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Background: The addition of an iliotibial band–based lateral extra-articular tenodesis (LET) to anterior cruciate ligament (ACL) reconstruction (ACLR) has been shown to reduce failure rates. However, there are concerns as to the potential overconstraint of tibiofemoral kinematics that may increase the risk of cartilage degradation. To date, no clinical study has investigated the effect of LET on patellofemoral joint articular cartilage health. Hypothesis: It was hypothesized that at 2 years postoperatively, (1) the addition of LET at the time of ACLR would have no effect on cartilage health on magnetic resonance imaging (MRI), and (2) higher cartilage relaxation values would be associated with worse patient-reported and functional outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: A subset of patients from the STABILITY 1 randomized controlled trial were included. All patients underwent primary ACLR with a hamstring autograft. Patients were randomized to either LET augmentation or not. Cartilage status in the patellofemoral joint between the ACLR group and ACLR+LET group was compared using 2-year postoperative quantitative MRI and the ACL osteoarthritis scores of both the surgical and the contralateral nonsurgical knees. Objective functional outcomes and patient-reported outcome measures (PROMs) were attained. Results: A total of 92 patients (43 patients in the ACLR group; mean age, 18.9 ± 3.2 years; 60.5% female; and 49 patients in the ACLR+LET group; mean age, 18.7 ± 3.2 years, 63.3% female) were included. No significant differences were seen in the mean values (ms) for adjusted T1ρ/T2 relaxation times in the medial patella (47.8/42.2 vs 47.3/43.2), central patella (45.5/42.5 vs 44.1/42.7), lateral patella (48.2/43.5 vs 47.3/43.0), medial trochlea (54.7/50.9 vs 56.4/50.9), central trochlea (53.3/51.1 vs 53.1/52.0), and lateral trochlea (54.9/52.1 vs 53.9/52.6) between the ACLR and ACLR+LET groups. No difference in overall ACL osteoarthritis scores was observed (P =.99). An increase in medial patellar T2 relaxation times was associated with a decreasing International Knee Documentation Committee score (P =.046), Knee injury and Osteoarthritis Outcome Score (KOOS) Symptoms subscale score (P =.01), and total KOOS (P =.01). Conclusion: There was no statistical difference in patellofemoral cartilage health between knees 2 years after primary ACLR with hamstring tendon autograft with or without LET. Statistically significant correlations were found between quantitative MRI relaxation times, functional outcome scores, and PROMs; however, the correlations were weak and the clinical significance is unknown. Registration: NCT02018354 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: Multilayered osteochondral scaffolds are becoming increasingly utilized for the repair of knee joint surface lesions (KJSLs). However, the literature on predictive factors is rather limited. Purpose: To (1) evaluate the clinical outcomes and safety of a combined single-step approach using a biomimetic collagen-hydroxyapatite scaffold (CHAS) and filtered bone marrow aspirate (fBMA) for the treatment of KJSLs and (2) identify significant predictors of the treatment outcomes. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent surgery because of a KJSL (size ≥1.5 cm2; International Cartilage Regeneration & Joint Preservation Society grades 3-4) using the combination above were selected from a hospital registry database (100 patients; minimum 2-year follow-up). Patient characteristics, medical history, knee joint and lesion status, intraoperative details, and cellular parameters of the injected fBMA were collected. The arthroscopic evaluation of chondral and meniscal tissue quality in all knee compartments was performed using the Chondropenia Severity Score. Treatment outcomes were determined clinically using patient-reported outcome measures (Knee Injury and Osteoarthritis Outcome Score, EuroQol–5 Dimensions–3 Levels, EuroQol–Visual Analog Scale, and Tegner Activity Scale) and by assessing the occurrence of serious adverse events and graft failure. Multivariable regression analysis was performed to identify significant predictors of the treatment outcomes. Results: At a mean follow-up of 54.2 ± 19.4 months, 78 (87%) patients completed the questionnaires with significant improvements toward the baseline (P <.00625): KOOS Pain subscale from 62 ± 17 to 79 ± 18, KOOS Total score from 57 ± 16 to 70 ± 20, EuroQol–Visual Analog Scale from 61 ± 21 to 76 ± 16, EuroQol–5 Dimensions–3 Levels from 0.57 ± 0.20 to 0.80 ± 0.21, and Tegner Activity Scale from 2.8 ± 1.5 to 3.9 ± 1.9. The graft failure rate was 4%. A longer duration of preoperative symptoms, previous surgery, larger lesions, older age, and female sex were the main negative predictors for the treatment outcomes. The Chondropenia Severity Score and the number of fibroblast colony-forming units in fBMA positively influenced some of the clinical results and safety. Conclusion: A CHAS augmented with fBMA proved to be an adequate and safe approach for the treatment of KJSLs up to midterm follow-up. Based on the subanalysis of predictive factors, the surgical intervention should be performed in a timely and precise manner to prevent lesion enlargement, deterioration of the general knee cartilage status, and recurrent surgical procedures, especially in older and female patients. When a CHAS is used, the quantity of MSCs seems to play a role in augmentation. Registration: NCT06078072 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: The understanding of noncontact anterior cruciate ligament (ACL) injury causation in soccer has improved over the past decades. Bidimensional video analyses have significantly augmented our awareness, representing to date the only practical method to describe injury biomechanics. However, the extent of the problem continues to raise serious concerns. Purpose: To advance our understanding of the causal pathways leading to ACL injury with a large-scale reconstruction of 3-dimensional (3D) whole-body joint kinematics of injuries that occurred to male elite soccer players, as well as to compare the joint angle time course among situational patterns. Study Design: Descriptive laboratory study. Methods: A total of 33 consecutive noncontact and indirect contact ACL injuries that occurred in 6 national and 2 international professional leagues (seasons 2020-2021 to 2022-2023 until December 2022) were analyzed: (1) multiview noncoaxial television images were inspected; (2) multiple camera views were taken from 400 ms before the initial ground contact to 200 ms after the injury frame; (3) a size-matched pitch was modeled and used to calibrate cameras; (4) a 3D skeletal model was adjusted to fit the player's pose in each frame/view; and (5) poses were interpolated, and Euler joint angles were extracted. Results: The authors reconstructed the 3D lower limb joint kinematic curves preceding and during ACL injuries in 33 cases; notably, a sudden external (up to 5°) and then internal knee rotation was observed after the initial contact and before the injury frame. The overall kinematics at injury were knee moderately flexed (45.9°± 21.7°), abducted (4.3°± 5.1°), and externally rotated (3.0°± 6.4°); trunk shallowly flexed (17.4°± 12.5°) and rotated and tilted toward the injured side; and hip flexed (32.0°± 18.7°), abducted (31.1°± 12.0°), and slightly internally rotated (6.6°± 12.2°). Variable behaviors were observed at the ankle level. Conclusion: Via reconstruction of the sequence of whole-body joint motion leading to injury, we confirmed the accepted gross biomechanics (dynamic valgus trend). This study significantly enriches the current knowledge on multiplanar kinematic features (transverse and coronal plane rotations). Furthermore, it was shown that ACL injuries in male professional soccer players manifest through distinct biomechanical footprints related to the concurrent game situation. Clinical Relevance: Interventions aimed at reducing ACL injuries in soccer should consider that environmental features (ie, situational patterns) affect injury mechanics. [ABSTRACT FROM AUTHOR]

Background: Spinopelvic parameters, including pelvic tilt (PT), sacral slope (SS), and pelvic incidence, have been developed to characterize the relationship between lumbar spine and hip motion, but a paucity of literature is available characterizing differences in spinopelvic parameters among patients with femoroacetabular impingement syndrome (FAIS) versus patients without FAIS, as well as the effect of these parameters on outcomes of arthroscopic treatment of FAIS. Purpose: To (1) identify differences in spinopelvic parameters between patients with FAIS versus controls without FAIS; (2) identify associations between spinopelvic parameters and preoperative patient-reported outcomes (PROs); and (3) identify differences in PROs between patients with stiff spines (standing-sitting ΔSS ≤10°) versus those without. Study Design: Cohort study; Level of evidence, 2. Methods: The study enrolled patients ≥18 years of age who underwent primary hip arthroscopy for treatment of FAIS with cam, pincer, or mixed (cam and pincer) morphology. Participants underwent preoperative standing-sitting imaging with a low-dose 3-dimensional radiography system and were matched on age and body mass index (BMI) to controls without FAIS who also underwent EOS imaging. Spinopelvic parameters measured on EOS films were compared between the FAIS and control groups. Patients with FAIS completed the modified Harris Hip Score (mHHS) and Non-Arthritic Hip Score (NAHS) before surgery and at 1-year follow-up. Outcome scores were compared between patients with stiff spines versus those without. Associations between spinopelvic parameters and baseline outcome scores were assessed with Pearson correlations. Continuous variables were compared with Student t test and/or Mann-Whitney U test, and categorical variables were compared with Fisher exact test. Results: A total of 50 patients with FAIS (26 men; 24 women; mean age, 36.1 ± 10.7 years; mean BMI, 25.6 ± 4.2) were matched to 30 controls without FAIS (13 men; 17 women; mean age, 36.6 ± 9.5 years; mean BMI, 26.7 ± 3.6). Age, sex, and BMI were not significantly different between the FAIS and control groups (P >.05). Standing PT was not significantly different between stiff and non-stiff cohorts (P =.73), but sitting PT in the FAIS group was more than double that of the control group (36.5° vs 15.0°; P <.001). Incidence of stiff spine was significantly higher in the FAIS group (62.0% vs 3.3%; P <.001). Among FAIS patients, those with stiff spines had a significantly higher prevalence of cam impingement, whereas those with non–stiff spines had a higher prevalence of mixed impingement (P =.04). No significant differences were seen in preoperative mHHS or NAHS scores or pre- to postoperative improvement in scores between FAIS patients with stiff spines versus those without (P >.05), but a greater sitting SS was found to be positively correlated with a higher baseline mHHS (r = 0.36; P =.02). Conclusion: Patients with FAIS were more likely to have a stiff spine (standing-sitting ΔSS ≤10°) compared with control participants without FAIS. FAIS patients with stiff spines were more likely to have isolated cam morphology than patient without stiff spines. Although sitting SS was positively correlated with baseline mHHS, no significant differences were seen in 1-year postoperative outcomes between FAIS patients with versus without stiff spine. [ABSTRACT FROM AUTHOR]

Background: Neck pain in a concussion population is an emerging area of study that has been shown to have a negative influence on recovery. This effect has not yet been studied in collegiate athletes. Hypothesis: New or worsened neck pain is common after a concussion (>30%), negatively influences recovery, and is associated with patient sex and level of contact in sport. Study Design: Cohort study; Level of evidence, 2. Methods: Varsity-level athletes from 29 National Collegiate Athletic Association member institutions as well as nonvarsity sport athletes at military service academies were eligible for enrollment. Participants completed a preseason baseline assessment and follow-up assessments at 6 and 24 to 48 hours after a concussion, when they were symptom-free, and when they returned to unrestricted play. Data collection occurred between January 2014 and September 2018. Results: A total of 2163 injuries were studied. New or worsened neck pain was reported with 47.0% of injuries. New or worsened neck pain was associated with patient sex (higher in female athletes), an altered mental status after the injury, the mechanism of injury, and what the athlete collided with. The presence of new/worsened neck pain was associated with delayed recovery. Those with new or worsened neck pain had 11.1 days of symptoms versus 8.8 days in those without (P <.001). They were also less likely to have a resolution of self-reported symptoms in ≤7 days (P <.001). However, the mean duration of the return-to-play protocol was not significantly different for those with new or worsened neck pain (7.5 ± 7.7 days) than those without (7.4 ± 8.3 days) (P =.592). Conclusion: This novel study shows that neck pain was common in collegiate athletes sustaining a concussion, was influenced by many factors, and negatively affected recovery. [ABSTRACT FROM AUTHOR]

Background: Pitch counts are only one measure of the true workload of baseball pitchers. Newer research indicates that workload measurement and prevention of injury must include additional factors. Thus, current monitoring systems gauging pitcher workload may be considered inadequate. Purpose/Hypothesis: The purpose of this study was to develop a novel method to determine workload in baseball pitchers and improve processes for prevention of throwing-related injuries. It was hypothesized that our pitching workload model would better predict throwing-related injuries occurring throughout the baseball season than a standard pitch count model. Study Design: Cohort study; Level of evidence, 2. Methods: This prospective observational study was conducted at an academic medical center and community baseball fields during the 2019 to 2023 seasons. Pitchers aged 13 to 18 years were monitored for pitching-related injuries and workload (which included pitching velocity; intensity, using preseason and in-season velocity as a marker of effort; and pitch counts). Results: A total of 71 pitchers had 313 recorded pitcher outings, 11 pitching-related injuries, and 24,228 pitches thrown. Gameday pitch counts for all pitchers ranged from 19 to 219 (mean, 77.5 ± 41.0). Velocity ranged from 46.8 to 85.7 mph (mean, 71.3 ± 5.8 mph). Intensity ranged from 0.7 to 1.3 (mean, 1.0 ± 0.08). The mean workload was 74.7 ± 40.1 for all pitchers. Risk factors significant for injury included throwing at a higher velocity in game (P =.001), increased intensity (eg, an increase in mean velocity thrown from preseason to in-season; P <.001), and being an older pitcher (P =.014). No differences were found for workload between injured and noninjured pitchers because the analysis was underpowered. Conclusion: Our workload model indicated that throwing at a higher velocity, throwing at a higher intensity, and older age were risk factors for injury. Thus, this novel workload model should be considered as a means to identify pitchers who may be at greater risk for injury. [ABSTRACT FROM AUTHOR]

