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Orthopaedic Journal of Sports Medicine
Journal Prestige (SJR): 0.935

Citation Impact (citeScore): 1
Number of Followers: 14

This is an Open Access Journal

Open Access journal
ISSN (Print) 2325-9671 - ISSN (Online) 2325-9671
Published by Sage Publications

[1174 journals]

High Rate of Radiographic Union at the Fibular Osteotomy Site With No
Complications After an Acute Oblique Osteotomy and Ligation Procedure to
Shorten the Fibula in High Tibial Osteotomy
- Authors: Daisuke Ueda, Kazunori Yasuda, Takuma Kaibara, Koji Yabuuchi, Jun Yamaguchi, Jun Onodera, Norimasa Iwasaki, Tomonori Yagi, Eiji Kondo
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:A fibular shortening osteotomy is needed to perform lateral closing-wedge high tibial osteotomy (LCW-HTO). To achieve this shortening, we have recently developed an acute oblique osteotomy and ligation (AO/L) procedure for the center of the fibular shaft, based on the AO procedure.Purpose:To compare the 2-year follow-up outcomes between the AO/L procedure and the AO procedure.Study Design:Cohort study; Level of evidence, 2.Methods:A prospective comparative cohort study was conducted involving 83 patients (83 knees) who underwent shortening osteotomy of the fibula in LCW-HTO between April 2017 and March 2019. The first consecutive 41 knees (AO group) underwent fibular osteotomy with the AO procedure. The remaining 42 knees (AO/L group) underwent fibular osteotomy with the AO/L procedure. All of the patients were evaluated for at least 2 years postoperatively via clinical and radiological assessments. To determine the time needed for complete union at the osteotomy site, we evaluated the radiographs using a radiographic union score for tibial fractures, which was modified for fibular osteotomy. Comparison of outcomes between the 2 groups was performed using the Student t test for continuous variables and the Mann-Whitney U test or Fisher exact test for discrete variables.Results:Around the fibular osteotomy site, no perioperative complications were found in either group. The radiographic union score was significantly higher in the AO/L group than in the AO group (P < .0001 at 2, 3, and 6 months; P = .0290 at 12 and 24 months). The union rate at the fibular osteotomy site was significantly higher in the AO/L group (97.6%) than in the AO group (82.9%) at 12 months (P = .0290).Conclusion:The AO/L procedure significantly accelerated the formation of bridging callus at the fibular osteotomy site and provided a significantly higher union rate compared with the AO procedure. Both AO/L and AO procedures were free from perioperative complications. These results suggest that the AO/L procedure is clinically useful as an osteotomy procedure to shorten the fibula in LCW-HTO.
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-12T10:55:38Z
  DOI: 10.1177/23259671221117480
  Issue No: Vol. 10, No. 8 (2022)
Midterm Outcomes After Revision Posterior Cruciate Ligament Reconstruction
With a Single-Bundle Transtibial Autograft
- Authors: Yi-Jou Chen, Cheng-Pang Yang, Chin-Shan Ho, Chun-Jui Weng, Alvin Chao-Yu Chen, Wei-Hsiu Hsu, Kuo-Yao Hsu, Yi-Sheng Chan
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:There is a lack of consensus regarding the optimal technique for revision posterior cruciate ligament (PCL) reconstruction.Purpose:To evaluate midterm outcomes after revision PCL reconstruction using a single-bundle transtibial autograft.Study Design:Case series; Level of evidence, 4.Methods:We reviewed 17 patients who underwent revision PCL reconstruction performed in our medical center by a single surgeon from 2003 to 2016. The cohort included 12 male and 5 female patients with a mean age of 31.3 years (range, 17-48 years). All of the patients underwent single-bundle transtibial reconstruction using the same surgical technique and were reviewed at a minimum of 4 years postoperatively. Preoperative and postoperative posterior stress radiography was performed. The preoperative tibial slope and tibiofemoral angle were also measured. Preoperative and postoperative functional outcomes were evaluated using the International Knee Documentation Committee (IKDC) subjective and objective scores as well as the Lysholm score.Results:The most common factor that contributed to the failure of primary surgery was misplaced tunnels, especially on the femoral side. There were 2 patients who had grade 2 laxity preoperatively, and 15 patients had grade 3 laxity preoperatively. At the latest follow-up, all 17 patients had grade 1 laxity. On posterior stress radiography, posterior displacement improved from 10.8 ± 2.1 mm preoperatively to 2.9 ± 1.1 mm at the latest follow-up (P < .001). The IKDC subjective score improved from 34.9 ± 6.8 preoperatively to 75.3 ± 15.7 postoperatively (P < .001), and the Lysholm score improved from 38.1 ± 10.0 preoperatively to 88.5 ± 7.6 postoperatively (P < .001). All patients reached the minimal clinically important difference (MCID) for the Lysholm score, and 94% reached the MCID for the IKDC subjective score, with 65% reaching the Patient Acceptable Symptom State.Conclusion:According to the findings of this study, arthroscopic revision PCL reconstruction with a single-bundle transtibial autograft offered satisfactory outcomes at midterm follow-up.
