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Orthopaedic Journal of Sports Medicine
Journal Prestige (SJR): 0.935
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  This is an Open Access Journal Open Access journal
ISSN (Print) 2325-9671 - ISSN (Online) 2325-9671
Published by Sage Publications Homepage  [1176 journals]
  • Comparison of Patient-Reported Outcomes for Immediate Unrestricted
           Weightbearing Versus Restricted Rehabilitation Protocols After
           Osteochondral Allograft Transplantation to the Distal Femur

    • Authors: Brian Prigmore, Erik Haneberg, Tristan Elias, Jack Wiedrick, Jessica Ballin, Brian J. Cole, Adam B. Yanke, Dennis C. Crawford
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:There is no standardized rehabilitation protocol after osteochondral allograft (OCA) transplantation surgery to the distal femur. The spectrum of recommendations includes restrictions to toe-touch weightbearing (TTWB) for 6 weeks and immediate weightbearing as tolerated (WBAT).Purpose/Hypothesis:The purpose of this study was to compare outcomes for immediate unrestricted WBAT to restricted TTWB after OCA transplantation to the distal femur. It was hypothesized that the immediate WBAT protocol would be noninferior to delayed, restricted TTWB.Study Design:Retrospective cohort study.Methods:A total of 74 patients who underwent press-fit, dowel technique OCA transplantation to the femoral condyle(s) for contained (International Cartilage Repair Society grade 3-4) lesions were identified in the Metrics of Osteochondral Allograft multicenter database: 36 patients (18 women/18 men) who were prescribed TTWB were allocated to the control cohort and 38 patients (21 women/17 men) who were prescribed WBAT were allocated to the test cohort. Baseline characteristics were similar except for larger grafts in test patients (3.4 vs 2.7 cm2; P = .004) and higher body mass index (BMI) in control patients (27.8 vs 24.9 kg/m2; P = .01). Failure rates, final patient-reported outcome (PRO) scores, and PRO score changes from baseline were compared between the cohorts. Multiple regression was used to control for potential confounders and investigate noninferiority using minimal clinically important differences (MCIDs).Results:The mean follow-up was 2 years (range, 1-5 years) in both cohorts. Both cohorts showed significant improvement in all PRO scores, with no significant between-group differences in failure rates, final PRO scores, or PRO changes from baseline. There were 3 cases of failure in each cohort (control cohort: allograft revision [n = 2], debridement [n = 1]; test cohort: chondroplasty [n = 2], conversion to total knee arthroplasty [n = 1]). Regression analysis showed that adjusted differences in final PRO scores based on weightbearing protocol were minor and less than MCIDs when controlling for age, sex, graft size, BMI, and allograft location. Analysis of the MCIDs with respect to the lower bounds of the confidence intervals indicated that WBAT was noninferior to TTWB with a reasonable degree of confidence (range, 84.1%-99.9% confidence).Conclusion:Results indicated that immediate unrestricted WBAT after OCA transplantation to the distal femur was equally safe and effective compared to restricted TTWB.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-28T01:30:28Z
      DOI: 10.1177/23259671241264856
      Issue No: Vol. 12, No. 8 (2024)
       
  • Borderline Developmental Dysplasia of the Hip With Osseous Impingement as
           Distinct From Femoroacetabular Impingement and Developmental Dysplasia of
           the Hip

    • Authors: Jia Zhang, Zhongyao Li, Yidong Wu, Kangkang Yu, Lu Gan, Yujie Liu, Chengfeng Xu, Chunbao Li
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Borderline developmental dysplasia of the hip (BDDH) accompanied by cam deformity and subspinous impingement has been found to benefit from arthroscopic surgery. However, the research comparing BDDH combined with osseous impingement to femoroacetabular impingement (FAI) without borderline dysplasia remains limited.Purpose/Hypothesis:To compare the clinical symptoms, intraoperative findings, and outcomes of hip arthroscopy in patients with BDDH and osseous impingement versus cam-type FAI. It was hypothesized that BDDH with osseous impingement could be classified as a distinct entity between FAI and developmental dysplasia of the hip (DDH).Study Design:Cohort study; Level of evidence, 3.Methods:Data were collected from patients 18 to 50 years old who underwent primary hip arthroscopy between September 2016 and October 2020. Patients were divided based on preoperative lateral center-edge angle (LCEA) into 2 groups: (1) BDDH group (LCEA 18°-25°; n = 67); and (2) cam-type FAI group without BDDH (FAI group; LCEA 25°-40° and alpha angle>55°; n = 145). Disparities in symptoms, preoperative examination, intraoperative findings and procedures, and patient-reported outcome (PRO) scores were compared.Results:Follow-up was available for 61 (91.0%) patients in the BDDH group and 125 (86.2%) patients in the FAI group. The incidence of cam deformity in BDDH patients was 91.8%. The preoperative characteristics and intraoperative findings were similar between the groups; however, preoperative internal and external hip rotation, Tönnis angle, femoroepiphyseal acetabular roof index, labral size, capsule thickness, and percentage of ligamentum teres tear were significantly higher in the BDDH group than the FAI group, and the percentage of pain aggravating factor, cam deformity, and anterior inferior iliac spine types 2 and 3 were also significantly different between groups (P < .05 for all). The percentage of intraoperative minimal acetabuloplasty, subspinous decompression, labral repair, ligamentum teres debridement, and capsular closure was significantly higher in the BDDH group than the FAI group, while the percentage of femoroplasty was higher in the FAI group (P < .05). Pre- to postoperative improvement on PRO scores was seen in both groups.Conclusion:Given the differences in etiology and surgical procedures between the 2 conditions, it is suggested that BDDH with osseous impingement be classified as an entity distinct from FAI and DDH (and separate from BDDH without impingement) while excluding joint instability.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-28T01:29:28Z
      DOI: 10.1177/23259671241249948
      Issue No: Vol. 12, No. 8 (2024)
       
  • Placebo Effect in the Treatment of Patellar Tendinopathy and Its
           Influencing Factors: Systematic Review With Meta-analysis and Meta
           Regression of Randomized Controlled Trials

    • Authors: Davide Previtali, Jacopo Albanese, Iacopo Romandini, Giulia Merli, Francesca Taraballi, Giuseppe Filardo
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:The effectiveness of nonsurgical treatment of patellar tendinopathy is questioned due to the conflicting results of placebo-controlled randomized controlled trials (RCTs) in which placebo arms often show impressive results.Purpose:To quantify the magnitude of placebo effect of the different nonsurgical treatments of patellar tendinopathy. We also evaluated the influence of patients and treatments characteristics on the response to the placebo.Study Design:Systematic review; Level of evidence, 1.Methods:We searched PubMed, Web of Science, Embase, Scopus, Cochrane Library, and gray literature databases on May 10, 2023, with no time limitation. RCTs on nonoperative treatment of patellar tendinopathy, including a placebo control arm reporting the evolution of symptoms after placebo administration, were included. A single-arm meta-analysis was performed with the Victorian Institute of Sport Assessment-Patella (VISA-P) at mid-term follow-up (3-6 months) as the primary outcome. The VISA-P score at short-term (1-3 months) and long-term (6-12 months) follow-ups, as well as visual analog scale (VAS) for pain at all 3 time points were also analyzed. A subanalysis based on the type of placebo and a meta-regression were conducted to look for potential determinants of the placebo effect. Risk of bias and level of evidence were also analyzed using the revised tool for risk of bias in randomized trials and Grading of Recommendations Assessment, Development and Evaluation.Results:In total, 14 studies (251 patients) were included. VISA-P score at mid-term follow-up (3-6 months) showed statistically significant improvements of 13 of 100 points (P = .001). The change at short-term follow-up (1-3 months) was not statistically significant, whereas at long-term follow-up (6-12 months) it was 27 of 100 points (P < .001). Regarding VAS, results were statistically significant only at mid-term (MD = −1.5/10; P = .02) and long-term (MD = −3.2/10; P < .001) follow-ups. The meta-regression showed positive correlations between the response to placebo and the follow-up length (P < .001) and the effect size in the experimental group (P = .006). The level of evidence was moderate for mid- and long-term results and low for short-term results.Conclusion:The placebo effect for nonsurgical treatments of patellar tendinopathy is long-lasting (up to 12 months) and statistically and clinically significant. It has a perceived and true component and differs among treatments. The duration of follow-up and the effect size of experimental groups correlate with the magnitude of the placebo component, underlining the importance of RCTs to determine the effectiveness of new treatments of patellar tendinopathy.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-28T01:28:18Z
      DOI: 10.1177/23259671241258477
      Issue No: Vol. 12, No. 8 (2024)
       
  • The Statistical Fragility of Lateral Extra-articular Tenodesis Research: A
           Systematic Review

    • Authors: Rory Byrne, Benjamin Ahn, Leon Zhao, Matthew Quinn, Om Naphade, Brett D. Owens
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:A P value of
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-28T01:26:58Z
      DOI: 10.1177/23259671241266329
      Issue No: Vol. 12, No. 8 (2024)
       
  • Arthroscopic Percutaneous Fixation of Mason Type 2 Radial Head Fractures

    • Authors: Marwa Raafat Kamal Ibrahim, Ahmed Elsayed Semaya, Mohammad Hasan, Hany Adel Morsy
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Management of radial head fractures around the elbow with open techniques can predispose to edema, postoperative pain, and adhesions. The resultant limitation in elbow range of motion negatively affects functional outcomes. Rehabilitation is then rendered a challenge in a joint with proneness to stiffness.Hypothesis:Arthroscopic percutaneous fixation of Mason type 2 radial head fractures would provide satisfactory radiological and clinical outcomes.Study Design:Case series; Level of evidence, 4.Methods:A total of 24 patients diagnosed with isolated Mason type 2 radial head fractures at a single institution between February 1, 2021, and December 31, 2021, received arthroscopic percutaneous fixation by headless screws. Functional evaluation included Mayo Elbow Performance Score and postoperative elbow range of motion measurements. Radiological evaluation was performed using elbow radiographs and computed tomography scans. Patients were evaluated for a minimum of 24 months.Results:This study included 12 male and 12 female participants with a mean age of 37.29 ± 11.93 years. At the end of the follow-up period (mean, 27.75 months; range, 24-32 months), the mean elbow flexion was 140.17° ± 8.21° and the extension deficit was 4.17° ± 3.81°. The Mayo Elbow Performance Score revealed 21 patients with excellent results and 3 patients with good results. All patients returned to preinjury activities at a mean time of 3.1 months (range, 2-6 months) postoperatively. Union was reached in all patients at a mean time of 7.63 weeks (range, 6-10 weeks). No neurological complications or reoperations were reported at the end of the follow-up period.Conclusion:Arthroscopic fixation was demonstrated to be a valid and valuable technique for managing isolated Mason type 2 radial head fractures. It allowed for accurate reduction without the need for soft tissue dissection, resulting in excellent clinical outcomes.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-27T09:32:11Z
      DOI: 10.1177/23259671241270351
      Issue No: Vol. 12, No. 8 (2024)
       
  • Evaluation of Patellar Dysplasia and Postoperative Pain After Mini-Open,
           Thin-Flap Trochleoplasty: A Retrospective Analysis of 75 Consecutive Cases
           

    • Authors: Per Arne Skarstein Waaler, Asle Birkeland Kjellsen, Trine Hysing-Dahl, Eivind Inderhaug
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:The association between inherent patellar anatomy and postoperative pain after trochleoplasty in patients with patellar instability is poorly understood.Purpose/Hypothesis:The study purpose was to evaluate outcomes after mini-open, thin-flap trochleoplasty. The hypothesis was that more severe patellar dysplasia would be correlated with increased postoperative pain after trochleoplasty.Study Design:Case series; Level of evidence 4.Methods:Patients with patellar instability who underwent mini-open, thin-flap trochleoplasty in combination with other individualized procedures between 2013 and 2022 were included. Patellar dysplasia was evaluated by calculating the Wiberg index at the widest and most distal cartilaginous parts of the patella on preoperative magnetic resonance imaging. At the postoperative follow-up, participants completed the visual analog scale for usual pain (VAS-U), Banff Patellofemoral Instability Instrument 2.0 (BPII), global rating of change scale, and an evaluation of their current symptom state. Redislocations and complications were recorded. The correlation between the Wiberg index and the VAS-U was calculated with the Spearman rho. Between-group analyses based on demographic and pathoanatomic features were conducted using the Mann-Whitney U test, independent-samples t test, and chi-square test.Results:Included were 75 knees in 63 patients (median age at surgery, 19.1 years; IQR, 16-22 years) with a median follow-up of 44 months (IQR, 23.8-83.2 months). The median BPII score was 78.2 (IQR, 54.8-92.5), with 88% reporting an improvement in knee function relative to before surgery, but 21.1% remained dissatisfied with their current knee symptom state. New episodes of patellar dislocation were seen in 3 knees (4%), and 14 knees (18.7%) underwent reoperation with either revision surgery (n = 7; 9.3%) or arthroscopic synovectomy (n = 7; 9.3%). A weak positive, nonsignificant correlation was found between increased postoperative pain and a higher Wiberg index, both at the widest (rS = 0.16; P = .23) and most distal (rS = 0.02; P = .89) parts of the patella. Significantly worse VAS-U scores were seen in female versus male patients (P = .013).Conclusion:Good patient-reported results with a low risk of redislocation were seen in the study cohort, but reoperation rates were high, and 21% of the patients remained dissatisfied with their current symptom state. More pronounced patellar dysplasia (increased Wiberg index) had only a poor association with more severe postoperative pain in the current study.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-27T09:30:22Z
      DOI: 10.1177/23259671241270352
      Issue No: Vol. 12, No. 8 (2024)
       
