Tag: pubmed

Arthrosc Sports Med Rehabil. 2024 Sep 19;7(1):101005. doi: 10.1016/j.asmr.2024.101005. eCollection 2025 Feb.

ABSTRACT

PURPOSE: To determine if there is a significant difference using femoral heads (FHs) as an anatomic horizon when measuring the lateral center-edge angle (LCEA) compared to floor, acetabular teardrops, and ischial tuberosities (ITs) and to determine their accuracy by comparing to a computed tomography (CT) scan with commercially available software.

METHODS: Between June 2019 and May 2020, patients with preoperative supine anteroposterior pelvis radiographs and CT scans were included and retrospectively analyzed. The LCEA was measured on all preoperative supine anteroposterior pelvis radiographs 4 times per hip, using the 4 methods. The 4 anatomic horizons used to measure LCEA were compared to each other to determine statistically significant difference. The LCEA measured in the CT scan at the 12-o’clock position was used to compare and determine radiographs’ LCEA accuracy.

RESULTS: Ninety-six patients (100 hips) met the inclusion criteria. Sixty-two were women (65%), and the mean age was 35.2 ± 15 years. The mean value for LCEA in CT was 32.2 and 31.1 for the 4 anatomic horizons on x-ray (P < .001). The lowest mean difference between CT scan and x-ray was obtained using the FHs (2.3 ± 2.4). Less mean difference was obtained between FHs and ITs (1.0 ± 0.8).

CONCLUSIONS: In this study, radiographic measurements underestimated LCEA compared with those from CT scans. Using the FHs as an anatomic horizon on radiographs was a more accurate method to measure LCEA than using acetabular teardrops, ITs, or floor. While this difference is statistically significant, it is not likely to be clinically significant.

CLINICAL RELEVANCE: Assessment of acetabular coverage is an essential aspect of diagnosing and managing hip pathologies. One of the methods used for this is the LCEA measurement, which is based on a radiographic analysis of the hip joint. It is important to compare the measurements using different horizons and increasingly sophisticated imaging modalities to provide the most accurate information to guide clinical decision making.

PMID:40041846 | PMC:PMC11873461 | DOI:10.1016/j.asmr.2024.101005

Arthrosc Sports Med Rehabil. 2024 Oct 9;7(1):101020. doi: 10.1016/j.asmr.2024.101020. eCollection 2025 Feb.

ABSTRACT

PURPOSE: To conduct a comprehensive analysis of public Instagram posts pertaining to the Latarjet procedure and Bankart repair with the aim of elucidating patients’ perspectives on the perioperative process, satisfaction, and expectations.

METHODS: We performed a descriptive social media-based investigation using relevant hashtags associated with surgical treatment of anterior shoulder instability, covering the period from January 2023 until January 2024. Posts were categorized by perspective, timing, content, tone, and satisfaction.

RESULTS: A total of 2,395 posts were retrieved, with 526 posts concerning surgical treatment of shoulder instability. Of the posts, 201 (37.9%) were authored by patients and 224 (42.3%) portrayed personal content and patient experience. Most were neutral (308; 58.1%) or positive (203; 38.3%) in tone. Rehabilitation was mentioned frequently by patients undergoing both procedures (49.2% of Bankart posts and 45.6% of Latarjet posts). Comparative analysis revealed no statistically significant differences regarding immobilization (P = .229), rehabilitation (P = .226), return to sport (P = .464), tone (P = .236), or expression of satisfaction (P = .826) between the 2 procedures. However, patients treated with the Latarjet procedure mentioned surgical site more frequently (P = .011). There were no differences in mentions of complications (P = .143). Complications were mentioned in 18 Bankart posts (9.6%), most commonly recurrence, and in 10 Latarjet posts (5.3%), in which the most mentioned complication was pain.

CONCLUSIONS: Social media posts reflect mostly a neutral or positive patient experience in the surgical treatment of anterior instability. Bankart and Latarjet posts exhibit no differences regarding satisfaction, tone, return to work, or return to activities of daily living. Mentions of complications are rare. The most frequent complication mentioned in Bankart posts is recurrence, whereas that in Latarjet posts is postoperative pain.

CLINICAL RELEVANCE: This analysis explores the relevance of social media as an instrument to gain insight into patients’ perceptions of surgical interventions for anterior shoulder instability.

PMID:40041843 | PMC:PMC11873532 | DOI:10.1016/j.asmr.2024.101020

Arthrosc Sports Med Rehabil. 2024 Jul 17;7(1):100979. doi: 10.1016/j.asmr.2024.100979. eCollection 2025 Feb.

ABSTRACT

PURPOSE: To use a publicly available Major League Baseball (MLB) game video to investigate whether pitch type and pitching elbow angle at peak valgus stress and at release point are associated with the odds of undergoing Tommy John surgery.

METHODS: This case-control study compared pitchers who had undergone ulnar collateral ligament reconstruction to a matched control group of pitchers who had not undergone the surgery. Pitchers were selected based on inclusion in online baseball player and injury databases, including the MLB Health and Injury Tracking System, with those pitching fewer than 10 innings in MLB excluded. The experimental group included measurements from all pitchers before their ulnar collateral ligament injury who eventually had undergone Tommy John surgery since 2010. Greedy matching algorithm was used to select a matched cohort of pitchers based on age, height, weight, years in the MLB, hand dominance, pitching role (starter vs reliever), and average pitching velocity. Conditional logistic regression models were used to measure the association between pitch angle and log odds of receiving a Tommy John surgery.