Background: Tumor-like distal femoral cortical irregularities (DFCIs) are a frequent incidental finding on knee magnetic resonance imaging (MRI) and are common in young competitive athletes. Purpose: To assess and compare the morphology and prevalence of DFCIs in competitive alpine skiers over 48 months during adolescence. Study Design: Case series; Level of evidence, 4. Methods: Adolescent competitive alpine skiers were prospectively recruited in 2018 and received bilateral 3-T MRI of the knee at baseline and after 48 months. All MRIs were evaluated for the presence and location of DFCIs, which were marked at 1 of 3 anatomic positions: (1) the femoral attachment of the medial head of the gastrocnemius muscle, (2) the lateral head of the gastrocnemius muscle, or (3) the attachment of the adductor magnus aponeurosis. The size of the DFCI was measured by 2 radiologists independently. The measurements were compared using the Wilcoxon signed-rank test, the interclass correlation coefficient (ICC), and Cohen Kappa. Results: A total of 63 athletes (mean age at follow-up, 19.6 ± 1.2 years; n = 25 female) were included in the study. At baseline, DFCIs were detected in 84 out of 126 knees (67%). At the 48-month follow-up, DFCIs were found in 88 out of 126 knees (70%), with multiple DFCIs in 3 knees and no significant difference between male and female patients (n = 24 male, n = 19 female; P =.71). No significant increase was detected for the number (P =.21) and size of the DFCIs between the baseline and the 48-month follow-up (mean size: baseline, 3.7 ± 0.8 mm; 48-month follow-up: 3.6 ± 0.9 mm; P =.66). The interrater agreement for the mean size measurements of DFCIs was good to excellent (ICC 0.88). Conclusion: DFCIs remain a frequent finding on knee MRI in competitive alpine skiers after skeletal maturation and do not disappear during adolescence. The DFCI size was constant in athletes aged between 15 and 19 years. Moreover, DFCIs should not be mistaken for a pathologic finding. [ABSTRACT FROM AUTHOR]

Background: Few previous studies have investigated how different injury mechanisms leading to sport-related concussion (SRC) in soccer may affect outcomes. Purpose: To describe injury mechanisms and evaluate injury mechanisms as predictors of symptom severity, return to play (RTP) initiation, and unrestricted RTP (URTP) in a cohort of collegiate soccer players. Study Design: Cohort study; Level of evidence, 2. Methods: The Concussion Assessment, Research and Education (CARE) Consortium database was used. The mechanism of injury was categorized into head-to-ball, head-to-head, head-to-body, and head-to-ground/equipment. Baseline/acute injury characteristics—including Sports Concussion Assessment Tool–3 total symptom severity (TSS), loss of consciousness (LOC), and altered mental status (AMS); descriptive data; and recovery (RTP and URTP)—were compared. Multivariable regression and Weibull models were used to assess the predictive value of the mechanism of injury on TSS and RTP/URTP, respectively. Results: Among 391 soccer SRCs, 32.7% were attributed to a head-to-ball mechanism, 27.9% to a head-to-body mechanism, 21.7% to a head-to-head mechanism, and 17.6% to a head-to-ground/equipment mechanism. Event type was significantly associated with injury mechanism [χ2(3) = 63; P <.001), such that more head-to-ball concussions occurred in practice sessions (n = 92 [51.1%] vs n = 36 [17.1%]) and more head-to-head (n = 65 [30.8%] vs n = 20 [11.1]) and head-to-body (n = 76 [36%] vs n = 33 [18.3%]) concussions occurred in competition. The primary position was significantly associated with injury mechanism [χ2(3) = 24; P <.004], with goalkeepers having no SRCs from the head-to-head mechanism (n = 0 [0%]) and forward players having the least head-to-body mechanism (n = 15 [19.2%]). LOC was also associated with injury mechanism (P =.034), with LOC being most prevalent in head-to-ground/equipment. Finally, AMS was most prevalent in head-to-ball (n = 54 [34.2%]) and head-to-body (n = 48 [30.4%]) mechanisms [χ2(3) = 9; P =.029]. In our multivariable models, the mechanism was not a predictor of TSS or RTP; however, it was associated with URTP (P =.044), with head-to-equipment/ground injuries resulting in the shortest mean number of days (14 ± 9.1 days) to URTP and the head-to-ball mechanism the longest (18.6 ± 21.6 days). Conclusion: The mechanism of injury differed by event type and primary position, and LOC and AMS were different across mechanisms. Even though the mechanism of injury was not a significant predictor of acute symptom burden or time until RTP initiation, those with head-to-equipment/ground injuries spent the shortest time until URTP, and those with head-to-ball injuries had the longest time until URTP. [ABSTRACT FROM AUTHOR]

Background: Even though arthroscopic rotator cuff repair is recognized as a standard treatment option, the risk of postoperative retear is a major concern. Purpose: To evaluate the effect of porcine-derived absorbable patch-type atelocollagen during arthroscopic rotator cuff repair. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 64 patients with rotator cuff tears diagnosed on magnetic resonance imaging (MRI) were enrolled prospectively from November 2020 to December 2021. Both groups had repairs using the suture bridge technique. For the atelocollagen group, before securing the lateral anchors, we inserted porcine-derived absorbable patch-type atelocollagen between the footprint and the tendon. On postoperative day 2, the patients underwent MRI to confirm containment of the patch-type atelocollagen. At 6 months and 1 year postoperatively, the signal intensity of the repaired tendon was assessed using MRI. Patients were evaluated using the Constant score as the primary outcome, along with the visual analog scale for pain; range of motion; American Shoulder and Elbow Surgeons score; University of California, Los Angeles, score; and Korean Shoulder Score preoperatively and at 2, 3, 6, and 12 months postoperatively. Results: No significant changes in the Constant score as primary outcome, pain or other functional scores, and range of motion were observed between the groups at 1 year postoperatively. The patch-type atelocollagen was confirmed to be contained by the time-zero MRI scan taken 2 days postoperatively. Among the 55 patients included in final analysis, 12 retear cases were recorded (21.8% retear rate). A significantly lower retear rate was found in the atelocollagen group, as 3 cases were observed in this group (10.3%) and 9 cases were observed in the conventional repair group (34.6%) (P =.048). Conclusion: The Constant score was not different between the groups. The retear rate after rotator cuff repair was significantly lower in the group that received porcine-derived absorbable patch-type atelocollagen compared with in the conventional group. Registration: KCT0005184 (Clinical Research Information Service [CRIS]; https://cris.nih.go.kr). [ABSTRACT FROM AUTHOR]

Background: Qualitative movement screening tools provide a practical method of assessing mechanical patterns associated with potential injury development. Biomechanics play a role in hamstring strain injury and are recommended as a consideration within injury screening and rehabilitation programs. However, no methods are available for the in-field assessment of sprint running mechanics associated with hamstring strain injuries. Purpose: To investigate the intra- and interrater reliability of a novel screening tool assessing in-field sprint running mechanics titled the Sprint Mechanics Assessment Score (S-MAS) and present normative S-MAS data to facilitate the interpretation of performance standards for future assessment uses. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Maximal sprint running trials (35 m) were recorded from 136 elite soccer players using a slow-motion camera. All videos were scored using the S-MAS by a single assessor. Videos from 36 players (18 men and 18 women) were rated by 2 independent assessors blinded to each other's results to establish interrater reliability. One assessor scored all videos in a randomized order 1 week later to establish intrarater reliability. Intraclass correlation coefficients (ICCs) based on single measures using a 2-way mixed-effects model, with absolute agreement with 95% CI and kappa coefficients with percentage agreements, were used to assess the reliability of the overall score and individual score items, respectively. T -scores were calculated from the means and standard deviations of the male and female groups to present normative data values. The Mann-Whitney U test and the Wilcoxon signed-rank test were used to assess between-sex differences and between-limb differences, respectively. Results: The S-MAS showed good intrarater (ICC, 0.828 [95% CI, 0.688-0.908]) and interrater (ICC, 0.799 [95% CI, 0.642-0.892]) reliability, with a standard error of measurement of 1 point. Kappa coefficients for individual score items demonstrated moderate to substantial intra- and interrater agreement for most parameters, with percentage agreements ranging from 75% to 88.8% for intrarater and 66.6% to 88.8% for interrater reliability. No significant sex differences were observed for overall scores, with mean values of 4.2 and 3.8 for men and women, respectively (P =.27). Conclusion: The S-MAS is a new tool developed for assessing sprint running mechanics associated with lower limb injuries in male and female soccer players. The reliable and easy-to-use nature of the S-MAS means that this method can be integrated into practice, potentially aiding future injury screening and research looking to identify athletes who may demonstrate mechanical patterns potentially associated with hamstring strain injuries. [ABSTRACT FROM AUTHOR]

Background: There is little evidence of the biomechanical performance of medial collateral ligament (MCL) reconstructions for restoring stability to the MCL-deficient knee regarding valgus, external rotation (ER), and anteromedial rotatory instability (AMRI). Hypothesis: A short isometric reconstruction will better restore stability than a longer superficial MCL (sMCL) reconstruction, and an additional deep MCL (dMCL) graft will better control ER and AMRI than single-strand reconstructions. Study Design: Controlled laboratory study. Methods: Nine cadaveric human knees were tested in a kinematics rig that allowed tibial loading while the knee was flexed-extended 0° to 100°. Optical markers were placed on the femur and tibia and displacements were measured using a stereo camera system. The knee was tested intact, and then after MCL (sMCL + dMCL) transection, and loaded in anterior tibial translation (ATT), ER, varus-valgus, and combined ATT + ER (AMRI loading). Five different isometric MCL reconstructions were tested: isolated long sMCL, a short construct, each with and without dMCL addition, and isolated dMCL reconstruction, using an 8 mm–wide synthetic graft. Results: MCL deficiency caused an increase in ER of 4° at 0° of flexion (P =.271) up to 14° at 100° of flexion (P =.002), and valgus laxity increased by 5° to 8° between 0° and 100° of flexion (P <.024 at 0°-90°). ATT did not increase significantly in isolated MCL deficiency (P >.999). All 5 reconstructions restored native stability across the arc of flexion apart from the isolated long sMCL, which demonstrated residual ER instability (P ≤.047 vs other reconstructions). Conclusion: All tested techniques apart from the isolated long sMCL graft are satisfactory in the context of restoring the valgus, ER, and AMRI stability to the MCL-deficient knee in a cadaveric model. Clinical Relevance: Contemporary MCL reconstruction techniques fail to control ER and therefore AMRI as they use a long sMCL graft and do not address the dMCL. This study compares 5 MCL reconstruction techniques. Both long and short isometric constructs other than the long sMCL achieved native stability in valgus and ER/AMRI. Double-strand reconstructions (sMCL + dMCL) tended to provide more stability. This study shows which reconstructions demonstrate the best biomechanical performance, informs surgical reconstruction techniques for AMRI, and questions the efficacy of current popular techniques. [ABSTRACT FROM AUTHOR]

Background: Restoration of osteochondral defects is critical, because osteoarthritis (OA) can arise. Hypothesis: Overexpression of insulin-like growth factor 1 (IGF-1) via recombinant adeno-associated viral (rAAV) vectors (rAAV-IGF-1) would improve osteochondral repair and reduce parameters of early perifocal OA in sheep after 6 months in vivo. Study Design: Controlled laboratory study. Methods: Osteochondral defects were created in the femoral trochlea of adult sheep and treated with rAAV-IGF-1 or rAAV- lacZ (control) (24 defects in 6 knees per group). After 6 months in vivo, osteochondral repair and perifocal OA were assessed by well-established macroscopic, histological, and immunohistochemical scoring systems as well as biochemical and micro–computed tomography evaluations. Results: Application of rAAV-IGF-1 led to prolonged (6 months) IGF-1 overexpression without adverse effects, maintaining a significantly superior overall cartilage repair, together with significantly improved defect filling, extracellular matrix staining, cellular morphology, and surface architecture compared with rAAV- lacZ. Expression of type II collagen significantly increased and that of type I collagen significantly decreased. Subchondral bone repair and tidemark formation were significantly improved, and subchondral bone plate thickness and subarticular spongiosa mineral density returned to normal. The OA parameters of perifocal structure, cell cloning, and matrix staining were significantly better preserved upon rAAV-IGF-1 compared with rAAV- lacZ. Novel mechanistic associations between parameters of osteochondral repair and OA were identified. Conclusion: Local rAAV-mediated IGF-1 overexpression enhanced osteochondral repair and ameliorated parameters of perifocal early OA. Clinical Relevance: IGF-1 gene therapy may be beneficial in repair of focal osteochondral defects and prevention of perifocal OA. [ABSTRACT FROM AUTHOR]

Background: The approach to managing the footprint area and reconstructing the tendon-bone interface (TBI) is critical for optimal healing. Purpose: To evaluate the outcomes of the semi–bone tunnel (SBT) technique using a double-row suture bridge combined with platelet-rich plasma (PRP) hydrogel for rotator cuff repair in a rabbit model. Study Design: Controlled laboratory study. Methods: A total of 48 New Zealand White rabbits were divided into 4 groups. The supraspinatus tendons were severed at the footprint to create a rotator cuff tear model in the surgical groups. Rabbits were treated with the traditional onto-surface repair (control group), SBT technique (SBT group), and SBT technique combined with PRP hydrogel implantation (SBT+PRP group). The rabbits without surgery were the normal group. At 8 weeks after surgery, macroscopic observation, magnetic resonance imaging (MRI) and micro–computed tomography (μCT) examinations, histological evaluations, and biomechanical tests were performed to assess the curative effects of the given treatments. Results: The MRI results showed that the repaired supraspinatus tendon presented a uniform signal, minimal inflammatory response, and the lowest signal-to-noise quotient value in the SBT+PRP group. The μCT results suggested that the SBT technique did not reduce the local bone mineral density in the TBI area compared with the onto-surface repair technique. The histological staining results showed that the regenerated TBI in the SBT+PRP group had a 4-layer structure similar to the natural tissue. The highest values for biomechanical properties were observed in the SBT+PRP group, and there was no significant difference between the SBT+PRP group and normal group. Conclusion: The SBT technique presented a better tendon-bone healing effect for rotator cuff tear in the rabbit model compared with the traditional onto-surface repair technique. The specimens in the SBT+PRP group had a similar TBI structure and biomechanical properties to the natural tissue. Clinical Relevance: The SBT technique can be an alternative surgical approach for rotator cuff repair, especially for moderate to large tears and cases requiring scaffold implantation. [ABSTRACT FROM AUTHOR]

