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SPORTS MEDICINE (77 journals)

Showing 1 - 79 of 79 Journals sorted alphabetically
American Journal of Sports Medicine     Hybrid Journal   (Followers: 165)
American Journal of Sports Science and Medicine     Open Access   (Followers: 39)
Archives of Sports Medicine and Physiotherapy     Open Access   (Followers: 2)
Arthroscopy, Sports Medicine, and Rehabilitation     Open Access   (Followers: 2)
Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology     Open Access   (Followers: 6)
Asian Journal of Sports Medicine     Open Access   (Followers: 11)
B&G Bewegungstherapie und Gesundheitssport     Hybrid Journal   (Followers: 2)
Baltic Journal of Sport and Health Sciences     Open Access   (Followers: 2)
Biomedical Human Kinetics     Open Access   (Followers: 8)
BMJ Open Sport & Exercise Medicine     Open Access   (Followers: 18)
British Journal of Sports Medicine     Hybrid Journal   (Followers: 78)
Case Studies in Sport and Exercise Psychology     Hybrid Journal   (Followers: 7)
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: 32)
Current Sports Medicine Reports     Full-text available via subscription   (Followers: 21)
European Journal of Sport Science     Hybrid Journal   (Followers: 66)
Exercise and Sport Sciences Reviews     Hybrid Journal   (Followers: 55)
German Journal of Exercise and Sport Research : Sportwissenschaft     Hybrid Journal   (Followers: 2)
International Journal of Athletic Therapy & Training     Hybrid Journal   (Followers: 15)
International Journal of Kinesiology and Sports Science     Open Access   (Followers: 18)
International Journal of Sport Nutrition & Exercise Metabolism     Hybrid Journal   (Followers: 83)
International Journal of Sports Medicine     Hybrid Journal   (Followers: 33)
International Journal of Sports Physiology and Performance     Hybrid Journal   (Followers: 22)
Journal of Aging and Physical Activity     Hybrid Journal   (Followers: 11)
Journal of Athletic Enhancement     Hybrid Journal   (Followers: 6)
Journal of Clinical Sport Psychology     Hybrid Journal   (Followers: 9)
Journal of Education, Health and Sport     Open Access   (Followers: 3)
Journal of Exercise & Organ Cross Talk     Open Access   (Followers: 4)
Journal of Functional Morphology and Kinesiology     Open Access  
Journal of Human Kinetics     Open Access   (Followers: 16)
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     Hybrid Journal   (Followers: 37)
Journal of Sport & Social Issues     Hybrid Journal   (Followers: 10)
Journal of Sport and Exercise Psychology     Hybrid Journal   (Followers: 23)
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: 22)
Journal of Sports Sciences     Hybrid Journal   (Followers: 34)
Journal of the International Society of Sports Nutrition     Open Access   (Followers: 55)
Knie Journal     Hybrid Journal  
Medicine & Science in Sports & Exercise     Hybrid Journal   (Followers: 59)
Motor Control     Hybrid Journal   (Followers: 7)
Movement & Sport Sciences : Science & Motricité     Full-text available via subscription   (Followers: 1)
OA Sports Medicine     Open Access   (Followers: 6)
Open Access Journal of Sports Medicine     Open Access   (Followers: 15)
Operative Techniques in Sports Medicine     Full-text available via subscription   (Followers: 1)
Physical Therapy in Sport     Hybrid Journal   (Followers: 41)
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)
Saudi Journal of Sports Medicine     Open Access   (Followers: 1)
Scandinavian Journal of Medicine & Science In Sports     Hybrid Journal   (Followers: 29)
Science & Sports     Hybrid Journal   (Followers: 9)
Science and Medicine in Football     Hybrid Journal   (Followers: 1)
Spor Bilimleri Dergisi / Hacettepe Journal of Sport Sciences     Open Access  
Spor ve Performans Araştırmaları Dergisi / Ondokuz Mayıs University Journal of Sports and Performance Researches     Open Access  
Sport Science and Health     Open Access   (Followers: 1)
Sport Sciences for Health     Hybrid Journal   (Followers: 5)
Sport, Education and Society     Hybrid Journal   (Followers: 12)
Sport, Ethics and Philosophy     Hybrid Journal   (Followers: 2)
Sport, Exercise, and Performance Psychology     Full-text available via subscription   (Followers: 13)
Sportphysio     Hybrid Journal  
Sports Health: A Multidisciplinary Approach     Hybrid Journal   (Followers: 4)
Sports Medicine     Full-text available via subscription   (Followers: 38)
Sports Medicine - Open     Open Access   (Followers: 12)
Sports Medicine and Arthroscopy Review     Full-text available via subscription   (Followers: 10)
Sports Medicine and Health Science     Open Access  
Sports Medicine International Open     Open Access   (Followers: 2)
Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology     Open Access   (Followers: 16)
Sportverletzung · Sportschaden     Hybrid Journal   (Followers: 2)
Sri Lankan Journal of Sports and Exercise Medicine     Open Access  
Translational Sports Medicine     Hybrid Journal  
Video Journal of Sports Medicine     Open Access  
Zeitschrift für Sportpsychologie     Hybrid Journal  
Similar Journals
Journal Cover
American Journal of Sports Medicine
Journal Prestige (SJR): 3.949
Citation Impact (citeScore): 6
Number of Followers: 165  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0363-5465 - ISSN (Online) 1552-3365
Published by Sage Publications Homepage  [1174 journals]
  • The Contribution of Posterior Capsule Hypertrophy to Soft Tissue
           Glenohumeral Internal Rotation Deficit in Healthy Pitchers: Response

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      Authors: Stephen J. Thomas, Ryan Paul
      Abstract: The American Journal of Sports Medicine, Volume 50, Issue 10, Page NP39-NP40, August 2022.

      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-01T03:07:22Z
      DOI: 10.1177/03635465221103564
      Issue No: Vol. 50, No. 10 (2022)
       
  • The Contribution of Posterior Capsule Hypertrophy to Soft Tissue
           Glenohumeral Internal Rotation Deficit in Healthy Pitchers: Letter to the
           Editor

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      Authors: Toru Omodani, Ryan P. Nussbaum, Kentaro Onishi
      Abstract: The American Journal of Sports Medicine, Volume 50, Issue 10, Page NP39-NP39, August 2022.

      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-01T03:06:49Z
      DOI: 10.1177/03635465221103565
      Issue No: Vol. 50, No. 10 (2022)
       
  • Top 5 AJSM Papers in Epidemiology and Statistics Over the Past 50 Years

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      Authors: James L. Carey
      Pages: 2595 - 2597
      Abstract: The American Journal of Sports Medicine, Volume 50, Issue 10, Page 2595-2597, August 2022.

      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-01T03:02:45Z
      DOI: 10.1177/03635465221113347
      Issue No: Vol. 50, No. 10 (2022)
       
  • Defining the Minimal Clinically Important Difference and Patient
           Acceptable Symptom State After Endoscopic Gluteus Medius or Minimus Repair
           With or Without Labral Treatment and Routine Capsular Closure at Minimum
           5-Year Follow-up

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      Authors: Morgan W. Rice, Lakshmanan Sivasundaram, Mario Hevesi, Robert B. Browning, Thomas D. Alter, Katlynn Paul, Shane J. Nho
      Pages: 2629 - 2636
      Abstract: The American Journal of Sports Medicine, Volume 50, Issue 10, Page 2629-2636, August 2022.
      Background:There is a paucity of information in the literature on midterm outcomes of endoscopic gluteus medius and/or minimus repair with concomitant labral treatment using only modern surgical techniques.Purpose:To define the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) at a minimum of 5 years postoperatively for patients undergoing endoscopic hip abductor repair with routine capsular closure.Study Design:Case series; Level of evidence, 4.Methods:Consecutive patients who underwent primary endoscopic repair of gluteus medius and/or minimus tears between January 2012 and December 2015 by the senior author were eligible for inclusion. Patient-reported outcome scores were assessed preoperatively and at 5 years postoperatively: Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sport Specific (HOS-SS), modified Harris Hip Score (mHHS), 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain. The MCID was uniquely calculated using the distribution method, and the PASS was determined via the anchor-based method utilizing receiver operating characteristic curves and Youden index.Results:A total of 46 patients were included in the study. The majority were female (87.0%), with a mean ± standard deviation age of 59.1 ± 8.9 years and body mass index of 27.3 ± 6.9. Significant postoperative improvements (P < .001) in each of the 5 patient-reported outcomes were observed at 5 years postoperatively. The MCID threshold values were calculated as follows: HOS-ADL, 11.5; HOS-SS, 15.1; mHHS, 13.3; iHOT-12, 11.8; and VAS, 15.8. The PASS thresholds were calculated as follows: HOS-ADL, 75.7; HOS-SS, 79.7; mHHS, 81.2; and iHOT-12, 60.8. A majority of patients achieved a clinically significant outcome, with 96.2% of patients reaching a threshold score for the MCID or PASS for at least 1 patient-reported outcome.Conclusion:Endoscopic hip abductor repair with concomitant arthroscopic labral treatment has a high rate of achievement of clinically significant outcomes and survivorship at a minimum 5-year follow-up. We defined the MCID for the HOS-ADL, HOS-SS, mHHS, iHOT-12, and VAS outcome scores to be 11.5, 15.1, 13.3, 11.8, and 15.8, respectively. The PASS threshold scores for the HOS-ADL, HOS-SS, mHHS and iHOT-12 scores of 75.7, 79.7, 81.2, and 60.8, respectively. Future researchers and clinicians can use the MCID and PASS values established in this study to better evaluate mid-term outcomes of patients undergoing hip abductor repair.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-01T03:08:45Z
      DOI: 10.1177/03635465221105469
      Issue No: Vol. 50, No. 10 (2022)
       
  • Society News

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      Pages: 2860 - 2860
      Abstract: The American Journal of Sports Medicine, Volume 50, Issue 10, Page 2860-2860, August 2022.

      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-01T02:55:49Z
      DOI: 10.1177/03635465221115718
      Issue No: Vol. 50, No. 10 (2022)
       
  • Corrigendum to “Immobilization in External Rotation and Abduction Versus
           Arthroscopic Stabilization After First-Time Anterior Shoulder Dislocation:
           A Multicenter Randomized Controlled Trial”

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      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-12T06:03:09Z
      DOI: 10.1177/03635465221119998
       
  • Corrigendum to “Early-Stage Primary Anti-inflammatory Therapy Enhances
           the Regenerative Efficacy of Platelet-Rich Plasma in a Rabbit Achilles
           Tendinopathy Model”

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      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-12T03:26:06Z
      DOI: 10.1177/03635465221120420
       
  • Risk Factors Affecting the Survival Rate of Collagen Meniscal Implant for
           Partial Meniscal Deficiency: An Analysis of 156 Consecutive Cases at a
           Mean 10 Years of Follow-up

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      Authors: Gian Andrea Lucidi, Alberto Grassi, Piero Agostinone, Stefano Di Paolo, Giacomo Dal Fabbro, Chiara D’Alberton, Nicola Pizza, Stefano Zaffagnini
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Collagen meniscal implant (CMI) is a biologic scaffold that can be used to replace meniscus host tissue after partial meniscectomy. The short-term results of this procedure have already been described; however, little is known about risk factors for failure.Purpose:To determine the factors that predict failure of meniscal scaffold implantation in a large series of patients treated at a single institution and to better define the indications for surgery.Study Design:Case-control study; Level of evidence, 3.Methods:The analysis included 186 consecutive patients with a minimum 5-year follow-up who underwent CMI scaffold implantation or combined procedures. Patients’ characteristics and details of the surgery were obtained via chart review. Patients with a Lysholm score 10 years (HR, 2.8; P = .020) were predictive of surgical or clinical failure.Conclusion:CMI for partial meniscal deficiency provided good long-term results, with 87.8% of the implants still in situ at a mean 10.9 years of follow-up. Outerbridge grade 3-4, lateral meniscal implants, and longer time from the meniscectomy to implantation of the CMI were identified as risk factors for clinical and surgical failure.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-04T12:22:01Z
      DOI: 10.1177/03635465221112635
       
  • Food and Drug Administration’s Position on Commonly Injected Biologic
           Materials in Orthopaedic Surgery: Response

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      Authors: C. Thomas Vangsness
      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-04T03:37:27Z
      DOI: 10.1177/03635465221116364
       
  • Food and Drug Administration’s Position on Commonly Injected Biologic
           Materials in Orthopaedic Surgery: Letter to the Editor

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      Authors: Andrew S. Ittleman, Shane A. Shapiro
      Abstract: The American Journal of Sports Medicine, Ahead of Print.

      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-04T03:37:07Z
      DOI: 10.1177/03635465221116119
       
  • Incidence, Timing, and Risk Factors for 5-Year Revision Surgery After
           Autologous Chondrocyte Implantation in 533 Patients

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      Authors: Stephen M. Gillinov, Andin Fosam, Patrick J. Burroughs, Christopher A. Schneble, William M. McLaughlin, Jay Moran, Andrew E. Jimenez, Jonathan N. Grauer, Michael J. Medvecky
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Autologous chondrocyte implantation (ACI) can be used to treat focal, full-thickness chondral defects of the knee. However, there is limited large-sample evidence available regarding the incidence, timing, and risk factors for revision surgery after ACI.Purpose:To assess the 5-year incidence, timing, and risk factors for revision surgery after ACI in a large national cohort.Study Design:Case series; Level of evidence, 4.Methods:The 2010-2020 PearlDiver database was queried for patients aged 20 to 59 years who underwent primary ACI of the knee without previous chondral procedures or knee arthroplasty. Revision surgery was defined as subsequent revision ACI, osteochondral allograft transplantation, osteochondral autograft transfer, unicompartmental knee arthroplasty, or total knee arthroplasty within 5 years. Kaplan-Meier analysis was used to assess both incidence and timing of revision surgery. Risk factors evaluated for revision surgery included patient age, sex, body mass index (BMI), Elixhauser Comorbidity Index (ECI) score, and previous or concomitant bony realignment procedures.Results:In total, 533 patients underwent primary ACI and met inclusion criteria. The 5-year incidence of revision surgery was 10.3%, with 63% of revisions occurring in the first 2 years after surgery. Risk factors associated with revision surgery included female sex (odds ratio, 2.58; 95% CI, 1.22-5.45; P = .013) and BMI ≥35 (odds ratio, 2.24; 95% CI, 1.01-4.94; P = .047). There was no relationship between age, ECI score, or previous or concomitant bony realignment procedures and revision surgery at 5 years (P> .05).Conclusion:In an analysis of 533 patients who underwent ACI, 10.3% required a subsequent articular cartilage procedure or conversion to knee arthroplasty in the first 5 postoperative years. Revision surgery was greatest in the first 2 postoperative years. Female sex and severe obesity (BMI, ≥35) were associated with increased risk of revision surgery, while age, ECI score, and previous or concomitant bony realignment procedures were not. These findings suggest that treatment of chondral defects of the knee with ACI is associated with durable outcomes at the 5-year follow-up.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-02T02:47:13Z
      DOI: 10.1177/03635465221111115
       
  • Influence of Sex, Race/Ethnicity, and Socioeconomic Factors on Meniscal
           Treatment With Pediatric and Adolescent ACL Reconstruction

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      Authors: Angela M. Mercurio, Ryan P. Coene, Danielle L. Cook, Lanna Feldman, Matthew D. Milewski
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The rate of anterior cruciate ligament (ACL) reconstruction is increasing over time in pediatric/adolescent populations, but there is less evidence to support how concomitant meniscal procedures are changing over time. There are also less data to suggest which characteristics are associated with meniscectomy versus meniscal repair treatment.Hypothesis:Age, sex, race/ethnicity, income, and insurance type may independently affect the rate of concomitant meniscal procedures and treatment modalities in pediatric patients with ACL reconstruction.Study Design:Descriptive epidemiology study.Methods:The Pediatric Health Information System database was queried for all patients aged ≤18 years who underwent ACL reconstruction with or without concomitant meniscal procedures from 2015 to 2019. Basic demographic data including age, sex, self-identified race/ethnicity, rural-urban commuting area code, predicted median income, and insurance status were collected. Linear regression was used to model trends and multiple logistic regression modeling was used to test for associations.Results:A total of 14,398 patients aged ≤18 years underwent ACL reconstruction during the study period, with 8337 patients (58%) having concomitant meniscal procedures with a 1.24-fold increase over 5 years. Of the concomitant meniscal treatment cohort, 41% had a meniscectomy and 59% had meniscal repair. There was a 0.82-fold change in meniscectomy and a 1.67-fold increase in meniscal repair during the study period. Male patients, older patients, Black race, living in an urban area, and those with nonprivate insurance had increased odds of undergoing a concomitant meniscal procedure (all P < .05). Patients of non-White race and those with nonprivate insurance had increased odds of having a meniscectomy versus meniscal repair (all P < .05). There were no associations detected between income bracket and the outcomes in this study.Conclusion:This study shows that in pediatric and adolescent patients undergoing ACL reconstruction, there was a rise in concomitant meniscal procedures from 2015 to 2019. In addition, patients of non-White race and those with nonprivate insurance have increased odds of undergoing meniscectomy versus meniscal repair.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-02T02:18:40Z
      DOI: 10.1177/03635465221109607
       
  • Does Degeneration of the Patellofemoral Joint After Medial Open-Wedge High
           Tibial Osteotomy Affect Clinical Outcomes'

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      Authors: Wan-Keun Yoon, Kang-Il Kim, Jun-Ho Kim, Sang Hak Lee, Myeong-Guk Jo
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Although biomechanical and clinical studies have reported adverse effects on the patellofemoral joint after medial open-wedge high tibial osteotomy (MOWHTO), there is a paucity of literature that describes outcomes longer than midterm follow-up.Purpose:We aimed to evaluate the mid- to long-term radiologic and clinical outcomes of the patellofemoral joint after MOWHTO and to assess whether radiologic deterioration of the patellofemoral joint affected clinical outcomes or survivorship after MOWHTO.Study Design:Case series; Level of evidence, 4.Methods:We retrospectively reviewed 170 knees that underwent MOWHTO and had a minimum 5-year follow-up. In radiologic evaluation, serial postoperative changes in the patellofemoral joint compared with the preoperative status were evaluated on the Merchant view according to the Kellgren-Lawrence grade. The American Knee Society (AKS) score, Knee injury and Osteoarthritis Outcome Score (KOOS), Kujala score, incidence of anterior knee pain, and survivorship were used to assess clinical outcomes. Using radiologic assessment of the patellofemoral joint, we divided the patients into a radiologic progression group and a radiologic nonprogression group to evaluate whether radiologic progression of patellofemoral arthritis affected long-term clinical outcomes and survivorship after MOWHTO.Results:The mean follow-up period was 96.3 months (range, 60-163 months). Arthritic progression of the patellofemoral joint on the Merchant view was observed in 44.9%, 56.3%, 66.0%, and 84.0% of the cases at 5, 7, 9, and 11 years, respectively. Clinical outcomes such as AKS scores and KOOS significantly improved after MOWHTO (P < .001) at the latest follow-up. The incidence of anterior knee pain was 5.3% (9/170 knees). One knee (0.6%) underwent conversion to TKA due to progressive medial osteoarthritis, so the survival rate was 99.4% at a mean follow-up of 96.3 months. Despite patellofemoral degeneration over time, there were no significant differences in clinical outcomes or survivorship between patients with and without radiologic progression at the latest follow-up.Conclusion:Although degeneration of the patellofemoral joint was observed with time after MOWHTO, the related symptoms were minimal and arthritic changes in the patellofemoral joint did not affect the clinical outcomes or survivorship after MOWHTO over a mid- to long-term follow-up.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-01T09:24:45Z
      DOI: 10.1177/03635465221113324
       
  • Transplantation of Parathyroid Hormone–Treated Achilles Tendon Promotes
           Meniscal Regeneration in a Rat Meniscal Defect Model

