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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  [1174 journals]
  • Scoping Review of Injuries in Amateur and Professional Men’s Ice
           Hockey: Response

    • Authors: Patrick Szukics, Peters T. Otlans, Alfonso Arevalo, Matthew Meade, Peter DeLuca, John P. Salvo
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.

      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-30T09:52:18Z
      DOI: 10.1177/23259671221124960
      Issue No: Vol. 10, No. 9 (2022)
       
  • Scoping Review of Injuries in Amateur and Professional Men’s Ice
           Hockey: Letter to the Editor

    • Authors: Romana Franceschini-Brunner, Mario Bizzini, Anine Nordstrøm
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.

      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-30T09:47:38Z
      DOI: 10.1177/23259671221124961
      Issue No: Vol. 10, No. 9 (2022)
       
  • Evaluation of Radiographic Changes 5 Years After Arthroscopic Rotator Cuff
           Repair

    • Authors: Ryogo Furuhata, Noboru Matsumura, Tomoki Matsuo, Hiroo Kimura, Taku Suzuki, Masaya Nakamura, Takuji Iwamoto
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Radiographic changes in the glenohumeral joint often occur after rotator cuff repair; however, the details of the progression and underlying causes remain unknown.Purpose:To retrospectively evaluate the timing and frequency of radiographic changes after arthroscopic rotator cuff repair and to clarify the predictive factors that affect the onset of such changes using multivariate analysis.Study Design:Case-control study; Level of evidence, 3.Methods:We retrospectively reviewed 100 patients with 5 years of follow-up after arthroscopic rotator cuff repair and evaluated the postoperative shift in radiographic findings on plain radiographs every year during follow-up. Factors related to osteoarthritis, acromial spur re-formation, and greater tuberosity resorption at 5 years after surgery were evaluated using logistic regression analyses. Explanatory variables included preoperative factors, intraoperative factors, and postoperative retear. Baseline variables significant in the univariate analyses were included in the multivariate models.Results:Of the 100 patients, 12 developed osteoarthritis, 26 developed acromial spur formation, and 16 developed greater tuberosity resorption at 5 years after surgery. The incidence and grade of osteoarthritis and acromial spur gradually increased over time postoperatively. On the other hand, greater tuberosity resorption developed within 2 years after surgery but did not progress later. Multivariate analysis showed that a larger anteroposterior tear size (odds ratio [OR], 1.09; 95% CI, 1.01-1.17; P = .037) was a risk factor for postoperative osteoarthritis. Early retear (OR, 10.26; 95% CI, 1.03-102.40; P = .047) was a risk factor for acromial spur re-formation. Roughness of the greater tuberosity (OR, 9.07; 95% CI, 1.13-72.82; P = .038) and larger number of suture anchors (OR, 3.34; 95% CI, 1.66-6.74; P = .001) were risk factors for greater tuberosity resorption.Conclusion:Our study showed that radiographic changes occurred in 40% of patients within 5 years after arthroscopic rotator cuff repair. While the osteoarthritic changes and acromial spur re-formation gradually progressed postoperatively, the greater tuberosity resorption stopped within 2 years after surgery. Tear size, morphology of the greater tuberosity, and the number of suture anchors can affect radiographic changes. Furthermore, this study suggested that acromial spur re-formation may be an indicator of early retears.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-30T09:38:28Z
      DOI: 10.1177/23259671221126095
      Issue No: Vol. 10, No. 9 (2022)
       
  • Risk Factors Affecting Return to Sports and Patient-Reported Outcomes
           After Opening-Wedge High Tibial Osteotomy in Active Patients

    • Authors: Hiroki Katagiri, Mikio Shioda, Yusuke Nakagawa, Toshiyuki Ohara, Nobutake Ozeki, Tomomasa Nakamura, Ichiro Sekiya, Hideyuki Koga
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Although opening-wedge high tibial osteotomy (OWHTO) is favored for active patients who expect to return to sports, there is still a lack of robust evidence for factors affecting their recovery.Purpose:To identify (1) risk factors leading to a decreased level of return to preoperative sports after OWHTO and (2) patient characteristics and intraoperative factors influencing patient-reported outcomes after return to sports.Study Design:Case-control study; Level of evidence, 3.Methods:Included were 69 patients who underwent OWHTO and who expected to return to their preoperative level of sports, measured as a Tegner activity level ≥2. All included patients had a minimum of 1 year of follow-up data. Logistic regression analyses were performed to assess the effect of independent variables on the level of return to preoperative sports after surgery; the independent variables were age, sex, body mass index, preoperative Tegner score, preoperative Kellgren-Lawrence grade, preoperative percentage of mechanical axis (%MA), opening gap width, concomitant meniscal treatment, postoperative %MA, postoperative medial proximal tibial angle (MPTA), and postoperative posterior tibial slope. Univariate and multiple regression analyses were performed to assess for influencing factors on postoperative International Knee Documentation Committee (IKDC) subjective scores in patients who were able to return to sports.Results:Of the 69 patients, 51 (73.9%) returned to sports after OWHTO. High preoperative Tegner scores were statistically associated with a decrease in return to sports (odds ratio, 1.494; P = .033). Multiple regression analysis (n = 46 patients) identified that a higher postoperative MPTA was associated with a decreased IKDC subjective score after return to sports (r = –0.345; P = .019).Conclusion:Higher postoperative MPTA was associated with the worsening of patient-reported outcomes among those patients who did return to their preoperative sports after OWHTO. Also, participation in high-activity sports was confirmed to be a significant risk factor for a decreased rate of return to preoperative sports. These findings can support preoperative planning and intraoperative decision making, particularly for active patients.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-30T09:06:56Z
      DOI: 10.1177/23259671221118836
      Issue No: Vol. 10, No. 9 (2022)
       
  • Evaluation of Health Care Disparities in Patients With Anterior Cruciate
           Ligament Injury: Does Race and Insurance Matter'

    • Authors: Lutul D. Farrow, Michael J. Scarcella, Christa L. Wentt, Morgan H. Jones, Kurt P. Spindler, Isaac Briskin, Brian M. Leo, Brett W. McCoy, Anthony A. Miniaci, Richard D. Parker, James T. Rosneck, Frank M. Sabo, Paul M. Saluan, Alfred Serna, Kim L. Stearns, Gregory J. Strnad, James S. Williams
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:It is unknown whether race- or insurance-based disparities in health care exist regarding baseline knee pain, knee function, complete meniscal tear, or articular cartilage damage in patients who undergo anterior cruciate ligament reconstruction (ACLR).Hypothesis:Black patients and patients with Medicaid evaluated for ACLR would have worse baseline knee pain, worse knee function, and greater odds of having a complete meniscal tear.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A cohort of patients (N = 1463; 81% White, 14% Black, 5% Other race; median age, 22 years) who underwent ACLR between February 2015 and December 2018 was selected from an institutional database. Patients who underwent concomitant procedures and patients of undisclosed race or self-pay status were excluded. The associations of race with preoperative Knee injury and Osteoarthritis Outcome Score (KOOS) Pain subscale, KOOS Function subscale, and intraoperatively assessed complete meniscal tear (tear that extended through both the superior and the inferior meniscal surfaces) were determined via multivariate modeling with adjustment for age, sex, insurance status, years of education, smoking status, body mass index (BMI), meniscal tear location, and Veterans RAND 12-Item Health Survey Mental Component Score (VR-12 MCS).Results:The 3 factors most strongly associated with worse KOOS Pain and KOOS Function were lower VR-12 MCS score, increased BMI, and increased age. Except for age, the other two factors had an unequal distribution between Black and White patients. Univariate analysis demonstrated equal baseline median KOOS Pain scores (Black, 72.2; White, 72.2) and KOOS Function scores (Black, 68.2; White, 68.2). After adjusting for confounding variables, there was no significant difference between Black and White patients in KOOS Pain, KOOS Function, or complete meniscal tears. Insurance status was not a significant predictor of KOOS Pain, KOOS Function, or complete meniscal tear.Conclusion:There were clinically significant differences between Black and White patients evaluated for ACLR. After accounting for confounding factors, no difference was observed between Black and White patients in knee pain, knee function, or complete meniscal tear. Insurance was not a clinically significant predictor of knee pain, knee function, or complete meniscal tear.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-30T09:00:26Z
      DOI: 10.1177/23259671221117486
      Issue No: Vol. 10, No. 9 (2022)
       
  • Is Prior Hip Arthroscopy Associated With Higher Complication Rates or
           Prolonged Opioid Claims After Total Hip Arthroplasty' A Matched Cohort
           Study

    • Authors: Bailey J. Ross, Ryan J. Wortman, Olivia C. Lee, Alfred A. Mansour, Wendell W. Cole, William F. Sherman
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Hip arthroscopy (HA) procedures have increased exponentially in recent years. Their effect on outcomes after subsequent total hip arthroplasty (THA) remains unclear.Purpose:To compare rates of complications and opioid claims after elective THA among patients with prior HA versus controls.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who underwent THA were identified in the PearlDiver database. Arthroplasty performed for hip fractures and hip avascular necrosis were excluded. Within this population, patients with HA before arthroplasty (n = 3156) were propensity score matched 1:1 with controls on age, sex, US region, and several comorbidities. Rates of medical complications within 90 days and prosthesis-related complications within 2 years were queried. The number of patients with an opioid claim within 0 to 30 days and subsequent opioid claim(s) during the 90-day global period were obtained to assess rates of prolonged opioid use after arthroplasty. Rates of postoperative complications and opioid claims were compared using logistic regression.Results:Patients with prior HA exhibited significantly lower rates of readmission (5.6% vs 7.3%; odds ratio [OR], 0.72), pulmonary embolism (0.2% vs 0.6%; OR, 0.45), urinary tract infection (3.1% vs 4.0%; OR, 0.75), and blood transfusion (3.6% vs 6.1%; OR, 0.55). The prior HA cohort also exhibited a significantly lower rate of prosthetic joint infection at 1 year postoperatively (0.6% vs 1.3%; OR, 0.50). Rates of dislocation, periprosthetic fracture, mechanical complications, and aseptic revision arthroplasty were statistically comparable between the cohorts within 2 years. The prior HA cohort was significantly less likely to file persistent opioid claims after 30 days postoperatively, including between 31 and 60 days (27.2% vs 33.1%; OR, 0.74) and 61 to 90 days (16.2% vs 20.9%; OR, 0.71).Conclusion:After elective THA, patients with prior HA exhibited significantly lower rates of medical complications and prolonged opioid claims within 90 days and prosthetic joint infection at 1 year. Rates of all other prosthesis-related complications within 2 years were statistically comparable.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-30T08:48:23Z
      DOI: 10.1177/23259671221126508
      Issue No: Vol. 10, No. 9 (2022)
       
  • Do the General Public and Health Care Professionals Think That Running Is
           Bad for the Knees' A Cross-sectional International Multilanguage
           Online Survey

    • Authors: Jean-Francois Esculier, Manuela Besomi, Danilo de Oliveira Silva, Samuele Passigli, Michael Skovdal Rathleff, Marienke Van Middelkoop, Christian Barton, Michael J. Callaghan, Matthew S. Harkey, Alison M. Hoens, Natasha M. Krowchuk, Anthony Teoli, Bill Vicenzino, Richard W. Willy, Michael A. Hunt
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Running is a popular sport with widely recognized health benefits. Given the high rates of knee injury in runners and the growing prevalence of knee osteoarthritis (KOA), it may be useful to assess perceptions about running and knee joint health.Purpose:The objectives of this study were to (1) explore and compare the perceptions of the general public (PUB) and health care professionals (HCPs) on the topic of running and knee health and (2) explore recommendations about running and knee health provided by HCPs.Study Design:Cross-sectional study.Methods:We conducted an online survey between June 18 and October 1, 2020. The questionnaire included questions on running and knee health, and HCPs were asked about their typical recommendations and level of confidence in providing recommendations on the topic. Perceptions (proportions) were compared between the PUB and HCPs using the chi-square test.Results:In total, 4521 responses (PUB, n = 2514; HCPs, n = 2007) were analyzed. A greater proportion of HCPs perceived regular running as healthy for knees (86% vs 68%; P < .001). More of the PUB than HCPs (P < .001) believed that running frequently (29% vs 13%), long distances (54% vs 45%), and on hard surfaces (60% vs 36%) increased the risk of developing KOA. Running for those with KOA was perceived by the PUB as posing an increased risk of getting more knee pain (48%) and needing joint replacement surgery (38%), more so than by HCPs (26% and 17%, respectively). The majority of HCPs reported being relatively confident in providing evidence-based recommendations about running and knee health and mostly recommended that runners with KOA modify training parameters instead of quit.Conclusion:More HCPs perceived running as healthy for knees when compared with the PUB. Most HCPs felt confident in providing evidence-based recommendations about running and knee health.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-30T06:52:35Z
      DOI: 10.1177/23259671221124141
      Issue No: Vol. 10, No. 9 (2022)
       
