Showing papers in "American Journal of Sports Medicine in 2009"
TL;DR: This study reviews and evaluates the human studies that have been published in the orthopaedic surgery and sports medicine literature and the regulation of PRP by antidoping agencies is discussed.
Abstract: Platelet-rich plasma (PRP) has been utilized in surgery for 2 decades; there has been a recent interest in the use of PRP for the treatment of sports-related injuries. PRP contains growth factors and bioactive proteins that influence the healing of tendon, ligament, muscle, and bone. This article examines the basic science of PRP, and it describes the current clinical applications in sports medicine. This study reviews and evaluates the human studies that have been published in the orthopaedic surgery and sports medicine literature. The use of PRP in amateur and professional sports is reviewed, and the regulation of PRP by antidoping agencies is discussed.
1,040 citations
TL;DR: This systematic analysis shows that microfracture provides effective short-term functional improvement of knee function but insufficient data are available on its long-term results.
Abstract: Background Despite the popularity of microfracture as a first-line treatment for articular cartilage defects in the knee, systematic information on its clinical efficacy for articular cartilage repair and long-term improvement of knee function is not available. Hypothesis Systematic analysis of the existing clinical literature of microfracture in the knee can improve the understanding of the advantages and limitations of this cartilage repair technique and can help to optimize its indications and clinical outcomes. Study design Systematic review. Methods A comprehensive literature search was performed using established search engines (MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials) to identify original human studies of articular cartilage repair with microfracture. Modified Coleman Methodology Scores were used to analyze the quality of the existing studies. Clinical efficacy of articular cartilage repair was evaluated by systematic analysis of short- and long-term functional outcome scores, macroscopic and microscopic repair cartilage quality, and findings of postoperative magnetic resonance imaging. Results Twenty-eight studies describing 3122 patients were included in the review. The average follow-up was 41 months, with only 5 studies reporting follow-up of 5 years or more. Six studies were randomized controlled trials and the mean Coleman Methodology Score was 58 (range, 22-97). Microfracture effectively improved knee function in all studies during the first 24 months after microfracture, but the reports on durability of the initial functional improvement were conflicting. Several factors were identified that affected clinical outcome. Defect fill on magnetic resonance imaging was highly variable and correlated with functional outcome. Macroscopic repair cartilage quality positively affected long-term failure rate, while the influence of histologic repair tissue quality remained inconclusive. Conclusion This systematic analysis shows that microfracture provides effective short-term functional improvement of knee function but insufficient data are available on its long-term results. Shortcomings of the technique include limited hyaline repair tissue, variable repair cartilage volume, and possible functional deterioration. The quality of the currently available data on micro-fracture is still limited by the variability of results and study designs. Further well-designed studies are needed to determine the long-term efficacy of microfracture and to define its specific clinical indications compared to other cartilage repair techniques.
871 citations
TL;DR: No universal methodological radiologic classification method exists, making comparisons of the studies and stating firm conclusions on the prevalence of knee osteoarthritis more than 10 years after anterior cruciate ligament injury difficult.
Abstract: BackgroundThis is a systematic review of studies on the prevalence of osteoarthritis in the tibiofemoral joint more than 10 years after an anterior cruciate ligament injury, the radiologic classification methods used, and risk factors for development of knee osteoarthritis.MethodsA systematic search was performed in PubMed, EMBASE, and AMED. Inclusion criteria were studies involving patients with anterior cruciate ligament injury, either isolated or combined with medial collateral ligament or meniscal injury and either surgically or nonsurgically treated, and a minimum 10-year follow-up with radiologic assessment. Methodological quality was evaluated using a modified version of the Coleman methodology score.ResultsSeven prospective and 24 retrospective studies were included. The mean modified Coleman methodology score was 52 of 90. Reported prevalence of knee osteoarthritis for subjects with isolated anterior cruciate ligament injury was between 0% and 13%. For subjects with anterior cruciate ligament and...
730 citations
TL;DR: The Lysholm knee score and the Tegner activity scale demonstrated acceptable psychometric parameters as patient-administered scores and showed acceptable responsiveness to be used in early return to function after anterior cruciate ligament treatment.
