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Orthopaedic Journal of Sports Medicine
Journal Prestige (SJR): 0.935
Citation Impact (citeScore): 1
Number of Followers: 14  

  This is an Open Access Journal Open Access journal
ISSN (Print) 2325-9671 - ISSN (Online) 2325-9671
Published by Sage Publications Homepage  [1176 journals]
  • When Should Bony Correction Be Considered in Addition to Medial
           Patellofemoral Ligament Reconstruction' Results of a Clinically
           Derived 2-Group Classification of Lateral Patellar Instability Based on
           122 Patients at 2- to 5-Year Follow-up

    • Authors: Felix Zimmermann, Danko Dan Milinkovic, Alexander Zimmerer, Peter Balcarek
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:The need for concomitant bony procedures to realign pathoanatomic risk factors in addition to medial patellofemoral ligament reconstruction (MPFL-R) remains unclear.Purpose:To evaluate a clinically derived 2-part classification of lateral patellar instability aimed at identifying patients indicated for a concomitant bony procedure.Study Design:Cohort study; Level of evidence, 3.Methods:The study included 122 patients (42 male, 80 female; mean ± SD age, 22 ± 6 years) who were assigned to a mild instability group (mIG) and a complex instability group (cIG) based on the reversed dynamic patellar apprehension test (ReDPAT) and J-sign. The mIG had a positive ReDPAT result 40° of knee flexion and/or a high-grade J-sign (grade 2 or 3). The mIG underwent isolated MPFL-R, and the cIG underwent MPFL-R and concomitant bony procedures depending on the established risk factor assessment. For evaluation, the BANFF Patellar Instability Instrument 2.0 (BPII 2.0) and numeric analog scale (0-10) for patellofemoral pain and subjective knee function were used. The minimal clinically important difference for the BPII 2.0 was ascertained by calculating half the standard deviation of baseline scores.Results:Radiographic analysis confirmed a significantly more pronounced pathoanatomic risk factor constellation in the cIG regarding severity of trochlear dysplasia, distal malalignment, and patellar height (all P < .05). At final follow-up, no patellar redislocation occurred in either group; 2 patients in the cIG reported patellar subluxation. Within both groups, all outcome scores improved significantly pre- to postoperatively (all P < .0001); no between-group difference was found regarding BPII 2.0 score and numeric analog scale for function. The minimal clinically important difference for the BPII 2.0 was met by 84% (32/38) of the mIG and 90% (76/84) of the cIG (P = .36), but the cIG experienced more patellofemoral pain than the mIG (1.3 ± 1.6 vs 2.1 ± 2.1; P = .036).Conclusion:Patients with a high-grade J-sign and/or a positive ReDPAT finding beyond 40° to 50° of knee flexion exhibited a significantly more pronounced pathoanatomic risk factor constellation; however, the correction of modifiable risk factors led to similarly good outcomes to patients who underwent isolated MPFL-R. A slightly higher level of patellofemoral pain after bony procedures was evident in these patients.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-27T11:46:56Z
      DOI: 10.1177/23259671221147572
      Issue No: Vol. 11, No. 1 (2023)
       
  • Similar Biomechanics Between the Double–Cortical Button and Docking
           Techniques for Ulnar Collateral Ligament Reconstruction: A Cadaveric
           Evaluation

    • Authors: George Russell Huffman, Christine Piper, Richa Gupta, Michael W. Hast
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:The docking technique is widely used to perform ulnar collateral ligament (UCL) reconstructions because of its high failure torque and reliable clinical outcomes. A double–cortical button technique was recently described, with advantages including the ability to tension the graft at the ulnar and humeral attachments and the creation of single bone tunnels.Purpose/Hypothesis:To compare the biomechanics between the docking and double-button UCL reconstruction techniques using cadaveric specimens. We hypothesized that there would be no difference in postoperative stiffness or maximum strength between the techniques.Study Design:Controlled laboratory study.Methods:Eight matched pairs of cadaveric elbow joints underwent controlled humeral valgus torsion cycles in a test frame. Toe region stiffness, elastic region stiffness, and maximum torque were measured during a 4-step protocol: intact, injured, reconstructed (10 and 1000 cycles), and ramp to failure. Graft strains were calculated using 3-dimensional motion capture.Results:After 10 cycles, intact ligaments from the docking and double-button groups exhibited mean ± SD elastic torsional stiffness of 1.60 ± 0.49 and 1.64 ± 0.35 N·m/deg (P = .827), while docking (1.10 ± 0.39 N·m/deg) and double-button (1.05 ± 0.29 N·m/deg) reconstructions were lower (P = .754). There were no significant differences in maximum torque between the docking (3.45 ± 1.35 N·m) and double-button (3.25 ± 1.31 N·m) groups (P = .777). Similarly, differences in maximum graft strains were not significant between the docking (8.1% ± 7.2%) and double-button (5.5% ± 3.1%) groups (P = .645). The groups demonstrated similar decreases in these measures after cyclic loading. Ramp-to-failure testing showed no significant differences in ultimate torque between the docking (8.93 ± 3.9 N·m) and double-button (9.56 ± 3.5 N·m) groups (P = .739).Conclusion:The biomechanical behavior of the double-button technique was not significantly different from that of the docking technique. Both reconstruction techniques restored joint stability, but neither fully recapitulated preinjury joint stiffness.Clinical Relevance:With its procedural advantages, results preliminarily support the use of the double-button reconstruction technique for UCL reconstruction as a reliable single-tunnel technique for primary or revision cases.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-27T11:27:24Z
      DOI: 10.1177/23259671221123342
      Issue No: Vol. 11, No. 1 (2023)
       
  • Effect of Increased Time to Surgery on the Ability of MRI to Rule Out
           Medial Meniscal Tears in Young Athletes With ACL Injury

    • Authors: Joseph M. Sliepka, Michael G. Saper, Woody Sorey, Simran Mand, Shamele Battan, Christopher Y. Kweon, Albert O. Gee, Gregory A. Schmale, Mia S. Hagen
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:The prevalence of meniscal tears in patients with anterior cruciate ligament (ACL) injury increases with extended time between injury and ACL reconstruction.Purpose/Hypothesis:The purpose of this study was to determine if there is a relationship between time from magnetic resonance imaging (MRI) to ACL reconstruction and the predictive value of MRI to diagnose meniscal tears in the young active population. It was hypothesized that increased time between MRI and ACL reconstruction would lead to a decrease in the negative predictive value of MRI in diagnosing meniscal tears, as more injuries may accrue over time in the ACL-deficient knee.Study Design:Case series; Level of evidence, 4.Methods:Included were patients aged 13 to 25 years at the authors’ institution who underwent primary ACL reconstruction from January 2017 to June 2020. Time from MRI to surgery as well as descriptions of medial and lateral meniscal tears on both MRI and operative reports were documented. Time from MRI to surgery was divided into 4 intervals: 0 to 6 weeks,>6 weeks to 3 months,>3 to 6 months, and beyond 6 months. Multivariable analysis was used to determine the positive and negative predictive values of MRI in diagnosing a meniscal tear as compared with arthroscopic findings.Results:A total of 432 patients were included with a mean age of 17.9 ± 3.4 years. The mean time from MRI to surgery was 70.5 ± 98 days. There was a significant decrease in the negative predictive value of MRI to identify a medial meniscal tear in patients who underwent ACL reconstruction>6 months after imaging (odds ratio, 0.16 [95% CI, 0.05-0.53]; P = .003). This same relationship was not shown for lateral meniscal tears, nor was any other predictor significant.Conclusion:The utility of MRI to rule out a medial meniscal tear significantly diminished in the young athletic population when>6 months passed between MRI and ACL reconstruction. These data suggest these tears occur between the time of the MRI and surgery and that the medial meniscus is more susceptible than the lateral meniscus to new injury once the ACL has torn.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-27T11:21:45Z
      DOI: 10.1177/23259671221141664
      Issue No: Vol. 11, No. 1 (2023)
       
  • Puncture Capsulotomy Technique for Hip Arthroscopy: Midterm Functional
           Outcomes