  • Extent of Cam Resection Relative to Epiphyseal Line and Its Association
           With Clinical Outcomes After Arthroscopic Treatment for Femoroacetabular
           Syndrome

    • Authors: Fan Yang, Hong-Jie Huang, Zi-Yi He, Yan Xu, Xin Zhang, Jian-Quan Wang
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Inadequate resection of cam lesions can cause inferior outcomes after hip arthroscopy and result in revision surgery for femoroacetabular impingement syndrome (FAIS).Purpose:To evaluate the association between postoperative cam lesions measured using the proximal boundaries of resection area (PBRE) relative to the epiphyseal line and 2-year outcomes after hip arthroscopy.Study Design:Cohort study; Level of evidence, 3.Methods:Included were patients with FAIS who had undergone primary hip arthroscopy between 2016 and 2018. The PBRE was calculated by measuring the linear distance from the PBRE to the epiphyseal line, dividing it by the diameter of the femoral head, and multiplying by 100; PBRE measurements were made at the 12-, 1-, and 2-o’clock positions on postoperative hip computed tomography. Within each clockface position, patients were divided into subgroups depending on whether their postoperative PBRE was greater than a half standard deviation above the mean (adequate resection) or less than or equal to a half standard deviation above the mean (inadequate resection). Patient-reported outcomes (PROs; Hip Outcome Score–Activities of Daily Living [HOS-ADL], International Hip Outcome Tool–Short Form [iHOT-12], modified Harris Hip Score [mHHS], and pain visual analog scale [VAS]) and rates of achieving the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) were compared among the subgroups.Results:Included were 80 pairs of hips at 12 o’clock, 81 pairs of hips at 1 o’clock, and 80 pairs of hips at 2 o’clock. All subgroups demonstrated significant improvements in PRO scores at a minimum 2-year follow-up compared with preoperatively. At the 12-o’clock position, the subgroup with adequate resection had significantly superior HOS-ADL (P = .004), iHOT-12 (P < .001), and mHHS (P < .001) scores and were more likely to achieve the MCID for the iHOT-12 score (P = .035) and the PASS for the HOS-ADL (P = .003), iHOT-12 (P = .007), and mHHS (P < .001) scores compared with the matched subgroup. There were no significant differences in PRO scores or rates of MCID and PASS for the 1- or 2-o’clock groups.Conclusion:The epiphyseal line may be a useful and reproducible landmark measurement for cam-type deformity. Patients considered to have inadequate resection at 12 o’clock had lower outcome scores at a minimum 2-year follow-up.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-29T10:12:17Z
      DOI: 10.1177/23259671221125509
      Issue No: Vol. 10, No. 9 (2022)
       
  • The 50 Most Cited Articles in Knee Medial Collateral Ligament Injury
           Research

    • Authors: Dylan Luxenburg, Henson Destine, Michael G. Rizzo, David Constantinescu, Miriyam Ghali, Lee D. Kaplan, Michael G. Baraga
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Medial collateral ligament (MCL) injury is a common orthopaedic knee injury with a plethora of published articles regarding evaluation, treatment, and outcome.Purpose:To perform a comprehensive bibliometric analysis of the 50 most cited articles in MCL research.Study Design:Cross-sectional study.Methods:We performed a keyword search of the Institute for Scientific Information’s Web of Knowledge database for the identification of articles published before September 2021 encompassing the MCL. The conducted search yielded 9534 articles. The results were then filtered using predetermined guidelines and criteria, and the 50 most cited articles were selected for analysis. Extracted data included title, authors, citation count, year of publication, topic, journal, article type, country of origin, and level of evidence.Results:The selected 50 articles ranged from 1976 to 2013. The largest proportion was classified as having level 4 evidence (n = 12; 24%). The majority of the articles were published in the decade from 2000 to 2009 (n = 17; 34%), followed by 1990 to 1999 (n = 16; 32%). The mean raw citation score per article was 133 (range, 74-422). The most popular topic discussed was surgical technique and outcome (n = 14; 28%), followed by anatomy and biomechanics (n = 13; 26%).Conclusion:This study provides a comprehensive and objective measure of the most cited articles on MCL research. Knowledge of the characteristics of these most influential articles improves the understanding of MCL injury and can guide discussion for future research.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-29T09:32:06Z
      DOI: 10.1177/23259671221124575
      Issue No: Vol. 10, No. 9 (2022)
       
  • No Difference in Knee Kinematics Between Anterior Cruciate
           Ligament–First and Posterior Cruciate Ligament–First Fixation During
           Single-Stage Multiligament Knee Reconstruction: A Biomechanical Study

    • Authors: Aly M. Fayed, Ryo Kanto, Taylor M. Price, Michael DiNenna, Monica A. Linde, Patrick Smolinski, Carola van Eck
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:For combined reconstruction of both the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), there is no consensus regarding which graft should be tensioned and fixed first.Purpose:The purpose of this study was to determine which sequence of graft tensioning and fixation better restores normal knee kinematics. The hypothesis was that ACL-first fixation would more closely restore normal knee kinematics, graft force, and the tibiofemoral orientation in the neutral (resting) position compared with PCL-first fixation.Study Design:Controlled laboratory study.Methods:A total of 15 unpaired human cadaveric knees were examined using a robotic testing system under the following 4 conditions: (1) 89.0-N anterior tibial load at different knee angles; (2) 89.0-N posterior tibial load at different knee angles; (3) combined rotational 7.0-N·m valgus and 5.0-N·m internal rotation load (simulated pivot shift) at 0°, 15°, and 30° of flexion; and (4) 5.0-N·m external rotation load at 0°, 15°, and 30° of flexion. The 4 evaluated knee states were (1) intact ACL and PCL (intact), (2) ACL and PCL deficient (deficient), (3) combined anatomic ACL-PCL reconstruction fixing the ACL first (ACL-first), and (4) combined anatomic ACL-PCL reconstruction fixing the PCL first (PCL-first). A 9.0 mm–diameter quadriceps tendon autograft was used for the ACL graft, tensioned with 40.0 N at 30° of flexion. A 9.5 mm–diameter hamstring tendon autograft (gracilis and semitendinosus, quadrupled loop, and augmented with an additional allograft strand if needed), tensioned with 40.0 N at 90° of flexion, was used for the PCL graft.Results:There were no statistically significant differences between ACL-first and PCL-first fixation regarding knee kinematics. ACL-first fixation restored anterior tibial translation to the intact state at all tested knee angles, while PCL-first fixation showed higher anterior tibial translation than the intact state at 90° of flexion (9.05 ± 3.05 and 5.87 ± 2.40 mm, respectively; P = .018). Neither sequence restored posterior tibial translation to the intact state at 30°, 60°, and 90° of flexion. At 15° of flexion, PCL-first fixation restored posterior tibial translation to the intact state, whereas ACL-first fixation did not.Conclusion:There were no differences in knee laxity between ACL-first and PCL-first fixation with the ACL graft fixed at 30° and the PCL graft fixed at 90°.Clinical Relevance:This study showed that there was no evidence to support the use of one tensioning sequence over the other in single-stage multiligament knee reconstruction.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-28T11:01:02Z
      DOI: 10.1177/23259671221118587
      Issue No: Vol. 10, No. 9 (2022)
       
  • Outcomes of Arthroscopic Lysis of Adhesions for the Treatment of
           Postoperative Knee Arthrofibrosis: A Systematic Review

    • Authors: Nathan Fackler, Garwin Chin, Theofilos Karasavvidis, Hunter Bohlen, Eric Smith, Arya Amirhekmat, Dean Wang
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Postoperative knee arthrofibrosis is a common and potentially detrimental complication affecting knee function and gait. Several cohort studies have reported good outcomes after arthroscopic lysis of adhesions (LOA) with manipulation under anesthesia (MUA).Purpose:To review the literature assessing the efficacy and complications of arthroscopic LOA and MUA for postoperative arthrofibrosis of the knee and evaluate whether any relevant subgroups are associated with different clinical presentation and outcomes.Study Design:Systematic review; Level of evidence, 4.Methods:This review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Eligible studies published from January 1, 1990, to April 1, 2021, were identified through a search of the US National Library of Medicine (PubMed/MEDLINE), EMBASE, and Cochrane databases. All studies included in this analysis included pre- and postoperative range of motion measurements for their treated patients. Studies reporting outcomes for patients with isolated cyclops lesions after anterior cruciate ligament reconstruction were excluded.Results:Eight studies comprising 240 patients were included. The mean time from index surgery to arthroscopic LOA and MUA was 8.4 months, and the mean postoperative follow-up was at 31.2 months. All studies demonstrated a significant improvement (41.6°) in arc of motion after arthroscopic LOA. Clinically significant improvements in outcome measures, including the International Knee Documentation Committee, Western Ontario and McMaster Universities Osteoarthritis Index, and Knee injury and Osteoarthritis Outcome Score, were reported after arthroscopic LOA across all applicable studies. Of 240 patients, a single complication (synovial fistula) occurred after LOA and MUA, which resolved without intervention.Conclusion:The results of this review indicated that arthroscopic LOA and MUA is a safe and efficacious treatment for postoperative arthrofibrosis of the knee.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-28T10:49:56Z
      DOI: 10.1177/23259671221124911
      Issue No: Vol. 10, No. 9 (2022)
       
  • Effect of 3-Dimensional Versus Single-Plane Changes in Pelvic Dynamics on
           Range of Motion in Hips With Femoroacetabular Impingement: A Computer
           Simulation Analysis

    • Authors: Hideki Honda, Naomi Kobayashi, Emi Kamono, Yohei Yukizawa, Shota Higashihira, Shu Takagawa, Hyonmin Choe, Hiroyuki Ike, Taro Tezuka, Yutaka Inaba
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Femoroacetabular impingement (FAI) is primarily caused by bony impingement between the acetabulum and femoral neck during hip motion. Increasing posterior pelvic tilt improves hip range of motion in patients with FAI.Purpose:To use computer simulation analysis to compare the effects of 3-dimensional (3D) changes in pelvic tilt (sagittal tilt [St], axial rotation, and coronal tilt) with changes in a single plane (St), with the aim of improving range of motion in patients with FAI.Study Design:Controlled laboratory study.Methods:We evaluated 43 patients with FAI treated by arthroscopic cam resection. A 3D simulation was used to construct the following pelvic models: a 5° and 10° increase posteriorly in St (St5° and St10°) and a combined 5° change in St, axial rotation, and coronal tilt (Complex5°) from the baseline of the anterior pelvic plane. Improvements in maximum internal rotation (MIR) at 45°, 70°, and 90° of hip flexion and improvements in maximum flexion with no internal rotation were compared among the St5°, St10°, and Complex5° models. The pelvic models of each single-plane change of 5° and 10° were evaluated in the same simulation.Results:At 90° and 70°, there was a significant difference between the Complex5° and St10° models with respect to improvement in MIR (P = .004 at 90° of flexion; P = .017 at 70° of flexion). There was no significant difference in MIR at 45° of flexion (P = .71) or in maximum flexion (P = .42).Conclusion:At 70° and 90° of hip flexion, a combined change in 3D pelvic alignment of 5° (ie, St, axial rotation, and coronal tilt) was more effective in improving hip MIR than a 10° change in St only.Clinical Relevance:Effective physical therapy for FAI should address pelvic motion in all 3 planes rather than in a single plane.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-28T10:34:17Z
      DOI: 10.1177/23259671221123604
      Issue No: Vol. 10, No. 9 (2022)
       
