORTHOPEDICS AND TRAUMATOLOGY (164 journals)
    - OTORHINOLARYNGOLOGY (80 journals)
    - PATHOLOGY (96 journals)
    - PEDIATRICS (270 journals)
    - PHYSICAL MEDICINE AND REHABILITATION (152 journals)
    - PSYCHIATRY AND NEUROLOGY (813 journals)
    - RADIOLOGY AND NUCLEAR MEDICINE (190 journals)
    - RESPIRATORY DISEASES (102 journals)
    - RHEUMATOLOGY (76 journals)
    - SPORTS MEDICINE (78 journals)
    - SURGERY (393 journals)
    - UROLOGY, NEPHROLOGY AND ANDROLOGY (150 journals)

SPORTS MEDICINE (78 journals)

Showing 1 - 79 of 79 Journals sorted alphabetically
American Journal of Sports Medicine     Hybrid Journal   (Followers: 199)
American Journal of Sports Science and Medicine     Open Access   (Followers: 37)
Apunts. Medicina de l'Esport     Full-text available via subscription   (Followers: 1)
Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology     Open Access   (Followers: 8)
Asian Journal of Sports Medicine     Open Access   (Followers: 11)
B&G Bewegungstherapie und Gesundheitssport     Hybrid Journal   (Followers: 2)
Biomedical Human Kinetics     Open Access   (Followers: 10)
BMJ Open Sport & Exercise Medicine     Open Access   (Followers: 16)
British Journal of Sports Medicine     Hybrid Journal   (Followers: 72)
Case Studies in Sport and Exercise Psychology     Hybrid Journal   (Followers: 5)
Case Studies in Sport Management     Full-text available via subscription   (Followers: 7)
Ciencia y Deporte     Open Access   (Followers: 1)
Clinical Journal of Sport Medicine     Hybrid Journal   (Followers: 35)
Clinics in Sports Medicine     Full-text available via subscription   (Followers: 31)
Current Sports Medicine Reports     Full-text available via subscription   (Followers: 21)
European Journal of Sport Science     Hybrid Journal   (Followers: 59)
Exercise and Sport Sciences Reviews     Hybrid Journal   (Followers: 54)
German Journal of Exercise and Sport Research : Sportwissenschaft     Hybrid Journal   (Followers: 4)
International Journal of Athletic Therapy & Training     Hybrid Journal   (Followers: 15)
International Journal of Kinesiology and Sports Science     Open Access   (Followers: 17)
International Journal of Sport Nutrition & Exercise Metabolism     Hybrid Journal   (Followers: 81)
International Journal of Sports Medicine     Hybrid Journal   (Followers: 36)
International Journal of Sports Physiology and Performance     Hybrid Journal   (Followers: 20)
Journal of Aging and Physical Activity     Hybrid Journal   (Followers: 11)
Journal of Athletic Enhancement     Hybrid Journal   (Followers: 7)
Journal of Clinical Sport Psychology     Hybrid Journal   (Followers: 10)
Journal of Education, Health and Sport     Open Access   (Followers: 4)
Journal of Functional Morphology and Kinesiology     Open Access  
Journal of Human Kinetics     Open Access   (Followers: 16)
Journal of Imagery Research in Sport and Physical Activity     Hybrid Journal   (Followers: 8)
Journal of ISAKOS     Hybrid Journal  
Journal of Physical Education Health and Sport     Open Access   (Followers: 1)
Journal of Reconstructive Microsurgery Open     Open Access  
Journal of Science and Medicine in Sport     Full-text available via subscription   (Followers: 31)
Journal of Sport & Social Issues     Hybrid Journal   (Followers: 12)
Journal of Sport and Exercise Psychology     Hybrid Journal   (Followers: 22)
Journal of Sport Rehabilitation     Hybrid Journal   (Followers: 16)
Journal of Sports Medicine     Open Access   (Followers: 19)
Journal of Sports Science and Medicine     Open Access   (Followers: 23)
Journal of Sports Sciences     Hybrid Journal   (Followers: 37)
Journal of the International Society of Sports Nutrition     Open Access   (Followers: 58)
Medicine & Science in Sports & Exercise     Hybrid Journal   (Followers: 62)
Motor Control     Hybrid Journal   (Followers: 7)
OA Sports Medicine     Open Access   (Followers: 6)
Open Access Journal of Sports Medicine     Open Access   (Followers: 16)
Operative Techniques in Sports Medicine     Full-text available via subscription   (Followers: 1)
Physical Therapy in Sport     Hybrid Journal   (Followers: 42)
Physician and Sportsmedicine     Open Access   (Followers: 6)
Research in Sports Medicine: An International Journal     Hybrid Journal   (Followers: 11)
Revista Andaluza de Medicina del Deporte     Open Access   (Followers: 2)
Revista Brasileira de Cineantropometria & Desempenho Humano     Open Access   (Followers: 1)
Revista Brasileira de Medicina do Esporte     Open Access  
Revista del Pie y Tobillo     Open Access  
Saudi Journal of Sports Medicine     Open Access   (Followers: 2)
Scandinavian Journal of Medicine & Science In Sports     Hybrid Journal   (Followers: 28)
Science & Motricité     Full-text available via subscription   (Followers: 1)
Science & Sports     Full-text available via subscription   (Followers: 11)
Science and Medicine in Football     Hybrid Journal  
South African Journal of Sports Medicine     Open Access   (Followers: 8)
Spor Bilimleri Dergisi / Hacettepe Journal of Sport Sciences     Open Access  
Spor Hekimliği Dergisi / Turkish Journal of Sports Medicine     Open Access  
Spor ve Performans Araştırmaları Dergisi / Ondokuz Mayıs University Journal of Sports and Performance Researches     Open Access  
Sport Sciences for Health     Hybrid Journal   (Followers: 5)
Sport, Education and Society     Hybrid Journal   (Followers: 13)
Sport, Ethics and Philosophy     Hybrid Journal   (Followers: 3)
Sport, Exercise, and Performance Psychology     Full-text available via subscription   (Followers: 13)
Sport- und Präventivmedizin     Hybrid Journal   (Followers: 3)
Sportphysio     Hybrid Journal  
Sports Health: A Multidisciplinary Approach     Hybrid Journal   (Followers: 4)
Sports Medicine     Full-text available via subscription   (Followers: 34)
Sports Medicine - Open     Open Access   (Followers: 13)
Sports Medicine and Arthroscopy Review     Full-text available via subscription   (Followers: 9)
Sports Medicine and Health Science     Open Access  
Sports Medicine International Open     Open Access   (Followers: 2)
Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology     Open Access   (Followers: 17)
Sportverletzung · Sportschaden     Hybrid Journal   (Followers: 2)
Sri Lankan Journal of Sports and Exercise Medicine     Open Access  
Translational Sports Medicine     Hybrid Journal  
Zeitschrift für Sportpsychologie     Hybrid Journal   (Followers: 2)
Similar Journals
Journal Cover
American Journal of Sports Medicine
Journal Prestige (SJR): 3.949
Citation Impact (citeScore): 6
Number of Followers: 199  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0363-5465 - ISSN (Online) 1552-3365
Published by Sage Publications Homepage  [1085 journals]
  • No Evidence for Effective Prevention of Venous Thromboembolism With
           Low-Molecular-Weight Heparin After Anterior Cruciate Ligament
           Reconstruction: Letter to the Editor
    • Authors: Raymond A. van Adrichem, Banne Nemeth, Rob G.H.H. Nelissen, Suzanne C. Cannegieter
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page NP1-NP2, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519873646
       
  • No Evidence for Effective Prevention of Venous Thromboembolism With
           Low-Molecular-Weight Heparin After Anterior Cruciate Ligament
           Reconstruction: Response
    • Authors: Jing Zhu, Ling Li, Hai Jiang, Zhonglan Chen, Jian Li, Xin Tang
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page NP2-NP4, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519873652
       
  • Adaptation of Running Biomechanics to Repeated Barefoot Running: Letter to
           the Editor
    • Authors: Peter Francis, Catherine B. Tucker, Cassie Oddy, Mark I. Johnson
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page NP5-NP6, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519878153
       
  • Adaptation of Running Biomechanics to Repeated Barefoot Running: Response
    • Authors: Karsten Hollander, Dominik Liebl, Stephanie Meining, Klaus Mattes, Steffen Willwacher, Astrid Zech
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page NP6-NP7, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519878154
       
  • Efficacy of Platelet-Rich Plasma for the Treatment of Interstitial
           Supraspinatus Tears: Letter to the Editor
    • Authors: Gerard A. Malanga, Ken Mautner, Christopher J. Rodgers, Brian J. Shiple, Steven E. Sampson, Jay E. Bowen, Ivan J. Perez
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page NP8-NP9, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519879424
       
  • Efficacy of Platelet-Rich Plasma for the Treatment of Interstitial
           Supraspinatus Tears: Response
    • Authors: Adrien J. Schwitzguebel, Frank C. Kolo, Jérôme Tirefort, Mo Saffarini, Alexandre Lädermann
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page NP9-NP10, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519879690
       
  • Timing of Surgery: Can It Predict Outcome' Letter to the Editor
    • Authors: Mingjin Zhong, Kan Ouyang
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page NP11-NP11, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519887114
       
  • Timing of Surgery: Can It Predict Outcome' Response
    • Authors: Kyle N. Kunze, Edward C. Beck, Benedict U. Nwachukwu, Junyoung Ahn, Shane J. Nho
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page NP11-NP12, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519887119
       
  • Problem of Multiplicity in Clinical Studies and Inferences Made When It Is
           Present: Letter to the Editor
    • Authors: Aleksi Reito
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page NP13-NP13, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519887113
       
  • Problem of Multiplicity in Clinical Studies and Inferences Made When It Is
           Present: Response
    • Authors: Joshua S. Everhart, David C. Flanigan
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page NP14-NP15, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519887115
       
  • Problem of Multiplicity in Clinical Studies and Inferences Made When It Is
           Present: Response
    • Authors: Jonathan Stone, Matthew Salzler
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page NP15-NP16, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519887112
       
  • Placing the Latarjet in Context
    • Authors: Bruce Reider
      Pages: 17 - 20
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page 17-20, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519892245
       
  • Outcomes of the Latarjet Procedure for the Treatment of Chronic Anterior
           Shoulder Instability: Patients With Prior Arthroscopic Bankart Repair
           Versus Primary Cases
    • Authors: Jean-David Werthel, Vincent Sabatier, Bradley Schoch, Lior Amsallem, Geoffroy Nourissat, Philippe Valenti, Jean Kany, Julien Deranlot, Nicolas Solignac, Philippe Hardy, Marie Vigan, Alexandre Hardy
      Pages: 27 - 32
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page 27-32, January 2020.
      Background:It remains unclear whether results differ between a Latarjet procedure performed after a failed arthroscopic Bankart repair and one performed as the primary operation.Purpose:To compare the postoperative outcomes of the Latarjet procedure when performed as primary surgery and as revision for a failed arthroscopic Bankart repair.Study Design:Cohort study; Level of evidence, 3.Methods:A multicenter retrospective comparative case-cohort analysis was performed for all patients undergoing a Latarjet procedure for recurrent anterior shoulder instability. Patients were separated into 2 groups depending on if the Latarjet procedure was performed after a failed arthroscopic Bankart repair (group 1) or as the first operation (group 2). Outcome measures included recurrent instability, reoperation rates, complications, pain, Walch-Duplay scores, and Simple Shoulder Test.Results:A total of 308 patients were eligible for participation in the study; 72 (23.4%) did not answer and were considered lost to follow-up, leaving 236 patients available for analysis. Mean follow-up was 3.4 ± 0.8 years. There were 20 patients in group 1 and 216 in group 2. Despite similar rates of recurrent instability (5.0% in group 1 vs 2.3% in group 2; P = .5) and revision surgery (0% in group 1 vs 6.5% in group 2; P = .3), group 1 demonstrated significantly worse pain scores (2.56 ± 2.7 vs 1.2 ± 1.7; P = .01) and patient-reported outcomes (Walch-Duplay: 52 ± 25.1 vs 72.2 ± 25.0; P = .0007; Simple Shoulder Test: 9.3 ± 2.4 vs 10.7 ± 1.9; P = .001) when compared with those patients undergoing primary Latarjet procedures.Conclusion:Functional outcome scores and postoperative pain are significantly worse in patients undergoing a Latarjet procedure after a failed arthroscopic Bankart repair when compared with patients undergoing primary Latarjet. The assumption that a failed a Bankart repair can be revised by a Latarjet with a similar result to a primary Latarjet appears to be incorrect. Surgeons should consider these findings when deciding on the optimal surgical procedure for recurrent shoulder instability.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519888909
       
  • No Relationship Between Strength and Power Scores and Anterior Cruciate
           Ligament Return to Sport After Injury Scale 9 Months After Anterior
           Cruciate Ligament Reconstruction
    • Authors: Richard F. O’Connor, Enda King, Chris Richter, Kate E. Webster, Éanna Cian Falvey
      Pages: 78 - 84
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page 78-84, January 2020.
      Background:Psychological factors including self-reported readiness to return to sport (RTS) after anterior cruciate ligament reconstruction (ACLR) measured with the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale have been shown to correlate with RTS. Physical deficits have been shown to exist in the later stages after ACLR rehabilitation. No previous studies have investigated the relationship between self-reported readiness to RTS and objective physical measures of power and strength.Purpose:To investigate the relationship between ACL-RSI scores and measures of strength and power scores after ACLR.Study Design:Case control study; Level of evidence, 3.Methods:This study recruited 452 male athletes who had undergone primary ACLR. Each athlete completed the ACL-RSI questionnaire, isokinetic strength testing, and jump testing approximately 9 months after surgery.Results:ACL-RSI scores showed a trivial or weak correlation with strength and power measures at 9 months after surgery (r = 0.06-0.16). Similar results were found for the relationship between ACL-RSI scores and limb symmetry index for strength and power measures (r = 0.04-0.15). Comparing the strength and power measures of athletes with higher (≥90) ACL-RSI scores (n = 93) versus athletes with lower (≤75) ACL-RSI scores (n = 92) showed no significant differences except for isokinetic hamstring strength, but with a trivial effect size (P = .040; effect size = 0.15).Conclusion:Self-reported readiness to RTS as measured by the ACL-RSI had little or no relationship with athletes’ strength and power measures, and there was no meaningful difference in strength and power between athletes with higher and lower ACL-RSI scores at 9 months after ACLR. The findings suggest that psychological recovery and physical recovery after ACLR are different constructs, and strategies to measure and address each construct separately may be necessary to ensure successful RTS after ACLR.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519887952
       
  • Arthroscopic Microfracture for Osteochondral Lesions of the Talus:
           Functional Outcomes at a Mean of 6.7 Years in 165 Consecutive Ankles
    • Authors: Seung-Won Choi, Gun-Woo Lee, Keun-Bae Lee
      Pages: 153 - 158
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page 153-158, January 2020.
      Background:Arthroscopic microfracture for osteochondral lesions of the talus (OLT) has shown good functional outcomes. However, some studies have reported that functional outcomes deteriorate over time after surgery.Purpose:To use various functional scoring systems to evaluate functional outcomes in a large sample of patients with OLT treated by arthroscopic microfracture.Study Design:Case series; Level of evidence, 4.Methods:The study cohort consisted of 165 ankles (156 patients) that underwent arthroscopic microfracture for small to mid-sized OLT. The mean lesion size was 73 mm2 (range, 17-146 mm2), and the mean follow-up period was 6.7 years (range, 2.0-13.6 years). The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale, visual analog scale (VAS) for pain, and 36-Item Short Form Health Survey (SF-36) were used to compare the functional outcomes between the preoperative and final follow-up assessments.Results:The mean FAOS significantly improved in regard to all subscores (P < .001). The AOFAS ankle-hindfoot scale showed an improvement from 71.0 points (range, 47.0-84.0) preoperatively to 89.5 points (range, 63.0-100) at the final follow-up (P < .001). The VAS score showed an improvement from 6.2 points (range, 4.0-9.0) preoperatively to 1.7 points (range, 0-6.0) at the final follow-up (P < .001). The mean SF-36 score improved from 62.4 points (range, 27.4-76.6) preoperatively to 76.2 points (range, 42.1-98.0) at the final follow-up (P < .001). Among 165 ankles, 22 ankles (13.3%) underwent repeat arthroscopic surgery for evaluation of repaired cartilage status.Conclusion:Arthroscopic microfracture showed good functional outcomes and improved quality of life with maintenance of satisfactory outcomes at a mean follow-up of 6.7 years. Therefore, arthroscopic microfracture seems to be reliable as a first-line treatment for OLT at an intermediate-term follow-up.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519887957
       
  • Radiographic and Demographic Factors Can Predict the Need for Primary
           Labral Reconstruction in Hip Arthroscopic Surgery: A Predictive Model
           Using 1398 Hips
    • Authors: David R. Maldonado, Jeffrey W. Chen, Rafael Walker-Santiago, Philip J. Rosinsky, Jacob Shapira, Ajay C. Lall, Cynthia Kyin, Benjamin G. Domb
      Pages: 173 - 180
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page 173-180, January 2020.
      Background:Labral tears are the most common findings in patients with symptomatic femoroacetabular impingement (FAI). The restoration of labral function is critical, and labral reconstruction has been proposed as an alternative for irreparable tears.Purpose:To compare preoperative radiographic measurements and demographics of patients who underwent primary arthroscopic labral reconstruction versus primary labral repair and to identify factors that are predictive of the need for reconstruction.Study Design:Case-control study; Level of evidence, 3.Methods:Patients who underwent their index hip arthroscopic procedure between October 2010 and November 2018 and underwent either labral reconstruction or repair were included in the study. A total of 18 variables (14 radiographic and 4 demographic) were assessed in a bivariate comparison and analyzed in a multivariate logistic model.Results:A total of 251 primary reconstruction and 1147 primary repair procedures were included. The logistic model selected age, body mass index (BMI), Tönnis grade, lateral center-edge angle (LCEA), and alpha angle. The odds of reconstruction were 2.52 times higher in patients with Tönnis grade 1 than 0 (odds ratio [OR], 2.52 [95% CI, 1.82-3.49]). Each additional degree in the LCEA was associated with a 6% increase in the odds of reconstruction (OR, 1.06 [95% CI, 1.04-1.09]) and 4% for each additional degree in the alpha angle (OR, 1.04 [95% CI, 1.03-1.05]). Higher age (per log 10 unit) and BMI also increased the likelihood of reconstruction (OR, 11.29 [95% CI, 4.23-30.10] and OR, 1.03 [95% CI, 1.00-1.06], respectively).Conclusion:In a multivariate analysis, factors identified as preoperative predictors for primary arthroscopic labral reconstruction in the setting of FAI and labral tears were Tönnis grade, LCEA, age, and BMI. These predictive factors may be useful for the clinician in determining the preoperative likelihood of primary labral reconstruction.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519887749
       
  • Spinopelvic Characteristics in Acetabular Retroversion: Does Pelvic Tilt
           Change After Periacetabular Osteotomy'
    • Authors: George Grammatopoulos, Saif Salih, Paul E. Beaule, Johan Witt
      Pages: 181 - 187
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page 181-187, January 2020.
      Background:Acetabular retroversion may lead to impingement and pain, which can be treated with an anteverting periacetabular osteotomy (aPAO). Pelvic tilt influences acetabular orientation; as pelvic tilt angle reduces, acetabular version reduces. Thus, acetabular retroversion may be a deformity secondary to abnormal pelvic tilt (functional retroversion) or an anatomic deformity of the acetabulum and the innominate bone (pelvic ring).Purpose:To (1) measure the spinopelvic morphology in patients with acetabular retroversion and (2) assess whether pelvic tilt changes after successful anteverting PAO (aPAO), thus testing whether preoperative pelvic tilt was compensatory.Study Design:Case series; Level of evidence, 4.Methods:A consecutive cohort of 48 hips (42 patients; 30 ± 7 years [mean ± SD]) with acetabular retroversion that underwent successful aPAO was studied. Spinopelvic morphology (pelvic tilt, pelvic incidence, anterior pelvic plane, and sacral slope) was measured from computed tomography scans including the sacral end plate in 21 patients, with adequate images. In addition, the change in pelvic tilt with aPAO was measured via the sacrofemoral-pubic angle with supine pelvic radiographs at an interval of 2.5 ± 2 years.Results:The spinopelvic characteristics included a pelvic tilt of 4° ± 4°, a sacral slope of 39° ± 9°, an anterior pelvic plane angle of 11° ± 5°, and a pelvic incidence of 42° ± 10°. Preoperative pelvic tilt was 4° ± 4° and did not change postoperatively (4° ± 4°) (P = .676).Conclusion:Pelvic tilt in acetabular retroversion was within normal parameters, illustrating “normal” sagittal pelvic balance and values similar to those reported in the literature in healthy subjects. In addition, it did not change after aPAO. Thus, acetabular retroversion was not secondary to a maladaptive pelvic tilt (functional retroversion). Further work is required to assess whether retroversion is a reflection of a pelvic morphological abnormality rather than an isolated acetabular abnormality. Treatment of acetabular retroversion should focus on correcting the deformity rather than attempting to change the functional pelvic position.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519887737
       
  • Articular Joint-Simulating Mechanical Load Activates Endogenous TGF-β in
           a Highly Cellularized Bioadhesive Hydrogel for Cartilage Repair
    • Authors: Peter Behrendt, Yann Ladner, Martin James Stoddart, Sebastian Lippross, Mauro Alini, David Eglin, Angela Rita Armiento
      Pages: 210 - 221
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page 210-221, January 2020.
      Background:The treatment of osteochondral defects (OCDs) constitutes a major problem for orthopaedic surgeons. The altered mechanics and the cell types, with associated soluble factors derived from the exposed subchondral bone, are likely responsible for the mechanically and structurally inferior articular cartilage subsequently obtained as a repair tissue. There is therefore an unmet clinical need for bioresponsive biomaterials that allow cell delivery, reduce cell infiltration from the bone marrow, and support chondrogenesis in the presence of joint mechanical loading.Purpose:To develop a cell-laden injectable biomaterial, with bioadhesive properties, low cell invasion, and good mechanoresilience, in which simulated joint loading could induce tissue maturation through the production and activation of transforming growth factor beta 1 (TGF-β1).Study Design:Controlled laboratory study.Methods:Human bone marrow–derived mesenchymal stromal/stem cells were encapsulated in tyramine-modified hyaluronic acid (HA-Tyr) hydrogels, with crosslinking initiated by the addition of horseradish peroxidase (HRP) and various concentrations of hydrogen peroxide (H2O2; 0.3-2 mM). Cytocompatibility and biomechanical and adhesive properties were analyzed by live/dead staining, rheology, and push-out test, respectively. For multiaxial loading, cell-laden hydrogels were subjected to 10% compression superimposed onto a 0.5-N preload and shear loading (±25°) at 1 Hz for 1 hour per day and 5 times a week for 4 weeks. TGF-β1 production and activation were measured by enzyme-linked immunosorbent assay (ELISA).Results:The viscoelastic properties of the cell-laden HA-Tyr hydrogels, as crosslinked with different ratios of HRP and H2O2, were demonstrated for a range of cell densities and HRP/H2O2 concentrations. In the absence of serum supplementation, cell invasion into HA-Tyr hydrogels was minimal to absent. The bonding strength of HA-Tyr to articular cartilage compared favorably with clinically used fibrin gel.Conclusion:HA-Tyr hydrogels can be mechanically conditioned to induce activation of endogenous TGF-b1 produced by the embedded cells. HA-Tyr hydrogels function as cell carriers supporting biomechanically induced production and activation of TGF-β1 and as bioadhesive materials with low cell invasion, suggesting that they hold promise as a novel biomaterial for OCD repair strategies.Clinical Relevance:Leveraging physiological joint mechanics to support chondrogenic graft maturation in an optimized mechanosensitive hydrogel in the absence of exogenous growth factors is of highest interest for OCD repair.
      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519887909
       
  • Society News
    • Pages: 262 - 263
      Abstract: The American Journal of Sports Medicine, Volume 48, Issue 1, Page 262-263, January 2020.