Abstract: Background: In 1982, the Lysholm score was first published as a physician-administered score in the American Journal of Sports Medicine. The Tegner activity scale was published in 1985.Hypothesis: ...
651 citations
TL;DR: The LESS is a valid and reliable tool for identifying potentially high-risk movement patterns during a jump-landing task and women had higher (worse) LESS scores than men.
Abstract: BackgroundAnterior cruciate ligament injuries are common in athletes and have serious sequelae. A valid clinical tool that reliably identifies individuals at an increased risk for ACL injury would be highly useful for screening sports teams, because individuals identified as “high-risk” could then be provided with intensive prevention programs.HypothesisA clinical screening tool (the Landing Error Scoring System, or LESS) will reliably identify subjects with potentially high-risk biomechanics.Study DesignCohort study (Diagnosis); Level of evidence, 2.MethodsA jump-landing-rebound task was used. Off-the-shelf camcorders recorded frontal and sagittal plane views of the subject performing the task. The LESS was scored from replay of this video. Three-dimensional lower extremity kinematics and kinetics were also collected and used as the gold standard against which the validity of the LESS was assessed. Three trials of the jump-landing task were collected for 2691 subjects. Kinematic and kinetic measures were...
557 citations
TL;DR: Characterized chondrocyte implantation for the treatment of articular cartilage defects of the femoral condyles of the knee results in significantly better clinical outcome at 36 months in a randomized trial compared with MF.
Abstract: Background: Damaged articular cartilage has limited capacity for self-repair. Autologous chondrocyte implantation using a characterized cell therapy product results in significantly better early structural repair as compared with microfracture in patients with symptomatic joint surface defects of the femoral condyles of the knee.Purpose: To evaluate clinical outcome at 36 months after characterized chondrocyte implantation (CCI) versus microfracture (MF).Study Design: Randomized controlled trial; Level of evidence, 1.Methods: Patients aged 18 to 50 years with single International Cartilage Repair Society (ICRS) grade III/IV symptomatic cartilage defects of the femoral condyles were randomized to CCI (n = 57) or MF (n = 61). Clinical outcome was measured over 36 months by the Knee injury and Osteoarthritis Outcome Score (KOOS). Serial magnetic resonance imaging (MRI) scans were scored using the Magnetic resonance Observation of Cartilage Repair Tissue (MOCART) system and 9 additional items. Gene expression...
484 citations
TL;DR: The data indicate that the injury surveillance system covered almost all of the participating athletes, and the results highlight areas of high risk for sport injury such as the in-competition period, the ankle and thigh, and specific sports.
Abstract: BackgroundStandardized assessment of sports injuries provides important epidemiological information and also directions for injury prevention.PurposeTo analyze the frequency, characteristics, and causes of injuries incurred during the Summer Olympic Games 2008.Study DesignDescriptive epidemiology study.MethodsThe chief physicians and/or chief medical officers of the national teams were asked to report daily all injuries newly incurred during the Olympic Games on a standardized injury report form. In addition, injuries were reported daily by the physicians at the medical stations at the different Olympic venues and at the polyclinic in the Olympic Village.ResultsPhysicians and/or therapists of 92 national teams covering 88% of the 10 977 registered athletes took part in the study. In total, 1055 injuries were reported, resulting in an incidence of 96.1 injuries per 1000 registered athletes. Half of the injuries (49.6%) were expected to prevent the athlete from participating in competition or training. The ...
459 citations
TL;DR: Multiple modifiable risk factors for patellofemoral pain syndrome pain have been identified and the risk factors need to be targeted in injury prevention programs.
Abstract: BackgroundPatellofemoral pain syndrome is one of the most common chronic knee injuries; however, little research has been done to determine the risk factors for this injury.HypothesisAltered lower extremity kinematics and kinetics, decreased strength, and altered postural measurements will be risk factors.Study DesignCohort study (prognosis); Level of evidence, 2.MethodsA total of 1597 participants were enrolled in this investigation and prospectively followed from the date of their enrollment (July 2005, July 2006, or July 2007) through January 2008, a maximum of 2.5 years of follow-up. Each participant underwent baseline data collection during their pre-freshman summer at the United States Naval Academy. Baseline data collection included 3-dimensional motion analysis during a jump-landing task, 6 lower extremity isometric strength tests, and postural alignment measurements (navicular drop and Q angle).ResultsRisk factors for the development of patellofemoral pain syndrome included decreased knee flexion...