Background: Recent studies have investigated the effect of psychological factors on return to sport (RTS), but none has tested the existence of psychological profiles linked to reinjury anxiety and its links with RTS and reinjury. Purpose: To assess the effect of different psychological profiles on RTS and reinjury. Study Design: Cohort study; Level of evidence, 2. Methods: The study screened patients who were involved in all types of sports for anterior cruciate ligament (ACL) reconstruction (hamstring and patellar tendon autografts). All participants were included during the RTS phase (90-180 days after ACL reconstruction). Reinjury anxiety, fear of reinjury, kinesiophobia, perceived stress, anxiety, depression, knee confidence, self-esteem, optimism, coping, and pain were measured. Hierarchical cluster analysis (Ward method) and analysis of variance were performed. In the second year after surgery, patients were recontacted by telephone to follow-up. RTS and reinjury were compared by profile type. Results: A total of 162 athletes were initially included, of whom 123 responded regarding RTS and reinjury. Cluster analysis showed a 4-cluster solution (χ2[21] = 428.59; λ =.064; P <.001). Profile 1 (27.8%) was characterized by moderate reinjury anxiety and no depression. Profile 2 (22.8%) was characterized by moderate reinjury anxiety and minor anxious-depressive reaction. Profile 3 (30.9%) was characterized by no reinjury anxiety, no depression, and high confidence. Profile 4 (18.5%) was characterized by high anxiety, high depression, and low confidence. Profile 4 had the lowest self-esteem and optimism scores compared with profile 3 (P <.001). In addition, a higher percentage of men was found in profile 3 as opposed to profile 4 (χ2[3] = 11.35; P <.01). Profile 4 had the highest rate of non-RTS with 54.2% (profile 1: 14.3%, P =.001; profile 2: 25.0%, P =.031; profile 3: 22.2%, P =.011). Finally, patients with profile 3 had a higher risk of reinjury (13.9%) than those with profile 4 (0%) (P =.047), who had an extremely conservative RTS. Conclusion: The different profiles will affect RTS, but also the risk of reinjury exclusively for profiles 3 and 4. Rehabilitation management will probably require all stakeholders to understand psychological profiles of athletes to develop an on-demand rehabilitation plan. [ABSTRACT FROM AUTHOR]

Background: Despite the prevalence of proximal hamstring avulsion injuries (PHAIs), the understanding of rerupture risk factors and the influence of injury chronicity on these rates remain limited. Purpose: To investigate the rerupture rate after PHAI repair and identify its associated risk factors and the optimal time to primary surgery. Study Design: Case-control study; Level of evidence, 3. Method: This is a retrospective analysis of prospectively collected data from the French Proximal Hamstring Avulsion Surgery Cohort Study targeting patients surgically treated for PHAI between 2002 and 2022. The primary outcome measure of this study was the rerupture rate of PHAI repair. The secondary outcome measures included the assessment of the potential risk factors for rerupture as well as the investigation of the incidence rate of rerupture for 100 person-years depending on various injury-surgery delay definitions. Results: This study analyzed 740 patients with a mean age of 45.9 years (SD, 13.6 years) and followed up for a mean of 4.9 years (SD, 3.9 years). The rerupture rate was 4.59% (34/740). Most reruptures (75%) occurred within the first 6 months after surgery (median, 88.5 days; interquartile range, 39.5-182 days), and 74% were atraumatic. Univariate analysis identified potential risk factors: longer initial surgery delay (hazard ratio [HR], 1.03; 95% CI, 1.01-1.04; P =.04) and initial complete ruptures (HR, 4.47; 95% CI, 1.07-18.7; P =.04). Receiver operating characteristic curve analysis found the optimal injury-surgery delay cutoff predicting rerupture to be 32 days (area under the curve, 0.62; 95% CI, 0.53-0.71). The relative Youden index was calculated at 0.24, corresponding to a sensitivity of 65% and a specificity of 59%. Surpassing this cutoff showed the highest HR (2.56), narrowest 95% CI (1.27-5.17), and highest incidence of rerupture (1.42 per 100 person-years) (P =.01). In the multivariate analysis, an injury-surgery delay of >32 days (HR, 2.5; 95% CI, 1.24-5.06; P =.01) and initial complete ruptures (HR, 4.33; 95% CI, 1.04-18.08; P =.04) emerged as significant risk factors for rerupture. Conclusion: This study found a 4.59% rerupture risk after PHAI repair. Most reruptures (75%) occurred within the first 6 months after surgery. Risk factors for rerupture included chronicity and initial complete injury. The optimal threshold for chronicity of PHAI lesions, based on rerupture rate, was marked by an injury-surgery delay of >32 days. [ABSTRACT FROM AUTHOR]

Background: Arthroscopic treatment of femoroacetabular impingement (FAI) and symptomatic labral tears confers short- to midterm benefits, yet further long-term evidence is needed. Moreover, despite the physiological and biomechanical significance of the chondrolabral junction (CLJ), the clinical implications of damage to this transition zone remain understudied. Purpose: To (1) report minimum 8-year survivorship and patient-reported outcome measures after hip arthroscopy for FAI and (2) characterize associations between outcomes and patient characteristics (age, body mass index, sex), pathological parameters (Tönnis angle, alpha angle, type of FAI, CLJ breakdown), and procedures performed (labral management, FAI treatment, microfracture). Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective cohort study included patients who underwent primary hip arthroscopy for symptomatic labral tears secondary to FAI by a single surgeon between 2002 and 2013. All patients were ≥18 years of age with minimum 8-year follow-up and available preoperative radiographs. The primary outcome was conversion to total hip arthroplasty (THA), and secondary outcomes included revision arthroscopy, patient-reported outcome measures, and patient satisfaction. CLJ breakdown was assessed using the Beck classification. Kaplan-Meier estimates and weighted Cox regression were used to estimate 10-year survivorship (no conversion to THA) and identify risk factors associated with THA conversion. Results: In this study of 174 hips (50.6% female; mean age, 37.8 ± 11.2 years) with mean follow-up of 11.1 ± 2.5 years, the 10-year survivorship rate was 81.6% (95% CI, 75.9%-87.7%). Conversion to THA occurred at a mean 4.7 ± 3.8 years postoperatively. Unadjusted analyses revealed several variables significantly associated with THA conversion, including older age; higher body mass index; higher Tönnis grade; labral debridement; and advanced breakdown of the CLJ, labrum, or articular cartilage. Survivorship at 10 years was inferior in patients exhibiting severe (43.6%; 95% CI, 31.9%-59.7%) versus mild (97.9%; 95% CI, 95.1%-100%) breakdown of the CLJ (P <.001). Multivariable analysis identified worsening CLJ breakdown (weighted hazard ratio per 1-unit increase, 6.41; 95% CI, 3.11-13.24), older age (1.09; 95% CI, 1.04-1.14), and higher Tönnis grade (4.59; 95% CI, 2.13-9.90) as independent negative prognosticators (P <.001 for all). Conclusion: Although most patients achieved favorable minimum 8-year outcomes, several pre- and intraoperative factors were associated with THA conversion; of these, worse CLJ breakdown, higher Tönnis grade, and older age were the strongest predictors. [ABSTRACT FROM AUTHOR]

Background: Anteromedial rotatory instability (AMRI) of the knee is a complex and severe condition caused by injury to the anterior cruciate ligament and/or the medial collateral ligament. Clinical studies dealing with AMRI are rare, and objective measurements are nonexistent. Purpose/Hypothesis: The objectives of this study were, first, to quantify anteromedial rotatory knee laxity in healthy individuals using a noninvasive image analysis software and, second, to assess intra- and interrater reliability and equivalence in measuring anteromedial knee translation (AMT). It was hypothesized that AMT could be reliably quantified using a noninvasive image analysis software. Study design: Cohort study; Level of evidence, 3. Methods: This prospective proof-of-concept study included healthy individuals aged 16 to 40 years with no history of knee injury or surgery. Three adhesive surface markers were placed on predefined landmarks on the medial side of the knee. Three independent investigators examined anteromedial rotatory knee laxity with an anterior drawer test in different tibial rotations (neutral tibial rotation, 15° of external tibial rotation, and 15° of internal tibial rotation). The entire examination of each knee was recorded, and AMT including the side-to-side difference (SSD) was assessed using a freely available and validated image analysis software (PIVOT iPad application). Group comparisons were performed using a 1-way analysis of variance with Bonferroni-adjusted post hoc analysis. Intraclass correlation coefficients (ICCs) were calculated to assess inter- and intrarater reliability of AMT measurements. Equivalence of measurements was evaluated using the 2 one-sided t -test procedure. Results: Anteromedial rotatory knee laxity was assessed in 30 knees of 15 participants (53% male) with a mean age of 26.2 ± 3.5 years. In all 3 raters, the highest AMT was observed in neutral tibial rotation (range of means, 2.2-3.0 mm), followed by external tibial rotation (range of means, 2.0-2.4 mm) and internal tibial rotation (range of means, 1.8-2.2 mm; P <.05). Intrarater reliability of AMT (ICC, 0.88-0.96) and SSD (ICC, 0.61-0.96) measurements was good to excellent and moderate to excellent, respectively. However, interrater reliability was poor to moderate for AMT (ICC, 0.44-0.73) and SSD (ICC, 0.12-0.69) measurements. Statistically significant equivalence of AMT and SSD measurements was observed between and within raters for almost all testing conditions. Conclusion: Anteromedial rotatory knee laxity could be quantified using a noninvasive image analysis software, with the highest AMT observed during neutral tibial rotation in uninjured individuals. Reliability and equivalence of measurements were good to excellent within raters and moderate between raters. [ABSTRACT FROM AUTHOR]

Background: It has been shown that chronic ankle instability (CAI) leads to abnormalities in neuromuscular control of more proximal joints than the ankle. Although strength of the hip and the ankle muscles has been largely investigated providing concordant results, limited evidence with contrasting results has been reported regarding knee extensor and flexor muscles. Purpose: To investigate maximal and submaximal isometric muscle strength in individuals with CAI. Study Design: Controlled laboratory study. Methods: Fifteen participants with unilateral CAI and 15 healthy matched controls were recruited. To quantify maximal strength, peak forces were recorded during a maximal isometric voluntary contraction of knee extensor and flexor muscles at 30° and 90° of knee flexion and normalized by the body weight of each participant. At both angles, submaximal isometric contractions at 20%, 50%, and 80% of the maximal voluntary isometric contraction were performed to analyze strength steadiness, in terms of coefficient of variation, and strength accuracy, in terms of absolute error. During all the assessments, knee extensor and flexor muscle activation was recorded by means of surface electromyography. Results: Knee flexor maximal isometric strength was significantly lower in the injured limb of individuals with CAI in comparison with healthy controls at both 30° (0.15 ± 0.05 vs 0.20 ± 0.05; P <.05) and 90° (0.14 ± 0.04 vs 0.18 ± 0.05; P <.05). Knee extensor and flexor steadiness was significantly lower (higher coefficient of variation) in both the injured and the noninjured limbs of individuals with CAI in comparison with healthy individuals at 90° and at 30° for knee flexor steadiness of the injured limb. Knee extensor and flexor accuracy was lower (higher absolute error) in both the injured and noninjured limbs of individuals with CAI in comparison with healthy individuals, mainly at 30°, while at 90° it was lower only in the injured limb. No differences between the 2 groups were found for maximal isometric strength of knee extensor muscles, as well as for muscle activations. Conclusion: Individuals with CAI show abnormalities in maximal and submaximal isometric strength of knee flexor muscles, and submaximal strength of the knee extensor muscles. Further studies should deeply investigate mechanisms leading to these abnormalities. Clinical Relevance: Rehabilitation interventions should consider abnormalities of neuromuscular control affecting joints more proximal than the ankle in individuals with CAI. Registration: NCT05273177 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: Time-dependent postoperative changes in knee joint line obliquity (KJLO) and subsequent adaptational changes in the hip and ankle joints have not been fully proven after medial open wedge high tibial osteotomy (MOWHTO). Purpose: To investigate the serial postoperative changes in KJLO and subsequent adaptational changes in the hip and ankle joints over time after MOWHTO. Study design: Case series, Level of evidence, 4. Methods: A total of 92 patients who underwent MOWHTO between April 2015 and December 2020 were evaluated. Radiographic parameters, including KJLO, ankle joint line obliquity (ALO), hip abduction angle (HAA), joint line convergence angle, weightbearing line ratio, and hip-knee-ankle angle, were analyzed in time sequence (preoperatively and 3, 6, 12, and 24 months postoperatively). Repeated-measures analysis of variance and post hoc analysis were used to demonstrate alterations and the statistical significance of KJLO and other related radiographic parameters over time. Results: The mean KJLO values were –1.9°, –2.1°, –2.7°, and –3.2° at 3, 6, 12, and 24 months postoperatively, respectively, indicating that there was consistent increase in valgus tilting of KJLO from 6 to 24 months (P <.001 for both 6-12 months and 12-24 months). ALO and HAA showed significant changes from 6 to 12 months (ALO, P <.001; HAA, P =.002), but not between 12 and 24 months (ALO: –3.0°, –2.7°, –1.9°, and −1.6°; HAA: –0.8°, –0.9°, –1.5°, and −1.8° at 3, 6, 12, and 24 months, respectively). The mean joint line convergence angle, weightbearing line ratio, and hip-knee-ankle angle did not change significantly from 3 months to 24 months postoperatively. Conclusion: There was a consistent increase in valgus tilting of the postoperative KJLO from 6 to 24 months after MOWHTO. The adaptive ALO and HAA significantly changed between 6 and 12 months and were maintained until 24 months after MOWHTO. It is necessary to consider the adaptive change when hip or ankle surgery is planned within this period. [ABSTRACT FROM AUTHOR]

Background: It is well known that rotator cuff repair is associated with an overall retear rate of 21% to 26%. However, a cuff retear may not necessarily be associated with poor clinical outcomes. Hypothesis: There would be no difference in clinical outcomes between patients with a cuff retear and those with an intact repair at a midterm follow-up of 5 years. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective study was conducted involving patients who received arthroscopic complete repair of the supraspinatus tendon between January 2009 and December 2017. Patients who did not have a postoperative magnetic resonance imaging (MRI) scan or who had a follow-up of <5 years were excluded. Clinical outcomes, including the visual analog scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion (FF) of the involved shoulder were assessed at the 2-year and 5-year follow-up points. Results: The study group included 105 patients with a mean follow-up of 85 months. MRI scans were performed at a mean of 20 months. Fourteen full-thickness cuff retears and 91 intact repairs were identified using postoperative MRI scans. Significant improvement in VAS score, ASES score, and FF were found between the preoperative assessment and the 2 designated follow-up points (2 years and 5 years) in both the cuff retear and the intact repair groups (P <.001). The VAS and ASES scores at the 2-year follow-up for the intact repair group were 1.8 ± 2.0 and 80.7 ± 18.1, respectively. The corresponding values for the retear group were 2.3 ± 2.2 and 71.9 ± 19.5, respectively. No significant difference was found between the 2 groups in the VAS and ASES scores at the 2-year follow-up. However, patients with an intact repair had a better VAS score (1.4 ± 1.8; P =.049) and ASES score (81.7 ± 17; P =.019) than those with a cuff retear at the 5-year assessment (3.0 ± 2.8 and 67.1 ± 22.9, respectively). In the intact repair group, 91% of patients achieved the minimal clinically important difference for the 5-year VAS score, compared with 54% in the cuff retear group (P <.001). The corresponding values for the 5-year ASES score were 80% and 54%, respectively (P =.044). FF measurements at the 5-year follow-up in patients with intact repair and those with a cuff retear were 161°± 23° and 144°± 37°, respectively (P =.059). Continuous improvement in VAS score and FF between the 2-year and 5-year follow-up was observed in the intact repair group (P =.005 and P =.04, respectively). Conclusion: The patients with an intact repair had better VAS and ASES scores compared with those who had a cuff retear at a midterm follow-up of 5 years. Between the 2-year and the 5-year follow-up, some further improvement was observed in the VAS score and FF in the intact repair group. [ABSTRACT FROM AUTHOR]