  • Independent Risk Factors Associated With Venous Thromboembolism After Knee
           Arthroscopy: A Retrospective Study of 222 Patients

    • Authors: Jinlong Wu, Xiaoqiao Huangfu, Xiaoyu Yan, Shikui Dong, Guoming Xie, Song Zhao, Caiqi Xu, Junjie Xu, Jinzhong Zhao
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:A serious complication after knee arthroscopy is venous thromboembolism (VTE), which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). However, asymptomatic VTE is frequently undetected.Purpose:To (1) report the incidence of VTE after knee arthroscopy using ultrasound examination and computed tomography pulmonary angiography (CTPA) and (2) discover the independent risk factors of VTE after knee arthroscopy and determine the corresponding cutoff values of these indicators.Study Design:Case-control study; Level of evidence, 3.Methods:Included were 222 patients (115 male) who underwent arthroscopic knee procedures between October 2022 and January 2023. Baseline characteristics, blood test results, and VTE assessments were collected. During the 2-week follow-up, routine lower extremity vascular ultrasound was applied for DVT measurement, with CTPA evaluation for suspected PE. Patients were allocated into VTE and no-VTE groups, and descriptive statistics were used to analyze baseline data. Logistic regression analysis was used to determine the correlation between binary variables and the presence of postoperative VTE. Multivariate logistic regression analysis was further performed to determine the independent risk factors of VTE.Results:Of the 222 patients, 37 (16.7%) had DVT and 1 (0.5%) had both DVT and PE. Compared to the no-VTE group, the VTE group was significantly older, with more female patients; higher body mass index (BMI) and postoperative D-dimer level; and higher rates of hypertension, hyperlipidemia, varicose veins of the lower extremity, and abnormal postoperative fibrin degradation product level (P≤ .043 for all). Notably, operative time>20 minutes was not significantly associated with postoperative VTE (P = .513). The independent risk factors for VTE included age>32 years (odds ratio [OR], 20.71 [95% CI, 4.40-97.47]; P < .001), BMI>23 kg/m2 (OR, 3.52 [95% CI, 1.11-11.14]; P = .032), hyperlipidemia (OR, 6.81 [95% CI, 1.86-24.88]; P = .004), and postoperative D-dimer level>0.63 mg/L (OR, 34.01 [95% CI, 7.36-157.07]; P < .001).Conclusion:The incidence of VTE after knee arthroscopy was 16.7% at the 2-week follow-up. Age>32 years, BMI>23 kg/m2, hyperlipidemia, and postoperative D-dimer>0.63 mg/L were independent risk factors of postoperative VTE within 2 weeks after knee arthroscopy. For patients with knee arthroscopy, the cutoff value of postoperative D-dimer for VTE was found to be 0.63 mg/L for timely intervention.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-23T12:30:51Z
      DOI: 10.1177/23259671241257820
      Issue No: Vol. 12, No. 8 (2024)
       
  • Anterior Labrum Periosteal Sleeve Avulsion Lesions of the Shoulder: A
           Scoping Review

    • Authors: Senthilvelan Rajagopalan, Mounika N.S. Chodavarapu, Srinivas B.S. Kambhampati, Shyam Kumar Chinta, Srinath Kamineni
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Anterior labrum periosteal sleeve avulsion (ALPSA) lesion of the shoulder is defined as a labral avulsion with an intact periosteum of the glenoid neck resulting in medial malattachment of the labrum, which is both nonanatomic and nonfunctional. It is relatively rare compared with Bankart lesions, and its results are usually reported in combination with other anterior labroligamentous lesions in the literature.Purpose:To (1) assess the size and scope of the literature on ALPSA lesions, (2) highlight the importance of this lesion, and (3) distinguish between ALPSA and Bankart lesions in diagnostic and treatment strategies.Study Design:Scoping review; Level of evidence, 4.Methods:The PubMed, Scopus, Embase, and Google Scholar databases were searched with the keywords “ALPSA,”“anterior labrum periosteal sleeve avulsion,”“anterior labral periosteal sleeve avulsion,” and “anterior labroligamentous periosteal sleeve avulsion” lesion. Duplicate articles and those that did not meet the inclusion criteria were excluded, resulting in the identification of 42 relevant articles. Their references were analyzed for further data curation.Results:This scoping review demonstrated that ALPSA lesions are difficult to clinically identify. Magnetic resonance angiography in the adduction internal rotation position is the most sensitive and specific imaging modality for identification. Optimal views are the anterosuperior portal for accurate identification and the anteroinferior portal for surgical repair during arthroscopy. Treatment begins with correctly identifying the labrum, in contradistinction to dense reactive fibrous tissue, and reattaching the labrum to the correct anatomic glenoid footprint. Chronic lesions with bone loss require either bone block or soft tissue augmentation procedures.Conclusion:There is paucity of exclusive literature on ALPSA lesions. It is important to distinguish this lesion from the Bankart lesion as it is associated with worse outcomes. The higher failure rates of ALPSA lesion repair indicate that the current repair techniques require further refinement to improve the outcomes to the standard of Bankart lesions.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-23T12:19:59Z
      DOI: 10.1177/23259671241258198
      Issue No: Vol. 12, No. 8 (2024)
       
  • Relationship Between Revision Rate, Osteoarthritis, and Obesity for ACL
           Reconstruction: A Nationwide Retrospective Cohort Study

    • Authors: Junwoo Byun, Han-Kook Yoon, Hyun-Cheol Oh, Taemi Youk, Joong-Won Ha, Seungyeon Kang, Sang-Hoon Park
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:The long-term goal of anterior cruciate ligament (ACL) reconstruction is to prevent secondary osteoarthritis due to instability. Obesity itself is also a risk factor for osteoarthritis and shows an increase in its incidence, but little is known about the relationship between obesity and the outcome of ACL reconstruction.Purpose/Hypothesis:This study aimed to determine the relationship between the outcome of ACL reconstruction and obesity. It was hypothesized that obesity would be associated with the revision rate of ACL reconstruction and additional surgical treatment for osteoarthritis in patients who undergo ACL reconstruction.Study design:Cohort study; Level of evidence, 3.Methods:Claims and health screening data of the National Health Insurance Service were used to analyze patients who underwent ACL reconstruction between January 1, 2003, and December 31, 2021. The association between obesity and risk of revision ACL reconstruction and additional surgical treatment for osteoarthritis or meniscal lesion was analyzed. Body mass index (BMI) was used to classify patients as underweight (BMI, 40 years. For patients aged>50 years, 2.02-fold and 2.52-fold increased risks of TKA were observed for the overweight and obese groups, respectively. The risk of additional surgery due to the meniscal lesion was high for the overweight (HR, 1.09; 95% CI, 1.03-1.15; P = .002) and obese (HR, 1.10; 95% CI, 1.01-1.21; P = .0351) groups, while no significant difference was found for the underweight and morbidly obese groups.Conclusion:This study highlights that obesity does not increase the revision rate of ACL reconstruction. However, the risk of additional surgical treatment for osteoarthritis and meniscal lesions increased as BMI increased. Further investigation is needed to determine the efficacy of ACL reconstruction for preventing osteoarthritis in obese patients.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-21T03:17:30Z
      DOI: 10.1177/23259671241266597
      Issue No: Vol. 12, No. 8 (2024)
       
  • Hip Rotation and Femoral Anteversion and Its Influence on Traction Force
           of the Pulled Limb in Hip Arthroscopy

    • Authors: Guanying Gao, Jiayang Liu, Jingtao Duan, Jianquan Wang, Yan Xu
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Several variables may affect the traction force during hip arthroscopy. Specifically, the degree of hip joint rotation may influence the magnitude of traction force during hip arthroscopy. However, there is currently limited research available on this particular issue.Purpose:To quantify the traction force applied to the pulled limb in various traction states and rotational positions. Additionally, the study aimed to investigate potential correlations between femoral anteversion, BMI, anesthesia methods, and the traction force required for hip dislocation.Hypothesis:It was hypothesized that traction force in different traction states and rotational positions would be different and that femoral anteversion, body mass index (BMI), and anesthesia methods may influence the traction force needed.Study Design:Cross-sectional study; Level of evidence, 4.Methods:Patients who attended the sports medicine clinic of our department and underwent arthroscopic surgery for the diagnosis of femoroacetabular impingement between June and December 2022 were retrospectively evaluated. The traction force at the following 6 key timepoints was measured—initial traction, traction to the operable width, after joint puncture, after capsulotomy, at 20 minutes after capsulotomy, and at 40 minutes after capsulotomy. In each state, the hip was rotated to the internal rotational position, external rotational position, and neutral position. The traction force at different states and positions was recorded and analyzed. The differences in traction force between the different joint capsular physical states and rotational positions were tested by analysis of variance and the Tukey method. The Pearson test was used to analyze the correlation between BMI and femoral anteversion in different groups.Results:A total of 41 patients were included in this study. The traction force increased after reaching the operable width and decreased significantly after capsulotomy (P < .05). Thereafter, the traction force decreased gradually over time (P < .05). Traction force in the external and internal rotational positions was significantly greater than that in the neutral position, across all states of traction (P < .05). Furthermore, the difference in traction force between the internal and neutral positions, as well as the difference in traction force between the external and neutral positions, was found to be significantly greater than the difference in traction force between the internal and external rotational positions in all traction states (P < .05). The difference between the traction forces in different rotational positions of the hip joint exhibited a negative correlation with femoral anteversion (Pearson correlation coefficient of neutral-internal in states 3, 4, and 5 was –0.33, –0.31, –0.31, respectively; P < .05) and a positive correlation with BMI (Pearson correlation coefficient of external-neutral in states 4 and 6 was 0.33 and 0.36, respectively; P < .05).Conclusion:Our findings show that the traction force decreased after joint puncture and capsulotomy and decreased over time during surgery. External or internal rotation increased the traction force. Patients with higher femoral anteversion or lower BMI may need lower traction force. These data may help in minimizing traction forces to help prevent complications due to traction during hip arthroscopy.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-21T03:15:34Z
      DOI: 10.1177/23259671241263581
      Issue No: Vol. 12, No. 8 (2024)
       
  • Comparing Ultrasound and MRI Evaluations of the Hamstring Tendon for
           Predicting Autograft Size in Anterior Cruciate Ligament Reconstruction

    • Authors: Yi Qiao, Xiuyuan Zhang, Yu Zhao, Chenliang Wu, Caiqi Xu, Jie Chen, Jinzhong Zhao, Song Zhao
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Adequate graft size and length are crucial factors in anterior cruciate ligament (ACL) reconstruction. Accurate identification of patients who may be at risk for an insufficient length or size of the hamstring tendon (HT) can aid surgeons in preoperative planning.Purpose:To evaluate whether magnetic resonance imaging (MRI) or ultrasound could more accurately predict the size of the semitendinosus tendon (ST) and gracilis tendon (GT) and to investigate the correlation between anthropometry, graft size, and imaging measurements to find a predictive formula.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Included in the study were 36 patients who underwent ACL reconstruction with HT autograft at our institution between July 2021 and May 2022. Anthropometric data and MRI and ultrasound measurements were collected preoperatively. The length and diameter of the HT were recorded intraoperatively. Correlations between anthropometry, graft size, and imaging measurements were analyzed. Linear regression analysis was performed to construct a prediction formula.Results:The intraoperative graft diameters of the ST and GT were weakly to moderately associated with their cross-sectional areas as measured by MRI and ultrasound. MRI and ultrasound interpreted 11.9% to 15.7% and 18.4% to 41.7% of the variation in the graft diameter of the HT, with an accuracy of 50.0% to 55.6% and 69.4% to 86.1%, respectively. The intraoperative lengths of the ST and GT were both associated with patient height and tendon lengths as measured by ultrasound. Additionally, intraoperative GT length was associated with patient weight. Four formulas combining relevant anthropometric parameters and imaging measurements were calculated from multilinear regression analysis, explaining up to 46.3% of the variance in the size of HT.Conclusion:Ultrasound and MRI alone showed limited ability to predict the graft diameter of the ST and GT, while ultrasound could more accurately predict the graft size than MRI. Among the different anthropometric variables, height was the most influential in predicting tendon length.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-21T03:00:14Z
      DOI: 10.1177/23259671241248187
      Issue No: Vol. 12, No. 8 (2024)
       
  • Large Language Models in Orthopaedic Publications: The Good, the Bad and
           the Ugly

    • Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.