  • Superior Bone Microarchitecture in Anatomic Versus Nonanatomic Fibular
           

    • Authors: Julian Stürznickel, Felix N. Schmidt, Conradin Schweizer, Herbert Mushumba, Matthias Krause, Klaus Püschel, Tim Rolvien
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Several fibula-based reconstruction techniques have been introduced to address ligamentous injuries of the posterolateral corner of the knee. These techniques involve a drill tunnel with auto- or allograft placement through the proximal fibula.Purpose:To determine the skeletal microarchitecture of the proximal fibula and its association with age and to compare the microarchitecture within the regions of different drill tunnel techniques for reconstruction of the posterolateral corner.Study Design:Descriptive laboratory study.Methods:A total of 30 human fibulae were analyzed in this cadaveric imaging study. High-resolution peripheral quantitative computed tomography measurements were performed in a 4.5 cm–long volume of interest at the proximal fibula. Three-dimensional microarchitectural data sets of cortical and trabecular compartments were evaluated using customized scripts. The quadrants representing the entry and exit drill tunnel positions corresponding to anatomic techniques (LaPrade/Arciero) and the Larson technique were analyzed. Linear regression models and group comparisons were applied.Results:Trabecular microarchitecture parameters declined significantly with age in women but not men. Analysis of subregions with respect to height revealed stable cortical and decreasing trabecular values from proximal to distal in both sexes. Along with a structural variability in axial slices, superior values were found for the densitometric and microarchitectural parameters corresponding to the fibular drill tunnels in the anatomic versus Larson technique (mean ± SD; bone volume to tissue volume at the entry position, 0.273 ± 0.079 vs 0.175 ± 0.063; P < .0001; cortical thickness at the entry position, 0.501 ± 0.138 vs 0.353 ± 0.081 mm; P < .0001).Conclusion:Age represented a relevant risk factor for impaired skeletal microarchitecture in the proximal fibula in women but not men. The region of drill tunnels according to anatomic techniques showed superior bone microarchitecture versus that according to the Larson technique.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-28T10:19:17Z
      DOI: 10.1177/23259671221126475
      Issue No: Vol. 10, No. 9 (2022)
       
  • The Role of the Trapezius in Stabilization of the Acromioclavicular Joint:
           A Biomechanical Evaluation

    • Authors: Maxwell T. Trudeau, Jonathan J. Peters, Benjamin C. Hawthorne, Ian J. Wellington, Matthew R. LeVasseur, Michael R. Mancini, Elifho Obopilwe, Giovanni Di Giacomo, Simone Cerciello, Augustus D. Mazzocca
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Acromioclavicular joint (ACJ) injuries are common, and many are adequately treated nonoperatively. Biomechanical studies have mainly focused on static ligamentous stabilizers. Few studies have quantified ACJ stabilization provided by the trapezius.Purpose/Hypothesis:To elucidate the stabilization provided by the trapezius to the ACJ during scapular internal and external rotation (protraction and retraction). It was hypothesized that sequential trapezial resection would result in increasing ACJ instability.Study Design:Controlled laboratory study.Methods:A biomechanical approach was pursued, with 10 cadaveric shoulders with the trapezius anatomically force loaded to normal. The trapezius was then serially transected over 8 trials, which alternated between clavicular defects (CD) and scapular defects (SD); each sequential defect consisted of 25% of the clavicular or scapular trapezial attachment. After each defect, specimens were tested with angle-controlled scapular internal and external rotation (12°) with rotary torque measurements to evaluate ACJ stability.Results:The mean resistance in rotary torque for 12° of scapular internal rotation (protraction) with native specimens was 7.0 ± 2.0 N·m. Overall, internal rotation demonstrated a significant decrease in ACJ stability with trapezial injury (P < .001). Eight sequential defects resulted in the following significant percentage decreases in rotary torque from native internal rotation: 1.5% (25% CD; 0% SD), 5.6% (25% CD; 25% SD), 5.1% (50% CD; 25% SD), 6.5% (50% CD; 50% SD), 3.8% (75% CD; 50% SD), 7.1% (75% CD; 75% SD), 6.7% (100% CD; 75% SD), and 12.3% (100% CD 100% SD) (P < .001). The mean resistance in rotary torque for 12° of scapular external rotation (retraction) with native specimens was 7.1 ± 1.7 N·m. External rotation did not demonstrate a significant decrease in ACJ stability with trapezial injury (P = .596). The 8 sequential defects resulted in decreases in rotary torque from native external rotation of 0%, 3.8%, 4.0%, 3.2%, 3.5%, 3.4%, 4.2%, and 0.7%.Conclusion:Trapezial injury resulted in increased instability in the setting of scapular internal rotation (protraction) of the ACJ.Clinical Relevance:These findings validate the inclusion of deltotrapezial fascial injury consideration in the modified Rockwood classification system. Repair of the trapezial insertion on the ACJ may provide improved outcomes in the setting of ACJ reconstruction.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-26T07:40:52Z
      DOI: 10.1177/23259671221118943
      Issue No: Vol. 10, No. 9 (2022)
       
  • Predictors Using Machine Learning of Complete Peroneal Nerve Palsy
           Recovery After Multiligamentous Knee Injury: A Multicenter Retrospective
           Cohort Study

    • Authors: Kinjal Vasavada, Dhruv S. Shankar, Andrew S. Bi, Jay Moran, Massimo Petrera, Joseph Kahan, Erin F. Alaia, Michael J. Medvecky, Michael J. Alaia
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Peroneal nerve (PN) palsy is one of the most debilitating sequelae of multiligamentous knee injuries (MLKIs). There is limited research on recovery from complete PN palsy.Purpose/Hypothesis:The purpose of this study was to characterize PN injuries and develop a predictive model of complete PN recovery after MLKI using machine learning. It was hypothesized that elevated body mass index (BMI) would be predictive of lower likelihood of recovery.Study Design:Case-control study; Level of evidence, 3.Methods:The authors conducted a retrospective review of patients seen at 2 urban hospital systems for treatment of MLKI with associated complete PN palsy, defined as the presence of complete foot drop with or without sensory deficits on physical examination. Recovery was defined as the complete resolution of foot drop. A random forest (RF) classifier algorithm was used to identify demographic, injury, treatment, and postoperative variables that were significant predictors of recovery from complete PN palsy. Validity of the RF model was assessed using overall accuracy, F1 score, and area under the receiver operating characteristic curve (AUC).Results:Overall, 16 patients with MLKI with associated complete PN palsy were included in the cohort. Among them, 75% (12/16) had documented knee dislocation requiring reduction. Complete recovery occurred in 4 patients (25%). Nerve contusions on magnetic resonance imaging were more common among patients without PN recovery, but there were no other significant differences between recovery and nonrecovery groups. The RF model found that older age, increasing BMI, and male sex were predictive of worse likelihood of PN recovery. The model was found to have good validity, with a classification accuracy of 75%, F1 score of 0.86, and AUC of 0.64.Conclusion:The RF model in this study found that increasing age, BMI, and male sex were predictive of decreased likelihood of nerve recovery. While further study of machine learning models with larger patient data sets is required to identify the most superior model, these findings present an opportunity for orthopaedic surgeons to better identify, counsel, and treat patients with MLKIs and concomitant complete PN palsy.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-22T12:11:43Z
      DOI: 10.1177/23259671221121410
      Issue No: Vol. 10, No. 9 (2022)
       
  • Female Athlete Triad Risk Factors Are More Strongly Associated With
           Trabecular-Rich Versus Cortical-Rich Bone Stress Injuries in Collegiate
           Athletes

    • Authors: Adam S. Tenforde, Nicole B. Katz, Kristin L. Sainani, Jennifer L. Carlson, Neville H. Golden, Michael Fredericson
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Bone stress injuries (BSIs) are common in athletes. Risk factors for BSI may differ by skeletal anatomy and relative contribution of trabecular-rich and cortical-rich bone.Hypothesis:We hypothesized that Female Athlete Triad (Triad) risk factors would be more strongly associated with BSIs sustained at trabecular-rich versus cortical-rich skeletal sites.Study Design:Cohort study; Level of evidence, 2.Methods:The study population comprised 321 female National Collegiate Athletic Association Division I athletes participating in 16 sports from 2008 to 2014. Triad risk factors and a Triad cumulative risk score were assessed using responses to preparticipation examination and dual energy x-ray absorptiometry to measure lumbar spine and whole-body bone mineral density (BMD). Sports-related BSIs were diagnosed by a physician and confirmed radiologically. Athletes were grouped into those sustaining a subsequent trabecular-rich BSI, a subsequent cortical-rich BSI, and those without a BSI. Data were analyzed with multinomial logistic regression adjusted for participation in cross-country running versus other sports.Results:A total of 19 participants sustained a cortical-rich BSI (6%) and 10 sustained a trabecular-rich BSI (3%) over the course of collegiate sports participation. The Triad cumulative risk score was significantly related to both trabecular-rich and cortical-rich BSI. However, lower BMD and weight were associated with significantly greater risk for trabecular-rich than cortical-rich BSIs. For every value lower than 1 SD, the odds ratios (95% CIs) for trabecular-rich versus cortical-rich BSI were 3.08 (1.25-7.56) for spine BMD; 2.38 (1.22-4.64) for whole-body BMD; and 5.26 (1.48-18.70) for weight. Taller height was a significantly better predictor of cortical-rich than trabecular-rich BSI.Conclusion:The Triad cumulative risk score was significantly associated with both trabecular-rich and cortical-rich BSI, but Triad-related risk factors appeared more strongly related to trabecular-rich BSI. In particular, low BMD and low weight were associated with significantly higher increases in the risk of trabecular-rich BSI than cortical-rich BSI. These findings suggest Triad risk factors are more common in athletes sustaining BSI in trabecular-rich than cortical-rich locations.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-21T05:35:21Z
      DOI: 10.1177/23259671221123588
      Issue No: Vol. 10, No. 9 (2022)
       
  • Qualitative and Quantitative Anatomy of the Humeral Attachment of the
           Pectoralis Major Muscle and Structures at Risk: A Cadaveric Study

    • Authors: Phob Ganokroj, Kaare Midtgaard, Bryant P. Elrick, Rony-Orijit Dey Hazra, Brenton W. Douglass, Philip C. Nolte, Annalise M. Peebles, Brad W. Fossum, Justin R. Brown, Peter J. Millett, Matthew T. Provencher
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Surgical pectoralis major (PM) repair can offer improved functional outcomes over nonoperative treatment. However, there is a lack of literature on consensus of the anatomical site of the humeral attachment.Purpose:To provide qualitative and quantitative anatomic analysis of the PM by focusing on humeral insertion and relevant structures at risk.Study Design:Descriptive laboratory study.Methods:Eight fresh-frozen male cadavers were dissected. The relevant landmarks that were collected and measured included (1) PM footprint length at the humeral insertion (total, sternal head, and clavicular head insertions); (2) PM tendon length from the humeral insertion to the musculotendinous junction; (3) distance from the PM humeral insertion to the lateral (LPN) and medial (MPN) pectoral nerves; and (4) distance from the coracoid process to the musculocutaneous nerve (MCN) in anatomical position.Results:The total PM footprint length was 81.4 mm (95% CI, 71.4-91.3). The sternal and clavicular heads that make up the PM had footprint lengths of 42.1 mm (95% CI, 32.9-51.4) and 56.6 mm (95% CI, 46.5-66.7), respectively. The PM tendon was wider at the clavicular head (74.7 mm; 95% CI, 67.5-81.7) than the sternal head insertions (43.0 mm; 95% CI, 40.1-45.9). The distances from the PM humeral insertion to LPN and MPN were 93.2 mm (95% CI, 83.1-103.3) and 103.8 mm (95% CI, 98.3-109.4), respectively. The coracoid process to MCN distance was 68.5 mm (95% CI, 60.2-76.8).Conclusion:This study successfully quantifies anatomic dimensions of the PM tendon, its sternal and clavicular head insertions, and its location relative to nearby vital structures. Such knowledge can provide surgeons with a better understanding of the PM in relation to nearby neurovascular structures during anatomic PM repair and reconstruction to avoid debilitating complications.Clinical Relevance:Knowledge of the quantitative anatomy of the PM at the humeral footprint along structures at risk may aid surgeons with identifying the injured part of the PM and improve outcomes for anatomic repair and reconstruction.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-21T05:28:52Z
      DOI: 10.1177/23259671221121333
      Issue No: Vol. 10, No. 9 (2022)
       
