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- Outcomes of Revision Arthroscopic Posterior Labral Repair and
Capsulorrhaphy: A Systematic Review
Authors: Callie A. Jewett, Patrick Reardon, Charles Cox, Eric Bowman, Rick W. Wright, Jonathan Dickens, Lance LeClere
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Failure rates up to 14% have been reported after arthroscopic posterior capsulolabral repair. It is unknown if revision arthroscopic posterior capsulolabral stabilization has inferior restoration of stability and return to sport when compared with primary repair. Optimal management of failed posterior capsulolabral stabilization is unknown.Purpose:To report outcomes of revision posterior capsulolabral repair and factors that contribute to failure and to determine optimal management of failed posterior stabilization procedures.Study Design:Systematic review; Level of evidence, 4.Methods:A computerized search of the PubMed, EMBASE, and Web of Science databases and manual screening of selected article reference lists were performed in January 2022. Randomized controlled trial, cohort, case-control, and case series studies reporting clinical outcomes of revision arthroscopic posterior capsulolabral repair were eligible. Patient characteristics, indications for revision, intraoperative findings, surgical techniques, and patient-reported outcomes were recorded. Owing to heterogeneity of reported outcomes, data were summarized and presented without pooled statistics.Results:Only 3 of the 990 identified studies met inclusion criteria. The included studies encompassed 26 revision arthroscopic posterior capsulolabral repairs, with follow-up ranging from 2.3 to 5.3 years. The failed index procedure was arthroscopic capsulolabral repair with suture anchors (n = 22) or posterior thermal capsulorrhaphy (n = 4). The primary indications for revision were recurrent instability and pain. Six patients experienced recurrent instability after revision. Patient satisfaction ranged from 15% to 25%.Conclusion:This systematic review of 3 studies demonstrated that the incidence of persistent pain and recurrent instability after revision arthroscopic posterior shoulder stabilization is common, and despite slight improvement in patient-reported outcomes, many patients are dissatisfied with their clinical outcomes. Revision arthroscopic posterior shoulder stabilization appears to have a significant failure rate, and there is need for additional prospective studies to help determine the best intervention for these patients.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-08T08:21:14Z
DOI: 10.1177/23259671231174474
Issue No: Vol. 11, No. 6 (2023)
- Effect of Prior Knee Arthroscopy on Midterm Outcomes After Medial
Opening-Wedge High Tibial Osteotomy: A Propensity Score–Matched Analysis
Authors: Hong Yeol Yang, Jae Hyeok Cheon, Chang Hyun Lee, Eun Kyoo Song, Jong Keun Seon
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Knee arthroscopy is frequently performed to improve joint function and relieve pain. However, there is no consensus regarding the effect of prior arthroscopy on outcomes following medial opening-wedge high tibial osteotomy (MOWHTO).Purpose:To compare midterm clinical outcomes and survival rates after MOWHTO between patients with and without a history of knee arthroscopy.Study Design:Cohort study; Level of evidence, 3.Methods:We enrolled patients who underwent MOWHTO between March 2008 and February 2017 and had ≥4 years of follow-up. Patients who had undergone knee arthroscopy were included in an arthroscopy group, and those who had not were included as controls. After propensity score matching based on age, sex, body mass index, and lesion size, 80 patients in each group were included. Clinical outcomes were assessed using the Knee injury and Osteoarthritis Outcome Score (KOOS), 36-Item Short Form Health Survey, and Tegner Activity Scale. Furthermore, survival rates and relevant risk factors that affected joint survivorship were analyzed, wherein conversion to total knee arthroplasty was considered the endpoint.Results:Although the pre- to postoperative improvement in clinical outcomes did not differ significantly between the groups, there were significant between-group differences in final postoperative scores on the KOOS–Activities of Daily Living (arthroscopy vs control, 78.1 ± 10.6 vs 81.0 ± 9.8; P = .031), KOOS–Sport and Recreation (45.4 ± 12.8 vs 48.7 ± 13.5; P = .045), 36-Item Short Form Health Survey Physical Component Summary (65.1 ± 12.7 vs 69.3 ± 11.8; P = .017), and Tegner Activity Scale (4.1 ± 1.1 vs 4.5 ± 1.0; P = .007). The survival rate was 96.8% at a mean follow-up of 8 years, and survival was not associated with a history of arthroscopy (P = .697; log-rank test).Conclusion:Although patients with prior arthroscopy had some inferior patient-reported outcome scores after MOWHTO, the overall clinical improvements were similar in the arthroscopy and control groups.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-08T08:18:48Z
DOI: 10.1177/23259671231175457
Issue No: Vol. 11, No. 6 (2023)
- French Translation and Validation of the OSTRC-H2 Questionnaire on Overuse
Injuries and Health Problems in Elite Athletes
Authors: Charlotte Beaudart, Margaux Galvanin, Rosalie Hauspy, Benjamin Matthew Clarsen, Christophe Demoulin, Stephen Bornheim, Julien Van Beveren, Jean-François Kaux
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:To evaluate the burden of overuse injuries, the Oslo Sports Trauma Research Centre (OSTRC) questionnaire on health problems (OSTRC-H2) was developed in English in 2013.Purpose:To translate and culturally adapt the OSTRC-H2 into French and investigate the reliability and validity of this new version.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:The OSTRC-H2 was translated from English to French according to international guidelines. A total of 80 elite athletes were then invited to complete the OSTRC-H2 weekly for 3 months. Potential ceiling effects, construct validity, and reliability were investigated. Convergent validity was measured using Pearson correlations for continuous items and kappa coefficients for binary items; internal consistency was measured using the Cronbach alpha coefficient; and test-retest reliability was measured using the intraclass correlation coefficient (ICC). Separate analyses were performed on the entire cohort of athletes (population 1 [P1]) and on athletes who reported a health problem during the follow-up (P2).Results:A total of 80 elite athletes took part in this study. The response rate was very high, with 909 of 960 questionnaires returned (95%). The mean weekly prevalence of health problems was 19.6% during the follow-up period. Nineteen participants reported a health problem during the follow-up (P2). The OSTRC-H2 showed very good test-retest reliability for both populations (ICC, 0.85 [95% CI, 0.77-0.90] for P1; ICC, 0.90 [95% CI, 0.68-0.98] for P2). Internal consistency was very good for P2 (Cronbach α = .94). The OSTRC-H2 demonstrated high concordance with the visual analog scale of symptom intensity (r = 0.52; P < .05), and low concordance with the overtraining questions from the Questionnaire de la Société Française de Médecine du Sport (κ from –0.01 to 0.12; P> .05).Conclusion:The French version of the OSTRC-H2 was found to be valid and reliable when applied to French-speaking elite athletes.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-08T08:14:31Z