      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-21T02:20:49Z
      DOI: 10.1177/23259671241265705
      Issue No: Vol. 12, No. 8 (2024)
       
  • Clinical Outcomes Affecting Return to Play Following Latarjet Procedure in
           Young Contact and Limited Contact Athletes

    • Authors: Mathangi Sridharan, Akshar Patel, Erryk Katayama, Dane Swinehart, Ryan C. Rauck, Gregory L. Cvetanovich, Julie Y. Bishop
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Several studies have examined return to play (RTP) and outcomes following the Latarjet procedure in contact athletes.Purpose:To investigate clinical outcomes affecting RTP following the Latarjet procedure in contact athletes.Study Design:Case series; Level of evidence, 4.Methods:A total of 67 contact athletes (72 shoulders) ≤35 years old who underwent Latarjet procedure for recurrent shoulder instability between January 1, 2018, and March 31, 2022, were retrospectively identified. Demographic information, medical history, surgical history, number of dislocations before surgery, and postoperative complications up to 6 months after surgery were reviewed. Outcomes evaluated included RTP, competition level, satisfaction, and patient-reported outcomes including visual analog scale for pain, American Shoulder and Elbow Surgeons (ASES) Score, and Disabilities of the Arm, Shoulder and Hand (DASH) scores.Results:There were a total of 67 patients (72 shoulders) included in the study with a mean age at surgery of 19.7 years for all shoulders. Of the total cohort, 46 patients (50 shoulders; [69.4%]) were available for follow-up by phone. Of the 46 patients contacted by phone, 22/46 were football players; 30/50 [60.0% of all shoulders]) were contact athletes and 19/46 [41.3%] limited contact athletes) were interviewed with a mean follow-up of 25.5 months (range, 10-49 months). Of 72 patients, 22 (30.6% of shoulders and 32.8% of patients) patients had prior shoulder surgery, most commonly arthroscopic stabilization. Only 1 patient experienced hardware failure, but this did not require reoperation. Sixteen of 46 (35%) athletes competed at the collegiate level, and 24/46 (52%) were high school athletes at the time of surgery; 34 of 46 patients (74%) returned to play, of which 30 of the 34 (88%) returned to playing at the same competition level; 15 of 22 (68%) football players returned to play. Only 4 of 51 (8%) reported subjective recurrent instability. Postoperative mean ASES score was 92.2, DASH score was 5.6, and visual analog scale for pain score was 4 (range, 0-50). A total of 43 of 46 (93%) patients reported improvement in quality of life after undergoing the Latarjet procedure for shoulder instability. Eight of 72 (11.1%) shoulders had unresolved pain or stiffness 6 months postoperatively, and 2 of 72 (2.8%) required revisions.Conclusion:Patient RTP, outcomes, and satisfaction were high following the Latarjet procedure in young contact athletes.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-20T10:35:10Z
      DOI: 10.1177/23259671241265029
      Issue No: Vol. 12, No. 8 (2024)
       
  • Return to Play After Arthroscopic Management of Rotator Cuff Tears in
           Professional Athletes of Contact Sports

    • Authors: Gautam P. Yagnik, Patrick F. Szukics, Jacob R. Seiler, Jonas W. Ravich, Luis A. Vargas, John E. Zvijac, John W. Uribe
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Rotator cuff tears are rare injuries in professional athletes who participate in contact sports, and limited data exist to guide players and team physicians regarding outcomes after surgical management.Purpose:To report the outcomes and return-to-play rates of professional contact sport athletes who underwent arthroscopic management of rotator cuff tears.Study Design:Case series; Level of evidence, 4.Methods:All professional athletes of contact sports who underwent arthroscopic management of a rotator cuff tear between 2002 and 2019 at the institution were identified. Patient information collected were age, sport, position, date of injury, date of surgery, and time to return to play; surgical data included tear size, acuity, pattern, and procedure performed. The primary outcome measure was the ability to return to play and the number of games played after surgery.Results:Overall, 10 rotator cuff tears in 9 professional athletes (8 tears in football players and 2 tears in hockey players) were identified; 9 of the tears were full-thickness tears that underwent arthroscopic single-row repair, while 1 was a partial tear that was debrided. Of the 9 athletes, 8 were able to return to play at the same level, at a mean time of 9.5 ± 4.3 months. The mean playing time after surgery was 32 ± 25 games (2.7 ± 2 seasons) for the football players and 22 games (1 season) for the hockey player who returned. Postoperative imaging was available in 8 of the 10 tears, and 7 of 8 (88%) demonstrated a healed repair. One football player and 1 hockey player with large (>3 cm) full-thickness tears did not return to play. The mean age of these players was 34.5 years and both had>10 years of professional playing experience.≥Conclusion:The study findings demonstrated that the majority (80%; n = 8) of the professional athletes in contact sports in this series were able to return to play at the same level after arthroscopic management of a symptomatic rotator cuff tear.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-20T10:33:30Z
      DOI: 10.1177/23259671241264166
      Issue No: Vol. 12, No. 8 (2024)
       
  • Association of Smaller Intercondylar Notch Size With Graft Failure After
           Anterior Cruciate Ligament Reconstruction

    • Authors: Jonathan D. Hughes, Stephanie A. Boden, Rebekah Belayneh, Jenna Dvorsky, Asher Mirvish, Brian Godshaw, Mikael Sansone, Jon Karlsson, Volker Musahl
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Smaller intercondylar notch sizes have been consistently associated with a predisposition for primary anterior cruciate ligament tears.Purpose:To evaluate the association between intercondylar notch size, graft size, and postoperative complications, including knee stiffness and return to the operating room, after primary anatomic anterior cruciate ligament reconstruction (ACLR).Study Design:Case-control study; Level of evidence, 3.Methods:This was a retrospective analysis of prospectively collected data from consecutive patients who underwent anatomic single-bundle primary ACLR using a bone-patellar tendon-bone or quadriceps tendon autograft performed by fellowship-trained orthopaedic sports medicine surgeons between April 2009 and August 2019. Graft failure was defined as patient report of instability, pathologic laxity on clinical examination, or graft rerupture confirmed by magnetic resonance imaging and/or subsequent arthroscopy. To ensure the purposeful selection of covariates, univariate analyses were conducted on the list of potential confounders selected a priori, and those with a significance value of P < .10 were considered for the multivariate regression model. Covariates found to be statistically significant with univariate analysis were patient age, notch size, and graft type. After validating all potential covariates, they were added to the regression model and then eliminated in a stepwise fashion.Results:In total, 252 patients were included for analysis (99 bone-patellar tendon-bone and 153 quadriceps tendon autograft; age, 22.2 ± 7.0 years; graft size, 9.8 ± 1.0 mm; time to follow-up, 50.4 ± 28.9 months). Knee stiffness developed in 23 patients (9.1%), and 15 grafts failed (6.0%). Smaller notch size on magnetic resonance imaging was significantly associated with graft failure (P = .005). There was a significantly higher risk of graft failure with notch size
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-20T10:33:00Z
      DOI: 10.1177/23259671241263883
      Issue No: Vol. 12, No. 8 (2024)
       
  • Patient Perception of Allograft Versus Autograft in ACL Reconstruction
           Using a Validated Online Survey Marketplace

    • Authors: Robert S. Dean, Tanner J. Hafen, Collin L. Braithwaite, Kevin X. Farley, Robert F. LaPrade, Joseph H. Guettler, James Bicos
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Little is known regarding the opinions of the general population on anterior cruciate ligament (ACL) graft options.Purpose:To evaluate the general population's perception of the use of allografts versus autografts in ACL reconstruction using a previously validated online marketplace platform.Methods:A prospective 34-question survey was distributed via the online marketplace. After collecting baseline demographics, participant preferences for ACL reconstruction with an allograft or autograft were established. All respondents completed a preeducation survey, reviewed an evidence-based education sheet, and completed a posteducation survey to assess their understanding. Upon completion, participants were asked which graft they would prefer. Participants were then asked if they would be willing to change their preference based on surgeon recommendation. Finally, participants were asked to rank the factors from the education sheet that were most influential.Study Design:Cross-sectional study.Results:There were 491 participants that completed the survey (mean age, 39.9 years [range, 19-72 years]; 244 male, 241 female, and 6 nonbinary/third-gender participants). Before reading the education sheet, 276 (56%) reported no graft preferences, 146 (30%) preferred autograft, and 69 (14%) preferred allograft. After reading the provided sheet, 226 (46%) participants preferred autograft, 185 (38%) preferred allograft, and 80 (16%) had no preference. The mean score on the preeducation test was 45%, and the mean score on the posteducation test was significantly greater (61%; P < .01). Overall, 345 participants (83.9%) stated they would change their preference for autograft or allograft if their surgeon recommended it. Surgeon preference (n = 330; 67%), educational information provided (n = 117; 24%), and previous knowledge (n = 44; 9%) were the most important factors for making graft selections. The mean ages of the participants selecting each graft type before and after education were as follows: allograft (37.8 ± 10.1 vs 40.6 ± 11.8 years; P = .05), autograft (38 ± 11.5 vs 39.5 ± 10.1 years; P = .21), and no preference (41.5 ± 11.2 vs 39.4 ± 11.8 years; P = .16).Conclusion:Education resulted in a greater number of individuals’ reporting a preference in graft type (either allograft or autograft) compared with preinformation questioning. In addition, 83.9% of the participants were willing to switch their graft choice if recommended by their surgeon.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-20T10:32:33Z
      DOI: 10.1177/23259671241263853
      Issue No: Vol. 12, No. 8 (2024)
       
  • Ensemble Algorithm for Risk Prediction of Clinical Failure After Anterior
           Cruciate Ligament Reconstruction

    • Authors: Tianlun Zhang, Zipeng Ye, Jiangyu Cai, Jiebo Chen, Ting Zheng, Junjie Xu, Jinzhong Zhao
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Patient-specific risk profiles of clinical failure after anterior cruciate ligament reconstruction (ACLR) are meaningful for preoperative surgical planning and postoperative rehabilitation guidance.Purpose:To create an ensemble algorithm machine learning (ML) model and ML-based web-based tool that can predict the patient-specific risk of clinical failure after ACLR.Study Design:Cohort study; Level of evidence, 3.Methods:Included were 432 patients (mean age, 26.8 ± 8.4 years; 74.1% male) who underwent anatomic double-bundle ACLR with hamstring tendon autograft between January 2010 and February 2019. The primary outcome was the probability of clinical failure at a minimum 2-year follow-up. The authors included 24 independent variables for feature selection and model development. The data set was split randomly into training sets (75%) and test sets (25%). Models were built using 4 ML algorithms: extreme gradient boosting, random forest, light gradient boosting machine, and adaptive boosting. In addition, a weighted-average voting (WAV) ensemble model was constructed using the ensemble-voting technique to predict clinical failure after ACLR. Concordance (area under the receiver operating characteristic curve [AUC]), calibration, and decision curve analysis were used to evaluate predictive performances of the 5 models.Results:Clinical failure occurred in 73 of the 432 patients (16.9%). The 8 most important predictors for clinical failure were follow-up period, high-grade preoperative knee laxity, time from injury to ACLR, participation in competitive sports, posterior tibial slope, graft diameter, age at surgery, and medial meniscus resection. The WAV ensemble algorithm achieved the best predictive performance based on concordance (AUC, 0.9139), calibration (calibration intercept, –0.1806; calibration slope, 1.2794; Brier score, 0.0888), and decision curve analysis (greatest net benefits) and was used to develop an web-based application to predict a patient's clinical failure risk of ACLR.Conclusion:The WAV ensemble algorithm was able to accurately predict patient-specific risk of clinical failure after ACLR. Clinicians and patients can use the web-based application during preoperative consultation to understand individual prediction outcomes.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-19T02:03:22Z
      DOI: 10.1177/23259671241261695
      Issue No: Vol. 12, No. 8 (2024)
       
  • Prognostic Factors on Preoperative MRI for Patient-Reported Outcomes After
           Posterior Medial Meniscus Root Repair

    • Authors: Sergio E. Flores, Rawee Manatrakul, Christopher Anigwe, Chotigar Ngarmsrikam, Brian T. Feeley, C. Benjamin Ma, Thomas M. Link, Drew A. Lansdown
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Repair of posterior medial meniscus root (PMMR) tears has demonstrated favorable outcomes and may prevent rapid progression of knee osteoarthritis; however, there is a paucity of data regarding prognostic factors affecting postoperative outcomes.Purpose/Hypothesis:The purpose of this study was to identify factors on preoperative magnetic resonance imaging (MRI) that predict postoperative outcomes after PMMR repair. It was hypothesized that patients with increasing levels of degenerative changes as evaluated through semiquantitative preoperative MRI scans would have worse postoperative patient-reported outcome (PRO) scores.Study Design:Cohort study; Level of evidence, 3.Methods:Patients who underwent PMMR repair between 2012 and 2020 and had minimum 2-year follow-up data were enrolled. Pre- and postoperative visual analog scale pain scores and postoperative PRO surveys including the Patient-Reported Outcomes Measurement Information System–Physical Function, Lysholm knee score, and Knee injury and Osteoarthritis Outcome Score (KOOS) were collected. Patients who achieved the Patient Acceptable Symptom State (PASS) on the KOOS subscales were reported. Two fellowship-trained musculoskeletal radiologists reviewed preoperative MRIs and calculated the Whole-Organ Magnetic Resonance Imaging Score for meniscus, cartilage, bone marrow edema–like lesions (BMELL), and meniscal extrusion. Statistical analysis was performed using the 2-sample t test, Mann-Whitney test, and Fisher exact test for categorical variables.Results:A total of 29 knees in 29 patients were evaluated (22 female, 7 male; mean age at surgery, 52.3 ± 9.9 years; body mass index, 27.6 ± 5.6 kg/m2; mean follow-up, 59.6 ± 26.5 months). Visual analog scale for pain scores decreased significantly from preoperatively (4.9 ± 2.0) to final follow-up (1.6 ± 1.9) (P < .001), and the percentage of patients meeting the PASS ranged from 44.8% for KOOS Sport and Recreation to 72.4% for KOOS Pain and KOOS Quality of Life. Patients with medial tibial BMELL (MT-BMELL) had significantly lower KOOS Symptoms scores (76.1 ± 17.3 vs 88.4 ± 9.7 without MT-BMELL; P = .032). Cartilage quality and presence of meniscal extrusion were not associated with outcomes.Conclusion:Patients with MT-BMELL on their preoperative MRI in the setting of PMMR tear were found to have worse KOOS Symptoms scores after PMMR repair.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-19T02:02:43Z
      DOI: 10.1177/23259671241263648
      Issue No: Vol. 12, No. 8 (2024)
       