    • Authors: Christopher T. Eberlin, Michael P. Kucharik, Paul F. Abraham, Mark R. Nazal, William K. Conaway, Nathan H. Varady, Scott D. Martin
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:The most common surgical approaches in hip arthroscopy are interportal and T-capsulotomy. However, these methods may introduce capsular instability. Puncture capsulotomy preserves capsuloligamentous integrity by avoiding iatrogenic transection of the iliofemoral capsular ligament.Purpose:To present minimum 2-year functional outcomes for patients who underwent arthroscopic treatment for acetabular labral tears and concomitant femoroacetabular impingement using the puncture capsulotomy technique.Study Design:Case series; Level of evidence, 4.Methods:The authors conducted a retrospective review of prospectively collected data on patients who underwent arthroscopic acetabular labral tear treatment between December 2013 and May 2019. Included were patients aged ≥18 years who underwent hip arthroscopy by a single surgeon and completed a minimum of 2 years of patient-reported outcome measure (PROM) surveys. Intraoperatively, patients underwent hip arthroscopy via puncture capsulotomy to treat labral tears and any concomitant femoroacetabular impingement. Clinical outcome data consisted of PROMs.Results:A total of 163 hips were included; the mean patient follow-up was 30.4 months (range, 24-60 months; 95% CI, 28.5-32.3 months). Patients had a mean age of 37.9 years (range, 36.1-39.6 years), with a mean body mass index of 25.9 (range, 25.2-26.5). There were significant improvements in mean [95% CI] baseline to final follow-up scores for the 33-Item International Hip Outcome Tool (iHOT-33) (39.6 [36.8-42.4] vs 76.1 [72.7-79.6]), Hip Outcome Score–Activities of Daily Living (70.0 [67.0-73.0] vs 89.3 [87.3-91.3]), modified Harris Hip Score (60.1 [57.9-62.4] vs 84.9 [82.5-87.2]), and Hip Outcome Score–Sports Specific Subscale (41.8 [37.9-45.6] vs 75.7 [71.7-79.7]) (P < .001 for all). Additionally, the mean [95% CI] visual analog scale pain scores were noted to significantly improve throughout the duration of the postoperative period (from 6.3 [5.9-6.7] to 2.2 [1.8-2.6]; P < .001). There were no incidences of infection, avascular necrosis of the femoral head, dislocation/instability, or femoral neck fracture. At the 2-year follow-up, 81.0%, 62.0%, and 58.9% of hips achieved previously published clinically meaningful iHOT-33 thresholds for minimally clinically important difference, Patient Acceptable Symptom Score, and substantial clinical benefit, respectively.Conclusion:Puncture capsulotomy demonstrated significantly improved functional and clinically meaningful outcomes at a minimum 2-year follow-up, along with a minimal complication rate.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-26T12:18:14Z
      DOI: 10.1177/23259671221144056
      Issue No: Vol. 11, No. 1 (2023)
       
  • Sex-Specific Differences in Hip Muscle Cross-sectional Area and Fatty
           Infiltration in Patients With Femoroacetabular Impingement Syndrome

    • Authors: Mirjam V. Douma, Nicola C. Casartelli, Reto Sutter, Michael Leunig, Nicola A. Maffiuletti
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Patients with femoroacetabular impingement syndrome (FAIS) show sex-specific differences in hip muscle function, hip morphology, and symptoms. Possible differences in hip muscle characteristics between men and women with FAIS are unknown.Purpose:To compare hip muscle cross-sectional area (CSA) and fatty infiltration between men and women with FAIS and investigate possible associations with patient-reported outcomes.Study Design:Cohort study; Level of evidence, 3.Methods:We retrospectively analyzed preoperative axial pelvic magnetic resonance imaging scans of 104 patients (54 women) who underwent hip surgery for FAIS. The main outcome measures were side-to-side percentage asymmetry in hip muscle CSA and involved-side fatty infiltration as measured with the Goutallier scale for a total of 10 hip muscles. Patient-reported outcomes included duration of hip symptoms, iHOT-12 (12-item International Hip Outcome Tool), and Hip Sports Activity Scale.Results:Women showed larger hip abductor muscle CSA asymmetry than men (P = .018), particularly for the gluteus medius (P = .049), while men exhibited more fatty streaks (grade 1) in the gluteus medius (P = .015) than women. Duration of symptoms was associated only with fatty infiltration of obturator externus in men (r S = –0.55, P = .018). iHOT-12 was associated with CSA asymmetry of the gluteus minimus (r = –0.41, P = .011) and iliopsoas (r = –0.36, P = .028) in men and with piriformis fatty infiltration (r S = –0.56, P = .030) in women. The Hip Sports Activity Scale was associated with iliopsoas CSA asymmetry (r S = 0.32, P = .026) and with fatty infiltration of the tensor fasciae latae (r S = –0.45, P = .046) and obturator externus (r S = –0.50, P = .023) in women.Conclusion:Patients with FAIS demonstrated few sex-specific quantitative and qualitative alterations of hip muscles. Women showed greater hip abductor muscle atrophy than men, particularly for the gluteus medius, while men showed a higher degree of fatty infiltration in this same muscle. The duration of hip symptoms was not associated with muscle atrophy. Patient-reported hip pain/function and sport activity level were only moderately associated with isolated muscular variables.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-26T04:00:00Z
      DOI: 10.1177/23259671221147528
      Issue No: Vol. 11, No. 1 (2023)
       
  • Deltotrapezial Stabilization of Acromioclavicular Joint Rotational
           Stability: A Biomechanical Evaluation

    • Authors: Benjamin C. Hawthorne, Michael R. Mancini, Ian J. Wellington, Michael B. DiCosmo, Matthew E. Shuman, Maxwell T. Trudeau, Caitlin G. Dorsey, Elifho Obopilwe, Mark P. Cote, Augustus D. Mazzocca
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Despite advances in surgical management of acromioclavicular (AC) joint reconstruction, many patients fail to maintain sustained anatomic reduction postoperatively.Purpose:To determine the biomechanical support of the deltoid and trapezius on AC joint stability, focusing on the rotational stability provided by the muscles to posterior and anterior clavicular rotation. A novel technique was attempted to repair the deltoid and trapezius anatomically.Study Design:Controlled laboratory study.Methods:Twelve human cadaveric shoulders (mean ± SD age, 60.25 ± 10.25 years) underwent servohydraulic testing. Shoulders were randomly assigned to undergo serial defects to either the deltoid or trapezius surrounding the AC joint capsule, followed by a combined deltotrapezial muscle defect. Deltotrapezial defects were repaired with an all-suture anchor using an anatomic technique. The torque (N·m) required to rotate the clavicle 20° anterior and 20° posterior was recorded for the following conditions: intact (native), deltoid defect, trapezius defect, combined deltotrapezial defect, and repair.Results:When compared with the native condition, the deltoid defect decreased the torque required to rotate the clavicle 20° posteriorly by 7.1% (P = .206) and 20° anteriorly by 6.1% (P = .002); the trapezial defect decreased the amount of rotational torque posteriorly by 5.3% (P = .079) and anteriorly by 4.9% (P = .032); and the combined deltotrapezial defect decreased the amount of rotational torque posteriorly by 9.9% (P = .002) and anteriorly by 9.4% (P < .001). Anatomic deltotrapezial repair increased posterior rotational torque by 5.3% posteriorly as compared with the combined deltotrapezial defect (P = .001) but failed to increase anterior rotational torque (P> .999). The rotational torque of the repair was significantly lower than the native joint in the posterior (P = .017) and anterior (P < .001) directions.Conclusion:This study demonstrated that the deltoid and trapezius play a role in clavicular rotational stabilization. The proposed anatomic repair improved posterior rotational stability but did not improve anterior rotational stability as compared with the combined deltotrapezial defect; however, neither was restored to native stability.Clinical Relevance:Traumatic or iatrogenic damage to the deltotrapezial fascia and the inability to restore anatomic deltotrapezial attachments to the acromioclavicular joint may contribute to rotational instability. Limiting damage and improving the repair of these muscles should be a consideration during AC reconstruction.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-25T09:11:53Z
      DOI: 10.1177/23259671221119542
      Issue No: Vol. 11, No. 1 (2023)
       