      Citation: The American Journal of Sports Medicine
      PubDate: 2020-01-01T08:00:00Z
      DOI: 10.1177/0363546519893646
       
  • Progressive Elbow Magnetic Resonance Imaging Abnormalities in Little
           League Baseball Players Are Common: A 3-Year Longitudinal Evaluation
    • Authors: Joshua B. Holt, Jason M. Pedowitz, Philip H. Stearns, Tracey P. Bastrom, M. Morgan Dennis, Jerry R. Dwek, Andrew T. Pennock
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Prior studies have revealed magnetic resonance imaging (MRI) evidence of elbow pathology in single-season evaluation of competitive youth baseball players. The natural history of these findings and risk factors for progression have not been reported.Purpose:To characterize the natural history of bilateral elbow MRI findings in a 3-year longitudinal study and to correlate abnormalities with prior MRI findings, throwing history, playing status, and physical examination.Study Design:Cohort study; Level of evidence, 2.Methods:A prospective study of Little League players aged 12 to 15 years was performed. All players had preseason and postseason bilateral elbow MRI performed 3 years before this study. Players underwent repeat bilateral elbow MRI, physical examination, and detailed assessment of throwing history, playing status, and arm pain. Imaging was read by a blinded musculoskeletal radiologist and compared with prior MR images to assess for progression or resolution of previously identified pathology.Results:All 26 players who participated in the previous single-season study returned for a 3-year assessment. At the completion of the study, 15 players (58%) had dominant arm MRI pathology. Eighty percent (12/15 players) of MRI findings were new or progressive lesions. Players with postseason MRI pathology at the beginning of the study were more likely to have MRI pathology at the 3-year follow-up than players with previously normal postseason MRI (P < .05), although 6 of the 14 players (43%) with previously normal MRI developed new pathology. Year-round play was a significant predictor of tenderness to elbow palpation (P = .027) and positive MRI findings at 3 years (P = .047). At the 3-year follow-up, 7 players (27%) reported having throwing elbow pain and 3 had required casting. Additionally, differences were noted in the dominant arm’s internal and external rotation in those that continued to play baseball (P < .05).Conclusion:Dominant elbow MRI abnormalities are common in competitive Little League Baseball players. Year-round play imparts significant risk for progression of MRI pathology and physical examination abnormalities.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-12-04T10:51:58Z
      DOI: 10.1177/0363546519888647
       
  • Effect of Adductor Canal Block Versus Femoral Nerve Block on Quadriceps
           Strength, Function, and Postoperative Pain After Anterior Cruciate
           Ligament Reconstruction: A Systematic Review of Level 1 Studies
    • Authors: Matthew Dean Edwards, Joseph Preston Bethea, Jennifer Lee Hunnicutt, Harris Scott Slone, Shane Kelby Woolf
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Femoral nerve block (FNB) is a popular technique for reducing postoperative pain in patients with anterior cruciate ligament reconstruction (ACLR), but it is also linked to a number of adverse effects, such as quadriceps weakness, antalgic ambulation, and increased fall risk. Adductor canal block (ACB) has been offered as a motor nerve–sparing alternative to FNB.Purpose:To evaluate available literature that compares the effects of ACB and FNB on functional outcomes after arthroscopic ACLR.Study Design:Systematic review.Methods:Following the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search of PubMed (Ovid), CINAHL, Scopus, Cochrane, and Google Scholar databases was conducted. Search terms were designed to capture studies comparing the effects of ACB and FNB in patients undergoing arthroscopic ACLR. Data were evaluated regarding study and patient characteristics, functional measures, opioid consumption, pain scores, and complications.Results:Eight randomized controlled trials (N = 655 patients) comparing the efficacy of ACB versus FNB in arthroscopic ACLR were included. The heterogeneity of outcome measures precluded meta-analysis. Seven studies reported functional measures, which included isokinetic strength, straight-leg raise, and other various measures. Follow-up periods varied between 1 hour and 6 months. In 3 trials, ACB was found to preserve quadriceps strength as measured using straight-leg raise for the first 12 to 24 hours after surgery, while 3 other trials found no difference between the groups. No differences were reported in isokinetic strength at 6 months. In other functional measures, ACB either outperformed or was equivalent to FNB. The majority of studies reporting opioid consumption, pain scores, and complications found no differences between the blocks.Conclusion:This systematic review suggests that when compared with FNB, ACB preserves quadriceps function in the early postoperative period after ACLR while providing a similar level of analgesia. Limitations of this study include the use of various functional measures and limited long-term follow-up. More research evaluating long-term functional outcomes with standardized measures is needed to draw adequate conclusions regarding the effects of ACB and FNB on function after ACLR.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-12-04T07:58:14Z
      DOI: 10.1177/0363546519883589
       
  • Psychometric Properties of the Hip–Return to Sport After Injury Scale
           (Short Form) for Evaluating Psychological Readiness to Return to Sports
           After Arthroscopic Hip Surgery
    • Authors: Denise M. Jones, Kate E. Webster, Kay M. Crossley, Ilana N. Ackerman, Harvi F. Hart, Parminder J. Singh, Michael G. Pritchard, Gauguin Gamboa, Joanne L. Kemp
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Successful return to sports activity after surgery requires both physical and psychological readiness. The Hip–Return to Sport After Injury (Short Form) has been developed to assess psychological readiness to return to sports after hip injury and hip surgery, including hip arthroscopy.Purpose:To evaluate the reliability, validity, responsiveness, and interpretability of the scale for a cohort of patients after hip arthroscopy with a range of sports participation levels.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:Invitations to participate were sent to 145 patients from 3 specialist surgeons. The study included 77 participants 1 to 24 months after hip arthroscopy (mean ± SD age, 35 ± 9 years; 62% women) and 33 healthy age-matched controls (age, 37 ± 7 years; 52% women). The scale was administered electronically on 3 occasions to patients: baseline (≥1 month postarthroscopy), 1 week later, and 6 months later. In addition to the scale, participants were asked about sports participation status and their global rating of postsurgical change. The scale was administered to healthy controls on 1 occasion. The minimal detectable difference, discriminant validity, floor and ceiling effects, responsiveness, and interpretability (minimally important change) were determined for the scale.Results:Among the postarthroscopy group, excellent test-retest reliability was found (intraclass correlation coefficient = 0.869; 95% CI, 0.756-0.932) with a minimal detectable difference of 26 points out of 100 at the individual level and 4 points out of 100 at the group level. At baseline discriminant validity was evident between those who had returned to sports (median = 69, n = 35) and those who had not returned to sports (median = 30, n = 42; Mann-Whitney U score = 232.5, z = −5.141, P < .001) and between the returned-to-sports postarthroscopy group and healthy controls (median = 96, n = 33; Mann-Whitney U score = 165.500, z = 5.666, P < .001). No floor or ceiling effects were evident. Responsiveness was demonstrated for the scale in relation to sports status. With sports status as an anchor, a minimally important change of 26 points was identified.Conclusion:Assessment of the Hip–Return to Sport After Injury (Short Form) supports its use as a reliable and valid measure of psychological readiness to return to sports in patients after hip arthroscopy.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-12-04T07:19:36Z
      DOI: 10.1177/0363546519888644
       
  • Improved Rotator Cuff Footprint Contact Characteristics With an Augmented
           Repair Construct Using Lateral Edge Fixation
    • Authors: Ekaterina Urch, Charles C. Lin, Yasuo Itami, Nilay A. Patel, Michelle H. McGarry, Orr Limpisvasti, Thay Q. Lee
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The transosseous-equivalent (TOE) rotator cuff repair construct has become the gold standard for the repair of medium and large rotator cuff tears. Repair failure, however, continues to be a problem. One contributing factor may be the inability of the TOE repair to replicate the native footprint contact characteristics during shoulder movement, especially in rotation. This results in higher strain across the repair, which leads to gapping and predisposes the construct to failure. In an effort to better reproduce the native compression forces throughout the footprint, an augmented TOE construct supplemented with lateral edge fixation is proposed, and the contact characteristics were compared with those of the gold standard TOE construct.Hypothesis:The augmented TOE repair will demonstrate improved footprint contact characteristics when compared with the classic TOE repair.Study Design:Controlled laboratory study.Methods:Ten fresh-frozen cadaveric shoulders underwent supraspinatus repair using both the classic TOE double-row construct and the augmented TOE repair. For the augmented repair, 2 luggage tag sutures were used to secure the lateral edge and incorporated into the lateral row anchors. A Tekscan pressure sensor (Tekscan Inc) placed under the repaired tendon was used to collect footprint contact area, force, peak pressure, and contact pressure data for each construct.Results:The augmented construct demonstrated significantly greater contact forces (average difference, 4.9 N) and significantly greater contact pressures (average difference, 23.1 kPa) at all degrees of abduction and all degrees of rotation. At 30° of internal and 30° of external rotation at both 0° and 30° of shoulder abduction, the augmented construct demonstrated significantly greater peak contact pressures.Conclusion:The augmented construct showed superior contact characteristics when compared with the classic TOE technique. The addition of lateral edge fixation to the classic TOE repair significantly improves bone-tendon contact characteristics with minimal additional surgical effort.Clinical Relevance:The results of this study indicate that lateral augmentation of the classic TOE repair produces a biomechanically superior construct that may optimize tendon healing.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-12-04T07:07:08Z
      DOI: 10.1177/0363546519888182
       
  • Physiotherapy as an Initial Treatment Option for Femoroacetabular
           Impingement: A Systematic Review of the Literature and Meta-analysis of 5
           Randomized Controlled Trials
    • Authors: Graeme Hoit, Daniel B. Whelan, Tim Dwyer, Prabjit Ajrawat, Jaskarndip Chahal
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Femoroacetabular impingement is a common and debilitating source of hip pain in young adults. Although physiotherapy is used as a mainstay of nonoperative care for femoroacetabular impingement, the evidence regarding different physiotherapy practices is poorly understood.Purpose:To collect and synthesize the best available evidence and arrive at a summary estimate of treatment effect for the utility of physiotherapy in the management of femoroacetabular impingement.Study Design:Meta-analysis.Methods:A systematic review was performed on February 2, 2019, of PubMed, EMBASE, and Cochrane Library databases using “femoroacetabular impingement OR hip pain” and “physiotherapy OR nonoperative management” and their synonyms as search terms. Central treatment themes were identified across protocols, and pooled analyses were conducted to assess for differences in patient-reported outcome measures across these themes.Results:A total of 5 randomized controlled trials met our inclusion criteria. The studies included 124 patients with a mean age of 35 years, of whom 24% were male. The average follow-up was 9.4 weeks (range, 6-12 weeks), and the follow-up rate across all participants was 86%. Among these 5 studies, 4 studies used a physiotherapy protocol that focused on core strengthening versus no core strengthening, 4 studies compared active strengthening versus passive modalities, and 3 studies compared supervised versus unsupervised physiotherapy. Pooled analysis across all studies demonstrated improved outcomes in the treatment groups compared with the controls (standardized mean difference [SMD], 0.76; 95% CI, 0.38-1.13; P < .0001). Core strengthening (SMD, 0.82; 95% CI, 0.39-1.26; P = .0002), active physiotherapy (SMD, 0.70; 95% CI, 0.29-1.10; P = .0008), and supervised physiotherapy (SMD, 0.58; 95% CI, 0.14-1.03; P = .01) were found to result in statistically significant improvements in functional outcomes compared with no core strengthening, passive modalities, and unsupervised care, respectively.Conclusion:Supervised physiotherapy programs focusing on active strengthening and core strengthening are more effective than unsupervised, passive, and non–core focused programs. Future studies with longer term follow-up and validated femoroacetabular impingement specific outcome measures are required to determine prognostic factors for success with nonoperative care as well as to determine the ideal patient profile and structured rehabilitation protocol.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-27T06:27:58Z
      DOI: 10.1177/0363546519882668
       
  • Return to Work and Sport After Proximal Tibial Osteotomy and the Effects
           of Opening Versus Closing Wedge Techniques on Adverse Outcomes: A
           Systematic Review and Meta-analysis
    • Authors: Kyle N. Kunze, Alexander Beletsky, Charles P. Hannon, Robert F. LaPrade, Adam B. Yanke, Brian J. Cole, Brian Forsythe, Jorge Chahla
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Although many studies have reported successful functional outcomes after proximal tibial osteotomy (PTO), a paucity of literature has sought to quantify outcomes and current rates of return to sport (RTS) and return to work (RTW) after PTO.Purpose:To (1) determine current rates of RTS and RTW after PTO and (2) quantify the incidence of complications and conversion to total knee arthroplasty (TKA) after PTO for all patients as well as those undergoing opening and closing wedge PTO.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:The Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed (2008-2019), EMBASE (2008-2019), and MEDLINE (2008-2019) databases were queried. Data pertaining to article information, patient demographics, surgical techniques, rates of complication and conversion to TKA, patient-reported outcome scores, RTS, and RTW were extracted. Data were synthesized, and a random effects meta-analysis of proportions using continuity correction methods was performed to determine the proportion of patients receiving opening and closing wedge PTO who experienced adverse events.Results:The review and meta-analysis included 33 studies involving 1914 patients who underwent PTO with a weighted mean ± SD age of 50.3 ± 9.9 years and body mass index of 26.9 ± 2.3 kg/m2. The pooled RTS and RTW rates were 75.7% (range, 55%-100%) in 814 patients and 80.8% (range, 41%-100%) in 505 patients, respectively. The pooled TKA rate was 12.5% (range, 0%-35.7%) at a mean of 70.6 months and the pooled complication rate was 11.1% (range, 0%-28.6%). The overall random pooled summary estimate of the proportion of patients who underwent opening wedge PTO and subsequently converted to TKA was 2.0% (95% CI, 1.0%-4.0%; I2 = 63.65) at a mean of 43.4 ± 31.9 months and who experienced a complication was 6.0% (95% CI, 3.0%-9.0%; I2 = 87.10%). For closing wedge PTO, the proportion of patients who converted to TKA was 5.0% (95% CI, 1.0%-9.0%; I2 = 93.1%) and experienced a complication was 2.0% (95% CI, 1.0%-3.0%; I2 = 90.0%). Only 53.8% of studies that referenced RTS provided postoperative RTS rates, and 80% of studies that referenced RTW provided RTW rates. Only 1 study defined RTS criteria, no studies defined RTW criteria, and 31 different outcome measures were reported across all studies.Conclusion:Patients undergoing PTO for osteoarthritis, cartilage defects, and symptomatic malalignment of the knee experience high rates of RTS and RTW. These patients also experience low rates of complications and conversion to TKA, regardless of opening or closing wedge technique. Significant heterogeneity exists with regard to criteria used to define RTS and RTW and patient-reported outcome measures used to assess clinical and functional improvements after PTO.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-27T06:24:15Z
      DOI: 10.1177/0363546519881638
       
  • Outcome Comparison of Graft Bridging and Superior Capsule Reconstruction
           for Large to Massive Rotator Cuff Tears: A Systematic Review
    • Authors: Jinrong Lin, Yaying Sun, Qingyan Chen, Shaohua Liu, Zheci Ding, Jiwu Chen
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Graft bridging (GB) and superior capsule reconstruction (SCR) were developed to treat large to massive rotator cuff tears (RCTs); however, the outcome differences between GB and SCR remain unclear.Purpose:To systematically review and compare the outcomes of GB and SCR for large to massive RCT.Study Design:Systematic review.Methods:A systematic review was performed via a comprehensive search of PubMed, Embase, and the Cochrane Library. Studies of GB or SCR were included according to the inclusion and exclusion criteria. The primary outcome was Constant-Murley score at the final follow-up. Secondary outcomes included the American Shoulder and Elbow Surgeons score, visual analog scale score for pain, active shoulder range of motion, and graft healing rate. Complication rate was the safety outcome measure. Outcomes were summarized into group SCR and group GB, and the results were compared statistically (P < .05).Results:A total of 23 studies were included in this review: 238 repairs from the 5 studies in group SCR and 593 repairs from the 18 studies in group GB. For group SCR and group GB, the mean age was 61.6 and 63.3 years, and the mean follow-up was 18.0 and 40.1 months, respectively. Overall, both procedures demonstrated improvement of clinical outcomes. When compared with group SCR, group GB had significantly higher mean differences of the Constant-Murley score (41.9 vs 19.8), American Shoulder and Elbow Surgeons score (39.3 vs 33.8), visual analog scale score for pain (4.4 vs 3.4), and active external rotation at side (15.3 vs 9.3). No statistically significant difference was detected in the mean difference of active forward flexion, internal rotation, abduction, and graft healing rate between the groups. The complication rates were 0.84% (2 of 238) in group SCR and 0.67% (4 of 593) in group GB.Conclusion:In general, GB showed significantly better clinical and functional outcomes postoperatively than SCR, with a similar complication rate. The available fair-quality evidence suggested that GB might be a better choice for large to massive RCT. More high-quality randomized controlled studies are required to further evaluate the relative benefits of the 2 procedures.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-26T01:10:05Z
      DOI: 10.1177/0363546519889040
       
  • Use of Platelet-Rich Plasma for the Improvement of Pain and Function in
           Rotator Cuff Tears: A Systematic Review and Meta-analysis With Bias
           Assessment
    • Authors: Xiao Chen, Ian A. Jones, Ryan Togashi, Caron Park, C. Thomas Vangsness
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Many clinical trials have investigated the use of platelet-rich plasma (PRP) to treat rotator cuff–related abnormalities. Several meta-analyses have been published, but none have focused exclusively on level 1 randomized controlled trials.Purpose:To assess the efficacy of PRP for rotator cuff–related abnormalities and evaluate how specific tendon involvement, the inclusion of leukocytes, and the use of gel/nongel formulations affect pain and functional outcomes.Study Design:Systematic review and meta-analysis.Methods:The literature was screened following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Baseline, short-term, and long-term data were extracted for the Constant score, University of California, Los Angeles (UCLA) score, visual analog scale (VAS) for pain, retear rate, Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) score. The 100-point modified Coleman Methodology Score (CMS) was used to assess methodological quality. Funnel plots and the Egger test were used to screen for publication bias, and sensitivity analysis was performed to evaluate the effect of potential outliers.Results:A total of 18 level 1 studies were included in this review, 17 (1116 patients) of which could be included in quantitative analysis. The mean modified CMS was 79.4 ± 10.39. The Constant scores of patients who received PRP were significantly better short term (weighted mean difference [WMD], 2.89 [95% CI, 0.89-4.90]; P < .01) and long term (WMD, 2.66 [95% CI, 1.13-4.19]; P < .01). The VAS scores were significantly improved short term (WMD, –0.45 [95% CI, –0.75 to −0.15]; P < .01). Sugaya grade IV and V retears in PRP-treated patients were significantly reduced long term (odds ratio [OR], 0.34 [95% CI, 0.20-0.57]; P < .01). In PRP-treated patients with multiple tendons torn, there were reduced odds of retears (OR, 0.28 [95% CI, 0.13-0.60]; P < .01). Patients who received leukocyte-rich PRP had significantly better Constant scores compared with the leukocyte-poor PRP group, but there was no difference in VAS scores. Patients receiving PRP gel reported higher Constant scores compared with the controls, whereas those receiving nongel PRP treatments did not, although there was no difference in VAS scores. Long-term odds of retears were decreased, regardless of leukocyte content (leukocyte-poor PRP: OR, 0.36 [95% CI, 0.16-0.82]; leukocyte-rich PRP: OR, 0.32 [95% CI, 0.16-0.65]; all P < .05) or usage of gel (nongel: OR, 0.42 [95% CI, 0.23-0.76]; gel: OR, 0.17 [95% CI, 0.05-0.51]; all P < .01).Conclusion:Long-term retear rates were significantly decreased in patients with rotator cuff–related abnormalities who received PRP. Significant improvements in PRP-treated patients were noted for multiple functional outcomes, but none reached their respective minimal clinically important differences. Overall, our results suggest that PRP may positively affect clinical outcomes, but limited data, study heterogeneity, and poor methodological quality hinder firm conclusions.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-19T05:50:19Z
      DOI: 10.1177/0363546519881423
       
  • A Contemporary Look at the Evaluation and Treatment of Adult Borderline
           and Frank Hip Dysplasia
    • Authors: Matthew J. Kraeutler, Marc R. Safran, Anthony J. Scillia, Olufemi R. Ayeni, Tigran Garabekyan, Omer Mei-Dan
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Adult hip dysplasia is often diagnosed according to the lateral center-edge angle (LCEA). Patients with frank hip dysplasia (LCEA
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-14T06:31:21Z
      DOI: 10.1177/0363546519881411
       
  • The Safety of Blood Flow Restriction Training as a Therapeutic
           Intervention for Patients With Musculoskeletal Disorders: A Systematic
           Review
    • Authors: Melissa C. Minniti, Andrew P. Statkevich, Ryan L. Kelly, Victoria P. Rigsby, Meghan M. Exline, Daniel I. Rhon, Derek Clewley
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The effectiveness of blood flow restriction training (BFRT) as compared with other forms of training, such as resistance training, has been evaluated in the literature in clinical and nonclinical populations. However, the safety of this intervention has been summarized only in healthy populations and not in clinical populations with musculoskeletal disorders.Purpose:To evaluate the safety and adverse events associated with BFRT in patients with musculoskeletal disorders.Study Design:Systematic review.Methods:A literature search was conducted with 3 online databases (MEDLINE, CINAHL, and Embase). Eligibility criteria for selecting studies were as follows: (1) BFRT was used as a clinical intervention, (2) study participants had a disorder of the musculoskeletal system, (3) authors addressed adverse events, (4) studies were published in English, and (5) the intervention was performed with human participants.Results:Nineteen studies met eligibility criteria, with a pooled sample size of 322. Diagnoses included various knee-related disorders, inclusion body myositis, polymyositis or dermatomyositis, thoracic outlet syndrome, Achilles tendon rupture, and bony fractures. Nine studies reported no adverse events, while 3 reported rare adverse events, including an upper extremity deep vein thrombosis and rhabdomyolysis. Three case studies reported common adverse events, including acute muscle pain and acute muscle fatigue. In the randomized controlled trials, individuals exposed to BFRT were not more likely to have an adverse event than individuals exposed to exercise alone. Of the 19 studies, the adverse events were as follows: overall, 14 of 322; rare overall, 3 of 322; rare BFRT, 3 of 168; rare control, 0 of 154; any adverse BFRT, 10 of 168; any adverse control, 4 of 154. A majority of studies were excluded because they did not address safety.Conclusion:BFRT appears to be a safe strengthening approach for knee-related musculoskeletal disorders, but further research is needed to make definitive conclusions and to evaluate the safety in other musculoskeletal conditions. Improved definitions of adverse events related to BFRT are needed to include clear criteria for differentiating among common, uncommon, and rare adverse events. Finally, further research is needed to effectively screen who might be at risk for rare adverse events.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-11T05:37:34Z
      DOI: 10.1177/0363546519882652
       
  • The Influence of Psychological Factors on the Incidence and Severity of
           Sports-Related Concussions: A Systematic Review
    • Authors: Lily N. Trinh, Symone M. Brown, Mary K. Mulcahey
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:An athlete’s preexisting psychological factors may influence the incidence and/or severity of sports-related concussions (SRCs).Purpose:To determine if emotional states, personality traits, temperament, life stressors, and explanatory styles (optimism vs pessimism) influence the incidence and severity of SRCs in athletes.Study Design:Systematic review.Methods:A systematic literature search of multiple major medical reference databases was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were included that evaluated the effect of preexisting psychological factors on the incidence and severity of SRCs in male and female athletes participating in all sports.Results:The initial search identified 1195 articles. Ten studies met our inclusion criteria and were included in our analysis. Factors such as meanness, aggression, and psychoticism were associated with an increased incidence of SRCs. Baseline traits of irritability, sadness, nervousness, and depressive symptoms were associated with worse symptomatology after SRCs. In young athletes, preexisting psychiatric illnesses, family history of psychiatric illness, and significant life stressors were associated with an increased risk of developing postconcussion syndrome after SRCs.Conclusion:This systematic review demonstrated a potential relationship between an athlete’s preexisting psychological factors and the incidence and severity of SRCs. These associations are not entirely clear owing to the heterogeneity across included studies and the low-to-moderate certainty of evidence. Future studies should attempt to evaluate men and women independently, use well-validated psychological questionnaires, and limit the usage of self-reported SRCs, when possible. Furthermore, the potential efficacy of baseline psychological factor and/or symptom reports on the prevention and management of SRCs should be explored.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-08T06:19:57Z
      DOI: 10.1177/0363546519882626
       
  • Diagnostic Performance of Magnetic Resonance Imaging for Detecting
           Meniscal Ramp Lesions in Patients With Anterior Cruciate Ligament Tears: A
           Systematic Review and Meta-analysis
    • Authors: Boyeon Koo, Sun Hwa Lee, Seong Jong Yun, Jae Gwang Song
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The clinical importance of meniscal ramp lesions in patients with anterior cruciate ligament (ACL) tear has emerged as a major issue. However, the diagnostic accuracy of magnetic resonance imaging (MRI) for detecting ramp lesions has a wide range.Purpose:To perform a systematic review and meta-analysis of the diagnostic performance of MRI for diagnosing ramp lesion in patients with ACL tear.Study Design:Systematic review and meta-analysis.Methods:A literature search of PubMed, EMBASE, and the Cochrane Library was performed based on the revised guidelines for the PRISMA DTA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses of Diagnostic Accuracy Studies) statement. Diagnostic performance studies using MRI as the index test and arthroscopy as the reference standard for ramp lesion were included. Bivariate and hierarchical summary receiver operating characteristic modeling was used to evaluate the diagnostic performance. Meta-regression analyses were performed to identify potential sources of heterogeneity.Results:The review and meta-analysis included 9 studies from 8 articles (883 patients with ACL tear and reconstruction). The summary sensitivity, summary specificity, and area under the hierarchical summary receiver operating characteristic for ramp lesion were 0.71 (95% CI, 0.59-0.81), 0.94 (95% CI, 0.88-0.97), and 0.90 (95% CI, 0.87-0.92), respectively. Among the potential covariates, magnet strength (P < .01), patient knee position (P = .04), and MRI interpreter (P = .04) were associated with heterogeneity in terms of sensitivity, whereas magnet strength (P = .03) was associated with heterogeneity in terms of specificity.Conclusion:MRI demonstrated moderate sensitivity and excellent specificity for diagnosing ramp lesion. Routine arthroscopic assessment is recommended for the presence of ramp lesion, regardless of whether it is suspected on MRI. Further clinicoradiological studies of diagnostic algorithms are needed for identifying ramp lesion, including high-resolution MRI with appropriate knee position.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-05T01:14:48Z
      DOI: 10.1177/0363546519880528
       
  • Outcomes After Arthroscopic Hip Labral Reconstruction: A Systematic Review
           and Meta-analysis
    • Authors: Michael D. Rahl, Collin LaPorte, Gabrielle K. Steinl, Michaela O’Connor, T. Sean Lynch, Travis J. Menge
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The acetabular labrum is critical to maintenance of hip stability and has been found to play a key role in preservation of the hip fluid seal. For irreparable labral damage, arthroscopic labral reconstruction is an evolving technique that has been shown to decrease hip pain and restore function.Purpose:To provide a comprehensive review of current literature for arthroscopic hip labral reconstruction, with a focus on determining if outcomes differ between autograft or allograft tissue.Study Design:Systematic review and meta-analysis.Methods:PubMed and Scopus online databases were searched with the key terms “hip,”“labrum,”“reconstruction,” and “graft” in varying combinations. Procedures performed, complications, failures, and functional outcome measures were included in this analysis. The inverse variance method was used to calculate pooled estimates and 95% CIs.Results:Eight studies with 537 hips were included. Mean age was 37.4 years (95% CI, 34.5-40.4 years), and mean follow-up time was 29 months (95% CI, 26-33 months). Survivorship after autograft reconstruction ranged from 75.7% to 100%, as compared with 86.3% to 90.0% in the allograft cohort. In the autograft cohort, failures included 0% to 13.2% conversion to total hip arthroplasty and 0% to 11.0% revision hip arthroscopy. Failures in the allograft cohort included 0% to 12.9% total hip arthroplasty conversion, 0% to 10.0% revision arthroscopy, and 0% to 0.8% open revision surgery. Based on 6 studies, the modified Harris Hip Score improved by a mean 29.0 points after labral reconstruction (P < .0001).Conclusion:Arthroscopic hip labral reconstruction results in clinically significant improvements in patient-reported outcomes. Our analysis indicates that there are no significant differences in outcomes based on graft type alone. A number of factors may determine graft choice, including patient preference, surgeon experience, operative time, morbidity, and cost. Proper patient selection based on age and severity of degenerative joint disease will also optimize outcomes after labral reconstruction.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-10-21T06:24:25Z
      DOI: 10.1177/0363546519878147
       