  • The Intra-articular Tendinous Graft Diameter of 10-mm Bone–Patellar
           Tendon–Bone Autografts in Adolescent Patients: An MRI Analysis of 100
           Patients

    • Authors: Samuel A. Beber, Ruth H. Jones, Peter Cirrincione, Preston W. Gross, Daniel W. Green, Harry G. Greditzer, Benton E. Heyworth, Peter D. Fabricant
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Bone–patellar tendon–bone (BPTB) autograft size may be one modifiable predictor of anterior cruciate ligament (ACL) reconstruction postoperative success, as smaller graft diameter has been associated with higher rates of rupture requiring revision. However, measuring the true intra-articular tendinous graft diameter of the soft tissue portion of a BPTB graft with standard intraoperative methods is difficult while keeping the graft intact.Purpose/Hypothesis:The purpose of the study was to use 3-dimensional magnetic resonance imaging (MRI) measurements to determine the cross-sectional area of the soft tissue, tendinous portion of a standard BPTB autograft with 10-mm diameter bone plugs, and, by calculation, the collagen graft size (ie, graft diameter), as would typically be reported in ACL reconstruction studies that consider soft tissue graft size. It was hypothesized that the calculated collagen graft diameter of 10-mm BPTB autografts would be significantly smaller than 10 mm.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 100 patients (10 girls and 10 boys at each age from 13 to 17 years) who underwent a knee MRI at a single academic orthopaedic center without documented extensor mechanism pathology were identified. The central 10-mm width of the patellar tendon that would be harvested for BPTB autograft was measured. The region of interest area tool was then used to measure the cross-sectional area of a 10-mm BPTB graft with subsequent soft tissue autograft diameter calculation.Results:The mean calculated tendinous graft diameter of a 10 mm–wide BPTB graft was 6.3 ± 0.5 mm and was significantly smaller than a 10-mm reference (P≤ .001). There was no significant association between age and cross-sectional area or graft diameter.Conclusion:Modern 3-dimensional imaging-based measurement techniques demonstrated that the true intra-articular tendinous soft tissue portion of 10-mm BPTB autografts shows substantial variation and is significantly smaller in diameter than the tunnels typically reamed to accommodate the bone plug portions of these grafts. Moreover, as graft size is a predictor of rupture rate, preoperative MRI-based evaluation may be an important tool when considering BPTB autograft for ACL reconstruction. Future comparative clinical research utilizing graft size as a study variable should consider quantifying and utilizing the diameter of the soft tissue component of BPTB autografts.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-19T02:02:15Z
      DOI: 10.1177/23259671241264503
      Issue No: Vol. 12, No. 8 (2024)
       
  • The 25 Most Cited Articles in Pediatric Orthopaedic Sports Medicine

    • Authors: Stefano DiCenso, R. Justin Mistovich
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Citation analysis reflects the influence a work has on a field of research and can be used to identify “classic” works and their qualities in medical specialties. By analyzing the characteristics of these works, we intended to determine what qualities make for a highly cited work in pediatric orthopaedic sports medicine.Purpose:To identify the top 25 most cited articles in the field of pediatric orthopaedic sports medicine.Study Design:Cross-sectional study.Methods:The Science Citation Index Expanded feature within the Web of Science database was searched using a Boolean string, generating 2008 pediatric orthopaedic sports medicine articles arranged by number of citations. The top 25 most cited articles were reviewed for authors, year of publication, source journal, country of origin, region of origin, diagnosis or condition of focus, and level of evidence (LOE).Results:Most of the articles were published in the 2000s (range, 1992-2016). The mean number of citations was 166 (range, 119-329), and the mean citation density was 13.25 (range, 4.25-29.57). There were 18 of 25 studies performed in the United States. A plurality of the articles were published in the American Journal of Sports Medicine. The LOE ranged from 2 to 4, with the most common being level 2 (11/25). Anterior cruciate ligament (ACL) injury management (14/25) and epidemiological studies on the incidence of various sports injuries (6/25) were the most represented topics of study. Since the 1990s, the mean citation density for articles related to ACL injuries in young athletes and the epidemiology of sports injuries has been increasing.Conclusion:This evaluation demonstrated that ACL injuries and the epidemiology of sports injuries had the highest citation density of the most influential studies in pediatric orthopaedic sports medicine. We identified attributes such as country of publication, journal of publication, and LOE that make for a highly cited pediatric orthopaedic sports medicine article. Overall, citation density in pediatric sports medicine is increasing. Nonetheless, the most represented LOE in the most cited works is level 2, with no level 1 studies being represented in the top 25. In terms of both topics and LOE, this study allows surgeons to identify deficiencies in the existing literature and meaningfully design future studies to improve on these.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-16T08:50:59Z
      DOI: 10.1177/23259671241260049
      Issue No: Vol. 12, No. 8 (2024)
       
  • Influence of Lead Knee Extension on Ball Velocity and Elbow Varus Torque
           in Professional and High School Baseball Pitchers

    • Authors: Brittany Dowling, Alexander Hodakowski, Christopher M. Brusalis, Micheal J. Luera, Calvin D. Smith, Nikhil N. Verma, Grant E. Garrigues
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:When the lead leg of a pitcher contacts the ground, the knee braces and then rapidly extends, initiating energy transfer to begin pelvis and trunk rotation.Purpose:To investigate the relationship of lead knee extension during the pitching delivery with peak lead knee extension velocity, ball velocity, and elbow varus torque in high school and professional pitchers.Study Design:Descriptive laboratory study.Methods:Data from 50 professional (PRO) and 50 high school (HS) pitcher groups were retrospectively analyzed. Pitchers threw 8 to 12 fastballs under 3-dimensional motion analysis (480 Hz). The groups were divided according to high or low lead knee extension: PRO-high (n = 18), PRO-low (n = 16), HS-high (n = 16), and HS-low (n = 17). Lead knee flexion, lead knee extension velocity, ball velocity, and elbow varus torque were analyzed between groups. Regression analyses were performed to quantify associations between lead knee extension and ball velocity and elbow varus torque for all pitchers.Results:At foot contact, all pitchers landed with similar knee flexion. PRO-high and HS-high pitchers had significantly greater lead knee extension through remaining pitching time points compared with the PRO-low and HS-low pitchers. PRO-high pitchers had faster ball velocity than PRO-low pitchers (39.8 ± 1.1 vs 39.3 ± 1.3 m/s, respectively), and HS-high pitchers had faster ball velocity than HS-low pitchers (34.1 ± 2.6 vs 31.2 ± 1.8 m/s, respectively) (P < .05). PRO-high pitchers had decreased elbow varus torque compared with PRO-low pitchers (85.3 ± 10.7 vs 95.4 ± 13.3 N·m, respectively); conversely, HS-high pitchers had greater elbow varus torque than HS-low pitchers (64.2 ± 14.7 vs 56.3 ± 12.2 N·m, respectively). For every 1° increase in lead knee extension, ball velocity increased by 0.47 m/s (P < .001) and elbow varus torque increased by 0.27 N·m (P = .025).Conclusion:Proper lead knee extension allowed efficient energy transfer through the kinetic chain to produce optimal ball velocity and minimize elbow varus torque in professional pitchers. Conversely, while proper lead knee extension improved ball velocity among high school pitchers, this did not minimize elbow varus torque.Clinical Relevance:Professional pitchers can extend their lead knee with minimal impact at the elbow. In high school pitchers, cognizance of proper full-body pitching mechanics remains a priority over increased velocity.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-16T08:50:29Z
      DOI: 10.1177/23259671241257539
      Issue No: Vol. 12, No. 8 (2024)
       
  • Effect of Different Screw Materials on ACL Reconstruction With the Tape
           Locking Screw Technique: A Retrospective Study From the FAST Cohort

    • Authors: Hasan Basri Sezer, Yoann Bohu, Alexandre Hardy, Adam Coughlan, Nicolas Lefevre
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Screws for graft fixation are available in 3 different materials for anterior cruciate ligament reconstruction (ACLR) with the Tape Locking Screw (TLS) technique: titanium, poly-l-lactic acid bioabsorbable, and polyetheretherketone (PEEK).Purpose:To compare the effect of the 3 different fixation materials on graft and implant survival after ACLR with the TLS technique.Study Design:Cohort study; Level of evidence, 3.Methods:Included were 521 patients from the French Prospective ACL Study (FAST) cohort who underwent primary surgical ACLR with the TLS technique. Patients were divided into 3 groups depending on the type of screw material used: titanium (TLS-T group), poly-l-lactic acid bioabsorbable (TLS-B group), or PEEK (TLS-P group). The primary endpoint was a retear within 2 years after ACLR. The secondary endpoints were complication rate, return to sports rate, and functional scores. Objective and subjective functional scores—including the International Knee Documentation Committee, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm score—were evaluated preoperatively and at the 2-year follow-up. Pain was assessed with the KOOS-Pain subscore recorded pre- and postoperatively every 6 months up to 2 years. Patient satisfaction was recorded at the 2-year follow-up.Results:No significant differences between the study groups were found in retear rates (4.4%, 4.5%, and 4.3% in the TLS-T, TLS-P, and TLS-B groups 2 years after surgery) or subjective and objective outcomes. The TLS-T group had the lowest rate of intraoperative implant-related complications (0.9%) compared with the TLS-P (4.3%) and TLS-B (7.7%) groups. Young age was a significant risk factor for retear in the TLS-T (P = .03) and TLS-B (P = .0001) groups, while a high level of sports was found to be a significant risk factor in the TLS-P (P = .04) group. All functional scores improved significantly at the 2-year follow-up (P < .0001), with no significant group difference. The KOOS-Pain subscore improved continuously with no significant group difference. The rate of return to preinjury sports was between 43.4% and 58.6%. The rate of highly satisfied patients at the final follow-up was between 86.2% and 91.8%.Conclusion:There was no difference in retear rate or objective and subjective functional scores between implant materials for TLS ACLR in this study.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-16T08:49:49Z
      DOI: 10.1177/23259671241258505
      Issue No: Vol. 12, No. 8 (2024)
       
  • Hormonal Contraceptive Influence on Baseline Vestibular/Ocular
           Symptomatology and Provocation for Concussion

    • Authors: Ryan N. Moran, J. Russell Guin, Christian Roehmer, Nicholas G. Murray
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Hormonal contraceptives (HCs) and the menstrual cycle have been suggested to affect symptom severity and postconcussion recovery. Additionally, hormones have been a suggested rationale for sex differences between female and male athletes on concussion assessment. Researchers have yet to explore the effects of HC use on baseline symptomatology, including symptom reporting and provocation.Purpose:To examine the influence of HC use on a baseline symptom reporting and vestibular/ocular provocation battery.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 61 college-aged individuals (21 HC-using women, 21 non–HC-using women, 19 men) were administered a baseline symptom battery consisting of the Post-Concussion Symptom Scale (PCSS), Headache Impact Test-6 (HIT-6), Pediatric Vestibular Symptom Questionnaire (PVSQ), and Vestibular/Ocular Motor Screening (VOMS). The main outcome measures consisted of PCSS symptom reporting (total symptoms, symptom severity score, and symptom factors), HIT-6 and PVSQ total scores, and VOMS item (ie, saccades, convergence, or vestibular/ocular reflex) symptom provocation scores.Results:Significant differences were reported on HIT-6, with the highest headache reporting in the HC group (P = .026). On the PVSQ, the HC group also reported greater dizziness and unsteadiness symptoms than the non-HC group (P = .023). Similar findings existed on the PCSS, with the HC group reporting greater total symptoms (P < .001), symptom severity (P < .001), and vestibular-somatic (P = .024), cognitive-sensory (P = .004), sleep-arousal (P = .001), and affective (P < .001) factors compared with the non-HC group. Smooth pursuit (ie, following finger smoothly with eyes) was the only VOMS items with differences between groups (P = .003), with the HC group having greater provocation compared with non-HC users (P = .020).Conclusion:HC use was associated with overall symptomatology and worse self-reported symptoms on vestibular-related inventories and concussion symptom scales and factors when compared with non-HC users and male controls. Additionally, HC users reported higher VOMS provocation scores on the smooth pursuit item than non-HC users and male controls.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-16T08:48:50Z
      DOI: 10.1177/23259671241259735
      Issue No: Vol. 12, No. 8 (2024)
       