443 citations
TL;DR: The incidence of injury to either knee after reconstruction is associated with younger age and higher activity level, but returning to full activities before 6 months postoperatively does not increase the risk of subsequent injury.
Abstract: BackgroundThe risk of subsequent anterior cruciate ligament injury to either knee after surgery based on sex, age, and activity has not been extensively studiedHypothesesWomen have a higher incidence of anterior cruciate ligament injury to the contralateral knee after surgery than men but do not have a difference in injuries to the reconstructed knee Young, competitive athletes have a higher incidence of injury than older patients The time to return to full activities does not affect injury rateStudy DesignCohort study (prognosis); Level of evidence, 2MethodsThe authors prospectively followed 1820 patients after primary anterior cruciate ligament reconstruction to determine if patients suffered an injury to either knee within 5 years after surgery Subsequent injury was evaluated based on sex, age, and activity levelResultsMinimum 5-year follow-up was obtained on 1415 patients (78%) Seventy-five patients (53%) had an injury to the contralateral knee, and 61 patients (43%) suffered an injury to th
417 citations
TL;DR: Initial ground contact flatfooted or with the hindfoot, knee abduction and increased hip flexion may be risk factors for anterior cruciate ligament injury.
Abstract: BackgroundMost anterior cruciate ligament research is limited to variables at the knee joint and is performed in the laboratory setting, often with subjects postinjury. There is a paucity of information on the position of the hip and ankle during noncontact anterior cruciate ligament injury.HypothesisWhen landing after maneuvers, athletes with anterior cruciate ligament injury (subjects) show a more flatfooted profile and more hip flexion than uninjured athletes (controls).Study DesignCase control study; Level of evidence, 3.MethodsData from 29 videos of subjects were compared with data from 27 videos of controls performing similar maneuvers. Joint angles were analyzed in 5 sequential frames in sagittal or coronal planes, starting with initial ground-foot contact. Hip, knee, and ankle joint angles were measured in each sequence in the sagittal plane and hip and knee angles in the coronal plane with computer software. The portion of the foot first touching the ground and the number of sequences required fo...
412 citations
TL;DR: The data demonstrate that marrow stimulation techniques have a strong negative effect on subsequent cartilage repair with autologous chondrocyte implantation and therefore should be used judiciously in larger cartilage defects that could require future treatment with autologies.
Abstract: BackgroundMarrow stimulation techniques such as drilling or microfracture are first-line treatment options for symptomatic cartilage defects. Common knowledge holds that these treatments do not compromise subsequent cartilage repair procedures with autologous chondrocyte implantation.HypothesisCartilage defects pretreated with marrow stimulation techniques will have an increased failure rate.Study DesignCohort study; Level of evidence, 2.MethodsThe first 321 consecutive patients treated at one institution with autologous chondrocyte implantation for full-thickness cartilage defects that reached more than 2 years of follow-up were evaluated by prospectively collected data. Patients were grouped based on whether they had undergone prior treatment with a marrow stimulation technique. Outcomes were classified as complete failure if more than 25% of a grafted defect area had to be removed in later procedures because of persistent symptoms.ResultsThere were 522 defects in 321 patients (325 joints) treated with ...
TL;DR: Both methods have shown satisfactory clinical outcome at medium-term follow-up and better clinical results and sport activity resumption were noted in the group treated with second-generation autologous chondrocyte transplantation.