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-12T10:37:35Z
  DOI: 10.1177/23259671221115423
  Issue No: Vol. 10, No. 8 (2022)
Increased Risk of ACL Injury for Female but Not Male Soccer Players on
Artificial Turf Versus Natural Grass: A Systematic Review and
Meta-Analysis
- Authors: Michelle Xiao, Jacie L. Lemos, Calvin E. Hwang, Seth L. Sherman, Marc R. Safran, Geoffrey D. Abrams
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:Both natural grass (NG) and artificial turf (AT) are popular playing surfaces for soccer. Biomechanical studies have found increased frictional forces on AT that may lead to anterior cruciate ligament (ACL) injury. The increased risk of ACL injury during soccer in female participants may amplify this effect.Purpose:To systematically review the literature for studies comparing ACL injury risk in soccer players on AT versus NG and to specifically determine whether there were differences in injury risk in male versus female players when considering the playing surface.Study Design:Systematic review; Level of evidence, 3.Methods:A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Three databases were searched for studies with evidence level 1 to 3 that compared the incidence of ACL injuries on AT versus NG in soccer players. Data recorded included study characteristics, sex, competition level, exposure setting (games or practices), turf type, and ACL injury information. Study methodological quality was analyzed using the methodological index for non-randomized studies (MINORS) score, and incidence rate ratios (IRRs) were calculated.Results:Included were 7 articles (3 studying professional soccer, 3 collegiate soccer, 1 youth-level soccer; 4 male cohorts, 2 female cohorts, and 1 male and female cohort; mean MINORS score, 20 ± 0.8). Pooled ACL injury IRRs demonstrated no significant differences in overall ACL injury risk when playing soccer on AT compared with NG (IRR = 0.57 [95% CI, 0.21-1.53]; P = .31). A significantly increased risk of ACL injury in games played on AT compared with NG was detected for female (IRR = 1.18 [95% CI, 1.05-1.31]; P = .004) but not for male players (IRR = 1.18 [95% CI, 0.97-1.42]; P = .09). Subgroup analyses showed no significant differences in injury risk for games (IRR = 1.07 [95% CI, 0.97-1.18]; P = .20) or practices (IRR = 0.21 [95% CI, 0.04-1.23]; P = .09).Conclusion:Findings indicated that female soccer players had a significantly higher risk of ACL injury when playing games on AT versus NG, whereas no significant difference was seen in male players. No differences were found for the combined male/female cohort or for soccer games or training sessions played on AT compared with NG.