  • Medial Meniscectomy at the Time of ACL Reconstruction Is Associated With
           Postoperative Anterior Tibial Translation: A Retrospective Analysis

    • Authors: Andrew Fithian, Aditya Manoharan, Michael Chapek, Virginia Xie, Jacob Ghahremani, Mckenzie Culler, Tanya Watarastaporn, Najeeb Khan
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Medial meniscal pathology and management have not been associated with postoperative anterior tibial translation (ATT) after anterior cruciate ligament reconstruction (ACLR).Purpose:The purpose of this study was to evaluate the role of medial meniscal injury and treatment on pre- and postoperative ATT in the setting of primary ACLR. More specifically, the association between repairable medial meniscal tears, medial meniscectomy, and postoperative ATT, along with rates of revision surgery, was examined.Study Design:Cohort study; Level of evidence, 3.Methods:A retrospective review was performed for patients who underwent ACLR between January 1, 2010 and December 31, 2015 at a single center. Descriptive data were obtained from an institutional database for a total of 396 patients included in this study and followed for 1 year postoperatively. Statistical analysis was performed to examine associations of meniscal treatment with postoperative ATT measurements made by KT-1000 arthrometer.Results:A total of 243 patients underwent isolated ACLR with autograft, 72 patients underwent autograft ACLR and partial medial meniscectomy (MMx) (ACLR + MMx), and 81 patients underwent autograft ACLR and medial meniscal repair (MMR) (ACLR + MMR). Patients with ACLR + MMx had higher mean age and body mass index compared with patients in the other groups. Patients who underwent ACLR + MMx had greater postoperative side-to-side ATT compared with patients undergoing ACLR (1.55 mm vs 1.07 mm; P = .04) or patients undergoing ACLR + MMR (1.55 mm vs 1.01 mm; P = .03). The ACLR + MMx group was less likely to have symmetric (
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-15T02:02:20Z
      DOI: 10.1177/23259671241263096
      Issue No: Vol. 12, No. 8 (2024)
       
  • Impaired Symmetry in Single-Leg Vertical Jump and Drop Jump Performance 7
           Months After ACL Reconstruction

    • Authors: Quentin Giacomazzo, Brice Picot, Thomas Chamu, Pierre Samozino, Benoit Pairot de Fontenay
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Anterior cruciate ligament reconstruction (ACLR) continues to be associated with a variable rate of return to sports and a concerning rate of further anterior cruciate ligament injury. Persistent functional deficits may explain these results and support the need to keep exploring lower limb functional indexes, especially during vertical jumping. This would help improve rehabilitation through the return-to-sports continuum and improve postoperative outcomes.Hypothesis:Vertical jumping performance indexes are impaired among patients 7 months after ACLR.Study Design:Cross-sectional study; Level of evidence, 3.Methods:A total of 202 patients who underwent ACLR and 50 healthy participants performed single-leg vertical jump (SLVJ) and single-leg drop jump (SLDJ) testing. Jump height (H) as well as reactive strength index (RSI) were assessed and the limb symmetry index (LSI) of each parameter was compared between both groups. Vertical jumping indexes were also compared between healthy participants and the injured and contralateral legs of ACLR patients. Frequency analysis (chi-square test) of participants exhibiting an LSI>90% for each parameter was calculated in both groups. The level of association between SLVJ-H, SLDJ-H, and SLDJ-RSI was evaluated using the Pearson coefficient (r).Results:At 6.6 ± 0.7 months (mean ± SD) postoperatively, participants after ACLR exhibited poorer LSI than the control group for all parameters (79.1 ± 14.8 vs 93.9 ± 4.5, 77.3 ± 14.6 vs 93.4 ± 5.2, and 71.9 ± 17.4 vs 93.4 ± 3.8; all P < .001; for the SLVJ-H, SLDJ-H, and SLDJ-RSI, respectively). Vertical jumping performance was lower on both injured and contralateral legs compared with healthy participants (all P < .001). Only 27%, 25%, and 16% of the ACLR patients exhibited an LSI>90% for the SLVJ-H, SLDJ-H, and SLDJ-RSI, respectively, in comparison with 80%, 72%, and 86% in the control group. Moderate correlations were observed between SLDJ-H and SLVJ-H (r = 0.494; P < .001) as well as between SLDJ-RSI and SLVJ-H (r = 0.488; P < .001) in the ACLR group.Conclusion:Vertical jumping indexes (both symmetry and absolute values) were highly impaired 7 months after ACLR. Deficits were more marked for reactive strength ability. Clinicians should focus on restoring vertical jumping abilities to improve functional performance after ACLR.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-15T02:01:50Z
      DOI: 10.1177/23259671241263794
      Issue No: Vol. 12, No. 8 (2024)
       
  • Prevalence of Concomitant Injuries by Sport in Pediatric Patients With ACL
           Rupture

    • Authors: Lucas A. Blumenschein, David A. Kolin, Peter D. Fabricant, Joshua Park, Allison Gilmore, Mark Seeley, R. Justin Mistovich
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Although the risk of concomitant injury with anterior cruciate ligament (ACL) tears as a function of specific sports participation has been studied in adults, the topic has not been examined in pediatric and adolescent patients.Purpose/Hypothesis:The purpose of the study was to determine if certain sports were associated with a higher risk of concomitant injuries in the setting of an ACL tear. It was hypothesized that the risk of concomitant injuries with ACL tears will differ by type of sport participation in the pediatric population.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Patients ≤18 years old from 2 tertiary children's hospitals who had undergone primary ACL reconstruction between 2006 and 2018 were included. Sport at the time of injury, demographic factors, and injury pattern (medial meniscal [MM] tears, lateral meniscal [LM] tears, posterior cruciate ligament [PCL] tears, medial collateral ligament [MCL] tears, lateral collateral ligament [LCL] tears, and any concomitant injury) were identified.Results:A total of 855 patients with a mean age of 15.5 ± 1.7 years (range, 7-22 years) met the inclusion criteria. Of the included patients, 353 (41.3%) had an isolated ACL tear. A concomitant MM tear was identified in 27.6% of patients, LM tear in 42.9%, PCL injury in 0.4%, MCL injury in 3.0%, and LCL injury in 0.5%. There was no difference in the likelihood of concomitant MM injuries by sex (29.3% for male patients vs 26% for female patients; P = .31) or by sex within basketball (29.3% for male patients vs 25.6% for female patients; P = .96) or soccer (32.3% vs 26.3%; P = .06). Boys had higher proportions of LM injuries overall (51.7% for male patients vs 34.6% for female patients; P < .001) but not within the basketball subgroup (50.5% vs 40.0%; P = .86) or the soccer subgroup (59.7% vs 40.0%; P = .19). No statistically significant associations were found between patient age and specific ACL concomitant injury patterns. When stratifying by body mass index, it was found overweight and obese individuals constituted a greater proportion of LM (49.6% vs 39.1%; P = .01) but not MM (29.4% vs 25.5%; P = .28) injuries when compared to normal-weight patients. Using basketball as the comparison group, soccer and football injuries were 18% more likely to result in any concomitant injury, including concomitant MM, LM, PCL, MCL, and LCL injuries.Conclusion:In the pediatric population, soccer and football players were more likely to present with a concomitant injury in addition to ACL injury relative to basketball players. This study aids in understanding sport-associated ACL injury patterns and can help physicians with patient counseling and injury prevention.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-15T02:00:46Z
      DOI: 10.1177/23259671241260051
      Issue No: Vol. 12, No. 8 (2024)
       
  • Incidence of Osteoarthritis Between ACL Reconstruction With Different
           Graft Types and Between ACL Reconstruction and Repair: A Systematic Review
           and Meta-analysis of Randomized Controlled Trials

    • Authors: Tom Vendrig, Michèle N.J. Keizer, Reinoud W. Brouwer, Roy A.G. Hoogeslag
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Variation in stiffness, fixation methods, and donor-site morbidity after anterior cruciate ligament reconstruction (ACLR) with different graft types and with anterior cruciate ligament suture repair (ACLSR) can lead to differences in dynamic knee laxity and consequent differences in posttraumatic osteoarthritis (PTOA) development.Purpose:To compare the incidence of PTOA between different graft types used for primary ACLR and between primary ACLR and ACLSR. It was hypothesized that the incidence of PTOA would vary between ACLR with different autografts and allografts and between ACLR and ACLSR.Study Design:Systematic review; Level of evidence, 1.Methods:A search of the literature was performed to identify all randomized controlled trials (RCTs) comparing radiographic evidence of PTOA after ACLR between different graft types—hamstring tendon (HT) autograft, bone-patellar tendon-bone (BPTB) autograft, quadriceps tendon autograft, and allograft—and between ACLR and ACLSR. The minimum follow-up was 2 years. Study quality was assessed using the modified Coleman Methodology Score. A meta-analysis was performed to determine whether there was a difference in the incidence of PTOA between the different graft types and between ACLR and ACLSR.Results:Eleven randomized controlled trials were included in the meta-analysis—HT: 440 patients (mean follow-up, 9.7 years); BPTB: 307 patients (mean follow-up, 11.8 years); allograft: 246 patients (mean follow-up, 5 years); ACLSR, 22 patients (5 years). No study reporting the incidence after ACLR with quadriceps tendon was included. The study quality ranged from 70 to 88. The meta-analysis indicated no significant difference in the incidence of PTOA between graft types used for ACLR and between ACLR and ACLSR (risk ratios: HT vs BPTB, 1.05; HT vs allograft, 0.81; BPTB vs allograft, 0.82; HT vs ACLSR, not estimable [P> .05 for all]). The combined number of patients with PTOA in all studies per graft type showed that patients who underwent ACLR with a BPTB autograft had the highest percentage of PTOA (HT, 23.4%; BPTB, 29.6%; allograft, 8.1%; ACLSR, 0%). However, excluding studies with a follow-up
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-14T02:07:56Z
      DOI: 10.1177/23259671241258775
      Issue No: Vol. 12, No. 8 (2024)
       
  • The Role of Humeral Torsion on Glenohumeral Rotation in Injured Baseball
           Players

    • Authors: Kalie Entler, J. Kaylin Kruseman, Sean M. Kennedy, John E. Conway, Griffin J. Reyes, J. Craig Garrison, Lane B. Bailey, Natalie L. Myers
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Differences in rotational range of motion (ROM) compared to humeral retrotorsion (HRT)–corrected rotational ROM exist in healthy baseball athletes, but it is unclear whether these differences exist in a pathological population.Purpose/Hypothesis:The purpose of this study was to determine if there are disparities between objectively measured differences in ROM and HRT-corrected deficits in injured baseball players. It was hypothesized that disparities would exist between (1) the side-to-side difference in glenohumeral external rotation (GER) and the HRT-corrected glenohumeral external rotation deficit (GERD) and (2) the side-to-side difference in glenohumeral internal rotation (GIR) and the HRT-corrected glenohumeral internal rotation deficit (GIRD).Study Design:Cross-sectional study; Level of evidence, 3.Methods:Data from 172 baseball players with shoulder or elbow injuries (45 shoulder, 127 elbow) were reviewed in July 2023. GER and GIR were measured on the injured and noninjured sides of all players, and diagnostic ultrasound was used to measure HRT. Dependent t tests were run to compare the side-to side differences in GER and GIR with the HRT-corrected GERD and GIRD, respectively.Results:In the players with a shoulder injury, there was a significant disparity between the side-to-side difference in GER and the HRT-corrected GERD (2°± 14° vs −13°± 15°, respectively) and between the side-to-side difference in GIR and the HRT-corrected GIRD (–14°± 8° vs 2°± 9°, respectively) (P < .001 for both). Similarly, players with an elbow injury had significant disparities between the side-to-side difference in GER and the HRT-corrected GERD (6°± 9° vs −10°± 9°, respectively) and between the side-to-side difference in GIR and the HRT-corrected GIRD (–12°± 8° vs 4°± 10°, respectively) (P < .001 for both).Conclusion:The results supported our hypothesis that there were disparities between objectively measured differences in GER and GIR compared with the HRT-corrected GERD and GIRD in injured baseball players. Consideration must be given to osseous adaptations that occur at the glenohumeral joint when evaluating and treating this population.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-14T02:07:01Z
      DOI: 10.1177/23259671241260084
      Issue No: Vol. 12, No. 8 (2024)
       
  • Patient Preferences for Graft Selection in Anterior Cruciate Ligament
           Reconstruction