  • Are Implant Choice and Surgical Approach Associated With Biceps Tenodesis
           Construct Strength' A Systematic Review and Meta-regression
    • Authors: Hiroshi F. Aida, Brendan Y. Shi, Eric G. Huish, Edward G. McFarland, Uma Srikumaran
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Despite the increasing use of biceps tenodesis, there is a lack of consensus regarding optimal implant choice (suture anchor vs interference screw) and implant placement (suprapectoral vs subpectoral).Purpose/Hypothesis:The purpose was to determine the associations of procedural parameters with the biomechanical performance of biceps tenodesis constructs. The authors hypothesized that ultimate failure load (UFL) would not differ between sub- and suprapectoral repairs or between interference screw and suture anchor constructs and that the number of implants and number of sutures would be positively associated with construct strength.Study Design:Meta-analysis.Methods:The authors conducted a systematic literature search for studies that measured the biomechanical performance of biceps tenodesis repairs in human cadaveric specimens. Two independent reviewers extracted data from studies that met the inclusion criteria. Meta-regression was then performed on the pooled data set. Outcome variables were UFL and mode of failure. Procedural parameters (fixation type, fixation site, implant diameter, and numbers of implants and sutures used) were included as covariates. Twenty-five biomechanical studies, representing 494 cadaveric specimens, met the inclusion criteria.Results:The use of interference screws (vs suture anchors) was associated with a mean 86 N–greater UFL (95% CI, 34-138 N; P = .002). Each additional suture used to attach the tendon to the implant was associated with a mean 53 N–greater UFL (95% CI, 24-81 N; P = .001). Multivariate analysis found no significant association between fixation site and UFL. Finally, the use of suture anchors and fewer number of sutures were both independently associated with lower odds of native tissue failure as opposed to implant pullout.Conclusion:These findings suggest that fixation with interference screws, rather than suture anchors, and the use of more sutures are associated with greater biceps tenodesis strength, as well as higher odds of native tissue failure versus implant pullout. Although constructs with suture anchors show inferior UFL compared with those with interference screws, incorporation of additional sutures may increase the strength of suture anchor constructs. Supra- and subpectoral repairs provide equivalent biomechanical strength when controlling for potential confounders.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-10-04T10:34:52Z
      DOI: 10.1177/0363546519876107
       
  • Outcomes of Hip Arthroscopic Surgery in Adolescents With a Subanalysis on
           Return to Sport: A Systematic Review
    • Authors: Sarah L. Chen, David R. Maldonado, Cammille C. Go, Cynthia Kyin, Ajay C. Lall, Benjamin G. Domb
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:There is a plethora of literature on outcomes after hip arthroscopic surgery in the adult population; however, outcomes in the adolescent population have not been as widely reported. Additionally, as adolescents represent a very active population, it is imperative to understand their athletic activity and return to sport after hip arthroscopic surgery.Purpose:To analyze patient-reported outcomes (PROs) after hip arthroscopic surgery in adolescents (aged 10-19 years) and present a return-to-sport analysis in the athletic adolescent subgroup.Study Design:Systematic review; Level of evidence, 4.Methods:The PubMed, Embase, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to identify articles that reported PROs after hip arthroscopic surgery in adolescents. The standardized mean difference was calculated to compare the effect size of hip arthroscopic surgery on various PROs. For the athletic subgroup, a return-to-sport summary was also provided.Results:Ten studies, with 618 adolescent hips and a collective study period of December 2004 to February 2015, were included in this systematic review. Across all studies, the mean age was 15.8 years (range, 11.0-19.9 years), and female patients composed approximately 56.7% of the entire cohort. The mean follow-up was 34.5 months (range, 12-120 months). The modified Harris Hip Score (mHHS) was reported in 9 studies, and at latest follow-up, scores were excellent in 4 studies (range, 90-95) and good in the remaining 5 studies (range, 82.1-89.6). All adolescents also showed significant improvement on the Non-Arthritic Hip Score (NAHS), the Hip Outcome Score–Activities of Daily Living (HOS-ADL), the HOS–Sport-Specific Subscale (HOS-SSS), the physical component of the 12-Item Short Form Health Survey (SF-12P), a visual analog scale for pain (VAS), and both versions of the International Hip Outcome Tool (iHOT-12 and iHOT-33) at latest follow-up (P < .05). Further, mean improvements reported in all studies surpassed reported values of the minimal clinically important difference and patient acceptable symptomatic state for the mHHS, HOS-ADL, HOS-SSS, and iHOT-33. Finally, the collective return-to-sport rate among athletic adolescents was 84.9%.Conclusion:In the setting of labral tears and femoroacetabular impingement, hip arthroscopic surgery can safely be performed in adolescents and leads to significant functional improvement. Furthermore, athletic adolescents return to sport at high levels after hip arthroscopic surgery.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-09-20T08:38:22Z
      DOI: 10.1177/0363546519875131
       
  • Outcomes of Revision Hip Arthroscopic Surgery: A Systematic Review and
           Meta-analysis
    • Authors: Michaela O’Connor, Gabrielle K. Steinl, Ajay S. Padaki, Kyle R. Duchman, Robert W. Westermann, T. Sean Lynch
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:While the indications for primary hip arthroscopic surgery in treating femoroacetabular abnormalities continue to be defined, the indications and outcomes for revision hip arthroscopic surgery remain ambiguous. However, revision hip arthroscopic surgery is performed in 5% to 14% of patients after their index procedure. While patient-reported outcomes (PROs) generally improve after revision procedures, the extent of their improvement is not well defined.Purpose:To determine the outcomes and efficacy of revision hip arthroscopic surgery in patients who remain symptomatic after their index procedure.Study Design:Meta-analysis and systematic review.Methods:The terms “hip arthroscopy,”“revisions,”“outcomes,” and “femoroacetabular impingement” were searched in PubMed, Web of Science, Scopus, Cochrane Library, and Google Scholar. After screening, 15 studies were included for review. In addition to hip-specific metrics, functional outcome measures were included. Pooled estimates and 95% CIs were calculated using inverse variance methods.Results:A total of 4765 hips in 4316 patients were identified. The most common indication for revision surgery was inadequate bony resection during the index procedure. Meta-analysis showed that all PROs improved significantly from baseline to final follow-up after revision hip arthroscopic surgery. Notably, the modified Harris Hip Score (mHHS) increased a mean of 17.20 points after revision hip arthroscopic surgery, the Hip Outcome Score–Activities of Daily Living (HOS-ADL) improved by 13.98, and the visual analog scale (VAS) for pain decreased by 3.16. However, when compared with primary hip arthroscopic surgery, the mean PRO scores after revision hip arthroscopic surgery were lower. After revision hip arthroscopic surgery, the rates of conversion to total hip arthroplasty ranged from 0% to 14.3%, and the rates of further arthroscopic revision ranged from 2% to 14%.Conclusion:Inadequate bony resection represents the most common indication for revision hip arthroscopic surgery. PROs improve significantly after revision hip arthroscopic surgery but remain lower than those of patients undergoing primary hip arthroscopic surgery.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-09-10T05:57:33Z
      DOI: 10.1177/0363546519869671
       
  • A Majority of Anterior Cruciate Ligament Injuries Can Be Prevented by
           Injury Prevention Programs: A Systematic Review of Randomized Controlled
           Trials and Cluster–Randomized Controlled Trials With Meta-analysis
    • Authors: Yu-Lun Huang, Jaehun Jung, Colin M.S. Mulligan, Jaekeun Oh, Marc F. Norcross
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Anterior cruciate ligament (ACL) injury prevention programs (IPPs) are generally accepted as being valuable for reducing injury risk. However, significant methodological limitations of previous meta-analyses raise questions about the efficacy of these programs and the extent to which meeting current best-practice ACL IPP recommendations influences the protective effect of these programs.Purpose:To (1) estimate the protective effect of ACL IPPs while controlling for common methodological limitations of previous meta-analyses and (2) systematically categorize IPP components and factors related to IPP delivery to assess the validity of current best-practice IPP recommendations.Study Design:Systematic review with meta-analysis.Methods:A systematic search of 5 electronic scientific databases was conducted to identify studies testing the efficacy of ACL IPPs. Studies were included if (1) the intervention aimed to prevent ACL injury, (2) the incidence rate (IR) or other outcome data that made it possible to calculate the IR for both the intervention and control groups were reported, and (3) the study design was a prospective randomized controlled trial (RCT) or cluster-RCT.Results:Of the 2219 studies screened, 8 studies were included in the quantitative synthesis, and their analysis revealed a significant reduction in ACL IR when athletes received IPPs (IR ratio = 0.47; 95% CI, 0.30-0.73; P < .001). The majority of included IPPs tended to meet minimum best-practice recommendations and incorporated plyometric, strengthening, and agility exercises along with feedback on proper landing technique. However, the specific exercises included in each IPP and key factors related to IPP delivery were highly variable.Conclusion:Despite limiting the analysis to only high-quality studies and controlling for time at risk and potential clustering effects, the study showed that ACL IPPs had a significant protective effect and reduced injury rates by 53%. However, significant variability in the specific exercises and the manner of program delivery suggests that ACL IPPs may be able to be designed within an overarching best-practice framework. This may allow practitioners the flexibility to develop IPPs that meet the specific characteristics of the target population and potentially increase the likelihood that these programs will be widely adopted and implemented.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-08-30T08:31:54Z
      DOI: 10.1177/0363546519870175
       
  • Anterior Cruciate Ligament Reconstruction Within 3 Weeks Does Not Increase
           Stiffness and Complications Compared With Delayed Reconstruction: A
           Meta-analysis of Randomized Controlled Trials
    • Authors: Luca Deabate, Davide Previtali, Alberto Grassi, Giuseppe Filardo, Christian Candrian, Marco Delcogliano
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Injury-to-surgery time has been identified as a key point in anterior cruciate ligament (ACL) reconstruction, with early versus delayed treatment remaining a debated and controversial topic in the management of ACL tears.Purpose/Hypothesis:The aim was to quantitatively synthesize the best literature evidence by including only randomized controlled trials (RCTs) comparing early versus delayed ACL reconstruction, with a clear and univocal definition of cutoffs of early or delayed surgery. The hypothesis was that early treatment would lead to similar final clinical results compared with the delayed approach while providing a faster recovery without an increase in complications after ACL reconstruction.Study Design:Meta-analysis.Methods:A systematic literature search was performed on February 12, 2019, using PubMed, Web of Science, Cochrane Library, and gray literature databases. According to previous literature, 2 analyses with different cutoffs for injury-to-surgery time (3 weeks and 10 weeks) were performed to distinguish early and delayed reconstruction. The influence of timing was analyzed through meta-analyses in terms of patient-reported outcome measures (PROMs), risk of complications, range of motion (ROM) limitation, risk of retears, and residual laxity. Risk of bias and quality of evidence were assessed following the Cochrane guidelines.Results:Eight studies (5 in 3-week cutoff analysis and 3 in 10-week cutoff analysis) were included. No differences were found in terms of PROMs, risk of complications, ROM limitation, risk of retears, and residual laxity either in the 3-week cutoff analysis or in the 10-week cutoff analysis (P> .05). The level of evidence was moderate to low for the outcomes of the 3-week cutoff analysis and low to very low for the outcomes of the 10-week cutoff analysis.Conclusion:This meta-analysis did not confirm the previously advocated benefits of delaying ACL surgery to avoid the acute posttraumatic phase. In fact, RCTs demonstrated that timing of surgery after ACL tears has no influence on the final functional outcome, risk of retears, or residual instability. While no data were available about the recovery time, literature results showed that early ACL reconstruction could be performed without increasing the risk of complications.Study Registration:CRD42019119319 (PROSPERO).
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-08-05T06:48:53Z
      DOI: 10.1177/0363546519862294
       
  • Suture Button Versus Hook Plate for Acute Unstable Acromioclavicular Joint
           Dislocation: A Meta-analysis
    • Authors: Cong Wang, Jia-Hong Meng, Yi-Wen Zhang, Ming-Min Shi
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Surgical treatment is indicated for unstable acromioclavicular (AC) joint dislocation. The hook plate (HP) technique is a commonly used treatment method, but the use of the suture button (SB) technique is increasing.Purpose:To conduct a meta-analysis of clinical studies evaluating patient outcomes between the SB and HP techniques for acute unstable AC joint dislocation.Study Design:Meta-analysis.Methods:A literature search of the Embase, PubMed, and Cochrane Library databases was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Cohort studies and case-control studies comparing the SB and HP procedures for acute unstable AC joint dislocation were included. Statistical analysis was performed with RevMan (v 5.3.5).Results:Eight clinical studies that met the inclusion criteria were identified and included a total of 204 patients treated with the SB technique and 195 patients with the HP technique. Patients treated with the SB technique had a higher Constant score (mean difference [MD], 3.95; 95% CI, 1.20-6.70; P = .005) and a lower visual analog scale pain score (MD, –0.75; 95% CI, –1.12 to 0.37; P < .0001) when compared with the HP technique. No significant differences in operation time (MD, –0.38; 95% CI, –7.14 to 6.37; P = .91), coracoclavicular distance (MD, –0.07; 95% CI, –0.49 to 0.35; P = .75), complications (odds ratio, 0.59; 95% CI, 0.22-1.54; P = .28), and loss of reduction (odds ratio, 2.55; 95% CI, 0.66-9.83; P = .17) were found between the SB and HP techniques. The subgroup analysis showed that the arthroscopic SB technique resulted in a higher Constant score (MD, 6.75; 95% CI, 4.21-9.29; P < .00001) as compared with the HP technique, but no differences were observed between the open SB and HP techniques (MD, 0.69; 95% CI, –0.82 to 2.20; P = .37).Conclusion:This meta-analysis demonstrated that the SB technique resulted in better functional outcomes and a reduced visual analog scale pain score when compared with the HP technique. However, for operation time, coracoclavicular distance, complications, and loss of reduction, there were no statistically significant differences between the techniques. Compared with the open procedure, arthroscopic SB may be superior for better functional outcomes.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-07-17T11:30:36Z
      DOI: 10.1177/0363546519858745
       
  • Dynamic Stabilization of Syndesmosis Injuries Reduces Complications and
           Reoperations as Compared With Screw Fixation: A Meta-analysis of
           Randomized Controlled Trials
    • Authors: Alberto Grassi, Kristian Samuelsson, Pieter D’Hooghe, Matteo Romagnoli, Massimiliano Mosca, Stefano Zaffagnini, Annunziato Amendola
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Several devices for obtaining dynamic fixation of the syndesmosis have been introduced in recent years, but their efficacy has been tested in only a few randomized controlled trials (RCTs), without demonstrating any clear benefit over the traditional static fixation with screws.Purpose:To perform a level 1 meta-analysis of RCTs to investigate the complications, subjective outcomes, and functional results after dynamic or static fixation of acute syndesmotic injuries.Study Design:Meta-analysis of RCTs.Methods:A systematic literature search was performed of the Medline/PubMed, Cochrane Central Register of Controlled Trials, and Embase electronic databases, as well as ClinicalTrials.gov for unpublished studies. Eligible studies were RCTs comparing dynamic fixation and static fixation of acute syndesmosis injuries. A meta-analysis was performed, while bias and quality of evidence were rated according to the Cochrane Database questionnaire and the Grading of Recommendations Assessment, Development and Evaluation guidelines.Results:Dynamic fixation had a significantly reduced relative risk (RR = 0.55, P = .003) of complications—in particular, the presence of inadequate reduction at the final follow-up (RR = 0.36, P = .0008) and the clinical diagnosis of recurrent diastasis or instability (RR = 0.10, P = .03). The effect was more evident when compared with permanent screws (RR = 0.10, P = .0001). The reoperation rate was similar between the groups (RR = 0.64, P = .07); however, the overall risk was reduced after dynamic fixation as compared with static fixation with permanent screws (RR = 0.24, P = .007). The American Orthopaedic Foot & Ankle Society score was significantly higher among patients treated with dynamic fixation—6.06 points higher (P = .005) at 3 months, 5.21 points (P = .03) at 12 months, and 8.60 points (P < .00001) at 24 months—while the Olerud-Molander score was similar. The visual analog scale for pain score was reduced at 6 months (–0.73 points, P = .003) and 12 months (–0.52 points, P = .005), and ankle range of motion increased by 4.36° (P = .03) with dynamic fixation. The overall quality of evidence ranged from “moderate” to “very low,” owing to a substantial risk of bias, heterogeneity, indirectness of outcome reporting, and evaluation of a limited number of patients.Conclusion:The dynamic fixation of syndesmotic injuries was able to reduce the number of complications and improve clinical outcomes as compared with static screw fixation—especially malreduction and clinical instability or diastasis—at a follow-up of 2 years. A lower risk of reoperation was found with dynamic fixation as compared with static fixation with permanent screws. However, the lack of patients or personnel blinding, treatment heterogeneity, small samples, and short follow-up limit the overall quality of this evidence.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-06-12T06:24:38Z
      DOI: 10.1177/0363546519849909
       
  • Hamstring Autograft Versus Hybrid Graft for Anterior Cruciate Ligament
           Reconstruction: A Systematic Review
    • Authors: Hong-De Wang, Shi-Jun Gao, Ying-Ze Zhang
      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2019-06-05T03:56:55Z
      DOI: 10.1177/0363546519849483
       
  • Two-Stage Revision Anterior Cruciate Ligament Reconstruction: A Systematic
           Review of Bone Graft Options for Tunnel Augmentation
    • Authors: Hytham S. Salem, Derek P. Axibal, Michelle L. Wolcott, Armando F. Vidal, Eric C. McCarty, Jonathan T. Bravman, Rachel M. Frank
      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2019-05-22T10:38:16Z
      DOI: 10.1177/0363546519841583
       
  • Properties and Function of the Medial Patellofemoral Ligament: A
           Systematic Review
    • Authors: Christian Huber, Qiang Zhang, William R. Taylor, Andrew A. Amis, Colin Smith, Seyyed Hamed Hosseini Nasab
      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2019-05-15T06:32:39Z
      DOI: 10.1177/0363546519841304
       
  • Hop Testing Lacks Strong Association With Key Outcome Variables After
           Primary Anterior Cruciate Ligament Reconstruction: A Systematic Review
    • Authors: Justin M. Losciale, Garrett Bullock, Christina Cromwell, Leila Ledbetter, Laura Pietrosimone, Timothy C. Sell
      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2019-05-07T08:11:18Z
      DOI: 10.1177/0363546519838794
       
  • A Practical Guide for the Current Use of Biologic Therapies in Sports
           Medicine
    • Authors: Joseph D. Lamplot, Scott A. Rodeo, Robert H. Brophy
      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2019-04-30T08:11:02Z
      DOI: 10.1177/0363546519836090
       
  • Repair of Rotator Cuff Tears in the Elderly: Does It Make Sense' A
           Systematic Review
    • Authors: Burak Altintas, Nicole L. Anderson, Rafael Pitta, Patrick S. Buckley, Sanjeev Bhatia, Matthew T. Provencher, Peter J. Millett
      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2019-04-30T08:03:02Z
      DOI: 10.1177/0363546519834574
       
  • Horizontal Instability of the Acromioclavicular Joint: A Systematic Review
    • Authors: Gianna M. Aliberti, Matthew J. Kraeutler, Jeffrey D. Trojan, Mary K. Mulcahey
      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2019-04-23T07:59:30Z
      DOI: 10.1177/0363546519831013
       
  • Outcomes After Latarjet Procedure: Patients With First-Time Versus
           Recurrent Dislocations
    • Authors: Alexandre Hardy, Vincent Sabatier, Pierre Laboudie, Bradley Schoch, Marie Vigan, Jean David Werthel, Geoffroy Nourissat, Philippe Valenti, Jean Kany, Julien Deranlot, Nicolas Solignac, Philippe Hardy
      First page: 21
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The preoperative number of dislocations has been previously proved to be a major factor influencing the results after Bankart repair with more preoperative dislocations correlated with higher recurrence rates and more reoperations. This could possibly be because of the lower quality of the tissue repaired during the procedure after multiple dislocations. On the other hand, the Latarjet procedure does not “repair” but rather reconstructs and augments the anterior glenoid.Purpose/Hypothesis:The main objective was to report the clinical outcomes of patients undergoing a Latarjet procedure after 1 dislocation versus multiple (≥2) dislocations. The hypothesis was that the preoperative number of dislocations would not influence clinical results.Study Design:Cohort study; Level of evidence, 3.Methods:Patients older than 18 years who had undergone a primary Latarjet procedure for shoulder instability with at least 2 years of follow-up were included. Three different techniques were used: a mini-open technique using 2 screws, an arthroscopic technique using 2 screws, and an arthroscopic technique using 2 cortical buttons. Patients were evaluated and answered a questionnaire to assess the number of episodes of dislocation before surgery, the time between the first dislocation and surgery, recurrence of the dislocation, revision surgery, the Walch-Duplay score, the Simple Shoulder Test score, and the visual analog scale (VAS) score for pain.Results:A total of 308 patients were included for analysis with a mean follow-up of 3.4 ± 0.8 years. Of that, 83 patients were included in the first-time dislocation group and 225 in the recurrent dislocation group. At last follow-up, the rates of recurrence and reoperation were not significantly different between groups: 4.8% in the first-time dislocation group versus 3.65% in the recurrent dislocation group and 6.1% versus 4.0%, respectively. The overall Walch-Duplay scores at last follow-up were also comparable between the 2 groups, 67.3 ± 24.85 and 71.8 ± 25.1, even though the first-time dislocation group showed a lower pain subscore (15.0 ± 8.6 vs 18.0 ± 7.5; P = .003). The VAS for pain was also significantly higher in the first-time dislocation group compared with the recurrent dislocation group (1.8 ± 2.3 vs 1.2 ± 1.7; P = .03).Conclusion:The number of episodes of dislocation before surgery does not affect postoperative instability rates and reoperation rates after the Latarjet procedure. However, patients with first-time dislocations had more postoperative pain compared with patients with recurrent dislocations before surgery.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-10-24T08:59:34Z
      DOI: 10.1177/0363546519879929
       
  • Peripheral-Track and Central-Track Hill-Sachs Lesions: A New Concept of
           Assessing an On-Track Lesion
    • Authors: Nobuyuki Yamamoto, Kiyotsugu Shinagawa, Taku Hatta, Eiji Itoi
      First page: 33
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:It has been demonstrated biomechanically that 25% is a critical size defect of the glenoid. However, a recent clinical study reported that a bone loss between 13.5% and 20% (subcritical bone loss) led to impairment of quality of life but not a recurrence of instability.Purpose:To clarify whether a subcritical bone loss exists in assessing a Hill-Sachs lesion via a disease-specific quality of life questionnaire.Study Design:Cohort study; Level of evidence, 3.Methods:Fifty patients (mean age, 27 years) with
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-22T05:34:50Z
      DOI: 10.1177/0363546519886319
       
  • Modified Arthroscopic Latarjet Procedure: Suture-Button Fixation Achieves
           Excellent Remodeling at 3-Year Follow-up
    • Authors: Jian Xu, Haifeng Liu, Wei Lu, Zhenhan Deng, Weimin Zhu, Liangquan Peng, Kan Ouyang, Hao Li, Daping Wang
      First page: 39
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Some studies have advocated the use of suture-button fixation during the Latarjet procedure to reduce complications associated with screw fixation. However, the sample size of these studies is relatively small, and their follow-up period is short.Purpose:To investigate the efficacy of the suture-button Latarjet procedure with at least 3 years of follow-up and remodeling of the coracoid graft.Study Design:Case series; Level of evidence, 4.Methods:A total of 152 patients who underwent the suture-button Latarjet procedure between February 2013 and February 2016 were selected, and 128 patients who met the inclusion criteria were enrolled in this study. Preoperative and postoperative clinical results were assessed. The position and healing condition of the coracoid graft and arthropathy of the glenoid and humeral head were also assessed using radiography and 3-dimensional computed tomography (CT).Results:The mean follow-up time was 40.3 ± 5.8 months. There were 102 patients included in this study. The mean visual analog scale score for pain during motion, the American Shoulder and Elbow Surgeons score, the Rowe score, and the Walch-Duplay score were improved considerably. A total of 100 grafts achieved bone union. The overall absorption rate was 12.6% ± 4.3%. Graft absorption mostly occurred on the edge and outside the “best-fit” circle of the glenoid. A vertical position was achieved in 98 grafts (96% of all cases) immediately postoperatively, with the mean graft midline center at the 4 o’clock position. In the axial view, CT showed that 89 grafts were flush to the glenoid, whereas 2 and 11 grafts were fixed medially and laterally, respectively. In all cases, the bone graft and glenoid tended to extend toward each other to form concentric circles during the remodeling process. During follow-up observations, the height of the 11 grafts that were positioned laterally (ie, above the glenoid level) exhibited a wave-curved change. No arthropathy was observed in any patient.Conclusion:Patient outcomes were satisfactory after the modified arthroscopic suture-button Latarjet technique. Graft absorption mostly occurred on the edge and outside the “best-fit” circle of the glenoid. The graft exhibited the phenomenon of ectatic growing when it fused with the glenoid and finally remodeled to a new concentric circle with the humeral head analogous to the original glenoid. Grafts positioned laterally did not cause arthropathy of the joints within the period of the study.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-25T08:52:50Z
      DOI: 10.1177/0363546519887959
       
  • Postoperative Recurrence of Instability After Arthroscopic Bankart Repair
           for Shoulders With Primary Instability Compared With Recurrent
           Instability: Influence of Bipolar Bone Defect Size
    • Authors: Shigeto Nakagawa, Takehito Hirose, Ryohei Uchida, Makoto Tanaka, Tatsuo Mae
      First page: 48
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:In shoulders with traumatic anterior instability, a bipolar bone defect has recently been recognized as an important indicator of the prognosis.Purpose:To investigate the influence of bipolar bone defects on postoperative recurrence after arthroscopic Bankart repair performed at primary instability.Study Design:Cohort study; Level of evidence, 3.Methods:The study group consisted of 45 patients (45 shoulders) who underwent arthroscopic Bankart repair at primary instability before recurrence and were followed for at least 2 years. The control group consisted of 95 patients (95 shoulders) with recurrent instability who underwent Bankart repair and were followed for at least 2 years. Glenoid defects and Hill-Sachs lesions were classified into 5 size categories on 3-dimensional computed tomography and were allocated scores ranging from 0 for no defect to 4 for the largest defect. The shoulders were classified according to the total score for both lesions (0-8 points). The postoperative recurrence rate was investigated for each score of bipolar bone defects and was compared between patients with primary instability and patients with recurrent instability. The same analysis was performed for the age at operation (
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-05T01:05:39Z
      DOI: 10.1177/0363546519880496
       
