Search

Background: In adults with anterior cruciate ligament (ACL) tears, bone bruises on magnetic resonance imaging (MRI) scans provide insight into the underlying mechanism of injury. There is a paucity of literature that has investigated these relationships in children with ACL tears. Purpose: To examine and compare the number and location of bone bruises between contact and noncontact ACL tears in pediatric patients. Study Design: Cohort study; Level of evidence, 3. Methods: Boys ≤14 years and girls ≤12 years of age who underwent primary ACL reconstruction surgery between 2018 and 2022 were identified at 3 separate institutions. Eligibility criteria required detailed documentation of the mechanism of injury and MRI performed within 30 days of the initial ACL tear. Patients with congenital lower extremity abnormalities, concomitant fractures, injuries to the posterolateral corner and/or posterior cruciate ligament, previous ipsilateral knee injuries or surgeries, or closed physes evident on MRI scans were excluded. Patients were stratified into 2 groups based on a contact or noncontact mechanism of injury. Preoperative MRI scans were retrospectively reviewed for the presence of bone bruises in the coronal and sagittal planes using fat-suppressed T2-weighted images and a grid-based mapping technique of the tibiofemoral joint. Results: A total of 109 patients were included, with 76 (69.7%) patients sustaining noncontact injuries and 33 (30.3%) patients sustaining contact injuries. There were no significant differences between the contact and noncontact groups in terms of age (11.8 ± 2.0 vs 12.4 ± 1.3 years; P =.12), male sex (90.9% vs 88.2%; P >.99), time from initial injury to MRI (10.3 ± 8.1 vs 10.4 ± 8.9 days; P =.84), the presence of a concomitant medial meniscus tear (18.2% vs 14.5%; P =.62) or lateral meniscus tear (69.7% vs 52.6%; P =.097), and sport-related injuries (82.9% vs 81.8%; P =.89). No significant differences were observed in the frequency of combined lateral tibiofemoral (lateral femoral condyle + lateral tibial plateau) bone bruises (87.9% contact vs 78.9% noncontact; P =.41) or combined medial tibiofemoral (medial femoral condyle [MFC] + medial tibial plateau) bone bruises (54.5% contact vs 35.5% noncontact; P =.064). Patients with contact ACL tears were significantly more likely to have centrally located MFC bruising (odds ratio, 4.3; 95% CI, 1.6-11; P =.0038) and less likely to have bruising on the anterior aspect of the lateral tibial plateau (odds ratio, 0.27; 95% CI, 0.097-0.76; P =.013). Conclusion: Children with contact ACL tears were 4 times more likely to present with centrally located MFC bone bruises on preoperative MRI scans compared with children who sustained noncontact ACL tears. Future studies should investigate the relationship between these bone bruise patterns and the potential risk of articular cartilage damage in pediatric patients with contact ACL tears. [ABSTRACT FROM AUTHOR]

Stemless implants in anatomic total shoulder arthroplasty (TSA) have demonstrated comparable results to stemmed implants with both spherical and elliptical humeral heads. The primary purpose of this study is to report the 2-year clinical outcomes of a new cohort of patients that underwent anatomic TSA using an elliptical humeral head and multiplanar osteotomy system. Patients who underwent anatomic TSA with the Catalyst total shoulder system (OrthoScience) from 2017 to 2019 by a single surgeon were included in this study. Preoperative shoulder radiographs, computer tomography scans, and/or magnetic resonance imagings were reviewed and classified according to the Walch Classification. At a minimum of 2-year follow-up, patient-reported outcome measurements (PROMs) were obtained, including the Western Ontario Osteoarthritis Shoulder index, American Shoulder and Elbow Surgeons score, Patient-Reported Outcomes Measurement Information System upper extremity, and the Single Assessment Numerical Evaluation (SANE) score. PROMs were stratified by age, body mass index, and medical comorbidities. Revisions, secondary surgeries, and any radiographic notes of hardware loosening were also recorded. Forty anatomic TSAs in 38 patients met inclusion criteria for the study. The average age of the cohort was 66.1 year old, 45% male, and with a mean body mass index of 31.5. PROMs were available for 27 out of 40 patients (70%) with a mean follow-up time of 33.9 ± 5.2 months. Radiographic analysis demonstrated that 6/27 (22%) were Walch A2 type glenoids while 21/27 (78%) were Walch B2 type glenoids. The mean PROMs for the cohort were as follows: Western Ontario Osteoarthritis Shoulder index (91.2 ± 8.8), American Shoulder and Elbow Surgeons score (85.4 ± 14.7), Patient-Reported Outcomes Measurement Information System upper extremity (31.5 ± 3.6), SANE ipsilateral (83.8 ± 15.9), and SANE contralateral (85.7 ± 10.3). Three patients (11%) required revision surgery, including 2 subscapularis repairs, and 1 revision to a reverse TSA. The present study demonstrated clinical outcomes using an ellipsoid anatomic TSA system on a high percentage of patients with B2 type glenoids at a minimum of 2-year follow-up. Further study is warranted to evaluate long-term outcomes of this new stemless ellipsoid anatomic TSA system. [ABSTRACT FROM AUTHOR]