    • Authors: Christian Pearsall, Aaron Z. Chen, Abed Abdelaziz, Bryan M. Saltzman, Dana P. Piasecki, Charles A. Popkin, Lauren H. Redler, William N. Levine, Christopher S. Ahmad, David P. Trofa
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Selecting an appropriate graft for anterior cruciate ligament (ACL) reconstruction requires consideration of a patient's preferences, goals, age, and physical demands alongside the risks and benefits of each graft choice.Purpose:To determine the most popular ACL reconstruction grafts among patients and the most important factors influencing their decisions.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Patients undergoing ACL reconstruction between October 2022 and April 2023 completed a survey either before (nonconsult group) or after (consult group) speaking with their surgeon, who provided an evidence-based description of the pros and cons of an allograft and the following autografts: bone-patellar tendon-bone (BPTB), hamstring tendon (HT), and quadriceps tendon (QT). Patient characteristics, graft choice, information influencing their graft choice, and surgeon recommendation were collected and compared between the groups.Results:Among the 100 included patients, 59.0% were male, and the mean age was 28.3 ± 10.4 years. The most popular grafts were the BPTB (56.0%), followed by the QT (29.0%), HT (8.0%), and allograft (7.0%). No significant difference was observed in the graft selection between the consult group (n = 60; BPTB, 46.7%; QT, 38.3%; HT, 8.3%; allograft, 6.7%) and nonconsult group (n = 40; BPTB, 70.0%; QT, 15.0%; HT, 7.5%; allograft, 7.5%) (P = .0757). In the consult group, 81.7% of patients selected the graft recommended to them by their surgeon. The top 2 graft selection reasons were usage in professional athletes and failure rates, while the top 2 ACL surgery concerns were returning to their desired level of athletics and graft failure risk. Among the 93 patients who researched their ACL graft options before their visit, the most popular information source was some form of media (72.0% [67/93]).Conclusion:The study findings underscore the importance of patient preference and surgeon recommendation in a patient's graft selection and highlight the need to be cognizant of the information sources available to patients when researching their graft options.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-14T02:06:41Z
      DOI: 10.1177/23259671241258429
      Issue No: Vol. 12, No. 8 (2024)
       
  • Kinematic Modeling of Pitch Velocity in High School and Professional
           Baseball Pitchers: Comparisons With the Literature

    • Authors: Joseph E. Manzi, Brittany Dowling, Zhaorui Wang, Suleiman Y. Sudah, Jay Moran, Frank R. Chen, Jennifer A. Estrada, Allen Nicholson, Michael C. Ciccotti, Joseph J. Ruzbarsky, Joshua S. Dines
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Kinematic parameters predictive of pitch velocity have been evaluated in adolescent and collegiate baseball pitchers; however, they have not been established for high school or professional pitchers.Purpose:To create multiregression models using anthropometric and kinematics features most predictive for pitch velocity in high school and professional pitchers and compare them with prior multiregression models evaluating other playing levels.Study Design:Descriptive laboratory study.Methods:High school (n = 59) and professional (n = 337) baseball pitchers threw 8 to 12 fastballs while being evaluated with 3-dimensional motion capture (480 Hz). Using anthropometric and kinematic variables, multiregression models for pitch velocity were created for each group. A systematic review was conducted to determine previous studies that established kinematic models for ball velocity in youth, high school, and collegiate pitchers.Results:Leg length was predictive of pitch velocity for high school and professional pitchers (P < .001 for both). When compared with previously established models for pitch velocity, almost all groups were distinct from one another when assessing age (Pmaximum < .001), weight (Pmax = .0095), and pitch velocity (Pmax < .001). Stride length was a significant predictor for the youth/high school pitchers, as well as the current study's high school and professional pitchers (P < .001 for all). Maximal shoulder external rotation (collegiate: P = .001; professional: P < .001) and maximal elbow extension velocity (high school/collegiate: P = .024; collegiate: P < .001; professional: P = .006) were shared predictors for the collegiate and current study's professional group multiregression models. Trunk flexion at ball release was a commonly shared predictor in the youth/high school (P = .04), high school/collegiate (P = .003), collegiate (P < .001), and the current study's professional group (P < .001).Conclusion:Youth, high school, collegiate, and professional pitchers had unique, predictive kinematic and anthropometric features predictive of pitch velocity. Leg length, stride length, trunk flexion at ball release, and maximal shoulder external rotation were predictive features that were shared between playing levels.Clinical Relevance:Coaches, clinicians, scouts, and pitchers can consider both the unique and the shared predictive features at each playing level when attempting to maximize pitch velocity.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-13T10:27:56Z
      DOI: 10.1177/23259671241262730
      Issue No: Vol. 12, No. 8 (2024)
       
  • Pediatric Concussions in Contact Sports: A 10-Year Retrospective Analysis
           of Mechanisms and Associated Symptoms

    • Authors: Joshua J. Cassinat, Alison Grise, Matthew Aceto, Vonda Wright
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Concussions make up a significant proportion of sports injuries. This study aimed to describe the mechanisms of injury and associated symptoms of pediatric patients diagnosed with concussions (age range, 4-17 years) from contact sports.Hypothesis:Mechanisms of injury would differ based on sex and age, with female athletes and younger athletes aged 4 to 11 years sustaining fewer concussions from player-to-player contact.Study Design:Descriptive epidemiology study.Methods:The National Electronic Injury Surveillance System was queried for all contact sport concussions presented to United States emergency departments. The sports analyzed included basketball, football, soccer, hockey, rugby, and lacrosse. Descriptive data, mechanisms of injury, and associated symptoms were analyzed for each sport. Differences in the number of concussions sustained by year and sport, the severity of the injury, and associated symptoms were compared using chi-square test, and differences in proportion were calculated for mechanisms of injury stratified by sex and age.Results:A total of 12,602 youth athletes sustained concussions between 2012 and 2021. Most patients were male (78.5%), with a mean age of 13.48 years. Football concussions were the most common, with 45.32% of the concussions. The mechanism of injury was largely sport-specific, with player-to-player contact the most common overall. Older male athletes were more likely to have concussions from player-to-player contact, whereas younger athletes were more impacted by head-to-ground mechanisms. Symptom presentation was not sport-specific, and headache and dizziness were the most common presentation at 41.2% and 26.2%, respectively.Conclusion:The most important overall mechanism of injury was player-to-player contact, especially in older male youth athletes, whereas younger athletes were more likely to be concussed due to head-to-ground injuries.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-13T10:27:17Z
      DOI: 10.1177/23259671241262009
      Issue No: Vol. 12, No. 8 (2024)
       
  • Bridge-Enhanced Anterior Cruciate Ligament Restoration: 6-Year Results
           From the First-in-Human Cohort Study

    • Authors: Braden C. Fleming, Ben Baranker, Gary J. Badger, Ata M. Kiapour, Kirsten Ecklund, Lyle J. Micheli, Martha M. Murray
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Bridge-enhanced anterior cruciate ligament restoration (BEAR) combines suture repair of the anterior cruciate ligament (ACL) with an extracellular matrix implant plus autologous blood to facilitate native ACL healing.Purpose/Hypothesis:The purpose of this study was to compare the 6-year follow-up outcomes of patients who underwent the BEAR procedure with those of a nonrandomized concurrent control group receiving autograft ACL reconstruction (ACLR) in the first-in-human safety study of the BEAR implant (BEAR I trial). Based on the 2-year results, it was hypothesized that isometric hamstring strength after the BEAR procedure would be greater than that after ACLR and that there would be no other differences in outcomes at 6 years.Study Design:Cohort study, Level of evidence, 2.Methods:Ten patients underwent BEAR and 10 received ACLR with a 4-stranded hamstring autograft. Outcomes assessed included the record of subsequent surgeries, the International Knee Documentation Committee (IKDC) Subjective Knee Score, IKDC physical examination grade, the Knee injury and Osteoarthritis Outcome Score, instrumented knee laxity, functional outcomes (ie, muscle strength assessments and hop testing), and qualitative magnetic resonance imaging assessment. Comparisons between treatments were based on computations of the mean differences and the associated 95% CIs.Results:One patient in the BEAR group and 3 patients in the ACLR group were lost to follow-up. In the period between 2 and 6 years, 1 patient in each group underwent revision surgery. There were no differences between groups at the 6-year follow-up in any of the outcome measures except for isometric hamstring strength, which was approximately equal to that of the contralateral knee in the BEAR group and
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-13T10:26:37Z
      DOI: 10.1177/23259671241260632
      Issue No: Vol. 12, No. 8 (2024)
       
  • Foot and Ankle MRI Findings in Asymptomatic Professional Ballet Dancers

    • Authors: Mai Katakura, Richard Clark, Justin C. Lee, Adam W.M. Mitchell, Joseph W. Shaw, Anika I. Tsuchida, Mary Jones, Shane Kelly, James D.F. Calder
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Previous research in sport populations has demonstrated that abnormal magnetic resonance imaging (MRI) findings may be present in individuals without symptoms or known pathology. Extending this understanding to ballet, particularly in relation to the foot and ankle, is important to guide medical advice given to dancers.Purpose:To assess foot and ankle MRI scans in asymptomatic ballet dancers focusing on bone marrow edema and the posterior ankle and to investigate whether these MRI findings would become symptomatic within 1 year.Study Design:Case series; Level of evidence, 4.Methods:In total, 31 healthy dancers (62 feet/ankles; 15 male and 16 female; age, 26.5 ± 4.3 years) who were dancing in full capacity were recruited from an elite professional ballet company. Orthogonal 3-plane short tau inversion recovery imaging of both feet and ankles was obtained using 3T MRI and the images were reviewed using a standardized evaluation form by 2 musculoskeletal radiologists. Injuries in the company were recorded and positive MRI findings were assessed for correlation with any injuries requiring medical attention during the subsequent 12 months.Results:A total of 51 (82%) of the 62 feet and ankles had ≥1 area of bone marrow edema. The most common locations of bone marrow edema were the talus (n = 41; 66%), followed by first metatarsal (n = 14; 23%). Os trigonum and Stieda process were seen in 5 (8%) and 8 (13%) ankles, respectively. Among them, 2 os trigona showed bone marrow edema. Fluid in the anterior and posterior talocrural joints and the subtalar joint was observed in 48%, 63%, and 63% of these joints, respectively. Fluid around foot and ankle tendons was observed, with the most prevalent being the flexor hallucis longus tendon (n = 13; 21%). Two dancers who had positive findings on their MRI subsequently developed symptoms during the next 12 months.Conclusion:Positive MRI findings are commonplace in the foot and ankle of asymptomatic professional ballet dancers. The majority do not result in the development of symptoms requiring medical attention within 12 months. Careful interpretation of MRI findings with the dancer's clinical picture is required before recommending activity modification or further intervention.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-13T10:25:57Z
      DOI: 10.1177/23259671241263593
      Issue No: Vol. 12, No. 8 (2024)
       
  • Prognostic Factors for Multiligament Knee Injury Treated With
           Multiligament Reconstruction: Functional and Radiological Outcomes at 2 to
           8 Years Postoperatively

    • Authors: Valentine Schneebeli, Virginie Philippe, Alexis Laurent, Lee Ann Applegate, Robin Martin
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Multiligament reconstruction (MLR) has become the standard surgical approach for treating multiligament knee injuries (MLKIs).Purpose:To identify prognostic factors for patient-reported outcome measures, return to work (RTW), return to sports, and radiographic osteoarthritis (OA) (Kellgren-Lawrence grade ≥2) after MLR for MLKI.Study Design:Case-control study; Level of evidence 3.Methods:Included were 52 consecutive patients (age, 35.5 ± 11 years; 75% men), with MLKI sustained between 2013 and 2019 and treated with MLR. At a mean follow-up of 3.8 ± 1.6 years, patient-reported outcome measure scores—including the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI), and the 12-Item Short-Form Health Survey—RTW, return to sports, and weightbearing radiographs were obtained. A total of 20 determinants were hypothesized and tested by univariate logistic regression for binary variables or linear regression for continuous variables. Only factors identified as significant (P < .10) were entered into a multivariate logistic regression model.Results:The prevalence of injury severity according to the Schenck knee dislocation (KD) classification was as follows: KD I (44%), KD III (36%), KD IV (10%), and KD V (10%). Increased KD grades resulted in decreased IKDC (P = .002) and all 5 KOOS subscales (P≤ .007 for all) scores. Medial meniscectomy (23%) was associated with a worse ACL-RSI score (P = .007) and RTW failure (odds ratio [OR], 36.8; P = .035). Peroneal nerve palsy (6%) was associated with a worse ACL-RSI score (P≤ .001). Radiographic OA was observed in 38%, with distribution predominantly patellofemoral (80%) and medial tibiofemoral (45%). Traumatic cartilage damage (Outerbridge grade>2 [37%]) was associated with secondary patellofemoral (OR, 10; P = .012) and medial tibiofemoral (OR, 10; P = .019) OA. Anterior cruciate ligament reconstruction failure (7%) was a risk factor for medial tibiofemoral OA (OR, 25.8; P = .006).Conclusion:Increased Schenck KD grade, permanent peroneal nerve palsy, and irreparable medial meniscus lesions were prognostic factors for worse functional outcomes 3.8 years after MLKI was treated with MLR. Traumatic cartilage damage and anterior cruciate ligament failure were associated with the development of early OA.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-12T01:07:03Z
      DOI: 10.1177/23259671241261103
      Issue No: Vol. 12, No. 8 (2024)
       
  • Predictive Value of the KOJI AWARENESS Self-Evaluation System for Running
           Injuries in Elite Male Long-Distance Runners: A Prospective Cohort Study