  • An Age-Based Approach to Anterior Shoulder Instability in Patients Under
           40 Years Old: Analysis of a US Population
    • Authors: Devin P. Leland, Christopher D. Bernard, Lucas K. Keyt, Aaron J. Krych, Diane L. Dahm, Joaquin Sanchez-Sotelo, Christopher L. Camp
      First page: 56
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:While a large volume of literature has focused on risk factors for anterior shoulder instability, the rates of recurrence are inconsistent and require additional population-based epidemiologic data.Purpose/Hypothesis:The purpose was to report the effect of patient age on the number of instability events before physician consultation, rate of surgical stabilization, recurrent instability, and progression to osteoarthritis in patients
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-22T06:04:28Z
      DOI: 10.1177/0363546519886861
       
  • Effect of Graft Choice on Revision and Contralateral Anterior Cruciate
           Ligament Reconstruction: Results From the New Zealand ACL Registry
    • Authors: Richard Rahardja, Mark Zhu, Hamish Love, Mark G. Clatworthy, Andrew Paul Monk, Simon W. Young
      First page: 63
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The patellar tendon is often considered the “gold standard” graft for reducing the risk of graft rupture after anterior cruciate ligament (ACL) reconstruction. However, its use may also be associated with an increased risk of injury to the contralateral ACL.Purpose:To clarify the association between graft choice and the risk of revision and contralateral ACL reconstruction.Study Design:Cohort study; Level of evidence, 2.Methods:Prospective data captured by the New Zealand ACL Registry between April 2014 and December 2018 were reviewed. All primary ACL reconstructions performed using either a hamstring tendon or patellar tendon autograft were included. Cox regression survival analysis adjusting for patient factors was performed to compare the risk of revision and contralateral ACL reconstruction between the hamstring tendon graft and the patellar tendon graft.Results:A total of 7155 primary ACL reconstructions were reviewed, of which 5563 (77.7%) were performed using a hamstring tendon graft and 1592 (22.3%) were performed using a patellar tendon graft. Patients with a hamstring tendon graft had a revision rate of 2.7% compared with 1.3% in patients with a patellar tendon graft (adjusted hazard ratio [HR], 2.51; 95% CI, 1.55-4.06; P < .001). The patellar tendon graft was associated with an increased risk of contralateral ACL reconstruction compared with the hamstring tendon graft (adjusted HR, 1.91; 95% CI, 1.15-3.16; P = .012). The number needed to treat (NNT) with a patellar tendon graft to prevent 1 revision was 73.6. However, the NNT with a hamstring tendon graft to prevent 1 contralateral reconstruction was 116.3.Conclusion:Use of a patellar tendon graft reduced the risk of graft rupture but was associated with an increased risk of injury to the contralateral ACL. Adequate rehabilitation and informed decision making on return to activity and injury prevention measures may be important in preventing subsequent injury to the healthy knee.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-15T06:31:01Z
      DOI: 10.1177/0363546519885148
       
  • How Much Time Is Needed Between Serial “Return to Play” Assessments to
           Achieve Clinically Important Strength Gains in Patients Recovering From
           Anterior Cruciate Ligament Reconstruction'
    • Authors: Stephan G. Bodkin, Margaret H. Rutherford, David R. Diduch, Stephen F. Brockmeier, Joe M. Hart
      First page: 70
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Pass rates for return-to-play evaluations are alarmingly low for patients after anterior cruciate ligament reconstruction (ACLR). Since timing of return to play is a complicated decision, it is important that patients be given optimal time to realize meaningful improvements in strength that warrant additional testing.Purpose:To (1) compare outcomes among patients assessed at different time points after ACLR, (2) determine strength gains indicative of improvements in subjective function, and (3) determine the amount of time necessary to achieve meaningful strength gains.Study Design:Cross-sectional/case-control study; Level of evidence, 3.Methods:A total of 293 patients participated in the study after ACLR (mean ± SD, 23.2 ± 10.1 years old; n = 142 female participants; 6.4 ± 0.9 months after ACLR). Participants were stratified on the month of their evaluation after ACLR: 5 to 6 months (n = 122), 6 to 7 months (n = 102), 7 to 8 months (n = 43), and 8 to 9 months (n = 26). The International Knee Documentation Committee (IKDC) subjective form and knee extensor and flexor torque and symmetry, as assessed through an isokinetic dynamometer, were compared among groups. Forty patients (20 female participants, 20.4 ± 7.1 years old) were referred for subsequent testing (2.14 ± 0.78 months after initial visit). Subjective improvement between visits was defined as a ≥9-point change of the IKDC score. Thresholds of knee extensor torque and symmetry indicative of subjective improvement and the time between assessments needed to achieve these strength improvements were determined.Results:Patients between 5 and 6 months (IKDC, 79.7; interquartile range [IQR], 70.1-88.5) had lower subjective function compared to patients between 6 and 7 months (IKDC, 83.9; IQR, 74.5-92.0; P = .019) and 8 and 9 months after ACLR (IKDC, 89.1; IQR 75.8-92.3; P = .026). Patients between 5 and 6 months (1.41 N·m/kg; IQR, 1.16-1.73 N·m/kg]) had lower knee extensor torque compared to patients 6 and 7 months (1.59 N·m/kg; IQR, 1.23-1.95 N·m/kg; P = .013) and 7 and 8 months after ACLR (1.62 N·m/kg; IQR, 1.30-1.86 N·m/kg; P = .046). Patients between 5 and 6 months (66.4%; IQR, 54.2-78.6) had lower symmetry compared to patients between 6 and 7 months (71.8%; IQR,61.1-82.9; P = .019) and 8 and 9 months afterACLR (75.2%; IQR, 66.6-87.7; P = .014). Of the 40 patients that completed follow-up assessments, an increase in knee extensor torque of 0.22 N·m/kg and symmetry of 5.75% discriminated patients that achieved subjective improvement. A period of 1.97 months between assessments discriminated those that achieved the established symmetry threshold.Conclusion:Patients demonstrate increasing subjective and quadriceps function when tested at later time points from surgery; however, the observed values are low, suggesting that at 9 months patients are demonstrating deficits that may be improving. Approximately 2 months is needed to observe clinically meaningful improvements.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-22T05:30:35Z
      DOI: 10.1177/0363546519886291
       
  • The Effect of Oral Contraceptive Hormones on Anterior Cruciate Ligament
           Strength
    • Authors: Jaclyn A. Konopka, Lauren Hsue, Wenteh Chang, Timothy Thio, Jason L. Dragoo
      First page: 85
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Women are 2 to 9 times more likely to experience an anterior cruciate ligament (ACL) injury than men. Various hormones including relaxin, progesterone, and estrogen influence ACL strength. Oral contraceptives (OCs) alter these hormone levels; however, studies have yet to comprehensively compare different OCs’ effects on the ACL.Hypothesis:OCs with increased progestin-to-estrogen ratios will (1) increase ACL collagen expression, (2) decrease ACL matrix metalloproteinase expression, and (3) increase ACL strength.Study Design:Controlled laboratory study.Methods:Untreated female rats were compared with rats treated with 1 of 5 clinically used OCs: norethindrone (NE) only, NE plus ethinylestradiol (EE), etynodiol diacetate (ED) plus EE, norgestimate (NG) plus EE, and drospirenone (DS) plus EE. Doses were scaled from human doses to account for differences in bioavailability and body weight, and OCs were administered daily via oral gavage for 4 rat estrous cycles (20 days). A total of 36 rats were then sacrificed (6 rats/group). ACLs underwent biomechanical testing to assess ACL strength, stiffness, and maximum load before failure. ACL specimens were also isolated for quantitative real-time polymerase chain reaction analysis to assess collagen, matrix metalloproteinase, and relaxin receptor–1 expression.Results:While the primary structural property of interest (ACL maximum load before failure) was not significantly improved by OC treatment, the main material property of interest (ACL strength) in rats treated with NE only, DS + EE, ED + EE, and NE + EE was significantly increased compared with untreated controls (P = .001, P = .004, P = .004, and P = .04, respectively). The order from strongest to weakest ACLs, which was also the same order as the highest to lowest progestin-to-estrogen ratios, was groups treated with NE only, DS + EE, ED + EE, NE + EE, and lastly NG + EE. Higher ratio formulations also increased the expression of type I collagen (P = .02) and decreased the expression of matrix metalloproteinase–1 (P = .04).Conclusion:OC formulations with higher progestin-to-estrogen ratios may be more protective for the ACL than formulations with lower ratios.Clinical Relevance:OC formulations with high progestin-to-estrogen ratios may benefit female athletes by reducing their ACL injury risk by decreasing the effects of relaxin on the ACL.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-25T09:29:57Z
      DOI: 10.1177/0363546519887167
       
  • Outcomes of Quadriceps Tendon With Patellar Bone Block Anterior Cruciate
           Ligament Reconstruction in Adolescent Patients With a Minimum 2-Year
           Follow-up
    • Authors: Alexia G. Gagliardi, Patrick M. Carry, Harin B. Parikh, Jay C. Albright
      First page: 93
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The incidence of anterior cruciate ligament (ACL) injury in the adolescent population is increasing. The quadriceps tendon–patellar bone autograft (QPA) has been established as a reliable graft choice for ACL reconstruction in the adult population.Purpose:To investigate graft failure, ability to return to sport, patient-reported functional outcomes, joint laxity, and subsequent injury among adolescent patients>2 years after primary ACL reconstruction with the QPA.Study Design:Case series; Level of evidence, 4.Methods:Consecutive patients who underwent QPA ACL reconstruction performed by a single surgeon were identified from an existing database. Information available in the database included demographics, concomitant/subsequent injuries, surgical procedures, graft failure, return to sport, and Lachman examination collected by medical record review. Pediatric International Knee Documentation Committee (Pedi-IKDC) and Lysholm scores were collected by telephone or during a clinic visit>2 years postoperatively.Results:The final cohort included 81 of 104 consecutive adolescent patients aged 10 to 18 years (mean ± SD, 15.9 ± 1.7 years at the time of surgery) for whom follow-up information was collected at>2 years after surgery. The cumulative incidence of graft failure within the 36-month follow-up period was 1.2% (95% CI, 0.1%-11.4%). The rate of ipsilateral non-ACL injuries was similar (1.2%; 95% CI, 0.2%-7.6%). Contralateral ACL and non-ACL injuries requiring surgical intervention were documented in 9.8% (95% CI, 4.9%-19.5%). The median Pedi-IKDC score was 94 (interquartile range, 89-98). The median Lysholm score was 99.5 (interquartile range, 89.0-100.0). At 36 months after surgery, 87.9% (95% CI, 81.4%-94.9%) of individuals had returned to play.Conclusion:The quadriceps tendon–patellar autograft is a novel graft that demonstrates excellent stability and favorable patient-reported outcomes. Based on these results, the QPA is a reliable choice for primary ACL reconstruction in adolescent patients.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-19T06:52:02Z
      DOI: 10.1177/0363546519885371
       
  • Graft Size and Orientation Within the Femoral Notch Affect Graft Healing
           at 1 Year After Anterior Cruciate Ligament Reconstruction
    • Authors: Takeshi Oshima, Sven Putnis, Samuel Grasso, Antonio Klasan, David Anthony Parker
      First page: 99
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The combined influence of anatomic and operative factors affecting graft healing after anterior cruciate ligament (ACL) reconstruction within the femoral notch is not well understood.Purpose:To determine the influence of graft size and orientation in relation to femoral notch anatomy, with the signal/noise quotient (SNQ) of the graft used as a measure of graft healing after primary single-bundle ACL reconstruction.Study Design:Case series; Level of evidence, 4.Methods:A total of 98 patients with a minimum 2-year follow-up after primary single-bundle ACL reconstruction with hamstring tendon autografts were included. Graft healing was evaluated at 1 year on magnetic resonance imaging (MRI) scan as the mean SNQ measured from 3 regions situated at sites at the proximal, middle, and distal graft. Patient characteristics, chondropenia severity score, tunnel sizes, tunnel locations, graft bending angle (GBA), graft sagittal angle, posterior tibial slope (PTS), graft length, graft volume, femoral notch volume, and graft-notch volume ratio (measured using postoperative 3-T high-resolution MRI) were evaluated to determine any association with 1-year graft healing. The correlation between 1-year graft healing and clinical outcome at minimum 2 years was also assessed.Results:There was no significant difference in mean SNQ between male and female patients (P> .05). Univariate regression analysis showed that a low femoral tunnel (P = .005), lateral tibial tunnel (P = .009), large femoral tunnel (P = .011), large tibial tunnel (P < .001), steep lateral PTS (P = .010), steep medial PTS (P = .004), acute graft sagittal angle (P < .001), acute GBA (P < .001), large graft volume (P = .003), and high graft-notch volume ratio (P < .001) were all associated with higher graft SNQ values. A multivariate regression analysis showed 2 significant factors: a large graft-notch volume ratio (P = .001) and an acute GBA (P = .004). The 1-year SNQ had a weak correlation with 2-year Tegner Activity Scale score (r = 0.227; P = .026) but no other clinical findings, such as International Knee Documentation Committee subjective and Lysholm scores and anterior tibial translation side-to-side difference.Conclusion:The 1-year SNQ value had a significant positive association with graft-notch volume ratio and GBA. Both graft size and graft orientation appeared to have a significant influence on graft healing as assessed on 1-year high-resolution MRI scan.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-15T06:07:56Z
      DOI: 10.1177/0363546519885104
       
  • Engagement of the Secondary Ligamentous and Meniscal Restraints Relative
           to the Anterior Cruciate Ligament Predicts Anterior Knee Laxity
    • Authors: Robert N. Kent, Carl W. Imhauser, Ran Thein, Niv Marom, Thomas L. Wickiewicz, Danyal H. Nawabi, Andrew D. Pearle
      First page: 109
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Patients with high-grade preoperative side-to-side differences in anterior laxity as assessed via the Lachman test after unilateral anterior cruciate ligament (ACL) rupture are at heightened risk of early ACL graft failure. Biomechanical factors that predict preoperative side-to-side differences in anterior laxity are poorly understood.Purpose:To assess, in a cadaveric model, whether the increase in anterior laxity caused by sectioning the ACL (a surrogate for preoperative side-to-side differences in anterior laxity) during a simulated Lachman test is associated with two biomechanical factors: (1) the tibial translation at which the secondary anterior stabilizers, including the remaining ligaments and the menisci, begin to carry force, or engage, relative to that of the ACL or (2) the forces carried by the ACL and secondary stabilizers at the peak applied anterior load.Study Design:Controlled laboratory study.Methods:Seventeen fresh-frozen human cadaveric knees underwent Lachman tests simulated through a robotic manipulator with the ACL intact and sectioned. The net forces carried by the ACL and secondary soft tissue stabilizers (the medial meniscus and all remaining ligaments, measured as a whole) were characterized as a function of anterior tibial translation. The engagement points of the ACL (with the ACL intact) and each secondary stabilizer (with the ACL sectioned) were defined as the anterior translation at which they began to carry force, or engaged, during a simulated Lachman test. Then, the relative engagement point of each secondary stabilizer was defined as the difference between the engagement point of each secondary stabilizer and that of the ACL. Linear regressions were performed to test each association (P < .05).Results:The increase in anterior laxity caused by ACL sectioning was associated with increased relative engagement points of both the secondary ligaments (β = 0.87; P < .001; R2 = 0.75) and the medial meniscus (β = 0.66; P < .001; R2 = 0.58). Smaller changes in anterior laxity were also associated with increased in situ medial meniscal force at the peak applied load when the ACL was intact (β = −0.06; P < .001; R2 = 0.53).Conclusion:The secondary ligaments and the medial meniscus require greater anterior tibial translation to engage (ie, begin to carry force) relative to the ACL in knees with greater changes in anterior laxity after ACL sectioning. Moreover, with the ACL intact, the medial meniscus carries more force in knees with smaller changes in anterior laxity after ACL sectioning.Clinical Relevance:Relative tissue engagement is a new biomechanical measure to characterize in situ function of the ligaments and menisci. This measure may aid in developing more personalized surgical approaches to reduce high rates of ACL graft revision in patients with high-grade laxity.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-25T09:14:46Z
      DOI: 10.1177/0363546519888488
       
  • A High-Grade J Sign Is More Likely to Yield Higher Postoperative Patellar
           Laxity and Residual Maltracking in Patients With Recurrent Patellar
           Dislocation Treated With Derotational Distal Femoral Osteotomy
    • Authors: ZhiJun Zhang, Hui Zhang, GuanYang Song, XueSong Wang, Jin Zhang, Tong Zheng, QianKun Ni, Hua Feng
      First page: 117
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:It has been speculated that the patellar J sign may have a negative effect on the clinical outcomes of patients with recurrent patellar dislocation (RPD).Purpose:To (1) evaluate clinical outcomes, postoperative patellar stability, and patellar maltracking correction in patients with RPD treated with derotational distal femoral osteotomy (DDFO) and combined procedures and (2) investigate the influence of J sign severity on the clinical outcomes.Study Design:Cohort study; Level of evidence, 3.Methods:Between January 2015 and December 2016, a total of 78 patients (81 knees) with RPD, a positive J sign, and an excessive femoral anteversion angle (FAA; ≥30°) were surgically treated with DDFO and combined procedures. J sign severity was graded according to a previously described classification system (grades 1-3). Routine radiography and computed tomography were performed on every patient to evaluate the patellar height, trochlear dysplasia, genu valgum, tibial tuberosity–trochlear groove distance, patellar lateral tilt angle, and patella–trochlear groove distance. The patellar lateral shift distance during stress radiography was measured preoperatively and postoperatively to quantify medial patellofemoral ligament (MPFL) graft laxity under anesthesia, and “MPFL residual graft laxity” was defined as the patellar ridge surpassing the apex of the lateral femoral trochlea. Patients were evaluated using the Kujala, International Knee Documentation Committee (IKDC), and Lysholm scores preoperatively and postoperatively. Patients were allocated into 3 subgroups in terms of the severity of the J sign: low-grade group 1 (grade 1; n = 19), low-grade group 2 (grade 2; n = 16), and high-grade group (grade 3; n = 12). Subgroup analyses were performed to investigate the influence of a high-grade J sign on the clinical outcomes.Results:Among the 78 patients (81 knees), 47 patients (47 knees) met the inclusion criteria. The mean follow-up time was 26.1 ± 1.7 months. The mean preoperative and postoperative FAAs were 36.2°± 5.3° and 10.0°± 2.1°, respectively, with a mean correction angle of 26.2°± 5.9°. At the final follow-up, all patient-reported outcomes improved significantly, and subgroup analyses showed that the high-grade group had significantly lower Kujala scores (75.6 vs 85.3 for low-grade group 1 [P < .001] and 83.4 for low-grade group 2 [P = .001]), Lysholm scores (77.6 vs 84.6 for low-grade group 1 [P = .003]), and IKDC scores (78.6 vs 87.3 for low-grade group 1 [P = .001] and 84.3 for low-grade group 2 [P = .033]) than the low-grade groups. The total rate of MPFL residual graft laxity was 8.5% (4/47), and the prevalence of the postoperative residual J sign was 38.3% (18/47). Subgroup analyses showed significant differences between the high-grade group and the 2 low-grade groups with regard to the MPFL residual graft laxity rate (33.3% vs 0.0% for low-grade group 1 [P = .016] and 0.0% for low-grade group 2 [P = .024]), residual J sign rate (91.7% vs 15.8% for low-grade group 1 [P < .001] and 25.0% for low-grade group 2 [P < .001]), and patellar lateral shift distance (14.2 vs 8.1 mm for low-grade group 1 [P = .002] and 8.7 mm for low-grade group 2 [P = .007]).Conclusion:In a group of patients treated for RPD with a positive preoperative J sign and increased FAA (≥30°), patients with a preoperative high-grade J sign had inferior clinical outcomes, more MPFL residual graft laxity, and greater residual patellar maltracking.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-25T08:17:03Z
      DOI: 10.1177/0363546519884669
       
  • Medial Meniscus Posterior Root Tear Treatment: A Matched Cohort Comparison
           of Nonoperative Management, Partial Meniscectomy, and Repair
    • Authors: Christopher D. Bernard, Nicholas I. Kennedy, Adam J. Tagliero, Christopher L. Camp, Daniel B.F. Saris, Bruce A. Levy, Michael J. Stuart, Aaron J. Krych
      First page: 128
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:There are limited data comparing the outcomes of similarly matched patients with a medial meniscus posterior root tear (MMPRT) treated with nonoperative management, partial meniscectomy, or repair.Purpose/Hypothesis:The purpose was to compare treatment failure, clinical outcome scores, and radiographic findings for a matched cohort of patients who underwent either nonoperative management, partial meniscectomy, or transtibial pull-through repair for an MMPRT. We hypothesized that patients who underwent meniscus root repair will have lower rates of progression to arthroplasty than patients who were treated with nonoperative management or partial meniscectomy.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who underwent transtibial medial meniscus posterior horn root repair were matched by meniscal laterality, age, sex, and Kellgren-Lawrence (K-L) grades to patients treated nonoperatively or with a partial meniscectomy. Progression to arthroplasty rates, International Knee Documentation Committee and Tegner scores, and radiographic outcomes were analyzed between groups.Results:Forty-five patients were included in this study (15 nonoperative, 15 partial meniscectomy, 15 root repair). Progression to arthroplasty demonstrated significant differences among treatment groups at a mean of 74 months (nonoperative, 4/15; partial meniscectomy, 9/15; meniscal repair, 0/15; P = .0003). The meniscus root repair group had significantly less arthritic progression, as measured by change in K-L grade from pre- to postoperatively (nonoperative, 1.0; partial meniscectomy, 1.1; meniscal repair, 0.1; P = .001).Conclusion:Meniscus root repair leads to significantly less arthritis progression and subsequent knee arthroplasty compared with nonoperative management and partial meniscectomy in a matched cohort based on patient characteristics.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-25T09:06:42Z
      DOI: 10.1177/0363546519888212
       
  • Minimum 10-Year Clinical and Radiological Outcomes of a Randomized
           Controlled Trial Evaluating 2 Different Approaches to Full Weightbearing
           After Matrix-Induced Autologous Chondrocyte Implantation
    • Authors: Jay R. Ebert, Michael Fallon, Timothy R. Ackland, Gregory C. Janes, David J. Wood
      First page: 133
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Longer term outcomes after matrix-induced autologous chondrocyte implantation (MACI) are lacking, while early postoperative weightbearing (WB) management has traditionally been conservative.Purpose:To investigate the longer term clinical and radiological outcomes after an 8-week (vs 12-week) WB protocol after MACI.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A randomized study design allocated 70 patients to an 8- (n = 34) or 12-week (n = 36) approach to full WB after MACI of the medial or lateral femoral condyle. Patients were evaluated preoperatively; at 3, 12, and 24 months after surgery; and at 5 and 10 years after surgery. At 10 years (range, 10.5-11.5 years), 60 patients (85.7%; 8 weeks: n = 29; 12 weeks: n = 31) were available for review. Clinical outcomes included patient-reported outcomes, maximal isokinetic knee extensor and flexor strength, and functional hop capacity. High-resolution magnetic resonance imaging (MRI) was undertaken to assess the quality and quantity of repair tissue per the MOCART (magnetic resonance observation of cartilage repair tissue) system. A combined MRI composite score was also evaluated.Results:Clinical and MRI-based scores for the full cohort significantly improved (P < .05) over the 10-year period. Apart from the Tegner activity score, which improved (P = .041), as well as tissue structure (P = .030), which deteriorated, there were no further statistically significant changes (P> .05) from 5 to 10 years. There were no 10-year differences between the 2 WB rehabilitation groups. At 10 years, 81.5% and 82.8% of patients in the 8- and 12-week groups, respectively, demonstrated good-excellent tissue infill. Graft failure was observed on MRI at 10 years in 7 patients overall, which included 4 located on 10-year MRI (8 weeks: n = 1; 12 weeks: n = 3) and a further 3 patients (8 weeks: n = 1; 12 weeks: n = 2) not included in the current analysis who proceeded to total knee arthroplasty. At 10 years, 93.3% of patients were satisfied with MACI for relieving their pain, with 83.3% satisfied with their ability to participate in sport.Conclusion:MACI provided high satisfaction levels and tissue durability beyond 10 years. The outcomes of this randomized trial demonstrate a safe 8-week WB rehabilitation protocol without jeopardizing longer term outcomes.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-25T09:25:54Z
      DOI: 10.1177/0363546519886548
       
  • Matrix Metalloproteinase Inhibition With Doxycycline Affects the
           Progression of Posttraumatic Osteoarthritis After Anterior Cruciate
           Ligament Rupture: Evaluation in a New Nonsurgical Murine ACL Rupture Model
           
    • Authors: Xueying Zhang, Xiang-Hua Deng, Zhe Song, Brett Croen, Camila B. Carballo, Zoe Album, Ying Zhang, Reyna Bhandari, Scott A. Rodeo
      First page: 143
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Doxycycline has broad-spectrum activity as a matrix metalloproteinase (MMP) inhibitor and thus could reduce the progression of posttraumatic osteoarthritis (PTOA) after anterior cruciate ligament (ACL) rupture.Hypothesis:Doxycycline would inhibit progression of PTOA in a murine ACL rupture model.Study Design:Controlled laboratory study.Methods:For the in vitro study, cadaveric C57BL/6 male mice knees (N = 108) were used for the development of a nonsurgical ACL rupture model. For the in vivo study, 24 C57BL/6 male mice then underwent ACL rupture with our manual procedure and were divided into 4 groups: untreated control; doxycycline, 10 mg/kg/d; doxycycline, 50 mg/kg/d; and doxycycline, 100 mg/kg/d. Doxycycline was administered in drinking water beginning immediately after ACL rupture. Radiographic imaging and paw prints were evaluated at 3, 7, 14, and 28 days. The foot length and toe spread were analyzed as measures of function. Histology and MMP-13 immunohistochemistry were done at 4 weeks.Results:Radiographs demonstrated anterior tibial subluxation and meniscal extrusion after ACL rupture, confirming knee joint instability without fractures. Statistically significant differences in gait were found between the intact and experimental groups. Histologic examination demonstrated cartilage damage, meniscal tears, and mild osteoarthritis after ACL rupture, similar to what occurs in human patients. Hypertrophy of the posterior horn of the medial and lateral meniscus was found, and tears of the posterior horn of the menisci were common. All doxycycline groups had a lower score than the untreated control group, indicating less cartilage damage. The posterior tibia of the untreated group had the most cartilage damage as compared with the 3 doxycycline groups, with a significant difference between the untreated and 50-mg/kg/d doxycycline groups, suggesting that the latter dose may protect against proteoglycan loss and decrease the progression of osteoarthritis. The nondoxycycline group had the highest synovial inflammation score among all groups, indicating that doxycycline has an inhibitory effect on synovitis. There was significantly lower MMP-13 expression on the tibia in the doxycycline-treated groups, with a positive correlation between doxycycline concentration and MMP-13 inhibition.Conclusion:Modulation of MMP-13 activity by doxycycline treatment may offer a novel biological pathway to decrease the progression of PTOA after ACL rupture.Clinical Relevance:Doxycycline is an approved, readily available drug with infrequent side effects of photosensitivity and gastrointestinal symptoms. Future clinical trials could evaluate doxycycline to reduce or prevent progressive cartilage damage after ACL rupture.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-22T05:37:52Z
      DOI: 10.1177/0363546519887158
       