DOI: 10.1177/23259671231173374
Issue No: Vol. 11, No. 6 (2023)
- A Milestone For OJSM
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-08T06:30:28Z
DOI: 10.1177/23259671231176484
Issue No: Vol. 11, No. 6 (2023)
- Association of Coracoacromial Ligament Degeneration With Rotator Cuff Tear
Patterns and Retear Rate
Authors: Hao-Chun Chuang, Chih-Kai Hong, Kai-Lan Hsu, Fa-Chuan Kuan, Yueh Chen, Joe-Zhi Yen, Chen-Hao Chiang, Hao-Ming Chang, Wei-Ren Su
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Coracoacromial ligament (CAL) degeneration is thought to be a factor in external impingement in bursal-sided rotator cuff tears, but CAL release is associated with adverse effects.Purpose:To investigate the association between CAL degeneration and the patterns of massive rotator cuff tears using multiple modalities and to assess the effect of CAL degeneration on supraspinatus tendon retear rates.Study Design:Cohort study; Level of evidence, 2.Methods:The authors prospectively recruited 44 patients who had undergone arthroscopic rotator cuff repair without acromioplasty or CAL release. Preoperative radiographs and magnetic resonance imaging (MRI) scans were reviewed to determine acromial morphology and CAL thickness, respectively. Rotator cuff tears were categorized as isolated supraspinatus or massive (involvement of ≥2 tendons), with massive tears categorized using the Collin classification. Acromial degeneration was analyzed using the Copeland-Levy classification. The CAL was biopsied intraoperatively and histologically analyzed using the Bonar score. At 6-month follow-up, the integrity of the repaired supraspinatus tendon was analyzed on MRI using the Sugaya classification. Finally, the associations among CAL degeneration, rotator cuff tear pattern, and arthroscopic grading were investigated.Results:Patients with Collin type B rotator cuff tear had significantly higher CAL Bonar scores than those with Collin type A or isolated supraspinatus tears (10.0 vs 6.8 and 3.4; P = .03 and P < .001, respectively). Patients with a degenerative acromial undersurface of Copeland-Levy stage 2 or 3 had CALs with significantly higher Bonar scores than those with an intact acromial undersurface (8.4 and 8.2 vs 3.5; P = .034 and P = .027, respectively). The CAL Bonar scores of patients with different stages of the 6-month postoperative Sugaya classification were comparable (6.5, 7.2, 8.0, and 7.8 for stages 1, 2, 3, and 4, respectively; P = .751).Conclusion:CAL degeneration was more severe in anterosuperior-type massive rotator cuff tears. Interestingly, even without acromioplasty, the severity of CAL degeneration did not affect the retear rate of the supraspinatus tendon.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-07T11:51:29Z
DOI: 10.1177/23259671231175873
Issue No: Vol. 11, No. 6 (2023)
- Relationship Between Lateral Tibial Posterior Slope and Tibiofemoral
Kinematics During Simulated Jump Landings in Male Cadaveric Knees
Authors: So Young Baek, Mélanie L. Beaulieu, Edward M. Wojtys, James A. Ashton-Miller
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:It is not known mechanistically whether a steeper lateral posterior tibial slope (LTS) leads to an increase in anterior tibial translation (ATT) as well as internal tibial rotation (ITR) during a given jump landing.Hypothesis:A steeper LTS will result in increased ATT and ITR during simulated jump landings when applying knee compression, flexion, and internal tibial torque of increasing severity.Study Design:Descriptive laboratory study.Methods:Seven pairs of cadaveric knees were harvested from young male adult donors (mean ± SD; age, 25.71 ± 5.53 years; weight, 71.51 ± 4.81 kg). The LTS of each knee was measured by a blinded observer from 3-T magnetic resonance images. Two sets of 25 impact trials of ∼700 N (1× body weight [BW] ±10%) followed by 2 sets of 25 trials of 1400 N (2× BW ±10%) were applied to a randomly selected knee of each pair. Similarly, on the contralateral knee, 2 sets of 25 impact trials of ∼1800 N (2.5× BW ±10%) followed by 2 sets of 25 trials of ∼2100 N (3× BW ±10%) were applied. Three-dimensional knee kinematics, including ATT and ITR, were measured at 400 Hz using optoelectronic motion capture. Two-factor linear mixed effect models were used to determine the relationship of LTS to ATT and ITR as impact loading increased.Results:As LTS increased, so did ATT and ITR during increasingly severe landings. LTS had an increasing effect on ATT (coefficient, 0.50; 95% CI, 0.29-0.71) relative to impact force (coefficient, 0.52; 95% CI, 0.50-0.53). ITR was proportional to LTS (coefficient, 1.36; 95% CI, 0.80-1.93) under increasing impact force (coefficient, 0.49; 95% CI, 0.47-0.52). For steeper LTS, the increase in ITR was proportionally greater than the increase in ATT.Conclusion:In male knee specimens, a steeper LTS significantly increased ATT and ITR during jump landings.Clinical Relevance:Increases in ITR and ATT during jump landings lead to increased strain on the anterior cruciate ligament and are therefore associated with greater risk of ligament failure.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-07T11:50:30Z
DOI: 10.1177/23259671231160213
Issue No: Vol. 11, No. 6 (2023)
- Neuromechanical Properties of the Vastus Medialis and Vastus Lateralis in
Adolescents With Patellofemoral Pain
Authors: Marion Crouzier, François Hug, Frances T. Sheehan, Natalie J. Collins, Kay Crossley, Kylie Tucker