    • Authors: Koji Murofushi, Sho Mitomo, Kenji Hirohata, Hidetaka Furuya, Hiroki Katagiri, Koji Kaneoka, Susumu Hara, Kazuyoshi Yagishita
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:The KOJI AWARENESS (KA) test is a practical self-evaluation tool that assesses body movements and may help develop individual conditioning plans to improve movement function. However, the association between preseason KA scores and in-season injury occurrence remains unexplored.Purpose:To investigate whether the KA self-screening test score can predict running-related injuries in elite long-distance runners.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 47 elite college male long-distance runners (age, 18-22 years) were enrolled in this study in June 2022. The participants underwent the KA self-screening test to assess preseason upper limb, core, and lower limb function. Running-related injuries with a training time loss of>3 weeks were tracked for 6 months during the season. The participants were divided into injury and noninjury groups, and between-group comparisons and receiver operating characteristic (ROC) curve analysis were used to determine the association between the KA scores and the injury incidence. Chi-square tests and risk ratios were calculated based on the cutoff value- and injury-based grouping.Results:Among the runners, 10 (21.3%) sustained an injury. There were no significant differences in the demographic characteristics between the injury and noninjury groups. The injury group had significantly lower KA scores than the noninjury group (median, 44.5 [interquartile range, 43-46.8] vs median, 48 [interquartile range, 46-50], respectively; P = .009). The ROC curve analysis determined a cutoff value of 46.5 points (sensitivity, 73%; specificity, 63.6%), indicating that the KA scores exhibited a relatively high predictive value for running-related injuries (area under the ROC curve, 0.764 [95% CI, 0.600-0.930]). The risk ratio for group division based on the cutoff value was 2.590 (95% CI, 1.329-5.047).Conclusion:These findings demonstrated that the KA test is an effective self-screening tool for predicting the risk of running-related injuries in elite male long-distance runners.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-12T01:06:33Z
      DOI: 10.1177/23259671241260517
      Issue No: Vol. 12, No. 8 (2024)
       
  • Single-Row Repair Versus Double-Row Repair in the Surgical Management of
           Achilles Insertional Tendinopathy: A Systematic Review

    • Authors: Luca Ramelli, Shgufta Docter, Christopher Kim, Ujash Sheth, Sam Si-Hyeong Park
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Approximately 6% of people will report Achilles tendon pain during their lifetime, and one-third of these individuals will have Achilles insertional tendinopathy (AIT). For patients who have failed conservative treatment, surgical repair is performed. Achilles tendon repair can occur through various techniques, including a single-row or double-row repair.Purpose:To determine if there are significant advantages to double-row repair over single-row repair with respect to biomechanical and clinical outcomes.Study design:Systematic review; Level of evidence, 3.Methods:A systematic review of the literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search of the EMBASE and PubMed databases was performed for all studies related to surgical treatment of AIT, which yielded 1431 unique results. These included both biomechanical and clinical studies. Clinical studies in which patients were not diagnosed with AIT, underwent surgery for repair of acute Achilles tendon rupture, or studies that included additional procedures such as a concomitant flexor hallucis longus transfer were excluded. Eligible studies were independently screened by 2 reviewers. A risk-of-bias assessment was conducted using the Cochrane Risk Of Bias In Non-randomized Studies–of Interventions and risk-of-bias tool for randomized trials tools.Results:A total of 23 studies were included, 4 of which were biomechanical studies and 19 were clinical studies. Biomechanical comparison found that there was a significant advantage to using double-row versus single-row fixation with respect to load at yield (354.7 N vs 198.7 N; P = .01) and mean peak load (433.9 N vs 212 N; P = .042). There was no significant difference between double-row and single-row repair with respect to load to failure. Significant heterogeneity of the studies did not allow for a statistical comparison of the clinical outcomes between double-row and single-row repairs.Conclusion:Although biomechanical studies favor double-row repair for AIT, the current data available on the clinical outcomes are not sufficient to determine if there is a clinical advantage of double-row repair. Larger, prospective randomized controlled trials utilizing validated outcome measures are needed to further elucidate whether the biomechanical advantages associated with double-row repair also translate into improved patient-reported outcomes.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-12T01:06:04Z
      DOI: 10.1177/23259671241262772
      Issue No: Vol. 12, No. 8 (2024)
       
  • Are Patient-Reported Outcome Measures for Anterior Cruciate Ligament
           Injuries Validated for Spanish Language and Culture'

    • Authors: Jeremy W. Siu, Edgar Garcia-Lopez, Nirav K. Pandya, Brian Feeley, Lauren M. Shapiro
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Patient-reported outcome measures (PROMs) have been adopted as a way to measure patient self-rated physical function and health status for patients with anterior cruciate ligament (ACL) injuries. Although multiple PROMs exist and have been translated into various languages, the cross-cultural adaptation and validity of these PROMs for Spanish-speaking patients is unknown.Purpose:To evaluate the adaptation quality and psychometric properties of Spanish-language adaptations of PROMs for patients with ACL injuries.Study Design:Scoping review; Level of evidence, 3.Methods:Under PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we reviewed published studies related to adaptation quality and psychometric properties of Spanish PROMs in patients with ACL injuries. The methodological quality of the included studies was assessed using the Guidelines for the Process of Cross-Cultural Adaptation of Self-Reported Measures, the Quality Criteria for Psychometric Properties of Health Status Questionnaires, and the Consensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The level of evidence for each PROM was determined based on the number of studies, methodological quality, consistency of results, and sample size.Results:The initial search strategy identified 5687 articles. After removal of duplicates, 1882 titles were screened, and 114 articles were assessed for eligibility. Six articles were selected for final review, comprising 4 PROMs: the Lysholm knee score, the Anterior Cruciate Ligament–Return to Sport After Injury (ACL-RSI), the Lower Extremity Functional Scale, and the Lower Limb Functional Index. Three studies followed all 6 processes for cross-cultural adaptation. None of the studies demonstrated all 14 domains required for cross-cultural validity (eg, description of translator expertise). The ACL-RSI achieved the highest level of evidence, with 3 of 9 domains demonstrating moderate evidence.Conclusion:This review identified 4 instruments that have been translated for Spanish-speaking patients with ACL injuries, none of which demonstrated appropriate adaptation or robust psychometric properties. The study highlights the need for improvement in PROMs for Spanish-speaking patients and the potential for mismeasurement and inappropriate application of PROM results in patients with ACL injuries.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-09T08:46:49Z
      DOI: 10.1177/23259671241256413
      Issue No: Vol. 12, No. 8 (2024)
       
  • Outcomes of ACL Reconstruction Utilizing Supercritical CO2-Sterilized
           Allografts

    • Authors: John E. Farey, Lucy J. Salmon, Justin P. Roe, Vivianne Russell, Keran Sundaraj, Leo A. Pinczewski
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Allograft tendons are perceived to have a high ACL graft failure rate in primary anterior cruciate ligament (ACL) reconstruction (ACLR). Historical series may be biased by graft processing methods that degrade the biomechanical properties of donor tendons such as irradiation. Supercritical carbon dioxide (SCCO2) is a validated method of terminally sterilizing biomaterials at physiological temperatures without irradiation, but in vivo use of SCCO2-processed tendon allografts for primary ACLR has not been reported to date.Hypothesis:ACLR with SCCO2 allografts would result in acceptable failure rates, subjective knee scores, and clinical evaluation at 2 years postoperatively.Study Design:Case series; Level of evidence, 4.Methods:Patients underwent primary ACLR with terminally sterilized SCCO2-processed human gracilis, peroneus longus, semitendinosus, tibialis anterior, and tibialis posterior tendon allografts. Patient demographics were collected, along with tendon donor age and sex. At 1 year postoperatively, subjective International Knee Documentation Committee (IKDC) and ACL–Return to Sport After Injury (ACL-RSI) scores were collected, as well as clinical evaluation. At 2 years postoperatively, the IKDC and ACL-RSI scores were repeated, and return to sports and further knee injuries were recorded.Results:A total of 144 patients with a medianage of 26 (IQR 14) years formed the study group. Patients were predominately male (58%). The loss to follow-up rate was 8% (n = 12). The mean age of allograft tendon donors was 37 (range 17-58) years, and the majority were male (83%). The mean allograft diameter was 8.9 ± 1.0 mm. At 2 years, ACL graft failureoccurred in 5% (n = 7). All graft failureswere in patients aged ≤25 years (P = .007). Neither donor age (≤40 or>40 years) nor donor sex was associated with graft failure (P> .05). The median IKDC subjective score was 95 and ACL-RSI score was 75. There were no revisions for sepsis within the first 2 years postoperatively.Conclusion:SCCO2 processing of allograft tendons demonstrated satisfactory clinical and patient-reported outcomes at 24 months postoperatively in a consecutive series of patients with primary ACLR, with similar ACL graft failure rates and subjective knee scores compared with those reported in published series of hamstring tendon autograft and fresh frozen nonirradiated allograft.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-09T08:46:09Z
      DOI: 10.1177/23259671241254115
      Issue No: Vol. 12, No. 8 (2024)
       
  • The Relationship Between Medial Meniscal Extrusion and Outcome Measures
           for Knee Osteoarthritis: A Systematic Review

    • Authors: David H. Kahat, Cyrus M. Nouraee, Jesse S. Smith, Cassiano C. Santiago, Edward R. Floyd, Stefan Zbyn, Hasan Abbasguliyev, Abdul Wahed Kajabi, Jutta M. Ellermann
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Medial meniscal extrusion (MME) has been associated with knee osteoarthritis (OA). However, there is no standardized method to measure MME.Purpose/Hypothesis:The purpose of this study was to investigate the relationship between MME and outcome measures related to knee OA and discuss different magnetic resonance imaging (MRI) methods of measuring MME. It was hypothesized that MME would be associated with outcome measures of OA and that the distance extruded over the tibial plateau would be the most common MRI method to measure MME.Study Design:Systematic review; Level of evidence, 3.Methods:The MEDLINE, Embase, Cochrane Library, Scopus, Web of Science Core Collection, Global Index Medicus, and ClinicalTrials.gov databases were systematically searched. The inclusion criteria were studies that (1) measured MME on nonoperated knees using MRI; (2) evaluated knee OA with at least 1 knee OA grading scale, outcome measure, or direct characterization of cartilage or bone; (3) statistically evaluated the association between MME and knee OA outcome measure; (4) were randomized controlled trials, nonrandomized controlled trials, cohort studies, or case series; and (5) reported original results.Results:A total of 19 studies were included, of which 14 reported MME as the distance extruded over the tibial plateau, 7 reported MME as the volume extruded over the tibial plateau, and 1 reported MME as the percentage of the tibial plateau covered by the meniscus. All studies reported that MME was significantly associated with at least 1 OA outcome measure—including increased Kellgren-Lawrence grade, osteophytes, cartilage damage, varus alignment, knee pain, bone marrow lesions, and progression to arthroplasty. Eight studies found that MME was associated with worse OA outcomes over time (range, 2-10 years).Conclusion:All 19 reviewed studies reported that MME was associated with at least 1 knee OA outcome measure reflective of worsening arthritis, suggesting a strong association between OA and MME. Future research is needed to investigate this relationship and standardize the methods of measuring MME.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-09T08:45:49Z
      DOI: 10.1177/23259671241248457
      Issue No: Vol. 12, No. 8 (2024)
       
  • Effect of Soccer Boot Outsole Configuration on Translational Traction
           Across Both Natural and Artificial Playing Surfaces

    • Authors: Danyon Loud, Paul Grimshaw, Richard Kelso, William S.P. Robertson
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Soccer boots are produced with different stud patterns and configurations to provide players with extra traction on specific surface types to minimize slipping and improve player performance. Excessive traction, however, can lead to foot fixation injuries, particularly anterior cruciate ligament tears.Purpose/Hypothesis:The purpose of this study was to explore the translational traction properties of 5 different outsole configurations moving in 4 different directions across both natural grass and artificial grass (AG) playing surfaces. It was hypothesized that longer studs or studs with an asymmetric shape would yield a higher traction coefficient compared with the recommended stud configuration for the given playing surface.Study Design:Descriptive laboratory study.Methods:A custom-built testing apparatus recorded the translational traction of 5 different soccer boots moving in an anterior, posterior, medial, or lateral direction on both natural grass and AG playing surfaces. A 3-way analysis of variance was performed to determine the effect of outsole configuration on the traction, and a post hoc Tukey analysis was performed to compare different outsole configurations with a control.Results:For the natural grass playing surface, the longer and asymmetric studs yielded a significantly higher (P < .05) traction coefficient on 75% of loading scenarios, while on AG, they yielded a significantly higher traction on 50% of loading scenarios.Conclusion:Some soccer boots yielded higher traction values compared with the recommended configuration.Clinical Relevance:The results highlight the importance of boot selection on different playing surfaces. Higher traction values could increase the injury risk for players due to excessive traction and foot fixation.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-08T09:38:09Z
      DOI: 10.1177/23259671241259823
      Issue No: Vol. 12, No. 8 (2024)
       
  • Systematic Review and Meta-analysis of Clinical Outcomes Following
           Meniscus Repair in Patients 40 Years and Older