  • Comparing Outcomes of Competitive Athletes Versus Nonathletes Undergoing
           Hip Arthroscopy for Treatment of Femoroacetabular Impingement Syndrome
    • Authors: Ian M. Clapp, Benedict U. Nwachukwu, Edward C. Beck, Kyleen Jan, Anirudh K. Gowd, Shane J. Nho
      First page: 159
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:A growing number of studies have examined return to sport in competitive athletes after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS); however, few have evaluated the rate of achieving meaningful clinical outcomes in this group.Purpose:To determine if competitive athletes (professional, semiprofessional, or collegiate) have better 2-year patient-reported outcomes and achieve the minimal clinically important difference (MCID) and substantial clinical benefit at higher rates when compared with nonathletes undergoing hip arthroscopy for the treatment of FAIS.Study Design:Cohort study; Level of evidence, 3.Methods:The study was a retrospective analysis of all consecutive patients who identified as either a competitive athlete or a nonathlete and had undergone hip arthroscopy for FAIS by a single fellowship-trained surgeon between January 2012 and April 2017. Patients in the 2 groups were matched 1:2 by age, sex, and body mass index. Baseline and clinical outcomes, including the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score, and international Hip Outcome Tool-12, were collected preoperatively and at 2 years postoperatively and compared between the groups. The MCID and substantial clinical benefit were calculated for each group separately and compared using chi-square analysis.Results:A total of 59 competitive athletes and 118 nonathletes were included in the final analysis. Most of the competitive athletes were soccer players (23.7%), followed by softball players (10.2%) and runners (10.2%). Postoperative score comparison between competitive athletes and nonathletes demonstrated a statistically significant difference in the HOS-SS (mean ± SD, 84.5 ± 19.0 vs 76.1 ± 23.8; P = .02). Meaningful outcome analysis demonstrated that competitive athletes had a higher rate of achieving the HOS-SS threshold for the MCID (97.4% vs 82.5%; P = .021). There was no other difference in frequency of achieving the threshold for any other meaningful clinical outcome between the groups.Conclusion:Hip arthroscopy for the treatment of FAIS in competitive athletes and nonathletes produced clinically meaningful outcomes in both patient groups. However, competitive athletes achieved the MCID on the HOS-SS at higher rates than nonathletes and had significantly higher scores at 2 years postoperatively on the HOS-SS.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-19T06:34:09Z
      DOI: 10.1177/0363546519885359
       
  • Atypical Hip Pain in Femoroacetabular Impingement: A Comparison of
           Outcomes Based on Primary Hip Pain Location
    • Authors: Mathew J. Hamula, Michael K. Ryan, Samuel L. Baron, David A. Bloom, Thomas Youm
      First page: 167
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Patients with symptomatic femoroacetabular impingement (FAI) typically have anterior groin pain. However, a subset of these patients may have pain located laterally, posteriorly, or in a combination of locations around the hip.Purpose:To report and compare outcomes of hip arthroscopy for patients with FAI and atypical hip pain versus classic anterior groin pain.Study Design:Cohort study; Level of evidence, 2.Methods:Consecutive patients undergoing hip arthroscopy for FAI between August 2011 and March 2013 were identified. A total of 258 patients were identified as having symptomatic FAI based on clinical, radiographic, and advanced imaging diagnosis of FAI. Exclusion criteria included isolated thigh, knee, or low back pain. We also excluded patients with hip abductor pathology and trochanteric bursitis. Of the 226 patients ultimately included, 159 (70.4%) reported anterior groin pain, while 67 (29.6%) reported isolated lateral or posterior hip pain or a combination of locations. Patients were categorized into 4 groups: isolated anterior groin pain, lateral hip pain, posterior hip pain, and multiple primary hip pain locations (combined). These patients were followed prospectively with a minimum follow-up of 2 years. Patient characteristics, surgical characteristics, modified Harris Hip Score (mHHS), Non-arthritic Hip Score (NAHS), revision hip arthroscopy, and conversions to total hip arthroplasty (THA) were recorded.Results:All 226 patients were included at final follow-up. Hip arthroscopy was performed by a single sports medicine fellowship-trained orthopaedic surgeon. Preoperative patient characteristics and baseline functional outcome scores did not significantly differ among groups. All 4 groups showed statistically significant improvements in mHHS and NAHS from baseline to final follow-up of a mean 2.63 years (range, 2.01-3.23 years). Functional outcome scores and rates of revision hip arthroscopy or conversion to THA did not significantly differ between groups.Conclusion:Hip arthroscopy can effectively improve patient outcomes in atypical hip pain. A careful history and physical examination should identify this clinically meaningful subset of patients with FAI who can benefit from surgical intervention while identifying patients with concomitant posterior extra-articular hip or spine pathology that should be addressed appropriately.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-25T05:28:23Z
      DOI: 10.1177/0363546519887733
       
  • Acetabular Morphologic Characteristics Predict Early Conversion to
           Arthroplasty After Isolated Hip Arthroscopy for Femoroacetabular
           Impingement
    • Authors: Brian D. Giordano, Benjamin D. Kuhns, Itay Perets, Leslie Yuen, Benjamin G. Domb
      First page: 188
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Hip arthroscopy in the setting of dysplasia and borderline dysplasia is controversial. Dysplasia severity is most often defined by the lateral center edge angle (LCEA) but can also be evaluated radiographically by the acetabular inclination (AI).Purpose/Hypothesis:The purpose was to determine the effect of AI on outcomes after isolated hip arthroscopy for femoroacetabular impingement (FAI). We hypothesized that patients with dysplasia would have higher rates of arthroplasty as well as inferior clinical and functional outcomes compared with patients who did not have dysplasia.Study Design:Cohort study; Level of evidence, 3.Methods:A hip arthroscopy registry was reviewed for participants undergoing arthroscopic correction of FAI from February 28, 2008, to June 10, 2013. Participants required a clinical diagnosis and isolated arthroscopic correction of FAI with preoperative imaging and intraoperative cartilage status recorded. AI dysplasia was defined as an AI greater than 10°, LCEA dysplasia as LCEA less than 18°, and borderline LCEA dysplasia as LCEA 18° to 25°. Patients without an acetabular deformity (LCEA 25°-40°; AI
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-25T09:00:37Z
      DOI: 10.1177/0363546519888894
       
  • Differential Effects of Platelets Selectively Activated by
           Protease-Activated Receptors on Meniscal Cells
    • Authors: Hongyao Xu, Xiangjie Zou, Pengcheng Xia, Mohammad Ahmad Kamal Aboudi, Ran Chen, He Huang
      First page: 197
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Meniscal injury is very common, and injured meniscal tissue has a limited healing ability because of poor vascularity. Platelets contain both pro- and anti-angiogenic factors, which can be released by platelet selective activation.Hypothesis:Platelets release a high level of vascular endothelial growth factor (VEGF) when they are activated by protease-activated receptor 1 (PAR1), whereas the platelets release endostatin when they are activated by protease-activated receptor 4 (PAR4). The PAR1-treated platelets enhance the proliferation of meniscal cells in vitro and promote in vivo healing of wounded meniscal tissue.Study Design:Controlled laboratory study.Method:Platelets were isolated from human blood and activated with different reagents. The released growth factors from the activated platelets were determined by immunostaining and enzyme-linked immunosorbent assay. The effects of the platelets with different treatments on meniscal cells were tested by an in vitro model of cell culture and an in vivo model of wounded meniscal healing.Results:The results indicated that platelets contained both pro- and antiangiogenic factors including VEGF and endostatin. In unactivated platelets, VEGF and endostatin were contained inside of the platelets. Both VEGF and endostatin were released from the platelets when they were activated by thrombin. However, only VEGF was released from the platelets when they were activated by PAR1, and only endostatin was released from the platelets when they were activated by PAR4. The rat meniscal cells grew much faster in the medium that contained PAR1-activated platelets than in the medium that contained either PAR4-activated platelets or unactivated platelets. The wounds treated with PAR1-activated platelets healed faster than those treated with either PAR4-activated platelets or unactivated platelets. Many blood vessel–like structures were found in the wounded menisci treated with PAR1-activated platelets.Conclusion:The PAR1-activated platelets released high levels of VEGF, which increased the proliferation of rat meniscal cells in vitro, enhanced the vascularization of menisci in vivo, and promoted healing of wounded menisci.Clinical Relevance:Our results suggested that selective activated platelets can be used clinically to enhance healing of wounded meniscal tissue.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-25T09:20:28Z
      DOI: 10.1177/0363546519886120
       
  • High Prevalence of Connective Tissue Gene Variants in Professional Ballet
    • Authors: Angelina M. Vera, Leif E. Peterson, David Dong, Varan Haghshenas, Thomas R. Yetter, Domenica A. Delgado, Patrick C. McCulloch, Kevin E. Varner, Joshua D. Harris
      First page: 222
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:There is a high prevalence of hypermobility spectrum disorder (HSD) in dancers. While there is no known genetic variant for HSD, hypermobile Ehlers-Danlos syndrome is a genetic disorder that exists within HSD. There are many connective tissue disorders (CTDs) with known (and unknown) genes associated with hypermobility. Hypermobility has distinct advantages for participation in flexibility sports, including ballet.Purpose:To determine the prevalence of gene variants associated with hypermobility in a large professional ballet company.Study Design:Cross-sectional study; Level of evidence, 3.Methods:In this cross-sectional investigation, 51 professional male and female dancers from a large metropolitan ballet company were eligible and offered participation after an oral and written informed consent process. Whole blood was obtained from peripheral venipuncture, and DNA was isolated. Isolated DNA was subsequently enriched for the coding exons of 60 genes associated with CTD that included hypermobility as a phenotype, including Ehlers-Danlos syndromes, osteogenesis imperfecta, Marfan syndrome, and others. Genes were targeted with hybrid capture technology. Prepared DNA libraries were then sequenced with next-generation sequencing technology. Genetic database search tools (Human Gene Mutation Database and e!Ensembl, http://useast.ensembl.org/) were used to query specific variants. Descriptive statistics were calculated.Results:Of 51 dancers, 32 (63%) agreed to participate in DNA analysis (mean ± SD age, 24.3 ± 4.4 years; 18 men, 14 women). Twenty-eight dancers had at least 1 variant in the 60 genes tested, for an 88% prevalence. A total of 80 variants were found. A variant in 26 of the 60 genes was found in at least 1 dancer. Among the 28 dancers with variants, 16 were found in the TTN gene; 10 in ZNF469; 5 in RYR1; 4 in COL12A1; 3 in ABCC6 and COL6A2; 2 in ADAMTS2, CBS, COL1A2, COL6A3, SLC2A10, TNC, and TNXB; and 1 in ATP6V0A2, B4GALT7, BMP1, COL11A1, COL5A2, COL6A1, DSE, FBN1, FBN2, NOTCH1, PRDM5, SMAD3, and TGFBR1. Nine variants found in this population have never been reported. No identified variant was identical to any other variant. No identified variant was known to be disease causing. In the general population, the prevalence of each variant ranges from never reported to 0.33%. In the study population, the prevalence of each variant was 3.13%. There was no association between hypermobility scores and genetic variants.Conclusion:Genetic variants in CTD-associated genes are highly prevalent (88%) in professional ballet dancers. This may significantly account for the high degree of motion in this population.
      Citation: The American Journal of Sports Medicine
      PubDate: 2019-11-25T08:35:15Z
      DOI: 10.1177/0363546519887955
       
  • Current Workload Recommendations in Baseball Pitchers: A Systematic Review
    • Authors: Neil K. Bakshi, Paul M. Inclan, Jacob M. Kirsch, Asheesh Bedi, Cristine Agresta, Michael T. Freehill
      First page: 229
      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2019-04-23T07:50:47Z
      DOI: 10.1177/0363546519831010
       
  • Cost-efficacy of Knee Cartilage Defect Treatments in the United States
    • Authors: Joshua S. Everhart, Andrew B. Campbell, Moneer M. Abouljoud, J. Caid Kirven, David C. Flanigan
      First page: 242
      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2019-04-30T04:43:00Z
      DOI: 10.1177/0363546519834557
       
  • Return to Sport After Arthroscopic Rotator Cuff Repair: Is There a
           Difference Between the Recreational and the Competitive Athlete'
    • Authors: Burak Altintas, Nicole Anderson, Grant J. Dornan, Robert E. Boykin, Catherine Logan, Peter J. Millett
      First page: 252
      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2019-03-11T04:42:43Z
      DOI: 10.1177/0363546519825624
       
  • Repair of a Meniscal Defect in a Rabbit Model Through Use of a
           Thermosensitive, Injectable, In Situ Crosslinked Hydrogel With
           Encapsulated Bone Mesenchymal Stromal Cells and Transforming Growth Factor
           β1
    • Authors: Chen Chen, Jialin Song, Jiayu Qiu, Jinzhong Zhao
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Meniscal injury repair with tissue engineering technique is promising. Among various scaffolds, the thermosensitive injectable hydrogel has recently attracted much attention.Purpose:(1) Evaluate the biocompatibility of thermosensitive, injectable, in situ crosslinked hydrogel and (2) determine whether the hydrogel with or without transforming growth factor β1 (TGF-β1) could support the fibrochondrogenic differentiation of bone mesenchymal stromal cells (BMSCs) and promote the repair of a critical-sized defect in rabbit meniscus.Study Design:Controlled laboratory study.Methods:The rheological and sustained release properties of the hydrogel were demonstrated. BMSCs were isolated and cultured. Cell viability, quantitative polymerase chain reaction (qPCR), and Western blot were tested in vitro. In vivo, a critical-sized defect was introduced into the meniscus of 30 rabbits. Each defect was randomly assigned to be implanted with either phosphate-buffered saline (PBS); BMSC-laden hydrogel; or BMSC-laden, TGF-β1-incorporated hydrogel. Histological and immunohistochemical analyses were performed at 8 weeks after surgery. The Ishida scoring system was adopted to evaluate the healing quantitatively.Results:The elastic modulus of the hydrogel was about 1000 Pa. The hydrogel demonstrated a sustained-release property and could promote proliferation and induce fibrochondrogenic differentiation of BMSCs after the incorporation of TGF-β1 (P < .001). At 8 weeks after surgery, a large amount of fibrocartilaginous tissue, which was positive on safranin-O staining and expressed strong type II collagen intermingled with weak type I collagen, was observed in the defect region of the BMSC-laden, TGF-β1-incorporated hydrogel group. In the BMSC-laden hydrogel group, the defect was filled with fibrous tissue together with a small amount of fibrocartilage. The mean ± SD quantitative scores obtained for the 3 groups—PBS; BMSC-laden hydrogel; and BMSC-laden, TGF-β1-incorporated hydrogel—were 1.00, 3.20 ± 0.84, and 5.00 ± 0.71, respectively (P < .001).Conclusion:The hydrogel was biocompatible and could stimulate strong fibrochondrogenic differentiation of BMSCs after the incorporation of TGF-β1. The local administration of the BMSC-laden, TGF-β1-incorporated hydrogel could promote the healing of rabbit meniscal injury.Clinical Relevance:This hydrogel is an alternative scaffold for meniscus tissue engineering.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519898519
       
  • Morphological Changes of the Femoral Tunnel and Their Correlation With
           Hamstring Tendon Autograft Maturation up to 2 Years After Anterior
           Cruciate Ligament Reconstruction Using Femoral Cortical Suspension
    • Authors: Shurong Zhang, Shaohua Liu, Liqin Yang, Shuang Chen, Shiyi Chen, Jiwu Chen
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Graft healing within the femoral tunnel after anterior cruciate ligament reconstruction (ACLR) using suspensory fixation could be reflected in graft maturation and tunnel morphological changes. However, the correlation between graft maturation and femoral tunnel changes remains unclear.Purpose:To quantitatively evaluate femoral tunnel morphological changes and graft maturation and to analyze their correlation after ACLR using femoral cortical suspension.Study Design:Case series; Level of evidence, 4.Methods:Patients who underwent single-bundle ACLR with a hamstring tendon autograft using femoral cortical suspension were included. Preoperative and postoperative (at 6, 12, and 24 months) knee function were evaluated using KT-1000 arthrometer testing, the Lysholm knee scoring scale, and the International Knee Documentation Committee (IKDC) questionnaire. At 1 day, 6 months, 12 months, and 24 months after ACLR, 3-dimensional magnetic resonance imaging was performed to observe the morphology of the femoral tunnel and to evaluate graft maturation using the graft signal/noise quotient (SNQ). The Pearson product moment correlation coefficients (r) of femoral tunnel radii versus clinical outcomes and graft SNQs at last follow-up were analyzed.Results:A total of 22 patients completed full follow-up. KT-1000 arthrometer, Lysholm, and IKDC scores improved over time postoperatively, but no significant improvement was seen after 12 months (P < .05). The radius of the tunnel containing the graft and the SNQs of the femoral intraosseous graft and intra-articular graft were the highest at 6 months, and they decreased by 24 months but remained higher than their 1-day postoperative values (P < .05). Expansion mainly occurred at the anteroinferior wall of the femoral tunnel. The tunnel aperture radius was positively correlated with SNQs of the intraosseous graft (r = 0.591; P < .05) and intra-articular graft (r = 0.359; P < .05) but not with clinical outcomes.Conclusion:After ACLR using suspensory fixation, morphological changes of the femoral tunnel were mainly observed in the part of the tunnel containing the graft, which expanded at 6 months and reduced by 24 months. Expansion mainly occurred at the anteroinferior wall of the femoral tunnel. Femoral tunnel expansion was correlated with inferior graft maturation but not with clinical outcomes.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519898136
       
  • 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
      DOI: 10.1177/0363546519899380
       
  • Location of Intra- and Extra-articular Hip Impingement Is Different in
           Patients With Pincer-Type and Mixed-Type Femoroacetabular Impingement Due
           to Acetabular Retroversion or Protrusio Acetabuli on 3D CT–Based
           Impingement Simulation
    • Authors: Till D. Lerch, Mathias Siegfried, Florian Schmaranzer, Christiane S. Leibold, Corinne A. Zurmühle, Markus S. Hanke, Michael K. Ryan, Simon D. Steppacher, Klaus A. Siebenrock, Moritz Tannast
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Diagnosis and surgical treatment of hips with different types of pincer femoroacetabular impingement (FAI), such as protrusio acetabuli and acetabular retroversion, remain controversial because actual 3-dimensional (3D) acetabular coverage and location of impingement cannot be studied via standard 2-dimensional imaging. It remains unclear whether pincer hips exhibit intra- or extra-articular FAI.Purpose:(1) To determine the 3D femoral head coverage in these subgroups of pincer FAI, (2) determine the impingement-free range of motion (ROM) through use of osseous models based on 3D-computed tomography (CT) scans, and (3) determine the osseous intra-and extra-articular 3D impingement zones by use of 3D impingement simulation.Study Design:Cross-sectional study; Level of evidence, 3.Methods:This is a retrospective, comparative, controlled study involving 70 hips in 50 patients. There were 24 patients (44 hips) with symptomatic pincer-type or mixed-type FAI and 26 patients (26 hips) with normal hips. Surface models based on 3D-CT scans were reconstructed and compared for hips with acetabular retroversion (30 hips), hips with protrusio acetabuli (14 hips), and normal asymptomatic hips (26 hips). Impingement-free ROM and location of impingement were determined for all hips through use of validated 3D collision detection software based on CT-based 3D models. No abnormal morphologic features of the anterior iliac inferior spine were detected.Results:(1) Mean total femoral head coverage was significantly (P < .001) increased in hips with protrusio acetabuli (92% ± 7%) and acetabular retroversion (71% ± 5%) compared with normal hips (66% ± 6%). (2) Mean flexion was significantly (P < .001) decreased in hips with protrusio acetabuli (104°± 9°) and acetabular retroversion (116°± 6°) compared with normal hips (125°± 13°). Mean internal rotation in 90° of flexion was significantly (P < .001) decreased in hips with protrusio acetabuli (16°± 12°) compared with normal hips (35°± 13°). (3) The prevalence of extra-articular subspine impingement was significantly (P < .001) higher in hips with acetabular retroversion (87%) compared with hips with protrusio acetabuli (14%) and normal hips (0%) and was combined with intra-articular impingement. The location of anterior impingement differed significantly (P < .001) between hips with protrusio acetabuli and normal hips.Conclusion:Using CT-based 3D hip models, we found that hips with pincer-type and mixed-type FAI have significantly larger femoral head coverage and different osseous ROM and location of impingement compared with normal hips. Additionally, intra- and extra-articular subspine impingement was detected predominantly in hips with acetabular retroversion. Acetabular rim trimming during hip arthroscopy or open surgical hip dislocation should be performed with caution for these hips. Patient-specific analysis of location of impingement using 3D-CT could theoretically improve diagnosis and planning of surgical treatment.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519897273
       
  • Human Amniotic Mesenchymal Stem Cell Sheets Encapsulating Cartilage
           Particles Facilitate Repair of Rabbit Osteochondral Defects
    • Authors: Qi You, Ziming Liu, Jun Zhang, Mengjie Shen, Yuwan Li, Ying Jin, Yi Liu
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Human amniotic mesenchymal stem cells (hAMSCs) are being widely applied in various fields. Therefore, hAMSCs represent a promising candidate to facilitate cartilage regeneration. Nonetheless, no studies have investigated the application of hAMSC sheets to repair cartilage defects in vivo.Purpose:To evaluate hAMSC sheets encapsulating cartilage particles to promote repair of rabbit osteochondral defects.Study Design:Controlled laboratory study.Methods:hAMSC sheets were constructed with passage 3 hAMSCs. The phenotypic and structural characteristics of hAMSC sheets were evaluated by flow cytometry and scanning electron microscopy, respectively. The potential for chondrogenic differentiation of hAMSC sheets was assessed by cartilage-specific marker staining, immunohistochemistry, and mRNA and protein expression (SOX9, COLII, and ACAN). Osteochondral defects (diameter, 3.5 mm; depth, 3 mm) were created in the left patellar grooves of 20 New Zealand White rabbits (female or male). The defects were treated with hAMSC sheet/cartilage particles (n = 5), cartilage particles (n = 5), hAMSC sheets (n = 5), or fibrin glue (n = 5). Macroscopic and histological evaluations of the regenerated tissue were conducted after 3 months. The survival time and differentiation of transplanted hAMSCs in the defect area were evaluated by immunofluorescence.Results:hAMSC sheets had a multilayered structure, with cells stacked layer by layer. Importantly, hAMSC sheets highly expressed phenotypic markers of mesenchymal stem cells. Cartilage-specific marker staining and immunohistochemistry were positive, and mRNA and protein expression was higher in the chondrogenically induced hAMSC sheet group than in the hAMSC sheet group (P < .05). hAMSC sheet/cartilage particles formed a large amount of hyaline-like cartilage in the defect area. In addition, macroscopic and histological scores were significantly higher than those in the other groups. Integration with surrounding normal cartilage and subchondral bone regeneration in the hAMSC sheet/cartilage particles group were better when compared with the other groups. A large number of human nuclear-specific antigen-positive cells were observed in the defect area of hAMSC sheet/cartilage particles and hAMSC sheet groups. Moreover, some positive cells expressed SOX9.Conclusion:hAMSC sheets encapsulating cartilage particles facilitate osteochondral defect repair.Clinical Relevance:Delivery of cells in the form of a cell sheet in conjunction with cartilage particles provides a novel approach for cell-based cartilage regeneration.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519897912
       
  • Minimum 5-Year Outcomes and Return to Sports After Resection Arthroplasty
           for the Treatment of Sternoclavicular Osteoarthritis
    • Authors: Travis J. Dekker, Lucca Lacheta, Brandon T. Goldenberg, Marilee P. Horan, Jonas Pogorzelski, Peter J. Millett
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Osteoarthritis of the sternoclavicular (SC) joint is a rare condition that leads to decreased function and persistent pain, ultimately altering the function of the shoulder and keeping individuals from their desired activities. SC resection in the setting of primary and posttraumatic osteoarthritis is the most common surgical treatment for these patients, but midterm results are lacking.Purpose/Hypothesis:The purpose was to assess the clinical outcomes, pain levels, return to sports rate, and survivorship after open SC joint resection in the setting of painful primary SC joint osteoarthritis. We hypothesized that an SC joint resection of maximum 10 mm would result in a significant improvement in clinical outcomes, decreased pain levels, a high rate of return to sports, and a high survivorship.Study Design:Case series; Level of evidence, 4.Methods:Patients who underwent SC joint resection (maximum 10 mm) by a single surgeon between the years 2006 and 2013 with minimum 5-year follow-up were reviewed. The following clinical outcomes were collected prospectively during this time period: 12-Item Short Form Health Survey Physical Component Score (SF-12 PCS), American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numerical Evaluation (SANE) score, Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, and patient satisfaction. Return to sports and pain were assessed through use of a customized questionnaire. Survivorship of SC joint resection was defined as not requiring further surgery on the affected joint.Results:A total of 21 SC joints were treated with resection of the medial clavicle and intra-articular disk and capsulorrhaphy for SC joint osteoarthritis in 19 patients with a mean age of 39.4 years (range, 12.5-66.7 years). At minimum 5-year follow-up, 19 SC joint resections were assessed in 16 of 19 patients (84%) with a mean follow-up of 6.7 years (range, 5.0-10.4 years). All outcome scores improved significantly from pre- to postoperative assessments: ASES (from 54 to 90.5; P = .003), SANE (from 61.8 to 90.4; P = .004), QuickDASH (from 43.1 to 13.8; P = .004), and SF-12 PCS (from 39.8 to 51.3; P = .004). Median satisfaction with surgical outcomes was 9 (range, 2-10), and pain levels improved from a score of 8 out of 10 to 3 out of 10 (scale of 0 to 10 with 0 being pain free and 10 worst possible pain). Of the 13 patients who answered the optional sports participation question, 13 (100%) patients had participated in sports before their injury. A total of 14 patients answered the question on sports participation after injury, with 12 (86%) indicating successful return to sports. Pain at its worst (P = .003) and pain with competition (P = .017) significantly decreased pre- to postoperatively. Resection survivorship at final follow-up was 84.2% at 5 years. We found that 3 patients (15%) had recurrent SC joint pain and were treated with revision surgery.Conclusion:Open SC resection arthroplasty with capsulorrhaphy in the setting of pain for SC osteoarthritis results in significant improvement in clinical outcomes, patient satisfaction, return to sports, and pain reduction at minimum 5-year follow-up.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519897892
       