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-12T08:20:05Z
  DOI: 10.1177/23259671221114353
  Issue No: Vol. 10, No. 8 (2022)
Involvement of Bacteria in the Pathological Changes Before Achilles Tendon
Rupture: A Case Series Investigating 16S rDNA in 20 Consecutive Ruptures
- Authors: Allan Cramer, Claus Moser, Blaine Gabriel Fritz, Per Hölmich, Kristoffer Weisskirchner Barfod
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:The source of the pathological changes that occur before an acute Achilles tendon rupture (ATR) is not fully understood. Bacterial DNA has previously been detected in samples from ruptured Achilles tendons, suggesting a pathogenic role of bacteria in ATR.Purpose/Hypothesis:The purpose of this study was to investigate if DNA from bacteria was present in acutely ruptured Achilles tendons. We hypothesized that 20% to 30% of the samples from the rupture site and no samples from healthy tissue would be positive for bacterial DNA.Study Design:Case series; Level of evidence, 4.Methods:This study included 20 consecutive patients scheduled for surgical repair of an acute ATR. Tendon biopsy specimens were taken from the rupture site and from the healthy tendon tissue proximal to the rupture to act as a control. Samples were blinded to the technician and analyzed using polymerase chain reaction targeted to the bacterial 16S rDNA gene and Sanger sequencing to identify the bacterial species present. McNemar test for paired proportions was performed to test for statistically significant differences in the number of samples positive for bacterial DNA between the ruptured and control regions of the Achilles tendon.Results:Of the 20 patients, 1 (5%) had a positive sample with bacterial DNA from the ruptured part of the Achilles tendon. The same patient also had a positive control sample, although with different bacterial DNA. An additional patient had a positive control sample. There was no statistically significant difference in the number of bacterial DNA–positive samples between the ruptured and control regions of the Achilles tendon. The bacteria found (Staphylococcus sp, Micrococcus sp, and Staphylococcus epidermidis) were normal commensal organisms on the human skin.Conclusion:Bacterial DNA was infrequent in tissue from ruptured Achilles tendons and, if identified, likely was a result of contamination. This suggests that bacteria are not involved in the pathological changes occurring before rupture of the Achilles tendon.
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-12T07:46:09Z
  DOI: 10.1177/23259671221112138
  Issue No: Vol. 10, No. 8 (2022)
Optimization of the Grashey View Radiograph for Critical Shoulder Angle
Measurement: A Reliability Assessment With Zero Echo Time MRI
- Authors: Adalet Elçin Yıldız, Yasin Yaraşır, Gazi Huri, Üstün Aydıngöz
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:Suboptimal positioning on Grashey view radiographs may limit the prognosticating potential of the critical shoulder angle (CSA) for shoulder disorders.Purpose:To investigate whether radiography optimized according to the latest research is reliable for measuring CSA in comparison with magnetic resonance imaging (MRI) featuring 3-dimensional (3D) zero echo time (ZTE) sequencing, which accentuates the contrast between cortical bone and surrounding soft tissue with high fidelity.