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      Authors: Kazuya Nishino, Yusuke Hashimoto, Yohei Nishida, Kumi Orita, Junsei Takigami, Hiroaki Nakamura
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Autologous tendon grafts are used for meniscal reconstruction of surgically removed knee joint meniscus. However, as meniscal reconstruction cannot prevent the progression of cartilage degeneration, additional procedures that confer meniscus-like histological properties to the transplanted tendon are required for improved outcomes.Hypotheses:Parathyroid hormone (PTH)(1-34) induces cartilage formation in the rat tendon, and transplantation of PTH-treated tendon promotes meniscal regeneration.Study Design:Controlled laboratory study.Methods:Rat Achilles tendon–derived cells were cultured with or without PTH for 28 days and stained with Alcian blue to determine chondrogenic differentiation. After 14 and 28 days of incubation, gene expression was assessed using quantitative real-time polymerase chain reaction. In an in vivo study, rat Achilles tendon was injected with PTH and then transplanted onto a medial meniscal defect. Macroscopic and histological assessments of the regenerated meniscus and of cartilage degeneration in the tibial plateau were performed at 4 and 8 weeks after surgery.Results:In vitro, PTH-treated cells showed better staining with Alcian blue than the control (normal medium) group. PTH1R, Col2a1, Sox9, and RUNX2 were significantly upregulated in PTH-treated cells (P < .05). Macroscopically, the in vivo results revealed more prominent meniscal coverage and lesser progression of articular cartilage degeneration in the PTH group than in the phosphate-buffered saline–injected group. Histologically, toluidine blue staining revealed metachromasia in the PTH-injected tissue at 4 and 8 weeks. The PTH-treated regenerated meniscus showed positive immunostaining for type II collagen in the area exhibiting metachromasia. Moreover, PTH-treated tendon had an enhanced histological score compared with the untreated group at 4 and 8 weeks (P < .05).Conclusion:PTH(1-34) induced cartilage formation in the rat tendon. Transplantation of PTH(1-34)–treated Achilles tendon in a rat meniscal defect model induced meniscal regeneration and preserved knee articular cartilage. Macroscopically, PTH groups showed a greater coverage of the regenerated meniscus. Histologically, the regenerated meniscus had higher cartilaginous matrix content in rats transplanted with PTH-treated tendons. PTH(1-34) stimulated tendon-derived cells to promote chondrogenic differentiation.Clinical Relevance:Meniscal transplantation using PTH-injected autologous tendon grafts might promote meniscal regeneration and prevent progression of cartilage degeneration by stimulating chondrogenic differentiation of tendon-derived cells.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-01T09:11:36Z
      DOI: 10.1177/03635465221112954
       
  • Bilateral Alterations in Isokinetic Strength and Knee Biomechanics During
           Side-Cutting 1 Year After Unilateral ACL Reconstruction

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      Authors: Huijuan Shi, Shuang Ren, Hongshi Huang, Hui Liu, Zixuan Liang, Yuanyuan Yu, Hanjun Li, Yingfang Ao
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Individuals with anterior cruciate ligament (ACL) reconstruction (ACLR) are a population that has a higher risk for ACL injury compared with the general population. To reduce the reinjury rate and improve the rehabilitation outcome after ACLR, risk factors for ACL injury have to be addressed.Purpose:To compare the knee biomechanics during side-cutting and isokinetic strength of the thigh muscle of the reconstructed leg with those of the contralateral leg and healthy controls and investigate the knee movement asymmetries in individuals with ACLR.Study Design:Controlled laboratory study.Methods:A total of 16 participants with ACLR (ACLR group; 11.8 ± 1.1 months after reconstruction) and 16 healthy controls (control group) were recruited. Landmark coordinates and ground-reaction forces during side-cutting and isokinetic strength of hamstring and quadriceps were collected. Two-way analysis of variance with the mixed design was performed to compare each dependent variable between groups and across legs.Results:The reconstructed leg had a significantly smaller knee flexion angle (P = .004) and less quadriceps strength (P = .003) than the contralateral leg. The knee extension moment and knee external rotation angle were decreased compared with both the contralateral leg (P = .001, P = .003, respectively) and the healthy control leg (P = .001, P = .001, respectively). The ACLR group showed greater knee abduction angles (P = .004) and smaller knee external rotation moments (P = .006) than the control group. The ACLR group also demonstrated greater asymmetries of knee flexion angle (P = .015), knee external rotation angle (P = .001), knee extension moment (P = .013), knee abduction moment (P = .001), and quadriceps strength (P = .046) than the control group.Conclusion:Knee biomechanics in the leg with ACLR were altered mainly in the sagittal plane during side-cutting compared with the contralateral leg. The altered movement patterns between the ACLR and control groups were primarily observed in the frontal and transverse planes. The ACLR group also demonstrated greater asymmetries of sagittal knee movement and concentric quadriceps strength than the control group.Clinical Relevance:Individuals with ACLR showed different alterations in the reconstructed and contralateral leg compared with healthy controls. These results suggest that rehabilitation programs after ACLR should further focus on restoring the knee flexion angle and quadriceps strength. Injury prevention programs need to be further targeted in the altered movement patterns observed between the ACLR and the healthy groups.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-01T08:55:59Z
      DOI: 10.1177/03635465221112940
       
  • ACL Graft Matching: Cadaveric Comparison of Microscopic Anatomy of
           Quadriceps and Patellar Tendon Grafts and the Femoral ACL Insertion Site

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      Authors: Takuya Kinoshita, Yusuke Hashimoto, Ken Iida, Hiroaki Nakamura
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The optimal graft choice between the bone–patellar tendon–bone (BPTB) and the quadriceps tendon remains controversial. Studies evaluating the microscopic anatomy of the quadriceps tendon–patellar bone (QTB) and BPTB grafts for anterior cruciate ligament (ACL) reconstruction are currently lacking.Hypothesis:The relationship between post–ACL reconstruction graft bending angle (GBA) and the angle corresponding to the GBA (cGBA) would indicate that the BPTB can bend more than the QTB at the femoral tunnel aperture.Study Design:Controlled laboratory study.Methods:Twenty paired human cadaveric knees fixed at
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-08-01T07:22:05Z
      DOI: 10.1177/03635465221110895
       
  • Buccally Absorbed Cannabidiol Shows Significantly Superior Pain Control
           and Improved Satisfaction Immediately After Arthroscopic Rotator Cuff
           Repair: A Placebo-Controlled, Double-Blinded, Randomized Trial

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      Authors: Michael J. Alaia, Eoghan T. Hurley, Kinjal Vasavada, Danielle H. Markus, Briana Britton, Guillem Gonzalez-Lomas, Andrew S. Rokito, Laith M. Jazrawi, Kevin Kaplan
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Despite the widespread use and sales of cannabidiol (CBD) products in the United States, there is a paucity of literature to evaluate its effectiveness, safety, or ideal route of administration for postoperative pain.Purpose:To evaluate the potential analgesic effects of buccally absorbed CBD in patients who have undergone arthroscopic rotator cuff repair (ARCR).Study Design:Randomized controlled trial; Level of evidence, 1.Methods:This was a US Food and Drug Administration–sanctioned, multicenter, placebo-controlled, randomized, double-blinded trial conducted in patients undergoing ARCR. Patients aged from 18 to 75 years undergoing ARCR were prospectively enrolled and randomized to the control and experimental groups. The experimental group received an oral, buccally absorbed tablet containing 25 mg of CBD 3 times a day if 80 kg, for 14 days postoperatively, while the control group received an identical placebo. Patients were followed up on days 1, 2, 7, and 14, and visual analog scale (VAS) for pain scores, opioid consumption, and satisfaction with pain control were recorded. Additionally, liver function tests were conducted on days 7 and 14 to assess safety, and nausea was monitored. P < .05 was considered to be statistically significant.Results:Overall, 100 patients were recruited, with 1 patient being excluded, for a total of 99 patients. There were no significant differences in patient demographics between the 2 groups. On day 1, the VAS pain score was significantly lower in the CBD group than in the control group (4.4 ± 3.1 vs 5.7 ± 3.2, respectively; P = .04), although this difference was no longer present on day 2 (4.7 ± 2.8 vs 5.3 ± 2.6, respectively; P = .32). On both days 1 and 2, patient satisfaction with pain control was significantly higher in the CBD group than in the control group (day 1: 7.0 ± 3.0 vs 5.6 ± 3.7, respectively [P = .04]; day 2: 7.3 ± 2.5 vs 6.0 ± 3.3, respectively [P = .03]). The quantity of opioids consumed was low in both groups, and there were no statistically significant differences in opioid consumption (P> .05). On days 7 and 14, there were no statistically significant differences in VAS scores, opioid consumption, or patient satisfaction with pain control between the CBD and control groups (P> .05 for all). There were no significant differences in liver function test results postoperatively (P> .05).Conclusion:Buccally absorbed CBD demonstrated an acceptable safety profile and showed significant promise in the reduction of pain in the immediate perioperative period after ARCR compared with the control. Further studies are currently ongoing to confirm dosing and effectiveness in other orthopaedic conditions.Registration:NCT04672252 (ClinicalTrials.gov identifier).
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-29T06:17:03Z
      DOI: 10.1177/03635465221109573
       
  • Clinical Outcomes of Osteochondral Fragment Fixation Versus Microfracture
           Even for Small Osteochondral Lesions of the Talus

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      Authors: Tomoyuki Nakasa, Yasunari Ikuta, Junichi Sumii, Akinori Nekomoto, Shingo Kawabata, Nobuo Adachi
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The bone marrow stimulation (BMS) technique is performed for osteochondral lesions of the talus (OLTs) with a lesion size of
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-28T08:48:20Z
      DOI: 10.1177/03635465221109596
       
  • Outcomes of Staged Bilateral Hip Arthroscopic Surgery in the Context of
           Femoroacetabular Impingement Syndrome: A Nested Matched-Pair Control Study
           Focusing on the Effect of Time Between Procedures

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      Authors: Hari K. Ankem, Samantha C. Diulus, Cynthia Kyin, Andrew E. Jimenez, Benjamin R. Saks, Payam W. Sabetian, David R. Maldonado, Ajay C. Lall, Benjamin G. Domb
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Bilateral hip symptoms from femoroacetabular impingement syndrome (FAIS) are a common finding in patients regardless of athletic involvement. Oftentimes, patients and surgeons choose to stage bilateral hip arthroscopic surgery.Purpose/Hypothesis:The purpose of this study was (1) to compare minimum 2-year outcomes between patients who underwent staged bilateral hip arthroscopic surgery for FAIS to a propensity score–matched control group that underwent unilateral hip arthroscopic surgery and (2) to investigate the effect of time between bilateral procedures on patient-reported outcomes (PROs). We hypothesized that, after bilateral hip arthroscopic surgery, the improvement in outcomes would be similar to that after unilateral hip arthroscopic surgery and the time duration between bilateral procedures would not affect the final outcome.Study Design:Cohort study; Level of evidence, 3.Methods:Data were retrospectively reviewed on a consecutive series of patients who underwent primary hip arthroscopic surgery at our institution between June 2008 and November 2017. Patients who underwent bilateral hip arthroscopic surgery with minimum 2-year PROs for the modified Harris Hip Score (mHHS), the Nonarthritic Hip Score (NAHS), the Hip Outcome Score–Sports Specific Subscale (HOS-SSS), patient satisfaction, and a visual analog scale (VAS) for pain were included. The study group was matched 1:1 based on age, sex, and body mass index to a control group that only required unilateral hip arthroscopic surgery. Additionally, a subanalysis was performed on the study group to determine the effect of time between arthroscopic procedures. Rates of achieving the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for the mHHS and HOS-SSS were determined. The P value was set at
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-25T03:33:55Z
      DOI: 10.1177/03635465221108955
       
  • Clinical Outcomes of Arthroscopic Bony Bankart Repair for Anterior
           Instability of the Shoulder: A Systematic Review

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      Authors: Aaron Z. Chen, Kaylre M. Greaves, Alirio J. deMeireles, Thomas A. Fortney, Bryan M. Saltzman, David P. Trofa
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Individual studies reporting the clinical outcomes of arthroscopic bony Bankart repair for anterior shoulder instability have reported excellent results but have been limited by their small sample sizes. No systematic review of the literature has been performed examining the clinical outcomes of arthroscopic bony Bankart repair.Purpose:To provide a systematic review of the literature to examine the functional outcomes, recurrence rate, and return to sports rate after arthroscopic bony Bankart repair for anterior instability of the shoulder.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted using the Cochrane Database of Systematic Reviews, Ovid/Embase, PubMed, and Web of Science. Studies that examined clinical outcomes after arthroscopic bony Bankart repair for anterior shoulder instability were included. Data pertaining to study characteristics and design, patient demographic characteristics, and clinical results, including functional outcomes, recurrence rate, and return to sports, were collected. The results from the studies were pooled, and weighted means and overall rates were calculated.Results:In total, 21 studies with 769 patients were included for analysis. Most patients were male (91.7%), the mean age was 26.7 years (range, 12-71 years), and the mean follow-up was 42.7 months (range, 6-120 months). The most commonly reported functional outcome score was the Rowe score (12 studies), which improved on average from 41.9 preoperatively to 90.8 postoperatively. The rate of recurrent instability was reported by all 21 studies, and the overall recurrence rate was 11.9% (88/738). Return to sports after arthroscopic bony Bankart repair was reported by 11 studies, with a pooled return to sports rate of 91.0% (264/290).Conclusion:Arthroscopic bony Bankart repair for anterior shoulder instability resulted in improvements in functional outcomes, a low rate of recurrent instability, and a high rate of return to sports. Although these findings are extremely promising, future prospective studies with larger sample sizes are needed to further evaluate the clinical outcomes of arthroscopic bony Bankart repair.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-06-24T05:21:52Z
      DOI: 10.1177/03635465221094832
       
  • Clinical and Magnetic Resonance Imaging Outcomes After Microfracture
           Treatment With and Without Augmentation for Focal Chondral Lesions in the
           Knee: A Systematic Review and Meta-analysis

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      Authors: Luc M. Fortier, Derrick M. Knapik, Suhas P. Dasari, Evan M. Polce, Filippo Familiari, Safa Gursoy, Jorge Chahla
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Focal cartilage lesions represent a common source of knee pain and disability, with the potential for the development and progression of osteoarthritis. Currently, microfracture (MFx) represents the most utilized first–line surgical treatment for small, focal chondral lesions. Recent investigations have examined methods of overcoming the limitations of MFx utilizing various augmentation techniques.Purpose:To perform a systematic review and meta–analysis evaluating clinical and radiographic outcomes in patients undergoing isolated MFx versus MFx augmented with orthobiologics or scaffolds for focal chondral defects of the knee.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:A systematic review was performed to identify studies evaluating outcomes and adverse events in patients undergoing isolated MFx versus augmented MFx for focal chondral defects in the knee from 1945 to June 1, 2021. Data were extracted from each article that met the inclusion/exclusion criteria. Meta-analyses were performed for all outcomes reported in a minimum of 3 studies.Results:A total of 14 studies were identified, utilizing 7 different types of injectable augmentation regimens and 5 different scaffolding regimens. Across the 14 studies, a total of 744 patients were included. The mean patient age was 46.8 years (range, 34-58 years), and 58.3% (n = 434/744) of patients were women. The mean final follow–up time was 26.7 months (range, 12-60 months). The mean chondral defect size ranged from 1.3 to 4.8 cm2. A post hoc analysis comparing mean improvement in postoperative outcomes scores compared with preoperative values found no significant differences in the improvement in the visual analog scale (VAS), International Knee Documentation Committee (IKDC), or Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores between patients undergoing isolated MFx and those undergoing MFx + augmentation. Patients undergoing MFx + augmentation reported significantly greater improvements in the Lysholm score and postoperative MOCART (magnetic resonance observation of cartilage repair tissue) scores compared with the isolated MFx group.Conclusion:Patients undergoing combined MFx + augmentation reported significant improvements in mean Lysholm and MOCART scores, without significant improvements in VAS, IKDC, or WOMAC scores when compared with patients undergoing isolated MFx.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-06-23T01:16:16Z
      DOI: 10.1177/03635465221087365
       
  • Patients Who Return to Sport After Primary Anterior Cruciate Ligament
           Reconstruction Have Significantly Higher Psychological Readiness: A
           Systematic Review and Meta-analysis of 3744 Patients

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      Authors: Michelle Xiao, Maike van Niekerk, Nikunj N. Trivedi, Calvin E. Hwang, Seth L. Sherman, Marc R. Safran, Geoffrey D. Abrams
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Although objective outcomes assessing knee function are essential measurements for return to sport, psychological factors have become increasingly recognized as equally important parameters for determining an athlete’s ability to return to sport after surgery.Purpose:To systematically review the literature to determine whether patients who returned to sport after anterior cruciate ligament (ACL) reconstruction had improved psychological scores (as measured with validated questionnaires) compared with patients who did not return to sport.Study Design:Systematic review and meta-analysis; Level of evidence, 3.Methods:A systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and was preregistered on PROSPERO. Four databases were searched for level 1 to 3 studies that compared at least 1 psychological outcome measured by a validated questionnaire for patients who did and did not return to sport after primary ACL reconstruction. The following data were recorded: study and patient characteristics; psychological metrics (ACL–Return to Sport Injury [ACL-RSI] scale, Knee Self-Efficacy Scale [K-SES], and Tampa Scale of Kinesiophobia [TSK/TSK-11]); International Knee Documentation Committee (IKDC) score; and clinical metrics. Study methodological quality was analyzed using the methodological index for non-randomized studies (MINORS), and the mean difference (MD) and 95% CI were calculated for each psychological outcome score using the inverse variance method.Results:We included and analyzed 16 articles (3744 patients; 38.9% female; mean age range, 17-28.7 years; mean MINORS score, 19.9 ± 1.4). Overall, 61.8% of athletes returned to sport (66.8% of male patients; 55.4% of female patients). Patients who returned scored significantly higher on the ACL-RSI scale (MD, 20.8; 95% CI, 15.9 to 25.7; P < .001), significantly higher on the K-SES (MD, 1.3; 95% CI, 0.2 to 2.3; P = .036), and significantly lower on the TSK/TSK-11 (MD, 10.1%; 95% CI, −12.1% to −8.2%; P = .004). Those returning to sport did not exceed the minimal clinically important difference for IKDC score versus those not returning to sport.Conclusion:Patients who returned to sport after primary ACL reconstruction had significantly higher psychological readiness, higher self-efficacy, and lower kinesiophobia compared with those who did not return to sport, despite having clinically similar knee function scores. Evaluation of psychological readiness, in combination with other objective measurements, is a critical component of return-to-sport evaluation in athletes after primary ACL reconstruction.Registration:CRD42021284735 (PROSPERO).
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-06-20T08:37:12Z
      DOI: 10.1177/03635465221102420
       
  • The Use of Intra-articular Platelet-Rich Plasma as a Therapeutic
           Intervention for Hip Osteoarthritis: A Systematic Review and Meta-analysis
           

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      Authors: Anthony Lim, John B. Zhu, Vikas Khanduja
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:There is a cohort of patients in whom hip preservation surgery is not indicated, because they have developed signs of early osteoarthritis (OA), and nor can they have a hip replacement, as they are too early in the disease process. Management of this cohort of patients is not standardised and both pharmacological and nonpharmacological measures are utilised to reduce pain. Interventions available for early OA include intra-articular injections of steroids, viscosupplementation and more recently platelet-rich plasma (PRP). However, the use of PRP in hip OA has not yet been studied systematically.Purpose:To assess intra-articular PRP as a therapeutic intervention for hip OA, including the duration of efficacy, influence of dose and composition of PRP, and the incidence of adverse effects.Study Design:A systematic review and meta-analysis; Level of evidence, 4.Methods:We performed literature searches on the MEDLINE, EMBASE, CINAHL, WEB OF SCIENCE, COCHRANE, and SCOPUS databases, and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Data were pooled using random-effects meta-analysis. We assessed the quality of the included studies using the methodological index for non-randomized studies instrument, with an additional assessment for randomized controlled trials with the revised Cochrane risk of bias tool for randomized trials. This is the first study to concisely collate the available data on the use of PRP in hip OA.Results:Eight studies were included in the analysis, with data from a total of 331 patients. PRP significantly reduced pain compared with the baseline at multiple time points, with the greatest effect at the 1- to 2-month follow-up, but PRP significantly improved function only at the 1- to 2-month follow-up. A significantly larger reduction in pain was achieved with a single injection of PRP compared with multiple injections, a total injected dose of PRP
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-06-07T01:42:44Z
      DOI: 10.1177/03635465221095563
       