  • Lateral Extra-articular Tenodesis Reduces Failure of Hamstring Tendon
           Autograft Anterior Cruciate Ligament Reconstruction: 2-Year Outcomes From
           the STABILITY Study Randomized Clinical Trial
    • Authors: Alan M.J. Getgood, Dianne M. Bryant, Robert Litchfield, Mark Heard, Robert G. McCormack, Alex Rezansoff, Devin Peterson, Davide Bardana, Peter B. MacDonald, Peter C.M. Verdonk, Tim Spalding, Kevin Willits, Trevor Birmingham, Chris Hewison, Stacey Wanlin, Andrew Firth, Ryan Pinto, Ashley Martindale, Lindsey O’Neill, Morgan Jennings, Michal Daniluk, Dory Boyer, Mauri Zomar, Karyn Moon, Raely Pritchett, Krystan Payne, Brenda Fan, Bindu Mohan, Gregory M. Buchko, Laurie A. Hiemstra, Sarah Kerslake, Jeremy Tynedal, Greg Stranges, Sheila Mcrae, LeeAnne Gullett, Holly Brown, Alexandra Legary, Alison Longo, Mat Christian, Celeste Ferguson, Nick Mohtadi, Rhamona Barber, Denise Chan, Caitlin Campbell, Alexandra Garven, Karen Pulsifer, Michelle Mayer, Nicole Simunovic, Andrew Duong, David Robinson, David Levy, Matt Skelly, Ajaykumar Shanmugaraj, Fiona Howells, Murray Tough, Tim Spalding, Pete Thompson, Andrew Metcalfe, Laura Asplin, Alisen Dube, Louise Clarkson, Jaclyn Brown, Alison Bolsover, Carolyn Bradshaw, Larissa Belgrove, Francis Millan, Sylvia Turner, Sarah Verdugo, Janet Lowe, Debra Dunne, Kerri McGowan, Charlie-Marie Suddens, Geert Declercq, Kristien Vuylsteke, Mieke Van Haver
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Persistent anterolateral rotatory laxity after anterior cruciate ligament (ACL) reconstruction (ACLR) has been correlated with poor clinical outcomes and graft failure.Hypothesis:We hypothesized that a single-bundle, hamstring ACLR in combination with a lateral extra-articular tenodesis (LET) would reduce the risk of ACLR failure in young, active individuals.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:This is a multicenter, prospective, randomized clinical trial comparing a single-bundle, hamstring tendon ACLR with or without LET performed using a strip of iliotibial band. Patients 25 years or younger with an ACL-deficient knee were included and also had to meet at least 2 of the following 3 criteria: (1) grade 2 pivot shift or greater, (2) a desire to return to high-risk/pivoting sports, (3) and generalized ligamentous laxity (GLL). The primary outcome was ACLR clinical failure, a composite measure of rotatory laxity or a graft rupture. Secondary outcome measures included the P4 pain scale, Marx Activity Rating Scale, Knee injury Osteoarthritis and Outcome Score (KOOS), International Knee Documentation Committee score, and ACL Quality of Life Questionnaire. Patients were reviewed at 3, 6, 12, and 24 months postoperatively.Results:A total of 618 patients (297 males; 48%) with a mean age of 18.9 years (range, 14-25 years) were randomized. A total of 436 (87.9%) patients presented preoperatively with high-grade rotatory laxity (grade 2 pivot shift or greater), and 215 (42.1%) were diagnosed as having GLL. There were 18 patients lost to follow-up and 11 who withdrew (~5%). In the ACLR group, 120/298 (40%) patients sustained the primary outcome of clinical failure, compared with 72/291 (25%) in the ACLR+LET group (relative risk reduction [RRR], 0.38; 95% CI, 0.21-0.52; P < .0001). A total of 45 patients experienced graft rupture, 34/298 (11%) in the ACLR group compared with 11/291 (4%) in the ACL+LET group (RRR, 0.67; 95% CI, 0.36-0.83; P < .001). The number needed to treat with LET to prevent 1 patient from graft rupture was 14.3 over the first 2 postoperative years. At 3 months, patients in the ACLR group had less pain as measured by the P4 (P = .003) and KOOS (P = .007), with KOOS pain persisting in favor of the ACLR group to 6 months (P = .02). No clinically important differences in patient-reported outcome measures were found between groups at other time points. The level of sports activity was similar between groups at 2 years after surgery, as measured by the Marx Activity Rating Scale (P = .11).Conclusion:The addition of LET to a single-bundle hamstring tendon autograft ACLR in young patients at high risk of failure results in a statistically significant, clinically relevant reduction in graft rupture and persistent rotatory laxity at 2 years after surgery.Registration:NCT02018354 (ClinicalTrials.gov identifier)
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519896333
       
  • Knee Extension Deficit in the Early Postoperative Period Predisposes to
           Cyclops Syndrome After Anterior Cruciate Ligament Reconstruction: A Risk
           Factor Analysis in 3633 Patients From the SANTI Study Group Database
    • Authors: Jean-Romain Delaloye, Jozef Murar, Thais D. Vieira, Florent Franck, Charles Pioger, Lionel Helfer, Adnan Saithna, Bertrand Sonnery-Cottet
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Cyclops syndrome is characterized by a symptomatic extension deficit attributed to impingement of a cyclops lesion within the intercondylar notch. The syndrome is an important cause of reoperation after anterior cruciate ligament reconstruction (ACLR). It has been suggested that remnant-preserving ACLR techniques may predispose to cyclops syndrome, but there is very limited evidence to support this. In general terms, risk factors for cyclops syndrome are not well-understood.Purpose:To determine the frequency of and risk factors for reoperation for cyclops syndrome in a large series of patients after ACLR.Study Design:Case-control study; Level of evidence, 3.Methods:A retrospective analysis of prospectively collected data was performed, including all patients who underwent primary ACLR between January 2011 to December 2017. Patients undergoing major concomitant procedures were excluded. Demographic data, intraoperative findings (including the size of preserved remnants), and postoperative outcomes were recorded. Those patients who underwent reoperation for cyclops syndrome were identified, and potential risk factors were evaluated in multivariate analysis.Results:A total of 3633 patients were included in the study, among whom 65 (1.8%) underwent reoperation for cyclops syndrome. Multivariate analysis demonstrated that preservation of large remnants did not predispose to cyclops lesions (odds ratio [OR], 1.11; 95% CI, 0.63-1.93). The most important risk factor was extension deficit in the early postoperative period. If present at 3 weeks postoperatively, it was associated with a>2-fold increased risk of cyclops syndrome (OR, 2.302; 95% CI, 1.268-4.239; P < .01), which was increased to 8-fold if present 6 weeks after ACLR (OR, 7.959; 95% CI, 4.442-14.405; P < .0001). None of the other potential risk factors evaluated were found to be significantly associated with an increased frequency of cyclops syndrome.Conclusion:Failure to regain full extension in the early postoperative period was the only significant risk factor for cyclops syndrome after ACLR in a large cohort of patients. Other previously hypothesized risk factors, such as preservation of a large anterior cruciate ligament remnant, did not predispose to the development of this debilitating postoperative complication.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519897064
       
  • Small Subchondral Drill Holes Improve Marrow Stimulation of Rotator Cuff
           Repair in a Rabbit Model of Chronic Rotator Cuff Tear
    • Authors: Yucheng Sun, Jae-Man Kwak, Erica Kholinne, Youlang Zhou, Jun Tan, Kyoung Hwan Koh, In-Ho Jeon
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Microfracture of the greater tuberosity has been proved effective for enhancing tendon-to-bone healing after rotator cuff repair. However, no standard diameter for the microfracture has been established.Purpose/Hypothesis:This study aimed to assess treatment with large- and small-diameter microfractures to enhance healing during rotator cuff repair surgery in a rabbit model of chronic rotator cuff tear. It was hypothesized that a small-diameter microfracture had advantages in terms of tendon-to-bone integration, bone-tendon interface maturity, microfracture healing, and biomechanical properties compared with a large-diameter microfracture.Study Design:Controlled laboratory study.Methods:Bilateral supraspinatus tenotomy from the greater tuberosity was performed on 21 New Zealand White rabbits. Bilateral supraspinatus repair was performed 6 weeks later. Small-diameter (0.5 mm) microfracture and large-diameter microfracture (1 mm) were performed on the left side and right side, respectively, in 14 rabbits as a study group, and simple repair without microfracture was performed in 7 rabbits as a control group. At 12 weeks later, 7 of 14 rabbits in the study group were sacrificed for micro–computed tomography evaluation and biomechanical testing. Another 6 rabbits were sacrificed for histological evaluation. In the control group, 3 of the 7 rabbits were sacrificed for histological evaluation and the remaining rabbits were sacrificed for biomechanical testing.Results:Significantly better bone-to-tendon integration was observed in the small-diameter microfracture group. Better histological formation and maturity of the bone-tendon interface corresponding to better biomechanical results (maximum load to failure and stiffness) were obtained on the small-diameter microfracture side compared with the large-diameter side and the control group. The large-diameter microfracture showed worse radiographic and histological properties for healing of the microfracture holes on the greater tuberosity. Additionally, the large-diameter microfracture showed inferior biomechanical properties but similar histological results compared with the control group.Conclusion:Small-diameter microfracture showed advantages with enhanced rotator cuff healing for biomechanical, histological, and radiographic outcomes compared with large-diameter microfracture, and large-diameter microfracture may worsen the rotator cuff healing.Clinical Relevance:This animal study suggested that a smaller diameter microfracture may be a better choice to enhance healing in clinical rotator cuff repair surgery in humans.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519896350
       
  • Bilateral Hip Arthroscopy in High-Level Athletes: Results of a Shorter
           Interval Between Staged Bilateral Hip Arthroscopies
    • Authors: Jeffrey D. Hassebrock, Anikar Chhabra, Justin L. Makovicka, Kostas J. Economopoulos
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Hip arthroscopy is a safe and effective mechanism for treating femoroacetabular impingement symptoms in high level athletes. Bilateral symptoms occur in a subset of this population.Purpose:To discuss outcomes of bilateral hip arthroscopy in high-level athletes and compare a standard staged timeline for bilateral hip arthroscopic surgery versus an accelerated timeline.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review of all staged bilateral hip arthroscopies was performed on high-level athletes over a 3-year period. Patients were categorized into cohorts based upon when the second procedure was performed (4-6 weeks after the index procedure or>6 weeks after the index procedure). Exclusion criteria included any prior hip surgery, advanced arthritis, previous pelvic or femoral fracture, or inflammatory arthropathy. Demographics, radiographic measurements, operative reports of procedures performed, and patient-reported outcomes (Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sport Specific Subscale, modified Harris Hip Score, return to sports, return to same level of play) were compared between groups at 6-month, 1-year, and 2-year intervals, with the Student t test used for continuous data and a chi-square test used for categorical data.Results:50 patients were identified: 22 in the accelerated surgery (AS) group and 28 in the standard surgery (SS) group. Age and number of collegiate participants were greater in the AS group, whereas the number of high school participants and the time away from sports were higher in the SS group. Preoperative alpha angles were significantly larger among the AS group, but no differences were found in postoperative alpha angles, center edge angles, or Tönnis grades. No significant difference was seen in patient-reported outcomes between the 2 groups at 6-month, 1-year, and 2-year follow-up.Conclusion:Bilateral hip arthroscopy performed 4 to 6 weeks apart is a safe and effective treatment option for athletes with bilateral femoroacetabular impingement and labral tears; the procedures entail a high rate of return to sports, return to the same level of sports, and decreased time lost from sports. This information could be useful for an athlete deciding on whether to proceed with bilateral hip arthroscopy and deciding on the timing for the procedures.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519895259
       
  • Female Team Physician Representation in Professional and Collegiate
           Athletics
    • Authors: Olivia C. O’Reilly, Molly A. Day, William T. Cates, Jaqueline E. Baron, Natalie A. Glass, Robert W. Westermann
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Although a sex-based balance in US graduate medical education has been well-documented, a discrepancy remains in orthopaedic surgery. In orthopaedic sports medicine, the representation of women as team physicians has not previously been characterized.Purpose:To quantify the sex-related composition of team physicians of select National Collegiate Athletic Association (NCAA) Division I collegiate and professional teams. Additionally, the authors assess the sex-related composition of orthopaedic surgeon team physicians specifically and compare these proportions to the sex-related composition of orthopaedic surgeon membership of the American Orthopaedic Society for Sports Medicine (AOSSM).Study Design:Cross-sectional study.Methods:Publicly available sex-related data were collected for team physicians in select NCAA Division I collegiate conferences and professional sports organizations. Subspecialty characteristics and sex distribution were described by use of percentages. Chi-square tests were used to assess whether sex distributions of team physicians in collegiate and professional sports were (1) representative between the populations of female and male physicians compared with the general public and (2) representative of the sex-based composition of orthopaedic surgeons nationally.Results:Women represented 12.7% (112/879) of all team physicians and 6.8% (30/443) of all orthopaedic surgeons (P < .0001). More than half (53.9%; 413/767) of male and 26.8% (30/112) of female team physicians were orthopaedic surgeons. In collegiate athletics, women comprised 18.1% of all team physicians and 7.7% of orthopaedic surgeon team physicians. In professional sports, women comprised 6.7% of all team physicians and 6.3% of orthopaedic surgeon team physicians, with the greatest proportion in the Women’s National Basketball Association (31.3%).Conclusion:Women comprise a minority of team physicians in select NCAA Division I collegiate and professional sports organizations. When compared with the composition of AOSSM orthopaedic surgeon membership, expected female orthopaedic surgeon representation varies between conferences and leagues with little statistical significance. Although efforts have been made to increase sex-based diversity in orthopaedic surgery, results of this study suggest that barriers affecting female orthopaedic surgeons as team physicians should be identified and addressed.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519897039
       
  • The Prevalence of Radiographic Findings of Structural Hip Deformities for
           Femoroacetabular Impingement in Patients With Hip Pain
    • Authors: Jun Zhou, Heath P. Melugin, Rena F. Hale, Devin P. Leland, Christopher D. Bernard, Bruce A. Levy, Aaron J. Krych
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Radiography is the initial imaging modality used to evaluate femoroacetabular impingement (FAI), and diagnostic radiographic findings are well-established. However, the prevalence of these radiographic findings in patients with hip pain is unknown.Purpose:The purpose was 3-fold: (1) to determine the overall prevalence of radiographic FAI deformities in young patients presenting with hip pain, (2) to identify the most common radiographic findings in patients with cam-type FAI, and (3) to identify the most common radiographic findings in patients with pincer-type FAI.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A geographic database was used to identify patients aged 14 to 50 years with hip pain between the years 2000 to 2016. The following were evaluated on radiographs: cam type: typical pistol grip deformity, alpha angle>55°; pincer type: crossover sign (COS), coxa profunda or protrusio acetabuli, lateral center edge angle (LCEA) ≥40°, Tönnis angle 55° was 577 (42.1%) and 1069 (78.0%), respectively. The mean alpha angle was 66.9°± 10.5°. The prevalence of pincer-type radiographic findings was the following: COS, 1062 (77.5%); coxa profunda, 844 (61.6%); ISS, 765 (55.8%); PWS, 764 (55.7%); Tönnis angle 55°. The most common radiographic finding for pincer-type FAI was the COS.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519896355
       
  • Prior Surgery Negatively Affects Cell Culture Identity in Patients
           Undergoing Autologous Chondrocyte Implantation
    • Authors: Jakob Ackermann, Alexandre Barbieri Mestriner, Courtney VanArsdale, Andreas H. Gomoll
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Recently, a cell identity assay has been introduced to evaluate the identity of cultured chondrocytes before autologous chondrocyte implantation (ACI), which was shown to be associated with graft survival after ACI.Purpose:To identify the influence of several patient- and lesion-specific factors on cell identity and viability assays.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 187 patients with second-generation ACI were included in this study. Patient and lesion characteristics, cell viability, cell identity, and biopsy specimen weight were recorded for each patient. A binomial logistic regression model was utilized to determine patient-specific predictive factors for cell product quality.Results:The implanted ACI cell products showed a cell viability of 93% ± 2.4% (mean ± SD; range, 84-98) with an identity score of 5.8 ± 2.1 (range, –0.08 to 9.46). Patients with multiple previous surgical procedures on the index knee had significantly lower cell identity scores when compared with patients without previous surgery (odds ratio = 0.31; 95% CI, 0.16-0.59; P < .001). Patients without surgical history had significantly higher cell identity scores than patients with 1 and ≥2 previous surgical procedures on the index knee (6.32 vs 5.32 vs 5.05; P = .006 and P < .001, respectively). Cell viability was not predicted by any preoperative variable (P> .05). Cell identity and viability were not associated with each other or with biopsy specimen weight (P> .05).Conclusion:Cartilage biopsy specimens from patients with ≥1 previous surgical procedures resulted in implants with lower cell identity scores when compared with patients without previous operations. None of the other patient- or lesion-specific factors were correlated, specifically biopsy specimen weight.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519897051
       
  • Delaminated Rotator Cuff Tears Showed Lower Short-term Retear Rates After
           Arthroscopic Double-Layer Repair Versus Bursal Layer–Only Repair: A
           Randomized Controlled Trial
    • Authors: Philipp R. Heuberer, Leo Pauzenberger, Michael S. Gruber, Roman C. Ostermann, Michael Hexel, Brenda Laky, Werner Anderl
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The rotator cuff is known to consist of 2 macroscopically visible layers that have different biomechanical properties. Sometimes the inferior layer may be neglected during rotator cuff repair. However, it is controversial whether double-layer (DL) repair is superior to single-layer (SL) repair in terms of retear rate and outcome.Purpose:To investigate whether DL as compared with SL repair could decrease retear rates after arthroscopic reconstruction of posterosuperior rotator cuff tears.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 70 patients were 1:1 randomized to receive an arthroscopic DL reconstruction (study group: DL suture-bridge repair) or SL reconstruction (control group: SL suture-bridge repair) for posterosuperior tears of the rotator cuff between 2.0 and 3.5 cm of the footprint detachment. Exclusion criteria were subscapularis tendon rupture (Lafosse>1°), fatty muscular infiltration>2°, and nondelaminated tendons. Tendon integrity according to Sugaya, fatty degeneration, and muscular atrophy were evaluated by magnetic resonance tomography. Pre- and postoperative evaluations included the Constant score, range of motion, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, subjective shoulder value, and postoperative satisfaction with the procedure. Complications were monitored throughout the study.Results:Ninety percent of patients (n = 34, DL; n = 29, SL) were followed-up. There were no significant group differences regarding baseline characteristics and pre- and postoperative fatty degeneration of the supraspinatus and atrophy of the supraspinatus and infraspinatus. The rate of magnetic resonance–verified intact repairs (Sugaya grades 1 + 2) was significantly higher in the DL group (70.6%) than in the SL group (44.8%; P = .045). One patient in the control group with a retear underwent revision. All functional and subjective scores improved significantly pre- to postoperatively in both groups (P < .05). No significant group differences were detected regarding postoperative Constant score, forward flexion, external rotation, American Shoulder and Elbow Surgeons score, Simple Shoulder Test, subjective shoulder value, and visual analog scale and between intact and retorn tendons. The majority of patients were very satisfied or satisfied with their arthroscopic procedure (DL, 94.1%; SL, 92.9%).Conclusion:This randomized controlled trial showed significantly lower retear rates after DL repair as compared with SL repair in delaminated rotator cuff tears. Clinical short-term outcome was not different between the DL and SL repair groups.Registration:NCT003362320 (ClinicalTrials.gov identifier).
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519897033
       
  • Anterior Cruciate Ligament Reconstruction in High School and College-Aged
           Athletes: Does Autograft Choice Influence Anterior Cruciate Ligament
           Revision Rates'
    • Authors: Kurt P. Spindler, Laura J. Huston, Alexander Zajichek, Emily K. Reinke, Annunziato Amendola, Jack T. Andrish, Robert H. Brophy, Warren R. Dunn, David C. Flanigan, Morgan H. Jones, Christopher C. Kaeding, Robert G. Marx, Matthew J. Matava, Eric C. McCarty, Richard D. Parker, Armando F. Vidal, Michelle L. Wolcott, Brian R. Wolf, Rick W. Wright
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Physicians’ and patients’ decision-making process between bone–patellar tendon–bone (BTB) and hamstring tendon autografts for anterior cruciate ligament (ACL) reconstruction (ACLR) may be influenced by a variety of factors in the young, active athlete.Purpose:To determine the incidence of both ACL graft revisions and contralateral ACL tears resulting in subsequent ACLR in a cohort of high school– and college-aged athletes who initially underwent primary ACLR with either a BTB or a hamstring autograft.Study Design:Cohort study; Level of evidence, 2.Methods:Study inclusion criteria were patients aged 14 to 22 years who were injured in sports, had a contralateral normal knee, and were scheduled to undergo unilateral primary ACLR with either a BTB or a hamstring autograft. All patients were prospectively followed for 6 years to determine whether any subsequent ACLR was performed in either knee after their initial ACLR. Multivariable regression modeling controlled for age, sex, ethnicity/race, body mass index, sport and competition level, baseline activity level, knee laxity, and graft type. The 6-year outcomes were the incidence of subsequent ACLR in either knee.Results:A total of 839 patients were eligible, of which 770 (92%) had 6-year follow-up for the primary outcome measure of the incidence of subsequent ACLR. The median age was 17 years, with 48% female, and the distribution of BTB and hamstring grafts was 492 (64%) and 278 (36%), respectively. The incidence of subsequent ACLR at 6 years was 9.2% in the ipsilateral knee, 11.2% in the contralateral normal knee, and 19.7% for either knee. High-grade preoperative knee laxity (odds ratio [OR], 2.4 [95% confidence interval [CI], 1.4-3.9]; P = .001), autograft type (OR, 2.1 [95% CI, 1.3-3.5]; P = .004), and age (OR, 0.8 [95% CI, 0.7-1.0]; P = .009) were the 3 most influential predictors of ACL graft revision in the ipsilateral knee. The odds of ACL graft revision were 2.1 times higher for patients receiving a hamstring autograft than patients receiving a BTB autograft (95% CI, 1.3-3.5; P = .004). No significant differences were found between autograft choices when looking at the incidence of subsequent ACLR in the contralateral knee.Conclusion:There was a high incidence of both ACL graft revisions and contralateral normal ACL tears resulting in subsequent ACLR in this young athletic cohort. The incidence of ACL graft revision at 6 years after index surgery was 2.1 times higher with a hamstring autograft compared with a BTB autograft.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519892991
       
  • Incidence of Displaced Posterolateral Tibial Plateau and Lateral Femoral
           Condyle Impaction Fractures in the Setting of Primary Anterior Cruciate
           Ligament Tear
    • Authors: David L. Bernholt, Nicholas N. DePhillipo, Matthew D. Crawford, Zachary S. Aman, W. Jeffrey Grantham, Robert F. LaPrade
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Bone bruising of the posterolateral tibial plateau and the lateral femoral condyle sulcus terminalis has a well-established association with anterior cruciate ligament (ACL) tears. Impaction fractures of the femur and tibia may occur in these locations; however, there is a paucity of literature describing these fractures.Purpose:The primary objective was to quantify the incidence, size, and location of impaction fractures of the posterolateral tibial plateau and lateral femoral condyle in patients with primary ACL tears. The secondary objective was to investigate the association between impaction fractures and concomitant meniscal and ligamentous injuries.Study Design:Case series; Level of evidence 4.Methods:Patients with available magnetic resonance imaging (MRI) scans who were treated for primary ACL tear by a single surgeon were identified. MRI scans were reviewed with denotation of posterolateral tibial and femoral condylar contusions and displaced impaction fractures. Measurements of the lateral tibial plateau were taken in all patients with displaced lateral tibial plateau fractures and in a subset of control patients without tibial plateau fracture present to characterize the size and location of the bony lesion. Associations of impaction fractures with concomitant meniscal or ligamentous injuries were evaluated through use of chi-square testing.Results:There were 825 knees identified with available MRI scans. Lateral tibial plateau bone bruising was present in 634 knees (76.8%), and lateral femoral condyle bone bruising was present in 407 knees (49.3%). Posterolateral tibial plateau impaction fractures were present in 407 knees (49.3%), and lateral femoral condylar impaction fractures were present in 214 knees (25.9%). Patients with posterolateral tibial plateau impaction fractures were older than patients without these fractures (42.6 vs 32.7 years; P < .001), whereas patients with lateral femoral condylar impaction fractures were younger (23.8 vs 32.7 years; P < .001). There were 71 knees (8.6%) with a posterolateral tibial plateau impaction fracture with greater than 10% loss of lateral tibial plateau depth, and this group had an increased incidence of lateral meniscus posterior root tears (22.1% vs 12.0%; P = .02).Conclusion:Posterolateral tibial plateau impaction fractures occurred with a high incidence (49.3%) in patients with primary ACL tears and demonstrated an increased association with lateral meniscus posterior horn root tears as their size increased. Lateral femoral condylar impaction fractures occurred in 25.9% of patients with primary ACL tears and entailed an increased incidence of lateral meniscal tears and medial meniscal ramp lesions.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519895239
       
  • Accuracy and Reliability of the Visual Assessment of Patellar Tracking
    • Authors: Matthew J. Best, Miho J. Tanaka, Shadpour Demehri, Andrew J. Cosgarea
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Abnormal patellar tracking is described as a “J-sign” when the patella exhibits excessive lateral displacement during active knee extension.Purpose:To determine (1) the accuracy and reliability of the visual assessment of patellar tracking when viewed by surgeons with patellofemoral expertise and (2) whether surgeon experience (in years) correlates with the ability to accurately identify the presence and severity of patellar maltracking.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:Using a web-based assessment, 32 orthopaedic surgeon members of the International Patellofemoral Study Group determined the presence or absence of maltracking (≥2 quadrants of lateral translation) in 10 single-knee videos of patients with patellar instability during active knee extension (qualitative analysis). Surgeons then graded patellar tracking in 20 single-knee videos as follows: 0 (
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519895246
       