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:An alteration in the force distribution among quadriceps heads is one possible underlying mechanism of patellofemoral pain. However, this hypothesis cannot be directly tested as there are currently no noninvasive experimental techniques to measure individual muscle force or torque in vivo in humans. In this study, the authors considered a combination of biomechanical and muscle activation measures, which enabled us to estimate the mechanical impact of the vastus medialis (VM) and vastus lateralis (VL) on the patella.Purpose/Hypothesis:The purpose of this study was to determine whether the relative index of torque distribution for the VM and VL differs between adolescents with and without patellofemoral pain. It was hypothesized that, relative to the VL, the VM would contribute less to knee extension torque in adolescents with patellofemoral pain compared with controls.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Twenty adolescents with patellofemoral pain and 20 matched control participants were included (38 female; age, 15.3 ± 1.8 years; weight, 58 ± 13 kg; height, 164 ± 8 cm). Muscle volumes and resting moment arms were quantified from magnetic resonance images, and fascicle lengths were obtained from panoramic B-mode ultrasonography. Muscle activation was estimated using surface electromyography during submaximal isometric tasks (wall-squat and seated tasks). Muscle torque was estimated as the product of muscle physiological cross-sectional area (ie, muscle volume/fascicle length), muscle activation (normalized to maximal activation), and moment arm.Results:Across tasks and force levels, the relative contribution of the VM to the overall medial and lateral vastii torque was 31.0% ± 8.6% for controls and 31.5 ± 7.6% for adolescents with patellofemoral pain (group effect, P> .34).Conclusion:For the tasks and positions investigated in this study, the authors found no evidence of lower VM torque generation (relative to the VL) in adolescents with patellofemoral pain compared with controls.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-07T06:25:51Z
DOI: 10.1177/23259671231155894
Issue No: Vol. 11, No. 6 (2023)
- Revision Rotator Cuff Repair With Versus Without an Arthroscopically
Inserted Onlay Bioinductive Implant in Workers’ Compensation Patients
Authors: Ryan S. Ting, Yao Chen Loh, Ron Rosenthal, Kaitlin Zhong, Hilal S.A. Al-Housni, Mina Shenouda, Lisa Hackett, Patrick H. Lam, George A.C. Murrell
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:The addition of onlay biological grafts to augment difficult rotator cuff repairs has shown encouraging results in a case series.Purpose/Hypothesis:The purpose of this study was to determine whether the addition of an onlay bioinductive implant would improve repair integrity, shear wave elastographic appearance of the repaired tendon and patch, and patient-rated and/or surgeon-measured shoulder function when used in workers' compensation patients undergoing revision arthroscopic rotator cuff repair. We hypothesized that the addition of the bioinductive implant would enhance repair integrity and clinical outcomes compared with standard repair.Study Design:Cohort study; Level of evidence, 3.Methods:A post hoc matched-cohort study was conducted on prospectively recruited workers’ compensation patients who received a bioinductive implant for revision rotator cuff repair (n = 19). The control group was selected from consecutive workers’ compensation revision rotator cuff repair patients before the introduction of bioinductive implants. Then, they were matched for age and tear size (n = 32). Kaplan-Meier curves were generated to compare the primary outcome of repair integrity between groups. The secondary outcomes were to evaluate the elastographic appearance of the tendon and patch in the bioinductive implant group and to compare patient-rated and surgeon-measured shoulder function between groups preoperatively and at 1 week, 6 weeks, 3 months, and 6 months postoperatively.Results:No major complications associated with the bioinductive implants were identified. Six months after the revision rotator cuff repair, the retear rate in the bioinductive implant group was 16% (3/19), compared with 19% (6/32) in the age- and tear size-matched control group (P = .458). At the final follow-up, the retear rate in the bioinductive implant group was 47% (9/19) at a mean of 14 months compared with 38% (12/32) at a mean of 29 months in the control group (P = .489). The shear wave elastographic stiffness of repaired tendons augmented with the bioinductive implant remained unchanged at 6 m/s from 1 week to 6 months postoperatively, which is lower than the stiffness of 10 m/s in healthy tendons. There were no significant differences in patient-rated or surgeon-measured outcomes between groups 6 months postoperatively.Conclusion:There were no differences in repair integrity or clinical outcomes between workers’ compensation patients who underwent revision arthroscopic rotator cuff repair with an onlay bioinductive implant compared to those who underwent standard revision rotator cuff repair.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-06T09:58:38Z
DOI: 10.1177/23259671231175883
Issue No: Vol. 11, No. 6 (2023)
- Long-term Quality of Life in Patients After ACL Reconstruction With
Concomitant Meniscal Injury Treatment: Patient-Reported Outcomes at
Minimum 10-Year Follow-up
Authors: Georgios Chalatsis, Vasileios Mitrousias, Athanasios Siouras, Freideriki Panteliadou, Ioannis Tziolas, Chrysovalantis Solomou, Michael Hantes
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Long-term studies of patients after anterior cruciate ligament (ACL) reconstruction with or without concomitant meniscal tear treatment are limited.Purposes:To (1) report postoperative outcomes after anatomic ACL reconstruction with a hamstring autograft, (2) investigate how concomitant treatment of meniscal injury could affect these outcomes, and (3) evaluate the association between quality of life and activity levels at a minimum 10-year follow-up.Study Design:Cohort study; Level of evidence, 3.Methods:Patients treated with a unilateral, anatomic ACL reconstruction between 2005 and 2011 were investigated. The following patient-reported outcome measures (PROMs) were reported for the overall sample as well as a subsample of patients with meniscal injury: International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm knee score, Tegner activity scale, 5-level EQ-5D (EQ-5D-5L), and patient satisfaction. Sex, age, body mass index (BMI), and meniscal injury treatment (meniscectomy vs meniscal repair) were examined as patient-specific risk factors regarding long-term activity and quality of life.Results:Overall, 106 patients, 90 men (85%) and 16 women (15%), were enrolled in the study, with a mean follow-up of 13.2 years. The ACL retear rate was 2.8%. The mean scores were 80.6 ± 16.7 (IKDC-SKF), 87.4 ± 15.0 (KOOS), 90.5 ± 11.5 (Lysholm), 5.6 ± 1.9 (Tegner), and 91.8 ± 14.5 (EQ-5D-5L). The majority (90.6%) of patients considered their knee state satisfactory during follow-up. When compared with patients who underwent meniscal repair, patients who underwent meniscectomy had statistically significantly lower scores on all PROMs except for the Tegner and EQ-5D-5L (P < .05 for all). The mean difference between the 2 groups was ≥7 points on all PROM scores. Patient sex, age, and BMI did not affect PROM scores. There was a statistically significant, strong positive correlation between quality of life and activity.Conclusion:Patients had few or no symptoms and considered their knee state satisfactory 13.2 years after anatomic ACL reconstruction. Patients with concomitant meniscal tears having undergone meniscal repair had improved PROMs compared with those treated with meniscectomy. Finally, participation in activities of daily living and sports was interrelated with quality of life and was not affected by patient age, sex, or BMI.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-05T12:51:40Z