The purposes of this study were (a) to analyze the changes in total and regional body composition measurements in a National Collegiate Athletic Association (NCAA) Division I female field hockey team throughout a 17-game competitive season using dual X-ray absorptiometry (DXA); (b) to examine improvements, if any, in athletic performance measures after a season; and (c) to report on the relationship between these body composition changes and changes in athletic performance. Preseason and postseason dual-energy DXA and performance data from the 2019-2020 season were retrospectively identified for 20 field players (forwards, midfielders, and defenders). Body composition data included total and regional fat mass, lean mass, and body fat percentage, whereas athletic performance measures included the vertical jump, 10-yard dash, and pro-agility (5-10-5) shuttle run. All variables were quantitative and analyzed using paired t-tests or its nonparametric equivalent and an alpha level of p, 0.05 was used to determine significance. After a competitive season, athletes had significant decreases in fat mass and increases in lean mass in their arms, legs, trunks, gynoids, and total body measurements. Android fat mass and body fat percentage also decreased. Athletes performed significantly better on the pro-agility shuttle run at the end of the season, but no significant differences were observed in other performance metrics. Moderate correlations were observed between changes in body composition (total fat mass and total lean mass) and changes in athletic performance. Our study provides a novel, longitudinal assessment of body composition and athletic performance for elite female field hockey athletes that will help trainers and coaches better understand how these variables change throughout a season and allow them to better prepare their players for competitive success. [ABSTRACT FROM AUTHOR]

Background: Osteochondral lesions of the talus (OCLT) are common injuries that can be difficult to treat. To date, long-term patient reported outcome measures (PROMs) of patients with particulated juvenile allograft cartilage implantation with or without calcaneal autograft have not been compared. Methods: Thirteen patients with difficult to treat OCLTs underwent arthroscopic-assisted implantation of particulated juvenile allograft cartilage (DeNovo NT®) with or without autogenous calcaneal bone grafting by a single surgeon. Calcaneal bone graft use was determined by lesion size > 150 mm2 and/or deeper than 5 mm. Patients were evaluated using physical examination, patient interviews, and PROMs. Results: When comparing patients in regards to calcaneal bone graft implantation, no difference in age, BMI, pre-operative PROMs, or follow-up was noted, however, calcaneal bone graft patients did have a significantly larger lesion size (188.5 ± 50.9 vs. 118.7 ± 29.4 mm2 respectively; p value = 0.027). VAS and FAAM ADL scores during final follow-up improvement did not significantly differ between cohorts. The FAAM Sports score improved significantly more for the DeNovo alone group compared to the bone graft cohort (p value = 0.032). The AOFAS score improvement did not differ between cohorts (p value = 0.944), however, the SF-36 PCS improved significantly more for the DeNovo alone group compared to the bone graft cohort (p value = 0.038). No intraoperative/perioperative complications were observed with calcaneal bone grafting. Conclusion: While patients followed over the course of ~ 8 years after implantation of particulated juvenile allograft cartilage (DeNovo NT®) with/without autogenous calcaneal bone graft had positive post-operative PROMs, patients without calcaneal bone graft had significantly greater improvement in functional outcome scores. Whether these differences are due to graft incorporation or larger lesion size is unclear. Level of Evidence: III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Background: Throwing arm kinetics differ in pitchers at varying arm slot (AS) positions (frontal-plane arm position at ball release relative to the vertical axis). Purpose: To determine how kinematic and kinetic values differ between professional and high school pitchers with varying AS positions, and whether these differences are similarly observed in both populations. Methods: High school (n = 130) and professional (n = 288) pitchers threw 8 to 12 fastballs under 3-dimensional motion capture technology. Pitchers in each cohort were subdivided based on mean AS position at ball release: AS1 (least degree of AS: most overhand throwing styles), AS2 (intermediate degree of AS: three-quarter throwing styles), or AS3 (greatest degree of AS: most sidearm throwing styles). Kinetic and kinematic parameters were compared between groups. Study Design: Controlled laboratory study. Results: High school pitchers had a more overhand AS at ball release (50° ± 11°) compared with professional pitchers (58° ± 14°) (P <.001). In both cohorts, AS1 pitchers had significantly greater shoulder abduction (high school, P <0.001; professional, P <0.0001) and lateral trunk flexion (high school, P < 0.001; professional, P <0.0001) at ball release compared with AS3 pitchers. Professional pitchers with an AS3 position had significantly delayed timing of maximum upper trunk angular velocity compared with AS1 pitchers (64% ± 7% vs 57% ± 7% of pitch time, respectively; P <.0001). A significant positive correlation between AS and elbow flexion torque was found in high school pitchers (P =.002; β = 0.28), and a significant negative correlation between AS and elbow varus torque (P <.001; β = –0.22) and shoulder internal rotation torque (P <.001; β = –0.20) was noted in professional pitchers. Conclusion: AS position was related to shoulder abduction and trunk lateral tilt. Professional and high school pitchers with varying AS positions did not experience similar changes in throwing arm kinetics. Clinical Relevance: In professional pitchers, the earlier onset of maximum upper trunk angular velocity with overhand throwing style may reflect inappropriate pelvis-trunk timing separation, a parameter implicated in upper extremity injury, and the negative correlation between AS and elbow varus and shoulder internal rotation torque suggests that both excessive and minimal AS positions have negative implications. [ABSTRACT FROM AUTHOR]