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:Patients with shoulder pain were prospectively and consecutively enrolled. All patients had Grashey view radiographs as well as 3.0-T MRI scans with isotropic 3D ZTE sequencing. Acceptable positioning on the radiographs was determined using the ratio of the transverse to longitudinal (RTL) diameter of the lateral glenoid outline; radiographs with an RTL ≥0.25 were repeated. Two observers independently measured the CSA on the radiographs and the coronal oblique reformatted ZTE images, the latter including verification of measurement points by cross-referencing against images from other planes. Reliability of measurements between observers and modalities was analyzed with the intraclass correlation coefficient (ICC). The paired-samples t test was used to compare the differences between imaging modalities.Results:Enrolled were 65 patients (35 female and 30 male; mean age, 40.2 years; range, 25-49 years). Radiographs with optimal positioning (RTL < 0.25) were attained after a mean of 1.6 exposures (range, 1-4); the mean RTL was 0.09 (range, 0-0.20). Interobserver agreement of CSA was excellent for radiographs (ICC = 0.91; 95% CI, 0.84-0.94) and good for ZTE MRI scans (ICC = 0.85; 95% CI, 0.71-0.92). Intermodality agreement of CSA between radiographs and ZTE MRI scans was moderate (ICC = 0.66; 95% CI, 0.48-0.73). The CSA was significantly different between an optimal radiograph (30.7° ± 4.3°) and ZTE MRI scan (31.8° ± 3.8) (P = .005). Subgroup analysis revealed no significant differences in CSA measurement between ZTE MRI scans and Grashey view radiographs with an RTL of
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-12T07:29:59Z
  DOI: 10.1177/23259671221109522
  Issue No: Vol. 10, No. 8 (2022)
Biomechanical Comparison of a Novel Multiplanar, Perpendicular Whipstitch
With the Krackow Stitch and Standard Commercial Whipstitch
- Authors: Stefano Muscatelli, Kempland C. Walley, Conor S. Daly-Seiler, Joseph A. Greenstein, Aaron Sciascia, David P. Patterson, Michael T. Freehill
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:Using alternating orthogonal suture throws with the looped whipstitch technique may allow enhanced suture fixation.Hypothesis:It was hypothesized that this novel multiplanar, perpendicular looped whipstitch (MP) technique would have improved biomechanical properties compared with the standard looped whipstitch (WS) and Krackow stitch (KS).Study Design:Controlled laboratory study.Methods:A total of 30 cadaveric tibialis anterior tendons were randomly assigned into 3 groups of 10. Tendons were secured to a custom clamp, and the other end was sutured using 1 of 3 techniques: the KS, WS, or novel MP. The MP was performed with alternating orthogonal throws starting right to left, then front to back, left to right, and back to front. Each technique used 4 passes of No. 2 FiberWire spaced 5 mm apart and ending 10 mm from the tendon end. Tendons were preloaded to 5 N, pretensioned to 50 N at 100 mm/min for 3 cycles, returned to 5 N for 1 minute, cycled from 5 to 100 N at 200 mm/min for 100 cycles, and then loaded to failure at 20 mm/min. Elongation was recorded after pretensioning and cycling and was measured both across the suture-tendon interface and from the base of the suture-tendon interface to markings on the suture limbs (construct elongation). One-way analyses of variance were performed, with Bonferroni post hoc analysis when appropriate.Results:There were no differences in cross-sectional area or stiffness among the 3 techniques. The ultimate load for WS (183.33 ± 57.44 N) was less compared with both MP (270.76 ± 39.36 N) and KS (298.90 ± 25.94 N) (P ≤ .001 for both). There was less construct elongation for KS compared with WS and MP for total displacement, measured from pretensioning to the end of cycling (P < .001). All 3 techniques saw a decrease in length (shortening) at the suture-tendon interface during testing. There was more shortening at the suture-tendon interface for WS compared with KS (P = .006).Conclusion:The KS appears superior, as it maximized strength while minimizing construct elongation or graft shortening. The ultimate load of the MP technique was greater than that of the standard technique but not significantly different from that of the KS technique.Clinical Relevance:The KS is preferred. If using a WS, multiplanar, perpendicular passes should be considered.