Background: A posterior tibial slope (PTS) >12° is an independent risk factor for anterior cruciate ligament (ACL) graft rupture, and a high tibial osteotomy (HTO) for slope correction can help avoid it. Management of patellar height is of major concern when performing HTO. Purpose: To evaluate the effect of tibial tubercle–sparing anterior closing-wedge osteotomy on patellar height in revision ACL reconstruction (ACLR). Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent arthroscopic revision ACLR combined with retro–tibial tubercle anterior closing-wedge HTO (ACW-HTO) between January 1, 2016, and March 31, 2021, were assessed for eligibility. Patellar height was measured on full weightbearing lateral radiographs according to the Insall-Salvati index (ISI) and Caton-Deschamps index (CDI) or frontal radiographs using the femoral patellar height index. The PTS was evaluated using the proximal anatomic axis of the tibia on standard short lateral radiographs. The delta (postoperative – preoperative) and the ratio (preoperative/postoperative) of the 3 patellar height indices and PTS were calculated. Preoperative and postoperative patellar heights were compared using independent t tests for each index. Also investigated was whether patients changed patellar height category (baja, normal, or alta) after slope osteotomy. Results: Among 475 revision ACLRs, 47 tibial tubercle–sparing ACW-HTOs were retained for analysis. No significant difference in patellar height was found between pre- and postoperative radiographs regardless of the index (preoperative – postoperative) (ISI: 1.0 ± 0.2 – 0.9 ± 0.2, P =.1729; CDI: 1.0 ± 0.2 – 1.0 ± 0.2, P =.4034; femoral patellar height index: 1.5 ± 0.2 – 1.5 ± 0.2; P =.5130). Fifteen patients (31.9%) exhibited a postoperative change in their patellar height category when measured by the ISI (6 moved up a category, 9 moved down one), and 18 patients (38.3%) changed category according to the CDI (10 moved up a category, 8 moved down one). No significant difference was found between pre- and postoperative patellar height among these patients (ISI: P =.2418; CDI: P =.3005). Conclusion: Changes in patellar height ratio are common after tibial tubercle–sparing ACW-HTO in patients undergoing revision ACLR. The clinical effect of these changes is unknown, and further study is needed to investigate whether they may result in patellofemoral symptoms. [ABSTRACT FROM AUTHOR]

Background: Proximal hamstring complex injury (PHCI) is a common injury among professional athletes, particularly those participating in pivot contact sports. Previous studies have suggested that surgery can be effective in restoring function and allowing athletes to return to sport (RTS), but the factors influencing successful RTS have been less clear. Purpose: To assess RTS capabilities after surgical treatment of PHCI in professional athletes and to identify favorable predictors of RTS. Study Design: Case series; Level of evidence, 4. Methods: This study (2002-2022) was conducted on professional athletes who underwent surgical treatment for PHCI at a sports surgery center. The primary outcome of the study was the RTS capability, evaluated based on the rate of athletes' return to their preinjury level of competition, time delay to RTS, and quality of RTS as measured using their level of performance and progression of scores on activity scales such as the Tegner Activity Scale (TAS) and University of California, Los Angeles (UCLA), scale. "Maintained performance" was defined as athletes returning to the same preinjury activity level (per the TAS and UCLA scale) and perceiving themselves to have maintained their performance. Secondary outcomes covered the potential RTS predictors and complication rate. The study distinguished 2 types of PHCI: proximal hamstring tendon avulsion injury (proximal rupture with empty footprint, or having a "positive dropped ice cream sign") and complete proximal hamstring free tendon rupture (PHTR; proximal rupture without empty footprint, or having a "negative dropped ice cream sign"). Results: The study examined 64 professional athletes (mean age, 27.3 years; 82.8% male) undergoing surgery for PHCI. The RTS rate was 98.4%, with 78.1% of the athletes returning to their preinjury level of competition at 6.2 months (SD, 2.5 months). Twelve (19%) patients had returned to sport at an inferior level of competition, and 2 (3.1%) were unable to continue in their preinjury sport. Subgroup analysis revealed variation in RTS based on sport type, with the highest rate of return to preinjury performance found in athletes in handball and sports with splits (fencing, squash, and escalade; 100%) and soccer (95.2%). In the univariate analysis, male sex (hazard ratio [HR], 4.05; 95% CI, 1.45-11.3; P =.008), higher preinjury TAS score (HR, 1.27; 95% CI, 1.06-1.52; P =.011), injury involving the semimembranosus (HR, 4.84; 95% CI, 2.31-10.2; P <.001) or conjoint tendon (HR, 3.12; 95% CI, 1.55-6.25; P =.001), and PHTR (HR, 7.77; 95% CI, 3.54-17.0; P <.001) were significantly associated with a better postoperative level of competition. Multivariate analysis identified 3 favorable predictors of RTS with HRs of 2.91 (95% CI, 1.01-8.35; P =.047) for male sex, 3.86 (95% CI, 1.78-8.37; P <.001) for isolated semimembranosus injury, and 5.18 (95% CI, 2.24-12.0; P <.001) for PHTR. The complication rate was 4.7%. Conclusion: Favorable predictors of early RTS were male sex, isolated semimembranosus injury, and PHTR injuries. Registration: NCT02906865 (ClinicalTrials.gov identifier). [ABSTRACT FROM AUTHOR]

Background: Historical MCL (medial collateral ligament) reconstruction (MCLR) techniques have focused on the superficial MCL (sMCL) to restore valgus stability while frequently ignoring the importance of the deep MCL (dMCL) in controlling tibial external rotation. The recent recognition of the medial ligament complex importance has multiple studies revisiting medial anatomy and questioning contemporary MCLR techniques. Purpose: To assess whether (1) an isolated sMCL reconstruction (sMCLR), (2) an isolated dMCL reconstruction (dMCLR), or (3) a novel single-strand short isometric construct (SIC) would restore translational and rotational stability to a knee with a dMCL and sMCL injury. Study Design: Controlled laboratory study. Methods: Biomechanical testing was performed on 14 fresh-frozen cadaveric knee specimens using a custom multiaxial knee activity simulator. The specimens were divided into 2 groups. The first group was tested in 4 states: intact, after sectioning the sMCL and dMCL, isolated sMCLR, and isolated dMCLR. The second group was tested in 3 states: intact, after sectioning the sMCL and dMCL, and after single-strand SIC reconstruction (SICR). In each state, 4 loading conditions were applied at 0°, 20°, 40°, 60°, and 90° of knee flexion: 8-N·m valgus torque, 5-N·m external rotation torque, 90-N anterior drawer, and combined 90-N anterior drawer plus 5-N·m tibial external rotation torque. Anterior translation, valgus rotation, and external rotation of the knee were measured for each state and loading condition using an optical motion capture system. Results: sMCL and dMCL transection resulted in increased laxity for all loading conditions at all flexion angles. Isolated dMCLR restored external rotation stability to intact levels throughout all degrees of flexion, yet valgus stability was restored only at 0° of flexion. Isolated sMCLR restored valgus and external rotation stability at 0°, 20°, and 40° of flexion but not at 60° or 90° of flexion. Single-strand SICR restored valgus and external rotation stability at all flexion angles. In the combined anterior drawer plus external rotation test, isolated dMCL and single-strand SICR restored stability to the intact level at all flexion angles, while the isolated sMCL restored stability at 20° and 40° of flexion but not at 60° or 90° of flexion. Conclusion: In the cadaveric model, single-strand SICR restored valgus and rotational stability throughout the range of motion. dMCLR restored rotational stability to the knee throughout the range of motion but did not restore valgus stability. Isolated sMCLR restored external rotation and valgus stability in early flexion. Clinical Relevance: In patients with anteromedial rotatory instability in the knee, neither an sMCLR nor a dMCLR is sufficient to restore stability. [ABSTRACT FROM AUTHOR]

Background: Bone morphogenetic protein 2 (BMP2) is an appealing osteogenic and chondrogenic growth factor for promoting tendon-bone healing. Recently, it has been reported that soluble vascular endothelial growth factor (VEGF) receptor 1 (sVEGFR1) (a VEGF receptor antagonist) could enhance BMP2-induced bone repair and cartilage regeneration; thus, their combined application may represent a promising treatment to improve tendon-bone healing. Moreover, BMP2 could stimulate skeletal stem cell (SSC) expansion and formation, which is responsible for wounded tendon-bone interface repair. However, whether the codelivery of BMP2 and sVEGFR1 increases tendon enthesis injury–activated SSCs better than does BMP2 alone needs further research. Purpose: To study the effect of BMP2 combined with sVEGFR1 on tendon-bone healing and injury-activated SSC lineage. Study Design: Controlled laboratory study. Methods: A total of 128 C57BL/6 mice that underwent unilateral supraspinatus tendon detachment and repair were randomly assigned to 4 groups: (1) untreated control group; (2) hydrogel group, which received a local injection of the blank hydrogel at the injured site; (3) BMP2 group, which received an injection of hydrogel with BMP2; and (4) BMP2 with sVEGFR1 group, which received an injection of hydrogel with BMP2 and sVEGFR1. Histology, micro–computed tomography, and biomechanical tests were conducted to evaluate tendon-bone healing at 4 and 8 weeks after surgery. In addition, flow cytometry was performed to detect the proportion of SSCs and their downstream differentiated subtypes, including bone, cartilage, and stromal progenitors; osteoprogenitors; and pro-chondrogenic progenitors within supraspinatus tendon enthesis at 1 week postoperatively. Results: The repaired interface in BMP2 with sVEGFR1 group showed a significantly improved collagen fiber continuity, increased fibrocartilage, greater newly formed bone, and elevated mechanical properties compared with the other 3 groups. There were more SSCs; bone, cartilage, and stromal progenitors; osteoprogenitors; and pro-chondrogenic progenitors in the BMP2 with sVEGFR1 group than that in the other groups. Conclusion: Our study suggests that the combined delivery of BMP2 and sVEGFR1 could promote tendon-bone healing and stimulate the expansion of SSCs and their downstream progeny within the injured tendon-bone interface. Clinical Relevance: Combining BMP2 with sVEGFR1 may be a good clinical treatment for wounded tendon enthesis healing. [ABSTRACT FROM AUTHOR]

Background: Timely and appropriate medical care after concussion presents a difficult public health problem. Concussion identification and treatment rely heavily on self-report, but more than half of concussions go unreported or are reported after a delay. If incomplete self-report increases exposure to harm, blood biomarkers may objectively indicate this neurobiological dysfunction. Purpose/Hypothesis: The purpose of this study was to compare postconcussion biomarker levels between individuals with different previous concussion diagnosis statuses and care-seeking statuses. It was hypothesized that individuals with undiagnosed concussions and poorer care seeking would show altered biomarker profiles. Study Design: Cohort study; Level of evidence, 3. Methods: Blood samples were collected from 287 military academy cadets and collegiate athletes diagnosed with concussion in the Advanced Research Core of the Concussion Assessment, Research and Education Consortium. The authors extracted each participant's self-reported previous concussion diagnosis status (no history, all diagnosed, ≥1 undiagnosed) and whether they had delayed or immediate symptom onset, symptom reporting, and removal from activity after the incident concussion. The authors compared the following blood biomarkers associated with neural injury between previous concussion diagnosis status groups and care-seeking groups: glial fibrillary acidic protein, ubiquitin c-terminal hydrolase-L1 (UCH-L1), neurofilament light chain (NF-L), and tau protein, captured at baseline, 24 to 48 hours, asymptomatic, and 7 days after unrestricted return to activity using tests of parallel profiles. Results: The undiagnosed previous concussion group (n = 21) had higher levels of NF-L at 24- to 48-hour and asymptomatic time points relative to all diagnosed (n = 72) or no previous concussion (n = 194) groups. For those with delayed removal from activity (n = 127), UCH-L1 was lower at 7 days after return to activity than that for athletes immediately removed from activity (n = 131). No other biomarker differences were observed. Conclusion: Individuals with previous undiagnosed concussions or delayed removal from activity showed some different biomarker levels after concussion and after clinical recovery, despite a lack of baseline differences. This may indicate that poorer care seeking can create neurobiological differences in the concussed brain. [ABSTRACT FROM AUTHOR]

Background: Quantitative analysis of the glenoid face knotless-type anchor placement for arthroscopic Bankart repair has not been reported. Purpose: To evaluate the clinical and radiologic outcomes after arthroscopic Bankart repair using knotless bioabsorbable anchors depending on the anchor location. Study design: Case series, Level of evidence, 4. Methods: A total of 124 patients (113 men and 11 women; age, 25.6 ± 7.5 years; follow-up time, 46.5 ± 18.2 months [range, 6.2-75.5 months]) who underwent arthroscopic Bankart repair with the bioabsorbable knotless anchor between 2017 and 2021 were included in this study. Among them, 118 patients were observed for >2 years (mean, 48.2 ± 16.8 months [range, 24-75.5 months]) and were analyzed for final clinical and radiologic outcomes. Using postoperative 6-month magnetic resonance imaging, remnant glenoid (%) and labral height were measured. Shoulder range of motion (ROM), radiographic osteoarthritic change, dislocation, apprehension test, and return to sports were recorded. Three groups were established based on the remnant glenoid, which represented the percentage of the exposed glenoid anteroposterior diameter to the original diameter using the best-fit circle method—group A: lower quartile; group B: interquartile; and group C: upper quartile—and variables were analyzed. Results: Overall, the remnant glenoid was 57% ± 6.4% (range, 41.5%-75%) after the surgery. Osteoarthritic change, dislocations, and positive apprehension tests were observed in 5 (4.2%), 4 (3.4%), and 12 (10.2%) patients, respectively. A total of 34 (28.8%) and 64 (54.2%) patients could return to sports without and with restrictions, respectively. Comparing groups A, B, and C, postoperative labral height (7 ± 1, 7 ± 2, and 7 ± 1 mm; P =.623), final osteoarthritic change (1, 4, and 0; P =.440), positive apprehension tests (5, 5, and 2; P =.387), and return to sports (complete/restricted/unable, 6/18/5, 19/29/11, 9/17/4; P =.769) were not different. All ROM were similar across the groups (all P >.054), except for external rotation (ER) at postoperative 6 months (41.3°± 12.8°; 50.2°± 18.5°; and 49.8°± 15.2°; P =.050). However, ER after 1 year was similar across the groups (all P >.544). In further analysis, patients with positive apprehension tests had lower labral height compared with others (5 [4-6] mm and 7 [6-8] mm; P <.001). Conclusion: In arthroscopic Bankart repair, the placement of knotless bioabsorbable anchors on the glenoid face, combined with the remplissage procedure or rotator interval closure, resulted in a low recurrence rate and moderate return to sports. However, most patients had some restrictions in returning to sports. Moreover, this technique was not associated with postoperative arthritis and shoulder stiffness, including ER deficit, which was not affected by the position of the anchor on the glenoid face for a minimum 2-year follow-up. [ABSTRACT FROM AUTHOR]