  • Collagen Scaffold Application in Arthroscopic Reconstruction of
           

    • Authors: Baris Gorgun, Alper Gamlı, Mehmet Emin Duran, Berhan Bayram, Tekin Kerem Ulku, Baris Kocaoglu
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Single-step all-arthroscopic techniques have gained popularity recently in the treatment of osteochondral lesions of the talus (OLT). Concomitant subchondral bone defects led surgeons to add autologous bone grafting to the surgical procedures. Collagen scaffolds have been used widely for stabilization of the reconstruction and regeneration of the articular surface.Purpose:To compare single-step all-arthroscopic treatment of OLT consisting of debridement, microfracture, autologous bone grafting, and application of fibrin sealant in 2 patient groups: with versus without collagen scaffold.Study Design:Cohort study; Level of evidence, 3.Methods:Included were 94 patients who underwent single-step all-arthroscopic treatment for OLT. Autologous bone grafting was applied to 48 patients (BG group), while autologous bone grafting plus collagen scaffold was applied to 46 patients (BG+S group). A fibrin sealant was applied to both groups. Clinical outcomes were assessed with the American Orthopaedic Foot & Ankle Society (AOFAS) score and the visual analog scale (VAS) for pain. Radiological outcomes were evaluated with the magnetic resonance observation of cartilage repair tissue score. The mean follow-up time was 69.3 ± 20.7 months.Results:Patients in both groups showed statistically significant improvement in pre- to postoperative AOFAS and VAS scores (P < .001 for all), with no difference between groups in AOFAS and VAS score improvement. Complete healing with or without hypertrophy was achieved in 42 patients in the BG group (87.5%) and 38 patients in the BG+S group (82.6%).Conclusion:The treatment of bone lesions in OLT may be the ultimate goal to obtain successful outcomes, in which case using a collagen scaffold besides grafting may not affect clinical and radiological outcomes.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-25T06:57:57Z
      DOI: 10.1177/23259671221145733
      Issue No: Vol. 11, No. 1 (2023)
       
  • Comparison of Trunk and Pelvic Kinematics in Youth Baseball Pitchers With
           and Without Upper Extremity Pain: A Cross-Sectional Study

    • Authors: Anthony W. Fava, Kevin A. Giordano, Kenzie B. Friesen, Adam Nguyen, Gretchen D. Oliver
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Motion of the pelvis and trunk during baseball pitching is associated with increased upper extremity (UE) kinetics. Increased kinetics on the UE may lead to throwing-arm pain in youth pitchers. Limited biomechanical comparisons have been conducted on youth pitchers with and without throwing-arm pain to identify mechanical risk factors associated with pain.Purpose:To examine trunk and pelvic kinematics in youth baseball pitchers with and without UE pain.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 26 male youth baseball pitchers (mean age, 12.7 ± 1.5 years; mean height, 162.2 ± 12.9 cm; mean weight, 52.6 ± 13.1 kg) were recruited to participate. An electromagnetic tracking system was used to obtain kinematic data during the fastball pitch. Data from a health history questionnaire was examined. Participants who answered “yes” to experiencing pain and who selected a region on their UE as the pain location were placed into the UE pain group. Participants who responded “no” to experiencing pain were placed into the pain-free group. We compared between-group differences in trunk rotation, flexion, and lateral flexion; pelvic rotation, anteroposterior tilt, and lateral tilt; and hip-shoulder separation from peak knee height to ball release of the baseball pitch using 1-dimensional statistical parametric mapping with an alpha level set at .05.Results:No statistically significant differences were observed between the UE pain and pain-free groups in the 7 trunk and pelvic kinematics analyzed from peak knee height to ball release (P> .05).Conclusion:Trunk and pelvic kinematics during the pitching motion did not differ between pain and pain-free groups of youth baseball pitchers.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-25T06:49:54Z
      DOI: 10.1177/23259671221145679
      Issue No: Vol. 11, No. 1 (2023)
       
  • Comparative Success of Repair Versus Reconstruction for Knee
           Extra-articular Ligament Injuries

    • Authors: Joseph B. Kahan, Patrick Burroughs, William M. Mclaughlin, Christopher A. Schneble, Jay Moran, Peter Y. Joo, Maxwell Modrak, Dustin L. Richter, Daniel Wascher, Gehron P. Treme, Robert C. Schenck, Jonathan N. Grauer, Michael J. Medvecky
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Surgical techniques and associated outcomes in treating acute and chronic extra-articular ligament knee injuries are in evolution, and there is question as to whether repair or reconstruction is optimal.Purpose/Hypothesis:The purpose of this study was to compare the subsequent surgery rate between surgical repair versus reconstruction for all extra-articular ligament injuries of the knee utilizing a large database. Our hypothesis was that overall surgical repair of both lateral and medial extra-articular knee injuries would have a higher revision rate than those treated by reconstruction.Study Design:Cohort study; Level of evidence, 3.Methods:The PearlDiver Mariner data set (2010-2019), with 122 million patients, was utilized to generate 2 patient cohorts: those who underwent surgical repair and those who underwent surgical reconstruction of a knee extra-articular ligament injury. All patients had a minimum of 2 years follow-up. Rates of concomitant or subsequent cruciate ligament reconstruction and rates of secondary procedures were assessed and compared between the 2 cohorts.Results:In total, 3563 patients were identified: extra-articular ligament reconstruction was performed for 2405 (67.5%), and repair was performed for 1158 (32.5%). Cruciate ligament reconstruction was performed for 986 (27.7%), of which 888 of 986 (90.1%) were performed on the same day as their extra-articular ligament procedure. At 2-year follow-up, the reconstruction cohort had higher rates of revision surgery compared with the repair cohort (8.2% vs 2.5%; P < .001).Conclusion:Using a large national database, knee extra-articular ligamentous reconstructions (those on both the lateral and the medial side) had a 3.3 times higher rate of revision surgery compared with repair at 2-year follow-up. Further study is needed to investigate the causes leading to revision surgery and to determine the optimal surgical treatment for both medial and lateral extra-articular knee ligament injuries.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-23T07:31:15Z
      DOI: 10.1177/23259671221143539
      Issue No: Vol. 11, No. 1 (2023)
       
  • Isolated, Full-Thickness Proximal Rectus Femoris Injury in Competitive
           Athletes: A Systematic Review of Injury Characteristics and Return to Play
           

    • Authors: Derrick M. Knapik, Thomas D. Alter, Aravinda Ganapathy, Matthew V. Smith, Robert H. Brophy, Matthew J. Matava
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Characteristics regarding mechanism of injury, management, and return-to-play (RTP) rate and timing are important when treating and counseling athletes with rectus femoris tears.Purpose:To systematically review the literature to better understand the prevalence, sporting activity, injury mechanisms, and treatment of patients with rectus femoris injury and to provide prognostic information regarding the rate and timing of RTP.Study Design:Systematic review; Level of evidence, 4.Methods:Following the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we queried PubMed/MEDLINE, Cochrane, OVID, EMBASE, and Google Scholar in March 2022 for studies reporting on athletes sustaining isolated, full-thickness tearing, or bony avulsion injuries to the proximal rectus femoris during sporting activity. Excluded were studies without evidence of full-thickness tearing or avulsion, with athletes sustaining concomitant injuries, or with injuries occurring from nonsporting activities. The percentage of athletes sustaining injuries was calculated based on sport, injury mechanism, and management (nonoperative versus operative).Results:Of 132 studies initially identified, 18 were included, comprising 132 athletes (mean age, 24.0 ± 5.4 years; range, 12-43 years). The most common sporting activities were soccer (70.5%) and rugby (15.2%). The most reported mechanisms of injury were kicking (47.6%) and excessive knee flexion/forced hip extension (42.9%). Avulsion injuries were reported in 86% (n = 114) of athletes. Nonoperative management was reported in 19.7% of athletes, with operative management performed in 80.3%. The mean follow-up time was 21.4 ± 11.4 months (range, 1.5-48 months). The RTP rate was 93.3% (n = 14) in nonoperatively treated and 100% (n = 106) in operatively treated athletes, and the mean RTP time was 11.7 weeks (range, 5.5-15.2 weeks) in nonoperatively treated and 22.1 weeks (range, 14.0-37.6 weeks) in operatively treated athletes. Complications were reported in 7.7% (2/26) of nonoperatively treated and 18% (n = 19/106) of operatively treated athletes.Conclusion:Full-thickness proximal rectus femoris injuries occurred most frequently in athletes participating in soccer and rugby secondary to explosive, eccentric contractions involved in kicking and sprinting. Operative management was performed in the majority of cases. Athletes who underwent operative repair had a 100% RTP rate versus 93.3% in athletes treated nonoperatively.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-23T06:04:05Z
      DOI: 10.1177/23259671221144984
      Issue No: Vol. 11, No. 1 (2023)
       
  • The Relative Citation Ratio: Evaluating a New Measure of Scientific
           Influence Among Academic Sports Medicine Surgeons