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-12T06:36:55Z
  DOI: 10.1177/23259671221107034
  Issue No: Vol. 10, No. 8 (2022)
Is the VISA-A Still Seaworthy, or Is It in Need of Maintenance'
- Authors: Haraldur B. Sigurðsson, Karin Grävare Silbernagel
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:The Victorian Institute of Sport Assessment–Achilles (VISA-A) questionnaire is validated and widely used in Achilles tendinopathy. How well it can evaluate treatment outcomes is not well understood.Purpose:To evaluate the responsiveness of the VISA-A in midportion Achilles tendinopathy and compare it with other patient-reported outcome measures.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:Enrolled were 97 participants with clinically diagnosed Achilles tendinopathy (median age, 50 years [interquartile range, 18 years]; symptom duration, 10 months [interquartile range, 28.7 months). The participants underwent a baseline evaluation and completed between 1 and 6 follow-up evaluations at 8, 16, 24, 32, 40, and/or 48 weeks. Participants completed the VISA-A, the Patient Reported Outcomes Measurement Information System short form Version 2.0 (PROMIS) Physical Function and Pain Interference subscales, and the Tampa Scale for Kinesiophobia (TSK). Three thresholds were evaluated with a receiver operating characteristic analysis (minimal clinically important difference [MCID], substantial benefit [SB], and complete recovery [CR]) using an 11-point global rating of change scale as an anchor. Thresholds were evaluated on raw scores as well as changes from baseline.Results:The VISA-A was able to detect all 3 thresholds for changes over time, with raw scores>70.5,>77.5, and>89.5 representing the MCID, SB, and CR, respectively; thresholds for changes from baseline on the VISA-A were increases of 23.5, 19.5, and 37.5 points from baseline, respectively. The PROMIS subscale raw scores had identical thresholds for SB and CR (52.45 for Physical Function and 45.6 for Pain Interference). A score
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-12T05:44:00Z
  DOI: 10.1177/23259671221108950
  Issue No: Vol. 10, No. 8 (2022)
External Validation of the FEAR Index in Borderline Acetabular Dysplasia
- Authors: Maria T. Schwabe, John C. Clohisy, Elizabeth A. Graesser, Cecilia Pascual-Garrido, Jeffrey J. Nepple
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:Given the lack of established, externally validated criteria for the diagnosis of unstable hips, the Femoro-Epiphyseal Acetabular Roof (FEAR) index has been proposed as a useful tool for identifying hips with instability in the setting of borderline acetabular dysplasia.Purposes:To (1) determine the external performance of the FEAR index in identifying hips with a clinical diagnosis of instability in the setting of borderline dysplasia and (2) assess the performance of the FEAR index compared with acetabular inclination or physeal scar angle alone.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:The authors reviewed 176 patients with borderline acetabular dysplasia (lateral center-edge angle, 20°-25°). A positive FEAR index was defined as ≥5°. An alternative threshold ≥2° was also assessed. Significant instability was determined by the senior surgeon based on the combination of patient and radiographic features; unstable hips were treated with periacetabular osteotomy (with or without hip arthroscopy), and stable hips were treated with isolated hip arthroscopy.Results:Only 18% of borderline hips had a positive FEAR index. The ≥5° positive FEAR index threshold had a sensitivity of 33% (23/70) and specificity of 92% (98/106) in predicting the clinical diagnosis of instability. The ≥2° FEAR index threshold had a sensitivity of 39% (27/70) and specificity of 89% (94/106) in predicting the clinical diagnosis of instability. No alternative threshold for the FEAR index resulted in high levels of sensitivity and specificity. A threshold of –5° was required to reach an adequate sensitivity of 74%. The FEAR index remained a significant predictor of hip instability even after controlling for acetabular inclination (odds ratio, 1.12; P < .001) or physeal scar angle (odds ratio, 1.6; P < .001).Conclusion:In the current study, a positive FEAR index was generally indicative of the presence of clinical instability, but the FEAR index alone remained inadequate to fully define the instability of a given hip, as it demonstrated low sensitivity (only 33%) in the external validation. The FEAR index is best used in the context of other clinical and radiographic features.