Background: Current classification systems for intra-articular pathology intraoperatively have been described for patients with femoroacetabular impingement rather than dysplasia. Purpose: To (1) describe intra-articular findings in dysplastic hips undergoing combined hip arthroscopy and periacetabular osteotomy (PAO); (2) propose a new chondrolabral classification system for dysplastic hips based on these findings; and (3) correlate patient-reported outcome measures (PROM) with the newly proposed classification. Study Design: Case series; Level of evidence, 4. Methods: A total of 46 hips underwent combined hip arthroscopy and PAO at our institution between September 2013 and December 2014, irrespective of symptoms or radiographic findings. PROMs were evaluated preoperatively and at 2 years postoperatively. At the time of hip arthroscopy, the chondrolabral junction was classified as normal without tear (1 hip, type 1); hypertrophic labrum without chondrolabral disruption (19 hips, type 2); chondrolabral disruption on the articular side, not extending into the capsular side (16 hips, type 3A); chondrolabral disruption extending through the capsular side (3 hips, type 3B); and exposed acetabular subchondral bone (7 hips, type 4). Results: There was a significant difference in postoperative modified Harris Hip Score (mHHS) (P =.020), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores (P =.037), and WOMAC total scores (P =.049) between chondrolabral junction types. Post hoc analyses demonstrated significant differences between type 2 (84.9 ± 12.9) and type 3A (67.8 ± 20.7; P =.198), and between type 2 and type 4 (59.3 ± 24.3; P =.011) in postoperative mHHS scores; and between type 2 (83.9 ± 12.9) and type 3A (68.9 ± 23.7; P =.045) in postoperative WOMAC total scores. In multivariate analysis, chondrolabral type 3 or type 4, age >35 years, and previous surgery were significantly correlated with worse mHHS scores at 2 years. Conclusion: This new chondrolabral classification is proposed to describe intra-articular pathology seen during combined hip arthroscopy and PAO, specifically in dysplastic hips. More advanced chondrolabral disease was associated with worse PROMs at 2 years. [ABSTRACT FROM AUTHOR]

Background: A limited number of studies have reported the long-term effectiveness of and associated factors for recurrence of anterior shoulder instability after arthroscopic Bankart repair (ABR). Purpose: To report the long-term clinical outcomes after ABR in a recreational sports population and identify the associated factors that influence the final instability status. Study Design: Case series; Level of evidence, 4. Methods: A retrospective study was performed in patients treated with ABR between 2007 and 2013 by a single surgeon. Patient data, magnetic resonance imaging measurements of bone loss and glenoid track, and intra- and perioperative factors were analyzed. After a minimum follow-up of 10 years, patient-reported outcomes including the Western Ontario Shoulder Instability Index score, the Rowe score, the visual analog scale for pain and function, the American Shoulder and Elbow Surgeons score, and sports activity were assessed. The current instability status was classified into 3 groups: stable, apprehensive, and redislocated. These groups were statistically compared with respect to outcomes and associated factors. Results: A total of 100 patients with a mean age of 22.4 ± 5.5 years and a mean follow-up of 12.7 ± 2.1 years were included. At the final follow-up, 38 patients (38%) showed recurrent symptoms: 19 patients (19%) with subjective apprehension and 19 patients (19%) with redislocation, including 10 patients (10%) with revision surgery. At the final follow-up, the redislocated group showed the lowest patient-reported outcomes and return to sports (both P <.001). The apprehensive group also showed a lower Western Ontario Shoulder Instability Index score (P =.011), Rowe score (P =.003), American Shoulder and Elbow Surgeons score (P =.027), and return to sports (P =.005) than the stable group. Participation in contact sports (P =.026), glenoid bone loss (P =.005), size of Hill-Sachs lesion (P =.009), and off-track lesions (P =.016) were all associated with recurrent symptoms, whereas age <20 years (P =.012), participation in contact sports (P =.003), and off-track lesions (P =.042) were associated with redislocation. Conclusion: After long-term follow-up in a recreational sports population, ABR demonstrated a 19% rate of subjective apprehension and 19% rate of redislocation, with a gradual decline in clinical outcomes and sports activity over time. Therefore, candidates for ABR should be selected based on consideration of risk factors such as off-track lesions, age <20 years, and participation in contact sports. [ABSTRACT FROM AUTHOR]

Background: Cell-based cartilage repair procedures of the patellofemoral joint have less reliable outcomes than those of the tibiofemoral joint. No previous studies have evaluated the influence of patellar shape on cell-based cartilage repair outcomes. Patellar dysplasia may predispose patients to worse outcomes after cell-based cartilage repair. Purpose/Hypothesis: The purpose of this study was to evaluate the relationship between Wiberg patellar type and outcomes after cell-based cartilage repair (autologous chondrocyte implantation or particulated juvenile allograft cartilage transplantation) for the treatment of patellar chondral lesions at a minimum 2-year follow-up. It was hypothesized that Wiberg classification of patellar shape would have no effect on patient-reported outcome measures (PROMs) or graft survival. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing autologous chondrocyte implantation or particulated juvenile allograft cartilage transplantation for full-thickness patellar chondral defects between 2016 and 2020 were retrospectively reviewed after institutional review board approval. The change in PROMs, including International Knee Documentation Committee (IKDC), Kujala, and Veterans RAND 12-item Health Survey Mental and Physical scores, from pre- to postoperatively and the percentage of patients who achieved the minimal clinically important difference (MCID) for IKDC and Kujala scores were compared for the Wiberg type A versus Wiberg type B versus Wiberg type C groups. The log-rank test was used to evaluate for differences in survival between subgroups. Results: A total of 59 patients (63 knees) were included, with a mean age of 33.3 ± 8.6 years, median body mass index of 26.0 (IQR, 21.8-30.2), and median follow-up time of 3.5 years (IQR, 2.6-4.2 years). In total, 26 (41%) patellae were Wiberg type A, 29 (46%) were Wiberg type B, and 8 (13%) were Wiberg type C. There were no differences between Wiberg type A versus Wiberg type B versus Wiberg type C groups with respect to change in PROMs from pre- to postoperatively or the percentage of patients who achieved the MCID for IKDC or Kujala scores (P >.05 for all). There were no differences in survival between groups (P =.45). Conclusion: Wiberg patellar type has no effect on patient-reported outcomes or graft survival at midterm follow-up. Patellar dysplasia should not be seen as a contraindication for cell-based cartilage repair procedures. [ABSTRACT FROM AUTHOR]

Background: In the setting of femoroacetabular impingement (FAI), decompression osteoplasties reconcile deleterious loading patterns caused by cam and pincer lesions. However, native variations of spinopelvic sagittal alignment may continue to perpetuate detrimental effects on the labrum, chondrolabral junction, and articular cartilage after hip arthroscopy. Purpose: To evaluate the effect of pelvic incidence (PI) on postoperative outcomes after hip arthroscopy for acetabular labral tears in the setting of FAI. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective query of prospectively collected data identified patients ≥18 years of age who underwent primary hip arthroscopy for FAI and acetabular labral tears between February 2014 and January 2022, with 3-, 6-, 12-, and 24-month follow-ups. Measurements for PI, pelvic tilt (PT), sacral slope (SS), and acetabular version were obtained via advanced diagnostic imaging. Patients were stratified into low-PI (<45°), moderate-PI (45°≤ PI ≤ 60°), and high-PI (>60°) cohorts. Patient-reported outcome measures (PROMs), clinically meaningful outcomes (ie, minimal clinically important difference, Patient Acceptable Symptom State, substantial clinical benefit, and maximal outcome improvement), visual analog scale (VAS) pain scores, and patient satisfaction were compared across cohorts. Results: A total of 74 patients met eligibility criteria and were stratified into low-PI (n = 28), moderate-PI (n = 31), and high-PI (n = 15) cohorts. Correspondingly, patients with high PI displayed significantly greater values for PT (P =.001), SS (P <.001), acetabular version (P <.001), and acetabular inclination (P =.049). By the 12- and 24-month follow-ups, the high-PI cohort was found to have significantly inferior PROMs, VAS pain scores, rates of clinically meaningful outcome achievement, and satisfaction relative to patients with moderate and/or low PI. No significant differences were found between cohorts regarding rates of revision arthroscopy, subsequent spine surgery, or conversion to total hip arthroplasty. Conclusion: After hip arthroscopy, patients with a high PI (>60°) exhibited inferior PROMs, rates of achieving clinically meaningful thresholds, and satisfaction at 12 and 24 months relative to patients with low or moderate PI. Conversely, the outcomes of patients with low PI (<45°) were found to match the trajectory of those with a neutral spinopelvic alignment (45°≤ PI ≤ 60°). These findings highlight the importance of analyzing spinopelvic parameters preoperatively to prognosticate outcomes before hip arthroscopy for acetabular labral tears and FAI. [ABSTRACT FROM AUTHOR]

Background: Chronic ankle instability (CAI) is a clinical sequela that causes the recurrence of ankle sprain by inducing ankle sensorimotor dysfunction. Animal models of CAI have recently shown that ankle ligament injuries mimicking an ankle sprain result in chronic loss of ankle sensorimotor function. However, the underlying mechanisms determining the pathogenesis of CAI remain unclear. Hypothesis: Ankle instability after an ankle sprain leads to the degeneration of the mechanoreceptors, resulting in ankle sensorimotor dysfunction and the development of CAI. Study Design: Controlled laboratory study. Methods: Four-week-old male Wistar rats (N = 30) were divided into 2 groups: (1) the ankle joint instability (AJI) group with ankle instability induced by transecting the calcaneofibular ligament (n = 15) and (2) the sham group (n = 15). Ankle instability was assessed using the anterior drawer test and the talar tilt test at 4, 6, and 8 weeks after the operation (n = 5, for each group at each time point), and ankle sensorimotor function was assessed using behavioral tests, including ladder walking and balance beam tests, every 2 weeks during the postoperative period. Morphology and number of mechanoreceptors in the intact anterior talofibular ligament (ATFL) were histologically analyzed by immunofluorescence staining targeting the neurofilament medium chain and S100 proteins at 4, 6, and 8 weeks postoperatively (n = 5 per group). Sensory neurons that form mechanoreceptors were histologically analyzed using immunofluorescence staining targeting the mechanosensitive ion channel PIEZO2 at 8 weeks postoperatively (n = 5). Results: Ankle sensorimotor function decreased over time in the AJI group, exhibiting decreased ankle instability compared with the sham group (P =.045). The number of mechanoreceptors in the ATFL was reduced (P <.001) and PIEZO2 expression in the sensory neurons decreased (P =.008) at 8 weeks postoperatively. The number of mechanoreceptors was negatively correlated with ankle sensorimotor dysfunction (P <.001). Conclusion: The AJI model demonstrated degeneration of the mechanoreceptors in the ATFL and decreased mechanosensitivity of the sensory neurons, which may contribute to CAI. Clinical Relevance: Ankle instability causes degeneration of mechanoreceptors and decreases the mechanosensitivity of sensory neurons involved in the development of CAI. This finding emphasizes the importance of controlling ankle instability after ankle sprains to prevent recurrence and the onset of CAI. [ABSTRACT FROM AUTHOR]

Background: Loss of meniscal function in association with degenerative changes affects the development and progression of knee osteoarthritis, for which there is currently no effective treatment. Extracorporeal shockwave therapy (ESWT) is an established treatment for musculoskeletal disorders. However, the therapeutic effect of ESWT on meniscal degeneration remains unclear. Purpose: To evaluate the therapeutic effect of ESWT on the degenerated meniscus in an anterior cruciate ligament transection (ACLT) model. Study Design: Controlled laboratory study. Methods: Twelve-week-old male Wistar rats were randomly assigned to 3 groups (normal, ESWT–, and ESWT+). Unilateral ACLT of the right knee was performed in the latter 2 groups. At 4 weeks after ACLT, the ESWT+ group received 800 shockwave impulses at an energy flux density of 0.22 mJ/mm2 in a single session. Histological changes were examined in the posterior portion of the medial meniscus after ESWT (n = 15 per group). Real-time polymerase chain reaction (PCR) was performed after ESWT (n = 5 per group) to analyze the expression of connective tissue growth factor/CCN family member 2 (CTGF/CCN2), sex determining region Y–box 9, vascular endothelial growth factor α, aggrecan, collagen type 1 alpha 2, and collagen type 2 alpha 1 (Col2α1). Immunohistochemistry was used to analyze the expression of CTGF/CCN2 and Ki-67 (n = 5 per group) after ESWT. Results: The meniscal histopathological score at 4 weeks after ACLT was significantly higher than that in the normal group, and the score in the ESWT+ group was significantly lower than that in the ESWT– group at 4 and 12 weeks after ESWT. Real-time PCR revealed that the mRNA expression of CTGF/CCN2 and Col2α1 decreased 4 weeks after ACLT. In the ESWT+ group, real-time PCR revealed that the mRNA expression of CTGF/CCN2 increased 24 hours after ESWT, and the expression of Col2α1 increased 4 weeks after ESWT (all significant data were P <.05). The ratio of CTGF/CCN2-positive cells and Ki67-positive cells was significantly higher in the ESWT+ group after ESWT. Conclusion: The present study revealed that ESWT might suppress ACLT-induced meniscal degeneration by stimulating cartilage repair factors and inducing collagen type 2. Clinical Relevance: ESWT can be an effective treatment to protect the degenerated meniscus in a rat model of ACLT. [ABSTRACT FROM AUTHOR]