    • Authors: Tiffany A. Smith, Suleiman Y. Sudah, Joseph E. Manzi, Christopher R. Michel, Daniel J. Kerrigan, Christopher N. Dijanic, David S. Constantinescu, Mariano E. Menendez, Ryan Plyler
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Objective measures of research influence are being increasingly utilized to evaluate and compare academic faculty. However, traditional bibliometrics, such as the Hirsch index and article citation count, are biased by time-dependent factors and are limited by a lack of field normalization. The relative citation ratio (RCR) is a new field- and time-normalized article-level metric developed by the National Institutes of Health (NIH).Purpose/Hypothesis:The purpose of this study was to evaluate the RCR among fellowship-trained academic sports medicine surgeons and to analyze physician factors associated with RCR values. We hypothesized that the mean RCR score for fellowship-trained academic sports medicine surgery faculty will fall above the NIH standard.Study Design:Cross-sectional study.Methods:A retrospective data analysis was performed using the iCite database for all fellowship-trained sports medicine surgery faculty associated with Accreditation Council for Graduate Medical Education–accredited orthopaedic surgery residency programs in December 2021. In eligible faculty, the mean RCR, weighted RCR, and total publication count were compared by sex, career duration, academic rank, and presence of additional degrees. A mean RCR value of 1.0 is the NIH-funded field-normalized standard. The data herein are presented as the median and interquartile range, in addition to the mean and standard deviation, to account for outliers of the mean and weighted RCR scores.Results:A total of 624 fellowship-trained sports medicine surgery faculty members from 160 orthopaedic surgery residency programs were included in the analysis. Overall, faculty produced impactful research, with a median RCR of 1.6 (interquartile range, 1.0-2.2) and a median weighted RCR of 19.3 (interquartile range, 5.1-69.3). Advanced academic rank and career longevity were associated with increased weighted RCR and total publication count. All subgroups analyzed had an RCR value>1.0.Conclusion:Study findings indicate that fellowship-trained academic sports medicine surgery faculty are highly productive and produce impactful research, as evidenced by the high median RCR value relative to the benchmark NIH RCR value of 1.0.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-20T09:58:30Z
      DOI: 10.1177/23259671221137845
      Issue No: Vol. 11, No. 1 (2023)
       
  • Isolated Adductor Magnus Injuries in Athletes: A Case Series

    • Authors: Sandra Mechó, Ramon Balius, Mireia Bossy, Xavier Valle, Carles Pedret, Ángel Ruiz-Cotorro, Gil Rodas
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Little is known about injuries to the adductor magnus (AM) muscle and how to manage them.Purpose:To describe the injury mechanisms of the AM and its histoarchitecture, clinical characteristics, and imaging features in elite athletes.Study Design:Case series; Level of evidence, 4.Methods:A total of 11 competitive athletes with an AM injury were included in the study. Each case was clinically assessed, and the diagnosis and classification were made by magnetic resonance imaging (MRI) according to the British Athletics Muscle Injury Classification (BAMIC) and mechanism, location, grade, and reinjury (MLG-R) classification. A 1-year follow-up was performed, and return-to-play (RTP) time was recorded.Results:Different mechanisms of injury were found; most of the athletes (10/11) had flexion and internal rotation of the hip with extension or slight flexion of the knee. Symptoms consisted of pain in the posteromedial (7/11) or medial (4/11) thigh during adduction and flexion of the knee. Clinically, there was a suspicion of an injury to the AM in only 3 athletes. According to MRI, 5 lesions were located in the ischiocondylar portion (3 in the proximal and 2 in the distal myoconnective junction) and 6 in the pubofemoral portion (4 in the distal and 2 in the proximal myoconnective junction). Most of the ischiocondylar lesions were myotendinous (3/5), and most of the pubofemoral lesions were myofascial (5/6). The BAMIC and MLG-R classification coincided in distinguishing injuries of moderate and mild severity. The management was nonoperative in all cases. The mean RTP time was 14 days (range, 0-35 days) and was longer in the ischiocondylar cases than in the pubofemoral cases (21 vs 8 days, respectively). Only 1 recurrence, at
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-17T06:50:29Z
      DOI: 10.1177/23259671221138806
      Issue No: Vol. 11, No. 1 (2023)
       
  • Associating Social Determinants of Health With PROMIS CAT Scores and
           Health Care Utilization After ACL Reconstruction

    • Authors: Alexander Ziedas, Joshua P. Castle, Varag Abed, Alexander Swantek, Sarah Chaides, Kareem Elhage, Johnathan Fife, Vasilios Moutzouros, Eric C. Makhni
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:The term “social determinants of health” (SDOH) refers to social and economic factors that influence a patient’s health status. The effect of SDOH on the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive test (CAT) scores and postoperative resource utilization in patients with anterior cruciate ligament reconstruction (ACLR) have yet to be thoroughly studied.Purpose:To investigate the impact SDOH have on PROMIS CAT outcomes and postoperative resource utilization in patients with ACLR.Study Design:Cohort study; Level of evidence, 3.Methods:The electronic medical record was used to identify the SDOH for patients who underwent ACLR by 1 of 3 sports medicine fellowship–trained orthopaedic surgeons between July 2017 and April 2020. PROMIS CAT measures of Physical Function (PROMIS-PF), Pain Interference (PROMIS-PI), and Depression (PROMIS-D) were completed at the preoperative, 6-month postoperative, and 12-month postoperative time points. Postoperative health care utilization was recorded as well. Independent 2-group t tests and Wilcoxon rank-sum tests were used to analyze mean differences between patient groups based on SDOH.Results:Two-hundred and thirty patients who underwent ACLR were included (mean age, 27 years; 59% male). Compared with White patients, Black patients were represented more frequently in the lowest median household income (MHI) quartile (63% vs 23%, respectively; P < .001). White patients were represented more frequently in the highest area deprivation index (ADI) quartile when compared with Black patients (67% vs 12%, respectively; P = .006). Significantly worse PROMIS-PF, PROMIS-PI, and PROMIS-D scores at all 3 time points were found among patients who were Black, female, smokers, and in the lower MHI quartiles, with higher ADI and public health care coverage. In terms of resource utilization, Black patients attended significantly fewer postoperative physical therapy visits when compared with their respective counterparts. Those in the lower MHI quartiles attended significantly fewer postoperative imaging encounters, and female patients attended significantly more postoperative virtual encounters than male patients.Conclusion:Specific SDOH variables, particularly those that reflect racial and socioeconomic disparities, were associated with differences in postoperative health care utilization and ACLR outcomes as measured by PROMIS CAT domains.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-16T04:01:53Z
      DOI: 10.1177/23259671221139350
      Issue No: Vol. 11, No. 1 (2023)
       
  • Effect of Cross-sectional Area of the Hamstring Tendon Autograft on
           Failure Rate or Clinical Outcomes After Double-Bundle ACL Reconstruction:
           Tendon Autograft

    • Authors: Shintaro Onishi, Tomoya Iseki, Ryo Kanto, Hiroshi Nakayama, Shinya Oka, Akio Matsumoto, Toshiya Tachibana, Shinichi Yoshiya, Motoi Yamaguchi
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:In previous studies examining the relationship between graft size and failure rate after anterior cruciate ligament reconstruction (ACLR), graft size was determined as diameter of the bone tunnel, and graft failure was defined as revision surgery. Consequently, the correlation between graft size and postoperative recurrent instability could not be assessed.Purpose:(1) To intraoperatively measure the cross-sectional area (CSA) of the hamstring tendon (HT) autograft and compare the CSA of the autograft with the bone tunnel and (2) to assess the effect of the graft CSA on postoperative graft failure among patients who underwent double-bundle ACLR.Study Design:Case-control study; Level of evidence, 3.Methods:The study included 129 patients who underwent double-bundle ACLR using an HT autograft (mean ± SD age, 16.7 ± 1.7 years; all with a Tegner activity level ≥6). All patients had a minimum follow-up of 2 years. During surgery, the graft CSA was measured using an area micrometer, combining the anteromedial (AM) and posterolateral (PL) grafts. The total area of the bone tunnel was defined as the combined CSAs of the AM and PL tunnels as calculated by the diameter of the drill. The relationship between the CSAs of the combined HT graft and the bone tunnel was statistically compared, as was the relationship between graft CSAs and graft failure, defined as reinjury, recurrent instability manifested as quantitative laxity measurement, or revision ACLR.Results:The CSAs of the midsubstance of the combined AM and PL graft significantly correlated with those of the bone tunnels (femoral side, R 2 = 0.334, P < .0001; tibial side, R 2 = 0.421, P < .0001). As for the relationship between the graft CSA and ACLR failure, there was no significant difference in the graft CSAs between the groups with and without graft failure in any of the failure criteria (P = .188).Conclusion:The graft CSA was not a predictor of early failure after double-bundle ACLR using an HT autograft in this patient population.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-14T04:00:00Z
      DOI: 10.1177/23259671221142857
      Issue No: Vol. 11, No. 1 (2023)
       