  • Surgical Techniques and Clinical Outcomes for Medial Epicondylitis: A
           Systematic Review

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      Authors: Alfonso Arevalo, Somnath Rao, Donald P. Willier, Christopher I. Schrock, Brandon J. Erickson, Robert A. Jack, Steven B. Cohen, Michael G. Ciccotti
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Medial epicondylitis (ME) is a pathological condition that arises in laborers and athletes secondary to repetitive wrist flexion and forearm pronation causing degeneration of the common flexor tendon. Although nonoperative management has demonstrated high rates of success, no standardized surgical technique has been established for situations when operative management is indicated.Purpose/Hypothesis:The purpose of this study was to perform a systematic review of the surgical treatment options for ME and evaluate the associated patient-reported outcomes (PROs). We hypothesized that surgical management of ME would vary across studies but no technique would prove to be superior.Study Design:Systematic review; Level of evidence, 4.Methods:Searches were conducted using PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature (CINAHL), SPORTDiscus, and Cochrane databases between 1980 and April 2020. All level 1 to 4 studies were identified that focused on surgical management and PROs in the setting of ME. Description of surgical technique and PROs were required for inclusion. Investigators independently dually abstracted and reviewed the studies for eligibility. Weighted means were calculated for demographic characteristics and available PROs.Results:Overall, 851 studies were identified according to the search criteria. A total of 16 studies met the inclusion and exclusion criteria and therefore were evaluated. Three surgical techniques were found: open (13 studies), arthroscopic (2 studies), and percutaneous (1 study). Descriptions of the open technique were subdivided into those with (7 studies) and without (6 studies) common flexor tendon repair. Analysis included 479 elbows; patients were primarily male (58.3%) with a weighted mean age of 47.2 years. Weighted mean follow-up was 4.6 years. Tennis and manual laborer were the most common sport and occupation, respectively. Surgical success ranged from 63% to 100%, with a low complication rate of 4.3%. Success rates for return to sports and work were 81%-100% and 66.7%-100%, respectively, and only 1 study reported a return to work rate
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-06-06T01:17:09Z
      DOI: 10.1177/03635465221095565
       
  • Closure of the Quadriceps Tendon Autograft Harvest Site for Anterior
           Cruciate Ligament Reconstruction: A Systematic Review

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      Authors: Wendell W. Cole, Shreya M. Saraf, Michaela Stamm, Mary K. Mulcahey
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The quadriceps tendon (QT) autograft is a commonly used and effective graft option for anterior cruciate ligament reconstruction (ACLR). Surgical techniques vary, and there is no current standard of care for management of the QT autograft harvest site.Purpose:To examine the literature on patient-reported outcomes and complications after ACLR with a QT autograft and to further clarify the frequency with which the harvest site is closed and potential biomechanical implications.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed using multiple medical databases. Level 1 to 4 studies on patients undergoing ACLR with a QT autograft were included. There were 2 independent reviewers who analyzed all studies. Study quality was analyzed using the methodological index for non-randomized studies checklist.Results:Overall, 13 studies with a total of 650 patients were included. The mean patient age for all studies was 31 years (range, 14-59 years) with a mean follow-up of 21.2 months (range, 6-84 months). Of the 13 studies, 12 studies (92%) documented patient sex, comprising 331 female patients (55%) and 274 male patients (45%). There were 8 studies (62%) that reported the use of a bony QT autograft in 273 patients, and 5 studies (38%) reported the use of a soft tissue QT autograft in 377 patients. The graft length harvested was most commonly 7 to 8 cm, while the tendon width harvested was 10 mm. Moreover, 5 studies (38%) did not discuss closure of the harvest site, while 2 studies (15%) only closed the harvest site if a capsular rent was present. The surgical technique for harvest-site closure varied when reported in 7 studies (54%). Good to excellent clinical outcomes were reported in 80% of patients when the harvest site was closed.Conclusion:Based on the results of this study, there is no consensus on whether the QT defect should be closed after harvesting the graft for ACLR. It has been reported that closure of the harvest site is performed if there is a capsular rent present. Several techniques are utilized to close the QT autograft harvest site; however, it is unclear if there is a difference in outcomes based on the technique used. Future studies should further clarify whether there are any biomechanical and clinical advantages to closing the QT autograft harvest site.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-06-06T01:15:27Z
      DOI: 10.1177/03635465221095233
       
  • Can We Identify Why Athletes Fail to Return to Sports After Arthroscopic
           Bankart Repair: A Systematic Review and Meta-analysis

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      Authors: Michael Kim, Aryan Haratian, Amir Fathi, Daniel R. Kim, Nilay Patel, Ioanna K. Bolia, Laith K. Hasan, Frank A. Petrigliano, Alexander E. Weber
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:No previous systematic reviews have reported on athletes who fail to return to sports after arthroscopic Bankart repair.Purpose:To review the literature on athletes who fail to return to sports after arthroscopic Bankart repair to determine the rate of athletes who did not return to sports and to identify the specific reasons for failure to return to sports by nonreturning athletes.Study Design:Systematic review and meta-analysis.Methods:A meta-analysis was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Three electronic databases (PubMed, Scopus, Web of Science) were queried for articles meeting the inclusion criteria. Studies were considered eligible only if reporting the rate of failure for return to sports and providing the specific reasons why athletes were unable to return to sports. All records were screened by title, abstract, and full text by 2 authors independently, with any discrepancies resolved by a third senior author. For articles selected for inclusion, data were collected on the number of athletes, average age, average follow-up time, type of sport played, rate of failure to return to sports, and specific reasons for failure to return. A random-effects model was used to conduct the meta-analysis.Results:Seventeen studies were selected for inclusion reporting on a total of 813 athletes. The calculated weighted rate of failure to return to sports after arthroscopic Bankart repair was 15.6% (95% CI, 10.9%-21.1%). A significantly higher proportion of athletes cited shoulder-dependent versus shoulder-independent reasons for failure to return to sports (81.7% vs 18.3%; P < .0001). The most cited reasons for failure to return included recurrent or persistent instability (33.3%), fear of reinjury (17.7%), apprehension (9.9%), changes in priorities or personal interest (8.5%), lack of time (7.1%), and discomfort or pain with sports (6.4%).Conclusion:Our study estimated the rate of failure to return to sports after arthroscopic Bankart repair to be 15.6%, with most athletes citing shoulder-related reasons as the primary factor precluding return. Identifying the potential reasons preventing successful return to sports can guide surgeons in counseling athletes regarding postoperative expectations and addressing hesitations for returning to sports.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-06-06T01:04:53Z
      DOI: 10.1177/03635465221089980
       
  • Surgical Management of Jones Fractures in Athletes: Orthobiologic
           Augmentation: A Systematic Review and Meta-analysis of 718 Fractures

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      Authors: Ahmed Khalil Attia, Greg A.J. Robertson, John McKinley, Pieter P. d’Hooghe, Nicola Maffulli
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The use of orthobiologics is expanding. However, the use of orthobiologic augmentation in primary fracture fixation surgery remains limited. Primary fracture fixation of the fifth metatarsal (Jones) in athletes is one of the rare situations where primary orthobiologic augmentation has been advocated.Purpose:To determine the effect of orthobiologic augmentation on the outcome of surgically managed Jones fractures in athletes.Study Design:Systematic review; Level of evidence, 4.Methods:Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent team members searched several databases including PubMed, MEDLINE, Embase, Google Scholar, Web of Science, Cochrane Library, and ClinicalTrials.gov through March 2021 to identify studies reporting on surgically managed Jones fractures of the fifth metatarsal exclusively in athletes. The primary outcomes were the return to play (RTP) rate and time to RTP, whereas the secondary outcomes were time to union, union rate, and refractures. Data were presented by type of treatment (biologically augmented fixation or fixation alone).Results:In the biologically augmented fixation group, successful RTP was reported in 195 (98.98%) of 197 fractures (odds ratio [OR], 97.5%; 95% CI, 95.8%-100%; I2 = 0), with a mean time to RTP of 10.3 weeks (95% CI, 9.5-11.1 weeks; I2 = 99%). In the group that received fixation without biological augmentation, successful RTP was reported in 516 (99.04%) of 521 fractures (OR, 98.7%; 95% CI, 97.8%-99.7%; I2 = 0], with a mean time to RTP of 9.7 weeks (95% CI, 7.84-11.53 weeks; I2 = 98.64%]. In the biologically augmented fixation group, fracture union was achieved in 194 (98.48%) of 197 fractures (OR, 97.6%; 95% CI, 95.5%-99.7%; I2 = 0%), with a mean time to fracture union of 9.28 weeks (95% CI, 7.23-11.34 weeks; I2 = 98.18%). In the group that received fixation without biological augmentation, fracture union was achieved in 407 (93.78%) of 434 fractures (OR, 97.4%; 95% CI, 96%-98.9%; I2 = 0%), with a mean time to fracture union of 8.57 weeks (95% CI, 6.82-10.32 weeks; I2 = 98.81%).Conclusion:Orthobiologically augmented surgical fixation of Jones fractures in athletes is becoming increasingly common, despite the lack of comparative studies to support this practice. Biologically augmented fixation of Jones fractures results in higher fracture union rates than fixation alone but similar rates of RTP and time to RTP. Although the current evidence recommends primary surgical fixation for the management of Jones fractures in athletes, further high quality comparative studies are required to establish the indication for orthobiologic augmentation.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-05-25T03:16:29Z
      DOI: 10.1177/03635465221094014
       
  • Lower Extremity Injury Rates on Artificial Turf Versus Natural Grass
           Playing Surfaces: A Systematic Review

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      Authors: Heath P. Gould, Stephen J. Lostetter, Eric R. Samuelson, Gregory P. Guyton
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:No study has provided a comprehensive systematic review of sports injuries on artificial turf versus natural grass.Purpose:To comprehensively examine the risk of overall injuries and multiple types of lower extremity injuries across all sports, all levels of competition, and on both old-generation and new-generation artificial turf.Study Design:Systematic review; Level of evidence, 3.Methods:A systematic review of the English-language literature was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. All included articles compared overall injury rates or lower extremity (hip, knee, or foot and ankle) injury rates on artificial turf and natural grass. All sports, levels of competition, and turf types were included. Studies were excluded if they did not include overall injury rates or lower extremity injury rates. Because of the heterogeneity of the included studies, no attempt was made to aggregate risk ratios to conduct a quantitative meta-analysis.Results:A total of 53 articles published between 1972 and 2020 were identified for study inclusion. Most studies on new-generation turf (13/18 articles) found similar overall injury rates between playing surfaces. When individual anatomic injury locations were analyzed, the greatest proportion of articles reported a higher foot and ankle injury rate on artificial turf compared with natural grass, both with old-generation (3/4 articles) and new-generation (9/19 articles) turf. Similar knee and hip injury rates were reported between playing surfaces for soccer athletes on new-generation turf, but football players, particularly those at high levels of competition, were more likely to sustain a knee injury on artificial turf than on natural grass.Conclusion:The available body of literature suggests a higher rate of foot and ankle injuries on artificial turf, both old-generation and new-generation turf, compared with natural grass. High-quality studies also suggest that the rates of knee injuries and hip injuries are similar between playing surfaces, although elite-level football athletes may be more predisposed to knee injuries on artificial turf compared with natural grass. Only a few articles in the literature reported a higher overall injury rate on natural grass compared with artificial turf, and all of these studies received financial support from the artificial turf industry.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-05-20T02:26:46Z
      DOI: 10.1177/03635465211069562
       
  • A Practical Guide to Lower Extremity Nerve Blocks for the Sports Medicine
           Surgeon

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      Authors: Connor R. Crutchfield, Eric A. Schweppe, Ajay S. Padaki, Gabrielle K. Steinl, Brian A. Roller, Anthony R. Brown, T. Sean Lynch
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Peripheral nerve blocks (PNBs) are vital in the administration of surgical analgesia and have grown in popularity for use in lower extremity arthroscopic procedures because of their capacity to safely and effectively control pain. The number and specificity of PNBs, however, have made choosing the best option for a procedure nebulous for orthopaedic surgeons.Purpose:To present a narrative literature review of the PNBs available for arthroscopic hip and knee procedures that is adapted to an audience of orthopaedic surgeons.Study Design:Narrative literature review.Methods:A combination of the names of various lower extremity PNBs AND “hip arthroscopy” OR “knee arthroscopy” was used to search the English medical literature including PubMed, Cochrane Library, ScienceDirect, Embase, and Scopus. Placement technique, specificity of blockade, efficacy, and complications were assessed. Searches were performed through May 2, 2021.Results:A total of 157 studies were included in this review of lower extremity PNBs. Femoral nerve, lumbar plexus, sciatic nerve, and fascia iliaca compartment blocks were most commonly used in arthroscopic hip surgery, while femoral nerve, 3-in-1, and adductor canal blocks were preferred for arthroscopic knee surgery. Each block demonstrated a significant benefit (P> .05) in ≥1 of the following outcomes: intraoperative morphine, pain scores, nausea, and/or opioid consumption. Combination blocks including the lateral femoral cutaneous nerve block, obturator nerve block, quadratus lumborum block, and L1 and L2 paravertebral block have also been described. Complication rates ranged from 0% to 4.8% in those administered with ultrasound guidance. The most commonly reported complications included muscular weakness, postoperative falls, neuropathy, intravascular and intraneural injections, and hematomas.Conclusion:When administered properly, PNBs were a safe and effective adjuvant method of pain control with a significant potential to limit postoperative narcotic use. While blockade choice varies by surgeon preference and procedure, all PNBs should be administered with ultrasound guidance, and vigilant protocols for the risk of postoperative falls should be exercised in patients who receive them.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-04-19T07:41:04Z
      DOI: 10.1177/03635465211051757
       
  • The Fragility Index of Statistically Significant Findings From Randomized
           Controlled Trials Comparing the Management Strategies of Anterior Shoulder
           Instability

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      Authors: Martin S. Davey, Eoghan T. Hurley, Tom R. Doyle, Hasan Dashti, Mohamed Gaafar, Hannan Mullett
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Debate centering on the management of anterior shoulder instability (ASI) in recent years has led to many randomized controlled trials (RCTs) being published on the topic. The fragility index (FI) has subsequently emerged as a novel method of assessing significant findings reported in RCTs, particularly those with small sample sizes.Purpose:To evaluate the FI of statistically significant findings in RCTs that reported the outcomes of management strategies of patients with ASI.Study Design:Systematic review; Level of evidence, 1.Methods:Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, 2 independent reviewers performed a systematic review of RCTs focusing on the outcomes of management strategies of patients with ASI. There were 3 main categories of RCTs included: (1) nonoperative management in internal rotation (IR) versus external rotation (ER), (2) nonoperative management versus a surgical intervention, and (3) surgical management with arthroscopic Bankart repair versus open Bankart repair. The Fisher exact test was utilized to calculate the FI for the reversal of statistical significance in all statistically significant dichotomous outcomes.Results:A total of 21 RCTs were included, including 1589 shoulders (mean age, 29.4 years) with a mean follow–up of 26.8 months. There were 10 RCTs (831 shoulders) that reported outcomes after the nonoperative management of ASI in IR versus ER, with a mean FI of 6.8. There were 5 RCTs (324 shoulders) that reported outcomes comparing the nonoperative and operative management of ASI, with a mean FI of 3.5. There were 6 RCTs (434 shoulders) that reported outcomes after the operative management of ASI with either arthroscopic Bankart repair or open Bankart repair, with a mean FI of 9.6.Conclusion:The overall FI of RCTs reporting the outcomes of management strategies for patients with ASI was high, suggesting a moderate fragility of statistically significant outcomes including recurrence, revision stabilization, and return to play.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-04-13T08:55:35Z
      DOI: 10.1177/03635465221077268
       
  • The Effect of the COVID-19 Pandemic on the Mental and Emotional Health of
           Athletes: A Systematic Review

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      Authors: Lori Jia, Michael V. Carter, Antonio Cusano, Xinning Li, John D. Kelly, Jessica D. Bartley, Robert L. Parisien
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The coronavirus disease 2019 (COVID-19) pandemic has caused the cancellation or postponement of virtually every sporting event, resulting in training disruptions, income loss, and career uncertainties for athletes around the world. At present, the effect of the COVID-19 pandemic on the mental and emotional health of athletes is not well understood.Purpose:To investigate the effect of the COVID-19 pandemic on the mental and emotional health of athletes and to identify risk factors associated with poor mental health outcomes.Study Design:Systematic review; Level of evidence, 4.Methods:The PubMed, Embase, and Cochrane Library databases were searched to identify all articles reporting on athletes’ mental and emotional health during the COVID-19 pandemic. Articles were selected based on relevant inclusion and exclusion criteria. Study characteristics, athlete demographics, and COVID-19 mental health data (sex-, type of sport—, and level of play—specific differences) were collected from each included article and analyzed.Results:A total of 35 studies were included in the final analysis, comprising athletes around the world and across numerous sports and levels of play. Most studies utilized at least 1 validated mental health questionnaire and assessed for outcomes such as depression, anxiety, stress, motivation, and athletic identity. Overall, athletes reported worse mental and emotional health during the COVID-19 pandemic, although these effects were attenuated by home training programs and quarantine training camps. Female sex and more elite levels of play were associated with an increased risk for poor mental health outcomes. Type of sport was associated with mixed results, with individual and team sports carrying different increased risks for poor mental and emotional health. Nearly all studies recommended the need for increased psychological support of athletes during the COVID-19 pandemic.Conclusion:The effect of the COVID-19 pandemic on the mental and emotional health of athletes is complex and multifaceted. Increased social interactions with coaches and teammates, continued access to training facilities and mental health professionals, and active utilization of healthy coping mechanisms can improve mental health outcomes for athletes in the era of COVID-19.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-04-12T10:01:08Z
      DOI: 10.1177/03635465221087473
       
  • One in Three Patients With Chronic Lateral Ankle Instability Has a
           Cartilage Lesion

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      Authors: Emma J. Wijnhoud, Quinten G.H. Rikken, Jari Dahmen, Inger N. Sierevelt, Sjoerd A.S. Stufkens, Gino M.M.J. Kerkhoffs
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Chronic lateral ankle instability (CLAI) is associated with the presence or development of intra-articular pathologies such as chondral or osteochondral lesions, or (O)CLs. Currently, the incidence of (O)CLs in patients with CLAI is unknown.Purpose:To determine the incidence of (O)CLs in patients with CLAI.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:A literature search was conducted in the PubMed (MEDLINE), Embase (Ovid), and Cochrane databases for articles published from January 2000 until December 2020. Two authors independently screened the search results and conducted the quality assessment using the methodological index for non-randomized studies (MINORS) criteria. Clinical studies were included that reported findings on the presence of ankle (O)CLs based on pre- or intraoperative diagnostic measures in patients with CLAI (>6 months of symptoms). Patient and lesion characteristics were pooled using a simplified method. Lesion characteristics included localization and chondral and osteochondral involvement. The primary outcome was the incidence of (O)CLs in ankles with CLAI. A random-effects model with 95% CIs was used to analyze the primary outcome. The distribution of (O)CLs in the ankle joint was reported according to talar or tibial involvement, with medial and lateral divisions for talar involvement.Results:Twelve studies were included with 2145 patients and 2170 ankles with CLAI. The pooled incidence of (O)CLs in ankles with CLAI was 32.2% (95% CI, 22.7%-41.7%). Among all lesions, 43% were chondral and 57% were osteochondral. Among all (O)CLs, 85% were located on the talus and 17% on the distal tibia. Of the talar (O)CLs, 68% were located medially and 32% laterally.Conclusion:(O)CLs were found in up to 32% of ankles with CLAI. The most common location was the talus (85%). Furthermore, most lesions were located on the medial talar dome (68%). These findings will aid physicians in the early recognition and treatment of ankle (O)CLs in the context of CLAI.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-04-06T03:19:54Z
      DOI: 10.1177/03635465221084365
       
  • Evidence-Based Hamstring Injury Prevention and Risk Factor Management: A
           Systematic Review and Meta-analysis of Randomized Controlled Trials