  • Does Complete Footprint Coverage Affect Outcomes After Conventional
           Arthroscopic Repair of Large-Sized Rotator Cuff Tears'

    • Authors: Eun Taek Jeong, Dong Ryun Lee, Jihwan Lee, Jongwon Lee, Taewoo Lho, Seok Won Chung
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:In large-sized rotator cuff tears, tendon repair with incomplete footprint coverage is performed frequently as a way of tension-free or low-tension repair.Purpose:To compare clinical outcomes after arthroscopic repair of large-sized rotator cuff tears between patients with complete versus incomplete footprint coverage.Study Design:Cohort study; Level of evidence, 3.Methods:Among 297 patients who underwent arthroscopic surgery for a large-sized rotator cuff tear, we selected 58 patients ( .05 for all).Conclusion:Whether the rotator cuff footprint was completely covered did not affect clinical outcomes in conventional arthroscopic repair of large-sized rotator cuff tears.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-21T05:13:56Z
      DOI: 10.1177/23259671221120598
      Issue No: Vol. 10, No. 9 (2022)
       
  • Effect of Soft Tissue Interposition and Postoperative Suspensory Cortical
           Button Migration on Functional Outcomes and Ligamentization After
           Single-Bundle ACL Reconstruction

    • Authors: Emre Anıl Özbek, Hakan Kocaoğlu, Mustafa Onur Karaca, Mustafa Mert Terzi, Merve Dursun, Ramazan Akmeşe
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Soft tissue interposition between a suspensory cortical button and the lateral femoral condyle is the most common cause of postoperative suspensory cortical button migration in patients undergoing anterior cruciate ligament reconstruction (ACLR).Purpose:To investigate the effects of soft tissue interposition and suspensory cortical button migration after ACLR on functional outcomes and graft ligamentization.Study Design:Cohort study; Level of evidence, 3.Methods:Included were 249 patients who underwent single-bundle ACLR with hamstring tendon autografts. To measure soft tissue imposition, the patients were divided into 2 groups: those in whom the suspensory cortical button was in contact with (group 1) or at least 1 mm away from (group 2) the lateral femoral condyle on 1-day postoperative radiographs. To measure suspensory cortical button migration, the patients in group 2 were further divided into 2 subgroups: those with button migration (group M) and those without migration (group non-M) as observed on 12-month postoperative radiographs. Ligamentization was evaluated according to Howell classification (grades 1-4) on 12-month follow-up magnetic resonance imaging scans. Also recorded were preoperative and 24-month postoperative Lysholm and Tegner scores and 24-month postoperative arthrometer measurements for anterior knee laxity.Results:There was no significant difference between groups 1 and 2 or between groups M and non-M in terms of demographic characteristics or additional intra-articular pathologies detected intraoperatively. Normal anterior laxity (
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-19T07:21:26Z
      DOI: 10.1177/23259671221122748
      Issue No: Vol. 10, No. 9 (2022)
       
  • Intra-articular Hip Injuries in National Basketball Association Players: A
           Descriptive Epidemiological Study

    • Authors: Anthony C. Egger, Anas Minkara, Richard Parker, James Rosneck
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Since the most recent epidemiologic study of injuries in National Basketball Association (NBA) players was completed in 2012, the understanding and diagnosis of intra-articular hip injury has advanced.Purpose:To report the epidemiology of intra- versus extra-articular hip injuries in NBA players with regard to missed games, risk factors for injury, and treatment types.Study Design:Cohort study; Level of evidence, 3.Methods:The NBA injury database was queried for all reported hip and groin injuries from 2013 to 2017. The injuries were then divided into intra-articular and extra-articular types. Variables compared between injury types included player age, NBA tenure, season schedule (preseason or offseason), onset type, injury mechanism, roster position, games missed, time to return to play, and need for surgery.Results:A total of 224 athletes sustaining 353 total hip pathologies were identified. Of these injuries, 216 (61.2%) were sustained during game competition and affected 156 (69.6%) of the athletes. Intra-articular injuries represented 39 (11.0%) cases and involved 36 (16.1%) players. The time to return to play was significantly longer after intra-articular versus extra-articular injury (44.6 ± 96.0 vs 11.8 ± 32.0 days; P = .03), and the number of games missed was significantly greater after intra-articular versus extra-articular injury (8.0 ± 18.7 vs 1.54 ± 4.9 games; P = .03). Patients with intra-articular hip injuries were more likely to undergo surgery (odds ratio, 5.5 [95% CI, 1.8-16.7]; P = .005). There was no statistically significant difference in the number of games missed due to surgery (35.2 ± 8.3 [intra-articular] vs 35.4 ± 11.6 [extra-articular]; P = .42) or nonoperative treatment (4.2 ± 3.4 [intra-articular] vs 1.3 ± 0.5 [extra-articular]; P = .11). Years of NBA tenure were not significantly different between intra-articular and extra-articular injuries (7.1 ± 3.7 vs 6.3 ± 4.0 years). For both types of hip injury, there was no correlation between player age and either days to return to play or number of games missed (R 2 = 0.014).Conclusion:NBA players with intra-articular hip injuries underwent surgery more frequently and had a longer return-to-play time compared with those with extra-articular hip injuries. NBA tenure and player age were not correlated with the risk of developing hip injury or the need for surgery.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-19T07:09:27Z
      DOI: 10.1177/23259671221122744
      Issue No: Vol. 10, No. 9 (2022)
       
  • Association of Preexisting Mental Health Conditions With Increased Initial
           Symptom Count and Severity Score on SCAT5 When Assessing Concussion

    • Authors: Kathryn J. Schulze, Michael Robinson, Heather M. MacKenzie, James P. Dickey
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Mental health conditions, such as depression, anxiety, and learning disabilities, are associated with symptoms that can overlap with those seen in persons with concussion. While concussion screening tools such as the Sport Concussion Assessment Tool–5th Edition (SCAT5) quantify the number of symptoms and symptom severity, it is not known whether these outcomes differ among individuals with concurrent mental health conditions compared with those without them.Purpose:To determine whether, during initial concussion assessment, individuals with a self-reported mental health condition have a significantly different number of self-reported concussion symptoms or symptom severity compared with those without a self-reported mental health condition (controls).Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective chart review was performed on consecutive patients aged ≥13 years who underwent post-concussion assessment at the Fowler Kennedy Sport Medicine Clinic between May 2018 and March 2020 (N = 765). Most participants did not self-report a mental health condition (n = 606; 79.2%). Participants with a self-reported mental health condition (n = 159) were classified as having a learning disability (n = 14; 8.8%), anxiety (n = 62; 39.0%), depression (n = 20; 12.6%), or multiple conditions (≥2 conditions: n = 63; 39.6%). Each participant with a mental health condition was matched with 2 control participants (overall pool, n = 318) based on age, sex, student status, and sport-related risk. Mann-Whitney U tests were used to determine the statistical significance of differences between each subgroup and their matched controls for the self-reported number of concussion symptoms and symptom severity as measured using the SCAT5.Results:The anxiety and multiple-conditions subgroups had a significantly greater number of reported symptoms than their corresponding control subgroups (median, 17 vs 15 [P = .004] and 18 vs 14.5 [P < .001], respectively). Additionally, the SCAT5 symptom severity score was significantly greater in the anxiety and multiple-conditions subgroups than their corresponding controls (median, 49 vs 34.5 [P = .018] and 62 vs 32 [P < .001], respectively).Conclusion:During initial concussion assessment, both the number of concussion-related symptoms and the symptom severity were greater in study participants with anxiety and multiple mental health conditions than participants without these conditions.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-19T06:29:55Z
      DOI: 10.1177/23259671221123581
      Issue No: Vol. 10, No. 9 (2022)
       
  • Prospective Assessment of Clinical Tests Used to Evaluate Tibial Stress
           Fracture

    • Authors: Michael D. Rosenthal, Mitchell J. Rauh, James E. Cowan
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Tibial stress fracture (SFx) is the most common SFx of the lower extremity. Presently, diagnostic accuracy of clinical examination techniques for tibial SFx remains suboptimal.Purpose:To assess the diagnostic effectiveness of 5 clinical tests for tibial SFx individually versus a test item cluster.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:A total of 50 patients with tibial pain (17 with bilateral symptoms) were assessed with 5 clinical examination tests (tibial fulcrum test, focal tenderness to palpation, heel percussion test, therapeutic ultrasound test, and 128-Hz tuning fork test) before they underwent diagnostic imaging (radionuclide bone scan). The application of the clinical tests was counterbalanced to minimize the likelihood of carryover effects. Patients provided a pain rating immediately before and after the application of each clinical test.Results:The prevalence of tibial SFx among the study participants was 52.2%. High levels of specificity were produced by the therapeutic ultrasound test (93.8%), tuning fork test (90.6%), and percussion test (90.6%). The fulcrum test had moderate to high specificity (84.4%). All tests demonstrated low levels of sensitivity, with the highest levels found for focal tenderness to palpation (48.6%) and fulcrum (45.7%). The fulcrum test provided the highest positive likelihood ratio (2.93), followed by the therapeutic ultrasound test (2.30). The fulcrum test had the lowest negative likelihood ratio (0.64), with the focal tenderness to palpation and tuning fork tests having negative likelihood ratios>1.0. Combinations of these clinical tests did not improve the prediction of tibial SFx above that observed among the individual tests.Conclusion:The clinical tests evaluated were generally highly specific, but all had low sensitivity. The fulcrum test provided the highest level of diagnostic accuracy; however, it was inadequate for definitive clinical management. Combining tests did not improve the diagnostic accuracy of tibial SFx.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-16T11:30:33Z
      DOI: 10.1177/23259671221122356
      Issue No: Vol. 10, No. 9 (2022)
       
  • Platelet-Rich Plasma Versus Microfragmented Adipose Tissue for Knee
           Osteoarthritis: A Randomized Controlled Trial