DOI: 10.1177/23259671231177279
Issue No: Vol. 11, No. 6 (2023)
- Translation and Validation of a Simplified Chinese Version of the Anterior
Cruciate Ligament–Quality of Life Questionnaire
Authors: Jun Kou, Bing Deng, Jinbiao Liu, Jun Wen, Li Yin, Qingyun Xie, Wang Wei
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:The Anterior Cruciate Ligament–Quality of Life (ACL-QOL) questionnaire is a widely used and effective scale for quality of life in patients with chronic anterior cruciate ligament (ACL) injury.Purpose:To translate and adapt the ACL-QOL questionnaire for Chinese patients and evaluate its reliability, validity, and responsiveness in this population.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:Translation and adaptation were conducted in accordance with the guidelines of the A merican Academy of Orthopaedic Surgeons Outcome Committee. Included were 121 patients who were diagnosed with a chronic ACL injury and underwent ACL reconstruction between January 2020 and June 2021. Preoperatively, patients completed the simplified Chinese version of the ACL-QOL (ACL-QOL-C), the Knee injury and Osteoarthritis Outcome Score, and the 12-Item Short Form Health Survey. The ACL-QOL-C was also completed at 12- and 24-week follow-ups. Psychometric evaluations were then performed and included score distribution, internal consistency, test-retest reliability, construct validity, and responsiveness.Results:The Cronbach alpha ranged from .905 to .975, indicating excellent internal consistency, and the intraclass correlation coefficient ranged from 0.864 to 0.985, indicating excellent test-retest reliability. The consistency between the above results and our a priori hypotheses was more than 70% (35/42), indicating good construct validity. The standard error of measurement and effect size of the total score and each item of the ACL-QOL-C were>0.8 at the final follow-up, indicating good responsiveness.Conclusion:The English version of the ACL-QOL has been successfully translated into Chinese, and it has been shown to be applicable for the assessment of the quality of life in Chinese patients with chronic ACL injury.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-05T12:51:04Z
DOI: 10.1177/23259671231175935
Issue No: Vol. 11, No. 6 (2023)
- Arabic Translation of the Knee Outcome Survey–Sports Activities Scale
With Cross-cultural Adaptation and Validation
Authors: Hamza M. Alrabai, Abdulrahman D. Algarni, Abdulrahman Ahmed Alshehri, Adel Faiz Alshihri, Ammar Saleh Almansour, Rawaf Khalid Alrawaf, Abdulaziz S. Al-Ahaideb
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:There are few sports-specific knee functional scales in the Arabic language. The Knee Outcome Survey–Sports Activities Scale (KOS-SAS) is a validated sports-specific patient-reported outcome measure that assesses knee function in an athletic population.Purpose:To provide a validated Arabic version of the KOS-SAS (KOS-SAS-Ar) while achieving cross-cultural adaptation for use in an Arabic-speaking population with sports-related knee disorders.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:There were 2 independent translators who conducted a forward translation of the KOS-SAS, followed by a backward translation by different translators. Subsequently, researchers and expert invitees judged the conceptual content and cultural adaptations of the final translation. A total of 276 patients completed the KOS-SAS-Ar as well as the International Knee Documentation Committee (IKDC) subjective assessment of knee function and a visual analog scale (VAS) for pain. Statistical analysis was performed for test-retest reliability, convergent validity, construct validity, and factor analysis.Results:The test-retest reliability of the KOS-SAS-Ar was high (r = 0.9). The items of the KOS-SAS-Ar had statistically significant internal consistency, with a Cronbach alpha of .924 (P < .0001). The KOS-SAS-Ar Symptoms subscore correlated with the VAS pain score (P < .0001), and the KOS-SAS-Ar Functional Limitations subscore correlated with the IKDC subjective score (P < .0001). The construct validity of the KOS-SAS-Ar was satisfactory (Kaiser-Meyer-Olkin value = 0.868; Bartlett test: P < .0001). Factor analysis showed a statistical correlation among the 11 items of the KOS-SAS-Ar.Conclusion:The KOS-SAS-Ar demonstrated favorable reliability and validity, and it appears to be a suitable tool for Arabic-speaking patients with sports-related knee conditions.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-05T12:50:30Z
DOI: 10.1177/23259671231175895
Issue No: Vol. 11, No. 6 (2023)
- Osteoconductive Scaffold Placed at the Femoral Tunnel Aperture in
Hamstring Tendon ACL Reconstruction: A Randomized Controlled Trial
Authors: Tobias Götschi, Sandro Hodel, Nathalie Kühne, Elias Bachmann, Xiang Li, Stefan M. Zimmermann, Jess G. Snedeker, Sandro F. Fucentese
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Bone tunnel enlargement after single-bundle anterior cruciate ligament reconstruction remains an unsolved problem that complicates revision surgery.Hypothesis:Positioning of an osteoconductive scaffold at the femoral tunnel aperture improves graft-to-bone incorporation and thereby decreases bone tunnel widening.Study Design:Randomized controlled trial; Level of evidence, 1.Methods:In a 1:1 ratio, 56 patients undergoing primary anterior cruciate ligament reconstruction were randomized to receive femoral fixation with cortical suspension fixation and secondary press-fit fixation at the tunnel aperture of the tendon graft only (control) or with augmentation by an osteoconductive scaffold (intervention). Adverse events, patient-reported outcomes, and passive knee stability were recorded over 2 years after the index surgery. Three-dimensional bone tunnel widening was assessed using computed tomography at the time of surgery and 4.5 months and 1 year postoperatively.Results:The intervention group exhibited a similar number of adverse events as the control group (8 vs 10; P = .775) including 2 partial reruptures in both groups. The approach was feasible, although 1 case was encountered where the osteoconductive scaffold was malpositioned without adversely affecting the patient’s recovery. There was no difference between the intervention and control groups in femoral bone tunnel enlargement, as expressed by the relative change in tunnel volume from surgery to 4.5 months (mean ± SD, 36% ± 25% vs 40% ± 25%; P = .644) and 1 year (19% ± 20% vs 17% ± 25%; P =.698).Conclusion:Press-fit graft fixation with an osteoconductive scaffold positioned at the femoral tunnel aperture is safe but does not decrease femoral bone tunnel enlargement at postoperative 1 year.Registration:NCT03462823 (ClinicalTrials.gov identifier).