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      Authors: Samuel S. Rudisill, Nathan H. Varady, Michael P. Kucharik, Christopher T. Eberlin, Scott D. Martin
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Hamstring injuries are common among athletes. Considering the potentially prolonged recovery and high rate of recurrence, effective methods of prevention and risk factor management are of great interest to athletes, trainers, coaches, and therapists, with substantial competitive and financial implications.Purpose:To systematically review the literature concerning evidence-based hamstring training and quantitatively assess the effectiveness of training programs in (1) reducing injury incidence and (2) managing injury risk factors.Study Design:Systematic review and meta-analysis; Level of evidence, 1.Methods:A computerized search of MEDLINE, CINAHL, Cochrane Central Register of Controlled Trials, and SPORTDiscus with manual screening of selected reference lists was performed in October 2020. Randomized controlled trials investigating methods of hamstring injury prevention and risk factor management in recreational, semiprofessional, and professional adult athletes were included.Results:Of 2602 articles identified, 108 were included. Eccentric training reduced the incidence of hamstring injury by 56.8% to 70.0%. Concentric hamstring strength increased with eccentric (mean difference [MD], 14.29 N·m; 95% CI, 8.53-20.05 N·m), concentric, blood flow–restricted, whole-body vibration, heavy back squat, FIFA 11+ (Fédération Internationale de Football Association), and plyometric training methods, whereas eccentric strength benefited from eccentric (MD, 26.94 N·m; 95% CI, 15.59-38.30 N·m), concentric, and plyometric training. Static stretching produced greater flexibility gains (MD, 10.89°; 95% CI, 8.92°-12.86°) than proprioceptive neuromuscular facilitation (MD, 9.73°; 95% CI, 6.53°-12.93°) and dynamic stretching (MD, 6.25°; 95% CI, 2.84°-9.66°), although the effects of static techniques were more transient. Fascicle length increased with eccentric (MD, 0.90 cm; 95% CI, 0.53-1.27 cm) and sprint training and decreased with concentric training. Although the conventional hamstring/quadriceps (H/Q) ratio was unchanged (MD, 0.03; 95% CI, –0.01 to 0.06), the functional H/Q ratio significantly improved with eccentric training (MD, 0.10; 95% CI, 0.03-0.16). In addition, eccentric training reduced limb strength asymmetry, while H/Q ratio and flexibility imbalances were normalized via resistance training and static stretching.Conclusion:Several strategies exist to prevent hamstring injury and address known risk factors. Eccentric strengthening reduces injury incidence and improves hamstring strength, fascicle length, H/Q ratio, and limb asymmetry, while stretching-based interventions can be implemented to improve flexibility. These results provide valuable insights to athletes, trainers, coaches, and therapists seeking to optimize hamstring training and prevent injury.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-04-06T03:18:50Z
      DOI: 10.1177/03635465221083998
       
  • Return to Work After Primary Hip Arthroscopy: A Systematic Review and
           Meta-analysis

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      Authors: Anna M. Blaeser, Edward S. Mojica, Brian J. Mannino, Thomas Youm
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Hip arthroscopy is a procedure commonly performed to correct various hip pathologies such as femoroacetabular impingement and labral tears. These hip pathologies commonly affect young, otherwise healthy patients. The recovery after hip arthroscopy can prevent patients from returning to work and impair performance levels, having significant economic repercussions. To date, there has been no cumulative analysis of the existing literature on return to work after hip arthroscopy.Purpose:The purpose of this study was to perform a systematic review of the existing literature regarding return to work after hip arthroscopy and analysis of factors associated with the ability to return to work and time to return to work.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:A literature search of the MEDLINE, EMBASE, and Cochrane Library databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies assessing functional outcomes and return to work, including return to military duty, after hip arthroscopy were included. Patients’ ability to return to work, as well as time to return, was compared between selected studies. Where available, workers’ compensation status as well as type of work was compared. All statistical analysis was performed using SPSS, Version 22. P < .05 was considered statistically significant.Results:Twelve studies with 1124 patients were included. Patients were followed for an average of 17.6 months. Using weighted means, the average rate of return to work was 71.35%, while full return to previous work duties was achieved at a rate of 50.89%. Modification to work duties was required at a rate of 15.48%. On average, the time to return to work was 115 days (range, 17-219 days). Rate of return by patients with workers’ compensation status was found to be 85.15% at an average of 132 days (range, 37-211 days). Rate of return to work in workers performing professions reported as strenuous vs light (ie, mostly sedentary) jobs showed a statistically higher return to work in light professions (risk ratio, 0.53; 95% CI, 0.41-0.69).Conclusion:After hip arthroscopy, there is a high rate of return to work at an average of 115 days after surgery. However, full return to work was achieved by only half of patients upon final follow–up.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-04-06T03:12:31Z
      DOI: 10.1177/03635465211064271
       
  • Examining the Efficacy of Medial Meniscus Posterior Root Repair: A
           Meta-analysis and Systematic Review of Biomechanical and Clinical Outcomes
           

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      Authors: Allison K. Perry, Ophelie Lavoie-Gagne, Derrick M. Knapik, Bhargavi Maheshwer, Alexander Hodakowski, Safa Gursoy, Robert F. LaPrade, Jorge Chahla
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Medial meniscus posterior root (MMPR) injuries accelerate the progression of osteoarthritis. While partial meniscectomy was once considered the gold standard for treatment, meniscus root repair has become increasingly utilized with reported improvements in clinical and biomechanical outcomes.Purpose:To perform a systematic review of biomechanical outcomes and a meta–analysis of clinical and radiographic outcomes after MMPR repair.Study Design:Meta-analysis and systematic review; Level of evidence, 4.Methods:The PubMed, Embase, and Cochrane databases were queried in August 2021 for studies reporting biomechanical, clinical, and radiographic outcomes after MMPR repair. Biomechanical studies were assessed for main results and conclusions. Data including study characteristics, cohort demographics, and outcomes were extracted. Included clinical studies were analyzed with a random–effects meta-analysis of proportions for binary outcomes or continuous outcomes for mean differences between preoperative and postoperative time points. Subgroup analysis for studies reporting repair outcomes with concomitant high tibial osteotomy (HTO) was performed where appropriate.Results:A total of 13 biomechanical studies were identified and reported an overall improvement in mean and peak contact pressures after MMPR repair. There were 24 clinical studies, consisting of 876 patients (877 knees), identified, with 3 studies (106 knees) reporting outcomes with concomitant HTO. The mean patient age was 57.1 years (range, 23-74 years), with a mean follow–up of 27.7 months (range, 2-64 months). Overall, clinical outcomes (Lysholm, Hospital for Special Surgery, International Knee Documentation Committee, visual analog scale for pain, Tegner, and Knee injury and Osteoarthritis Outcome Score scores) were noted to improve postoperatively compared with preoperatively, with improved Lysholm scores in patients undergoing concomitant HTO versus MMPR repair alone. Meniscal extrusion was not significantly improved after MMPR repair compared with preoperative measurements. The progression in Kellgren-Lawrence grades from grade 0 to grades 1 to 3 occurred in 5.9% (21/354) of patients after repair, with no patients progressing from grades 1 to 3 to grade 4.Conclusion:MMPR repair generally improved biomechanical outcomes and led to improved patient–reported outcomes with greater improvements noted in patients undergoing concomitant HTO. Repair did not significantly improve meniscal extrusion, while only 5.9% of patients were noted to progress to low–grade osteoarthritis. The high level of heterogeneity in the included biomechanical and clinical investigations emphasizes the need for more well–designed studies that evaluate outcomes after MMPR repair.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-04-06T03:10:09Z
      DOI: 10.1177/03635465221077271
       
  • How Does Platelet-Rich Plasma Compare Clinically to Other Therapies in the
           Treatment of Knee Osteoarthritis' A Systematic Review and
           Meta-analysis

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      Authors: Lauro Augusto Veloso Costa, Mário Lenza, James J. Irrgang, Freddie H. Fu, Mário Ferretti
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:There has been an increase in interest in the use of biological therapies in orthopaedic conditions such as knee osteoarthritis. Platelet-rich plasma (PRP) is one of these therapies, but it still lacks consistent results.Purpose:To evaluate the effects (benefits and harms) of PRP intra-articular injection compared with other nonsurgical methods for the treatment of knee osteoarthritis.Study Design:Systematic review and meta-analysis of randomized and quasi–randomized controlled trials; Level of evidence, 2.Methods:Three electronic databases were searched to identify relevant studies published before January 2021. The primary outcomes were pain, function, and failure of treatment. Risks of bias of all trials were assessed using a Cochrane risk of bias tool. The Grading of Recommendations Assessment, Development and Evaluation System was used to assess the quality of evidence of included studies.Results:A total of 40 studies with 3035 participants were included. Analysis of this review focused on comparing PRP with hyaluronic acid, corticosteroid, and saline, as we believe they are the most relevant comparisons with the most studies available. At 6-month follow-up, PRP was as effective as and in some studies more effective than other therapies regarding pain, function, and stiffness. However, current evidence is of low or very low quality and is based on trials with high risk of bias and great heterogeneity among them. No significant difference among treatments was found concerning major adverse events and treatment failure.Conclusion:Although studies suggest that PRP may be more effective than or at least as effective as other modalities of nonsurgical treatment for knee osteoarthritis in terms of pain, function, and adverse events, serious limitations and methodological flaws are considerable in the current literature. Therefore, the authors are not able to make recommendations for clinical practice regarding PRP for knee osteoarthritis.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-03-22T04:43:10Z
      DOI: 10.1177/03635465211062243
       
  • Core Muscle Injury: Evaluation and Treatment in the Athlete

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      Authors: Julianne M. Forlizzi, Mark B. Ward, James Whalen, Thomas H. Wuerz, Thomas J. Gill
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Pain in the groin region, where the abdominal musculature attaches to the pubis, is referred to as a “sports hernia,”“athletic pubalgia,” or “core muscle injury” and has become a topic of increased interest due to its challenging diagnosis. Identifying the cause of chronic groin pain is complicated because significant symptom overlap exists between disorders of the proximal thigh musculature, intra-articular hip pathology, and disorders of the abdominal musculature.Purpose:To present a comprehensive review of the pathoanatomic features, history and physical examination, and imaging modalities used to make the diagnosis of core muscle injury.Study Design:Narrative and literature review; Level of evidence, 4.Methods:A comprehensive literature search was performed. Studies involving the diagnosis, treatment, and rehabilitation of athletes with core muscle injury were identified. In addition, the senior author’s extensive experience with the care of professional, collegiate, and elite athletes was analyzed and compared with established treatment algorithms.Results:The differential diagnosis of groin pain in the athlete should include core muscle injury with or without adductor longus tendinopathy. Current scientific evidence is lacking in this field; however, consensus regarding terms and treatment algorithms was facilitated with the publication of the Doha agreement in 2015. Pain localized proximal to the inguinal ligament, especially in conjunction with tenderness at the rectus abdominis insertion, is highly suggestive of core muscle injury. Concomitant adductor longus tendinopathy is not uncommon in these athletes and should be investigated. The diagnosis of core muscle injury is a clinical one, although dynamic ultrasonography is becoming increasingly used as a diagnostic modality. Magnetic resonance imaging is not always diagnostic and may underestimate the true extent of a core muscle injury. Functional rehabilitation programs can often return athletes to the same level of play. If an athlete has been diagnosed with athletic pubalgia and has persistent symptoms despite 12 weeks of nonoperative treatment, a surgical repair using mesh and a relaxing myotomy of the conjoined tendon should be considered. The most common intraoperative finding is a deficient posterior wall of the inguinal canal with injury to the distal rectus abdominis. Return to play after surgery for an isolated sports hernia is typically allowed at 4 weeks; however, if an adductor release is performed as well, return to play occurs at 12 weeks.Conclusion:Core muscle injury is a diagnosis that requires a high level of clinical suspicion and should be considered in any athlete with pain in the inguinal region. Concurrent adductor pathology is not uncommon.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-03-02T03:46:55Z
      DOI: 10.1177/03635465211063890
       
  • Does the Choice of Acellular Scaffold and Augmentation With Bone Marrow
           Aspirate Concentrate Affect Short-term Outcomes in Cartilage Repair' A
           Systematic Review and Meta-analysis

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      Authors: Zachariah Gene Wing Ow, Hannah Li Xin Cheang, Jin Hean Koh, Joshua Zhi En Koh, Katelyn Kaye-Ling Lim, Dean Wang, Tom Minas, James L. Carey, Heng An Lin, Keng Lin Wong
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Matrix-induced chondrogenesis (MIC) is a promising treatment option for critical-size cartilage lesions of the knee; however, there exists substantial heterogeneity in the choice of acellular scaffold matrix for MIC cartilage repairs.Hypothesis:The choice of acellular matrix will not affect patient outcomes after MIC cartilage repair procedures, and the addition of concentrated bone marrow aspirate (cBMA) will improve short-term patient outcomes regardless of matrix choice.Study Design:Meta-analysis; Level of evidence, 4.Methods:Studies were stratified by matrix type: multilayered, single layered, and gel based. Continuous outcomes were analyzed with pairwise meta-analysis using the inverse variance model with random effects applied. Binary outcomes were analyzed as pooled proportions in a single-arm fashion; after which, reconstruction of relative risks (RRs) with confidence intervals was performed using the Katz logarithmic method.Results:A total of 876 patients were included: 469 received multilayered bioscaffolds; 238, gel-based scaffolds; and 169, single-layered scaffolds. The mean age of patients was 36.2 years (95% CI, 33.9 to 38.4), while the mean lesion size was 3.91 cm2 (95% CI, 3.40 to 4.42). The weighted mean follow-up was 23.8 months (95% CI, 20.1 to 27.6). Multilayered bioscaffolds were most effective at improving visual analog scale scores (P = .03; weighted mean difference [WMD], −4.44 [95% CI, −4.83 to −4.06]; P < .001). There were significantly lower risks of incomplete defect filling for gel-based scaffolds when compared with multilayered scaffolds (RR, 0.78 [95% CI, 0.69 to 0.88]; P < .001) and single-layered scaffolds (RR, 0.58 [95% CI, 0.41 to 0.81]; P = .001). Augmentation with cBMA further improved clinical scores across all scaffolds, with significant improvements in Tegner score (P = .02), while decreasing incomplete defect filling rates as well. There was significantly greater improvement in visual analog scale scores (P = .01) for single-layered scaffolds with cBMA augmentation (WMD, −4.88 [95% CI, −5.38 to −4.37]; P < .001) as compared with single-layered scaffolds without cBMA augmentation (WMD, −4.08 [95% CI, −4.46 to −3.71]; P < .001). All significant improvements were below their respective minimum clinically important differences.Conclusion:While cartilage repair with acellular scaffolds provides significant improvements in pain and function for patients, there is insufficient clinical evidence to suggest which scaffold material is the most superior in influencing such improvements. The enhancement of cartilage repair procedures with cBMA may provide further functional improvements and improve defect filling; however, more long-term evidence is required to evaluate the effects.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-02-28T11:53:50Z
      DOI: 10.1177/03635465211069565
       
  • A Systematic Review of Long-term Clinical and Radiological Outcomes of
           Arthroscopic and Open/Mini-open Rotator Cuff Repairs

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      Authors: Fabian Plachel, Olivia Imkyeong Jo, Katja Rüttershoff, Octavian Andronic, Lukas Ernstbrunner
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Arthroscopic rotator cuff repair (aRCR) has shown similar midterm functional results and retear rates as open/mini-open rotator cuff repair (oRCR). A pooled analysis of long-term results of both techniques is yet missing.Purpose:To evaluate the long-term results of aRCR and oRCR for full-thickness rotator cuff tears.Study Design:Systematic review; Level of evidence, 4.Methods:The systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The CENTRAL (Cochrane), MEDLINE (PubMed), and Embase databases were searched for studies that reported on long-term clinical and radiographic outcomes of full-thickness aRCR and oRCR with a minimum follow-up of 9 years.Results:Eleven studies were included: 5 studies on aRCR and 6 studies on oRCR. Studies were based on 550 shoulders (539 patients) with a mean patient age of 56.3 years (range, 25-77). After a mean follow-up of 14.0 years (range, 9-20), the mean preoperative absolute Constant score (CS) and American Shoulder and Elbow Surgeons (ASES) shoulder score were significantly improved postoperatively (CS, 44 to 78 points; ASES, 52% to 91%; both comparisons, P < .001). The retear rate was 41% (141 of 342 shoulders) without a significant difference between groups (aRCR, 43%; oRCR, 39%) (P = .364). A retear was associated with significantly reduced CS as compared with a healed repair (P = .004). No significant differences were found in postoperative functional scores, complications, and retear rates after failed cuff repairs between the arthroscopic and open/mini-open repair groups.Conclusion:Pooled analysis of arthroscopic and open rotator cuff repairs demonstrated sustained improvement in long-term shoulder scores and pain with a substantial retear rate in both groups, which was associated with inferior shoulder function. There were no significant differences in long-term functional outcomes, retear rates, and complications. Both surgical techniques may be used on the basis of factors such as patient or surgeon preference and cost. Further studies using a more robust randomized controlled trial or larger cohort design are recommended to ascertain whether one surgical repair technique is superior to the other.Registration:CRD42020180448 (PROSPERO).
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-02-18T02:06:59Z
      DOI: 10.1177/03635465211073332
       
  • Outcomes of Distal Femoral Osteotomy for Valgus Malalignment: A Systematic
           

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      Authors: Connor C. Diaz, Ophelie Z. Lavoie-Gagne, Derrick M. Knapik, Avinaash Korrapati, Jorge Chahla, Brian Forsythe
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Valgus knee deformity increases the risk for lateral articular chondral damage, contributing to earlier onset and accelerated progression of osteoarthritis. Distal femoral osteotomy (DFO) unloads the lateral joint compartment and can be performed using closing wedge (CW) or opening wedge (OW) techniques.Purpose:To perform a systematic review and meta-analysis for patients with valgus knee deformity undergoing DFO to determine differences in patient-reported outcome measures (PROMs), complications, and survival rates, comparing CW versus OW DFO.Study Design:Systematic review, Level of evidence, 4.Methods:A literature review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines utilizing PubMed, Cochrane Database, Ovid/MEDLINE, and Scopus. Inclusion criteria consisted of studies reporting outcomes in patients undergoing CW or OW DFO for the treatment of valgus knee deformities with symptomatic lateral compartment pathology with a minimum 2-year follow-up. PROMs and complications were analyzed using random-effects modeling to identify differences in outcomes as a function of surgical technique. Long-term survival data, defined as conversion to total knee arthroplasty, were analyzed using a multiple metaregression model as a function of individual study follow-up time points and surgical technique.Results:In total, we included 23 retrospective studies (n = 619 knees), of which 10 studies (n = 271 knees) reported outcomes after CW DFO and 13 studies (n = 348 knees) reported on OW DFO outcomes. Good to excellent clinical outcomes were reported in PROMs when compared with preoperative values with both techniques, while no significant differences between techniques were appreciated on functional Knee Society Scores and Tegner scores. No significant differences were appreciated in the incidence of complications reported in patients undergoing CW (20%) versus OW (33%) DFO (P = .432). Pain requiring hardware removal was the most commonly reported complication in both groups. The survival rate for CW DFO was 81.5% (mean follow-up, 8.8 ± 4.3 years) compared with 90.5% for OW DFO (mean follow-up, 4.5 ± 1.5 years). Multiple metaregression demonstrated that patient follow-up (P < .001) was significantly associated with knee survival, while surgical technique (P = .810) was not a predictor of clinical failure.Conclusions:Both CW and OW DFO techniques were associated with good to excellent clinical outcomes with no significant differences in PROMs based on technique. Pain requiring hardware removal was the most common complication in both techniques, while long-term survivability was found to be a function of follow-up and not surgical technique. Technique selection should be based on shared patient-physician decision making with an emphasis on surgeon preference and technique familiarity.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-02-14T11:10:50Z
      DOI: 10.1177/03635465211051740
       
  • Shoulder Stabilization Versus Immobilization for First-Time Anterior
           Shoulder Dislocation: A Systematic Review and Meta-analysis of Level 1
           Randomized Controlled Trials