    • Authors: Michael Baria, Angela Pedroza, Christopher Kaeding, Sushmitha Durgam, Robert Duerr, David Flanigan, James Borchers, Robert Magnussen
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Platelet-rich plasma (PRP) has been established as safe and effective for knee osteoarthritis (OA). Another orthobiologic therapy, microfragmented adipose tissue (MFAT), has gained attention because of its heterogeneous cell population (including mesenchymal stem cells). However, prospective comparative data on MFAT are lacking. Because of the safety, efficacy, and simplicity of PRP, new therapeutics such as MFAT should be compared directly with PRP.Purpose:To compare patient-reported outcomes of a single injection of PRP versus MFAT for knee OA.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:A total of 58 patients with symptomatic knee OA (Kellgren-Lawrence grades 1-4) were randomized to receive a single injection of either leukocyte-rich PRP or MFAT under ultrasound guidance. PRP was created by processing 156 mL of whole blood. MFAT was created by harvesting 30 mL of adipose tissue via standard lipoaspiration. Scores for the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and visual analog scale for pain with Activities of Daily Living (VAS-ADL) were recorded at baseline and at 1, 3, and 6 months after the injection. The primary outcome was the KOOS–Pain subscore at 6 months after the injection.Results:The PRP group (n = 30) had a mean volume of 5.12 ± 1.12 mL injected. This consisted of a mean platelet count of 2673.72 ± 1139.04 × 103/µL and mean leukocyte count of 25.36 ± 13.27 × 103/µL (67.81% lymphocytes, 18.66% monocytes, and 12.33% neutrophils). The MFAT group (n = 28) had a mean volume of 7.92 ± 3.87 mL injected. The mean total nucleated cell count was 3.56 ± 4.62 million/mL. In both groups, KOOS subscale and VAS-ADL scores improved from baseline, and there was no significant difference between the PRP and MFAT groups in the final KOOS–Pain subscore (80.38 ± 16.07 vs 81.61 ± 16.37, respectively; P = .67) or any other outcome score.Conclusion:A single injection of either PRP or MFAT resulted in a clinically meaningful improvement for patients with knee OA at 6 months, with no difference between treatment groups.Registration:NCT04351087 (ClinicalTrials.gov identifier).
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-16T11:04:14Z
      DOI: 10.1177/23259671221120678
      Issue No: Vol. 10, No. 9 (2022)
       
  • A Systematic Review of Acute Irreducible Shoulder Dislocations in the 21st
           Century

    • Authors: Daniel J. Liechti, Kevin H. Shepet, Julie E. Glener, Eric J. Neumann, Shafic Sraj
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Rarely, closed reduction cannot be achieved in patients with acute shoulder dislocation, necessitating open management. A paucity of literature exists regarding these cases.Purpose:To perform a systematic review on the mechanism, management, and outcome data of acute irreducible shoulder dislocations.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, PubMed, and MEDLINE between 2000 and 2020. Inclusion criteria were as follows: human participants, acute irreducible shoulder dislocation requiring open management, English language, and publication within the past 20 years. We excluded basic science articles, technique articles, reviews, editorials, and studies of chronic shoulder dislocations or dislocations with ipsilateral humeral shaft fractures.Results:Twelve articles fit the inclusion criteria and were considered for review. All studies were single case reports (level 4 evidence). Ten of the 12 studies were of male patients. The direction of dislocation included 7 anterior/anteroinferior, 2 posterior, 1 inferior, 1 bilateral inferior, and 1 superolateral. Most dislocations were irreducible owing to a mechanical block to reduction. The most common type of block was an incarcerated long head of the biceps tendon, followed by interposition of 1 of the rotator cuff tendons. The axillary and musculocutaneous nerves, displaced fracture fragments, and Hill-Sachs and bony Bankart lesions were other causes of blocks to reduction. Eleven patients were treated with open surgery, while 1 patient was treated arthroscopically. Procedures performed were dependent on concurrent pathology. Final follow-up ranged from 6 weeks to 2 years, with no repeat dislocation episodes reported. Complications after open reduction included 1 case of brachial plexopathy (posterior cord) and 1 case of musculocutaneous nerve palsy.Conclusion:There is a paucity of literature on the management of irreducible acute shoulder dislocations. The most common irreducible dislocation found in this systematic review was anterior with a mechanical block attributed to interposition of the long head of the biceps tendon. When patients were treated with an open or arthroscopic procedure, recurrence was low, with none reporting recurrent dislocation in limited follow-up.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-16T04:46:59Z
      DOI: 10.1177/23259671221121633
      Issue No: Vol. 10, No. 9 (2022)
       
  • Epidemiology With Video Analysis of Knee Injuries in the Women’s
           National Basketball Association

    • Authors: Kobi Axelrod, Neal Canastra, Nicholas J. Lemme, Edward J. Testa, Brett D. Owens
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Knee injuries are the most common type of injury seen in the Women’s National Basketball Association (WNBA). However, there are sparse epidemiologic data regarding these injuries over the past 20 years.Purpose/Hypothesis:The purpose of this study was to determine the prevalence, return to play (RTP) rate/length, and mechanism of knee injuries in the WNBA. We hypothesized that anterior cruciate ligament (ACL) tears would have the highest prevalence and longest RTP times.Study Design:Descriptive epidemiology study.Methods:Publicly available WNBA injury reports were used to find WNBA athletes who sustained knee injuries. The RTP length was determined by calculating the number of days between the date of the injury and the date of the first game they played after returning. The RTP rate was determined by calculating the number of players who returned to play from each injury compared with the total number of each injury. Incidence of knee injuries, frequency, and time to RTP were calculated for each injury. Available videos were analyzed to determine the mechanism and body position at the time of injury.Results:Overall, 99 WNBA players were identified as having sustained a knee injury during the study period resulting in loss of play. ACL tears (n = 37; 37%) were the most devastating injury, resulting in the longest time before RTP (n = 375 days; 70%). The position with the highest incidence of knee injuries was guard, accounting for 53% of knee injuries. Video analysis conducted on 12 knee injuries revealed that such injuries were most commonly noncontact (83%).The mechanisms of injury were most commonly planting (58%) and landing from a jump (33%) with the knee flexed in the valgus position (100%).Conclusion:Study findings indicated that ACL tears are the most common clinically significant knee injuries sustained in the WNBA, accounting for 37% of total knee injuries with a mean RTP rate of 375 days. The most common mechanism of injury was planting the foot or landing from a jump with a flexed knee in the valgus position. Knee injuries had a high RTP rate in WNBA players but resulted in them missing a significant amount of playing time.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-15T06:25:53Z
      DOI: 10.1177/23259671221120832
      Issue No: Vol. 10, No. 9 (2022)
       
  • Translation, Validity, and Reliability of the Dutch Anterior Cruciate
           Ligament–Quality of Life Questionnaire

    • Authors: Astrid J. de Vries, Reinoud W. Brouwer, Rianne Huis in t’ Veld, Wybren A. van der Wal, Inge H.F. Reininga, Roy A.G. Hoogeslag
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:The Anterior Cruciate Ligament–Quality of Life (ACL-QoL) questionnaire is a valid and reliable injury-specific instrument to assess the impact of an ACL rupture on the daily life of a patient.Purpose:To translate the ACL-QoL into Dutch (ACL-QoL-NL) and to study its psychometric properties in patients with an ACL rupture.Study Design:Cohort study (diagnosis); Level of evidence, 2.Methods:The original ACL-QoL questionnaire was translated from English to Dutch according to international guidelines. The study population consisted of 122 patients with a confirmed ACL rupture who completed the ACL-QoL-NL as well as 4 questionnaires: the International Knee Documentation Committee subjective score, Knee injury and Osteoarthritis Outcome Score, 36-item Short Form Health Survey, and Lysholm Knee Score. We determined the internal consistency, construct validity, and prevalence of floor and ceiling effects of the ACL-QoL-NL total score as well as its 5 subscales. To determine test-retest reliability, we analyzed the data of 68 patients who had a stable knee condition and who completed the ACL-QoL-NL a second time after a 2-week interval.Results:The confirmatory factor analysis showed that the original structure of the ACL-QoL-NL was confirmed, except for 4 of 31 items. Internal consistency of the total scale and all 5 subscales was good. More than 75% of the predefined hypotheses on the correlations between the ACL-QoL-NL and the 4 questionnaires were met, indicating good construct validity. No significant floor or ceiling effects were observed. Test-retest reliability was good, and no systematic bias between test and retest was found. Standard error of measurement for the total score was 4.8 points out of 100, and the smallest detectable changes at the group and individual levels were 1.6 and 13.2 points, respectively.Conclusion:The ACL-QoL-NL questionnaire was successfully translated from English to Dutch and demonstrated good internal consistency, validity, and reliability, with no presence of floor or ceiling effects.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-15T05:59:26Z
      DOI: 10.1177/23259671221123297
      Issue No: Vol. 10, No. 9 (2022)
       
  • Effect of Anterior Horn Tears of the Lateral Meniscus on Knee Stability

    • Authors: Kousuke Shiwaku, Tomoaki Kamiya, Hidenori Otsubo, Tomoyuki Suzuki, Shogo Nabeki, Satoshi Yamakawa, Yohei Okada, Atsushi Teramoto, Kota Watanabe, Kousuke Iba, Hiromichi Fujie, Toshihiko Yamashita
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Investigations on the biomechanical characteristics of the anterior horn of the lateral meniscus (AHLM) related to anterior cruciate ligament (ACL) tibial tunnel reaming have revealed increased contact pressure between the femur and tibia, decreased attachment area, and decreased ultimate failure strength.Purpose/Hypothesis:The purpose of this study was to investigate the influence of a complete radial tear of the AHLM on force distribution in response to applied anterior and posterior drawer forces and internal and external rotation torques. We hypothesized that the AHLM plays an important role in knee stability, primarily at lower knee flexion angles.Study Design:Controlled laboratory study.Methods:A total of 9 fresh-frozen cadaveric knee specimens and a robotic testing system were used. Anterior and posterior drawer forces up to 89 N and internal and external rotation torques up to 4 N·m were applied at 0°, 30°, 60°, and 90° of knee flexion. A complete AHLM tear was then made 10 mm from the lateral border of the tibial attachment of the ACL, and the same tests performed in the intact state were repeated. Next, the recorded intact knee motion was reproduced in the AHLM-torn knee, and the change in the resultant force after an AHLM tear was determined by calculating the difference between the 2 states.Results:In the torn AHLM, the reduction in the resultant force at 0° for external rotation torque (34.8 N) was larger than that at 60° (5.2 N; P < .01) and 90° (6.7 N; P < .01).Conclusion:The AHLM played a role in facilitating knee stability against an applied posterior drawer force of 89 N and external rotation torque of 4 N·m, especially at lower knee flexion angles.Clinical Relevance:This study provides information about the effects of AHLM injuries that may occur during single-bundle ACL reconstruction using a round tunnel.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-14T11:12:01Z
      DOI: 10.1177/23259671221119173
      Issue No: Vol. 10, No. 9 (2022)
       
  • Hip Labral Reconstruction With a Polyurethane Scaffold: Restoration of
           Femoroacetabular Contact Biomechanics

    • Authors: Bruno Capurro, Francisco Reina, Anna Carrera, Joan Carles Monllau, Fernando Marqués-López, Oliver Marín-Peña, Raúl Torres-Eguía, Marc Tey-Pons
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Many advances have been made in hip labral repair and reconstruction and in the restoration of the suction seal.Purpose/Hypothesis:The purpose of this study was to evaluate the biomechanical effects of segmental labral reconstruction with a synthetic polyurethane scaffold (PS) in comparison with segmental labrectomy. Our hypothesis was that reconstruction with a icroporous polyurethane implant would normalize joint kinetics of the hip and restore the suction seal.Study Design:Controlled laboratory study.Methods:We used 10 hips from 5 fresh-frozen pelvises with an intact acetabular labrum without osteoarthritis. Using an intra-articular pressure measurement system, the contact area, contact pressure, and peak force were assessed for the following conditions: intact labrum, partial anterosuperior labrectomy, and PS reconstruction. For each condition, all specimens were analyzed in 4 positions (90° of flexion, 90° of flexion and internal rotation, 90° of flexion and external rotation, and 20° of extension) and underwent a labral seal test. The relative change from the intact condition was determined for all conditions and positions.Results:Compared with the intact labrum, labrectomy resulted in a significant decrease in the contact area (P < .001) and a significant increase in the peak force (P < .001) and contact pressure (P < .001) across all positions. Compared with labrectomy, PS reconstruction resulted in a significant increase in the contact area (P < .001) and a significant decrease in the contact pressure (P ≤ .02) and peak force (P < .001) across all positions. Compared with the intact labrum, PS reconstruction restored the contact area and peak force to normal values in all positions (P> .05), whereas the contact pressure was significantly decreased compared with labrectomy (P < .05) but did not return to normal values. The labral seal was lost in all specimens after labrectomy but was restored in 80% of the specimens after PS reconstruction.Conclusion:Femoroacetabular contact biomechanics significantly worsened after partial labrectomy; reconstruction using a PS restored the contact area and peak force to the intact state and improved the contact pressure increases seen after partial labrectomy. The contact area and peak force were normalized, and the labral seal was re-established in most cases.Clinical Relevance:This study provides biomechanical evidence for the use of a scaffold for labral reconstruction.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-14T11:00:22Z
      DOI: 10.1177/23259671221118831
      Issue No: Vol. 10, No. 9 (2022)
       