Background: Static anterior tibial translation (SATT) is radiographically measured to show the amount of tibial translation during the single-leg stance, and thus it is representative of the physiological axial load subjected to the anterior cruciate ligament (ACL) during the stance. Increased SATT has been associated with increased posterior tibial slope (PTS) and is also associated with increased graft failure. Purpose: To compare the SATT value in a control population with that in a population with an isolated ACL injury, as well as to compare the effect of tibial slope on SATT between the 2 groups. Study Design: Cohort study; Level of evidence, 3. Methods: A consecutive series of patients without ligamentous or meniscal injuries between 2019 and 2022 was reviewed. A matched consecutive cohort of patients with nonacute ACL injuries (surgery between 6 and 12 weeks after injury) without concomitant pathology was reviewed. Preoperative SATT and PTS were measured with a previously validated technique on lateral weightbearing knee radiographs. The SATT value was determined, and regression analysis was performed to investigate the relationship between SATT and PTS. Results: In total, 101 controls and 115 patients with an ACL injury were included in this study. The mean SATT was 1.31 mm (SD, 2.44 mm) and the mean PTS was 10.61° (SD, 3.28°) in the control cohort. The SATT was larger (mean, 2.27 mm; SD, 3.36 mm) in the ACL-injured cohort despite the tibial slope measurement being less in the ACL-injured cohort (mean, 9.46°; SD, 2.85°; P =.016). Linear regression analysis showed that for every 1° of increase in PTS, there was a 0.34-mm increase in SATT in the control cohort; however, there was a greater increase of 0.5 mm for every 1° of increase in PTS in the ACL-injured cohort. We found no significant differences in SATT when the cohorts were compared by age (P =.26) or sex (P =.10). Conclusion: The present study reports a reference SATT value of 1.31 mm (SD, 2.44 mm) in a non–ACL-injured cohort, which was lower than in the ACL-injured cohort (mean, 2.27 mm; SD, 3.36 mm). The effect of slope on weightbearing anterior tibial translation was greater in the ACL-injured population than in the control cohort. [ABSTRACT FROM AUTHOR]

Background: In baseball, youth athletes play on smaller fields with shorter distances between bases, shorter pitching distances, and smaller mounds. Despite this, youth athletes use baseballs weighing the same amount as those used at the professional level, possibly predisposing youth baseball players to injuries. Purpose: (1) To determine the effects of throwing a smaller, lighter, and both smaller and lighter baseball on throwing arm stress in youth athletes and (2) to also investigate how changing the ball size and weight would affect elbow varus torque, shoulder distraction force, and throwing arm internal rotation velocity during the throwing motion. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This cross-sectional cohort study analyzed the kinematics and kinetics of 38 youth baseball players (mean age, 8.3 ± 0.8 years) throwing a baseball modified in size and weight. Three-dimensional motion data were collected using a retroreflective marker set and a 12-camera motion analysis system. Full-body kinematics and kinetics were calculated using commercial software. Participants threw 5 different types of baseballs 3 times each, in random order, with full effort from a pitching mound to a target 14 m away. The balls used were a 5-oz regular baseball, 5-oz (0.142-kg) baseball with a 5% reduced circumference, 4-oz (0.113-kg) baseball, 4-oz baseball with a 5% reduced circumference, and 3-oz (0.085-kg) baseball. Analysis of variance was used to determine statistical differences in elbow varus torque, shoulder distraction force, and throwing arm internal rotation velocity among baseball types. The Tukey post hoc test was used to further investigate differences between the ball groups, considering P <.05 to be significant. Results: Analysis of variance detected a significant difference in elbow varus torque among ball groups (P =.024). The Tukey post hoc test revealed a moderate difference in elbow varus torque between the 5-oz baseball (4.73 ± 1.06 percentage body weight × height [%BW × H]) and 3-oz baseball (4.06 ± 0.83 %BW × H) (P =.017; d = 0.677 [95% CI, 0.08-1.27]). No significant differences were found in shoulder distraction force or throwing arm internal rotation velocity among ball groups. Conclusion: Compared with a 5-oz baseball, throwing a 3-oz baseball resulted in decreased elbow varus torque with a moderate effect size. [ABSTRACT FROM AUTHOR]

Background: Intra-articular (IA) platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) injections have shown efficacy and safety in treating osteoarthritis (OA). However, the effectiveness and mechanisms of combined intraosseous (IO) administration of these orthobiologics have yet to be explored. Purpose/Hypothesis: The purpose of this study was to evaluate the effect on pain, cartilage, synovium/infrapatellar fat pad (IFP), and subchondral bone in rat knee OA, comparing isolated IA with combined IA and IO (IA+IO) injections of PRP or BMAC. It was hypothesized that combined injections would be superior to sole IA injections. Study Design: Controlled laboratory study. Methods: A total of 48 rats were divided into 6 groups: sham (only joint puncture during OA induction with IA+IO saline injection treatment) and 5 groups with OA induction, control (IA+IO saline injection), PRP (IA PRP+IO saline injection), BMAC IA (IA BMAC+IO saline injection), PRP IA+IO (IA+IO PRP injection), and BMAC IA+IO (IA+IO BMAC injection). OA was induced by IA injection of monosodium iodoacetate (MIA). Rats were administered different orthobiologics according to their grouping 3 weeks after the MIA injection. Pain changes were evaluated using the weightbearing ratio assay at weeks 3, 4, 5, 7, and 9 after OA induction. Rats were euthanized at week 9 for gross, radiological, histological, immunohistochemical, and immunofluorescence assessments of cartilage, synovium, and subchondral bone. Results: Compared with the control group, all orthobiologics injection groups had reduced joint pain. Compared with IA injection, IA+IO injections provided superior pain relief by suppressing calcitonin gene-related peptide and substance P in both the synovium/IFP and subchondral bone. IA+IO injections slowed the progression of subchondral bone lesions by inhibiting CD31hiEmcnhi vessel formation and excessive osteoclast and osteoblast turnover while preserving subchondral bone microarchitecture, slowing cartilage degeneration. However, IA+IO injections did not outperform isolated IA injections in reducing synovitis and synovium/IFP fibrosis. Compared with PRP, BMAC exhibited superior inhibition of pain-related mediators, but no significant differences were observed in synovitis suppression, infrapatellar fat pad fibrosis, and subchondral bone protection. Conclusion: IA+IO injections of orthobiologics were more effective in relieving pain, slowing cartilage degeneration, and inhibiting abnormal vascularization and remodeling compared with isolated IA injections. BMAC showed superior pain relief in the synovium/IFP and subchondral bone compared with PRP. Further research is needed to optimize PRP and BMAC components for enhanced efficacy in OA management. Clinical Relevance: Our findings contribute to advancing the understanding of pain relief mechanisms and support the endorsement of IO injection of orthobiologics for the treatment of OA and joint pain. [ABSTRACT FROM AUTHOR]

Background: Meniscal allograft transplantation (MAT) is an accepted and effective treatment option in the context of unsalvageable menisci, particularly in young and active patients. It has been shown to reduce pain and improve knee function in previously symptomatic patients. However, there is still limited knowledge about the long-term survival rates of allografts, the durability of clinical results, and the influence of patient-specific parameters, such as leg alignment, tibial slope, and preoperative International Cartilage Regeneration & Joint Preservation Society (ICRS) grade. Purpose: To determine (1) the long-term clinical success rate after MAT with bony fixation in a large, single-center cohort of consecutive patients, and (2) if patient-specific and procedural variables influence the clinical, anatomic, and subjective outcomes and risk of failure. Study Design: Case-control study; Level of evidence, 3. Methods: Data on 185 consecutive knees undergoing MAT in a single institution were prospectively collected and screened for inclusion in this study. The minimum follow-up time was 2 years. Radiographic variables (ICRS grade and Kellgren-Lawrence grade) were assessed preoperatively and at follow-up. Subjective patient-reported outcome measures (PROMs) (Lysholm score, Knee injury and Osteoarthritis Outcome Score [KOOS] including subscores, International Knee Documentation Committee [IKDC] score, and visual analog scale [VAS] score) were collected preoperatively and at follow-up. Clinical failure was defined as revision surgery due to graft failure or conversion to total knee arthroplasty. Anatomic failure was considered a tear covering >20% of the allograft, any peripheral tear, and unstable peripheral fixation leading to dislocation of the graft. Subjective failure was defined as Lysholm score ≤65. Preoperative tibial slope and leg alignment were assessed. Survival analyses were performed using the Kaplan-Meier estimate. Univariate and multivariate analyses were performed to determine risk factors for clinical and anatomic failure. Results: A total of 157 knees met inclusion criteria. After a mean follow-up time of 7 ± 3.5 years, 127 (80.9%) knees were free of clinical, anatomic, and subjective failure. Fourteen (8.9%) knees experienced clinical failure, 26 (16.6%) knees were identified as having experienced anatomic failure, and 13 (8.3%) patients experienced subjective failure with a reported Lysholm score of ≤65 at a mean follow-up of 7 years. Concurrent osteochondral allograft transplantation was identified as a predictor of both clinical (hazard ratio [HR], 4.55; 95% CI, 1.46-14.17; P =.009) and anatomic (HR, 3.05; 95% CI, 1.34-6.92; P =.008) failure. Cartilage damage of ICRS grade 3 or 4 of the index compartment conveyed an increased risk for clinical (HR, 3.41; 95% CI, 1.05-11.01; P =.04) and anatomic (HR, 3.04; 95% CI, 1.31-7.11; P =.01) failure. High-grade cartilage damage preoperatively (HR, 10.67; 95% CI, 1.037-109.768; P =.046), patient age >25 years (HR, 5.44; 95% CI, 0.120-246.070; P =.384), and a body mass index >30 (HR, 2.24; 95% CI, 0.748-6.705; P =.149) were associated with subjective failure. PROMs including KOOS and IKDC were significantly improved at final follow-up compared with preoperative scores across all measurements (P <.005). Conclusion: MAT showed good to excellent clinical results at a mean follow-up of 7 years. Low ICRS lesion grade was associated with a higher clinical and anatomic survival rate. Patients with concurrent OCA transplantation are at a higher risk of clinical and anatomic failure, but still report significantly improved PROMs. These results suggest that MAT has a lasting beneficial effect both in isolation and in complex cases with ≥1 concurrent procedures. [ABSTRACT FROM AUTHOR]

Background: Hip arthroscopy has become the mainstay surgical intervention for the treatment of femoroacetabular impingement syndrome (FAIS). However, postoperative outcomes and rates of secondary surgery are mixed in patients with differing levels of preoperative osteoarthritis (OA). Furthermore, there is a paucity of literature comparing patients with and without OA at long-term follow-up. Purpose: To compare outcomes and rates of secondary surgery at minimum 10-year follow-up, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), in patients with Tönnis grade 1 undergoing hip arthroscopy for FAIS compared with a propensity-matched control group of patients with Tönnis grade 0. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013 were identified. Patients with Tönnis grade 1 were propensity matched in a 1:2 ratio by age, sex, and body mass index (BMI) to patients with Tönnis grade 0. Patient-reported outcomes (PROs) were collected at varying timepoints including preoperatively and 1, 2, 5, and 10 years postoperatively and compared between the 2 cohorts. Rates of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) achievement at 10 years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to total hip arthroplasty (THA) were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier gross survivorship curve. A subanalysis was performed comparing patients with Tönnis grade 1 who converted to THA and those who did not. Results: A total of 31 patients with Tönnis grade 1 (age, 42.6 ± 9.0 years; BMI, 28.0 ± 6.3) were successfully matched to 62 patients with Tönnis grade 0 (age, 42.1 ± 8.5, P =.805; BMI, 26.1 ± 3.9, P =.117). Both the Tönnis grade 1 and Tönnis grade 0 groups demonstrated significant improvements regarding all PROs at minimum 10 years (P <.05 for all), except for the Hip Outcome Score Activities of Daily Living subscale (HOS-ADL) (P =.066) in the Tönnis grade 1 cohort. No significant difference (P >.05 for all) was noted between cohorts regarding any 10-year PRO. When the authors evaluated comparisons between preoperative and 1-, 2-, 5-, and 10-year PRO measures, significant differences were noted between cohorts regarding 2-year HOS-ADL (P =.021), Hip Outcome Score Sports-Specific subscale (P =.016), and modified Harris Hip Score (P =.026); otherwise, differences did not reach significance. High rates of 10-year MCID and PASS achievement were seen, with no significant differences between groups. Patients with Tönnis grade 1 had significantly higher rates of conversion to THA compared with patients who had Tönnis grade 0 (25.8% vs 4.8%; P =.006). Patients with Tönnis grade 1 had significantly lower gross survivorship compared with those who had Tönnis grade 0 (71.0% vs 85.5%, respectively; P =.04). Conclusion: Hip arthroscopy confers comparable postoperative clinical improvements to patients who have FAIS with and without mild OA; however, the benefits among patients with mild OA may be less durable. Patients with Tönnis grade 1 had significantly higher conversion to THA and reduced gross survivorship compared with patients with no evidence of preoperative OA, suggesting that patients with evidence of OA may need to be cautioned on the higher rate of conversion surgery. [ABSTRACT FROM AUTHOR]

Background: Distal tibial allograft (DTA) reconstruction for glenoid bone loss is nonanatomic, as it does not match the glenoid radius of curvature (ROC) in the anterior-posterior (AP) plane. The dorsal articular portion of the distal radius has not been previously described as an allograft reconstruction option for glenoid bone loss. Purpose: To evaluate distal radius fresh-frozen allograft (DRA) as a potential match for glenoid reconstruction. Study Design: Controlled laboratory study. Methods: Eighteen fresh-frozen human cadaveric specimens—including 6 shoulder, 6 wrist, and 6 tibia specimens—were used. The ROC and the graft length were measured in the superior-inferior (SI) plane. A 30% defect was created in all glenoid specimens, and both DTAs and DRAs were harvested to assess graft fit after fixation. Computed tomography analysis was used to assess bony ROC and bone mineral density (BMD). Results: The cadaveric specimens had a mean age of 77 years. The mean SI glenoid length was 39.7 mm compared with 36.8 mm for the DRA and 30 mm for the DTA. The ROC in the SI plane was 29 ± 5.3 mm for the glenoid, 37.8 ± 4.9 mm for the DRA, and 24 ± 3.7 mm for the DTA. In the AP plane, the ROC was 39.6 ± 6.6 mm for the glenoid, 30.4 ± 18.6 mm for the DRA, and 126.3 ± 9.5 mm for the DTA. On computed tomography analysis, the ROC in the SI plane was 30.4 ± 1.5 mm for the glenoid, 30.3 ± 5.6 mm for the DRA, and 24.5 ± 9.4 mm for the DTA. In the AP plane, the ROC was 30.8 ± 2 mm for the glenoid, 19.1 ± 2.3 mm for the DRA, and 46.7 ± 21.7 mm for the DTA. The BMD was 226.3 ± 79 Hounsfield units (HU) for the glenoid, 228.5 ± 94.7 HU for the DRA, 235 ± 96.2 HU for the coracoid process, and 235.1 ± 84.6 HU for the DTA. Conclusion: Compared with the DTA, the DRA had a greater mean graft length in the SI plane, providing utilization in cases of larger bony defects; the DRA has a more acute ROC in the AP plane (closer to that of the glenoid), providing a greater potential buttress to anterior humeral translation. Compared with currently utilized grafts, the DRA BMD was not significantly diminished. This study presents the DRA as a novel allograft reconstruction option in the setting of anterior glenoid bone loss; further biomechanical and clinical investigation is indicated. [ABSTRACT FROM AUTHOR]