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-11T07:46:03Z
  DOI: 10.1177/23259671221113837
  Issue No: Vol. 10, No. 8 (2022)
A 3-Dimensional Classification for Degenerative Glenohumeral Arthritis
Based on Humeroscapular Alignment
- Authors: Benjamin D. Kleim, Maximillian Hinz, Stephanie Geyer, Bastian Scheiderer, Andreas B. Imhoff, Sebastian Siebenlist
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:Seminal classifications of degenerative arthritis of the shoulder (DAS) describe either cuff tear arthropathy in the coronal plane or primary osteoarthritis in the cross-sectional plane. None consider a biplanar eccentricity.Purpose/Hypothesis:The purpose of this study was to investigate humeroscapular alignment (HSA) of patients with DAS in both the anteroposterior (A-P) and superoinferior (S-I) planes on computed tomography (CT) after 3-dimensional (3D) reconstruction and develop a classification based on biplanar HSA in 9 quadrants. It was hypothesized that biplanar eccentricity would occur frequently.Study Design:Cross-sectional study; Level of evidence, 3.Methods:The authors analyzed 130 CT scans of patients who had undergone shoulder arthroplasty. The glenoid center, trigonum, and inferior angle of the scapula were aligned in a single plane using 3D reconstruction software. Subluxation of the HSA was measured as the distance from the center of rotation of the humeral head to the scapular axis (line from trigonum through glenoid center) and was expressed as a percentage of the radius of the humeral head in both the A-P and the S-I directions. HSA was described in terms of A-P alignment first (posterior/central/anterior), then S-I alignment (superior/central/inferior), for a total of 9 different alignment combinations. Additionally, glenoid erosion was graded 1-3.Results:Subluxation of the HSA was 74.1% posterior to 23.5% anterior in the A-P direction and 17.2% inferior to 68.6% superior in the S-I direction. A central HSA was calculated as between 20% posterior to 5% anterior (A-P) and 5% inferior to 20% superior (S-I), after a graphical analysis. Posterior subluxation>60% of the radius was labeled as extraposterior, and static acetabularization was labeled as extrasuperior. Overall, 21 patients had central-central, 40 centrosuperior, and 1 centroinferior alignment. Of 60 shoulders with posterior subluxation, alignment was posterocentral in 31, posterosuperior in 25, and posteroinferior in 5. There were 3 patients with anterocentral and 4 anterosuperior subluxation; in addition, 4 cases with extraposterior and 17 with extrasuperior subluxation were identified.Conclusion:There was a high prevalence of biplanar eccentricity in DAS. The 3D classification system using combined HSA and glenoid erosion can be applied to describe DAS comprehensively.
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-11T07:26:19Z
  DOI: 10.1177/23259671221110512
  Issue No: Vol. 10, No. 8 (2022)
Arthroscopic Extensor Carpi Radialis Brevis Tenotomy and Debridement
Versus Debridement Alone for Refractory Lateral Epicondylitis: Clinical
and MRI Evaluation
- Authors: Hong Li, Xiang Dong Yang, XiaoAo Xue, Qingguo Zhang, Lingchao Ye, Yinghui Hua, Xiaobo Zhou
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:Arthroscopic debridement of the extensor carpi radialis brevis (ECRB) tendon is a widely accepted procedure used in refractory lateral epicondylitis. However, residual pain occurs in some patients.Purpose:To investigate the clinical effectiveness of arthroscopic extended debridement (ECRB tenotomy and debridement) in the treatment of lateral epicondylitis.Study Design:Cohort study; Level of evidence, 3.Methods:Patients with refractory lateral epicondylitis were consecutively recruited for this study. They underwent traditional ECRB debridement (control group) or extended ECRB debridement (ED group) under arthroscopy. The Disabilities of the Arm, Shoulder and Hand (DASH) score, visual analog scale (VAS) for pain, and Mayo Elbow Performance Score (MEPS) were used to compare elbow function between the groups at 3, 6, and 12 months postoperatively. Magnetic resonance imaging (MRI) was also performed to evaluate pathology at 12 months.Results:A total of 69 patients participated in the study (33 patients in the ED group and 36 in the control group). After surgery, all patients showed improvement on all 3 outcome scores. Compared with the control group, the ED group had significantly better postoperative MEPS and VAS scores at 3 months (P ≤ .001 for both) and 6 months (P ≤ .03 for both) but similar values at 12 months. DASH scores between groups were similar at all time periods. At the 12-month follow-up, no patients in the ED group reported pain with strenuous work. Return-to-work (RTW) times were also shorter in the ED group compared with the controls (8 ± 4 vs 18 ± 8 weeks; P < .001). Postoperative MRI assessments revealed no high signal intensities on the lateral epicondyle in the ED group, while there was an increased internal signal intensity on the lateral epicondyle in 83% of the controls.Conclusion:Collectively, the extended ECRB debridement technique resulted in enhanced pain relief in the early postoperative period as well as providing faster RTW times compared with the traditional debridement technique. At 1 year follow-up, there were no differences in outcome measures between groups, but residual abnormal MRI findings were more common in the traditional debridement group.