  • Effect of Accelerated Rehabilitation on Early Return to Sport After
           Arthroscopic Ankle Lateral Ligament Repair

    • Authors: Atsushi Teramoto, Yasutaka Murahashi, Katsunori Takahashi, Kota Watanabe, Toshihiko Yamashita
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Although the minimal invasiveness of arthroscopic ankle lateral ligament repair (ALLR) means that an early return to sporting activities can be anticipated, studies have described postoperative cast immobilization and the avoidance of weightbearing for a certain period. Accelerated rehabilitation may be helpful for an early return to sport.Purpose:To investigate clinical outcomes of ALLR and accelerated rehabilitation with a minimum duration of postoperative ankle immobilization and proactive early weightbearing.Study Design:Case series; Level of evidence, 4.Methods:This study investigated 23 ankles of 22 patients (11 men, 11 women; mean age, 38.7 years) who underwent ALLR for chronic lateral ankle instability. Postoperative management included the avoidance of weightbearing until postoperative day 3, after which full weightbearing walking with a brace was permitted. The objective was to return to competitive sport 8 weeks after surgery. The following were evaluated: pre- and postoperative instability and pain symptoms, ankle range of motion, anterior drawer distance on stress radiograph, anterior translation measured with a capacitance-type strain sensor, the Ankle-Hindfoot Scale from the Japanese Society for Surgery of the Foot, and the SAFE-Q (Self-Administered Foot Evaluation Questionnaire).Results:Two male patients dropped out and were excluded from analysis. Postoperatively, instability and pain resolved or improved in all patients. There was no significant postoperative change in range of motion. There were significant pre- to postoperative improvements in talar tilt angle (from 12.2°-5.6°, P < .01), anterior drawer distance (8.2-4.4 mm, P < .01), and anterior translation (10.5-4.6 mm, P < .01) as well as the Ankle-Hindfoot Scale score (68.8-96.8, P < .01) and all subscales of the SAFE-Q (P ≤ .01 for all). Complete return to sport was achieved by 75% of the patients at 8 weeks postoperatively.Conclusion:When accelerated rehabilitation with proactive weightbearing exercises was implemented from postoperative day 3 without ankle immobilization after ALLR, there were significant improvements in objective assessments of ankle stability and clinical scores, and as many as 75% of the patients were able to make a complete return to sport within 8 weeks.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-13T03:54:25Z
      DOI: 10.1177/23259671221121676
      Issue No: Vol. 10, No. 9 (2022)
       
  • Comparison of Treatment Methods for Syndesmotic Injuries With Posterior
           Tibiofibular Ligament Ruptures: A Cadaveric Biomechanical Study

    • Authors: Katsunori Takahashi, Atsushi Teramoto, Yasutaka Murahashi, Shogo Nabeki, Kousuke Shiwaku, Tomoaki Kamiya, Kota Watanabe, Toshihiko Yamashita
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Studies on ankle syndesmosis have focused on anterior inferior tibiofibular ligament (AITFL) and interosseous membrane injuries; however, the characteristics of posterior inferior tibiofibular ligament (PITFL) ruptures remain unclear.Purpose/Hypothesis:This study evaluated the biomechanical characteristics of syndesmotic instability caused by PITFL injury and compared various treatment methods. We hypothesized that PITFL injury would lead to syndesmotic internal rotational instability and that the stability would be restored with suture tape (ST) PITFL augmentation.Study Design:Controlled laboratory study.Methods:Ten uninjured fresh-frozen cadaveric leg specimens were tested via forces applied to the external and internal rotation of the ankle joint. The fibular rotational angle (FRA) related to the tibia, anterior tibiofibular diastasis (aTFD), and posterior tibiofibular diastasis (pTFD) were measured using a magnetic tracking system. Six models were created: (1) intact, (2) AITFL injury; (3) AITFL + PITFL injury; (4) suture button (SB) fixation; (5) SB + anterior ST (aST) fixation; and (6) SB + aST + posterior ST fixation. The FRA, aTFD, and pTFD were statistically compared between the intact ankle and each injury or fixation model.Results:In the intact state, the changes in FRA and aTFD were 1.09° and 0.33 mm when external rotation force was applied and were 0.57° and 0.41 mm when internal rotation force was applied. In the AITFL injury model, the changes in FRA and aTFD were 2.38° and 1.51 mm when external rotation force was applied, which were significantly greater versus intact (P = .032 and .008, respectively). In the AITFL + PITFL injury model, the changes in FRA and pTFD were 2.12° and 1.02 mm when internal rotation force was applied, which were significantly greater versus intact (P = .007 and .003, respectively). In the SB fixation model, the change in FRA was 2.98° when external rotation force was applied, which was significantly higher compared with intact (P < .001). There were no significant differences between the SB + aST fixation model and the intact state on any measurement.Conclusion:PITFL injury significantly increased syndesmotic instability when internal rotation force was applied. SB + aST fixation was effective in restoring syndesmotic stability.Clinical Relevance:These results suggest that SB + aST fixation is sufficient for treating severe syndesmotic injury with PITFL rupture.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-13T03:47:55Z
      DOI: 10.1177/23259671221122811
      Issue No: Vol. 10, No. 9 (2022)
       
  • A Scoping Review of Postoperative Rehabilitation Protocols After Superior
           Capsular Reconstruction for Irreparable Rotator Cuff Tears

    • Authors: Kaibo Zhang, Qinghong Xia, Sike Lai, Jian Li, Weili Fu
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Superior capsular reconstruction (SCR) is an option for patients with massive or irreparable rotator cuff tears.Purpose:To describe the literature on rehabilitation protocols after SCR of rotator cuff tears, with emphasis on the timing of the introduction of motion.Study Design:Scoping review; Level of evidence, 4.Methods:We conducted a scoping review of articles published on PubMed, Ovid, Embase, and the Cochrane Library from inception to October 2020. The methodological index for non-randomized studies (MINORS) was used to assess the individual studies. For each article, we summarized the study characteristics, patient demographics, and rehabilitation protocols after SCR: duration of immobilization, initiation of passive range of motion (ROM), active-assisted ROM, active ROM, strengthening, and return to activities. In a subgroup narrative analysis, rehabilitation protocols were stratified by graft type: autograft versus nonautograft (xenograft, allograft, and synthetic).Results:A total of 21 studies met the search criteria. Six studies had level 3 evidence and 15 had level 4 evidence; 16 studies were considered high quality according to the MINORS score. After SCR, an abduction immobilizer was recommended for a duration of 3 to 6 weeks. Of the 21 studies, 7 (33%) started passive ROM during the first week, and 5 reported strict immobilization without motion for up to 6 weeks. All 8 studies that reported return-to-sports timing recommended delaying return until at least 6 months postoperatively. Passive ROM was recommended earlier for patients with nonautograft versus autograft (χ2 = 225; P < .001). There was a high level of heterogeneity in the rehabilitation protocols after SCR.Conclusion:The majority of published protocols were descriptive. At present, there is little agreement on the published rehabilitation guidelines after SCR, precluding specific clinical best practice suggestions. Although there was a tendency of recommending early motion in nonautograft cases, the optimal protocols based on graft healing and functional outcomes require further verification based on the clinical outcomes from high-quality studies.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-10T01:39:49Z
      DOI: 10.1177/23259671221120052
      Issue No: Vol. 10, No. 9 (2022)
       
  • Comparison of Open Versus Arthroscopic Repair for Subscapularis Tendon
           Tears With or Without Concomitant Supraspinatus Tendon Tears

    • Authors: Mete Gedikbas, Tahir Ozturk, Fırat Erpala, Eyup Cagatay Zengin
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:The literature comparing open and arthroscopic repair of subscapularis tendon (ST) tears is insufficient.Purpose:To compare the clinical results of open versus arthroscopic repair of ST tears with or without concomitant supraspinatus tears.Study Design:Retrospective cohort study.Methods:We retrospectively evaluated 70 patients treated for isolated ST tears and ST tears with concomitant supraspinatus tendon tears at a single center between 2011 and 2019. Patients were divided into 2 groups: those who underwent open ST repairs (group O) and those with an arthroscopic ST repair (group A). Range of motion (ROM), liftoff and belly-press tests, and Constant-Murley (CM) scores were included in the pre- and postoperative functional evaluations. The minimal clinically important difference was calculated using the anchor-based method for changes in CM score. Tear size was evaluated according to the Lafosse classification. The categorical data were assessed using the Pearson chi-square, Fisher exact, and Fisher-Freeman-Halton tests. The parametric and nonparametric data were evaluated using the Student t test and Mann-Whitney U test, respectively. The dependent groups (for nonnormally distributed data) were evaluated using the Wilcoxon signed rank test.Results:Group O included 34 patients, and group A included 36 patients. The mean age was 62.9 years, and the mean follow-up period was 66.7 months. Even though group O exhibited a significantly better preoperative CM score (53.7 ± 4.6 vs 48.9 ± 6.8 [mean ± SD]; P = .001), group A had a significantly better postoperative CM score (88.7 ± 4.7 vs 84.6 ± 2.9; P < .001). Our measurements revealed a minimal clinically important difference of 11.5 points for the CM score. Group A had significantly greater postoperative ROM in abduction (153° vs 143.9°; P = .005) and forward elevation (159.1° vs 149.7°; P = .005), as well as significantly greater postoperative improvement in positive belly-press test results (P = .028). Complications occurred in 4 patients in group O and in 1 patient in group A.Conclusion:The study findings indicated that arthroscopic ST repair was more advantageous than open repair in terms of ROM and functional outcomes.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-10T01:33:47Z
      DOI: 10.1177/23259671221120662
      Issue No: Vol. 10, No. 9 (2022)
       
  • Assessment of Anatomic Restoration and Clinical Outcomes Between Medial
           and Lateral Meniscal Allograft Transplantation

    • Authors: Ho Won Jeong, Joo Sung Kim, Hee Seung Nam, Gwon Seok Noh, Yong Seuk Lee
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Proper anatomic restoration is an important consideration for meniscal allograft transplantation (MAT), even with the different anatomica characteristics between the medial meniscus and lateral meniscus.Purpose/Hypothesis:The purpose of this study was to assess the accuracy of anatomic restoration in medial and lateral MAT (MMAT and LMAT) procedures and to compare their outcomes. We hypothesized that (1) the anatomic differences between the medial and lateral menisci will mean a less accurate anatomic restoration for MMAT and (2) clinical outcomes after MMAT will be inferior compared with LMAT.Study Design:Cohort study; Level of evidence, 3.Methods:We retrospectively evaluated 20 patients who underwent MMAT using the bone plug technique and 21 patients who underwent LMAT using the keyhole technique at a single institution from July 2014 to June 2019. Demographic data, previous surgeries, and concomitant procedures were recorded, as were lower limb alignment and osteoarthritis grade on radiographs. Using preoperative and follow-up magnetic resonance imaging, the meniscal position, rotation, extrusion, and intrameniscal signal intensity were evaluated. Clinical outcomes were evaluated using the International Knee Documentation Committee and Lysholm scores.Results:The mean follow-up was 41.15 ± 18.86 and 45.43 ± 21.32 months for the MMAT and LMAT patients, respectively. Concomitant procedures were performed in 90% of MMATs and 15% of LMATs. There was no significant difference between the native and postoperative root positions after LMAT; however, for MMAT, the position of the anterior root was located significantly posteriorly (P = .002) and medially (P = .007) compared with preoperatively. In addition, the allograft medial meniscus was restored in a more internally rotated position (P = .029). MMATs also exhibited significantly increased meniscal extrusion compared with LMATs (posterior horn, P < .001; midbody, P = .027; anterior horn, P = .006). However, there was no significant difference between the 2 groups at final follow-up in intrameniscal signal intensity or clinical scores.Conclusion:LMAT showed higher accuracy than MMAT in restoring meniscal position and rotation, and there was less meniscal extrusion. However, clinical scores improved after both LMAT and MMAT compared with preoperative values, and midterm clinical outcomes were similar. The small anatomical errors seen in the MMAT technique were not clinically relevant at midterm follow-up.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-10T01:28:28Z
      DOI: 10.1177/23259671221113280
      Issue No: Vol. 10, No. 9 (2022)
       