Abstract: BackgroundVarious approaches have been proposed to treat articular cartilage lesions, which are plagued by inherent limited healing potential.PurposeTo compare the clinical outcome of patients treated with second-generation autologous chondrocyte implantation implants with those treated with the microfracture repair technique at 5-year follow-up.Study DesignCohort study; Level of evidence, 2.MethodsEighty active patients (mean age, 29.8 years) and grade III to IV cartilage lesions of the femoral condyles or trochlea were treated with arthroscopic second-generation autologous chondrocyte implantation Hyalograft C or microfracture (40 patients per group). Patients achieved a minimum 5-year follow-up and were prospectively evaluated.ResultsBoth groups showed statistically significant improvement of all clinical scores from preoperative interval to 5-year follow-up. There was a significant improvement for the International Knee Documentation Committee subjective score from preoperative to 5-year follow-up (Wi...
TL;DR: Initial defect size is an important and easily obtainable prognostic factor in osteochondral lesions of the talus and so may serve as a basis for preoperative surgical decisions.
Abstract: BackgroundIdentifying factors associated with favorable or unfavorable outcomes would provide patients with accurate expectations of the arthroscopic marrow stimulation techniques.PurposeTo investigate the prognostic significance and optimal measures of defect size in osteochondral lesion of the talus as treated with arthroscopy.HypothesisA critical, or threshold, defect size may exist at which clinical outcomes become poor in the treatment of osteochondral lesion of the talus.Study DesignCohort study; Level of evidence, 3.MethodsIn sum, 120 ankles underwent arthroscopic marrow stimulation treatment for osteochondral lesion of the talus and were evaluated for prognostic factors. Clinical failure was defined as patients’ having osteochondral transplantation or an American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale score less than 80. Linear regression analysis and the Kaplan-Meier method were used to identify optimal cutoff values of defect size.ResultsEight ankles (6.7%) required oste...
TL;DR: Arthroscopic biceps tenodesis can be considered an effective alternative to the repair of a type II SLAP lesion, allowing patients to return to a presurgical level of activity and sports participation.
Abstract: BackgroundOverhead athletes report an inconsistent return to their previous level of sport and satisfaction after arthroscopic SLAP lesion repair.HypothesisArthroscopic biceps tenodesis offers a viable alternative to the repair of an isolated type II SLAP lesion.Study DesignCohort study; Level of evidence, 3.MethodsTwenty-five consecutive patients operated for an isolated type II SLAP lesion between 2000 and 2004 were evaluated at a mean of 35 months postoperatively (range, 24-69). Patients with associated instability, rotator cuff rupture, posterosuperior impingement, or previous shoulder surgery were excluded. Ten patients (10 men) with an average age of 37 years (range, 19-57) had a SLAP repair performed with suture anchors. Fifteen patients (9 men and 6 women) with an average age of 52 years (range, 28-64) underwent arthroscopic biceps tenodesis performed with an absorbable interference screw. Arthroscopic diagnosis and treatment were performed by a single experienced shoulder surgeon, and all patient...
TL;DR: The mechanical, vascular, neural, and other theories that seek to explain the pathologic process are explored in this article, as is the rationale for surgical intervention.
Abstract: Overuse disorders of tendons, or tendinopathies, present a challenge to sports physicians, surgeons, and other health care professionals dealing with athletes. The Achilles, patellar, and supraspinatus tendons are particularly vulnerable to injury and often difficult to manage successfully. Inflammation was believed central to the pathologic process, but histopathologic evidence has confirmed the failed healing response nature of these conditions. Excessive or inappropriate loading of the musculotendinous unit is believed to be central to the disease process, although the exact mechanism by which this occurs remains uncertain. Additionally, the location of the lesion (for example, the midtendon or osteotendinous junction) has become increasingly recognized as influencing both the pathologic process and subsequent management. The mechanical, vascular, neural, and other theories that seek to explain the pathologic process are explored in this article. Recent developments in the nonoperative management of chronic tendon disorders are reviewed, as is the rationale for surgical intervention. Recent surgical advances, including minimally invasive tendon surgery, are reviewed. Potential future management strategies, such as stem cell therapy, growth factor treatment, and gene transfer, are also discussed.
TL;DR: Because severe injuries negatively affect athletes’ health and often place an increased burden on the health care system, future research should focus on developing interventions to decrease the incidence and severity of sports-related injuries.