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-05T10:16:04Z
  DOI: 10.1177/23259671221092733
  Issue No: Vol. 10, No. 8 (2022)
Revision Rates After Primary ACL Reconstruction Performed Between 1969 and
2018: A Systematic Review and Metaregression Analysis
- Authors: Rasmus J. Liukkonen, Ville T. Ponkilainen, Aleksi Reito
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:Numerous studies, including randomized controlled trials (RCTs), have been published on the optimal graft choice for primary anterior cruciate ligament (ACL) reconstruction.Purpose:To review existing studies to investigate whether advances in orthopaedics have affected revision rates after primary ACL reconstruction.Study Design:Systematic review; Level of evidence, 4.Methods:The PubMed database was searched from inception to December 31, 2020, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Patient series, observational studies, clinical trials, and registry-based studies investigating primary ACL reconstruction were included, as were high-quality RCTs from an additional study. The minimum required follow-up time for inclusion was 1 year. The primary outcome measure was the pooled prevalence of revision ACL reconstruction. The effect of the year the surgery was performed on revision rates was evaluated with metaregression analysis. All graft types were analyzed simultaneously, and all analyses were repeated separately for each graft type.Results:Overall, 330 articles with 52,878 patients were included, with a median patient age of 28 years (range, 15-57 years). The primary ACL reconstructions were performed between 1969 and 2018. At a median of 2.3 years of follow-up, the overall revision rate was 3.14% (95% CI, 2.76% to 3.56%); it was 2.71% (95% CI, 2.25% to 3.27%) for hamstring autografts, 2.38% (95% CI, 1.82% to 3.11%) for bone–patellar tendon–bone (BPTB) autografts, and 5.24% (95% CI, 4.02% to 6.80%) for other graft types. For hamstring grafts, the revision rate increased over time (year of surgery), with a 0.0434 (95% CI, 0.0150 to 0.0718) increase effect in the logit-transformed scale for every additional year. There was a slight decrease in revision rates for BPTB (β = –0.0049; 95% CI, –0.0352 to 0.0254) and other graft types (β = –0.0306; 95% CI, –0.0608 to −0.0005) over time; however, confidence intervals for BPTB included the zero change.Conclusion:Based on this systematic review and meta-analysis, ACL reconstruction is a reliable procedure with overall low historical revision rates. BPTB autograft had the lowest revision rate and a slightly decreasing trend of failures during the past 45 years, although both BPTB and hamstring autografts are reliable graft choices.
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-05T02:47:24Z
  DOI: 10.1177/23259671221110191
  Issue No: Vol. 10, No. 8 (2022)
Ultrasound-Guided Anterior Talofibular Ligament Repair With Augmentation
Can Restore Ankle Kinematics: A Cadaveric Biomechanical Study
- Authors: Soichi Hattori, Kentaro Onishi, Calvin K. Chan, Satoshi Yamakawa, Yuji Yano, Philipp W. Winkler, MaCalus V. Hogan, Richard E. Debski
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:Anterior talofibular ligament (ATFL) repair of the ankle is a common surgical procedure. Ultrasound (US)-guided anchor placement for ATFL repair can be performed anatomically and accurately. However, to our knowledge, no study has investigated ankle kinematics after US-guided ATFL repair.Hypothesis:US-guided ATFL repair with and without inferior extensor retinaculum (IER) augmentation will restore ankle kinematics.Study Design:Controlled laboratory study; Level of evidence, 4.Methods:A 6 degrees of freedom robotic testing system was used to apply multidirectional loads to fresh-frozen cadaveric ankles (N = 9). The following ankle states were evaluated: ATFL intact, ATFL deficient, combined ATFL repair and IER augmentation, and isolated US-guided ATFL repair. Three loading conditions (internal-external rotation torque, anterior-posterior load, and inversion-eversion torque) were applied at 4 ankle positions: 30° of plantarflexion, 