    • Authors: Matthew J. Sedgwick, Christopher Saunders, Alan M.J. Getgood
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Meniscal repair has been associated with long-term benefit in patients compared with meniscectomy. As a generalization, meniscal repair in older patients is less likely to be successful, leading to reduced adoption of meniscal repair compared with younger patients.Purpose:To establish the clinical performance of meniscal repair in “older” patients (age, ≥40 years) and compare it with performance in “younger” patients (age, 5 patients aged ≥40 years. Outcomes of interest were success/failure rate (as defined by the study), revision meniscal procedure rate, and patient-reported outcomes. Meta-analyses were used to synthesize outcomes across all studies in older patients. Meta-analyses were also used to compare outcomes between older and younger patients across studies, providing data on both age groups.Results:Fourteen studies were identified. Meniscal repair in older patients was determined to have a failure rate of 12% (95% CI, 7.3% to 19.4%) and a revision meniscal procedure rate of 9.8% (95% CI, 6.2% to 15.0%). The postoperative Lysholm score was 86.7 (95% CI, 81.7 to 91.7). No statistically significant differences were observed between older and younger patients in failure rate (relative risk [RR], 0.73 [95% CI, 0.44 to 1.21]; P = .2205), revision meniscal procedure rate (RR, 0.69 [95% CI, 0.41 to 1.16]; P = .1613), or Lysholm scores (mean difference, 2.3 [95% CI, –4.7 to 9.2]; P = .5278, 4 studies).Conclusion:Meniscal repair in selected patients aged ≥40 years resulted in good success rates and patient-reported outcome measures, which appear similar to those reported for patients aged
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-08T09:37:29Z
      DOI: 10.1177/23259671241258974
      Issue No: Vol. 12, No. 8 (2024)
       
  • Association Between Low-Dose Ketamine After Periacetabular and/or Femoral
           Osteotomy and Postoperative Opioid Requirements

    • Authors: Nicholas G. Girardi, Sean Malin, Christopher Zielenski, Jessica H. Lee, Kaleigh Henry, Matthew J. Kraeutler, Omer Mei-Dan
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Previous studies have sought to determine the effect of inpatient ketamine therapy on postoperative pain in a variety of surgical specialties.Purpose:To determine the effects of postoperative ketamine analgesia after periacetabular osteotomy (PAO) and/or derotational femoral osteotomy (DFO) on opioid requirements, pain, and discharge time.Study Design:Cohort study; Level of evidence, 3.Methods:Prospective data were collected on 145 patients who underwent PAO and/or DFO by the senior author between January 2021 and December 2022. Hip arthroscopy was performed 3 to 10 days before addressing any intra-articular pathology. In 2021, patients (n = 91 procedures; control group) received a traditional postoperative multimodal pain regimen. In 2022, postoperative low-dose ketamine (0.1-1 mg/kg/h) was added to the multimodal analgesic approach until 24 hours before discharge (n = 81 procedures; ketamine group). The ketamine and control groups were matched based on procedure type. Total opioid consumption was collected using milligram morphine equivalents (MMEs) for both groups. Postoperative pain was measured using the Defense and Veterans Pain Rating Scale (DVPRS), which was analyzed as the mean score per day. Data on the mean MME and DVPRS were analyzed for up to 7 days postoperatively. Linear mixed statistical analysis was performed to determine the significance of low-dose postoperative ketamine on postoperative pain and opioid utilization.Results:Patients who did not receive ketamine after PAO and/or DFO utilized a mean of 181 ± 335 MMEs and had a mean DVPRS score of 4.18 ± 1.63. Patients who received postoperative ketamine required a mean of 119 ± 291 MMEs and had a mean DVPRS score of 4.34 ± 1.61. The ketamine group was found to consume a significantly lower total MME dose per day (P < .001). No significant difference was found in the mean DVPRS score between the ketamine and control groups (P = .42). Also, no significant difference was found on the day of discharge (P = .79).Conclusion:Patients who received postoperative ketamine after PAO and/or DFO had a significant decrease in MME dose when compared with a control group of patients who did not receive ketamine. Surgeons should consider adding ketamine to their postoperative multimodal pain control protocol to decrease opioid consumption while adequately addressing postoperative pain.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-08T09:36:43Z
      DOI: 10.1177/23259671241257260
      Issue No: Vol. 12, No. 8 (2024)
       
  • Evaluating Return to Sports After Surgical Treatment of Unstable
           Osteochondritis Dissecans of the Knee: A Systematic Review

    • Authors: Carlo Coladonato, Andres R. Perez, John Hayden Sonnier, Sean Wilson, Ryan W. Paul, Richard Gawel, Gregory Connors, Kevin B. Freedman, Meghan E. Bishop
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:Although the incidence of osteochondritis dissecans (OCD) of the knee may be low, an overview and comparison of sports-related outcomes with current surgical management techniques are needed.Purpose:To summarize the available evidence regarding outcomes for different surgical treatment options for unstable OCD of the knee in both skeletally mature and immature patients by calculating the return to sports (RTS) rate, the mean RTS time, and other sports-related postoperative outcome measures.Study Design:Systematic review; Level of evidence, 4.Methods:A systematic review of studies on RTS after surgical correction of unstable OCD within the knee was conducted utilizing PubMed, Embase, and the Cochrane databases. Included were studies discussing the treatment of unstable OCD with minimum 1-year follow-up outcomes. Multivariate analysis was used to compare studies grouped together based on RTS and skeletal maturity.Results:Of 2229 articles, 6 studies (197 patients; 198 knees) met the inclusion criteria and were included in our analysis. The percentage of patients who returned to the previous level of sport ranged from 52% to 100%; those returning to any level of sport ranged from 87% to 100%. Clinical outcomes did not differ between patients with open versus closed physes. Osteochondral Autograft Transfer System (OATS) procedures had a 100% RTS rate across several studies with skeletally mature and mixed cohorts, and microfracture had the lowest overall RTS rate (52%). For skeletally immature patients, all examined studies that utilized either open or arthroscopic reduction and internal fixation, 77% and 78%, respectively, had acceptable RTS rates. Arthroscopic fixation had a higher rate of revision surgery in both skeletally mature and immature patients.Conclusion:Our analysis indicated that the treatment of unstable OCD lesions using the OATS technique demonstrated high RTS rates across several studies, while microfracture alone exhibited the lowest RTS rate. Both arthroscopic and open internal fixation utilizing bioabsorbable screws yielded satisfactory RTS rates for juvenile patients with OCD.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-07T03:05:40Z
      DOI: 10.1177/23259671241258489
      Issue No: Vol. 12, No. 8 (2024)
       
  • Malay Translation and Validation of the Oslo Sports Trauma Research Center
           Questionnaire on Health Problems

    • Authors: Wan Ikram Shah bin Hadi, Mohd Nahar Azmi bin Mohamed, Ahmad Hazwan bin Ahmad Shushami, Samihah binti Abdul Karim
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:The Oslo Sports Trauma Research Center Questionnaire on Health Problems (OSTRC-H) is a proven surveillance method to register acute injury, overuse injury, or illness in athletes. However, it has not yet been translated into Malay.Purpose:To translate, culturally adapt, and validate the OSTRC-H into Malay using internationally established guidelines.Study Design:Cohort study (diagnosis); Level of evidence, 3.Methods:The Malay translation of the OSTRC-H (OSTRC-H.M) was distributed to 54 elite (ie, professional) and recreational athletes. Face validity, content validity, and construct validity were assessed for the validity measurement properties, while test-retest and internal consistency were used for reliability measurement properties.Results:The content validity index was satisfactory at 0.93. The OSTRC-H.M showed good internal consistency, with a Cronbach α value of .84. Confirmatory factor analysis showed a good model for construct validity, with values of 0.99 and 0.04 for comparative fit index and root mean square error of approximation, respectively. Per-item intraclass correlation coefficients (ICCs) for test-retest reliability ranged from 0.55 to 0.80. The overall test-retest reliability of the questionnaire was good (ICC, 0.8; 95% CI, 0.63-0.88; P < .001).Conclusion:The OSTRC-H.M was found to be valid and reliable and therefore acceptable for application among Malay-speaking athletes.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-07T03:04:19Z
      DOI: 10.1177/23259671241263355
      Issue No: Vol. 12, No. 8 (2024)
       
  • The Relationship Between All-Suture and Solid Medial-Row Anchors and
           Patient-Reported Outcomes for Double-Row Suture Bridge Rotator Cuff Repair
           

    • Authors: John J. Feldman, Brook Ostrander, Matthew P. Ithurburn, Glenn S. Fleisig, Robert Tatum, Mims G. Ochsner, Michael K. Ryan, Marcus A. Rothermich, Benton A. Emblom, Jeffrey R. Dugas, E. Lyle Cain
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:The use of all-suture anchors for rotator cuff repair is increasing. Potential benefits include decreased bone loss and decreased damage to the chondral surface. Minimal evidence exists comparing outcomes among medial-row anchor fixation methods in double-row suture bridge rotator cuff repair.Purpose:To compare the clinical outcomes between all-suture and solid medial-row anchors in double-row suture bridge rotator cuff repair.Study Design:Case series; Level of evidence, 4.Methods:A total of 352 patients (mean age at surgery, 60.3 years) underwent double-row suture bridge rotator cuff repair at our institution. Patients were separated into 2 groups based on whether they underwent all-suture (n = 280) or solid (n = 72) anchor fixation for the medial row. Outcomes data were collected via an ongoing longitudinal data repository or through telephone calls (minimum follow-up time, 2.0 years; mean follow-up time, 3.0 years). Outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) standardized shoulder assessment form and the visual analog scale (VAS). The same rehabilitation protocol was administered to all patients. The proportions of patients meeting previously published Patient Acceptable Symptom State (PASS) thresholds were calculated for the outcome measures, and outcome scores and the proportions of patients meeting PASS thresholds between groups were compared using linear and logistic regression, respectively.Results:The groups did not differ in terms of age at surgery, sex distribution, rotator cuff tear size, or number of medial-row anchors used. The solid anchor group had a longer follow-up time compared with the all-suture anchor group (3.6 ± 0.7 vs 2.8 ± 0.8 years, respectively; P < .01). After controlling for follow-up time, the solid and all-suture anchor groups did not differ in ASES scores (89.6 ± 17.8 vs 88.8 ± 16.7, respectively; P = .44) or VAS scores (1.1 ± 2.1 vs 1.2 ± 2.1, respectively; P = .37). Similarly, after controlling for follow-up time, the solid and all-suture anchor groups did not differ in the proportions of patients meeting PASS cutoffs for the ASES (84.7% vs 80.7%, respectively; P = .44) or the VAS (80.6% vs 75.0%, respectively; P = .83).Conclusion:Double-row suture bridge rotator cuff repair using all-suture anchors for medial-row fixation demonstrated similar excellent clinical outcomes to rotator cuff repair using solid medial-row anchors.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-07T03:03:19Z
      DOI: 10.1177/23259671241262264
      Issue No: Vol. 12, No. 8 (2024)
       
  • Anterior Cruciate Ligament Ruptures in Russian Premier League Soccer
           Players During the 2010 to 2021/2022 Competitive Seasons: The Epidemiology
           and Details of Return to Sports

    • Authors: Eduard Bezuglov, Georgiy Malyakin, Anton Emanov, Irina Baranova, Igor Stepanov, Evgeniy Goncharov, Maria Shoshorina, Sergey Izmailov, Ryland Morgans
      Abstract: Orthopaedic Journal of Sports Medicine, Volume 12, Issue 8, August 2024.
      Background:There are limited data on the epidemiology of anterior cruciate ligament (ACL) ruptures in elite adult soccer players, especially in the Russian Premier League (RPL). There is an increased risk of injury due to a combination of additional risk factors such as playing in extremely high and low temperatures, frequent long flights, and regular play on natural and artificial surfaces.Purpose:To study the epidemiology of ACL ruptures and determine the patterns associated with their occurrence in RPL soccer players.Study Design:Descriptive epidemiology study.Methods:All ACL ruptures requiring surgery sustained by players competing in the RPL across 12 competitive seasons between 2010 and 2022 were analyzed. All required data were collected from media analysis and confirmed by club doctors.Results:A total of 85 players sustained 100 injuries during 12 competitive seasons. A total of 96.5% of players returned to competitive play. The injury incidence in RPL and during participation of RPL teams in European Cups were 0.4760 and 0.5622 per 1000 playing hours, respectively. When analyzing the outcomes of the primary ACL surgery (a total of 76 operations), the following data were obtained: in 11 cases (14.5%), there was a reinjury on the ipsilateral knee joint and in 4 cases (5.3%) on the contralateral knee joint. The mean return–to-play time after all operations was 284 ± 116 days. The time of return to play after primary reconstruction was 289 ± 136 days, 278 ± 91 days after reconstruction on the contralateral knee and 271 ± 51.5 days after the first ACL revision reconstruction on the ipsilateral knee joints.Conclusion:RPL ACL injury epidemiology is similar to that in the other leagues from around the world, although there are factors that can potentially influence the number of these injuries.
      Citation: Orthopaedic Journal of Sports Medicine
      PubDate: 2024-08-07T03:02:21Z
      DOI: 10.1177/23259671241261957
      Issue No: Vol. 12, No. 8 (2024)
       
 
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