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      Authors: John W. Belk, Benjamin R. Wharton, Darby A. Houck, Jonathan T. Bravman, Matthew J. Kraeutler, Braden Mayer, Thomas J. Noonan, Adam J. Seidl, Rachel M. Frank, Eric C. McCarty
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Multiple studies have compared redislocation rates after stabilization and immobilization for patients experiencing a traumatic, first-time anterior shoulder dislocation (ASD).Purpose:To systematically review the literature to compare rates of recurrent instability and subsequent instability surgery in patients undergoing treatment for a first-time ASD with surgical stabilization versus shoulder immobilization.Study Design:Systematic review and meta-analysis; Level of evidence, 1.Methods:A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify level 1 randomized studies that compared outcomes of surgical stabilization versus immobilization for treatment of primary ASD. The following search phrase was used: (glenohumeral OR anterior shoulder) AND (conservative OR nonoperative OR nonsurgical OR physiotherapy) AND (Bankart OR repair OR stabilization OR surgical OR surgery OR arthroscopic OR arthroscopy) AND (instability OR dislocation). Patients with soft tissue disruption alone as well as those with additional minor bony lesions (Hill-Sachs, Bankart) were included. Recurrent instability and subsequent instability surgery rates, the Western Ontario Shoulder Instability Index (WOSI), and range of motion were evaluated.Results:A total of 5 studies met inclusion criteria, including 126 patients undergoing surgical stabilization (mean age, 23.6 years; range, 15.0-39.0 years) and 133 patients undergoing treatment with sling immobilization only (mean age, 23.1 years; range, 15.0-31.0 years). Mean follow-up was 59.7 months. Overall, 6.3% of operative patients experienced recurrent instability at latest follow-up compared with 46.6% of nonoperative patients (P < .00001). Similarly, 4.0% of operative patients underwent a subsequent instability surgery compared with 30.8% of nonoperative patients (P < .00001). These same trends were demonstrated when data were isolated to nonoperative patients immobilized in internal rotation. When comparing the operative and nonoperative groups at latest follow-up, 1 study found significantly improved WOSI scores among operative patients (P = .035) and 1 study found significantly improved abducted external rotation in nonoperative patients (P = .02).Conclusion:Patients, particularly active men in their 20s and 30s, undergoing treatment for a first-time ASD with a surgical stabilization procedure can be expected to experience significantly lower rates of recurrent instability and a significantly decreased need for a future stabilization procedure when compared with patients treated nonoperatively.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-02-11T06:32:59Z
      DOI: 10.1177/03635465211065403
       
  • Isolated Osteochondral Autograft Versus Allograft Transplantation for the
           Treatment of Symptomatic Cartilage Lesions of the Knee: A Systematic
           Review and Meta-analysis

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      Authors: David P. Trofa, Ian S. Hong, Cesar D. Lopez, Allison J. Rao, Ziqing Yu, Susan M. Odum, Claude T. Moorman, Dana P. Piasecki, James E. Fleischli, Bryan M. Saltzman
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Focal cartilage lesions of the knee remain a difficult entity to treat. Current treatment options include arthroscopic debridement, microfracture, autograft or allograft osteochondral transplantation, and cell-based therapies such as autologous chondrocyte transplantation. Osteochondral transplantation techniques restore the normal topography of the condyles and provide mature hyaline cartilage in a single-stage procedure. However, clinical outcomes comparing autograft versus allograft techniques are scarce.Purpose:To perform a comprehensive systematic review and meta-analysis of high-quality studies to evaluate the results of osteochondral autograft and allograft transplantation for the treatment of symptomatic cartilage defects of the knee.Study Design:Systematic review and meta-analysis; Level of evidence, 2.Methods:A comprehensive search of the literature was conducted using various databases. Inclusion criteria were level 1 or 2 original studies, studies with patients reporting knee cartilage injuries and chondral defects, mean follow-up ≥2 years, and studies focusing on osteochondral transplant techniques. Exclusion criteria were studies with nonknee chondral defects, studies reporting clinical outcomes of osteochondral autograft or allograft combined with other procedures, animal studies, cadaveric studies, non–English language studies, case reports, and reviews or editorials. Primary outcomes included patient-reported outcomes and failure rates associated with both techniques, and factors such as lesion size, age, sex, and the number of plugs transplanted were assessed. Metaregression using a mixed-effects model was utilized for meta-analyses.Results:The search resulted in 20 included studies with 364 cases of osteochondral autograft and 272 cases of osteochondral allograft. Mean postoperative survival was 88.2% in the osteochondral autograft cohort as compared with 87.2% in the osteochondral allograft cohort at 5.4 and 5.2 years, respectively (P = .6605). Patient-reported outcomes improved by an average of 65.1% and 81.1% after osteochondral autograft and allograft, respectively (P = .0001). However, meta-analysis revealed no significant difference in patient-reported outcome percentage change between osteochondral autograft and allograft (P = .97) and a coefficient of 0.033 (95% CI, –1.91 to 1.98). Meta-analysis of the relative risk of graft failure after osteochondral autograft versus allograft showed no significant differences (P = .66) and a coefficient of 0.114 (95% CI, –0.46 to 0.69). Furthermore, the regression did not find other predictors (mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location) that may have significantly affected patient-reported outcome percentage change or postoperative failure between osteochondral autograft versus allograft.Conclusion:Osteochondral autograft and allograft result in favorable patient-reported outcomes and graft survival rates at medium-term follow-up. While predictors for outcomes such as mean age, percentage of female patients, lesion size, number of plugs/grafts used, and treatment location did not affect the comparison of the 2 cohorts, proper patient selection for either procedure remains paramount to the success and potentially long-term viability of the graft.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-02-09T11:35:49Z
      DOI: 10.1177/03635465211053594
       
  • Early and Delayed Surgery for Isolated ACL and Multiligamentous Knee
           Injuries Have Equivalent Results: A Systematic Review and Meta-analysis

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      Authors: Harmen D. Vermeijden, Xiuyi A. Yang, Maarten V. Rademakers, Gino M.M.J. Kerkhoffs, Jelle P. van der List, Gregory S. DiFelice
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Early surgery for acute ligamentous injuries has recently shown good clinical and functional outcomes.Purpose:To assess the advantages of early vs delayed surgery in patients undergoing isolated anterior cruciate ligament (ACL) or multiligament-injured knee (MLIK) surgery.Study Design:Meta-analyses of Level 1, 2, and 3 studies; Level of evidence, 4.Methods:A systematic search was performed via PubMed, EMBASE, and Cochrane for studies reporting outcomes of timing of surgery after isolated ACL injury or in the MLIK setting using accelerated rehabilitation protocols. Two analyses were conducted to differentiate early and delayed treatment (3- and 6-week cutoffs). Collected outcomes included meniscal or chondral lesions, failure and reoperation rates, range of motion (ROM) deficits, other complications, muscle strength, instrumented laxity, and functional outcomes. Outcomes were reported in risk ratios (RR) or mean differences with 95% CIs.Results:For timing of isolated ACL surgery, 16 studies were included with 2093 patients. High-grade evidence indicated that there were no differences in meniscal or chondral lesions, failure and reoperation rates, stiffness, ROM deficits, complications, muscle strength, instrumented laxity, and functional outcomes between patients treated early and late (all P> .05). When including only studies that set no preoperative criteria for early surgery, the findings were similar. Regarding MLIK surgery, 14 studies were included with 1172 patients. Low evidence was noted for the following: patients treated early had significantly fewer meniscal injuries (RR, 0.7; P = .04) and chondral injuries (RR, 0.5; P < .001), while no differences were found in reoperation rates, complications, stiffness, ROM deficits, muscle strength, instrumented laxity, and functional outcomes between the groups. Other than higher Lysholm scores in the early group for the 3-week analysis (mean difference, 6.8; P = .01), there were no differences between cutoff analyses.Conclusion:This systematic review with meta-analysis found no differences in clinical and functional outcomes between early and delayed surgery for isolated ACL injuries. For MLIK injuries, there were also no differences in surgical outcomes between early and delayed surgery.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-01-31T04:24:49Z
      DOI: 10.1177/03635465211069356
       
  • Role of Delay Between Injury and Surgery on the Outcomes of Rotator Cuff
           Repair: A Systematic Review and Meta-analysis

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      Authors: Jelle P. van der List, Laura M. Kok, Tjarco D.W. Alta, Maarten P.J. van der List, Arthur van Noort
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Outcomes of rotator cuff repair (RCR) are influenced by several well-described factors, but the role of delay from injury to surgery on the outcomes is not clear.Purpose:To assess the role of delay to surgery on the outcomes of RCR in the literature.Study Design:Systematic review with meta-analysis; Level of evidence, 4.Methods:PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. All studies assessing outcomes after RCR—either retear rates or patient-reported outcome measures (PROMs)—and reporting delay to surgery were identified through June 2021 in PubMed, Embase, and Cochrane. Inclusion criteria consisted of traumatic injuries, mean age 3 months after injury did not have significantly higher retear rates (OR, 1.1 [95% CI, 0.5 to 3.1]; P = .700), lower Constant-Murley score (MD, −6.2 [95% CI, −16.4 to 4.1]; P = .240), or lower ASES score (American Shoulder and Elbow Surgeons; MD, –12.9 [95% CI, −26.0 to −0.2]; P = .050) compared with those having surgery within 3 months. Similarly, delaying surgery for 6 months did not result in higher retear rates (OR, 1.7 [95% CI, 0.8 to 3.7]; P = .190) or lower PROMs. Delaying surgery for 1 year, however, led to an increased likelihood of retear when compared with
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-01-31T04:23:49Z
      DOI: 10.1177/03635465211069560
       
  • Risk Factors for Failure After Osteochondral Allograft Transplantation of
           the Knee: A Systematic Review and Exploratory Meta-analysis

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      Authors: Kyle N. Kunze, Joseph S. Manzi, Joshua Wright-Chisem, Prem Ramkumar, Benedict U. Nwachukwu, Riley J. Williams
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Graft failure after osteochondral allograft transplantation (OCA) of the knee is a devastating outcome, often necessitating subsequent interventions. A comprehensive understanding of the risk factors for failure after OCA of the knee may provide enhanced prognostic data for the knee surgeon and facilitate more informed shared decision-making discussions before surgery.Purpose:To perform a systematic review and meta-analysis of risk factors associated with graft failure after OCA of the knee.Study Design:Systematic review and meta-analysis; Level of evidence, 4.Methods:The PubMed, Ovid/MEDLINE, and Cochrane databases were queried in April 2021. Data pertaining to study characteristics and risk factors associated with failure after OCA were recorded. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and graft failure by generating effect estimates in the form of odds ratios (ORs) with 95% CIs, while mean differences (MDs) were calculated for continuous data. Qualitative analysis was performed to describe risk factors that were variably reported.Results:A total of 16 studies consisting of 1401 patients were included. The overall pooled prevalence of failure was 18.9% (range, 10%-46%). There were 44 risk factors identified, of which 9 were explored quantitatively. There was strong evidence to support that the presence of bipolar chondral defects (OR, 4.20 [95% CI, 1.17-15.08]; P = .028) and male sex (OR, 2.04 [95% CI, 1.17-3.55]; P = .012) were significant risk factors for failure after OCA. Older age (MD, 5.06 years [95% CI, 1.44-8.70]; P = .006) and greater body mass index (MD, 1.75 kg/m2 [95% CI, 0.48-3.03]; P = .007) at the time of surgery were also significant risk factors for failure after OCA. There was no statistically significant evidence to incontrovertibly support that concomitant procedures, chondral defect size, and defect location were associated with an increased risk of failure after OCA.Conclusion:Bipolar chondral defects, male sex, older age, and greater body mass index were significantly associated with an increased failure rate after OCA of the knee. No statistically significant evidence presently exists to support that chondral defect size and location or concomitant procedures are associated with an increased graft failure rate after OCA of the knee. Additional studies are needed to evaluate these associations.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-01-20T02:32:55Z
      DOI: 10.1177/03635465211063901
       
  • Rate and Timing of Return to Golf After Hip, Knee, or Shoulder
           Arthroplasty: A Systematic Review and Meta-analysis

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      Authors: Patrick G. Robinson, Tom R. Williamson, Andrew P. Creighton, Jennifer Cheng, Andrew D. Murray, Heidi Prather, Joshua S. Dines, Lawrence V. Gulotta, Edwin P. Su, Joel M. Press, Roger Hawkes, Nick D. Clement
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The physical and mental health benefits of golf are well recognized, and as a moderate-intensity activity, it is an ideal sport for patients after joint arthroplasty.Purpose:To assess the rate and timing of returning to golf and the factors associated with these after hip, knee, or shoulder arthroplasty.Study Design:Meta-analysis; Level of evidence, 4.Methods:A search of PubMed and Medline was performed in March 2021 in line with the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Search terms included sport, golf, and arthroplasty. The criterion for inclusion was any published research article studying return to golf after arthroplasty. Random-effects modeling was used to measure rates of returning to golf for each type of arthroplasty.Results:A total of 23 studies were included for review. All studies were retrospective in their methodology. The mean age of patients was 66.8 years (SD, 3.37). Four studies reported on hip arthroplasty, 6 on knee arthroplasty, and 13 on shoulder arthroplasty. Among 13 studies, the mean rate of returning to golf was 80% (95% CI, 70%-89.9%). Hip, knee, and shoulder arthroplasty had mean return rates of 90% (95% CI, 82%-98%), 70% (95% CI, 39%-100%), and 80% (95% CI, 68%-92%), respectively. Among 9 studies, the mean time to return to golf was 4.4 months (95% CI, 3.2-6). Change in handicap was reported in 8 studies (35%) with a mean change of −0.1 (95% CI, –2.4 to +2.2). There were no studies presenting factors associated with return to golf.Conclusion:This is the first meta-analysis of returning to golf after joint arthroplasty. The study reports a high rate of returning to golf, which was greatest after hip arthroplasty. However, the study highlights the paucity of prospective data on demographic, surgical, and golf-specific outcomes after arthroplasty. Future prospective studies are required to eliminate response bias and accurately capture golf and patient-specific outcomes.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-01-12T02:48:48Z
      DOI: 10.1177/03635465211064292
       
  • Outcomes of Arthroscopic Decompression of the Anterior Inferior Iliac
           Spine: A Systematic Review and Meta-analysis

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      Authors: Andrew L. Schaver, Steven M. Leary, Jacob L. Henrichsen, Christopher M. Larson, Robert W. Westermann
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Anterior inferior iliac spine (AIIS) impingement has been increasingly recognized as a source of extra-articular impingement and hip pain. However, no aggregate data analysis of patient outcomes after AIIS decompression has been performed.Purpose:To evaluate outcomes after arthroscopic AIIS decompression.Study Design:Meta-analysis; Level of evidence, 4.Methods:A systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. PubMed, EMBASE, and Cochrane Central Register of Controlled Trials were queried for all English-language studies reporting outcomes of arthroscopic AIIS decompression performed in isolation or in conjunction with hip impingement correction surgery. After screening, 10 articles were included. The indications for AIIS decompression were recorded, and weighted mean improvements in patient-reported outcome (PRO) scores, complication rates, and revision rates were calculated.Results:A total of 547 patients (311 women; 57%) were identified, with a total of 620 operative hips. The mean age was 28.42 ± 5.6 years, and the mean follow-up was 25.22 ± 11.1 months. A total of 529 hips (85%) underwent AIIS decompression, 530 hips (85%) underwent femoral osteochondroplasty, and 458 hips (74%) underwent labral repair. Of the patients, 13% underwent bilateral AIIS decompression. The mean modified Harris Hip Score improved from 61.3 ± 6.9 to 88.7 ± 4.7 postoperatively (change, 27.4 ± 5.7 points; P < .001), the Hip Outcome Score–Activities of Daily Living improved from 67.2 ± 10.6 to 91.1 ± 3.2 postoperatively (change, 24.0 ± 8.0 points; P = .001), and the Hip Outcome Score–Sports Specific Subscale improved from 36.8 ± 19.2 to 82.8 ± 3.8 postoperatively (change, 46.0 ± 18.2 points; P = .002). The pooled risk of postoperative complications was 1.1% (95% CI, 0.1%-2.1%), and the pooled risk of needing revision surgery was 1.0% (95% CI, 0.1%-2.0%). No complication was directly attributed to the AIIS decompression portion of the procedure.Conclusion:PROs improved significantly after hip arthroscopy with AIIS decompression, with a low risk of postoperative complications and subsequent revision surgeries. Failure to identify extra-articular sources of hip pain in outcomes of femoroacetabular impingement syndrome, including from the AIIS, could lead to poorer outcomes and future revision surgery.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-01-12T02:37:45Z
      DOI: 10.1177/03635465211062903
       
  • Intra-articular Injection of Autologous Adipose-Derived Stem Cells or
           Stromal Vascular Fractions: Are They Effective for Patients With Knee
           Osteoarthritis' A Systematic Review With Meta-analysis of Randomized
           Controlled Trials

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      Authors: Kang-Il Kim, Myung-Seo Kim, Jun-Ho Kim
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Intra-articular injection of adipose-derived stem cells, which are divided into adipose-derived mesenchymal stem cells (ASCs) and adipose-derived stromal vascular fractions (ADSVFs), has been reported to be a viable treatment modality for knee osteoarthritis (OA); however, its efficacy remains limited.Purpose:This study aimed to provide comprehensive information about the efficacy and safety of intra-articular injections of autologous ASCs and ADSVFs without adjuvant treatment in patients with knee OA.Study Design:Meta-analysis; Level of evidence, 1.Methods:A systematic search of the MEDLINE, Embase, Web of Science, and Cochrane Library databases was performed to identify randomized controlled trials (RCTs) that evaluated the efficacy and safety of intra-articular injections of autologous ASCs or ADSVFs without adjuvant treatments compared with placebo or hyaluronic acid in patients with knee OA. Clinically, the 100-mm visual analog scale for pain relief and the Western Ontario and McMaster Universities Osteoarthritis Index for functional improvement were implemented. Radiologically, cartilage status was assessed using magnetic resonance imaging (MRI). Procedure-related knee pain, swelling, and adverse events (AEs) were evaluated for safety. Additionally, we performed subgroup analyses comparing ASCs versus ADSVFs. Methodological quality was assessed using the modified Coleman Methodology Score (mCMS).Results:A total of 5 RCTs were included in this study. Based on the meta-analysis, ASCs or ADSVFs showed significantly better pain relief at 6 months (Z = 7.62; P < .0001) and 12 months (Z = 7.21; P < .0001) and functional improvement at 6 months (Z = 4.13; P < .0001) and 12 months (Z = 3.79; P = .0002), without a difference in procedure-related knee pain or swelling compared with controls. Although a meta-analysis with regard to cartilage improvements was not performed owing to heterogeneous MRI assessment, 3 studies reported significantly improved cartilage status after the injection. No serious AEs associated with ASCs or ADSVFs were reported. Subgroup analyses showed similar efficacy between ASC and ADSVF treatments. The median mCMS was 70 (range, 55-75).Conclusion:For patients with knee OA, intra-articular injection of autologous ASCs or ADSVFs without adjuvant treatment showed remarkable clinical efficacy and safety at short-term follow-up. Some degree of efficacy has been shown for cartilage regeneration in knee OA, although the evidence remains limited. Further RCTs that directly compare ASCs and ADSVFs are needed.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-01-12T02:30:06Z
      DOI: 10.1177/03635465211053893
       
  • Hip Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome
           in Hips With Mild Osteoarthritis (Tönnis Grade 1): A Matched Comparative
           Cohort Analysis at Minimum 5-Year Follow-up