15° of plantarflexion, 0° of plantarflexion, and 15° of dorsiflexion. The resulting kinematics were recorded and compared using a 1-way repeated-measures analysis of variance with the Benjamini-Hochberg test.Results:Anterior translation in response to an internal rotation torque significantly increased in the ATFL-deficient state compared with the ATFL-intact state at 30° and 15° of plantarflexion (P = .022 and .03, respectively). After the combined US-guided ATFL repair and augmentation, anterior translation was reduced significantly compared with the ATFL-deficient state at 30° and 15° of plantarflexion (P = .0012 and .005, respectively). Anterior translation was not significantly different for the isolated ATFL-repair state compared with the ATFL-deficient or ATFL-intact states at 30° and 15° of plantarflexion.Conclusion:Combined US-guided ATFL repair with augmentation of the IER reduced lateral ankle laxity due to ATFL deficiency. Isolated US-guided ATFL repair did not reduce laxity due to ATFL deficiency, nor did it increase instability compared with the intact ankle.Clinical Relevance:US-guided ATFL repair with IER augmentation is a minimally-invasive technique to reduce lateral ankle laxity due to ATFL deficiency. Isolated US-guided ATFL repair may be a viable option if accompanied by a period of immobilization.
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-05T02:39:18Z
  DOI: 10.1177/23259671221111397
  Issue No: Vol. 10, No. 8 (2022)
Magnetic Resonance Imaging of Lateral Meniscus Root Tears in the Pediatric
and Adolescent Knee: Is the Diagnosis Missed, Mentioned, or Made'
- Authors: John Schlechter, Theresa Pak, Bryn Gornick, Edward McDonald
  Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 8, August 2022.
  Background:Failure to address meniscus root tears may place undue loads on anterior cruciate ligament (ACL) reconstructive surgery in the adult population. Because the intraoperative management of lateral meniscus posterior root tears (LMPRTs) may diverge from standard meniscal work and requires specialty items, preoperative diagnosis may be advantageous.Purpose:To evaluate the reliability of radiologist interpretations of preoperative knee magnetic resonance imaging (MRI) scans of lateral meniscus root pathology in a mixed pediatric and adolescent population.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:A retrospective review of medical records was performed to identify patients younger than 18 years with an arthroscopically confirmed LMPRT who underwent knee arthroscopy between March 1, 2010, and April 1, 2020. Arthroscopic findings were compared with the reading radiologist’s preoperative MRI interpretations, and patients were stratified into 2 groups: (1) LMPRT diagnosis made preoperatively or (2) diagnosis missed or only mentioned to describe pathology nonspecific to the root. Variables such as body mass index (BMI), open physes, time from injury to MRI, time from MRI to surgery, MRI magnet field strength, musculoskeletal radiologist designation, insurance type, and tear grade were assessed between groups.Results:Overall, 1116 knee arthroscopies were performed, with 49 LMPRTs found; all 49 LMRPTs were found concomitantly with ACL tears (49/535; 9.2%). The average patient age was 15.97 years (range, 11.52-17.97 years). There were 50 MRI scans for 49 patients. An LMPRT was diagnosed based on preoperative MRI scans in 12 of these 50 scans (24%) and mentioned or missed in 38 of the 50 scans (76%). No significant difference was seen between the diagnosis-made versus diagnosis-mentioned/missed groups in BMI, skeletal maturity, time from injury to MRI, time from MRI to surgery, MRI magnet strength, fellowship training of the reading radiologist, tear grade, or insurance type.Conclusion:In 76% of patients, a definitive diagnosis of LMPRT was not made on preoperative MRI scans. Notably, all LMPRTs found intraoperatively were found concomitantly with ACL tears.
  Citation: Orthopaedic Journal of Sports Medicine
  PubDate: 2022-08-02T03:55:57Z
  DOI: 10.1177/23259671221114629
  Issue No: Vol. 10, No. 8 (2022)