Abstract: BackgroundOver 7 million students participate in high school athletics annually. Despite numerous health benefits, high school athletes are at risk for injury.HypothesisSevere injury rates and patterns differ by gender and type of exposure.Study DesignDescriptive epidemiology study.MethodsSports-related injury data were collected during the 2005-2007 academic years from 100 nationally representative United States high schools via RIO (Reporting Information Online). Severe injury was defined as any injury that resulted in the loss of more than 21 days of sports participation.ResultsParticipating certified athletic trainers (ATCs) reported 1378 severe injuries during 3 550 141 athlete-exposures (0.39 severe injuries per 1000 athletic exposures). Football had the highest severe injury rate (0.69), followed by wrestling (0.52), girls’ basketball (0.34), and girls’ soccer (0.33). The rate in all boys’ sports (0.45) was higher than all girls’ sports (0.26) (rate ratio [RR], 1.74; 95% confidence interval [CI], 1...
TL;DR: A history of concussion and gender may account for significant differences in postconcussive neurocognitive test scores in soccer players and may play a role in determining recovery.
Abstract: BackgroundThis study was designed to investigate differences in recovery in male and female soccer athletes.HypothesesSoccer players with a history of concussion will perform worse on neurocognitive testing than players without a history of concussion. Furthermore, female athletes will demonstrate poorer performance on neurocognitive testing than male athletes.Study DesignCohort study (prognosis): Level of evidence, 2.MethodsComputer-based neuropsychological testing using reaction time, memory, and visual motor-speed composite scores of the ImPACT test battery was performed postconcussion in soccer players ranging in age from 8 to 24 years (N = 234; 141 females, 93 males). A multivariate analysis of variance was conducted to examine group differences in neurocognitive performance between male and female athletes with and without a history of concussion.ResultsSoccer players with a history of at least 1 previous concussion performed significantly worse on ImPACT than those who had not sustained a prior con...
TL;DR: The addition of MSCs to the healing rotator cuff insertion site did not improve the structure, composition, or strength of the healing tendon attachment site despite evidence that they are present and metabolically active.
Abstract: BackgroundRotator cuff tendons heal to bone with interposed scar tissue, which makes repairs prone to failure. The purpose of this study was to determine if the application of bone marrow-derived mesenchymal stem cells (MSCs) can improve rotator cuff healing after repair.HypothesisApplication of MSCs to the repair site will result in superior results compared with controls on histologic and biomechanical testing.Study DesignControlled laboratory study.MethodsNinety-eight Lewis rats underwent unilateral detachment and repair of the supraspinatus tendon; 10 rats were used for MSC harvest. Eight animals were used for cell tracking with Ad-LacZ. The remaining animals received either 106 MSCs in a fibrin carrier, the carrier alone, or nothing at the repair site. Animals were sacrificed at 2 and 4 weeks for histologic analysis to determine the amount of fibrocartilage formation and the collagen organization at the insertion. Biomechanical testing was also performed.ResultsSpecimens treated with Ad-LacZ–transduc...
TL;DR: The repair technique described restores the ability of the medial meniscus to absorb hoop stress and eliminate joint-space narrowing, possibly decreasing the risk of degenerative disease.
Abstract: BackgroundAvulsion of the posterior horn attachment of the medial meniscus can compromise load-bearing ability, produce meniscus extrusion, and result in tibiofemoral joint-space narrowing, articular cartilage damage, and osteoarthritis.HypothesisAvulsion of the posterior horn of the medial meniscus will increase peak contact pressure and decrease contact area in the medial compartment of the knee, and posterior horn repair will restore contact area and peak contact pressures to values of the control knee.Study DesignControlled laboratory study.MethodsEight fresh-frozen human cadaveric knees had tibiofemoral peak contact pressures and contact area measured in the control state. The posterior horn of the medial meniscus was avulsed from its insertion and knees were retested. The meniscal avulsion was repaired by suture through a transosseous tunnel and the knees were tested a third time.ResultsAvulsion of the posterior horn attachment of the medial meniscus resulted in a significant increase in medial join...
TL;DR: The results suggest that reconstruction of theglenoid concavity might be necessary in shoulders with an anterior glenoid defect of at least 20% of the glenoids length.