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-05T12:49:00Z
DOI: 10.1177/23259671231174478
Issue No: Vol. 11, No. 6 (2023)
- Epidemiology of Patellar Tendinopathy in Athletes and the General
Population: A Systematic Review and Meta-analysis
Authors: Sebastiano Nutarelli, Camilla Mondini Trissino da Lodi, Jill L. Cook, Luca Deabate, Giuseppe Filardo
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Patellar tendinopathy (PT) mainly affects athletes who use the tendon for repeated energy storage and release activities. It can have a striking impact on athletes’ careers, although data on its real prevalence and incidence are sparse. Research efforts should start from the results of reliable and updated epidemiological research to help better understand the impact of PT and underpin preventative measures.Purpose:To determine the prevalence and incidence of PT in athletes and the general population.Design:Systematic review; Level of evidence, 3.Methods:A systematic review of the literature was performed on January 17, 2022, and conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, Web of Science, and Wiley Cochrane Library databases were searched for epidemiological reports of any evidence level and clinical studies reporting data on the incidence or prevalence of PT for the 11,488 retrieved records. The primary endpoint was the prevalence and incidence of PT in sport-active patients. The secondary endpoints were PT prevalence and incidence in subgroups of athletes based on sex, age, sport type, and sport level played, as well as the same epidemiological measures in the general population.Results:A total of 28 studies, with 28,171 participants, were selected and used for the qualitative and quantitative analysis. The general and athletes’ populations reported an overall PT prevalence of 0.1% and 18.3%, respectively. In athletes, the prevalence of PT was 11.2% in women and 17% in men (P = .070). The prevalence of PT in athletes
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-05T12:44:50Z
DOI: 10.1177/23259671231173659
Issue No: Vol. 11, No. 6 (2023)
- Can Hip Passive Range of Motion Predict Hip Microinstability' A
Comparative Study
Authors: Daniel M. Curtis, W. Michael Pullen, Justin N. Hopkins, Iain R. Murray, Adam Money, Nicole A. Segovia, Marc R. Safran
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Hip microinstability is an increasingly recognized cause of pain and disability in young adults. It is unknown whether differences in passive hip range of motion (ROM) exist between patients with versus without hip microinstability.Hypothesis:Underlying ligamentous and capsular laxity will result in differences in clinically detectable passive ROM between patients with femoroacetabular impingement (FAI), patients with microinstability, and asymptomatic controls.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A retrospective review of all patients undergoing hip arthroscopy between 2012 and 2018 was conducted. Patients with a diagnosis of isolated microinstability based on intraoperative findings were identified and classified as having isolated FAI, instability, or FAI + instability. Patients without a history of hip injury were included as controls. Range of motion was recorded in the supine position for flexion, internal rotation, and external rotation. Univariate and multivariate analysis was performed on each measurement in isolation as well as combinations of motion to include total rotation arc, flexion + rotation arc, and flexion + 2× rotation arc Models were then created and tested to predict instability status.Results:In total, 263 hips were included: 69 with isolated instability, 50 with FAI, 50 with FAI + instability, and 94 control hips. A higher proportion of patients in the instability and FAI + instability groups were female compared with the FAI and control groups (P < .001). On univariate analysis, differences were found in all groups in all planes of motion (P < .001). Multivariable analysis demonstrated differences in all groups in flexion and flexion + rotation arc. In symptomatic patients, the best performing predictive model for hip microinstability was flexion + rotation arc ≥200° (Akaike information criterion, 132.3; P < .001) with a sensitivity of 68.9%, specificity of 80.0%, positive predictive value of 89.1%, and negative predictive value of 51.9%.Conclusion:Patients with hip microinstability had significantly greater ROM than symptomatic and asymptomatic cohorts without hip microinstability. Symptomatic patients with hip flexion + rotation arc ≥200° were highly likely to have positive intraoperative findings for hip microinstability, whereas instability status was difficult to predict in patients with a flexion + rotation arc of
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-05T12:43:30Z
DOI: 10.1177/23259671231169978
Issue No: Vol. 11, No. 6 (2023)
- Association of Trochlear Length on Sagittal MRI to Trochlear Dysplasia in
Knees With Patellar Instability
Authors: Miho J. Tanaka, Zachary L. LaPorte, Nicholas P.J. Perry, Maria V. Velasquez Hammerle, Varun Nukala, Fang Liu
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Trochlear dysplasia is a primary risk factor for patellar instability and leads to loss of the osteochondral constraint of the patella. Trochleoplasty techniques include the Peterson grooveplasty, which alters the length of the trochlea; however, a radiographic measurement of trochlear length to support this has not been described.Purpose:To describe measurements to quantify trochlear length on sagittal magnetic resonance imaging in patients with and without patellar instability and to correlate trochlear length with measurements of trochlear dysplasia.