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      Authors: Lakshmanan Sivasundaram, Morgan W. Rice, Nolan S. Horner, Thomas D. Alter, Christopher G. Ephron, Shane J. Nho
      First page: 2598
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:There is a paucity of information in the literature on midterm outcomes from the arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) with concomitant labral treatment in patients with mild osteoarthritis (OA) using modern surgical techniques.Purpose:To compare outcomes of hip arthroscopy for the treatment of FAIS between patients with mild OA (Tönnis grade 1) and patients without OA (Tönnis grade 0) at minimum 5-year follow-up.Study Design:Cohort study; Level of evidence, 3.Methods:Patients were identified who underwent primary hip arthroscopy for FAIS with routine capsular closure between January 2012 and December 2015. Patients with Tönnis grade 1 were matched 1:3 by age, sex, and body mass index to patients without OA. The Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports Subscale (HOS-SS), modified Harris Hip Score, and 12-item International Hip Outcome Tool were collected preoperatively and at 5 years postoperatively and compared between groups using an independent t test. Survivorship rate and percentage achievement of a Patient Acceptable Symptom State (PASS) or minimal clinically important difference (MCID) were compared using a Fisher exact test.Results:A total of 50 patients (54 hips) with Tönnis grade 1 were matched to 162 patients (162 hips) with Tönnis grade 0. The mean ± SD age and body mass index of the Tönnis grade 1 group were 44.5 ± 9.6 years and 28.5 ± 5.5, respectively. Patient-reported outcome (PRO) scores improved significantly for both groups from presurgery to 5 years postoperatively for all PROs (P≤ .03). There were no significant differences in preoperative PROs between the groups. Patients with Tönnis grade 1 had significantly lower postoperative scores on the HOS-ADL (74.7 ± 22.6 vs 83.0 ± 20.1; P = .04) and HOS-SS (58.8 ± 33.7 vs 71.8 ± 29.3; P = .03) than patients with grade 0. Patients with Tönnis grade 1 also had significantly lower rates of achievement of the MCID (57.1% vs 80.2%; P < .01) and PASS (34.1% vs 53.4%; P = .03) for any PRO when compared with patients with Tönnis grade 0. Gross survivorship was significantly lower for Tönnis grade 1 versus grade 0 (77.8% vs 96.9%; P < .001).Conclusion:Patients with Tönnis grade 1 arthritis experienced significant improvement in PROs after hip arthroscopy for the treatment of FAIS. However, they had significantly lower postoperative HOS-ADL and HOS-SS scores with significantly lower rates of achievement on the MCID and PASS, with a significantly lower gross survivorship rate at a minimum 5 years postoperatively in comparison with those with Tönnis grade 0 changes.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-22T05:42:55Z
      DOI: 10.1177/03635465221107354
       
  • Effect of Sacroiliac Joint Pain on Outcomes in Patients Undergoing Hip
           Arthroscopy for the Treatment of Femoroacetabular Impingement Syndrome: A
           Matched Comparative Cohort Analysis at Minimum 2-Year Follow-up

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      Authors: Nolan S. Horner, Morgan W. Rice, Lakshmanan Sivasundaram, Christopher G. Ephron, Shane J. Nho
      First page: 2606
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Patients with femoroacetabular impingement syndrome (FAIS) may frequently have co-existing sacroiliac joint (SIJ) pain. It is known that patients with lower back pain undergoing total hip arthroplasty (THA) have inferior outcomes; however, it is unclear what the effect of SIJ pain is on outcomes after hip arthroscopy.Purpose:To determine whether patients undergoing hip arthroscopy with SIJ pain either subjectively or on physical examination achieve similar postoperative improvement in patient-reported outcomes (PROs) compared with patients without SIJ pain at 2-year follow-up.Study Design:Cohort study; Level of evidence, 3.Methods:Patients with a minimum 2-year follow-up who underwent primary hip arthroscopy for FAIS with SIJ pain were matched in a 1:2 ratio to controls without SIJ pain. Baseline demographics, as well as postoperative PROs and rates of achievement of the minimal clinically important difference (MCID) or Patient Acceptable Symptom State (PASS) at 2-year follow-up were compared between the 2 groups.Results:A total of 73 patients (75 hips) with SIJ pain were matched to 150 control patients (150 hips) without SIJ pain. Both groups demonstrated statistically significant improvement in all PROs at 2 years (P < .05 for all). Patients with SIJ pain had significantly lower postoperative PRO scores for the Hip Outcome Score–Activities of Daily Living (HOS-ADL) (SIJ pain: 80.4 ± 22.4 vs no SIJ pain: 88.0 ± 15.1; P = .006), modified Harris Hip Score (mHHS) (SIJ pain: 73.2 ± 22.8 vs no SIJ pain: 80.0 ± 17.3; P < .001), and International Hip Outcome Tool–12 questionnaire (iHOT-12) (SIJ pain: 61.7 ± 25.9 vs no SIJ pain: 73.7 ± 23.7; P = .008). There were no statistically significant differences in improvement (delta) in PRO scores between the 2 groups (P> .05 for all). The SIJ pain group had significantly lower achievement of MCID for the HOS-ADL (SIJ pain: 65.2% vs no SIJ pain: 80.5%; P = .044) but not HOS-SS, mHHS, or iHOT-12 (P> .05 for all). The SIJ pain group had significantly lower achievement of PASS for the mHHS (SIJ pain: 27.5% vs no SIJ pain: 45.3%; P = .030) and iHOT-12 (SIJ pain: 31.0% vs no SIJ pain: 56.0%; P = .010) but not the HOS-ADL and HOS-SS (P> .05 for both). Only 4.1% of patients with SIJ pain and 2.4% of controls required revision surgery or converted to THA at the time of final follow-up (P = .69).Conclusion:Patients with FAIS and SIJ pain on history or physical examination experience significant improvement in PROs at 2 years after hip arthroscopy. However, they may be less likely to achieve the MCID or PASS and have significantly lower postoperative PROs compared with a matched cohort of patients without SIJ pain. Overall rates of revision and conversion to THA were similarly low in both groups.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-21T06:39:01Z
      DOI: 10.1177/03635465221108975
       
  • 5-Year Arthroscopy-Free Survivorship and Outcomes of Adolescents
           Undergoing Primary Hip Arthroscopy: A Comparison Between Traumatic and
           Atraumatic Injuries

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      Authors: Michael S. Lee, Olivia A. Paraschos, Andrew E. Jimenez, Jade S. Owens, David R. Maldonado, Benjamin G. Domb
      First page: 2613
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:There is a paucity of literature evaluating the outcomes of adolescent patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with a discrete traumatic event related to an injury.Purpose:(1) To evaluate 5-year outcomes of adolescents undergoing hip arthroscopy for FAIS with traumatic injuries (TIs) and (2) to compare the traumatic group with a propensity-matched control group of patients with atraumatic injuries.Study Design:Cohort study; Level of evidence, 3.Methods:Data were reviewed for all adolescent patients (
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-19T07:14:34Z
      DOI: 10.1177/03635465221103255
       
  • Primary Arthroscopic Labral Management: Labral Repair and Complete Labral
           Reconstruction Both Offer Durable, Promising Results at Minimum 5-Year
           Follow-up

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      Authors: John P. Scanaliato, Clare K. Green, Catherine E. Salfiti, Cole M. Patrick, Andrew B. Wolff
      First page: 2622
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Increased understanding of the acetabular labrum’s role in hip joint biomechanics has led to a greater focus on the conservation and restoration of normal labral anatomic characteristics; however, labral repair is often not possible in the setting of severe intrasubstance damage or deficiency.Purpose:To compare 5-year postoperative patient-reported outcomes between hips treated with primary complete arthroscopic labral reconstruction and those treated with primary labral repair.Study Design:Cohort study; Level of evidence, 3.Methods:All hips that underwent primary labral repair or reconstruction by the senior surgeon between January 2015 and December 2015 were included. Hips that had undergone a previous intra-articular procedure were excluded. Visual analog scales and patient-reported outcome (PRO) instruments were completed by patients within 1 week before surgery as a baseline measurement, between 22 and 26 months postoperatively for 2-year outcomes, and between 58 and 62 months for 5-year outcomes. PRO scores collected included the modified Harris Hip Score (mHHS), the 12-Item International Hip Outcome Tool, and the visual analog scale for pain and satisfaction. Pain and satisfaction were assessed using visual analog scales.Results:A total of 68 primary labral repairs and 62 primary complete labral reconstructions were included in the final analysis. Patients in the reconstruction cohort were older (38.3 vs 29.9 years; P < .001), had a higher incidence of severe labral tearing (62.90% vs 5.88%; P < .001), required a greater number of concomitant procedures (P < .001), and were more likely to have Beck grade III or IV chondral damage (12.94% vs 1.47%; P < .001). Both groups demonstrated statistically significant increases in outcome scores at minimum 5-year follow-up. Patients who underwent labral reconstruction had a significantly greater increase in mHHS from the preoperative assessment to latest follow-up compared with patients undergoing labral repair (27.43 vs 17.13; P = .04). No statistically significant differences between the 2 cohorts were found in achievement of minimal clinically important difference, Patient Acceptable Symptom State, maximum outcome improvement, and substantial clinical benefit at latest follow-up (P> .05). In total, 2 patients in the repair cohort and 3 patients in the reconstruction cohort required revision arthroscopy (P = .574). Further, 1 patient from each group converted to arthroplasty (P = .947).Conclusion:The results of this study suggest that primary complete labral reconstruction is a viable surgical option for hips with moderate to severe labral pathology. At minimum 5-year follow-up, labral reconstruction produced similar outcomes to labral repair despite less favorable preoperative patient characteristics in the reconstruction cohort.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-18T10:52:05Z
      DOI: 10.1177/03635465221109237
       
  • Comparison of Acetabular Measurements Between 2 Validated Software
           Programs Used in Hip Preservation Surgery

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      Authors: Pierre Laboudie, Daniel Fischman, Andrew D. Speirs, Saif Salih, Fernando Holc, Paul E. Beaule, Johan D. Witt, George Grammatopoulos
      First page: 2637
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Validated software tools (Clinical Graphics [CG] and Hip2Norm) permit measurement of the percentage of femoral head coverage (%FHC), which aids in morphological classification and prediction of outcome after hip preservation surgery.Purpose:(1) To assess whether acetabular parameter measurements determined from 2 commonly used software systems are comparable. (2) To determine which parameters influence the correlation or differences between software outputs and measurements.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:The study included 69 patients (90 hips) who underwent periacetabular osteotomy and had comprehensive preoperative imaging available. Lateral center-edge angle (LCEA), acetabular index (AI), and %FHC were determined using 3-dimensional computed tomography (CT) measurements by CG and Hip2Norm software. Images of 18 pelvises were segmented to determine spinopelvic parameters and subtended acetabular angles. Between-group measurements were compared using correlation coefficients and Bland-Altman analyses. The difference in the outputs of the 2 programs was defined as delta (Δ). Radiographic parameters were tested to assess whether they were responsible for differences in %FHC between software programs.Results:Strong correlations between LCEA (ρ = 0.862) and AI (ρ = 0.825) measurements were seen between the Hip2Norm and CG programs. However, weak correlation was seen in the estimate of %FHC (ρ = 0.358), with the presence of a systematic error. Hip2Norm consistently produced lower anterior, posterior, and total %FHC values than CG. The %FHC determined by CG, but not Hip2Norm, correlated with acetabular subtended angles (P < .05). Pelvic tilt measured on CT did not correlate with pelvic tilt estimated by Hip2Norm (P = .56), and ΔPelvicTilt strongly correlated with the difference in %FHC by the 2 software programs (ρ = 0.63; P = .005), pelvic incidence (ρ = 0.73; P < .001), and pelvic tilt (ρ = −0.91; P < .001) as per CT.Conclusion:The correlation of %FHC between Hip2Norm and CG was weak (ρ = 0.358). The difference in measurements of %FHC correlated with ΔPelvicTilt. The %FHC determined by CG strongly correlated with the segmented acetabular subtended angles and thus more likely reflected true values. Hip preservation surgeons should be aware of these measurement differences because %FHC is important in the diagnosis and prognosis of acetabular dysplasia.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-22T05:46:38Z
      DOI: 10.1177/03635465221109240
       
  • The Vascularization Course of Labral Autograft and Its Effect on Tissue
           Healing: Acetabular Labral Augmentation Versus Labral Reconstruction in a
           Porcine Model

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      Authors: Tiao Su, Yunong Ao, Liu Yang, Guang-xing Chen
      First page: 2647
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The preservation of the native labral vascularization is assumed to be the potential advantage of acetabular labral augmentation, the effect of which remains unknown.Purpose:To identify the vascular distribution within the labral autograft and its effect on the healing process between labral augmentation (AUG) and reconstruction (RECON) in a porcine model.Study Design:Controlled laboratory study.Methods:A total of 36 pigs randomly underwent unilateral labral augmentation or reconstruction (AUG group, n = 18; RECON group, n = 18). The pigs were randomly sacrificed at 6, 12, and 24 weeks postoperatively. The labral autografts were harvested for macroscopic evaluation and histologic assessment. The labral autograft was zoned into 2 halves to observe the vascular distribution: the capsular half (zone I) and the articular half (zone II). Each zone was divided into 2 parts: the peripheral part (IA and IIA) and the part attached to the acetabulum (IB and IIB).Results:At 6 weeks, there existed more vascular ingrowth in zone I, whereas zone IIB appeared nearly avascular in both groups. At 12 weeks, the area with the greatest vascularity was zone II in the RECON group and zone IA in the AUG group. The vascularity was concentrated at zones IA and IIA in both groups at 24 weeks. The labral autografts were hypertrophic with sufficient filling of the labral defect in both groups at 6 weeks. At 12 weeks, an insufficient volume of the articular half was observed in 3 of 6 labral autografts in the RECON group, while all autografts remained well integrated with the chondrolabral junction in the AUG group. At 24 weeks, unsatisfactory merging of the labral autograft with the cartilage at the articular side was found in 2 of 6 labral autografts in the RECON group, which was not observed in the AUG group despite the sufficient volume of autografts labrum in both groups.Conclusion:Slow vascular ingrowth within the articular half might account for the poor healing of the reconstructed labral autograft. Labral augmentation provides the possibility of better tissue healing because of the preservation of the original chondrolabral junction compared with labral reconstruction.Clinical Relevance:Labral augmentation might be a feasible alternative to labral reconstruction under the condition of viable labral remnants.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-19T07:04:17Z
      DOI: 10.1177/03635465221108195
       
  • Clinical Safety and Effectiveness of Adipose-Derived Stromal Cell vs
           Stromal Vascular Fraction Injection for Treatment of Knee Osteoarthritis:
           2-Year Results of Parallel Single-Arm Trials

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      Authors: Naomasa Yokota, Stephen Lyman, Hiroto Hanai, Kazunori Shimomura, Wataru Ando, Norimasa Nakamura
      First page: 2659
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:There are currently no disease-modifying treatments available for knee osteoarthritis (OA), although cultured adipose-derived stromal cells (ASCs) have shown promise in experimental models. However, given the regulatory limits on the use of cultured cells in humans, previous trials have focused primarily on the stromal vascular fraction (SVF) intra-articular injection. Therefore, the therapeutic value of ASCs for knee OA remains unknown.Purpose:To study ASC versus SVF intra-articular injection in patients with Kellgren-Lawrence (KL) knee OA grades 2 to 4 in parallel single-arm trials.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 80 patients were enrolled, with 42 (72 knees) receiving ASC intra-articular injection and 38 (69 knees) receiving SVF. Patient-reported outcome measures were assessed at 1, 3, 6, 12, and 24 months using the Knee injury and Osteoarthritis Outcome Score 5 (KOOS5) and pain visual analog scale (VAS). The percentages of patients achieving the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were also calculated. Per protocol, a subset of the ASC group received an ASC booster injection after 6 months. A repeated-measures analysis of variance compared results between treatment arms and by KL grade over time.Results:Patient-reported outcome measures improved substantially after both treatments (P < .05 at all time points), with the ASC group more likely to achieve the MCID (50% vs 24%; P = .01) and PASS (45% vs 24%; P = .04) for the pain VAS and the MCID (43% vs 16%; P = .02) for the KOOS5 at 12 months, although not at 24 months. Knees treated with ASC for KL grade 2/3 OA had significantly superior outcomes compared with those with KL grade 4 OA for the KOOS5 (P = .01) and pain VAS (P = .03), but no such difference was observed in knees treated with SVF. Three patients receiving ASCs (7%; all KL grade 3) sought additional nonoperative treatment by 24 months versus 9 patients receiving SVF (24%; all KL grade 3) (P = .06). ASC booster injections conferred no additional benefit. Notably, patients in the ASC cohort reported more injection-site pain and swelling after the booster injection than after the initial injection (P < .01).Conclusion:This represents the first head-to-head comparison of ASCs and SVF for the treatment of knee OA in humans. ASC and SVF injections both substantially improved knee pain and function at all follow-up time points, although ASC injections demonstrated significantly better improvements with regard to the MCID and PASS for the pain VAS and the MCID for the KOOS5 at 12 months. There appears to be no benefit to a booster ASC injection after initial treatment. Given less donor-site morbidity and equivalent superior outcomes at 2 years, the use of ASCs over SVF in the treatment of knee OA may be warranted.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-14T10:17:38Z
      DOI: 10.1177/03635465221107364
       
  • Subchondral Drilling Independent of Drill Hole Number Improves Articular
           Cartilage Repair and Reduces Subchondral Bone Alterations Compared With
           Debridement in Adult Sheep

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      Authors: Niklas Stachel, Patrick Orth, David Zurakowski, Michael D. Menger, Matthias W. Laschke, Magali Cucchiarini, Henning Madry
      First page: 2669
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Subchondral drilling is an established marrow stimulation technique for small cartilage defects, but whether drilling is required at all and if the drill hole density affects repair remains unclear.Hypotheses:Osteochondral repair is improved when the subchondral bone is perforated by a higher number of drill holes per unit area, and drilling is superior to defect debridement alone.Study Design:Controlled laboratory study.Methods:Rectangular full-thickness chondral defects (4 × 8 mm) were created in the trochlea of adult sheep (N = 16), debrided down to the subchondral bone plate without further treatment as controls (no treatment; n = 7) or treated with either 2 or 6 (n = 7 each) subchondral drill holes (diameter, 1.0 mm; depth, 10.0 mm). Osteochondral repair was assessed at 6 months postoperatively by standardized (semi-)quantitative macroscopic, histological, immunohistochemical, biochemical, and micro–computed tomography analyses.Results:Compared with defect debridement alone, histological overall cartilaginous repair tissue quality (P = .025) and the macroscopic aspect of the adjacent cartilage (P≤ .032) were improved after both drilling densities. Only drilling with 6 holes increased type 2 collagen content in the repair tissue compared with controls (P = .038). After debridement, bone mineral density was significantly decreased in the subchondral bone plate (P≤ .015) and the subarticular spongiosa (P≤ .041) compared with both drilling groups. Debridement also significantly increased intralesional osteophyte sectional area compared with drilling (P≤ .034). No other differences in osteochondral repair existed between subchondral drilling with 6 or 2 drill holes.Conclusion:Subchondral drilling independent of drill hole density significantly improves structural cartilage repair compared with sole defect debridement of full-thickness cartilage defects in sheep after 6 months. Subchondral drilling also leads to a better reconstitution of the subchondral bone compartment below the defects. Simultaneously, drilling reduced the formation of intralesional osteophytes caused by osseous overgrowth compared with debridement.Clinical Relevance:These results have important clinical implications, as they support subchondral drilling independent of drill hole number but discourage debridement alone for the treatment of small cartilage defects. Clinical studies are warranted to further quantify the effects of subchondral drilling in similar settings.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-14T10:07:23Z
      DOI: 10.1177/03635465221104775
       
  • Trends in Health Care Expenditures and Patient Out-of-Pocket Expenses in
           Primary Anterior Cruciate Ligament Reconstruction