  • Review of Reliable and Valid Noninvasive Tools for the Diagnosis of
           Chronic Exertional Compartment Syndrome

    • Authors: Annick M. van der Kraats, Michiel Winkes, Heinrich M.J. Janzing, Rob P.R. Eijkelenboom, Marleen T.G. de Koning
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Currently, invasive dynamic intracompartmental pressure (ICP) measurements are considered the gold standard for diagnosis of chronic exertional compartment syndrome (CECS). During recent years, different noninvasive imaging modalities have been presented as a possible replacement for ICP measurement.Purpose:To provide an overview of the current state of evidence and possibilities regarding noninvasive diagnostic methods for CECS.Study Design:Scoping review; Level of evidence, 4.Methods:The PubMed (MEDLINE) and Embase databases were searched using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Full-text articles were included if they reported on noninvasive diagnostic methods for CECS, included ≥5 patients with CECS, and were published between 1994 and 2022. Articles not written in English were excluded. Systematic reviews, letters to the editor, and case reports were not eligible for inclusion. Out of 961 articles identified in the initial search, 25 studies (N = 1257 participants) were included. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies–Comparative (QUADAS-C) tool for comparative studies and the QUADAS-2 tool for noncomparative studies. Narrative synthesis was used to present results.Results:The level of evidence for the 25 studies ranged from 2 to 4. Four studies were classified as having a low risk of bias, 21 studies were classified as being at risk of bias. The following noninvasive diagnostic tools for CECS were reported: magnetic resonance imaging/diffusion tensor imaging (n = 8), near-infrared spectroscopy (n = 6), electromyography (n = 4), single-photon emission computed tomography (n = 5), ultrasound (n = 2), myotonometry (n=1) and predictive clinical model (n = 1). There was insufficient evidence in the literature to support the use of any of these noninvasive diagnostic tools as a gold standard for CECS.Conclusion:Despite the need to replace the controversial use of ICP for the diagnosis of CECS, our review indicated a lack of validity on all discussed noninvasive diagnostic tools as a replacement.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-13T04:00:11Z
      DOI: 10.1177/23259671221145151
      Issue No: Vol. 11, No. 1 (2023)
       
  • The Utility of MRI in Evaluating Ruptures of the Patellar Tendon

    • Authors: Peters Otlans, Juliana Heimur, John Hayden Sonnier, Devyn Gibby, Kevin B. Freedman
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Although the identification of patellar tendon rupture is a clinical diagnosis aided by standard radiography, magnetic resonance imaging (MRI) may aid in identifying the location of the rupture and concomitant pathology.Purpose:To evaluate the characteristics of patellar tendon tears needing surgical repair and to determine whether patient or injury factors were predictive of tear location.Study Design:Case series; Level of evidence, 4.Methods:Consecutive patients who underwent primary patellar tendon repair for rupture between May 15, 2017, and April 10, 2020, were reviewed retrospectively. Exclusion criteria included age .05). Patellar tendon ruptures were able to be clinically diagnosed correctly in>99% of cases. MRI was used to evaluate 77 (49.4%) knees. Patients who underwent MRI before surgery were more likely to have a history of preexisting tendinitis (P = .015) and a lower preoperative Insall-Salvati ratio (1.68 vs 1.52; P = .017).Conclusion:Patient and injury factors were not predictive of tear location. The majority of patellar tendon tears were avulsion-type injuries from the inferior patella. MRI was not necessary to aid in the diagnosis of patellar tendon rupture, as 99.4% of tears were able to be diagnosed clinically without advanced imaging.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-13T04:00:03Z
      DOI: 10.1177/23259671221144980
      Issue No: Vol. 11, No. 1 (2023)
       
  • Evaluating the Need for Preoperative MRI Before Primary Hip Arthroscopy in
           Patients 40 Years and Younger With Femoroacetabular Impingement Syndrome:
           A Multicenter Comparative Analysis

    • Authors: Prem N. Ramkumar, Ava S. Berrier, J. Matthew Helm, Dylan S. Koolmees, Ayoosh Pareek, Aaron J. Krych, Eric C. Makhni, Joshua D. Harris, Benedict U. Nwachukwu
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Routine hip magnetic resonance imaging (MRI) before arthroscopy for patients with femoroacetabular impingement syndrome (FAIS) offers questionable clinical benefit, delays surgery, and wastes resources.Purpose:To assess the clinical utility of preoperative hip MRI for patients aged ≤40 years who were undergoing primary hip arthroscopy and who had a history, physical examination findings, and radiographs concordant with FAIS.Study Design:Cohort study; Level of evidence, 3.Methods:Included were 1391 patients (mean age, 25.8 years; 63% female; mean body mass index, 25.6) who underwent hip arthroscopy between August 2015 and December 2021 by 1 of 4 fellowship-trained hip surgeons from 4 referral centers. Inclusion criteria were FAIS, primary surgery, and age ≤40 years. Exclusion criteria were MRI contraindication, reattempt of nonoperative management, and concomitant periacetabular osteotomy. Patients were stratified into those who were evaluated with preoperative MRI versus those without MRI. Those without MRI received an MRI before surgery without deviation from the established surgical plan. All preoperative MRI scans were compared with the office evaluation and intraoperative findings to assess agreement. Time from office to arthroscopy and/or MRI was recorded. MRI costs were calculated.Results:Of the study patients, 322 were not evaluated with MRI and 1069 were. MRI did not alter surgical or interoperative plans. Both groups had MRI findings demonstrating anterosuperior labral tears treated intraoperatively (99.8% repair, 0.2% debridement, and 0% reconstruction). Compared with patients who were evaluated with MRI and waited 63.0 ± 34.6 days, patients who were not evaluated with MRI underwent surgery 6.5 ± 18.7 days after preoperative MRI. MRI delayed surgery by 24.0 ± 5.3 days and cost a mean $2262 per patient.Conclusion:Preoperative MRI did not alter indications for primary hip arthroscopy in patients aged ≤40 years with a history, physical examination findings, and radiographs concordant with FAIS. Rather, MRI delayed surgery and wasted resources. Routine hip MRI acquisition for the younger population with primary FAIS with a typical presentation should be challenged.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-12T12:51:38Z
      DOI: 10.1177/23259671221144776
      Issue No: Vol. 11, No. 1 (2023)
       
  • Single-Leg Squat and Reported Pain in Collegiate Softball Pitchers

    • Authors: Katherine M. Everhart, Kenzie B. Friesen, Nicole M. Bordelon, Anthony W. Fava, Hillary A. Plummer, David M. Shannon, Gretchen D. Oliver
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Single-leg squat (SLS) performance is related to altered mechanics related to injury during the windmill softball pitch; however, it is unknown if SLS kinematics differ between softball pitchers with and without upper extremity pain.Purpose/Hypothesis:The purpose of this study was to compare knee valgus, trunk rotation, trunk lateral flexion, and trunk flexion during an SLS in collegiate softball pitchers with and without self-reported upper extremity pain. It was hypothesized that those who reported upper extremity pain would show increased compensatory trunk and knee kinematics compared with those without pain.Study Design:Controlled laboratory study.Methods:A total of 75 collegiate softball players (mean age, 20.4 ± 1.7 years; mean height, 173.3 ± 7.7 cm; mean weight, 79.1 ± 11.6 kg) participated and were placed in pain (n = 20) or no-pain (n = 55) groups. Participants performed an SLS once per side. Kinematic data were collected at 100 Hz using an electromagnetic tracking system. A 2 (pain vs no pain) × 2 (descent vs ascent) × 2 (drive leg vs stride leg) mixed-design multivariate analysis of variance with Wilks lambda distribution was used to determine differences in drive-leg and stride-leg lower body mechanics between the descent and ascent phases of the SLS between the pitchers in the current study with and without pain.Results:There was no significant effect in the 3-way interaction between upper extremity pain, side, and phase (Λ = 0.960; F[4, 70] = 0.726; P = .577; η2 = 0.04). However, there were large effects for the phase × side interaction (Λ = 0.850; P = .021; η2 = 0.150). There was a main effect of phase (Λ = 0.283; P < .001; η2 = 0.717).Conclusion:Study findings indicated that SLS mechanics do not differ between collegiate softball pitchers with and without reported upper extremity pain. Drive-leg mechanics showed more stability in the SLS than stride-leg mechanics.Clinical Relevance:Softball pitchers are at risk of upper extremity injury. It is important to identify mechanisms that may lead to pain in order to mitigate the risk of injury.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-12T12:46:57Z
      DOI: 10.1177/23259671221144757
      Issue No: Vol. 11, No. 1 (2023)
       
