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Background: Both partial- and full-thickness quadriceps tendon (QT) graft harvests are used for anterior cruciate ligament reconstruction (ACLR). Purpose: To evaluate the impact of QT graft harvest depth (full or partial thickness) on electromechanical delay (EMD), peak torque (PT), and rate of torque development (RTD) after ACLR. Study Design: Controlled laboratory study. Methods: A total of 26 patients who underwent either partial-thickness (n = 14) or full-thickness (n = 12) autograft QT ACLR were recruited between June and November 2021 (>1 year before participation). Patients performed isokinetic knee extension testing with surface electromyography of the quadriceps muscles. Mixed repeated-measures analysis of variance with least significant difference post hoc testing was used to determine significant differences (mean difference [MD] ± SE) or interactions for all variables. Results: A significant speed×depth interaction was seen for the vastus medialis (P =.005). Pairwise analyses showed significantly longer EMD for the partial-thickness graft than the full-thickness graft (MD ± SE, 19.92 ± 6.33 ms; P =.006). In the partial-thickness graft, the EMD was significantly longer at 90 deg/s versus 180 deg/s (MD ± SE, 19.11 ± 3.95 ms; P <.001) and 300 deg/s (MD ± SE, 16.43 ± 5.30 ms; P =.006). For PT, the full-thickness graft had a significantly lower PT on the operated versus nonoperated side at all speeds (MD ± SE: 90 deg/s, −57.0 ± 10.5 N·m, P <.001; 180 deg/s, −26.0 ± 10.2 N·m, P =.020; 300 deg/s, −20.3 ± 8.9 N·m, P =.034). For RTD, the full-thickness graft showed significantly Slower RTD for the operated versus nonoperated side at all time points (MD ± SD: RTD0-25 (0-25% of the range of motion), −131.3 ± 50.9 N·m/s, P =.018; RTD25-50, −197.0 ± 72.5 N·m/s, P =.014; RTD50-75, −113.3 ± 39.8 N·m/s, P =.013; RTD75-100, −149.4 ± 35.9 N·m/s, P <.001). Conclusion: Compared with partial-thickness QT, full-thickness QT showed a shorter vastus medialis EMD at higher loading, and therefore greater stiffness, as well as slower RTD and lower PT across all testing speeds. Clinical Relevance: The impact of full-thickness QT autograft on EMD and neuromuscular performance should be considered for ACLR. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament reconstruction (ACLR) using the quadriceps tendon is an increasingly popular technique. Both partial-thickness quadriceps tendon (PT-Q) and full-thickness quadriceps tendon (FT-Q) graft depths are employed. Hypothesis/Purpose: This study was designed to assess isokinetic peak torque, average power, and total work during knee extension in patients with FT-Q or PT-Q grafts for ACLR. We hypothesized that both groups would show lower isokinetic values for the operated side, with greater deficits in the FT-Q group than in the PT-Q group. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 26 patients who underwent ACLR with either an FT-Q or PT-Q graft were recruited between June 2021 and November 2021. Patients underwent isokinetic knee extension testing at > 1 year after surgery. Mixed repeated-measures analysis of covariance with least square difference post hoc testing was used to determine significant differences or interactions for all variables. Results: Peak torque was significantly lower for the operated limb than the nonoperated limb in the FT-Q group (mean difference [MD] ± standard error [SE], −38.6 ± 8.3 Nċm [95% CI, −55.7 to −21.5 Nċm]; P <.001; d = 0.90) but not in the PT-Q group (MD ± SE, −7.3 ± 7.7 Nċm [95% CI, −23.2 to 8.5 Nċm]; P =.348; d = 0.20). Similarly, average power for the operated limb was lower than that for the nonoperated limb in the FT-Q group (MD ± SE, −53.6 ± 13.4 W [95% CI, −81.3 to −26.9 W]; P <.001; d = 0.88) but not in the PT-Q group (MD ± SE, –4.1 ± 12.4 W [95% CI, −29.8 to 21.5 W]; P =.742; d = 0.07), and total work was lower for the operated limb compared with the nonoperated limb in the FT-Q group (MD ± SE, −118.2 ± 27.1 J [95% CI, −174.3 to −62.2 J]; P <.001; d = 0.96) but not in the PT-Q group (MD ± SE, −18.3 ± 25.1 J [95% CI, −70.2 to 33.6 J]; P =.472; d = 0.15). Conclusion: The FT-Q group showed significant deficits in the operated limb compared with the nonoperated limb for all isokinetic variables. In contrast, no significant differences were found between the nonoperated and operated limbs for the PT-Q group. [ABSTRACT FROM AUTHOR]