  • Injuries to Ice Hockey Referees and Linesmen: A Survey of International
           Ice Hockey Federation Officials

    • Authors: Charles A. Popkin, Thomas A. Fortney, Ajay S. Padaki, Andrew J. Rogers, David P. Trofa, T. Sean Lynch, Markku Tuominen, Michael J. Stuart
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Ice hockey referees and linesmen are at risk for musculoskeletal injuries because of the lack of protective equipment and contact with players, sticks, pucks, the ice surface and boards.Purpose:To quantify and analyze injuries reported by officials of the International Ice Hockey Federation (IIHF).Study Design:Descriptive epidemiology study.Methods:A 61-question survey tool was designed by an interdisciplinary team to evaluate musculoskeletal injuries experienced by ice hockey officials. This survey was administered to 600 active IIHF referees and linesmen. Only completed survey responses were included in the statistical analysis. Continuous variables were analyzed using unpaired t-tests, while categorical data were assessed utilizing chi-square tests.Results:Of the 600 surveys administered, 264 surveys were completed by officials from 45 countries (44% response rate). Of the respondents, 72% were male, and 28% were female, with a mean age of 31.1 ± 5.8 years. Officiating experience averaged 11.4 ± 6.0 years (6.3 ± 4.5 years with the IIHF). A total of 295 injuries were reported by 55% of the officials. Injuries occurred more frequently during games compared with training, and officials who worked year-round had more total injuries than those who took time off (P = .03). The most common injuries involved the wrist and hand (n = 64 [22%]), head and face (n = 58 [20%]), and the knee (n = 47 [16%]). Wrist and hand trauma included 23 fractures. Knee and shoulder injuries were most likely to require surgery compared with other body areas (P < .001); 30 officials underwent surgery because of an acute knee injury (10%). Injury prevention activities were effective at reducing injuries (P = .04).Conclusion:Most ice hockey officials experienced musculoskeletal injuries during their career. The risk of trauma to the wrist and hand can possibly be reduced via equipment modifications including protective gloves. A greater emphasis should be placed on injury prevention programs and time away from officiating competitions.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-08T02:20:39Z
      DOI: 10.1177/23259671221117504
      Issue No: Vol. 10, No. 9 (2022)
       
  • Clinical and MRI Donor-Site Outcomes After Autograft Harvesting From the
           Medial Trochlea for Talar Osteochondral Lesions: Minimum 5-Year Clinical
           Follow-up

    • Authors: Changjun Guo, Xingchen Li, Yuan Zhu, Chonglin Yang, Xiangyang Xu
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Autologous osteochondral transplantation (AOT) is a treatment option for large or cystic osteochondral lesions of the talus (OLTs), with promising clinical results. However, donor-site morbidity (DSM) has always been a concern with this procedure.Purpose:To investigate the clinical and radiological outcomes of autograft harvesting from the medial trochlea for OLTs.Study Design:Case series; Level of evidence, 4.Methods:A total of 46 consecutive patients were included after AOT procedures for OLTs, with donor autografts (single or double plugs) harvested from the medial trochlea of the ipsilateral knee. Lysholm scores were collected postoperatively at 12-month intervals to assess clinical outcomes. Postoperative magnetic resonance imaging (MRI) was used to assess the donor site using the MOCART (magnetic resonance observation of cartilage repair tissue) score. DSM was evaluated at 12-month intervals. Statistical analysis was performed to compare patients treated with single-plug and double-plug AOT procedures and establish whether there was any correlation between MOCART and Lysholm scores.Results:The mean follow-up period was 98.3 months (range, 67-144 months). The Lysholm scores for all patients were 92.5 ± 6.1 and 99.9 ± 0.2 at the 12-month and final follow-ups, respectively. MRI of the donor sites was taken at an average of 93.8 ± 20.5 (range, 61-141) months postoperatively, and the mean MOCART score was 76.2 ± 4.9. The overall incidence of DSM in this study was 4.3% at 12 months, postoperatively, which decreased to 0% at the 24-month follow-up. There was no significant difference in either the Lysholm score (P = .16) or the MOCART score (P = .83) between the single-plug and double-plug groups at the final follow-up. There were no significant correlations between MOCART and Lysholm scores and patient age, number of grafts, or body mass index.Conclusion:According to the study findings, the DSM of donor autografts harvested from the medial trochlea was low, and the number (single or double) of grafts did not affect the functional outcome.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-06T08:04:58Z
      DOI: 10.1177/23259671221120075
      Issue No: Vol. 10, No. 9 (2022)
       
  • Correlating Biomechanical Gait Analysis With Patient-Reported Outcomes
           After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

    • Authors: Abhishek S. Kannan, Matthew J. Hartwell, Trevor Grace, Eric Hammond, Kylen K.J. Soriano, Richard B. Souza, Alan L. Zhang
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Postoperative biomechanics after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) are an outcome of interest, but correlation with patient-reported outcomes (PROs) remains unclear.Purpose/Hypothesis:The purpose of this study was to assess the correlation between changes in hip biomechanics in FAIS patients after hip arthroscopy and changes in PRO scores. We hypothesized that gait analysis would demonstrate significant correlations between pre- and postoperative changes in biomechanics and changes in PRO scores.Study Design:Descriptive laboratory study.Methods:FAIS patients without dysplasia or arthritis who underwent primary hip arthroscopy for labral repair and femoroplasty underwent preoperative and 1-year postoperative 3-dimensional motion tracking and biomechanical testing during normal gait. Joint kinematics calculated included flexion/extension (sagittal plane), abduction/adduction (frontal plane), and internal/external rotation (transverse plane). Peak hip angles and moments were compared between baseline and 1-year postoperative measures. At baseline, 1-year, and 2-year postoperatively, patients completed the following PRO surveys: 12-Item Short Form Health Survey (SF-12), modified Harris Hip Score (mHHS), and Hip disability and Osteoarthritis Outcome Score (HOOS). Joint kinematics that significantly improved 1 year after surgery were assessed for correlations with PRO scores.Results:A total of 10 patients (12 hips) were enrolled prospectively. PROs significantly improved at 1 and 2 years postoperatively compared with baseline values for HOOS, mHHS, and SF-12 Physical Component Score, with all patients achieving the minimal clinically important difference (MCID) on the HOOS Sport/Recreation and Quality of Life subscales. From preoperatively to 1-year postoperatively, significant improvements were seen in peak hip abduction angle (from −2.3° ± 1.8° to −4.6° ± 1.8°; P = .0058) and peak hip extension moment (from −1.03 ± 0.19 to −0.85 ± 0.20 N·m/kg; P = .014); however, there were no significant correlations between these changes and the pre- to postoperative changes on any PRO scores.Conclusion:Gait analysis of FAIS patients after hip arthroscopy demonstrated small, albeit significant, changes in postoperative hip kinetics and kinematics; however, these changes did not correlate with the large, clinically significant improvements in PROs at 1 year after surgery.Clinical Relevance:The results of this study suggest that the degree of improvement in short-term PROs after hip arthroscopy for FAIS may not be related to small changes in biomechanics postoperatively.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-05T11:46:22Z
      DOI: 10.1177/23259671221121352
      Issue No: Vol. 10, No. 9 (2022)
       
  • Trends in Level of Evidence of Systematic Reviews in Sports Medicine,
           2010-2020 : A Systematic Review and Meta-analysis

    • Authors: Tyler Paras, Soheil Sabzevari, David Solomon, Clair Smith, Christine McDonough, Albert Lin
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Popularization of systematic reviews has been met with controversy because of concerns that the primary literature for certain topics may not be suited for systematic review and meta-analysis.Purpose:To assess the rate of publication of systematic reviews based on their level of evidence (LOE) in influential orthopaedic sports medicine journals and commonly studied topics in sports medicine.Study Design:Systematic review.Methods:An electronic search was performed using the PubMed database of studies published from January 2010 to December 2020. The advanced search function was used to identify systematic reviews from the Journal of Shoulder and Elbow Surgery (JSES), American Journal of Sports Medicine (AJSM), Arthroscopy, British Journal of Sports Medicine (BJSM), Journal of Bone and Joint Surgery–American Volume (JBJS), and Sports Medicine (SM Auckland), as well as reviews of the most common areas of sports medicine research, including rotator cuff repair (RCR), shoulder instability (SI), anterior cruciate ligament reconstruction (ACLR), and meniscal repair. The LOE was assigned to each included study according to the Oxford Centre for Evidence-Based Medicine. Studies were grouped as LOE 1-2, LOE 3-5, and nonclinical systematic reviews. A negative binomial regression was used to determine the changes in publication rate over time.Results:A total of 2162 systematic reviews were included in this study. From 2010 to 2020, the rate of publication of LOE 3-5 systematic reviews increased significantly among most of the surveyed journals (AJSM, P < .0001; Arthroscopy, P = .01; BJSM, P < .0001; JSES, P < .0001; SM Auckland, P < .0001), with the exception of JBJS (P = .57). The rate of publication of LOE 1-2 systematic reviews increased in AJSM (P < .0001), Arthroscopy (P = .02), BJSM (P < .0001), and SM Auckland (P < .0001); however, no significant changes were seen in JBJS (P = .08) or JSES (P = .15). The publication rate of LOE 3-5 systematic reviews increased for all sports medicine topics surveyed (meniscal repair, P < .0001; RCR, P < .0001; SI, P < .0001; ACLR, P < .0001). However, the publication rate of LOE 1-2 studies only increased for RCR (P = .0003) and ACLR (P < .0001).Conclusion:The rate of publication of LOE 3-5 systematic reviews exponentially increased in orthopaedic sports medicine journals over the past decade, outpacing the publication rate of LOE 1-2 systematic reviews.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-05T11:36:58Z
      DOI: 10.1177/23259671221121330
      Issue No: Vol. 10, No. 9 (2022)
       
  • Open Debridement Alone Versus Open Debridement With Tendon Repair for
           Lateral Epicondylitis: A Comparison of Complications and 5-Year
           Reoperation Rates From a Large Insurance Database

    • Authors: Jay Moran, Stephen M. Gillinov, Christopher A. Schneble, Andrew E. Jimenez, Ravi Vaswani, Joshua I. Mathew, Joseph E. Manzi, Allen D. Nicholson, Theodore A. Blaine, David W. Altchek, Lawrence V. Gulotta, Joshua S. Dines
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Open debridement (OD) of the extensor carpi radialis brevis tendon, both with and without repair to the lateral epicondyle, are effective treatments for recalcitrant lateral epicondylitis. However, few comparative studies exist within the literature.Purpose:To (1) compare the 5-year reoperation rates of patients who underwent OD alone versus OD with tendon repair (ODR) and (2) identify the 90-day adverse event rates, total same-day reimbursement amounts, and national usage trends for these 2 procedures from 2010 to 2019.Study Design:Cohort study; Level of evidence, 3.Methods:The PearlDiver MUExtr database was reviewed for patients diagnosed with lateral epicondylitis who underwent OD alone and ODR or reattachment between January 2010 and December 2019. These patients were stratified into 2 cohorts: the OD cohort and ODR cohort. The 5-year reoperation rates were assessed and compared, and the incidence of 90-day postoperative complications and risk factors were identified. The number of ODs and ODRs performed each year and the mean same-day reimbursement amounts (in US$) for both procedures were assessed.Results:Overall, 41,932 lateral epicondylitis patients who underwent debridement were identified, with 17,139 OD patients and 24,793 ODR patients. There were no significant changes in the proportion of OD versus ODR procedures performed during the study period (P = .18). A significantly higher incidence of hematoma was seen after OD compared with ODR (0.19% vs 0.12%; P = .04), but ODR had a significantly lower 5-year reoperation rate than OD (2.8% vs 3.9%; P = .006), with an absolute risk reduction of 1.1% and a number needed to treat of 91. Finally, ODR ($1683.17 ± $12.15) had a higher mean same-day reimbursement than OD ($1479.05 ± $15.78) (P = .001).Conclusion:Both OD and ODR had low complication rates. The 5-year reoperation rates were low for both procedures, but they were significantly higher for OD. Over the 10-year study period, there were no significant changes in the relative percentages of OD versus ODR performed. ODR had a significantly higher mean same-day reimbursement.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-02T12:20:12Z
      DOI: 10.1177/23259671221120812
      Issue No: Vol. 10, No. 9 (2022)
       