  • Closing-Wedge Posterior Tibial Slope–Reducing Osteotomy in Complex
           Revision ACL Reconstruction

    • Authors: Thiago Vivacqua, Stephan Thomassen, Philipp W. Winkler, Gian A. Lucidi, Alexis Rousseau-Saine, Andrew D. Firth, Mark Heard, Volker Musahl, Alan M.J. Getgood
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:A posterior tibial slope (PTS)>12° has been shown to correlate with failure of anterior cruciate ligament (ACL) reconstruction (ACLR). PTS-reducing osteotomy has been described to correct the PTS in patients with a deficient ACL, mostly after failure of primary ACLR.Purpose:To report radiologic indices, clinical outcomes, and postoperative complications after PTS-reducing osteotomy performed concurrently with revision ACLR (R-ACLR).Study Design:Case series; Level of evidence, 4.Methods:A review of medical records at 3 institutions was performed of patients who had undergone PTS-reducing osteotomy concurrently with R-ACLR between August 2010 and October 2020. Radiologic parameters recorded included the PTS, patellar height according to the Caton-Deschamps Index (CDI), and anterior tibial translation (ATT). Patient-reported outcomes (International Knee Documentation Committee [IKDC] and Knee injury and Osteoarthritis Outcome Score [KOOS]), reoperations, and complications were evaluated.Results:Included were 23 patients with a mean follow-up of 26.7 months (range, 6-84 months; median, 22.5 months). Statistically significant differences from preoperative to postoperative values were found in PTS (median [range], 14.0° [12°-18°] vs 4.0° [0°-15°], respectively; P < .001), CDI (median, 1.00 vs 1.10, respectively; P = .04) and ATT (median, 8.5 vs 3.6 mm, respectively; P = .001). At the final follow-up, the IKDC score was 52.4 ± 19.2 and the KOOS subscale scores were 81.5 ± 9.5 (Pain), 74 ± 21.6 (Symptoms), 88.5 ± 8 (Activities of Daily Living); 52.5 ± 21.6 (Sport and Recreation), and 48.8 ± 15.8 (Quality of Life). A traumatic ACL graft failure occurred in 2 patients (8.7%). Reoperations were necessary for 6 patients (26.1%) because of symptomatic hardware, and atraumatic recurrent knee instability was diagnosed in 1 patient (4.3%).Conclusion:Tibial slope–reducing osteotomy resulted in a significant decrease of ATT and can be considered in patients with a preoperative PTS ≥12° and ≥1 ACLR failure. In highly complex patients with multiple prior surgeries, the authors found a reasonably low graft failure rate (8.7%) when utilizing PTS-reducing osteotomy. Surgeons must be aware of potential complications in patients with multiple previous failed ACLRs.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-11T10:32:51Z
      DOI: 10.1177/23259671221144786
      Issue No: Vol. 11, No. 1 (2023)
       
  • Return to Play After Shoulder Surgery in Professional Baseball Players: A
           Systematic Review and Meta-analysis

    • Authors: Carew C. Giberson-Chen, Brian L. Shaw, Samuel S. Rudisill, Robert E. Carrier, Evan M. Farina, Brad Pearson, Peter D. Asnis, Evan A. O’Donnell
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:The current literature lacks an updated review examining return to play (RTP) and return to prior performance (RTPP) after shoulder surgery in professional baseball players.Purpose:To summarize the RTP rate, RTPP rate, and baseball-specific performance metrics among professional baseball players who underwent shoulder surgery.Study Design:Systematic review; Level of evidence, 4.Methods:A literature search was performed utilizing the PubMed, MEDLINE, and CINAHL databases and according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Inclusion criteria were English-language studies reporting on postoperative RTP and/or RTPP in professional baseball players who underwent shoulder surgery between 1976 and 2016. RTP rates, RTPP rates, and baseball-specific performance metrics were extracted from qualifying studies. A total of 2034 articles were identified after the initial search. Meta-analysis was performed where applicable, yielding weighted averages of RTP and RTPP rates and comparisons between pitchers and nonpitchers for each type of surgery. Baseball-specific performance metrics were reported as a narrative summary.Results:Overall, 26 studies featuring 1228 professional baseball players were included. Patient-level outcome data were available for 529 players. Surgical interventions included rotator cuff debridement (n = 197), rotator cuff repair (RCR; n = 43), superior labrum from anterior to posterior repair (n = 124), labral repair (n = 103), latissimus dorsi/teres major (LD/TM) repair (n = 21), biceps tenodesis (n = 17), coracoclavicular ligament reconstruction (n = 15), anterior capsular repair (n = 5), and scapulothoracic bursectomy (n = 4). Rotator cuff debridement was the most common surgical procedure, while scapulothoracic bursectomy was the least common (37.2% and 0.8% of interventions, respectively). Meta-analysis revealed that the RTP rate was highest for LD/TM repair (84.5%) and lowest for RCR (53.5%), while the RTPP rate was highest for LD/TM repair (100.0%) and lowest for RCR (27.9%). RTP and RTPP rates were generally higher for position players than for pitchers. Nonvolume performance metrics were unaffected by shoulder surgery, while volume statistics decreased or remained similar.Conclusion:RTP and RTPP rates among professional baseball players were modest after most types of shoulder surgery. Among surgical procedures commonly performed on professional baseball players, RTP and RTPP rates were highest for LD/TM repair and lowest for RCR.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-11T10:19:51Z
      DOI: 10.1177/23259671221140853
      Issue No: Vol. 11, No. 1 (2023)
       
  • Quantitative Magnetic Resonance Imaging–Based Tendon Healing of
           Different Regions of the Shoulder: Comparison Between the Suture-Bridge
           and Single-Row Techniques

    • Authors: Yuxue Xie, Xiangwen Li, Shaohua Liu, Yiwen Hu, Ye Chen, Shiyin Liu, Puye Wu, Hongyue Tao, Shuang Chen
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Rotator cuff retears occur more often at the proximal region with the suture-bridge (SB) technique than at the typical footprint region with the single-row (SR) technique. Few longitudinal clinical trials have focused on the postoperative tendon quality of the repaired rotator cuff at different regions between the 2 techniques.Purpose:To compare tendon healing of the proximal and distal regions between the SB and SR techniques.Study Design:Cohort study; Level of evidence, 3.Methods:Included were consecutive patients who underwent arthroscopic rotator cuff repair and undertook clinical and magnetic resonance imaging (MRI) examinations at 3, 6, and 12 months postoperatively between 2016 and 2017. These patients were divided into the SB and SR groups according to the technique used. The repaired tendon was segmented into distal and proximal regions on ultrashort echo time–T2* mapping images. Clinical outcomes (Constant score, American Shoulder and Elbow Surgeons score, Fudan University Shoulder Score, and visual analog scale for pain) and MRI-based tendon healing (T2* values) of different regions were compared between the 2 groups. The differences in T2* values and clinical scores were determined by 1-way analysis of variance for repeated measurements.Results:A total of 31 patients (17 in SB group and 14 in SR group) were included. At 12-month follow-up, significant improvements from preoperatively were achieved for all patients in all clinical scores (P < .001 for all). No significant between-group differences were found in T2* values of the distal region at any time point; however, the mean T2* value of the proximal region at 3 months was significantly higher in the SB group compared with the SR group (P = .03). This difference became nonsignificant at subsequent follow-up time points.Conclusion:Significant clinical improvements over time can be expected in the first year after arthroscopic rotator cuff repair. In the early postoperative period, higher T2* values in the proximal region of the repaired tendon (representing inferior tendon quality) were seen with the SB technique compared with the SR technique; however, this phenomenon was resolved over time.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-11T09:57:51Z
      DOI: 10.1177/23259671221137835
      Issue No: Vol. 11, No. 1 (2023)
       