Background: Quadriceps tendon (QT) autografts are increasingly popular for anterior cruciate ligament reconstruction (ACLR). However, no study has compared QT autografts with bone–patellar tendon–bone (BTB) autografts regarding the electromechanical delay (EMD), the peak torque (PT), and the rate of force development (RFD) in the superficial quadriceps muscles (rectus femoris [RF], vastus medialis [VM], and vastus lateralis [VL]). Hypotheses: We hypothesized (1) there would be a significantly lower PT, lower RFD, and longer quadriceps EMD of the operative limb for the QT versus the BTB autograft; (2) the PT, the RFD, and the quadriceps EMD of the operative limb would be significantly depressed compared with those of the nonoperative limb, regardless of the surgical technique; and (3) there would be greater increases in the RF EMD than in the VM or the VL EMD. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 34 patients (age, 18-40 years), who had undergone ACLR (QT, n = 17; BTB, n = 17) at least 1 year before testing and performed 3 perceived maximal effort isometric tests, which were time synchronized with surface electromyography (EMG) on their operative and nonoperative limbs, were included in this study. EMD, PT, and RFD data were analyzed using a 2 (limb) × 2 (graft) × 3 (repetition) mixed repeated-measures analysis of variance. Results: The EMD, the PT, and the RFD were not significantly affected by graft choice. For the VL, a significant repetition × graft × limb interaction was detected for the VL EMD (P =.027; ηp = 0.075), with repetition 3 having longer EMD than repetition 2 (mean difference [MD], 16 milliseconds; P =.039). For the RF EMD, there was a significant repetition × limb interaction (P =.027; ηp = 0.074), with repetition 3 being significantly longer on the operative versus the nonoperative limb (MD, 24 milliseconds; P =.004). Further, the operative limb EMD was significantly longer for repetition 3 versus repetition 2 (MD, 17 milliseconds; P =.042). For the PT, there was a significant effect for repetition (P =.003; ηp = 0.114), with repetition 1 being significantly higher than both repetitions 2 (MD, 8.52 N·m; P =.001) and 3 (MD, 7.79 N·m; P =.031). For the RFD, significant limb (P =.034; ηp = 0.092) and repetition (P =.010; ηp = 0.093) effects were seen, with the nonoperative limb being significantly faster than the operative limb (MD, 23.7 N·m/s; P =.034) and repetition 1 being significantly slower than repetitions 2 (MD, -20.46 N·m/s; P =.039) or 3 (MD, −29.85 N·m/s; P =.002). Conclusion: The EMD, the PT, and the RFD were not significantly affected by graft type when comparing QT and BTB autografts for ACLR; however, all neuromuscular variables were affected regardless of the QT or the BTB harvest. [ABSTRACT FROM AUTHOR]

Background: Meniscal injuries are among the most common orthopaedic injuries, with a significant volume of published literature. Purpose: To perform a comprehensive bibliometric analysis that appropriately evaluates the 50 most cited articles in meniscal research. Study Design: Cross-sectional study. Methods: We performed a keyword search of the ISIWeb of Knowledge database and then pared the results down to the 50 most cited articles using specific inclusion and exclusion criteria. Data extracted included title, first author, citation count, year of publication, topic, journal, article type, country of origin, and level of evidence. Correlation coefficients were calculated between publication date and citation density and between publication date and raw citation count. Results: The 50 most cited articles were published from 1975 to 2013. The mean number of citations was 258.24 (range, 163-926; median, 225). The majority of articles were published in The American Journal of Sports Medicine (19%), the Journal of Bone and Joint Surgery (12%), and Arthritis & Rheumatology (14%). Most articles focused on either the anatomy and biomechanics of meniscal injury or on prevention and physical rehabilitation (12 papers each). Conclusion: The most popular fields of meniscal research involved anatomy/biomechanics and prevention/rehabilitation, and both are areas that will likely increase the probability of an article's being highly cited in the future. This study provided a quality selection of the most cited articles on meniscal injury and may provide a foundation for both beginner and senior clinician readers for further discussion and research. [ABSTRACT FROM AUTHOR]