  • Effect of a Condensed NBA Season on Injury Risk: An Analysis of the 2020
           Season and Player Safety

    • Authors: Landon H. Morikawa, Sailesh V. Tummala, Joseph C. Brinkman, Skye A. Buckner Petty, Anikar Chhabra
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Health and safety concerns surrounding the coronavirus 2019 (COVID-19) pandemic led the National Basketball Association (NBA) to condense and accelerate the 2020 season. Although prior literature has suggested that inadequate rest may lead to an increased injury risk, the unique circumstances surrounding this season offer a unique opportunity to evaluate player safety in the setting of reduced interval rest.Hypothesis:We hypothesized that the condensed 2020 NBA season resulted in an increased overall injury risk as compared with the 2015 to 2018 seasons.Study Design:Descriptive epidemiology study.Methods:A publicly available database, Pro Sports Transactions, was queried for injuries that forced players to miss ≥1 game between the 2015 and 2020 seasons. Data from the 2019 season were omitted given the abrupt suspension of the league year. All injury incidences were calculated per 1000 game-exposures (GEs). The primary outcome was the overall injury proportion ratio (IPR) between the 2020 season and previous seasons. Secondary measures included injury incidences stratified by type, severity, age, position, and minutes per game.Results:A total of 4346 injuries occurred over a 5-season span among 2572 unique player-seasons. The overall incidence of injury during the 2020 season was 48.20 per 1000 GEs but decreased to 39.97 per 1000 GEs when excluding COVID-19. Despite this exclusion, the overall injury rate in 2020 remained significantly greater (IPR, 1.42 [95% CI, 1.32-1.52]) than that of the 2015 to 2018 seasons (28.20 per 1000 GEs). On closer evaluation, the most notable increases seen in the 2020 season occurred within minor injuries requiring only a 1-game absence (IPR, 1.53 [95% CI, 1.37-1.70]) and in players who were aged 25 to 29 years (IPR, 1.57 [95% CI, 1.40-2.63]), averaging ≥30.0 minutes per game (IPR, 1.67 [95% CI, 1.47-1.90]), and playing the point guard position (IPR, 1.67 [95% 1.44-1.95]).Conclusion:Players in the condensed 2020 NBA season had a significantly higher incidence of injuries when compared with the prior 4 seasons, even when excluding COVID-19–related absences. This rise is consistent with the other congested NBA seasons of 1998 and 2011. These findings suggest that condensing the NBA schedule is associated with an increased risk to player health and safety.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-02T08:14:28Z
      DOI: 10.1177/23259671221121116
      Issue No: Vol. 10, No. 9 (2022)
       
  • Correlation of Delayed Gadolinium-Enhanced MRI of Cartilage (dGEMRIC)
           Value With Hip Arthroscopy Intraoperative Findings and Midterm
           Periacetabular Osteotomy Outcomes

    • Authors: Jessica H. Lee, Darby A. Houck, Brandt A. Gruizinga, Tigran Garabekyan, Mary K. Jesse, Matthew J. Kraeutler, Omer Mei-Dan
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is an advanced imaging technique that is purported to quantify cartilage damage in acute and chronic joint disease and predict periacetabular osteotomy (PAO) outcomes. There is a paucity of literature relating dGEMRIC values to arthroscopic findings before PAO and postoperative outcomes after PAO.Purpose:To assess the utility and validity of dGEMRIC as a preoperative and prognostic assessment tool of cartilage status and integrity as it relates to intraoperative findings and midterm postoperative outcomes after PAO.Study Design:Case series; Level of evidence, 4.Methods:We analyzed a cohort of 58 patients (70 hips) with a median age of 30.1 years (range, 15-50) with hip dysplasia who underwent hip arthroscopy, followed by a PAO with preoperative dGEMRIC. The primary outcome measures were intraoperative assessment and correlation with cartilage damage (presence of cartilage flap, Outerbridge grade of the acetabulum and femoral head). Secondary outcome measures were postoperative patient-reported outcome (PRO) scores, including the International Hip Outcome Tool and Non-arthritic Hip Score. Correlation analyses were performed to determine the relationship between dGEMRIC values and (1) PROs and (2) intraoperative assessment of cartilage damage.Results:There were significant negative linear relationships between dGEMRIC values and the primary outcome measures: presence of a cartilage flap (coronal, P = .004; sagittal, P < .001), Outerbridge grade of acetabular articular cartilage lesion (coronal, P = .002; sagittal, P = .003), and Outerbridge grade of femoral head articular cartilage lesion (coronal, P = .001; sagittal, P < .001). Despite significant overall improvement in all patients, there was no significant correlation between preoperative dGEMRIC values and improvement in PROs from presurgery to latest postoperative follow-up (median, 2.2 years; range, 1.0-5.0 years).Conclusion:Although dGEMRIC values (sagittal and coronal) were significant predictors of the intraoperative presence of cartilage flaps and overall cartilage integrity, they were not associated with midterm outcomes after PAO.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-02T02:07:13Z
      DOI: 10.1177/23259671221117606
      Issue No: Vol. 10, No. 9 (2022)
       
  • Open Repair of Complete Proximal Hamstring Avulsions in Workers’
           Compensation Patients

    • Authors: Emma E. Johnson, Joseph M. Brutico, Lasya Rangavajjula, Yuwei Xia, Ryan W. Paul, Peters Otlans, Justin W. Arner, Sommer Hammoud, James P. Bradley, Steven B. Cohen
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Several studies have reported excellent results after surgical repair of proximal hamstring avulsions. However, the effect on these patients of receiving workers’ compensation has not yet been explored.Hypothesis:Workers’ compensation patients undergoing proximal hamstring repair of complete tears will have similar outcomes when compared with a matched control group of non–workers’ compensation patients.Study Design:Cohort study; Level of evidence, 3.Methods:Workers’ compensation patients who underwent complete proximal hamstring avulsion open repair between 2010 and 2019 were identified (WC group). A control group was matched by age (±3 years), sex, and body mass index (BMI; ±3). Demographics and patient-reported outcome measures were compared, including standard and custom Marx activity rating scale (MARS), standard and custom lower extremity functional scale (LEFS), and visual analog scale (VAS) for pain. Rate and time to return to work were recorded.Results:The WC group was composed of 20 patients (8 men, 12 women) with a mean age of 52.3 years and BMI of 32.4. The 20 matched controls (8 men, 12 women) who underwent repair had a mean age of 50.6 years and a mean BMI of 31.2. There was no difference between the groups regarding age (P = .924), sex (P> .999), or BMI (P = .330). The WC group reported similar mean MARS (3.3 vs 5.4; P = .174), custom MARS (87.5 vs 97.0; P = .215), and VAS pain (3.3 vs 3.8; P = .698) scores compared with controls. However, the WC group had significantly lower standard LEFS (69.1 vs 94.1; P < .001) and custom LEFS (62.3 vs 87.9; P < .001) scores, returned to work at a lower rate (70.0% vs 94.1%; P = .039), and required more time to return to work after repair (4.3 vs 3.5 months; P = .029) compared with controls.Conclusion:Workers’ compensation patients who underwent open proximal hamstring repair for complete avulsions experienced inferior patient-reported outcomes, required more time to return to work, and returned to work at a lower rate than a matched control group.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-01T07:01:22Z
      DOI: 10.1177/23259671221119774
      Issue No: Vol. 10, No. 9 (2022)
       
  • Benefits of Meniscal Repair in Selected Patients Aged 60 Years and Older

    • Authors: Martin Husen, Nicholas I. Kennedy, Sara Till, Anna Reinholz, Michael J. Stuart, Aaron J. Krych, Daniel B.F. Saris
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:Little is known about the benefits and outcomes of meniscal repair in patients older than 60 years.Purpose:To (1) report the clinical and radiographic outcomes of meniscal repair in patients aged ≥60 years and compare them with matched patients who underwent meniscectomy and (2) identify procedural failures.Study Design:Cohort study; Level of evidence, 2.Methods:We included 32 knees in 32 patients aged ≥60 years (20 female, 12 male; mean age, 64.5 ± 4.6 years) who underwent meniscal repair surgery at a single medical institution between 2010 and 2020. Patients were matched according to age, sex, body mass index, and meniscal tear type with a comparison cohort who underwent meniscectomy (n = 49 patients [49 knees]; 32 female, 17 male). For all patients, demographic information, clinical history, physical examination findings, treatment details, and radiographic images were reviewed and analyzed. At final follow-up (mean, 42.2 months; range, 13-128 months), patients completed the 2000 International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee injury and Osteoarthritis Outcome Score (KOOS), and Lysholm score. Clinical failure was defined as revision surgery and/or progression to total knee arthroplasty (TKA). A matched-pairs t test was used to analyze differences between the 2 treatment groups, and Kaplan-Meier analysis was used to determine the rates of knee osteoarthritis and progression to TKA.Results:The majority of patients had a medial meniscal tear (72.8%), whereas the lateral meniscus was torn in 27.2% of cases. Most tears were located in the meniscal root (56.8%), followed by the posterior horn (34.6%) and midbody (8.6%). At final follow-up, all outcome scores were higher in the repair group compared with the meniscectomy group (IKDC, 78.9 ± 13.4 vs 56.0 ± 15.4; KOOS, 86.6 ± 11.9 vs 61.7 ± 16.2; Lysholm, 88.3 ± 13.3 vs 68.7 ± 15.2, respectively; P < .001 for all). Clinical failure was observed in 22% of patients in the repair group.Conclusion:All clinical outcome scores were higher in the meniscal repair group compared with the matched meniscectomy group at final follow-up. The clinical failure rate of the repair group was 22%. These findings support meniscal repair in selected patients aged ≥60 years.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-01T05:39:58Z
      DOI: 10.1177/23259671221117491
      Issue No: Vol. 10, No. 9 (2022)
       
  • Effect of Preoperative Joint Space Width on Lateral Meniscal Allograft
           Transplantation: Outcomes at Midterm Follow-up

    • Authors: Dhong Won Lee, Dong Ryun Lee, Min Ah Kim, Joon Kyu Lee, Jin Goo Kim
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 10, Issue 9, September 2022.
      Background:It remains unclear whether lateral joint space narrowing without severe cartilage loss before meniscal allograft transplantation (MAT) affects clinical outcomes and graft extrusion.Hypothesis:Patients with greater preoperative joint space narrowing would show more graft extrusion, more osteoarthritis progression, and worse clinical outcomes than would those with less narrowing.Study Design:Case-control study; Level of evidence, 3.Methods:We retrospectively evaluated 61 patients who underwent lateral MAT and had a minimum follow-up of 4 to 5 years. The median preoperative joint space width (JSW) on Rosenberg view radiographs was used to classify patients into those with less joint space narrowing (JSW ≥3 mm; group A) and greater joint space narrowing (JSW
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2022-09-01T04:59:36Z
      DOI: 10.1177/23259671221103845
      Issue No: Vol. 10, No. 9 (2022)
       
 
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