Abstract: BackgroundThere have been few biomechanical studies to clarify which size of a glenoid defect is critical. However, those studies have assumed that the defect occurred anteroinferiorly. Recent studies have reported that the defect is located anteriorly rather than anteroinferiorly. Therefore, the effect of the anterior, not anteroinferior, glenoid defect on shoulder stability needs to be investigated.HypothesisThe anterior glenoid defect would have a similar effect on anterior shoulder stability as that of the anteroinferior glenoid defect.Study DesignControlled laboratory study.MethodsEight fresh-frozen cadaveric shoulders were used (mean age, 74 years). The specimen was attached to a shoulder-testing device with the arm in abduction and external rotation. An osseous defect was created stepwise with a 2-mm increment of the defect width. The stability ratio was used to evaluate joint stability. With a 50-N axial force, the translational force applied to the humeral head was measured by a force transducer....
TL;DR: Local delivery of platelet-rich plasma can shorten recovery time after a muscle strain injury in a small-animal model and may be a useful product in clinical treatment of muscle injuries.
Abstract: Background Standard nonoperative therapy for acute muscle strains usually involves short-term rest, ice, and nonsteroidal anti-inflammatory medications, but there is no clear consensus on how to accelerate recovery. Hypothesis Local delivery of platelet-rich plasma to injured muscles hastens recovery of function. Study design Controlled laboratory study. Methods In vivo, the tibialis anterior muscles of anesthetized Sprague-Dawley rats were injured by a single (large strain) lengthening contraction or multiple (small strain) lengthening contractions, both of which resulted in a significant injury. The tibialis anterior either was injected with platelet-rich plasma, was injected with platelet-poor plasma as a sham treatment, or received no treatment. Results Both injury protocols yielded a similar loss of force. The platelet-rich plasma only had a beneficial effect at 1 time point after the single contraction injury protocol. However, platelet-rich plasma had a beneficial effect at 2 time points after the multiple contraction injury protocol and resulted in a faster recovery time to full contractile function. The sham injections had no effect compared with no treatment. Conclusion Local delivery of platelet-rich plasma can shorten recovery time after a muscle strain injury in a small-animal model. Recovery of muscle from the high-repetition protocol has already been shown to require myogenesis, whereas recovery from a single strain does not. This difference in mechanism of recovery may explain why platelet-rich plasma was more effective in the high-repetition protocol, because platelet-rich plasma is rich in growth factors that can stimulate myogenesis. Clinical relevance Because autologous blood products are safe, platelet-rich plasma may be a useful product in clinical treatment of muscle injuries.
TL;DR: The incidence of glenohumeral instability in collegiate athletics is high, and it is affected by sex, sport, type of event, and mechanism of injury.
Abstract: BackgroundGlenohumeral instability is a common injury sustained by young athletes. Surprisingly, little is known regarding the incidence of glenohumeral instability in collegiate athletes or the relevant risk factors for injury. A better understanding of the populations most at risk may be used to develop preventive strategies.HypothesisThe incidence of glenohumeral instability in collegiate athletics is high, and it is affected by sex, sport, type of event, and mechanism of injury.Study DesignDescriptive epidemiologic study.MethodsThe National Collegiate Athletic Association injury database was queried for all glenohumeral instability events occurring between the years 1989 and 2004. An analysis of the injuries was performed by sport, activity (competition versus practice), sex, type of event (primary versus recurrent), mechanism of injury, and time loss from athletic performance. Incidence rates and incidence rate ratios were calculated.ResultsA total of 4080 glenohumeral instability events were documen...
TL;DR: At 4-month follow-up, eccentric loading alone was less effective when compared with a combination of eccentric loading and repetitive low-energy shock-wave treatment.