Background: Posterior glenohumeral instability is an increasingly recognized cause of shoulder pain and dysfunction among young, active populations. Outcomes after posterior stabilization procedures are commonly assessed using patient-reported outcome measures including the Single Assessment Numeric Evaluation (SANE), the Rowe instability score, the American Shoulder and Elbow Surgeons (ASES) score, and the visual analog scale (VAS) for pain. The clinical significance thresholds for these measures after arthroscopic posterior labral repair (aPLR), however, remain undefined. Purpose: We aimed to define the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) for the SANE, Rowe score, and ASES score as well as the VAS pain after aPLR. Additionally, we sought to determine preoperative factors predictive of reaching, as well as failing to reach, clinical significance. Study Design: Case-control study; Level of evidence, 3. Methods: This study was a retrospective analysis of patient-reported outcome scores collected from patients who underwent aPLR between January 2011 and December 2018. To determine the clinically significant threshold that corresponded to achieving a meaningful outcome, the MCID, SCB, and PASS were calculated for the SANE, Rowe score, ASES score, and VAS pain utilizing either an anchor- or distribution-based method. Additionally, univariate and multivariate logistic regression analyses were performed to determine the factors associated with achieving, or not achieving, the MCID, SCB, and PASS. Results: A total of 73 patients with a mean follow-up of 82.55 ± 24.20 months were available for final analysis. MCID, SCB, and PASS values for the VAS pain were 1.10, 6, and 3, respectively; for the ASES score were 7.8, 34, and 80, respectively; for the SANE were 10.15, 33, and 85, respectively; and for the Rowe score were 11.3, 60, and 90, respectively. To meet the MCID, male sex (odds ratio [OR], 1.1639; P =.0293) was found to be a positive predictor for the VAS pain, and a lower preoperative SANE score (OR, 0.9939; P =.0003) was found to be a negative predictor for the SANE. Dominant arm involvement was associated with lower odds of achieving the PASS for the ASES score (OR, 0.7834; P =.0259) and VAS pain (OR, 0.7887; P =.0436). Patients who reported a history of shoulder trauma were more likely to reach the PASS for the SANE (OR, 1.3501; P =.0089), Rowe score (OR, 1.3938; P =.0052), and VAS pain (OR, 1.3507; P =.0104) as well as the SCB for the ASES score (OR, 1.2642; P =.0469) and SANE (OR, 1.2554; P =.0444). A higher preoperative VAS pain score was associated with higher odds of achieving the SCB for both the VAS pain (OR, 1.1653; P =.0110) and Rowe score (OR, 1.1282; P =.0175). Lastly, concomitant biceps tenodesis was associated with greater odds of achieving the SCB for the ASES score (OR, 1.3490; P =.0130) and reaching the PASS for the SANE (OR, 1.3825; P =.0038) and Rowe score (OR, 1.4040; P =.0035). Conclusion: To our knowledge, this study is the first to define the MCID, SCB, and PASS for the ASES score, Rowe score, SANE, and VAS pain in patients undergoing aPLR. Furthermore, we found that patients who reported a history of shoulder trauma and those who underwent concomitant biceps tenodesis demonstrated a greater likelihood of achieving clinical significance. Dominant arm involvement was associated with lower odds of achieving clinical significance. [ABSTRACT FROM AUTHOR]

Background: Preoperative risk factors contributing to poor outcomes after arthroscopic partial meniscectomy (APM) have not yet been consolidated and codified into an index scoring system used to predict APM success. Purpose: To create an index score using available preoperative factors to predict the likelihood of favorable postoperative outcomes after APM. Study Design: Case-control study; Level of evidence, 3. Methods: A consecutive cohort of patients undergoing primary APM were enrolled in this study. Patients completed pre- and postoperative patient-reported outcome measure (PROM) questionnaires that included the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Veterans RAND 12-Item Health Survey (VR-12 Physical and Mental), and Marx Activity Rating Scale (MARS). Multivariable logistic regression models were performed to evaluate independent predictors of KOOS Pain, Symptoms, and Activities of Daily Living scores and achievement of the minimal clinically important difference (MCID) and substantial clinical benefit (SCB). The authors assigned points to each variable proportional to its odds ratio, rounded to the nearest integer, to generate the index score. Results: In total, 468 patients (mean age, 49 years [SD, 10.4 years; range, 19-81 years]) were included in this study. In the univariate analysis, shorter symptom duration, lower Kellgren-Lawrence (KL) grade, lower preoperative KOOS Pain value, and lower VR-12 Physical score were associated with a higher likelihood of clinical improvement at 1 year. In the multivariable model for clinical improvement with MCID, symptom duration (<3 months: OR, 3.00 [95% CI, 1.45-6.19]; 3-6 months: OR, 2.03 [95% CI, 1.10-3.72], compared with >6 months), KL grade (grade 0: OR, 3.54 [95% CI, 1.66-7.54]; grade 1: OR, 3.04 [95% CI, 1.48-6.26]; grade 2: OR, 2.31 [95% CI, 1.02-5.27], compared with grade 3), and preoperative KOOS Pain value (score <45: OR, 3.00 [95% CI, 1.57-5.76]; score of 45-60: OR, 2.80 [95% CI, 1.47-5.35], compared with score >60) were independent significant predictors for clinical improvement. The scoring algorithm demonstrated that a higher total score predicted a higher likelihood of achieving the MCID: 0 = 40%, 1 = 68%, 2 = 80%, 3 = 89%, and 4 = 96%. Conclusion: Using this model, the authors developed an index score that, using preoperative factors, can help identify which patients will achieve clinical improvement after APM. Longer symptom duration and higher KL grade were associated with a decreased likelihood of clinical improvement as measured by KOOS Pain at 1 year postoperatively. [ABSTRACT FROM AUTHOR]

Background: The glenoid track concept for shoulder instability primarily describes the medial-lateral relationship between a Hill-Sachs lesion and the glenoid. However, the Hill-Sachs position in the craniocaudal dimension has not been thoroughly studied. Hypothesis: Hill-Sachs lesions with greater inferior extension are associated with increased risk of recurrent instability after primary arthroscopic Bankart repair. Study Design: Case-control study; Level of evidence, 3. Methods: The authors performed a retrospective analysis of patients with on-track Hill-Sachs lesions who underwent primary arthroscopic Bankart repair (without remplissage) between 2007 and 2019 and had a minimum 2-year follow-up. Recurrent instability was defined as recurrent dislocation or subluxation after the index procedure. The craniocaudal position of the Hill-Sachs lesion was measured against the midhumeral axis on sagittal magnetic resonance imaging (MRI) using either a Hill-Sachs bisecting line through the humeral head center (sagittal midpoint angle [SMA], a measure of Hill-Sachs craniocaudal position) or a line tangent to the inferior Hill-Sachs edge (lower-edge angle [LEA], a measure of Hill-Sachs caudal extension). Univariate and multivariate regression were used to determine the predictive value of both SMA and LEA for recurrent instability. Results: In total, 176 patients were included with a mean age of 20.6 years, mean follow-up of 5.9 years, and contact sport participation of 69.3%. Of these patients, 42 (23.9%) experienced recurrent instability (30 dislocations, 12 subluxations) at a mean time of 1.7 years after surgery. Recurrent instability was found to be significantly associated with LEA >90° (ie, Hill-Sachs lesions extending below the humeral head equator), with an OR of 3.29 (P =.022). SMA predicted recurrent instability to a lesser degree (OR, 2.22; P =.052). Post hoc evaluation demonstrated that LEA >90° predicted recurrent dislocations (subset of recurrent instability) with an OR of 4.80 (P =.003). LEA and SMA were found to be collinear with Hill-Sachs interval and distance to dislocation, suggesting that greater LEA and SMA proportionally reflect lesion severity in both the craniocaudal and medial-lateral dimensions. Conclusion: Inferior extension of an otherwise on-track Hill-Sachs lesion is a highly predictive risk factor for recurrent instability after primary arthroscopic Bankart repair. Evaluation of Hill-Sachs extension below the humeral equator (inferior equatorial extension) on sagittal MRI is a clinically facile screening tool for higher-risk lesions with subcritical glenoid bone loss. This threshold for critical humeral bone loss may inform surgical stratification for procedures such as remplissage or other approaches for at-risk on-track lesions. [ABSTRACT FROM AUTHOR]

Background: The pathology of dorsal wrist pain in gymnasts without abnormal radiographic findings remains unclear. Purpose/Hypothesis: The purpose of this study was to identify abnormal wrist sagittal kinematics in gymnasts with dorsal wrist pain. It was hypothesized that gymnasts with dorsal wrist pain would show abnormal sagittal kinematics with reversible hypermobility of the intercarpal joint. Study Design: Controlled laboratory study. Methods: Participants included 19 wrists in male gymnasts with dorsal wrist pain, 18 wrist in male gymnasts without wrist pain, and 20 adult men without a history of wrist pain. Magnetic resonance imaging (T2-weighted sagittal images) findings at 0°, 30°, 60°, and 90° of wrist extension were used in kinematic analysis. The angles and translations of the radiolunate, capitolunate, and third carpometacarpal joint were measured and compared between the 3 groups. Results: At 90° of wrist extension, gymnasts with dorsal wrist pain had a significantly lower radiolunate joint angle (28.70°± 6.28° vs 36.19°± 7.81°; P =.020) and a significantly higher capitolunate joint angle (57.99°± 6.15° vs 50.50°± 6.98°; P =.004) and distal translation (1.17 ± 0.50 mm vs 0.46 ± 0.62 mm; P =.002) than gymnasts without dorsal wrist pain. Conclusion: Gymnasts with dorsal wrist pain showed abnormal wrist sagittal kinematics. These novel findings may facilitate understanding of dorsal wrist pain, which can be recognized as a new syndrome termed "gymnast's lunate dyskinesia." [ABSTRACT FROM AUTHOR]

Background: Impaired quadriceps muscle strength after anterior cruciate ligament reconstruction (ACLR) is associated with worse clinical outcomes and a risk of reinjuries. Yet, we know little about quadriceps muscle strength in patients reconstructed with a quadriceps tendon (QT) graft, which is increasing in popularity worldwide. Purpose: To describe and compare isokinetic quadriceps strength in patients undergoing ACLR with a QT, hamstring tendon (HT), or bone–patellar tendon–bone (BPTB) autograft. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We included patients with QT grafts (n = 104) and matched them to patients with HT (n = 104) and BPTB (n = 104) grafts based on age, sex, and associated meniscal surgery. Data were collected through clinical strength testing at a mean of 7 ± 1 months postoperatively. Isokinetic strength was measured at 90 deg/s, and quadriceps strength was expressed as the limb symmetry index (LSI) for peak torque, total work, torque at 30° of knee flexion, and time to peak torque. Results: Patients with QT grafts had the most impaired isokinetic quadriceps strength, with the LSI ranging between 67.5% and 75.1%, followed by those with BPTB grafts (74.4%-81.5%) and HT grafts (84.0%-89.0%). Patients with QT grafts had a significantly lower LSI for all variables compared with patients with HT grafts (mean difference: peak torque: −17.4% [95% CI, −21.7 to −13.2], P <.001; total work: −15.9% [95% CI, −20.6 to −11.1], P <.001; torque at 30° of knee flexion: −8.8% [95% CI, −14.7 to −2.9], P =.001; time to peak torque: −17.7% [95% CI, −25.8 to −9.6], P <.001). Compared with patients with BPTB grafts, patients with QT grafts had a significantly lower LSI for all variables (mean difference: peak torque: −6.9% [95% CI, −11.2 to −2.7], P <.001; total work: −7.7% [95% CI, −12.4 to −2.9], P <.001; torque at 30° of knee flexion: −6.3% [95% CI, −12.2 to −0.5], P =.03; time to peak torque: −8.8% [95% CI, −16.9 to −0.7], P =.03). None of the graft groups reached a mean LSI of >90% for peak torque (QT: 67.5% [95% CI, 64.8-70.1]; HT: 84.9% [95% CI, 82.4-87.4]; BPTB: 74.4% [95% CI, 72.0-76.9]). Conclusion: At 7 months after ACLR, patients with QT grafts had significantly worse isokinetic quadriceps strength than patients with HT and BPTB grafts. None of the 3 graft groups reached a mean LSI of >90% in quadriceps strength. [ABSTRACT FROM AUTHOR]

Background: Biomechanical studies have shown that an increased medial posterior tibial slope (MPTS) may affect anteroposterior knee laxity and tibial shear forces, ultimately increasing the risk for graft failure after anterior cruciate ligament (ACL) reconstruction. Previous clinical studies have, however, reported inconclusive results. Purpose: The purpose of this study was to evaluate the relationship between the MPTS and graft failure as well as functional outcomes after anatomic primary isolated ACL reconstruction using a hamstring tendon autograft. It was hypothesized that an increased MPTS would be associated with a higher ACL graft failure rate. Furthermore, a higher MPTS would negatively correlate with functional outcomes in patients without ACL graft failure. Study Design: Case-control study; Level of evidence, 3. Methods: Consecutive patients who underwent isolated primary ACL reconstruction with an anteromedial portal drilling technique between January 2011 and December 2019 were retrospectively reviewed. The MPTS was measured on preoperative lateral knee radiographs. At a minimum of 24 months postoperatively, the ACL graft failure rate and patient-reported outcome measures (PROM; International Knee Documentation Committee subjective knee form, Lysholm score, Tegner Activity Scale, visual analog scale for pain and subjective instability) were evaluated. Differences in the MPTS between patients with and without ACL graft failure as well as the frequency of graft failure between those with an MPTS <12° and those with an MPTS ≥12° were assessed for statistical significance. Binary logistic regression analysis was performed to stratify the risk of graft failure with the following variables: MPTS, age at surgery, and sex. Correlation analysis was performed to evaluate the relationship between the MPTS and PROM in patients without ACL graft failure. Results: In total, 326 patients were included (median follow-up, 71.0 months [IQR, 49.0-104.0 months]). There was no significant difference in the MPTS between patients with and without graft failure (10.6°± 3.2° vs 11.2°± 2.8°, respectively; P =.264). Additionally, there was no significant difference in the frequency of graft failure between patients with an MPTS <12° and those with an MPTS ≥12° (15.6% vs 16.5%, respectively; P =.835). Binary logistic regression showed that younger age at the time of surgery (odds ratio, 1.069 [95% CI, 1.031-1.109]) was associated with graft failure; sex and MPTS were not associated with graft failure. In patients without ACL graft failure, there was no significant correlation between the MPTS and PROM. Conclusion: In patients who underwent anatomic primary isolated ACL reconstruction, an increased MPTS was not associated with a higher rate of graft failure or inferior functional outcomes. Younger age was a significant nonmodifiable risk factor for ACL graft failure. [ABSTRACT FROM AUTHOR]