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 66 age- and sex-matched knees (36 female and 30 male; mean age, 20.8 ± 4.8 years) were included in this study, of which 33 had patellar instability. Trochlear extension length (TEL) and trochlear alpha angle (TAA) were measured on 3 sagittal magnetic resonance imaging scans (center of the knee, center of the medial condyle, and center of the lateral condyle), and measurements were compared between symptomatic and control knees. Receiver operating characteristic curve analysis was performed, and the area under the curve (AUC) was calculated to describe the accuracy of each measurement to distinguish between knees with and without patellar instability. Linear and multivariate regression analyses were performed to assess the relationship between sagittal measurements and axial measurements of trochlear dysplasia, including lateral trochlear inclination, sulcus angle, and trochlear depth, as well as patient size reflected by the epicondylar distance.Results:In symptomatic knees, the central trochlea extended more proximally than in control knees, as determined by the TEL (14.0 ± 3.0 vs 11.5 ± 2.3 mm, respectively; P < .001) and TAA (68.4° ± 3.8° vs 70.5° ± 3.4°, respectively; P = .017). AUC calculations showed that a TEL ≥11 mm at the central trochlea was predictive of patellar instability in both male and female knees (AUC = 0.83 and 0.77, respectively), as was a TAA ≤67° in female knees (AUC = 0.72). An independent association between the central TEL and sulcus angle was found. The central TEL showed a weak correlation with patient size, as measured by the epicondylar distance, while the TAA did not.Conclusion:In knees with symptomatic patellar instability, the central trochlea was found to extend 2.5 mm more proximally than in control knees, and this increase in length correlated with severity of trochlear dysplasia. As radiographic examinations of the trochlea and grooveplasty procedures are often based on the proximal extent of the cartilaginous trochlea, further studies are needed to identify the role of trochlear length in the assessment and treatment of trochlear dysplasia in the setting of patellar instability.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-05T12:41:20Z
DOI: 10.1177/23259671231169730
Issue No: Vol. 11, No. 6 (2023)
- Effects of Lateral Opening-Wedge Distal Femoral Osteotomy on Meniscal
Allograft Transplantation: A Biomechanical Evaluation
Authors: Simon Lee, Justin R. Brown, Christopher Bartolomei, Travis Turnbull, Jon W. Miles, Grant J. Dornan, Rachel M. Frank, Armando F. Vidal
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Lateral meniscal deficiency with valgus malalignment increases the rate of lateral compartment osteoarthritis. Lateral meniscal allograft transplantation (LMAT) with a concomitant varus-producing opening-wedge distal femoral osteotomy (DFO) is an option yet to be evaluated biomechanically.Purpose/Hypothesis:The purpose of this study was to clarify the biomechanical effects of the realignment procedure in the setting of LMAT. We hypothesized that (1) given the dependence of the lateral compartment on the lateral meniscus, a DFO and increasing degrees of varus would be insufficient to restore lateral compartment pressures to normal from a lateral meniscus-deficient state, and that (2) LMAT would restore lateral compartment pressures to the intact state while DFO would decrease lateral compartment pressures for any given state of the meniscus.Study Design:Controlled laboratory study.Methods:Ten cadaveric knees underwent opening-wedge varus-producing DFO secured by an external fixator. Anatomic alignment was standardized to 6° of mechanical valgus, and each joint was tested in full extension. Submeniscal placement of thin film pressure sensors allowed for the recording of contact pressure, peak contact pressure, and contact area. The specimens were loaded on a biaxial dynamic testing machine with loading angles between 9° valgus and 6° varus of mechanical alignment. Conditions tested included intact meniscus, meniscal deficiency, and meniscal transplantation.Results:Isolated varus-producing DFO to 6° in the meniscus-deficient state failed to restore joint pressures and contact areas to the intact state, with significant changes in mean contact pressure (175%), mean peak contact pressure (135%), and contact area (–41%) (all P < .05 vs intact), while LMAT restored all outcome measures (all P> .05 compared with intact). After LMAT, every additional 1° of DFO correction contributed to a decrease in the mean contact pressure, peak pressure, and contact area of 5.6% (–0.0479 N/mm2), 5.9% (–0.154 N/mm2), and 1.4% (–6.99 mm2) for the lateral compartment and 7.3% (+0.034 N/mm2), 12.6% (+0.160 N/mm2), and 4.3% (+20.53 mm2) for the medial compartment, respectively.Conclusion:Isolated DFO was inadequate to restore load distribution in meniscus-deficient knees, while concomitant LMAT restored near normal forces and improved the lateral compartment biomechanical profile.Clinical RelevanceOur findings support the concomitant use of LMAT and varus-producing DFO in the setting of lateral meniscal deficiency with valgus malalignment. This study provides tools for the orthopaedic surgeon to individualize the correction for each patient.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-05T12:40:47Z
DOI: 10.1177/23259671231156639
Issue No: Vol. 11, No. 6 (2023)
- Comparison of Visibility and Risk of Neurovascular Tissue Injury Between
Portals in Needle Arthroscopy of the Anterior Ankle Joint: A Cadaveric
Study
Authors: Jumpei Inoue, Youichi Yasui, Jun Sasahara, Tetsuya Takenaga, Kenjiro Wakabayashi, Masahiro Nozaki, Makoto Kobayashi, Myongsu Ha, Hiroaki Fukushima, Jiro Kato, Wataru Miyamoto, Hirotaka Kawano, Hideki Murakami, Masahito Yoshida
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:For needle arthroscopy with 0° viewing, the visible range of intra-articular structures and the difference between portals remain unknown, as do the risks for neurovascular tissue at each portal.Purpose:To clarify the visibility and safety of needle arthroscopy.Study Design:Descriptive laboratory study.Methods:Ten cadaveric ankle specimens were used. A needle arthroscope with a 1.9-mm diameter was inserted from 4 portals (anteromedial [AM], anterolateral [AL], medial midline [MM], and anterocentral [AC]). Visibility was assessed using a 15-point ankle arthroscopy checklist. In addition, the ankles were dissected to measure the distance between each portal and neurovascular tissues. The visibility of the ankle joint was compared between portals.Results:The success rate of visibility in the deltoid ligament and the tip of the medial malleolus was 100% from the AM, MM, and AC portals and 10% from the AL portal, with significant differences between the portals (P < .01). The visibility success rates in the origin of the anterior talofibular ligament and the tip of the lateral malleolus were 20% for the AM portal, 90% for the MM and AC portals, and 100% for the AL portal, with significant differences between the portals (P < .01). All other points of the ankle joint were visualized from all the portals with a 100% success rate. The AC portal was in contact with the anterior neurovascular bundle in 4 of the 10 specimens.Conclusion:When needle arthroscopy was performed from the AM or AL portal, the site opposite to the portal in the ankle joint was difficult to visualize. Conversely, most points of the ankle joint could be visualized from the MM and AC portals. Care should be taken when creating an AC portal because of its proximity to the anterior neurovascular bundle.Clinical Relevance:The present study provides information regarding which portal should be selected to perform needle arthroscopy in the ankle joint, which will be beneficial for management of ankle injuries.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-02T11:07:00Z
DOI: 10.1177/23259671231174477
Issue No: Vol. 11, No. 6 (2023)
- Landing Posture in Elite Female Athletes During a Drop Vertical Jump
Before and After a High-Intensity Ergometer Fatigue Protocol: A Study of
20 Japanese Women’s Soccer League Players
Authors: Aguri Kamitani, Kunio Hara, Yuta Fujii, Shohei Yoshida
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Even elite athletes, who usually show stable postural control, sometimes cannot control their posture after high-load training. This instability may contribute to anterior cruciate ligament injury.Purpose/Hypothesis:The purpose of this study was to evaluate the landing posture of elite female soccer players before and after a novel high-intensity fatigue-inducing exercise protocol. We hypothesized that the landing posture will change before versus after the fatigue protocol.Study Design:Descriptive laboratory study.Method:The study participants were 20 female elite soccer players. All athletes performed 3 drop vertical jumps (DVJs), pedaled an ergometer 8 times with full force for 10 seconds each (fatigue protocol), and then repeated the 3 DVJs. We measured and compared the athletes’ blood lactate levels before and after the fatigue protocol, as well as the hip flexion, knee flexion, and ankle dorsiflexion angles and final landing posture during the DJVs.Results:Blood lactate levels increased significantly pre- to postprotocol (from 2.7 ± 1.9 to 15.0 ± 3.6 mmol/L; P < .001), while there were decreases in hip flexion angle (from 35.0° ± 11.2° to 22.4° ± 8.8°; P < .001) and ankle dorsiflexion angle (from 26.4° ± 3.9° to 20.0° ± 3.7°; P < .001). The number of athletes who could not maintain a stable DVJ final landing posture increased from 10% before the fatigue protocol to 70% after.Conclusion:The elite female athletes in our study showed significant decreases in hip flexion and ankle dorsiflexion angles in the DVJ landing after a fatigue-inducing protocol. Most elite athletes were unable to maintain a stable posture on the DVJ landing after the fatigue protocol.Clinical Relevance:This study advances our understanding of how elite athletes land in a fatigued state.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-02T08:37:53Z
DOI: 10.1177/23259671231171859
Issue No: Vol. 11, No. 6 (2023)
- Comparison of Return-to-Sports Rates Between Male and Female Australian
Athletes After ACL Reconstruction
Authors: Haydn J. Klemm, Julian A. Feller, Kate E. Webster
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Return to sports (RTS) is a goal for most patients who undergo anterior cruciate ligament reconstruction (ACLR). Although it has been reported that women RTS at a significantly lower rate compared with men, demographic and contextual factors that may be associated with this have not been investigated.Purpose:To compare RTS rates between men and women and investigate factors that may be associated with different rates of RTS in an Australian context.Study Design:Cohort study; Level of evidence, 3.Methods:A total of 1338 patients who underwent primary ACLR between January 2014 and December 2017 were invited to complete a detailed sports participation questionnaire 2 to 7 years after surgery. RTS rates were calculated and compared between men and women overall and after stratifying by age at surgery (
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-02T08:35:33Z
DOI: 10.1177/23259671231169199
Issue No: Vol. 11, No. 6 (2023)
- MRI Findings Associated With Anterior Cruciate Ligament Tears in National
Football League Athletes
Authors: Robert H. Brophy, Jon C. Baker, Jana M. Crain, Mackenzie M. Herzog, Ben Stollberg, Edward M. Wojtys, Christina D. Mack
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Anterior cruciate ligament (ACL) tears are a high-frequency injury requiring a lengthy recovery in professional American football players. Concomitant pathology associated with ACL tears as identified on magnetic resonance imaging (MRI) is not well understood in these athletes.Purpose:To describe the MRI findings of concomitant injuries associated with ACL tears among athletes in the National Football League (NFL).Study Design:Cross-sectional study; Level of evidence, 3.Methods:Of 314 ACL injuries in NFL athletes from 2015 through 2019, 191 complete MRI scans from the time of primary ACL injury were identified and reviewed by 2 fellowship-trained musculoskeletal radiologists. Data were collected on ACL tear type and location, as well as presence and location of bone bruises, meniscal tears, articular cartilage pathology, and concomitant ligament pathology. Mechanism data from video review were linked with imaging data to assess association between injury mechanism (contact vs noncontact) and presence of concomitant pathology.Results:Bone bruises were evident in 94.8% of ACL tears in this cohort, most often in the lateral tibial plateau (81%). Meniscal, additional ligamentous, and/or cartilage injury was present in 89% of these knees. Meniscal tears were present in 70% of knees, lateral (59%) more than medial (41%). Additional ligamentous injury was present in 71% of all MRI scans, more often a grade 1/2 sprain (67%) rather than a grade 3 tear (33%), and most often involving the medial collateral ligament (MCL) (57%) and least often the posterior cruciate ligament (10%). Chondral damage was evident in 49% of all MRI scans, with ≥1 full-thickness defect in 25% of all MRI scans, most often lateral. Most (79%) ACL tears did not involve direct contact to the injured lower extremity. Direct contact injuries (21%) were more likely to have a concomitant MCL tear and/or medial patellofemoral ligament injury and less likely to have a medial meniscal tear.Conclusion:ACL tears were rarely isolated injuries in this cohort of professional American football athletes. Bone bruises were almost always present, and additional meniscal, ligamentous, and chondral injuries were also common. MRI findings varied by injury mechanism.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-01T05:00:43Z