Abstract: BackgroundResults of a previous randomized controlled trial have shown comparable effectiveness of a standardized eccentric loading training and of repetitive low-energy shock-wave treatment (SWT) in patients suffering from chronic midportion Achilles tendinopathy. No randomized controlled trials have tested whether a combined approach might lead to even better results.PurposeTo compare the effectiveness of 2 management strategies—group 1: eccentric loading and group 2: eccentric loading plus repetitive low-energy shock-wave therapy.Study DesignRandomized controlled trial; Level of evidence, 1.MethodsSixty-eight patients with a chronic recalcitrant (>6 months) noninsertional Achilles tendinopathy were enrolled in a randomized controlled study. All patients had received unsuccessful management for >3 months, including at least (1) peritendinous local injections, (2) nonsteroidal anti-inflammatory drugs, and (3) physiotherapy. A computerized random-number generator was used to draw up an allocation schedule...
TL;DR: Patients with moderate to large chondral lesions with failed prior cartilage treatments can expect sustained and clinically meaningful improvement in pain and function after autologous chondrocyte implantation.
Abstract: BackgroundThis is a prospective clinical study to assess the effectiveness of autologous chondrocyte implantation in patients who failed prior treatments for articular cartilage defects of the knee.HypothesisAutologous chondrocyte implantation provides clinical benefit in patients with failed articular cartilage treatments.Study DesignCohort study; Level of evidence, 2.MethodsOne hundred fifty-four patients with failed treatment for articular cartilage defects of the knee received autologous chondrocyte implantation in a multicenter, prospective study. Follow-up was 48 months. Outcomes included change from baseline in knee function, knee pain, quality of life, and overall health. Duration of benefit after autologous chondrocyte implantation was compared with the failed prior non—autologous chondrocyte implantation procedure. Safety information was recorded. Additional analyses were performed on the 2 major cohorts of prior procedures entered into the study, marrow-stimulation technique or debridement alon...
TL;DR: Valgus torque at the elbow during baseball pitching is associated with 6 biomechanical variables of sequential body motion, and a condition of late trunk rotation, reduced shoulder external rotation, and increased elbow flexion appeared to be most closely related to valgUS torque.
Abstract: BackgroundStudies have shown that various biomechanical factors affect valgus extension overload during baseball pitching; yet, their relationships are not clearly defined, and factors such as trunk rotation and arm slot have not been investigated.HypothesisThe onset of trunk rotation, with other biomechanical variables that define sequential body motion, will significantly predict elbow valgus loading.Study DesignDescriptive laboratory study.MethodsSixty-nine adult baseball players pitched off an indoor mound during 3-dimensional motion analysis to measure whole body kinematics and kinetics at 240 Hz. Thirteen biomechanical variables were calculated and extracted for regression analysis to investigate their associations with elbow valgus load. A 2-way analysis of variance compared valgus torques between pitchers with 2 onsets of trunk rotation (before and after front-foot contact) and 2 arm slot positions (overhand and sidearm).ResultsSix biomechanical variables had significant correlations (P < .02) wit...
TL;DR: No clinical or MRI differences were seen between patients repaired with a SR or DR technique and at 1 year, there were no differences in any of the postoperative measures of motion or strength.
Abstract: BackgroundDouble-row arthroscopic rotator cuff repair has become more popular, and some studies have shown better footprint coverage and improved biomechanics of the repair.HypothesisDouble-row rotator cuff repair leads to superior cuff integrity and early clinical results compared with single-row repair.Study DesignRandomized controlled trial; Level of evidence, 1.MethodsForty patients were randomized to either single-row or double-row rotator cuff repair at the time of surgical intervention. Patients were followed with clinical measures (UCLA, Constant, WORC, SANE, ASES, as well as range of motion, internal rotation strength, and external rotation strength). Magnetic resonance imaging (MRI) studies were performed on each shoulder preoperatively, 6 weeks, 3 months, and 1 year after repair.ResultsMean anteroposterior tear size by MRI was 1.8 cm. A mean of 2.25 anchors for single row (SR) and 3.2 for double row (DR) were used. There were 2 retears at 1 year in each group. There were 2 additional cases that...
TL;DR: The loss of 3° to 5° of knee extension, to include loss of hyperextension, adversely affected the subjective and objective results after surgery, especially when coupled with meniscectomy and articular cartilage damage.