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      Authors: Andrew D. Carbone, Kevin Wang, Justin Tiao, Brennan Chu, Jashvant Poeran, Alexis C. Colvin, James N. Gladstone, Shawn G. Anthony
      First page: 2680
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Anterior cruciate ligament reconstruction (ACLR) is one of the most commonly performed orthopaedic procedures in the United States, and the number of procedures is increasing annually, as is the cost. Patients are expected to shoulder a larger out-of-pocket expenditure.Purpose:To answer the following questions: (1) How is reimbursement changing for ACLR, and how is this affecting patients’ out-of-pocket expenditures' (2) How are reimbursements from payers and patients’ out-of-pocket expenses for ACLR distributed, and how is this changing' (3) Does performing ACLR in an ambulatory surgery center (ASC) result in lower costs for payers and patients'Study Design:Economic and decision analysis study; Level of evidence, 4.Methods:A total of 37,763 patients who underwent outpatient primary arthroscopic ACLR in the United States between 2013 and 2017 were identified using the IBM MarketScan Commercial Claims and Encounters Database. Patients with concomitant procedures and revision ACLR were excluded. Recorded outcomes were total patient payments and reimbursed claim totals in US dollars.Results:Day-of-surgery reimbursement decreased 4.3% from $11,536 in 2013 to $11,044 in 2017, while patient out-of-pocket expenses increased 36% from $1085 in 2013 to $1480 in 2017. Day-of-surgery charges were the highest expense for patients, followed by physical therapy and magnetic resonance imaging (MRI) costs. Total reimbursement for MRI decreased 22.5%, while patient out-of-pocket expenses for MRI increased 166%. ACLR performed in an outpatient hospital resulted in 61% greater day-of-surgery expenditure for payers compared with ACLR performed in an ASC; however, the median total patient out-of-pocket savings for ACLRs performed in an ASC versus outpatient hospital was only $11.Conclusion:Out-of-pocket expenses for patients are increasing as they are forced to cover a larger percentage of their health care costs despite overall payer reimbursement decreasing. High-deductible health plans reimbursed the least out of all insurance types while having the highest patient out-of-pocket expenditure.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-14T10:15:17Z
      DOI: 10.1177/03635465221107082
       
  • Use of a Novel Multimodal Imaging Technique to Model In Vivo Quadriceps
           Force and ACL Strain During Dynamic Activity

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      Authors: Zoë A. Englander, Jacqueline N. Foody, Hattie C. Cutcliffe, Jocelyn R. Wittstein, Charles E. Spritzer, Louis E. DeFrate
      First page: 2688
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Quadriceps loading of the anterior cruciate ligament (ACL) may play a role in the noncontact mechanism of ACL injury. Musculoskeletal modeling techniques are used to estimate the intrinsic force of the quadriceps acting at the knee joint.Purpose/Hypothesis:The purpose of this paper was to develop a novel musculoskeletal model of in vivo quadriceps force during dynamic activity. We used the model to estimate quadriceps force in relation to ACL strain during a single-leg jump. We hypothesized that quadriceps loading of the ACL would reach a local maximum before initial ground contact with the knee positioned in extension.Study Design:Descriptive laboratory study.Methods:Six male participants underwent magnetic resonance imaging in addition to high-speed biplanar radiography during a single-leg jump. Three-dimensional models of the knee joint, including the femur, tibia, patellofemoral cartilage surfaces, and attachment-site footprints of the patellar tendon, quadriceps tendon, and ACL, were created from the magnetic resonance imaging scans. The bone models were registered to the biplanar radiographs, thereby reproducing the positions of the knee joint at the time of radiographic imaging. The magnitude of quadriceps force was determined for each knee position based on a 3-dimensional balance of the forces and moments of the patellar tendon and the patellofemoral cartilage contact acting on the patella. Knee kinematics and ACL strain were determined for each knee position.Results:A local maximum in average quadriceps force of approximately 6500 N (8.4× body weight) occurred before initial ground contact. ACL strain increased concurrently with quadriceps force when the knee was positioned in extension.Conclusion:This novel participant-specific modeling technique provides estimates of in vivo quadriceps force during physiologic dynamic loading. A local maximum in quadriceps force before initial ground contact may tension the ACL when the knee is positioned in extension.Clinical Relevance:These data contribute to understanding noncontact ACL injury mechanisms and the potential role of quadriceps activation in these injuries.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-19T07:11:34Z
      DOI: 10.1177/03635465221107085
       
  • Differentiation in Posterior Tibial Slope by Sex, Age, and Race: A
           Cadaveric Study Utilizing 3-Dimensional Computerized Tomography

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      Authors: Bryce N. Clinger, Scott Plaster, Talia Passarelli, Justin Marshall, Daniel C. Wascher
      First page: 2698
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Posterior tibial slope (PTS) has recently gained increased attention for its possible role in anterior cruciate ligament and posterior cruciate ligament injury. The possible differences among age, sex, and ethnicity in PTS have not yet been reported.Purpose:To describe demographic variances of proximal tibial anatomy and to detect differences in regard to ethnicity, sex, and age.Study Design:Cross-sectional study; Level of evidence, 3.Methods:In total, 250 cadaveric specimens with full-body computerized tomography scans from the New Mexico Descendant Imaging Database were randomly selected (inclusion/exclusion criteria: older than 18 years, complete imaging of the knee without previous surgery or arthroplasty) and reviewed by 3 independent observers measuring medial posterior tibial slope (MPTS), lateral posterior tibial slope (LPTS), and global posterior tibial slope (PTS), which was calculated as the mean of the MPTS and LPTS. Individuals were evenly divided among male and female and ethnicities/races: African American/Black, Asian American, Hispanic, Native American, and White. Intraclass correlation coefficient was calculated for interobserver reliability and analysis of variance statistical testing to determine statistical significance between groups. Fisher exact test was also used to understand PTS differences among ethnicities when looking at clinically significant values for potential ligamentous injury.Results:Measurements were obtained from 250 specimens with a mean age of 49.4 years (range, 19 to 103 years). The mean PTS was 8.92° (range, –9.4° to 14.95°). Asian Americans had a 1.7° greater mean MPTS than Whites (P = .016), and African Americans/Blacks had a 1.6° greater mean PTS than Whites (P = .022). No difference in mean PTS was seen between age and sex. When looking at clinically significant PTS, 61 (24.4%) individuals had tibial slopes 12°, 32 (12.8%) and 29 (11.6%), respectively. Statistically significant differences were seen among ethnicities with PTS 12° (P = .106). No sex-based differences were seen in the percentage of specimens with a PTS of>12° or
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-19T07:07:14Z
      DOI: 10.1177/03635465221108187
       
  • Primary Fixation and Cyclic Performance of Single-Stitch All-Inside and
           Inside-Out Meniscal Devices for Repairing Vertical Longitudinal Meniscal
           Tears

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      Authors: Samuel Bachmaier, Aaron J. Krych, Patrick A. Smith, Mirco Herbort, Daniel Ritter, Robert F. LaPrade, Coen A. Wijdicks
      First page: 2705
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Primary device fixation and the resistance against gap formation during repetitive loading influence the quality of meniscal repair. There are limited biomechanical data comparing primary tensioning and cyclic behavior of all-inside versus inside-out repair.Hypothesis:All-inside devices provide higher initial load on the meniscal repair than inside-out fixation, and stiffer constructs show higher resistance against gap formation during cyclic loading.Study Design:Controlled laboratory study.Methods:In total, 60 longitudinal bucket-handle tears in human cadaveric menisci were created and repaired with a single stitch and randomly assigned to 4 all-inside groups (TrueSpan, FastFix 360, Stryker AIR, FiberStich) and 2 inside-out groups (suture repair [IO-S], suture tape [IO-ST]). Residual load after repair tensioning (50 N) and relief displacement were measured. Constructs underwent cyclic loading between 2 and 20 N over 500 cycles (0.75 Hz) with cyclic stiffness, gap formation, and final peak elongation measured. Ultimate load and stiffness were analyzed during pull to failure (3.15 mm/s).Results:All-inside repair demonstrated significantly higher primary fixation strength than inside-out repair. The significantly highest load (mean ± SD; 20.1 ± 0.9 N; P < .037) and relief displacement (–2.40 ± 0.32 mm; P < .03) were for the knotless soft anchoring FiberStich group. The lowest initial load (9.0 ± 1.5 N; P < .001) and relief displacement (–1.39 ± 0.26 mm; P < .045) were for the IO-S repair group. The final gap formation (500th cycle) of FiberStich (0.75 ± 0.37 mm; P < .02) was significantly smaller than others and that of the IO-S (1.47 ± 0.33 mm; P < .045) significantly larger. The construct stiffness of the FiberStich and IO-ST groups was significantly greater at the end of cyclic testing (16.7 ± 0.80 and 15.5 ± 1.42 N/mm; P < .042, respectively) and ultimate failure testing (23.4 ± 3.6 and 20.6 ± 2.3 N/mm; P < .005). The FastFix 360 (86.4 ± 4.8 N) and Stryker AIR (84.4 ± 4.6 N) groups failed at a significantly lower load than the IO-S group (P < .02) with loss of anchor support. The FiberStich (146.8 ± 23.4 N), TrueSpan (142.0 ± 17.8 N), and IO-ST (139.4 ± 7.3 N) groups failed at significantly higher loads (P < .02) due to suture tearing.Conclusion:Overall, primary fixation strength of inside-out meniscal repair was significantly lower than all-inside repair in this cadaveric tissue model. Although absolute differences among groups were small, meniscal repairs with higher construct stiffness (IO-ST, FiberStich) demonstrated increased resistance against gap formation and failure load.Clinical Relevance:Knotless single-stitch all-inside meniscal repair with a soft anchor resulted in less gapping, but the overall clinical significance on healing rates remains unclear.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-05T06:48:07Z
      DOI: 10.1177/03635465221107086
       
  • Treatment-Monitoring Capabilities of Serum and Urine Biomarkers for
           Meniscal Allograft Transplantation in a Preclinical Canine Model

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      Authors: Michael A. Ewing, Aaron M. Stoker, Emily V. Leary, Chantelle C. Bozynski, Josephine Luk, James P. Stannard, James L. Cook
      First page: 2714
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Meniscal allograft transplantation (MAT) has been developed as a treatment for meniscal deficiency. Despite promising outcomes, there are no real-time methods to evaluate graft survivorship and predict functional outcomes.Hypothesis:Assessment of serum and urine biomarkers could be used to develop biomarker panels—prognostic (1- and 3-month postsurgical time points) and diagnostic (6-month time point)—based on strong associations with clinically relevant outcome metrics obtained 6 months after surgery.Study Design:Descriptive laboratory study.Methods:Twelve adult purpose-bred research hounds were included and underwent medial meniscal release to induce meniscal deficiency. Three months after meniscal release surgery, medial menisci were replaced with fresh-frozen meniscus (n = 4), fresh meniscus (n = 4), or fresh meniscotibial osteochondral allograft (n = 4) such that a spectrum of pain and functional outcomes could be anticipated. Serum and urine from all dogs were collected preoperatively and at 1, 3, and 6 months after MAT surgery. Dogs were assessed for pain-related and functional outcomes at the same time points. To develop a prognostic panel of biomarkers, biomarker data from the 1- and 3-month post-MAT surgery time points were used to model 6-month clinical outcomes. A diagnostic panel of biomarkers was developed using data from the 6-month post-MAT surgery to model 6-month clinical outcomes. Primary outcomes for pain and function were visual analog scale (VAS) and operated limb percentage total pressure index (%TPI), respectively. Using random subject effects, linear mixed models were used to develop prognostic biomarker panels, and linear fixed-effect models were used to develop diagnostic biomarker panels, with variance explained for each panel reported (R2) along with individual biomarker relationships.Results:Across prognostic biomarker panels, a panel including serum IL-6, IL-8, IL-10, and IL-18 was fit for the primary functional outcome, operated limb %TPI (R2 = 0.450), whereas a panel including serum CTX-II and OPG was fit for the primary pain-related outcome, VAS (R2 = 0.516). Across diagnostic biomarker panels, a panel including serum MMP-1 and MMP-3 and urine PINP and TIMP-1 was fit for %TPI (R2 = 0.863). Separately, a panel including urine CTX-I, CTX-II, IL-8, MMP-2, and TIMP-1 was fit as diagnostic biomarkers for the VAS for pain (R2 = 0.438).Conclusion:Biomarker panels of selected serum and/or urine proteins can model clinically relevant metrics for function and pain in a preclinical model of MAT.Clinical Relevance:Biomarker panels could be used to provide real-time diagnostic and prognostic data regarding outcomes after MAT.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-14T10:11:18Z
      DOI: 10.1177/03635465221105481
       
  • Pulsed Electromagnetic Field Enhances Healing of a Meniscal Tear and
           Mitigates Posttraumatic Osteoarthritis in a Rat Model

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      Authors: Ming Wang, Yucong Li, Lu Feng, Xiaoting Zhang, Haixing Wang, Nianli Zhang, Ingmar Viohl, Gang Li
      First page: 2722
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Meniscal tears in the avascular region are thought to rarely heal and are a considerable challenge to treat. Although the therapeutic effects of a pulsed electromagnetic field (PEMF) have been extensively studied in a variety of orthopaedic disorders, the effect of a PEMF on meniscal healing has not been reported.Hypothesis:PEMF treatment would promote meniscal healing and prevent osteoarthritis progression.Study Design:Controlled laboratory study.Methods:A total of 72 twelve-week-old male Sprague-Dawley rats with full-thickness longitudinal medial meniscal tears in the avascular region were divided into 3 groups: control (Gcon), treatment with a classic signal PEMF (Gclassic), and treatment with a high–slew rate signal PEMF (GHSR). Macroscopic observation and histological analysis of the meniscus and articular cartilage were performed to evaluate the meniscal healing and progression of osteoarthritis. The synovium was harvested for histological and immunofluorescent analysis to evaluate the intra-articular inflammation. Meniscal healing, articular cartilage degeneration, and synovitis were quantitatively evaluated according to their scoring systems.Results:Dramatic degenerative changes of the meniscus and articular cartilage were noticed during gross observation and histological evaluation in Gcon at 8 weeks. However, the menisci in the 2 treatment groups were restored to normal morphology, with a smooth surface and shiny white color. Particularly, the HSR signal remarkably enhanced the fibrochondrogenesis and accelerated the remodeling process of the regenerated tissue. The meniscal healing scores of the PEMF treatment groups were significantly higher than those in Gcon at 8 weeks. Specifically, the HSR signal showed a significantly higher meniscal repair score than did the classic signal at week 8 (P < .01). Additionally, the HSR signal significantly downregulated the secretion levels of interleukin 1 beta (IL-1β) and tumor necrosis factor alpha (TNF-α) in the meniscus and synovium as compared with the control group. When compared with the 2 treatment groups, Gcon had significantly higher degeneration scores (Gcon vs Gclassic, P < .0001; Gcon vs GHSR, P < .0001). The HSR signal also exhibited significantly lower synovitis scores compared with the other two groups (Gcon vs Gclassic, P < .0001; Gclassic vs GHSR, P = .0002).Conclusion:A PEMF promoted the healing of meniscal tears in the avascular region and restored the injured meniscus to its structural integrity in a rat model. As compared with the classic signal, the HSR signal showed increased capability to promote fibrocartilaginous tissue formation and modulate the inflammatory environment, therefore protecting the knee joint from posttraumatic osteoarthritis development.Clinical Relevance:Adjuvant PEMF therapy may offer a new approach for the treatment of meniscal tears attributed to the enhanced meniscal repair and ameliorated osteoarthritis progression.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-14T10:13:37Z
      DOI: 10.1177/03635465221105874
       
  • Mechanical and Microstructural Properties of Meniscus Roots Vary by
           Location

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      Authors: Peter S. Chang, Lorenzo F. Solon, Spencer P. Lake, Ryan M. Castile, J. Ryan Hill, Robert H. Brophy
      First page: 2733
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Despite the growing awareness of the clinical significance of meniscus root tears, there are relatively limited biomechanical and microstructural data available on native meniscus roots that could improve our understanding of why they are injured and how to best treat them.Purpose/Hypothesis:The purpose of the study was to measure the material and microstructural properties of meniscus roots using mechanical testing and quantitative polarized light imaging. The hypothesis was that these properties vary by location (medial vs lateral, anterior vs posterior) and by specific root (anteromedial vs anterolateral, posteromedial vs posterolateral).Study Design:Descriptive laboratory study.Methods:Anterior and posterior meniscus roots of the medial and lateral meniscus were isolated from 22 cadavers (10 female, 12 male; mean ± SD age, 47.1 ± 5.1 years) and loaded in uniaxial tension. Quantitative polarized light imaging was used to measure collagen fiber organization and realignment under load. Samples were subjected to preconditioning, stress-relaxation, and a ramp to failure. Time-dependent relaxation behavior was quantified. Modulus values were computed in the toe and linear regions of the stress-strain curves. The degree of linear polarization (DoLP) and angle of polarization—measures of the strength and direction of collagen alignment, respectively—were calculated during the stress-relaxation test and at specific strain values throughout the ramp to failure (zero, transition, and linear strain).Results:Anterior roots had larger moduli than posterior roots in the toe (P = .007) and linear (P < .0001) regions and larger average DoLP values at all points of the ramp to failure (zero, P = .016; transition, P = .004; linear, P = .002). Posterior roots had larger values across all regions in terms of standard deviation angle of polarization (P < .001). Lateral roots had greater modulus values versus medial roots in the toe (P = .027) and linear (P = .014) regions. Across all strain points, posterolateral roots had smaller mean DoLP values than posteromedial roots.Conclusion:Posterior meniscus roots have smaller modulus values and more disorganized collagen alignment at all strain levels when compared with anterior roots. Posterolateral roots have lower strength of collagen alignment versus posteromedial roots.Clinical Relevance:These data findings may explain at least in part the relative paucity of anterior meniscus root tears and the predominance of traumatic posterolateral roots tears as compared with degenerative posteromedial root tears.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-21T06:29:11Z
      DOI: 10.1177/03635465221106746
       
  • Comparative Effects of Exosomes and Ectosomes Isolated From
           Adipose-Derived Mesenchymal Stem Cells on Achilles Tendinopathy in a Rat
           Model

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      Authors: Tengjing Xu, Yunting Lin, Xinning Yu, Guangyao Jiang, Jiajie Wang, Kaiwang Xu, Jinghua Fang, Siheng Wang, Xuesong Dai
      First page: 2740
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Extracellular vesicles derived from mesenchymal stem cells (MSC-EVs) have gained momentum as a treatment for tendinopathy. Multiple studies have demonstrated significant differences in cargo composition between the 2 subtypes of MSC-EVs (ie, exosomes and ectosomes), which may result in different therapeutic effects. However, the effects of the 2 EV subtypes on tendinopathy have not yet been compared.Purpose:To compare the effects of adipose stem cell–derived exosomes (ASC-Exos) and ectosomes (ASC-Ectos) on Achilles tendinopathy.Study Design:Controlled laboratory study.Methods:Rats were administered collagenase injections to generate a model of Achilles tendinopathy. A week later, 36 rats were randomly assigned to 3 groups. In each group, Achilles tendons were injected with equal volumes of ASC-Exos, ASC-Ectos, or saline (12 legs/group). The healing outcomes were evaluated by magnetic resonance imaging, histology, immunohistochemistry, transmission electron microscopy, and biomechanical testing at 3 and 5 weeks after collagenase injection.Results:At 3 and 5 weeks, the ASC-Exo group had better histological scores (P = .0036 and P = .0276, respectively), a lower fibril density (P < .0001 and P = .0310, respectively), and a larger collagen diameter (P = .0052 and P < .0001, respectively) than the ASC-Ecto group. At 5 weeks, the expression of collagen type 1 and CD206 in the ASC-Exo group was significantly higher than that in the ASC-Ecto group (P = .0025 and P = .0010, respectively). Regarding biomechanical testing, the ASC-Exo group showed higher failure load (P = .0005), tensile stress (P < .0001), and elastic modulus (P < .0001) than the ASC-Ecto group.Conclusion:ASC-Exos had more beneficial effects on tendon repair than ASC-Ectos in a rat model of Achilles tendinopathy.Clinical Relevance:Administration of ASC-EVs may have the potential to treat Achilles tendinopathy, and delivery of ASC-Exos could provide additional benefits. It is necessary to compare the healing responses caused by different EV subtypes to further understand their effects on tendinopathy and to aid clinical decision making.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-22T03:31:22Z
      DOI: 10.1177/03635465221108972
       
  • Long-term Results of Arthroscopic Repair of Full-Thickness Traumatic
           Rotator Cuff Tears in Active Duty Military Patients Under the Age of 40
           Years