Background: Acute tibiofemoral knee dislocations (KDs) with a single cruciate ligament remaining intact are rare and can be classified as Schenck KD I. The inclusion of multiligament knee injuries (MLKIs) has contributed to a recent surge in Schenck KD I prevalence and has convoluted the original definition of the classification. Purpose: To (1) report on a series of true Schenck KD I injuries with radiologically confirmed tibiofemoral dislocation and (2) introduce suffix modifications to further subclassify these injuries based on the reported cases. Study Design: Case series; Level of evidence, 4. Methods: A retrospective chart review identified all Schenck KD I MLKIs at 2 separate institutions between January 2001 and June 2022. Single-cruciate tears were included if a concomitant complete disruption of a collateral injury was present or injuries to the posterolateral corner, posteromedial corner, or extensor mechanism. All knee radiographs and magnetic resonance imaging scans were retrospectively reviewed by 2 board-certified orthopaedic sports medicine fellowship-trained surgeons. Only documented cases consistent with a complete tibiofemoral dislocation were included. Results: Of the 227 MLKIs, 63 (27.8%) were classified as KD I, and 12 (19.0%) of the 63 KD I injuries had a radiologically confirmed tibiofemoral dislocation. These 12 injuries were subclassified based on the following proposed suffix modifications: KD I-DA (anterior cruciate ligament [ACL] only; n = 3), KD I-DAM (ACL + medial collateral ligament [MCL]; n = 3), KD I-DPM (posterior cruciate ligament [PCL] + MCL; n = 2), KD I-DAL (ACL + lateral collateral ligament [LCL]; n = 1), and KD I-DPL (PCL + LCL; n = 3). Conclusion: The Schenck classification system should only be used to describe dislocations with bicruciate injuries or with single-cruciate injuries that have clinical and/or radiological evidence of tibiofemoral dislocation. Based on the presented cases, the authors recommend the suffix modifications for subclassifying Schenck KD I injuries with the goal of improving communication, surgical management, and the design of future outcome studies. [ABSTRACT FROM AUTHOR]