Background: In some large to massive rotator cuff tears (RCTs), fatty degeneration (FD) is more severe in the infraspinatus than the supraspinatus muscle, and in such cases, suprascapular neuropathy is highly suspected. Nerve release at the suprascapular notch might alleviate this problem. Purpose: To evaluate the effects of the transverse scapular ligament (TSL) release in patients with large to massive RCTs with more severe FD of the infraspinatus than the supraspinatus. Study Design: Cohort study; Level of evidence, 3. Methods: Between September 2017 and January 2022, arthroscopic TSL release with rotator cuff repair was performed in patients with large to massive RCTs and more severe FD of the infraspinatus muscle than the supraspinatus muscle (TSL group). Cuff integrity, FD, and atrophy of cuff muscles were evaluated using preoperative and 1-year postoperative magnetic resonance imaging. In addition, results were compared with those of patients who did not undergo TSL release during arthroscopic large to massive rotator cuff repair (NTSL group). Results: A total of 103 patients—20 in the TSL group and 83 in the NTSL group—were included. Group preoperative characteristics, including tear size and supraspinatus FD, were not significantly different, but infraspinatus FD (TSL vs NTSL; grade, 0-4, 0/0/5/10/5 vs 1/33/42/4/3) and atrophy (grade, 1-3. 3/9/8 vs 56/20/7) differed significantly (P <.001). Healing failure occurred in 13 of 20 (65%) patients in the TSL group and 30 of 83 (36%) patients in the NTSL group, which was a statistically significant difference (P =.019). Postoperatively, infraspinatus FD and atrophy were more severe in the TSL group than in the NTSL group (P <.001), and supraspinatus FD was more severe in the TSL group (P =.029). Seven patients in the TSL group achieved healing, but FD and atrophy of the supraspinatus and the infraspinatus showed no improvement in this group (all, P >.05). Conclusion: In patients with more FD in the infraspinatus than the supraspinatus muscle, TSL release appeared to have no benefit for cuff healing or FD reversal in cuff muscles. The possibility of suprascapular nerve entrapment remains in patients with more FD in the infraspinatus than the supraspinatus, and this potential nerve problem is not properly addressed by TSL release alone. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) injury increases risks for osteoarthritis (OA), a poorly modifiable and disabling condition. Joint changes of potentially reversible pre-OA have been described just 2 years after ACL reconstruction (ACLR) when early bone shape changes have also been reported. Purpose: This study evaluates relationships between interlimb differences in tibiofemoral bone shape derived from statistical shape modeling (SSM) of magnetic resonance imaging (MRI) and participant factors on patient-reported outcomes 2 years after unilateral ACLR. Study Design: Cross-sectional study; Level of evidence, 3. Methods: SSM-derived tibiofemoral bone shape and subchondral bone area were assessed from bilateral knee MRI scans of 72 participants with unilateral ACLR (mean age, 34 ± 11 years; 32 women) and compared with a reference cohort of 398 older individuals without OA (mean age, 50 ± 3 years; 213 women). Multivariable logistic regression models examined relationships between participant and surgical factors with interlimb differences in bone shapes or subchondral bone areas. Relationships between patient-reported outcomes and the interlimb differences in bone shape and subchondral area were examined using similar models. Results: Bone shape scores and subchondral bone areas were greater (more OA-like) in ACLR knees than uninjured contralateral knees in every bone metric tested (P ≤.001). Interlimb differences in femur shape scores of participants with ACLR were 65% greater (P <.001) than those of the significantly older reference cohort. Taller height, medial meniscal tears, and decreasing age were associated with larger interlimb differences in shape scores and subchondral areas (P <.05). Bone–patellar tendon–bone (BPTB) autograft recipients demonstrated greater interlimb subchondral area differences compared with allograft recipients (P <.05). Interlimb differences for hamstring autograft recipients did not differ from those with BPTB or allograft. Greater interlimb differences in medial femur subchondral areas were associated with worse patient-reported Knee injury and Osteoarthritis Outcome Score Symptoms (R = 0.27; P =.040). Conclusion: Even in the absence of radiographic OA, just 2 years after unilateral ACLR patients showed greater bone shape scores and subchondral areas consistent with pre-OA in their ACLR knees. Furthermore, greater medial femur bone areas were weakly associated with worse symptoms. Patients who are younger, are taller, have meniscal tears, or have BPTB grafts may be at increased risk for bony asymmetries 2 years after ACLR. [ABSTRACT FROM AUTHOR]

Background: Surgical treatments for chronic posterosuperior massive rotator cuff tear (MRCT) are still controversial. Superior capsular reconstruction (SCR), which provides a static stabilizer to decrease superior humeral head translation, and lower trapezius tendon transfer (LTTT) with centralization of the humeral head, which prevents superior humeral head migration, are potential surgical options. To date, SCR combined with LTTT has not been fully investigated. Hypothesis: Restoration of static stabilizer and dynamic stabilizer together would effectively improve shoulder kinematics in posterosuperior MRCT. Study Design: Controlled laboratory study. Methods: A custom-made shoulder mechanics testing system was used to test 8 fresh-frozen cadaveric shoulders. The testing conditions were as follows: (1) intact; (2) posterosuperior MRCT (supraspinatus and infraspinatus removed); (3) SCR using the fascia lata; (4) LTTT; and (5) SCR combined with LTTT. The total rotational range of motion (ROM), superior translation, anteroposterior translation, and peak subacromial contact pressure were evaluated at 0°, 30°, and 60° of shoulder abduction. Repeated-measures analysis of variance and Tukey post hoc tests were performed. Results: The total rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure increased in posterosuperior MRCTs (all, P <.05). The rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure at 0° and 30° of shoulder abduction decreased in SCR (all, P <.05). However, there was no significant improvement in rotational ROM, superior translation, and peak subacromial contact pressure at 60° of shoulder abduction (P >.05). LTTT resulted in a significant decrease in the superior translation, anteroposterior translation, and peak subacromial contact pressure at 0°, 30°, and 60° of shoulder abduction (P <.05). SCR combined with LTTT restored the total rotational ROM, superior translation, anteroposterior translation, and peak subacromial contact pressure at 0°, 30°, and 60° of shoulder abduction (all, P <.05). Conclusion: In the cadaveric model, SCR combined with LTTT showed improved shoulder kinematics and contact pressures in the posterosuperior MRCT model compared with SCR or LTTT alone. Clinical Relevance: SCR combined with LTTT may be regarded as an alternative surgical procedure for posterosuperior MRCTs. [ABSTRACT FROM AUTHOR]

Background: Hinge fractures are considered risk factors for delayed or nonunion of the osteotomy gap in distal femoral osteotomies (DFOs). Limited evidence exists regarding the treatment of hinge fractures after DFO, which could improve stability and thus bone healing. Purpose: To (1) examine the effect of hinge fractures on the biomechanical properties of the bone-implant construct, (2) evaluate the biomechanical advantages of an additional fixation of a hinge fracture, and (3) test the biomechanical properties of different types of varisation DFOs. Study Design: Controlled laboratory study. Methods: A total of 32 fresh-frozen human distal femora equally underwent medial closing wedge DFO or lateral opening wedge DFO using a unilateral locking compression plate. The following conditions were serially tested: (1) preserved hinge; (2) hinge fracture along the osteotomy plane; (3) screw fixation of the hinge fracture; and (4) locking T-plate fixation of the hinge fracture. Using a servo-hydraulic materials testing machine, we subjected each construct to 15 cycles of axial compression (400 N; 20 N/s) and internal and external rotational loads (10 N·m; 0.5 N·m/s) to evaluate the stiffness. The axial and torsional hinge displacement was recorded using a 3-dimensional optical measuring system. Repeated-measures 1-way analysis of variance and post hoc Bonferroni correction were used for multiple comparisons. Statistical significance was set at P <.05. Results: Independent from the type of osteotomy, a fractured hinge significantly (P <.001) increased rotational displacement and reduced stiffness of the bone-implant construct, resulting in ≥1.92 mm increased displacement and ≥70% reduced stiffness in each rotational direction, while the axial stiffness remained unchanged. For both procedures, neither a screw nor a plate could restore intact rotational stiffness (P <.01), while only the plate was able to restore intact rotational displacement. However, the plate always performed better compared with the screw, with significantly higher and lower values for stiffness (+38% to +53%; P <.05) and displacement (–55% to −72%; P <.01), respectively, in ≥1 rotational direction. At the same time, the type of osteotomy did not significantly affect axial and torsional stability. Conclusion: Hinge fractures after medial closing wedge DFO and lateral opening wedge DFO caused decreased bone-implant construct rotational stiffness and increased fracture-site displacement. In contrast, the axial stiffness remained unchanged in the cadaveric model. Clinical Relevance: When considering an osteosynthesis of a hinge fracture in a DFO, an additional plate fixation was the construct with the highest stiffness and least displacement, which could restore intact hinge rotational displacement. [ABSTRACT FROM AUTHOR]

Background: Medial patellofemoral ligament (MPFL) reconstruction is associated with high complication rates because of graft overloading from incorrect graft positioning. To improve clinical outcomes, it is crucial to gain a better understanding of MPFL elongation patterns. Purpose: To assess MPFL length changes in healthy knees from 0° to 90° of dynamic flexion and their relationship with anatomic parameters of the patellofemoral joint. Study Design: Descriptive laboratory study. Methods: Dynamic computed tomography scans of an active flexion-extension-flexion movement in 115 knees from 63 healthy participants were evaluated to construct knee joint models. Using these models, the MPFL length was measured as the shortest wrapping path from the Schöttle point on the femur to 3 insertion points on the superomedial border of the patella (proximal, central, and distal). MPFL length changes (%) relative to the length in full extension were calculated, and their correlations with the tibial tuberosity–trochlear groove distance, Caton-Deschamps index, and lateral trochlear inclination were analyzed. Results: The proximal fiber was the longest in full extension and progressively decreased to a median length of −6.0% at 90° of flexion. The central fiber exhibited the most isometric pattern during knee flexion, showing a median maximal decrease of 2.8% relative to the full extension length and no evident elongation. The distal fiber first slightly decreased in length but increased at deeper flexion angles. The median overall length changes were 4.6, 4.7, and 5.7 mm for the proximal, central, and distal patellar insertion, respectively. These values were either not or very weakly correlated with the tibial tuberosity–trochlear groove distance, Caton-Deschamps index, and lateral trochlear inclination when the anatomic parameters were within the healthy range. Conclusion: The median MPFL length changed by approximately 5 mm between 0° and 90° of flexion. Proximally, the length continuously decreased, indicating slackening behavior. Distally, the length increased at deeper flexion angles, indicating tightening behavior. Clinical Relevance: In MPFL reconstruction techniques utilizing the Schöttle point to establish the femoral insertion, one should avoid distal patellar insertion, as it causes elongation of the ligament, which may increase the risk for complications due to overloading. [ABSTRACT FROM AUTHOR]

Background: Rotator cuff repair is a common orthopaedic procedure, yet the rate of failure to heal after surgery is high. Repair site rupture is due to poor tendon-to-bone healing and lack of regeneration of the native fibrocartilaginous enthesis. During development, the enthesis is formed and mineralized by a pool of progenitors activated by hedgehog signaling. Furthermore, hedgehog signaling drives regenerative enthesis healing in young animals, in contrast to older animals, in which enthesis injuries heal via fibrovascular scar and without participation of hedgehog signaling. Hypothesis: Hedgehog activation improves tendon-to-bone healing in an animal model of rotator cuff repair. Study Design: Controlled laboratory study. Methods: A total of 78 adult Sprague-Dawley rats were used. Supraspinatus tendon injury and repair were completed bilaterally, with microsphere-encapsulated hedgehog agonist administered to right shoulders and control microspheres administered to left shoulders. Animals were sacrificed after 3, 14, 28, or 56 days. Gene expression and histological, biomechanical, and bone morphometric analyses were conducted. Results: At 3 days, hedgehog signaling pathway genes Gli1 (1.70; P =.029) and Smo (2.06; P =.0173), as well as Runx2 (1.69; P =.0386), a transcription factor of osteogenesis, were upregulated in treated relative to control repairs. At 14 days, transcription factors of tenogenesis, Scx (4.00; P =.041), and chondrogenesis, Sox9 (2.95; P =.010), and mineralized fibrocartilage genes Col2 (3.18; P =.031) and Colx (1.85; P =.006), were upregulated in treated relative to control repairs. Treatment promoted fibrocartilage formation at the healing interface by 28 days, with improvements in tendon-bone maturity, organization, and continuity. Treatment led to improved biomechanical properties. The material property strength (2.43 vs 1.89 N/m2; P =.046) and the structural property work to failure (29.01 vs 18.09 mJ; P =.030) were increased in treated relative to control repairs at 28 days and 56 days, respectively. Treatment had a marginal effect on bone morphometry underlying the repair. Trabecular thickness (0.08 vs 0.07 mm; P =.035) was increased at 28 days. Conclusion: Hedgehog agonist treatment activated hedgehog signaling at the tendon-to-bone repair site and prompted increased mineralized fibrocartilage production. This extracellular matrix production and mineralization resulted in improved biomechanical properties, demonstrating the therapeutic potential of hedgehog agonism for improving tendon-to-bone healing after rotator cuff repair. Clinical Relevance: This study demonstrates the therapeutic potential of hedgehog agonist treatment for improving tendon-to-bone healing after rotator cuff injury and repair. [ABSTRACT FROM AUTHOR]