  • Association of Lumbar Spondylolytic Spondylolisthesis With the Incidence
           and Prognosis of Anterior Ring Apophyseal Abnormalities of the Vertebrae
           in Young Gymnasts

    • Authors: Makoto Urushibara, Takayuki Kawasaki, Takato Aihara, Atsushi Kojima
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Although anterior apophyseal abnormalities of the vertebrae and spondylolytic spondylolisthesis (SS) are prevalent in gymnasts during growth spurts, no studies have examined the relationship between apophyseal abnormalities and SS.Hypothesis:A significant relationship will exist between anterior apophyseal abnormalities and SS in young gymnasts.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 306 gymnasts (123 male, 183 female; age range, 6-28 years) with>2 weeks of back pain were enrolled in this study. Apophyseal abnormalities were evaluated using radiography. In the primary analysis, multiple logistic regression analysis was performed to assess the odds ratio (OR) for multivariate factors (age, body mass index, sex, skeletal maturity, competitive level, and presence of spondylolysis or SS) influencing the incidence of apophyseal abnormalities. In the secondary analysis, 90 of the 306 gymnasts were followed up radiographically for a minimum of 2 years, and factors contributing to the worsening of apophyseal abnormalities were identified.Results:In the primary analysis, the chi-square test revealed a relationship between anterior ring apophyseal abnormalities and SS at the L5-S1 segment (OR, 7.6). Multiple logistic regression analysis demonstrated that the presence of SS at L5-S1 (OR, 9.5) and competitive level (international: OR, 6.7; national: OR, 4.5) correlated with the incidence of apophyseal abnormalities. The secondary analysis identified the presence of SS at L5-S1 (OR, 5.9) as a significant factor contributing to the worsening of apophyseal abnormalities.Conclusion:The presence of SS was a factor affecting the incidence and prognosis of anterior apophyseal abnormalities.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-10T04:54:35Z
      DOI: 10.1177/23259671221142560
      Issue No: Vol. 11, No. 1 (2023)
       
  • Reliability of Upright Chest Radiography as a Diagnostic Screening Tool
           for Acromioclavicular Joint Dislocations

    • Authors: Tanakorn Chaichana, Adinun Apivatgaroon, Possawat Rujiraphum, Prakasit Sanguanjit, Bancha Chernchujit
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:The standard radiographic view for diagnosing acromioclavicular joint (ACJ) dislocations is the Zanca view of both shoulders to assess superior displacement of the distal clavicle by measuring the coracoclavicular distance (CCD) and comparing it with the uninjured shoulder; however, there is no consensus on a gold standard for diagnostic measures to classify acute ACJ injuries.Purpose:To compare the CCD from an upright chest radiograph with a standard Zanca view of both shoulders in patients with an ACJ dislocation.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:We reviewed the records of 70 patients with an ACJ dislocation between 2010 and 2021 who had both an upright chest radiograph and a Zanca view. An ACJ dislocation was classified as low grade (Rockwood types 1-3) or high grade (Rockwood type 5). The CCD was measured on the upright chest radiograph and the Zanca view by 2 independent reviewers, and the percentage of the CCD difference compared with the unaffected side (ΔCCD) was calculated and compared between the upright chest radiograph and the Zanca view. Interrater and intrarater reliability were determined using the intraclass correlation coefficient.Results:Included were 70 patients (55 male and 15 female; mean age, 46 years). There were 29 patients (41.43%) with a low-grade injury and 41 patients (58.57%) with a high-grade injury. In the overall analysis, the ΔCCD on the upright chest radiograph and Zanca view was significantly different (130.25% ± 88.42% vs 152.69% ± 106.56%, respectively; mean difference, 22.44% [95% CI, 2.40% to 42.48%]; P = .029). The subgroup analysis revealed that the ΔCCD on the upright chest radiograph and Zanca view was significantly different for patients with a low-grade injury (60.71% ± 25.79% vs 91.46% ± 68.54%, respectively; mean difference, 30.76% [95% CI, 7.18% to 54.33%]; P = .012) but not different for patients with a high-grade injury (179.45% ± 83.87% vs 196.00% ± 107.97%, respectively; mean difference, 16.56% [95% CI, –14.06% to 47.18%]; P = .281). The intraclass correlation coefficients for the ΔCCD measurements indicated good to excellent interrater and intrarater reliability.Conclusion:The study findings indicated that upright chest radiography can be used as a diagnostic screening tool for high-grade ACJ dislocations, but not for low-grade ACJ injuries, compared with the Zanca view.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-10T04:48:37Z
      DOI: 10.1177/23259671221143767
      Issue No: Vol. 11, No. 1 (2023)
       
  • Combined 3-Dimensional CT and Multidirectional CT Arthrography for
           Femoroacetabular Impingement and Hip Lesions: A Cross-sectional Study
           Comparing Imaging and Hip Arthroscopic Surgery Findings

    • Authors: Chieh-An Chuang, Huan Sheu, Cheng-Pang Yang, Hao-Che Tang, Chen-Te Wu, Chen-Ju Fu, Yi-Sheng Chan
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:There is limited research investigating the diagnostic strength of 3-dimensional computed tomography (3D-CT) and multidirectional CT arthrography (CTA) for femoroacetabular impingement (FAI) and related hip lesions.Purpose:To evaluate the diagnostic strength of combined 3D-CT and CTA in patients with FAI and related hip lesions by comparing it with hip arthroscopic surgery findings.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:This study included patients who were suspected of having FAI and related hip lesions and who underwent a combination of 3D-CT and CTA and subsequent hip arthroscopic surgery between December 2013 and December 2017. The CT and intraoperative arthroscopic findings were recorded and compared. The sensitivity, specificity, and accuracy of 3D-CT for FAI and those of CTA for related hip lesions were calculated.Results:A total of 114 patients with 114 hips were included in our study. There were 101 patients with positive findings and 13 patients with negative findings for FAI (including cam, pincer, and combined morphology) according to 3D-CT. The sensitivity, specificity, and accuracy of 3D-CT for FAI were 91.58%, 57.14%, and 89.47%, respectively. The sensitivity, specificity, and accuracy of CTA for labral tears were 94.64%, 100.00%, and 94.73%, respectively. For acetabular cartilage defects, the sensitivity, specificity, and accuracy of CTA were 60.71%, 91.37%, and 76.31%, respectively. For femoral cartilage defects, the sensitivity, specificity, and accuracy of CTA were 82.22%, 76.81%, and 78.94%, respectively.Conclusion:The study results indicated that 3D-CT was able to provide excellent accuracy for FAI compared with hip arthroscopic surgery findings. In addition, multidirectional CTA demonstrated promising diagnostic strength for hip lesions such as labral tears and chondral defects.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-09T04:49:38Z
      DOI: 10.1177/23259671221143459
      Issue No: Vol. 11, No. 1 (2023)
       
  • The Bone Bridge for Tibial ACL Graft Fixation: A Biomechanical Analysis of
           Different Tibial Fixation Methods for ACL Reconstruction

    • Authors: Christian Peez, Marvin Greßmann, Michael J. Raschke, Johannes Glasbrenner, Thorben Briese, Andre Frank, Elmar Herbst, Christoph Kittl
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:The tibial fixation site is considered the weak link in anterior cruciate ligament (ACL) reconstruction, and conflicting results regarding the biomechanical properties of various fixation methods have been reported.Purpose:To examine knots tied over a bone bridge and its biomechanical properties as a suitable tibial fixation method in ACL reconstruction.Study Design:Controlled laboratory study.Methods:We divided 40 fresh-frozen porcine tibiae into 4 equal groups to evaluate flexor tendon grafts set with standard tibial fixation techniques: (1) bone bridge (BB group), (2) suspension button (SB group), (3) combined interference screw and bone bridge (IFS/BB group), and (4) combined interference screw and suspension button (IFS/SB group). Each construct was subjected to cyclic loading (1500 cycles, 50-250 N, 1 Hz) with a servohydraulic materials testing machine to measure elongation; load-to-failure testing (displacement rate: 25 mm/s) was then performed. Load to failure, stiffness, and yield load were compared between constructs using 1-way analysis of variance.Results:The hybrid fixation constructs (IFS/BB and IFS/SB groups) showed significantly better biomechanical properties than the isolated extracortical fixation constructs (BB and SB groups) (P < .05 for all). There were no differences between the isolated extracortical fixation constructs or between the hybrid fixation constructs in elongation or load to failure; however, stiffness of the IFS/BB group was significantly higher than that of the IFS/SB group (175.3 ± 16.6 vs 144.9 ± 20.1 N/mm, respectively; P < .05). Stiffness between the SB and BB groups was not significantly different.Conclusion:Hybrid fixation had superior biomechanical performance compared with isolated extracortical fixation. However, tibial graft fixation using a bone bridge either as isolated extracortical fixation or combined with an interference screw for hybrid fixation showed equivalent biomechanical properties compared with suspension button–based graft fixation.Clinical Relevance:The clinical use of a bone bridge for tibial graft fixation could reduce the cost for ACL reconstruction and lower the rate of implant-associated issues.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-06T11:51:35Z
      DOI: 10.1177/23259671221143478
      Issue No: Vol. 11, No. 1 (2023)
       