Abstract: BackgroundFew long-term studies exist that evaluate how the loss of normal knee range of motion affects results after anterior cruciate ligament reconstruction.HypothesisPatients with normal knee motion will have higher subjective scores than patients with less than normal motion.Study DesignCohort study; Level of evidence, 2.MethodsPatients were prospectively evaluated at > 10 years after anterior cruciate ligament reconstruction according to International Knee Documentation Committee criteria. Normal knee motion was within 2° of extension (including hyperextension) and 5° of flexion compared with the uninvolved knee. Regression analysis was performed to determine what factors affected subjective scores.ResultsObjective follow-up was obtained on 502 patients at a mean of 14.1 years postoperatively. Regression analysis showed that the most statistically significant factor related to lower subjective scores was lack of normal knee extension; loss of normal flexion was also significant. Patients who had men...
TL;DR: The data indicate that a high-risk zone can be used to identify noninjured players at high risk of future ACL rupture, and individual preventive efforts can be introduced in time.
Abstract: BackgroundA high percentage of female athletes who sustain an anterior cruciate ligament (ACL) rupture suffer serious long-term consequences such as osteoarthritis and disability. Thus, identification of risk factors has high clinical relevance in the prevention of ACL rupture.HypothesisNoninjured athletes with low knee flexor electromyography (EMG) preactivity and high knee extensor EMG preactivity during sidecutting are at increased risk of future ACL rupture.Study DesignCohort study (prognosis); Level of evidence, 2.MethodsFifty-five elite female athletes (team handball and soccer) aged 24 ± 5 years with no history of ACL injury were tested for EMG preactivity of vastus lateralis and medialis, rectus femoris, semitendinosus, and biceps femoris during a standardized side-cutting maneuver. The incidence of ACL ruptures was registered in the following 2 match seasons.ResultsDuring the subsequent 2 match seasons, 5 athletes sustained a confirmed noncontact ACL rupture. Before injury, all 5 players displaye...
TL;DR: The odds of a cartilage lesion in the adult knee increased by nearly 1% for each month that elapsed from the injury date until the surgery date and that of cartilage lesions were nearly twice as frequent if there was a meniscal tear, and vice versa.
Abstract: Results: Of a total of 3475 patients, there were 909 patients (26%) with cartilage lesions, 1638 patients (47%) with meniscal tears, and 527 patients (15%) with both cartilage and meniscal lesions. The odds of a cartilage lesion in the adult knee (>16 years) increased by 1.006 (95% confidence interval, 1.003-1.010) for each month that elapsed from injury to surgery. The cartilage in young adults (17-40 years) deteriorated further with an increase in odds of 1.03 (95% confidence interval, 1.02-1.05) related to the aging in years of the patient. The odds for meniscal tears in young adults increased by 1.004 (95% confidence interval, 1.002-1.006) for each month that elapsed since injury. The presence of 1 degenerative lesion increased the odds of having the other degenerative lesion by between 1.6 and 2.0 in all patient groups. Conclusion: The odds of a cartilage lesion in the adult knee increased by nearly 1% for each month that elapsed from the injury date until the surgery date and that of cartilage lesions were nearly twice as frequent if there was a meniscal tear, and vice versa.
TL;DR: A comprehensive quantitative review of the published English-language literature comparing the outcomes of tenotony and tenodesis for lesions of the tendon of the long head of the biceps brachii suggests that biceps tenotomy be the preferred method.
Abstract: BackgroundPrimary and secondary lesions of the tendon of the long head of the biceps brachii are common, with no clear consensus about their optimal management.HypothesisThere is no difference in outcomes of tenotomy and tenodesis for lesions of the tendon of the long head of the biceps brachii.Study DesignWe performed a comprehensive quantitative review of the published English-language literature comparing the outcomes of tenotony and tenodesis for lesions of the tendon of the long head of the biceps brachii.MethodsAll relevant articles in peer-reviewed journals were retrieved, and each article was scored using the Coleman Methodology Score, a highly repeatable methodology score, by 2 independent reviewers.ResultsScores were predominantly low for quality of the studies, with patient number and validated outcome measures being the weakest areas.ConclusionThere is a lack of quality evidence to advocate one technique over the other. We emphasize the need for appropriately powered, well-conducted, randomize...