Background: Bone bruises are commonly seen on magnetic resonance imaging (MRI) in acute anterior cruciate ligament (ACL) injuries and can provide insight into the underlying mechanism of injury. There are limited reports that have compared the bone bruise patterns between contact and noncontact mechanisms of ACL injury. Purpose: To examine and compare the number and location of bone bruises in contact and noncontact ACL injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Three hundred twenty patients who underwent ACL reconstruction surgery between 2015 and 2021 were identified. Inclusion criteria were clear documentation of the mechanism of injury and MRI within 30 days of the injury on a 3-T scanner. Patients with concomitant fractures, injuries to the posterolateral corner or posterior cruciate ligament, and/or previous ipsilateral knee injury were excluded. Patients were stratified into 2 cohorts based on a contact or noncontact mechanism. Preoperative MRI scans were retrospectively reviewed by 2 musculoskeletal radiologists for bone bruises. The number and location of the bone bruises were recorded in the coronal and sagittal planes using fat-suppressed T2-weighted images and a standardized mapping technique. Lateral and medial meniscal tears were recorded from the operative notes, while medial collateral ligament (MCL) injuries were graded on MRI. Results: A total of 220 patients were included, with 142 (64.5%) noncontact injuries and 78 (35.5%) contact injuries. There was a significantly higher frequency of men in the contact cohort compared with the noncontact cohort (69.2% vs 54.2%, P =.030), while age and body mass index were comparable between the 2 cohorts. The bivariate analysis demonstrated a significantly higher rate of combined lateral tibiofemoral (lateral femoral condyle [LFC] + lateral tibial plateau [LTP]) bone bruises (82.1% vs 48.6%, P <.001) and a lower rate of combined medial tibiofemoral (medial femoral condyle [MFC] + medial tibial plateau [MTP]) bone bruises (39.7% vs 66.2%, P <.001) in knees with contact injuries. Similarly, noncontact injuries had a significantly higher rate of centrally located MFC bone bruises (80.3% vs 61.5%, P =.003) and posteriorly located MTP bruises (66.2% vs 52.6%, P =.047). When controlling for age and sex, the multivariate logistical regression model demonstrated that knees with contact injuries were more likely to have LTP bone bruises (OR, 4.721 [95% CI, 1.147-19.433], P =.032) and less likely to have combined medial tibiofemoral (MFC + MTP) bone bruises (OR, 0.331 [95% CI, 0.144-0.762], P =.009) compared with those with noncontact injuries. Conclusion: Significantly different bone bruise patterns were observed on MRI based on ACL injury mechanism, with contact and noncontact injuries demonstrating characteristic findings in the lateral tibiofemoral and medial tibiofemoral compartments, respectively. [ABSTRACT FROM AUTHOR]

Background: Peroneal nerve (PN) palsy is one of the most debilitating sequelae of multiligamentous knee injuries (MLKIs). There is limited research on recovery from complete PN palsy. Purpose/Hypothesis: The purpose of this study was to characterize PN injuries and develop a predictive model of complete PN recovery after MLKI using machine learning. It was hypothesized that elevated body mass index (BMI) would be predictive of lower likelihood of recovery. Study Design: Case-control study; Level of evidence, 3. Methods: The authors conducted a retrospective review of patients seen at 2 urban hospital systems for treatment of MLKI with associated complete PN palsy, defined as the presence of complete foot drop with or without sensory deficits on physical examination. Recovery was defined as the complete resolution of foot drop. A random forest (RF) classifier algorithm was used to identify demographic, injury, treatment, and postoperative variables that were significant predictors of recovery from complete PN palsy. Validity of the RF model was assessed using overall accuracy, F1 score, and area under the receiver operating characteristic curve (AUC). Results: Overall, 16 patients with MLKI with associated complete PN palsy were included in the cohort. Among them, 75% (12/16) had documented knee dislocation requiring reduction. Complete recovery occurred in 4 patients (25%). Nerve contusions on magnetic resonance imaging were more common among patients without PN recovery, but there were no other significant differences between recovery and nonrecovery groups. The RF model found that older age, increasing BMI, and male sex were predictive of worse likelihood of PN recovery. The model was found to have good validity, with a classification accuracy of 75%, F1 score of 0.86, and AUC of 0.64. Conclusion: The RF model in this study found that increasing age, BMI, and male sex were predictive of decreased likelihood of nerve recovery. While further study of machine learning models with larger patient data sets is required to identify the most superior model, these findings present an opportunity for orthopaedic surgeons to better identify, counsel, and treat patients with MLKIs and concomitant complete PN palsy. [ABSTRACT FROM AUTHOR]