  • Rethinking Patellar Tendinopathy and Partial Patellar Tendon Tears: A
           Novel Classification System
    • Authors: Mikhail Golman, Margaret L. Wright, Tony T. Wong, T. Sean Lynch, Christopher S. Ahmad, Stavros Thomopoulos, Charles A. Popkin
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Patellar tendinopathy is an overuse injury of the patellar tendon frequently affecting athletes involved in jumping sports. The tendinopathy may progress to partial patellar tendon tears (PPTTs). Current classifications of patellar tendinopathy are based on symptoms and do not provide satisfactory evidence-based treatment guidelines.Purpose:To define the relationship between PPTT characteristics and treatment guidelines, as well as to develop a magnetic resonance imaging (MRI)–based classification system for partial patellar tendon injuries.Study Design:Cohort study (prognosis); Level of evidence, 2.Methods:MRI characteristics and clinical treatment outcomes were retrospectively reviewed for 85 patients with patellar tendinopathy, as well as 86 physically active control participants who underwent MRI of the knee for other conditions. A total of 56 patients had a PPTT and underwent further evaluation for tear size and location. The relationship between tear characteristics and clinical outcome was defined with use of statistical comparisons and univariate and logistic regression models.Results:Of the 85 patients, 56 had partial-thickness patellar tendon tears. Of these tears, 91% involved the posterior and posteromedial regions of the proximal tendon. On axial MRI views, patients with a partial tear had a mean tendon thickness of 10 mm, as compared with 6.2 mm for those without (P < .001). Eleven patients underwent surgery for their partial-thickness tear. All of these patients had a tear>50% of tendon thickness (median thickness of tear, 10.3 mm) on axial views. Logistic regression showed that tendon thickness>8.8 mm correlated with the presence of a partial tear, while tendon thickness>11.45 mm and tear thickness>55.7% predicted surgical management.Conclusion:Partial-thickness tears are located posterior or posteromedially in the proximal patellar tendon. The most sensitive predictor for detecting the presence of a partial tear was patellar tendon thickness, in which thickness>8.8 mm was strongly correlated with a tear of the tendon. Tracking thickness changes on axial MRI may predict the effectiveness of nonoperative therapy: athletes with patellar tendon thickness>11.5 mm and/or>50% tear thickness on axial MRI were less likely to improve with nonoperative treatment. A novel proposed classification system for partial tears, the Popkin-Golman classification, can be used to guide treatment decisions for these patients.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519894333
       
  • PROMIS Versus Legacy Patient-Reported Outcome Measures in Patients
           Undergoing Surgical Treatment for Symptomatic Acetabular Dysplasia
    • Authors: Deborah J. Li, John C. Clohisy, Maria T. Schwabe, Elizabeth L. Yanik, Cecilia Pascual-Garrido
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:No previous study has investigated how the Patient-Reported Outcomes Measurement Information System (PROMIS) performs compared with legacy patient-reported outcome measures in patients with symptomatic acetabular dysplasia treated with periacetabular osteotomy (PAO).Purpose:To (1) measure the strength of correlation between the PROMIS and legacy outcome measures and (2) assess floor and ceiling effects of the PROMIS and legacy outcome measures in patients treated with PAO for symptomatic acetabular dysplasia.Study Design:Cohort study (Diagnosis); Level of evidence, 2.Methods:This study included 220 patients who underwent PAO for the treatment of symptomatic acetabular dysplasia. Outcome measures included the Hip disability and Osteoarthritis Outcome Score (HOOS) pain, HOOS activities of daily living (ADL), modified Harris Hip Score (mHHS), PROMIS pain, and PROMIS physical function subsets, with scores collected preoperatively and/or postoperatively at a minimum 12-month follow-up. The change in mean scores from preoperatively to postoperatively was calculated only in a subgroup of 57 patients with scores at both time points. Distributions of the PROMIS and legacy scores were compared to evaluate floor and ceiling effects, and Pearson correlation coefficients were calculated to evaluate agreement.Results:The mean age at the time of surgery was 27.7 years, and 83.6% were female. The mean follow-up time was 1.5 years. Preoperatively, neither the PROMIS nor the legacy measures showed significant floor or ceiling effects. Postoperatively, all legacy measures showed significant ceiling effects, with 15% of patients with a maximum HOOS pain score of 100, 29% with a HOOS ADL score of 100, and 21% with an mHHS score of 100. The PROMIS and legacy instruments showed good agreement preoperatively and postoperatively. The PROMIS pain had a moderate to strong negative correlation with the HOOS pain (r = −0.66; P < .0001) and mHHS (r = −0.60; P < .0001) preoperatively and the HOOS pain (r = −0.64; P < .0001) and mHHS (r = −0.64; P < .0001) postoperatively. The PROMIS physical function had a moderate positive correlation with the HOOS ADL (r = 0.51; P < .0001) and mHHS (r = 0.49; P < .0001) preoperatively and a stronger correlation postoperatively with the HOOS ADL (r = 0.56; P < .0001) and mHHS (r = 0.56; P < .0001).Conclusion:We found good agreement between PROMIS and legacy scores preoperatively and postoperatively. PROMIS scores were largely normally distributed, demonstrating an expanded ability to capture variability in patients with improved outcomes after treatment.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519894323
       
  • More Than a 2-Fold Risk of Contralateral Anterior Cruciate Ligament
           Injuries Compared With Ipsilateral Graft Failure 10 Years After Primary
           Reconstruction
    • Authors: Alberto Grassi, Luca Macchiarola, Gian Andrea Lucidi, Federico Stefanelli, Mariapia Neri, Annamaria Silvestri, Francesco Della Villa, Stefano Zaffagnini
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Failure of anterior cruciate ligament (ACL) reconstruction or an injury to the ACL in the contralateral knee represents a devastating event for patients, especially those young and physically active. However, controversies are still present regarding long-term failure rates and risk factors.Purpose:To assess the long-term rate of ipsilateral graft failure and contralateral ACL injuries after ACL reconstruction performed at a single center using the same surgical technique with a hamstring autograft and to investigate the effect of sex, age, and preinjury activity level as predictors of second ACL injuries.Study Design:Case series; Level of evidence, 4.Methods:The study cohort consisted of 244 consecutive patients (mean age, 30.7 years) who underwent ACL reconstruction with a single bundle plus lateral plasty technique using the hamstring tendon between November 2007 and May 2009. The number of subsequent ACL injuries (ipsilateral ACL revision or contralateral ACL reconstruction) was determined at a minimum follow-up of 10 years. Survivorship of either knee and subgroup analysis included sex, age, preoperative Tegner activity level, timing of ACL reconstruction, body mass index, and smoking status.Results:Ipsilateral ACL revision was performed in 8 (3.4%) patients and contralateral ACL reconstruction in 19 (7.8%) patients. Only 1 patient had both ipsilateral and contralateral injuries. No predictors were found for ipsilateral ACL revision, while age
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519893711
       
  • Patellofemoral Cartilage Restoration: A Systematic Review and
           Meta-analysis of Clinical Outcomes
    • Authors: Betina B. Hinckel, Eli L. Pratte, Charles A. Baumann, Anirudh K. Gowd, Jack Farr, Joseph N. Liu, Adam B. Yanke, Jorge Chahla, Seth L. Sherman
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Many surgical options for treating patellofemoral (PF) cartilage lesions are available but with limited evidence comparing their results.Purpose:To determine and compare outcomes of PF cartilage restoration techniques.Study Design:Systematic review and meta-analysis.Methods:PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines were followed by utilizing the PubMed, EMBASE, and Cochrane Library databases. Inclusion criteria were clinical studies in the English language, patient-reported outcomes after PF cartilage restoration surgery, and>12 months’ follow-up. Quality assessment was performed with the Coleman Methodology Score. Techniques were grouped as osteochondral allograft transplantation (OCA), osteochondral autograft transfer (OAT), chondrocyte cell–based therapy, bone marrow–based therapy, and scaffolds.Results:A total of 59 articles were included. The mean Coleman Methodology Score was 71.8. There were 1937 lesions (1077 patellar, 390 trochlear, and 172 bipolar; 298 unspecified). The frequency of the procedures was as follows, in descending order: chondrocyte cell–based therapy (65.7%), bone marrow–based therapy (17.2%), OAT (8%), OCA (6.6%), and scaffolds (2.2%). When compared with the overall pooled lesion size (3.9 cm2; 95% CI, 3.5-4.3 cm2), scaffold (2.2 cm2; 95% CI, 1.8-2.5 cm2) and OAT (1.5 cm2; 95% CI, 1.1-1.9 cm2) lesions were smaller (P < .001), while chondrocyte cell–based therapy lesions were larger (4.7 cm2; 95% CI, 4.1-5.3 cm2; P = .039). Overall, the instability pool was 11.9%, and the anatomic risk factors pool was 32.1%. Statistically significant improvement was observed on at least 1 patient-reported outcome in chondrocyte cell–based therapy (83%), OAT (78%), OCA (71%), bone marrow–based therapy (64%), and scaffolds (50%). There were no significant differences between any group and the overall pooled change in International Knee Documentation Committee score (30.2; 95% CI, 27.4-32.9) and Lysholm score (25.2; 95% CI, 16.9-33.5). There were no significant differences between any group and the overall pooled rate in minor complication rate (7.6%; 95% CI, 4.7%-11.9%) and major complication rate (8.3%; 95% CI, 5.7%-12.0%); however, OCA had a significantly greater failure rate (22.7%; 95% CI, 14.6%-33.4%) as compared with the overall rate (6.8%; 95% CI, 4.7%-9.5%).Conclusion:PF cartilage restoration leads to improved clinical outcomes, with low rates of minor and major complications. There was no difference among techniques; however, failures were higher with OCA.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519886853
       
  • Morphologic Variants of Posterolateral Tibial Plateau Impaction Fractures
           in the Setting of Primary Anterior Cruciate Ligament Tear
    • Authors: David L. Bernholt, Nicholas N. DePhillipo, W. Jeffrey Grantham, Matthew D. Crawford, Zachary S. Aman, Mitchell Iung Kennedy, Robert F. LaPrade
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Impaction fractures of the posterolateral tibial plateau commonly occur in the setting of anterior cruciate ligament (ACL) tears, with considerable variability found in fracture size and morphologic features.Purpose:The primary objective was to characterize different morphologic variants of posterolateral tibial plateau impaction fractures. The secondary objective was to investigate the association between these impaction fracture variants and concomitant meniscal and ligamentous injuries.Study Design:Cross-sectional study; Level of evidence 3.Methods:Patients treated for primary ACL tears and having magnetic resonance imaging available were included in this study, and magnetic resonance images were reviewed with denotation of displaced posterolateral tibial impaction fractures. A classification system was created based on morphologic variants of impaction fractures; associations were evaluated through use of independent chi-square testing.Results:There were 825 knees meeting the inclusion criteria, with displaced posterolateral tibial plateau impaction fractures present in 407 knees (49.3%). We observed 3 distinct morphologic variants of lateral tibial plateau impaction fractures: (I) posterior cortical buckle not involving the articular surface; (II) posterior impaction fracture involving the articular surface, with subtypes based on (A) tibial plateau depth bone loss 10%; and (III) displaced osteochondral fragment, with subtypes for (A) shear or (B) depressed fragment. Type IIIA impaction fractures were associated with an increased incidence of lateral meniscus posterior root tears (33.3% vs 12.4%; P = .009) and an increased incidence of lateral meniscal tears (83.3% vs 56.7%; P = .024) compared with all knees without type IIIA impaction fracture. An increased incidence of medial collateral ligament (MCL) tears was noted in patients with type IIIA impaction fractures compared with those who had no fracture or had another fracture type (61.1% vs 20.1%; P < .001). Type IIIB impaction fractures were associated with an increased incidence of lateral meniscal tears (80.0% vs 56.2%; P = .005).Conclusion:A high prevalence of displaced posterolateral tibial plateau impaction fractures occur in the setting of ACL tears, and they can be classified into distinct morphologic subtypes. Posterolateral tibial plateau impaction fractures with displaced depressed or shear fragments were both associated with an increased incidence of lateral meniscal tears, whereas impaction fractures with a shear fragment were associated with an increased incidence of lateral meniscus posterior root tears and MCL tears.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519893709
       
  • Upper Extremity and Hip Range of Motion Changes Throughout a Season in
           Professional Baseball Players
    • Authors: Justin M. Chan, John Zajac, Brandon J. Erickson, David W. Altchek, Christopher Camp, Struan H. Coleman, Joshua S. Dines
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Loss of upper and lower extremity range of motion (ROM) is a significant risk factor for injuries in professional baseball players.Purpose/Hypothesis:The purpose was to determine changes in ROM in professional baseball players over the course of a single season and their careers. We hypothesized that pitchers and position players would lose ROM, specifically total shoulder motion (total ROM [TROM]) and hip internal rotation (IR), over the course of a season and their careers.Study Design:Case series; Level of evidence, 4.Methods:Upper and lower extremity ROM measurements were recorded during pre-, mid-, and postseason on all professional baseball players for a single organization between 2011 and 2018. ROM measurements were compared for pitchers and position players over the course of the season and their careers. Also, ROM measurements over the pre-, mid-, and postseason were compared between pitchers and position players.Results:A total of 166 professional baseball players (98 pitchers, 68 position players) were included. Pitcher hip external rotation (ER; P < .001), IR (P = .010), and TROM (P < .001) for lead and trail legs decreased over the course of the season. Pitcher shoulder ER (P = .005), TROM (P = .042), and horizontal adduction (P < .001) significantly increased over the course of the season. Position player shoulder flexion (P = .046), hip ER (P < .001, lead leg; P < .001, trail leg), and hip TROM (P = .001; P = .002) decreased over the course of the season. Position player shoulder ER (P = .031) and humeral adduction (P < .001) significantly increased over the course of the season. Over the course of pitchers’ careers, there was decreased shoulder IR (P = .014), increased shoulder horizontal adduction (P < .001), and hip IR (P = .042) and hip TROM (P = .027) for the lead leg. Position players experienced loss of hip TROM (P = .010, lead leg; P = .018, trail leg) over the course of their careers. Pitchers started with and maintained more shoulder ER and gained more shoulder TROM over a season as compared with position players.Conclusion:Pitchers and position players saw overall decreases in hip ROM but increases in shoulder ROM over the course of the season and career.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519894567
       
  • Prospective Randomized Comparison of Capsular Management Techniques During
           Hip Arthroscopy
    • Authors: Kostas J. Economopoulos, Anikar Chhabra, Christopher Kweon
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Capsular management during hip arthroscopy remains controversial. Studies evaluating this topic consist mostly of retrospective comparative reviews of prospectively gathered data on a large series of patients.Purpose/Hypothesis:The purpose was to perform a prospective randomized trial to comparatively assess 3 commonly performed capsular management techniques. It was hypothesized that capsular closure during hip arthroscopy would result in superior outcomes when compared with unclosed capsulotomy management techniques.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:Patients (N = 150) who had hip arthroscopy with labral repairs and femoral osteoplasties performed by the senior author were randomly assigned into 3 groups at the time of their surgery: T-capsulotomy without closure (TC), interportal capsulotomy without closure (IC), and interportal capsulotomy with closure (CC). All patients underwent labral repair and femoral osteoplasty. Patient-reported outcomes were obtained preoperatively and at 3, 6, 12, and 24 months postoperatively. Other outcomes obtained included the need for future hip surgery.Results:Patient demographics, preoperative patient-reported outcomes, and radiographic measurements were similar among all 3 groups. Revision hip arthroscopy was performed in 5 TC cases, 2 IC cases, and 1 CC case (P = .17). Conversion to hip arthroplasty occurred in 4 patients in the TC group and none in the IC and CC groups (P = .02). The CC group showed higher modified Harris Hip Score (mHHS) and Hip Outcome Score–Activities of Daily Living (HOS-ADL) at the 2-year follow-up when compared with the IC group (P = .003 and P < .001, respectively). When compared with the TC group, the CC group demonstrated superior mHHS (86.2 vs 76), HOS-ADL (85.6 vs 76.8), and HOS-SSS (Hip Outcome Score–Sports-Specific Subscale; 74.4 vs 65.3) at the final 2-year follow-up (P < .001). At the 2-year follow-up, the IC group had a higher mHHS (81.7 vs 76), HOS-ADL (82 vs 76.8), and HOS-SSS (71.4 vs 65.3; P> .001) as compared with the TC group.Conclusion:Patients undergoing complete capsular closure during hip arthroscopy showed improved patient-reported and surgical outcomes when compared with those with unrepaired T-capsulotomy or interportal capsulotomy. These results suggest that repair after capsulotomy may be a favorable arthroscopic capsular management technique.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519894301
       
  • Pathoanatomy of the Jones Fracture in Male University Soccer Players
    • Authors: Kohei Fujitaka, Yasuhito Tanaka, Akira Taniguchi, Munehiro Ogawa, Shinji Isomoto, Shingo Otuki, Mamoru Okubo
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Jones fractures are relatively common in soccer players and require an extended recovery period because this type of fracture has a high incidence of delayed union, nonunion, and refracture. There has been some previous research on risk factors for Jones fracture, but no study has yet investigated the effect of the length of the fifth metatarsal bone and the positional relationship of the articular surface of the fifth metatarsal bones and the tarsal bones. Clarification of the characteristics of the foot structure that predispose soccer players to Jones fracture may aid in the prevention of this injury.Purpose:To investigate the association between Jones fracture and foot structure as assessed with a mapping system on weightbearing dorsoplantar and lateral foot radiographs.Study Design:Cohort study; Level of evidence, 3.Methods:We used a mapping system to evaluate the radiographs of 60 feet from 30 university soccer players with Jones fractures and a control group of 60 feet from 60 male university soccer players without Jones fracture. The groups were compared regarding the length of the fifth metatarsal and the positions of the metatarsal and tarsal bones.Results:Analysis of weightbearing dorsoplantar foot radiographs showed that the fifth metatarsal was significantly longer and that its proximal tip was positioned more proximally in the Jones fracture group as compared with the control group. Analysis of weightbearing lateral foot radiographs showed that the reference points for the medial arch were significantly higher in the Jones fracture group than in the control group.Conclusion:This study indicated that the proximally longer fifth metatarsal may cause greater stress at the base of the fifth metatarsal bone because the lever arm becomes long. In addition, high medial longitudinal arch may contribute to increased load on the lateral side of the foot. Thus, these anatomic features may be useful to identify soccer players at high risk of Jones fracture at medical checkup.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519893365
       
  • The Influence of Lumbosacral Spine Pathology on Minimum 2-Year Outcome
           After Hip Arthroscopy: A Nested Case-Control Analysis
    • 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, Ahead of Print.
      Background:Previous literature has examined the association between lumbosacral pathology and hip pathomechanics. However, the effect of lumbosacral pathologies and previous lumbosacral surgery on achieving meaningful outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) has yet to be studied conclusively.Purpose:To determine whether a history of lumbosacral spine pathology has an influence on achieving minimal clinically important differences (MCIDs) after hip arthroscopy for FAIS.Study Design:Cohort study; Level of evidence, 3.Methods:Patients undergoing hip arthroscopy for FAIS by a single, fellowship-trained orthopaedic surgeon between January 2012 and April 2017 with minimum 2-year follow-up were retrospectively reviewed. Patients with a history of lumbosacral spine pathology (eg, lumbosacral fusion, disc or vertebral pathology, or history of lumbosacral fractures) were matched 1:2 by age, body mass index, and sex to patients without spine pathology. Clinical outcomes including the Hip Outcome Score–activities of daily living subscale (HOS-ADL), HOS–sports subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool–12 (iHOT-12), visual analog scale (VAS) pain, and VAS satisfaction were compared between the groups using an independent t test. The threshold of every outcome score for achieving MCID was calculated separately for each group and frequencies were compared.Results:A total of 83 of 108 eligible patients with lumbosacral pathology were identified and matched to 166 patients without any spine pathology. When compared with the non–spine pathology group, the lumbosacral pathology group had significantly lower 2-year postoperative outcome score averages across all reported outcome tools (all P < .001). There were significant differences in the proportion achieving the threshold for HOS-ADL (60.6% vs 80.0%; P = .004), HOS-SS (57.6% vs 82.1%; P < .001), mHHS (66.7% vs 81.7%; P = .025), and iHOT-12 (54.8% vs 87.6%; P < .001) scores for MCID when comparing the lumbosacral and nonlumbosacral pathology groups.Conclusion:Patients with a history of lumbosacral pathology achieved significantly lower short-term meaningful clinical outcomes after undergoing hip arthroscopy for FAIS when compared with patients without spine pathology. The present study findings have implications for preoperative patient screening, shared decision-making processes/expectation management, and rehabilitation strategies.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519892916
       
  • Shoe Cushioning Influences the Running Injury Risk According to Body Mass:
           A Randomized Controlled Trial Involving 848 Recreational Runners
    • Authors: Laurent Malisoux, Nicolas Delattre, Axel Urhausen, Daniel Theisen
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Shoe cushioning is expected to protect runners against repetitive loading of the musculoskeletal system and therefore running-related injuries. Also, it is a common belief that heavier runners should use footwear with increased shock absorption properties to prevent injuries.Purpose:The aim of this study was to determine if shoe cushioning influences the injury risk in recreational runners and whether the association depends on the runner’s body mass.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:Healthy runners (n = 848) randomly received 1 of 2 shoe prototypes that only differed in their cushioning properties. Global stiffness was 61.3 ± 2.7 and 94.9 ± 5.9 N/mm in the soft and hard versions, respectively. Participants were classified as light or heavy according to their body mass using the median as a cut-off (78.2 and 62.8 kg in male and female runners, respectively). They were followed over 6 months regarding running activity and injury (any physical complaint reducing/interrupting running activity for at least 7 days). Data were analyzed through time-to-event models with the subhazard rate ratio (SHR) and their 95% confidence interval (CI) as measures of association. A stratified analysis was conducted to investigate the effect of shoe cushioning on the injury risk in lighter and heavier runners.Results:The runners who had received the hard shoes had a higher injury risk (SHR, 1.52 [95% CI, 1.07-2.16]), while body mass was not associated with the injury risk (SHR, 1.00 [95% CI, 0.99-1.01]). However, after stratification according to body mass, results showed that lighter runners had a higher injury risk in hard shoes (SHR, 1.80 [95% CI, 1.09-2.98]) while heavier runners did not (SHR, 1.23 [95% CI, 0.75-2.03]).Conclusion:The injury risk was higher in participants running in the hard shoes compared with those using the soft shoes. However, the relative protective effect of greater shoe cushioning was found only in lighter runners.Registration:NCT03115437 (ClinicalTrials.gov identifier)
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519892578
       
  • Intra-articular Injection of Culture-Expanded Mesenchymal Stem Cells
           Without Adjuvant Surgery in Knee Osteoarthritis: A Systematic Review and
           Meta-analysis
    • Authors: Seong Hwan Kim, Yoshi Pratama Djaja, Yong-Beom Park, Jung-Gwan Park, Young-Bong Ko, Chul-Won Ha
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Although many clinical studies have assessed the efficacy of mesenchymal stem cells (MSCs) in knee osteoarthritis, evidence on their efficacy remains unclear owing to heterogeneity of cell entity and concomitant procedures.Purpose:To determine the efficacy of culture-expanded MSCs in knee osteoarthritis in terms of clinical outcome and cartilage repair via meta-analysis of randomized controlled trials (RCTs) without adjuvant surgery.Study Design:Meta-analysis.Methods:PubMed, Embase, the Cochrane Library, CINAHL, and Scopus were searched from inception to December 31, 2018. RCTs with culture-expanded MSCs for treating knee osteoarthritis were included. Studies with adjuvant surgery or cell concentrate were excluded. Quality was assessed by the Cochrane Collaboration risk-of-bias tool. For meta-analysis, data on clinical outcomes were measured using a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and data on cartilage repair were measured using the Whole-Organ Magnetic Resonance Imaging Score (WORMS); categorization related to improvement was extracted.Results:Six RCTs (203 patients) were included. Two studies were deemed to have a low risk of bias. In pooled analysis, the only significant difference was in the VAS score (mean difference, –13.55; 95% CI, –22.19 to −4.9). In cumulative pain analysis with VAS and WOMAC pain scores, there was significant improvement after treatment (standardized mean difference, –0.54; 95% CI, –0.85 to −0.23). There was no significant difference in cartilage repair assessed by magnetic resonance imaging (standardized mean difference, 0.11; 95% CI, –0.51 to 0.73), WORMS (standardized mean difference, 1.68; 95% CI −14.84 to 18.21), or categorical results (odds ratio, 1.56; 95% CI, 0.32-7.59).Conclusion:Intra-articular injection of culture-expanded MSCs without adjuvant surgery can improve pain for patients experiencing knee osteoarthritis at short-term follow-up (6-12 months). However, evidence regarding function and cartilage repair remains limited.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519892278
       
  • Application of Machine Learning for Predicting Clinically Meaningful
           Outcome After Arthroscopic Femoroacetabular Impingement Surgery
    • Authors: Benedict U. Nwachukwu, Edward C. Beck, Elaine K. Lee, Jourdan M. Cancienne, Brian R. Waterman, Katlynn Paul, Shane J. Nho
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Hip arthroscopy has become an important tool for surgical treatment of intra-articular hip pathology. Predictive models for clinically meaningful outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) are unknown.Purpose:To apply a machine learning model to determine preoperative variables predictive for achieving the minimal clinically important difference (MCID) at 2 years after hip arthroscopy for FAIS.Study Design:Case-control study; Level of evidence, 3.Methods:Data were analyzed for patients who underwent hip arthroscopy for FAIS by a high-volume fellowship-trained surgeon between January 2012 and July 2016. The MCID cutoffs for the Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) were 9.8, 14.4, and 9.14, respectively. Predictive models for achieving the MCID with respect to each were built with the LASSO algorithm (least absolute shrinkage and selection operator) for feature selection, followed by logistic regression on the selected features. Study data were analyzed with PatientIQ, a cloud-based research and analytics platform for health care.Results:Of 1103 patients who met inclusion criteria, 898 (81.4%) had a minimum of 2-year reported outcomes and were entered into the modeling algorithm. A total of 74.0%, 73.5%, and 79.9% met the HOS-ADL, HOS-SS, and mHHS threshold scores for achieving the MCID. Predictors of not achieving the HOS-ADL MCID included anxiety/depression, symptom duration for>2 years before surgery, higher body mass index, high preoperative HOS-ADL score, and preoperative hip injection (all P < .05). Predictors of not achieving the HOS-SS MCID included anxiety/depression, preoperative symptom duration for>2 years, high preoperative HOS-SS score, and preoperative hip injection, while running at least at the recreational level was a predictor of achieving HOS-SS MCID (all P < .05). Predictors of not achieving the mHHS MCID included history of anxiety or depression, high preoperative mHHS score, and hip injections, while being female was predictive of achieving the MCID (all P < .05).Conclusion:This study identified predictive variables for achieving clinically meaningful outcome after hip arthroscopy for FAIS. Patient factors including anxiety/depression, symptom duration>2 years, preoperative intra-articular injection, and high preoperative outcome scores are most consistently predictive of inability to achieve clinically meaningful outcome. These findings have important implications for shared decision-making algorithms and management of preoperative expectations after hip arthroscopy for FAI.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519892905
       