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      Authors: John P. Scanaliato, Michael D. Eckhoff, John C. Dunn, Hunter Czajkowski, Walter A. Fink, Nata Parnes
      First page: 2753
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Arthroscopic rotator cuff repair is an effective procedure through which to decrease pain and increase strength, with favorable long-term outcomes demonstrated in older patient populations with full-thickness rotator cuff tears. The long-term outcomes after this procedure in younger, higher-demand patients, however, is not as clearly defined.Purpose:To report on the long-term outcomes after arthroscopic rotator cuff repair of traumatic full-thickness rotator cuff tears in active duty military patients under the age of 40 years at the time of surgery.Study Design:Case series; Level of evidence, 4.Methods:Preoperative, midterm, and final evaluations were collected, including scores on the visual analog scale for pain, Single Assessment Numeric Evaluation, and American Shoulder and Elbow Surgeons shoulder form. A total of 42 patients were screened for inclusion: 3 underwent additional surgical procedures on the operative shoulder and 2 were lost to follow-up, leaving 37 patients with mean follow-up of 104.51 months available for analysis. A subgroup analysis was performed comparing outcomes between patients with Southern California Orthopaedic Institute grade 1 or 2 tears and those with grade 3 or 4 tears.Results:At final follow-up, pain per the visual analog scale decreased to 1.16 from 8.03 (P < .0001); the Single Assessment Numeric Evaluation score increased to 87.32 from 48.24 (P < .0001); and the American Shoulder and Elbow Surgeons score increased to 88.68 from 41.00 (P < .0001). There was no statistically significant difference in outcome scores or range of motion between midterm and final follow-up. Improvement in outcome scores and range of motion at final follow-up did not vary between patients with small and large tears. Of 42 patients, 37 (88.1%) were able to return to full unrestricted active duty and sporting activity, while 5 (11.9%) were medically separated from the military.Conclusion:Active duty military patients under the age of 40 years with traumatic full-thickness rotator cuff tears had statistically and clinically significant increases in outcome scores and decreases in pain after arthroscopic rotator cuff repair at long-term follow-up.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-21T06:31:01Z
      DOI: 10.1177/03635465221107371
       
  • Defining Minimal Clinically Important Difference and Patient Acceptable
           Symptom State After the Latarjet Procedure

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      Authors: Mariano E. Menendez, Suleiman Y. Sudah, Matthew R. Cohn, Pablo Narbona, Alexandre Lädermann, Johannes Barth, Patrick J. Denard
      First page: 2761
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The Latarjet procedure is one of the most well-established treatment options for anterior shoulder instability. However, meaningful clinical outcomes after this surgery have not been defined.Purpose:This study aimed to establish the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for commonly used outcome measures in patients undergoing the Latarjet procedure and determine correlations between preoperative patient characteristics and achievement of MCID or PASS.Study Design:Case series; Level of evidence, 4.Methods:A multicenter retrospective review at 4 institutions was performed to identify patients undergoing primary open Latarjet procedure with minimum 2-year follow-up. Data collected included patient characteristics (age, sex, sports participation), radiological parameters (glenoid bone loss, off-track Hill-Sachs lesion), and 4 patient-reported outcome measures (collected preoperatively and 2 years postoperatively): the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), the visual analog scale (VAS) for pain, and the Western Ontario Shoulder Instability Index (WOSI). The MCID and PASS for each outcome measure were calculated, and Pearson and Spearman coefficient analyses were used to identify correlations between MCID or PASS and preoperative variables (age, sex, sports participation, glenoid bone loss, off-track Hill-Sachs lesion).Results:A total of 156 patients were included in the study. The MCID values for ASES, SANE, VAS pain, and WOSI were calculated to be 9.6, 12.4, 1.7, and 254.9, respectively. The PASS values for ASES, SANE, VAS pain, and WOSI were 86.0, 82.5, 2.5, and 571.0, respectively. The rates of patients achieving MCID were 61.1% for VAS pain, 71.6% for ASES, 74.1% for SANE, and 84.2% for WOSI. The rates of achieving PASS ranged from 78.4% for WOSI to 84.0% for VAS pain. There was no correlation between any of the studied preoperative variables and the likelihood of achieving MCID or PASS.Conclusion:This study defined MCID and PASS values for 4 commonly used outcome measures in patients undergoing the Latarjet procedure. These findings are essential for incorporating patient perspectives into the clinical effectiveness of the Latarjet procedure and provide valuable parameters for the design and interpretation of future clinical trials.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-18T10:49:45Z
      DOI: 10.1177/03635465221107939
       
  • Biomechanical and Histological Results of Dual-Suspensory Reconstruction
           Using Banded Tendon Graft to Bridge Massive Rotator Cuff Tears in a
           Chronic Rabbit Model

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      Authors: Junjie Xu, Kang Han, Zipeng Ye, Chenliang Wu, Xiulin Wu, Ziyun Li, Tianlun Zhang, Caiqi Xu, Wei Su, Jinzhong Zhao
      First page: 2767
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Bridging rotator cuff tendon defects with a patch is a reasonable treatment for massive rotator cuff tears (MRCTs). However, the poor outcomes associated with routine patch repair have prompted exploration into superior bridging techniques and graft structures.Purpose:To detect whether dual-suspensory reconstruction using a banded graft would be superior to routine bridging using a patch graft to treat MRCTs and to detect the comparative effectiveness of patellar tendon (PT) and fascia lata (FL) grafts in dual-suspensory reconstruction.Study Design:Controlled laboratory study.Methods:Unilateral chronic MRCTs were created in 72 mature male New Zealand White rabbits, which were randomly divided into 3 groups: (1) patch bridging repair using rectangular FL autograft (PR-FL), (2) dual-suspensory bridging reconstruction using banded FL autograft (DSR-FL), and (3) dual-suspensory bridging reconstruction using banded PT autograft (DSR-PT). In each group, the mean failure load and stiffness of the cuff-graft-humerus (C-G-H) complexes of 6-week and 12-week specimens were recorded, with the failure modes and sites noted. Moreover, cuff-to-graft and graft-to-bone interface healing and graft substance remodeling of the complexes were histologically evaluated (via hematoxylin and eosin, Picrosirius red, Masson trichrome, and Safranin O/fast green staining) at 6 and 12 weeks to assess integrations between the bridging constructs and the native bone or rotator cuff tendons.Results:The DSR-PT group had the greatest mean failure loads and stiffness of the C-G-H complexes at 6 and 12 weeks (41.81 ± 7.00 N, 10.34 ± 2.68 N/mm; 87.62 ± 9.20 N, 17.98 ± 1.57 N/mm, respectively), followed by the DSR-FL group (32.04 ± 5.49 N, 8.20 ± 2.27 N/mm; 75.30 ± 7.31 N, 14.39 ± 3.29 N/mm, respectively). In the DSR-PT and DSR-FL groups, fewer specimens failed at the graft-to-bone junction and more failed at the cuff-to-graft junction, but both groups had higher median failure loads at 6 and 12 weeks (DSR-PT: cuff-to-graft junction, 37.80 and 83.76 N; graft-to-bone junction, 45.46 and 95.86 N) (DSR-FL: cuff-to-graft junction, 28.52 and 67.68 N; graft-to-bone junction, 37.92 and 82.18 N) compared with PR-FL (cuff-to-graft junction, 27.17 and 60.04 N; graft-to-bone junction, 30.12 and 55.95 N). At 12 weeks, the DSR-FL group had higher median failure loads at graft substance (72.26 N) than the PR-FL group (61.27 N). Moreover, the PR-FL group showed more inflammatory responses at the 2 healing interfaces and the graft substance in the 6-week specimens and subsequently displayed poorer interface healing (assessed via collagen organization, collagen maturity, and fibrocartilage regeneration) and graft substance remodeling (assessed via collagen organization and maturity) in 12-week specimens compared with the DSR-PT and DSR-FL groups. Superior interface healing and substance remodeling processes were observed in the DSR-PT group compared with the DSR-FL group.Conclusion:When compared with routine patch repair, the dual-suspensory reconstructions optimized biomechanical properties and improved interface healing and graft substance remodeling for bridging MRCTs. Furthermore, the dual-suspensory technique using the PT graft presented superior histological and biomechanical characteristics than that using FL.Clinical Relevance:The dual-suspensory reconstruction technique using banded tendon grafts may enhance bridging constructs for MRCTs in humans, warranting further investigations of clinical outcomes.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-19T07:17:34Z
      DOI: 10.1177/03635465221102744
       
  • Pull-out Strength of Suture Anchor and Torque of Buddy Anchor for an
           Osteoporotic Humeral Head in Rotator Cuff Repair: Parallel Versus
           Divergent Insertion

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      Authors: Woo-Sung Do, Joo-Hyung Kim, Joon-Ryul Lim, Tae-Hwan Yoon, Yong-Min Chun
      First page: 2782
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:The buddy anchor technique is useful to reinforce loose anchors in the osteoporotic humeral head during arthroscopic rotator cuff repair. However, theoretical parallel insertion of the buddy anchor to index a loose anchor is challenging in arthroscopy and can widen the entry site and decrease structural integrity.Purpose:To investigate and compare the biomechanical stability between 2 buddy anchor insertion techniques (parallel insertion vs divergent insertion) in the osteoporotic humeral head.Study Design:Controlled laboratory study.Methods:A total of 24 paired fresh-frozen cadaveric shoulders were used, and each pair was randomly assigned to either the parallel insertion group or the divergent insertion group. In the parallel insertion group, the buddy anchor was inserted parallel to the index loose anchor. In the divergent insertion group, the buddy anchor was inserted at a 20° angle in the medial direction to the index loose anchor. The insertion torque of the buddy anchor and ultimate pull-out strength of the index anchor were measured and compared between the 2 groups.Results:The mean maximum insertion torque was significantly higher in the parallel insertion group (16.1 ± 1.8 cN·m) compared with the divergent insertion group (12.0 ± 1.5 cN·m) (P < .001). The mean ultimate pull-out strength was significantly higher with divergent insertion (192.2 ± 28.6 N) than with parallel insertion (147.7 ± 23.6 N) (P < .001).Conclusion:For application of the buddy anchor system in the cadaveric osteoporotic humeral bone model, divergent insertion showed better ultimate pull-out strength than conventional parallel insertion, despite inferior maximum insertion torque.Clinical Relevance:The results of this study widen the applicability and accessibility for the buddy anchor system.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-01T08:45:42Z
      DOI: 10.1177/03635465221104766
       
  • Effects of Heavy Slow Resistance Training Combined With Corticosteroid
           Injections or Tendon Needling in Patients With Lateral Elbow Tendinopathy:
           A 3-Arm Randomized Double-Blinded Placebo-Controlled Study

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      Authors: Christian Couppé, Simon Døssing, Per Martin Bülow, Volkert Dirk Siersma, Camilla Kampp Zilmer, Christine Winther Bang, Rikke Høffner, Mathilde Kracht, Paul Hogg, Gabriella Edström, Michael Kjaer, Stig Peter Magnusson
      First page: 2787
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Lateral elbow tendinopathy is a disabling tendon overuse injury. It remains unknown if a corticosteroid injection (CSI) or tendon needling (TN) combined with heavy slow resistance (HSR) training is superior to HSR alone in treating lateral elbow tendinopathy.Purpose/Hypothesis:The purpose was to investigate the effects of HSR combined with either (1) a CSI, (2) TN, or (3) placebo needling (PN) as treatment for lateral elbow tendinopathy. We hypothesized that 12 weeks of HSR in combination with a CSI or TN would have superior effects compared with PN at 12, 26, and 52 (primary endpoint) weeks’ follow-up on primary (Disabilities of the Arm, Shoulder and Hand [DASH] score) and secondary outcomes in patients with chronic unilateral lateral elbow tendinopathy.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:A total of 60 patients with chronic unilateral lateral elbow tendinopathy were randomized to perform 12 weeks of home-based HSR with elastic band exercises combined with either (1) a CSI, (2) TN, or (3) PN, and at 12, 26, and 52 weeks, we assessed the primary outcome, the DASH score, and secondary outcomes: shortened version of the DASH (QuickDASH) score, pain (numerical rating scale [NRS] score), pain-free grip strength, and hypervascularization (power Doppler area).Results:A CSI, TN, and PN improved patient outcomes equally based on the DASH (Δ20 points), QuickDASH (Δ21 points), and NRS (Δ2.5 points) scores after 12 weeks. Further, after 12 weeks, a CSI also resulted in decreased hypervascularization (power Doppler area) compared with PN (Δ–2251 pixels, P = .0418). Except for the QuickDASH score (CSI increased score by Δ15 points compared with PN; P = .0427), there were no differences between the groups after 52 weeks.Conclusion:These results suggest that 12 weeks of HSR improved symptoms in both the short and the long term and that a CSI or TN did not amplify this effect. In addition, a CSI seemed to impair patient-reported outcomes compared with HSR alone at long-term follow-up.Registration:NCT02521298 (ClinicalTrials.gov identifier).
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-22T05:50:45Z
      DOI: 10.1177/03635465221110214
       
  • Variability in Pitch Count Limits and Rest Day Requirements by State:
           

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      Authors: Joseph E. Manzi, Kyle N. Kunze, Jennifer A. Estrada, Brittany Dowling, Kathryn D. McElheny, Joshua S. Dines, James B. Carr
      First page: 2797
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:It is unknown how different pitch count limits and rest day requirements affect cumulative pitch counts during a baseball season.Purpose:To determine (1) the variability of pitch count rules in high school baseball and (2) the theoretical effect of different pitch count limits and rest day combinations on game, weekly, and seasonal pitch totals in high school baseball pitchers.Study Design:Cross-sectional study.Methods:Pitch count rules for the 2019-2020 academic year for 48 sanctioned states were recorded from each state’s athletic association website. Maximum pitch count limits were recorded along with the number of pitches allowed before requiring 0 to 5 rest days before the next pitching outing. Rules were also analyzed for several distinctions, including the athlete’s level of competition, age, and grade. To determine the effect of pitch count rules and rest days, a theoretical 3-month season was calculated in the following scenarios: (1) variable maximum pitch count limits with a universal 3-day rest requirement, (2) universal 110 pitch count limit with variable rest day requirements (3, 4, or 5 days), and (3) actual pitch count limits and required rest days for every state assuming pitchers throw as many pitches as allowed. Analysis of variance and Student t tests were used to compare between-group and intragroup seasonal pitch totals based on variations in required rest days.Results:The most common maximum pitch count limit for a varsity high school athlete was 110 pitches (range, 100-125 pitches) with 4 rest days (range, 0-5 days). We found that 23 states (48%) did not make distinctions for pitch count rules based on the athlete’s level of competition, age, or grade. We noted a 25% increase in total seasonal pitch counts between the smallest and largest pitch count limit when assuming constant 3-day rest. We found a 53% difference in total seasonal pitch count when rest days varied between 3 and 5 days with a constant 110-pitch limit. Allowing 140 pitches in a 4-day span without a specific rest day requirement resulted in the highest seasonal pitch count (Nevada). There was a 49% difference in maximum seasonal pitch counts between the most and least restrictive states (P < .001). Submaximum pitch limits resulted in higher seasonal pitch counts than maximum pitch limits in 56% of states.Conclusion:Pitch count rules vary widely by state. Required rest days influenced total seasonal pitch counts more than maximum or submaximum pitch count limits.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-21T06:41:01Z
      DOI: 10.1177/03635465221111098
       
  • Evaluation of SS-31 as a Potential Strategy for Tendinopathy Treatment: An
           In Vitro Model

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      Authors: Xueying Zhang, Ying Zhang, Meng Zhang, Yusuke Nakagawa, Camila B. Caballo, Hazel H. Szeto, Xiang-Hua Deng, Scott A. Rodeo
      First page: 2805
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:Studies in our laboratory have demonstrated mitochondrial dysfunction in human and animal models of supraspinatus tendinopathy. SS-31 (elamipretide) has been reported to improve mitochondrial function and to be effective in clinical trials for several diseases. The potential of SS-31 in treating tendinopathy has not been explored.Hypothesis:SS-31 would improve mitochondrial function in human tenocytes sampled from patients with tendinopathy.Study Design:Controlled laboratory study.Methods:Healthy tenocytes were obtained from normal hamstring tendon biopsy specimens in 9 patients undergoing anterior cruciate ligament reconstruction, and tenocytes were collected from degenerative supraspinatus tendon biopsy specimens in 9 patients undergoing rotator cuff repair. Tenocytes were cultured, used at passage 1, and assigned to 4 groups: healthy tenocytes, healthy tenocytes with 1μM SS-31 treatment for 72 hours, degenerative tenocytes, and degenerative tenocytes with 1μM SS-31 treatment for 72 hours. The outcomes included measurements of mitochondrial potential, mitochondrial morphology by transmission electron microscopy imaging, reactive oxygen species and superoxidative dismutase activity, gene expression, and cell viability.Results:An increase in the cell fraction with depolarized mitochondria was found in degenerative tenocytes (P = .014), followed by a decrease after SS-31 treatment (P = .018). Transmission electron microscopy images demonstrated morphological changes with a decreased number and size of mitochondria per cell in the degenerative tenocytes (P = .018) and with improvement after SS-31 treatment. There was no significant difference in the level of reactive oxygen species between healthy and degenerative tenocytes in culture, but superoxidative dismutase activity was significantly decreased in the degenerative group (P = .006), which then increased after SS-31 treatment (P = .012). These findings suggested that mitochondrial dysfunction may be reversed by SS-31 treatment. The gene expression of matrix metalloproteinase-1 (matrix remodeling, P = .029) and fatty acid–binding protein 4 (fatty infiltration, P = .046) was significantly upregulated in the degenerative tenocytes and reduced by SS-31 treatment (P = .048; P = .007). Gene expression for hypoxia-inducible factor1 α and the proapoptotic regulator Bcl-2–associated X protein was increased in the degenerative tenocytes. There was a significant decrease in cell viability in degenerative tenocytes as compared with the healthy tenocytes, with small improvement after treatment with SS-31.Conclusion:There are changes in mitochondrial structure and function in tenocytes derived from degenerative tendons, and SS-31, as a mitochondrial protectant, could improve mitochondrial function and promote the healing of tendinopathy.Clinical Relevance:Mitochondrial dysfunction appears to play a role in the development of tendinopathy, and SS-31, as a mitochondrial protective agent, may be a therapeutic agent in the treatment of tendinopathy.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-21T06:33:41Z
      DOI: 10.1177/03635465221107943
       
  • Kinematic Differences Between the Dominant and Nondominant Legs During a
           Single-Leg Drop Vertical Jump in Female Soccer Players

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      Authors: Yu Nakahira, Shuji Taketomi, Kohei Kawaguchi, Yuri Mizutani, Masato Hasegawa, Chie Ito, Emiko Uchiyama, Yosuke Ikegami, Sayaka Fujiwara, Ko Yamamoto, Yoshihiko Nakamura, Sakae Tanaka, Toru Ogata
      First page: 2817
      Abstract: The American Journal of Sports Medicine, Ahead of Print.
      Background:In soccer, the roles of the dominant (kicking) and nondominant (supporting) legs are different. The kinematic differences between the actions of the dominant and nondominant legs in female soccer players are not clear.Purpose:To clarify the kinematic differences between dominant and nondominant legs during a single-leg drop vertical jump (DVJ) in female soccer players.Study Design:Controlled laboratory study.Methods:A total of 64 female high school and college soccer players were included in this study. Participants performed a single-leg DVJ test utilizing video motion capture with artificial intelligence during the preseason period. This study assessed the knee flexion angles, knee valgus angles, hip flexion angles, and lower leg anterior inclination angle at 3 time points (initial contact, maximum flexion of the knee, and toe-off) and compared them between the dominant and nondominant legs. These angles were calculated from motion capture data and analyzed in 3 dimensions. A paired t test was used to analyze the differences between legs, and the significance level was set at P < .05.Results:The knee valgus angle at initial contact was greater in the nondominant leg (mean ± SD, 0.8°± 5.2°) than the dominant leg (−0.9°± 4.9°) (P < .01). There were no differences between legs for any other angles at any of the time points.Conclusion:The kinematics of the dominant and nondominant legs of female soccer players in a single-leg DVJ differ in knee valgus angle.Clinical Relevance:Leg dominance is associated with the risk of sports injuries. Kinematic differences between the dominant and nondominant legs may be a noteworthy factor in elucidating the mechanisms and risk of sports injury associated with leg dominance.
      Citation: The American Journal of Sports Medicine
      PubDate: 2022-07-18T10:47:29Z
      DOI: 10.1177/03635465221107388
       
 
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