Background: Tibiofemoral bone bruise patterns seen on magnetic resonance imaging (MRI) are associated with ligamentous injuries in the acutely injured knee. Bone bruise patterns in multiligament knee injuries (MLKIs) and particularly their association with common peroneal nerve (CPN) injuries are not well described. Purpose: To analyze the tibiofemoral bone bruise patterns in MLKIs with and without peroneal nerve injury. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively identified 123 patients treated for an acute MLKI at a level 1 trauma center between January 2001 and March 2021. Patients were grouped into injury subtypes using the Schenck classification. Within this cohort, patients with clinically documented complete (motor and sensory loss) and/or partial CPN palsies on physical examination were identified. Imaging criteria required an MRI scan on a 1.5 or 3 Tesla scanner within 30 days of the initial MLKI. Images were retrospectively interpreted for bone bruising patterns by 2 board-certified musculoskeletal radiologists. The location of the bone bruises was mapped on fat-suppressed T2-weighted coronal and sagittal images. Bruise patterns were compared among patients with and without CPN injury. Results: Of the 108 patients with a MLKI who met the a priori inclusion criteria, 26 (24.1%) were found to have a CPN injury (N = 20 complete; N = 6 partial) on physical examination. For CPN-injured patients, the most common mechanism of injury was high-energy trauma (N = 19 [73%]). The presence of a grade 3 posterolateral corner (PLC) injury (N = 25; odds ratio [OR], 23.81 [95% CI, 3.08-184.1]; P =.0024), anteromedial femoral condyle bone bruising (N = 24; OR, 21.9 [95% CI, 3.40-202.9]; P <.001), or a documented knee dislocation (N = 16; OR, 3.45 [95% CI, 1.38-8.62]; P =.007) was significantly associated with the presence of a CPN injury. Of the 26 patients with CPN injury, 24 (92.3%) had at least 1 anteromedial femoral condyle bone bruise. All 20 (100%) patients with complete CPN injury also had at least 1 anteromedial femoral condyle bone bruise on MRI. In our MLKI cohort, the presence of anteromedial femoral condyle bone bruising had a sensitivity of 92.3% and a specificity of 64.6% for the presence of CPN injury on physical examination. Conclusion: In our MLKI cohort, the presence of a grade 3 PLC injury had the greatest association with CPN injury. Additionally, anteromedial femoral condyle bone bruising on MRI was a highly sensitive finding that was significantly correlated with CPN injury on physical examination. The high prevalence of grade 3 PLC injuries and anteromedial tibiofemoral bone bruising suggests that these MLKIs with CPN injuries most commonly occurred from a hyperextension-varus mechanism caused by a high-energy blow to the anteromedial knee. [ABSTRACT FROM AUTHOR]

Background: Bone bruise patterns in the knee can aid in understanding the mechanism of injury in anterior cruciate ligament (ACL) ruptures. There is no universally accepted magnetic resonance imaging (MRI)mapping technique to describe the specific locations of bone bruises. Hypothesis: The authors hypothesized that (1) our novel mapping technique would show high interrater and intrarater reliability for the location of bone bruises in noncontact ACL-injured knees and (2) the bone bruise patterns reported from this technique would support the most common mechanisms of noncontact ACL injury, including valgus stress, anterior tibial translation, and internal tibial rotation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Included were 43 patients who underwent ACL reconstruction between 2018 and 2020, with MRI within 30 days of the injury on a 3.0-T scanner, documentation of a noncontact mechanism of injury, and no concomitant or previous knee injuries. Images were retrospectively reviewed by 2 radiologists blinded to all clinical data. The locations of bone bruises were mapped on fat-suppressed T2-weighted coronal and sagittal images using a novel technique that combined the International Cartilage Repair Society (ICRS) tibiofemoral articular cartilage surgical lesions diagram and the Whole-Organ Magnetic Resonance Imaging Scoring (WORMS) mapping system. Reliability between the reviewers was assessed using the intraclass correlation coefficient (ICC), where ICC >0.90 indicated excellent agreement. Results: The interrater and intrarater ICCs were 0.918 and 0.974, respectively, for femoral edema mapping and 0.979 and 0.978, respectively, for tibial edemamapping. Significantlymore bone bruises were seen within the lateral femoral condyle compared with the medial femoral condyle (67% vs 33%; P < .0001), and more bruises were seen within the lateral tibial plateau compared with the medial tibial plateau (65% vs 35%; P < .0001). Femoral bruises were almost exclusively located in the anterior/central regions (98%) of the condyles as opposed to the posterior region (2%; P < .0001). Tibial bruises were localized to the posterior region (78%) of both plateaus as opposed to the anterior/central regions (22%; P < .0001). Conclusion: The combined mapping technique offered a standardized and reliable method for reporting bone bruises in noncontact ACL injuries. The contusion patterns identified using this technique were indicative of the most commonly reported mechanisms for noncontact ACL injuries. [ABSTRACT FROM AUTHOR]