DOI: 10.1177/23259671231169190
Issue No: Vol. 11, No. 6 (2023)
- Effects of Malpositioning of the Knee on Radiographic Measurements: The
Influence of Adduction, Abduction, and Malrotation on Measured Tibial
Slope
Authors: Elise C. Bixby, Liana J. Tedesco, Jamie E. Confino, John D. Mueller, Lauren H. Redler
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Increased posterior tibial slope (PTS) is a risk factor for knee pathology. Accurate measurement of PTS is predicated on a quality lateral knee radiograph; however, little is known about how the quality of the radiograph affects the measured PTS.Purposes:To (1) describe a method for measuring malalignment on lateral knee radiographs, (2) assess the effects of malpositioning of the knee on radiographic measures of malalignment, and (3) determine any correlations between malalignment and the measured PTS.Study Design:Descriptive laboratory study.Methods:Using a setup similar to that of a standard radiology suite, 25 sets of radiographs were taken using 5 sawbone models. Each set included a true lateral view and separate malpositioned radiographs at 5°, 10°, and 15° of adduction, abduction, internal rotation, and external rotation. Malalignment for each radiograph was quantified as the anterior-posterior distance (APD) and proximal-distal distance (PDD) between femoral condyles. The medial PTS was measured in duplicate, and the interrater reliability was calculated.Results:The interrater reliability was excellent, with intraclass correlation coefficients of 0.92, 0.91, and 0.96 for the APD, PDD, and PTS, respectively. Malrotation significantly affected the APD (P < .001), with a mean change of 5.6 mm per 5°. Malpositioning in abduction/adduction significantly affected the PDD (P < .001), with a mean change of 5.1 mm per 5°. There was no significant impact of rotation or APD on the PTS. Abduction/adduction did affect the PTS (P < .001) above a threshold of 5° of malpositioning. The PTS decreased as the PDD increased, moving from adduction to abduction (R 2 = 0.5687).Conclusion:The measured PTS was more sensitive to malpositioning by abduction/adduction than by malrotation. Malrotation affected the APD, while abduction/adduction affected the PDD. Thus, the accuracy of the measured PTS was compromised more by poorly aligned distal femoral condyles than it was by poorly aligned posterior femoral condyles.Clinical Relevance:To minimize the effects of malpositioning, we recommend utilizing radiographs with a PDD of
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-01T04:48:48Z
DOI: 10.1177/23259671231164670
Issue No: Vol. 11, No. 6 (2023)
- Risk Factors for Graft Failure After Meniscal Allograft Transplantation: A
Systematic Review and Meta-analysis
Authors: Kyle N. Kunze, Ryann A. Davie, Prem Narayan Ramkumar, Jorge Chahla, Benedict U. Nwachukwu, Riley J. Williams
Abstract: Orthopaedic Journal of Sports Medicine, Volume 11, Issue 6, June 2023.
Background:Graft failure after meniscal allograft transplantation (MAT) may necessitate revision surgery or conversion to arthroplasty. A comprehensive understanding of the risk factors for failure after MAT of the knee may facilitate more informed shared decision-making discussions before surgery and help determine whether MAT should be performed based on patient risk.Purpose:To perform a systematic review and meta-analysis of risk factors associated with graft failure after MAT of the knee.Study Design:Systematic review; Level of evidence, 4.Methods:The PubMed, OVID/Medline, and Cochrane databases were queried in October 2021. Data pertaining to study characteristics and risk factors associated with failure after MAT were recorded. DerSimonian-Laird binary random-effects models were constructed to quantitatively evaluate the association between risk factors and MAT graft failure by generating effect estimates in the form of odds ratios (ORs) with 95% CIs. Qualitative analysis was performed to describe risk factors that were variably reported.Results:In total, 17 studies including 2184 patients were included. The overall pooled prevalence of failure at the latest follow-up was 17.8% (range, 3.3%-81.0%). In 10 studies reporting 5-year failure rates, the pooled prevalence of failure was 10.9% (range, 4.7%-23%). In 4 studies reporting 10-year failure rates, the pooled prevalence was 22.7% (range, 8.1%-55.0%). A total of 39 risk factors were identified, although raw data presented in a manner amenable to meta-analysis only allowed for 3 to be explored quantitatively. There was strong evidence to support that an International Cartilage Regeneration & Joint Preservation Society grade>3a (OR, 5.32; 95% CI, 2.75-10.31; P < .001) was a significant risk factor for failure after MAT. There was no statistically significant evidence to incontrovertibly support that patient sex (OR, 2.16; 95% CI, 0.83-5.64; P = .12) or MAT laterality (OR, 1.11; 95% CI, 0.38-3.28; P = .85) was associated with increased risk of failure after MAT.Conclusion:Based on the studies reviewed, there was strong evidence to suggest that degree of cartilage damage at the time of MAT is associated with graft failure; however, the evidence was inconclusive on whether laterality or patient sex is associated with graft failure.
Citation: Orthopaedic Journal of Sports Medicine
PubDate: 2023-06-01T04:37:49Z
DOI: 10.1177/23259671231160296
Issue No: Vol. 11, No. 6 (2023)
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