  • Management of Failed Proximal Biceps Surgery: Clinical Outcomes After
           Revision to Subpectoral Biceps Tenodesis
    • Authors: David D. Savin, Brian R. Waterman, Shelby Sumner, Catherine Richardson, John Newgren, Anirudh K. Gowd, Anthony A. Romeo
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The preferred surgical technique to manage biceps–superior labral pathology is often debated, and rates of revision and persistence of pain vary widely according to surgical technique and patient characteristics.Purpose:To evaluate the clinical and functional outcomes of patients undergoing revision subpectoral tenodesis after failed primary tenodesis or tenotomy of the long head of the biceps.Study Design:Case series; Level of evidence, 4.Methods:All patients undergoing revision biceps management by the senior surgeon between 2006 and 2016 and with a minimum 24-month follow-up were retrospectively identified. Patients being treated with concomitant rotator cuff repair or capsular release were excluded. Patient characteristic variables were recorded. Patient-reported outcomes including the functional score, Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons were obtained, and range of motion, strength, and complications were quantified.Results:In total, 25 patients with revision biceps tenodesis were identified at a mean follow-up of 76.5 ± 31.5 months. The average age was 44.4 ± 14.3 years, and the surgical indications included failure of index suprapectoral biceps tenodesis (56%), subpectoral biceps tenodesis (36%), and patient dissatisfaction after tenotomy (8%). There was a significant improvement in the VAS score (P < .001), SANE (P = .001), SST (P = .035), functional score (P < .001), and forward elevation (P = .028), whereas postoperative strength (P = .440), abduction (P = .100), and external rotation (P = .745) improvement failed to achieve statistical significance after revision surgery. There was no difference in postoperative outcome measures between modes of failures, concomitant procedures, and sex. Twenty-two (88%) patients reported high satisfaction and stated they would have this revision surgery again. The overall complication rate was 48%, with half of these reporting pain of>3 on a scale of 10 and 4% of patients requiring additional surgeries.Conclusion:The current study demonstrates high patient satisfaction (88%) and significant improvement in functional outcomes with revision biceps tenodesis, a mini-open subpectoral technique, after previous failed tenodesis or tenotomy. Although this may be an effective strategy to address failed prior biceps surgery, the potential complication of persistent pain must be emphasized. Patients should be counseled on the high complication rate (48%), with persistent pain being the most common complaint.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519892922
       
  • Associations of Preoperative Patient Mental Health and Sociodemographic
           and Clinical Characteristics With Baseline Pain, Function, and
           Satisfaction in Patients Undergoing Rotator Cuff Repairs
    • Authors: Sambit Sahoo, Eric T. Ricchetti, Alexander Zajichek, Peter J. Evans, Lutul D. Farrow, Brett W. McCoy, Morgan H. Jones, Anthony A. Miniaci, Vani J. Sabesan, Mark S. Schickendantz, William H. Seitz, Kurt P. Spindler, Kim L. Stearns, Greg Strnad, Alparslan Turan, Vahid Entezari, Peter B. Imrey, Joseph P. Iannotti, Kathleen A. Derwin
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Shoulder pain and dysfunction are common indications for rotator cuff repair surgery, yet the factors that are associated with these symptoms are not fully understood.Purpose/Hypothesis:This study aimed to investigate the associations of patient and disease-specific factors with baseline patient-reported outcome measures (PROMs) in patients undergoing rotator cuff repair. We hypothesized that tear size and mental health status, as assessed by the Veterans RAND 12-Item Health Survey mental component score (VR-12 MCS), would be associated with baseline total Penn Shoulder Score (PSS) and its pain, function, and satisfaction subscale scores.Study Design:Cross-sectional study; Level of evidence, 3.Methods:We prospectively identified 12 patient factors and 12 disease-specific factors as possible statistical predictors for baseline PROMs in patients undergoing surgical repair of superior-posterior rotator cuff tears at a single institution over a 3-year period. Multivariable statistical modeling and Akaike information criterion comparisons were used to investigate the unique associations with, and relative importance of, these factors in accounting for variation in baseline PSS and its subscale scores.Results:A total of 1442 patients who had undergone surgery by 23 surgeons met inclusion criteria, with a baseline median total PSS of 38.5 (pain, 12; function, 24.2; satisfaction, 2). Adjusted R2 in multivariable models demonstrated that the 24 general patient and disease-specific factors accounted for 22% to 24% of the variability in total PSS and its pain and function subscale scores. Large/massive tear size was significantly associated with worse PSS total score and function score but not pain or satisfaction scores. Lower VR-12 MCS was significantly associated with worse total PSS and all 3 subscale scores. Among other factors significantly associated with baseline PROMs were sex, race, preoperative opioid use, years of education, employment status, acromion status, and adhesive capsulitis. Lower VR-12 MCS, preoperative opioid use, female sex, and black race were the factors most strongly associated with baseline PROMs.Conclusion:Large/massive tear size, lower VR-12 MCS, and several additional patient and disease-specific factors are associated with baseline PROMs in patients undergoing rotator cuff repair. Further studies are needed to investigate whether these factors will also predict poor postoperative PROMs.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519892570
       
  • Rotator Cuff Repair With Autologous Tenocytes and Biodegradable Collagen
           Scaffold: A Histological and Biomechanical Study in Sheep
    • Authors: Björn P. Roßbach, Mehmet F. Gülecyüz, Lena Kempfert, Matthias F. Pietschmann, Tina Ullamann, Andreas Ficklscherer, Thomas R. Niethammer, Anja Zhang, Roland M. Klar, Peter E. Müller
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Large rotator cuff tears still represent a challenging problem in orthopaedics. The use of tenocytes on biomaterials/scaffolds for the repair of large rotator cuff defects might be a promising approach in the field of tendon regeneration.Hypothesis:Cultivated autologous tenocytes seeded on a collagen scaffold lead to enhanced histological and biomechanical results after rotator cuff repair in a sheep model as compared with unseeded scaffolds in an acute setting.Study Design:Controlled laboratory study.Methods:At the tendon-bone junction of the infraspinatus tendon of the right foreleg of 24 sheep, a 3.5 × 1.5–cm tendon defect was created. Sheep were randomly allocated to group 1, a defect; group 2, where an unseeded collagen scaffold was implanted; or group 3, which received the implantation of a collagen scaffold seeded with autologous tenocytes. Twelve weeks postoperatively, tendon regeneration was examined histologically and biomechanically.Results:The histology of the neotendons of group 3 showed better fiber patterns, a higher production of proteoglycans, and an increased genesis of collagen III in contrast to groups 1 and 2. Immunostaining revealed less tissue dedifferentiation, a more structured cartilage layer, and homogeneous cartilage-bone transition in group 3 in comparison with groups 1 and 2. Biomechanically, the tensile strength of the reconstructed tendons in group 3 (mean load to failure, 2516 N; SD, 407.5 N) was approximately 84% that of the native tendons (mean load to failure, 2995 N; SD, 223.1 N) without statistical significance. A significant difference (P = .0095) was registered between group 1 (66.9% with a mean load to failure of 2004 N; SD, 273.8 N) and the native tendons, as well as between group 2 (69.7% with a mean load to failure of 2088 N; SD, 675.4 N) and the native tendons for mean ultimate tensile strength. In breaking stress, a significant difference (P = .0095) was seen between group 1 (mean breaking stress, 1335 N/mm2; SD, 182.7 N/mm2) and the native tendons, as well as between group 2 (breaking stress, 1392 N/mm2; SD, 450.2 N/mm2) and the native tendons (mean breaking stress, 1996 N/mm2; SD, 148.7 N/mm2). Again, there was no significant difference between group 3 (mean breaking stress, 1677 N/mm2; SD, 271.7 N/mm2) and the native tendons.Conclusion:Autologous tenocytes seeded on collagen scaffolds yield enhanced biomechanical results after tendon-bone reconstruction as compared with unseeded scaffolds in an acute setting. Biomechanical results and histological outcomes were promising, showing that the use of autologous tenocytes with specific carrier matrices could be a novel approach for repairing rotator cuff tears.Clinical Relevance:This study supports the use of tenocytes and scaffolds for improving the quality of tendon-bone regeneration.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519892580
       
  • Patellofemoral Pain in Adolescents: Understanding Patellofemoral
           Morphology and Its Relationship to Maltracking
    • Authors: Cameron N. Fick, Camila Grant, Frances T. Sheehan
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Developing bone is highly adaptable and, as such, is susceptible to pathological shape deformation. Thus, it is imperative to quantify if changes in patellofemoral morphology are associated with adolescent-onset patellofemoral pain, as a pathway to improve our understanding of this pain’s etiology.Purpose:To quantify and compare patellofemoral morphology in adolescent patients with patellofemoral pain with matched healthy adolescent controls and determine if a relationship exists between patellofemoral shape and kinematics (measured during active flexion-extension).Study Design:Cross-sectional study; Level of evidence, 3.Methods:Using 3-dimensional static magnetic resonance images acquired during a previous study, we measured patellar, trochlear, and lateral patellar width; trochlear and patellar depth; Wiberg index; patellar-height ratio; lateral trochlear inclination; cartilage length; and lateral femoral shaft length. Student t test was used to compare shape parameters between adolescents with patellofemoral pain and controls. Pearson correlations and stepwise linear regression models were used to explore the relationship among morphology, kinematics (medial-lateral shift/tilt), and pain.Results:Relative to controls, adolescents with patellofemoral pain had larger sulci (mean ± SD, 6.6 ± 0.7 vs 6.0 ± 1.1 mm; 95% CI, 0.6 mm; P = .043; d = 0.66), lateral patellar width (23.1 ± 2.4 vs 21.4 ± 2.6 mm; 95% CI, 1.6 mm; P = .033; d = 0.70), and patella-trochlear width ratio (1.2 ± 0.1 vs 1.1 ± 0.1; 95% CI, 0.1; P < .001; d = 1.26). Shape correlated with kinematics in both cohorts and in the entire population. In the patellofemoral pain group, lateral shaft length (r = 0.518; P = .019), Wiberg index (r = 0.477; P = .033), and patellar-height ratio (r = −0.582; P = .007) were correlated with medial shift. A moderate correlation existed between patellar-height ratio and lateral patellar tilt (r = 0.527; P = .017). Half of the variation in patellar shift in the patellofemoral pain cohort was explained by the patellar-height ratio and Wiberg index (R2 = 0.487; P = .003). Linear correlations with pain were not found.Conclusion:This study provides direct evidence that patellofemoral morphology is altered and influences maltracking in adolescents with patellofemoral pain, highlighting the multifactorial etiology of this pain. Neither morphology nor kinematics (measured during active flexion-extension) correlated with pain. Both increases and decreases in these parameters likely lead to pain, negating a direct linear correlation.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519889347
       
  • The Effect of Psychological Impairment on Outcomes in Patients With
           Prearthritic Hip Disorders: A Systematic Review and Meta-analysis
    • Authors: Abby L. Cheng, Maria Schwabe, Michelle M. Doering, Graham A. Colditz, Heidi Prather
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Recent studies have suggested that mental health disorders negatively affect postoperative outcomes in patients with femoroacetabular impingement (FAI). However, the outcome measures reported and the effect sizes have varied. Furthermore, it is unknown whether similar effects are present in young adults with other hip disorders such as acetabular dysplasia.Purpose:To synthesize current evidence regarding the effect of baseline psychological impairment on postintervention outcomes in patients with prearthritic hip disorders.Study Design:Systematic review and meta-analysis.Methods:In February 2019, the Ovid Medline, Embase, Scopus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and ClinicalTrials.gov databases were searched for longitudinal studies that evaluated the effect of baseline psychological impairment (such as depression or anxiety) on a postintervention clinical outcome in patients with prearthritic hip disorders including FAI, acetabular dysplasia, and/or acetabular labral tears. Descriptive measures of study quality and bias were recorded, and studies that reported statistically comparable outcomes were analyzed in meta-analyses through use of random effects models.Results:We identified 12 eligible studies, all of which specifically evaluated patients with FAI after hip arthroscopy. No eligible studies described patients with acetabular dysplasia. Of the included studies, 8 studies reported odds ratios (ORs). The other 4 studies reported mean postoperative scores on patient-reported outcome measures (PROMs), all of which were scored from 0 to 100, with higher numbers being favorable. Patients with psychological impairment were less likely to achieve a favorable outcome after arthroscopy (OR, 0.74; 95% CI, 0.62 to 0.88; P < .001), and they reported worse postoperative PROM scores compared with nonimpaired patients (weighted mean difference, −20.2 points; 95% CI, −32.9 to −7.5; P < .001).Conclusion:Baseline psychological impairment is associated with clinically significantly worse outcomes in patients with femoroacetabular impingement who undergo hip arthroscopy. More standardized reporting would facilitate improved understanding of this important, potentially modifiable risk factor.Registration:CRD42019124836 (PROSPERO).
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519883246
       
  • Absolute Meniscal Extrusion After Lateral Meniscal Allograft
           Transplantation Does Not Progress During Long-term Follow-up: Average of
           10.3 Years’ Follow-up Longitudinal Magnetic Resonance Imaging Study
    • Authors: Sang-Min Lee, Seong-Il Bin, Jong-Min Kim, Bum-Sik Lee, Jun-Gu Park
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Long-term outcomes after lateral meniscal allograft transplantation (MAT) are not completely understood.Purpose/Hypothesis:We investigated changes in meniscal extrusion in the coronal and sagittal planes using magnetic resonance imaging (MRI) after lateral MAT through long-term follow-up. We hypothesized that meniscal extrusion would progress during follow-up.Study Design:Case series; Level of evidence, 4.Methods:Patients subjected to lateral MAT were followed up by MRI evaluation in both planes at 1, 4 to 6, and>8 years after MAT. Meniscal extrusion and entire meniscal widths in the coronal plane and anterior (ACMD) and posterior (PCMD) cartilage meniscal distances in the sagittal plane were measured, and values were compared at each time point. Clinical outcomes were evaluated using the Lysholm score.Results:A total of 27 patients were included with a mean MRI follow-up period of 10.3 years (range, 8.1-15.3 years). The mean absolute meniscal extrusion (coronal plane) was not significantly different at each time point. However, the relative value differed (0.27 ± 0.04 at 1 year; 0.33 ± 0.06 at>8 years after MAT) owing to entire meniscal width reduction. There was no difference in the mean absolute value of the ACMD in the sagittal plane. However, relative values differed (0.21 ± 0.01 at 1 year; 0.27 ± 0.06 at>8 years) owing to entire meniscal width reduction. Absolute and relative values of the PCMD remained unaffected at each time point. The Lysholm score increased after surgery but did not differ postoperatively.Conclusion:During the long-term follow-up of extrusion after lateral MAT using MRI, absolute extrusion remained unchanged across all planes. Relative extrusion in the coronal plane and of the ACMD in the sagittal plane significantly increased, with no differences in the PCMD on follow-up. Clinical outcomes after surgery improved compared with those before surgery and were maintained throughout the long-term follow-up period.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519889046
       
  • Factors Associated With an Increased Risk of Recurrence After a First-Time
           Patellar Dislocation: A Systematic Review and Meta-analysis
    • Authors: Lachlan S. Huntington, Kate E. Webster, Brian M. Devitt, John P. Scanlon, Julian A. Feller
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Recurrent dislocations after a first-time lateral patellar dislocation may occur in more than 50% of patients and can cause long-term disability. Many factors have been suggested to influence the risk of recurrence.Purpose:To systematically review and quantitatively synthesize the literature for factors associated with an increased risk of recurrence after a first-time patellar dislocation.Study Design:Systematic review and meta-analysis of observational studies.Methods:A total of 4 electronic databases were searched to identify relevant studies published before February 7, 2019. A quality assessment was performed with the National Heart, Lung, and Bone Institute quality assessment score. Factors assessed for their effect on the recurrence rate were documented, and the rates of recurrence were compared. Pooled dichotomous data were analyzed using random-effects meta-analysis with odds ratios (ORs).Results:A total of 17 studies met the criteria for inclusion. The overall rate of recurrent dislocations after a first-time lateral patellar dislocation was 33.6%. An increased risk of recurrence was reported in patients with a younger age (OR, 2.61; P < .00001), open physes (OR, 2.72; P < .00001), trochlear dysplasia (OR, 4.15; P = .009), an elevated tibial tuberosity–trochlear groove (TT-TG) distance (OR, 2.87; P < .00001), and patella alta (OR, 2.38; P = .004). Sex, patterns of medial patellofemoral ligament injury, and history of contralateral dislocations were not found to be associated with an increased recurrence rate (P≥ .05). In studies that reported on the presence of multiple risk factors, recurrence rates were 7.7% to 13.8% when no risk factors were present but increased to 29.6% to 60.2% when 2 risk factors were present and to 70.4% to 78.5% when 3 risk factors were present.Conclusion:Younger age, open physes, trochlear dysplasia, elevated TT-TG distance, and patella alta were key risk factors for the recurrence of lateral patellar dislocations. Despite being not infrequently cited as risk factors, patient sex and a history of contralateral dislocations were not found to be significant risk factors. The presence of multiple risk factors increased the risk, and the development of predictive instability scores in large patient cohorts using all established risk factors should be a focus of future studies.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519888467
       
  • Posterior Medial Meniscus Root Tears Potentiate the Effect of Increased
           Tibial Slope on Anterior Cruciate Ligament Graft Forces
    • Authors: Brian T. Samuelsen, Zachary S. Aman, Mitchell Iung Kennedy, Grant J. Dornan, Hunter W. Storaci, Alex W. Brady, Travis Lee Turnbull, Robert F. LaPrade
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Increased posterior tibial slope and posterior medial meniscus root tears increase the force experienced by the anterior cruciate ligament (ACL) and predispose patients to higher rates of primary ACL injury or ACL graft failure after an ACL reconstruction (ACLR). However, the interplay among sagittal plane tibial slope, medial meniscus root tears, and ACLR graft force remains inadequately defined.Purpose/Hypothesis:The purpose was to quantify the effect of sagittal plane tibial slope on ACLR graft force at varying knee flexion angles with an intact medial meniscus, a posterior medial meniscus root tear, and a medial meniscus root repair. Our null hypothesis was that changes in slope and meniscal state would have no effect on the forces experienced by the ACLR graft.Study Design:Controlled laboratory study.Methods:Ten male fresh-frozen cadaveric human knees underwent a posteriorly based high tibial osteotomy. A spanning external fixator and wedges of varying sizes were used to stabilize the osteotomy and allow for accurate slope adjustment. After ACLR, specimens were compressed with a 1000-N axial load at flexion angles of 0° and 30° for each of the 3 meniscal states and at tibial slopes of 0° to 15° at 3° increments. Graft loads were recorded through a force transducer clamped to the graft.Results:Increasing tibial slope led to a linear increase in ACLR graft force at 0° and 30° of knee flexion. Posterior medial meniscus root tear led to significant increases in ACLR graft forces over the intact state, while root repair restored the function of the medial meniscus as a secondary stabilizer. At 30° of knee flexion, the tibial slope effect on ACLR graft force was potentiated in the root tear state as compared with the intact and root repair states—test of interaction effect: t(139) = 2.67 (P = .009).Conclusion:Increases in tibial slope lead to a linear increase in ACLR graft forces, and this effect is magnified in the setting of a posterior medial meniscus root tear. At slopes>12°, a slope-changing osteotomy could be considered in the setting of a revision ACLR with a concomitant medial meniscus root tear.Clinical Relevance:Defining the relationship between tibial slope and varying states of meniscal insufficiency can help determine when it may be necessary to perform a slope-decreasing proximal tibial osteotomy before ACLR and meniscal repair.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519889628
       
  • Predictors of Pain, Function, and Change in Patellofemoral Pain
    • Authors: Alexandra Hott, Jens Ivar Brox, Are Hugo Pripp, Niels Gunnar Juel, Sigurd Liavaag
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Identification of factors predictive of outcome and change is important to improve treatment for patellofemoral pain (PFP). Few studies have examined the predictive value of psychological factors in PFP, although they have been reported to be important predictors in other musculoskeletal pain conditions.Purpose:To evaluate predictors of pain, function, and change 1 year after an exercise-based intervention in PFP.Study Design:Cohort study; Level of evidence, 3.Methods:In sum, 112 patients were recruited to a randomized controlled trial; 98 attended 1-year follow-up. There were no between-group differences in the trial; thus, the material was analyzed as 1 cohort. Nine baseline factors—sex, bilateral pain, worst pain, pain duration, Anterior Knee Pain Scale (AKPS), kinesiophobia, anxiety and depression, self-efficacy, and number of pain sites throughout the body—were investigated for their predictive ability on outcome at 1 year (AKPS, worst pain) and for change at 1 year (global change score, change in AKPS, and change in worst pain). Multivariable linear regression models with stepwise backward removal method were used to find predictors of poor outcome.Results:Number of pain sites at baseline was a significant predictor of worse outcome for AKPS (B = −2.7; 95% CI, –4.0 to −1.3; P < .01), worst pain (B = 0.5; 95% CI, 0.2-0.8; P < .01), global change (B = −0.8; 95% CI, –1.2 to −0.5; P < .01), change in AKPS (B = −2.7; 95% CI, –4.0 to −1.3; P < .01), and change in worst pain (B = 0.5, 95% CI, 0.2-0.8; P < .01) at 1 year. Baseline scores for AKPS and worst pain predicted respective 1-year levels and change scores (P < .01). Lower self-efficacy and male sex predicted less global change (P < .01). Longer pain duration predicted final score and change score for worst pain (P < .01). The predictive models had reasonable fit with adjusted R2 from 0.22 to 0.35.Conclusion:Higher number of pain sites throughout the body was a consistent predictor of poor outcome and less change at 1 year. Baseline levels for AKPS and worst pain predicted respective final scores and change scores.Registration:NCT02114294 (ClinicalTrials.gov identifier).
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519889623
       
  • Platelet-Rich Plasma Versus Corticosteroid Injections in the Management of
           Elbow Epicondylitis and Plantar Fasciitis: An Updated Systematic Review
           and Meta-analysis
    • Authors: Kai Huang, Grey Giddins, Li-dong Wu
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Platelet-rich plasma (PRP), as a promising alternative to traditional corticosteroid (CS), is now increasingly used in the treatment of elbow epicondylitis (EE) and plantar fasciitis (PF). To date, however, the synthesis of information on the clinical efficacy of PRP versus CS is limited with divergent conclusions.Purpose:To compare the clinical efficacy of PRP and CS injections in reducing pain and improving function in EE and PF.Study Design:Systematic review and meta-analysis.Methods:Online databases were searched from inception to October 2018 for prospective studies evaluating PRP versus CS injections for EE or PF. Independent reviewers undertook searches, screening, and risk-of-bias appraisals. The primary outcomes of interest were pain and function in both the short term (1-3 months) and the long term (≥6 months).Results:Twenty trials with 1268 participants were included. For EE, PRP provides a statistically and clinically meaningful long-term improvement in pain, with a very large effect size of −1.3 (95% CI, −1.9 to −0.7) when compared with CS, but the evidence level was low. For EE, there was moderate evidence that CS provides a statistically meaningful improvement in pain in the short term, with a medium effect size of 0.56 (95% CI, 0.08-1.03) as compared with PRP; this improvement might not be clinically significant. For PF, there was low evidence that PRP provides a statistically and clinically meaningful long-term improvement in function (American Orthopedic Foot & Ankle Society score), with a very large effect size of 1.94 (95% CI, 0.61-3.28). There were no significant differences between the groups in improvement in function in EE and pain and short-term function in PF, but the quality of the evidence was low.Conclusion:The use of PRP yields statistically and clinically better improvement in long-term pain than does CS in the treatment of EE. The use of PRP yields statistically and clinically better long-term functional improvement than that of CS in the treatment of PF.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519888450
       
  • What Neuromonitoring Changes Can Be Expected During Hip Arthroscopy in the
           Pediatric Population'
    • Authors: Trevor J. Shelton, Akash Patel, Lauren Agatstein, Brian M. Haus
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:As its indications have evolved, hip arthroscopy is now performed more frequently in pediatric patients. However, despite this increase, there is a lack of evidence in the literature about its safety in this population in regard to traction injury of the nerves of the lower extremity.Purpose:To determine neuromonitoring changes of the sciatic, femoral, and obturator nerves during hip arthroscopy in the pediatric population and determine the rate of and risk factors for clinical neurapraxia.Study Design:Case series; Level of evidence, 4.Methods:A retrospective review was performed of all pediatric patients who underwent hip arthroscopy with neuromonitoring from December 2013 to October 2018. Neuromonitoring included somatosensory evoked potentials (SSEPs) in the peroneal and posterior tibial nerves and electromyography (EMG) signal for the obturator, femoral, and peroneal and posterior tibial nerves. Traction was applied using a radiolucent traction table. We recorded total traction time, surgery time, SSEP changes>50% after traction application, and EMG activity. We also recorded whether there was a clinical neurapraxia and when nerve function returned, and analyzed surgical and patient characteristic data for risk factors for neurapraxia.Results:A total of 89 patients had hip arthroscopy (median traction time, 69 minutes). SSEP changes>50% occurred in 78% of patients in the peroneal nerve and 73% in the posterior tibial nerve. EMG activity was observed in 9% of patients in the obturator nerve, 8% in the femoral nerve, 12% in the peroneal nerve, and 8% in the posterior tibial nerve. Clinical neurapraxia was seen in 19% of patients in either the peroneal nerve or posterior tibial nerve but resolved by 2 days postoperatively. Those who sustained a neurapraxia had a 32-minute longer surgery and 6-minute longer traction time. The clinical rate of neurapraxia of the pudendal nerve was 0%.Conclusion:Neuromonitoring changes are common during hip arthroscopy and nearly 1 in 5 pediatric patients will have some decreased sensation in either the peroneal or the posterior tibial nerve that resolves within 1 to 2 days after surgery. In pediatric patients, longer surgery and traction times during hip arthroscopy are associated with a higher rate of neurapraxia than that reported for adults.
      Citation: The American Journal of Sports Medicine
      DOI: 10.1177/0363546519889038
       
 
JournalTOCs
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
Email: journaltocs@hw.ac.uk
Tel: +00 44 (0)131 4513762
 


Your IP address: 34.229.131.116
 
Home (Search)
API
About JournalTOCs
News (blog, publications)
JournalTOCs on Twitter   JournalTOCs on Facebook

JournalTOCs © 2009-