Background: Although claims of increased injury rates with Thursday night National Football League (NFL) games exist, a paucity of data exist substantiating these claims. Purpose: To evaluate the effect of rest between games on in-game injury rates as it pertains to overall injury incidence, location, and player position. Study Design: Descriptive epidemiologic study. Methods: Data were obtained from official NFL game books for regular season games from all 32 teams for the 2013-2016 seasons. All in-game injuries recorded in official game books were included. Rest periods between games were classified as short (4 days), regular (6-8 days), or long (≥10 days). Overall observed injury rates per team-game were analyzed in relation to different rest periods using negative binomial regression. For results with significant overall findings, pairwise comparisons were tested using the Wald chi-square test. Exploratory secondary analyses were performed in a similar fashion to assess differences in injury rates for the different rest periods when stratified by anatomic location and player position. Results: A total of 2846 injuries were identified throughout the 4 seasons. There was an overall significant difference in injuries per team-game between short, regular, and long rest (P =.01). With short rest, an observed mean of 1.26 injuries per game (95% CI, 1.06-1.49) was significantly different from the 1.53 observed injuries per game with regular rest (95% CI, 1.46-1.60; P =.03), but not compared with the 1.34 observed injuries per game with long rest (P =.56). For player position, only the tight end, linebacker, and fullback group demonstrated significant differences between the injury rates for different rest categories. Quarterback was the only position with more injuries during games played on Thursday compared with both regular and long rest. This specific analysis was underpowered and the difference was not significant (P =.08). No differences were found regarding injury rates in correlation with differences in rest periods with different injury locations. Conclusion: A short rest period between games is not associated with increased rates of observed injuries reported in NFL game books; rather, our data suggest there are significantly fewer injuries for Thursday night games compared with games played on regular rest. Future research correlating rest and quarterback injury rates is warranted. [ABSTRACT FROM AUTHOR]

Background: In recent years, there has been a documented increase in the number of professional baseball players on the disabledlist and the total number of days on the disabled list. Pitchers account for the largest number of disabled list reports.Purpose: To examine the relationship between magnetic resonance imaging (MRI) findings in asymptomatic professional pitchersand subsequent time on the disabled list (DL).Study Design: Cohort study (Prognosis); Level of evidence, 2.Methods: A total of 21 asymptomatic professional pitchers from a single Major League Baseball (MLB) organization underwentpreseason MRIs of their dominant shoulder from 2001 to 2010. Asymptomatic was defined as no related DL stays in the 2 seasonsbefore the MRI. These studies were reevaluated by a fellowship-trained musculoskeletal radiologist who was blinded topatient name, injury history, and baseball history. A second investigator who was blinded to the MRI results collected demographicdata, total career number of innings pitched, and any subsequent DL reports for each subject.Results: The mean age at the time ofMRI was 29.04 years (range, 20-39 years). Eleven of 21 pitchers had a rotator cuff tear (RCT): 9had an articular surface tear (AST), and 2 had a full-thickness rotator cuff tear (FTT). Ten had superior labral anterior posterior (SLAP)tears, and 13 had either anterior or posterior labral tears. There was a statistically significant relationship between the number ofinnings pitched and presence of an RCT (AST + FTT). The mean number of career innings pitched by those with an RCT was1014 compared with a mean of 729 innings pitched in pitchers without an RCT (P<.01). In addition, the number of career inningspitched was moderately correlated with presence of RCT (r = 0.46) and presence of superior and anterior/posterior labral tears(r = 0.43). There were no statistically significant findings between any single preseason MRI finding and subsequent time on the DL.Conclusion: The MRI findings in asymptomatic MLB pitchers do not appear to be related to near future placement on the DL.However, there was a significant difference in numbers of innings pitched between pitchers who had an RCT and those whodid not and a moderate correlation between innings pitched and the presence of RCT as well as the presence of labral lesions.This finding supports the notion that RCT and labral injury in pitchers may result from repetitive overhead motion with subsequentstrain on the rotator cuff tendons and glenoid labrum. Asymptomatic shoulder lesions in professional baseball pitchers appear tobe more frequent than previously thought. [ABSTRACT FROM AUTHOR]