  • Comparison of Locking-Loop Suture Bridge Repair and Single-Row Suture
           Anchor Repair in Small to Medium Rotator Cuff Tears: A Prospective Cohort
           Study With Clinical and Ultrasound Evaluations

    • Authors: Yu-Chun Wang, Hung-Chou Chen, Chin-Chean Wong, Wen-Pei Chang, Chun-Hao Lin, Chen-Kun Liaw, Chih-Hwa Chen, Pei-Wei Weng
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Single-row (SR) and double-row repair techniques have been described to treat rotator cuff tears. We present a novel surgical strategy of arthroscopic-assisted mini-open repair in which a locking-loop suture bridge (LLSB) is used.Purpose:To compare the functional outcomes and repair integrity of LLSB technique to the SR technique for arthroscopic-assisted mini-open repair of small to medium rotator cuff tears.Study Design:Cohort study; Level of evidence, 3.Methods:Included were 39 patients who underwent LLSB repair (LLSB group) and 44 patients who underwent SR suture anchor repair (SR group) from 2015 to 2018. We evaluated all patients preoperatively and at 3, 6, 12, and 24 months postoperatively using the visual analog scale (VAS) for pain, Oxford Shoulder Score (OSS), and American Shoulder and Elbow Surgeons (ASES) score. Also, shoulder sonography was performed at 12 months postoperatively to evaluate repair integrity using the Sugaya classification system. The independent-sample t test was used to analyze functional outcomes (VAS, OSS, and ASES scores), and the Fisher exact test was used to analyze postoperative sonography results.Results:Patients in both the LLSB and SR groups saw a significant improvement on all 3 outcome measures from preoperatively to 24 months postoperatively (P < .001 for all). However, when comparing scores between groups, only the scores at 3 months postoperatively differed significantly (VAS: P = .002; OSS: P < .001; ASES: P = .005). Shoulder sonography at 12 months postoperatively revealed no significant difference in repair integrity between the LLSB and SR groups (retear rate: 10.26% and 6.82%, respectively; P = .892).Conclusion:Better outcome scores were seen at 3-month follow-up in the LLSB group, with no difference in retear rates compared with the SR group at 12 months postoperatively. The LLSB technique was found to be a reliable technique for rotator cuff repair of small- to medium-sized tears.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-05T07:35:22Z
      DOI: 10.1177/23259671221142242
      Issue No: Vol. 11, No. 1 (2023)
       
  • Comparison of Suture Button and Syndesmotic Screw for Ankle Syndesmotic
           Injuries: A Meta-analysis of Randomized Controlled Trials

    • Authors: Baoyun Xu, Shanshan Wang, Jindong Tan, Wan Chen, Kang-lai Tang
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:The syndesmotic screw (SS) and suture button (SB) fixation methods are both widely used for the reduction of ankle syndesmotic injury, with varying outcomes.Purpose:To review recently published randomized controlled trials (RCTs) to assess the outcomes between SS and SB fixation for ankle syndesmotic injury.Study Design:Systematic review; Level of evidence, 1.Methods:The PubMed, Embase, ClinicalTrials.gov, and Cochrane databases were searched for relevant RCTs published between 1966 and 2021 according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Eligible studies were RCTs comparing SS and SB fixation for ankle syndesmotic injury. The risk of bias was evaluated using the Cochrane Risk of Bias tool. Primary outcomes included complications, malreduction, and unplanned reoperation, and secondary outcomes were the American Orthopaedic Foot & Ankle Society (AOFAS) score, Olerud-Molander ankle score (OMAS), and EuroQol-5 Domain (EQ-5D) score. The mean difference (MD) and risk ratio (RR) were calculated for continuous and dichotomous outcomes, respectively. Random- or fixed-effects model was applied according to heterogeneity.Results:Of 389 studies, 8 RCTs involving 512 patients were included. Overall, 257 patients received SS fixation and 255 patients received SB fixation. The 2 groups did not differ significantly in malreduction (RR, –0.06; 95% CI, –0.18 to 0.07) or EQ-5D (MD, 0.01; 95% CI, –0.01 to 0.03). However, the SB group showed significant advantages over the SS group in complications (RR, 0.42; 95% CI, 0.26 to 0.66), unplanned reoperation (RR, 0.62; 95% CI, 0.43 to 0.89), AOFAS score (MD, 3.04; 95% CI, 1.77 to 4.31), and OMAS (MD, 4.51; 95% CI, 1.54 to 7.48). The risk of bias of the included studies was acceptable.Conclusion:The results showed that there were no significant differences between the SS and SB groups in malreduction and EQ-5D scores. However, the SB group had significantly better local irritation rates, unplanned reoperation rates, AOFAS scores, and OMASs.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-05T07:11:22Z
      DOI: 10.1177/23259671221127665
      Issue No: Vol. 11, No. 1 (2023)
       
  • Relationship Between Preoperative Shoulder Osteoarthritis Severity Score
           and Postoperative PROMIS-UE Score After Rotator Cuff Repair

    • Authors: Michael R. Davies, Natalie Kucirek, Daria Motamedi, C. Benjamin Ma, Brian T. Feeley, Drew Lansdown
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 1, January 2023.
      Background:Mild to moderate glenohumeral joint osteoarthritis is a common finding among patients who are evaluated for rotator cuff tears. However, the impact of preoperative shoulder joint degeneration on patient-reported outcomes after rotator cuff repair (RCR) is not well-established.Purpose:To apply the magnetic resonance imaging (MRI)–based Shoulder Osteoarthritis Severity (SOAS) score to the evaluation of patients undergoing RCR and determine the relationship between preoperative shoulder pathology present on MRI and postoperative Patient-Reported Outcomes Measurement Information System–Upper Extremity (PROMIS-UE) scores.Study Design:Case-control study; Level of evidence, 3.Methods:Seventy-one MRI scans corresponding to 71 patients were analyzed by 2 independent reviewers and scored using the SOAS criteria. Intraclass correlation coefficients were calculated for total SOAS score as well as for each subscore. Spearman correlations were calculated between averaged SOAS scores, patient characteristics, and PROMIS-UE scores. Linear regression analysis was performed between the independent variables of patient age, sex, body mass index, and significant SOAS score components determined by univariate analysis with the dependent variable of PROMIS-UE score. Significance was defined as P < .05 for univariate analyses and < .0125 for multivariate analyses using the Bonferroni correction.Results:The mean PROMIS-UE score of this cohort was 51.5 ± 7.4, while the mean total SOAS score was 21.5 ± 8.4. There was a negative correlation between total SOAS score and postoperative PROMIS-UE score (r = –0.24; P = .040). Both cartilage wear (r = –0.33; P = .0045) and acromioclavicular joint degeneration (r = –0.24; P = .048) individually demonstrated negative correlations with PROMIS-UE score. When a multivariate linear regression with Bonferroni correction was applied to the significant variables identified in univariate analysis along with patient characteristics, none were independently correlated with PROMIS-UE score.Conclusion:In this cohort of patients undergoing RCR, increasing preoperative total SOAS score was predictive of lower postoperative PROMIS-UE scores. SOAS subscores with the strongest negative correlations with PROMIS-UE scores included cartilage wear and acromioclavicular joint degeneration. The cartilage subscore was negatively correlated with PROMIS-UE scores independent of patient factors in multivariate analysis.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2023-01-04T07:44:17Z
      DOI: 10.1177/23259671221143801
      Issue No: Vol. 11, No. 1 (2023)
       
 
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