RESULTS: There were 249 paired cases and controls (N = 498) included in the conditional logistic regression analysis. There was no statistically significant association between average elbow angle at peak valgus stress and the odds of undergoing Tommy John surgery (odds ratio, 1.02; 95% confidence interval, 0.99-1.03; P = .14).

CONCLUSIONS: Peak valgus elbow angle, release point angles, and combinations of angles and specific pitches were not associated with an increased risk of undergoing Tommy John surgery.

LEVEL OF EVIDENCE: Level III, observational study, case-control design.

PMID:40041841 | PMC:PMC11873486 | DOI:10.1016/j.asmr.2024.100979

Arthrosc Sports Med Rehabil. 2024 Sep 10;7(1):100998. doi: 10.1016/j.asmr.2024.100998. eCollection 2025 Feb.

ABSTRACT

PURPOSE: To analyze a series of cases with and without medial meniscal posterior root tears (MMPRTs) to determine whether varus alignment and increased sagittal medial tibial slope (MTS) are risk factors for MMPRTs.

METHODS: The study evaluated 2 groups of patients: The tear group included patients with arthroscopically confirmed MMPRTs, and the no-tear group consisted of control patients matched to the tear group who underwent similar imaging but did not have meniscal root tears. Age, sex, side of injury, and body mass index were recorded for all cases. Preoperative joint space height and Kellgren-Lawrence grade were measured on radiographs. Group matching was performed based on demographic factors (age, sex, and body mass index), joint space height, and Kellgren-Lawrence grade. Mechanical axis measurements were determined from full-limb-length radiographs. MTS was analyzed on preoperative magnetic resonance imaging. Two observers performed the measurements on 2 separate occasions, and intraobserver reliability and interobserver reliability were analyzed using the intraclass correlation coefficient (ICC). Multivariate regression analysis was performed to identify potential risk factors associated with MMPRTs.

RESULTS: Of the 142 matched patients included, 76 had root tears (tear group) and 66 did not (no-tear group). Both mechanical axis (183.2° ± 3.2° vs 181.2° ± 2.3°) and MTS (4° ± 1.9° vs 2.4° ± 2.5°) measurements were significantly greater in the tear group (P < .01 for each). However, despite the statistical significance, the small degrees of difference between the groups raises questions about the clinical significance. The intraobserver ICCs were 0.98 and 0.99 for mechanical axis and 0.87 and 0.98 for MTS. The interobserver ICCs showed excellent reliability for mechanical axis (0.95) and good reliability for MTS (0.77). The lower intraobserver and interobserver reliabilities for MTS measurements also suggest a higher likelihood of error. The multivariate logistic regression model indicated that the risk of sustaining an MMPRT increased with varus alignment (odds ratio, 1.268; 95% confidence interval, 1.104-1.478; P = .001) and increased MTS (odds ratio, 1.364; 95% confidence interval, 1.137-1.677; P = .002).

CONCLUSIONS: In this study, MMPRTs were associated with varus alignment and steeper MTS. However, the clinical significance of these associations may be limited owing to the small differences between the groups.

LEVEL OF EVIDENCE: Level III, retrospective case-control study.

PMID:40041827 | PMC:PMC11873484 | DOI:10.1016/j.asmr.2024.100998

Arthrosc Sports Med Rehabil. 2024 Sep 26;7(1):101011. doi: 10.1016/j.asmr.2024.101011. eCollection 2025 Feb.

ABSTRACT

PURPOSE: To determine the safest screw length that will avoid penetrating the femoral physis for surgical fixation of juvenile osteochondritis dissecans lesions and to compare the safe screw lengths for different regions in the condyles.

METHODS: After institutional review board approval, we retrospectively reviewed T1-weighted magnetic resonance images of pediatric patients. Longitudinal axis reference lines were made on the femur. Lines were then placed at 45° anterior and posterior to this axis to simulate screw start points. From these points, we measured the shortest distance from the articular surface to the physis, noting the shortest distances. These measurements simulated screw lengths in the anterior, posterior, and central regions on both the medial and lateral condyle. Statistical analysis was performed to determine the 95% confidence interval for all measurements. Analysis of variance was performed to compare different regions.

RESULTS: A total of 97 knee magnetic resonance images from patients aged 6 to 17 years were reviewed. The safe screw lengths among all samples were 14.1 mm, 20.9 mm, 18.2 mm, 14.4 mm, 17.5 mm, and 14.1 mm for the anteromedial, central medial, posteromedial, anterolateral, central lateral, and posterolateral regions, respectively. There was a difference in simulated screw lengths among all 6 groups (P < .001). There was a moderate correlation between increasing age of the patient and increasing screw length (r = .397, P < .001).

CONCLUSIONS: While a screw length of 14 mm appears to be safe in all ages and regions of the distal femur, safe screw length varies based on age and location of the lesion. The posteromedial region has a safe length of 18 mm.

CLINICAL RELEVANCE: Surgeons must respect the physis when repairing knee osteochondritis dissecans lesions in pediatric patients. Fluoroscopic confirmation should be used to confirm safe screw lengths, and surgeons should use caution when using screws longer than 14 mm (or 18 mm posteromedially), particularly in younger patients.

PMID:40041824 | PMC:PMC11873472 | DOI:10.1016/j.asmr.2024.101011

Arthrosc Sports Med Rehabil. 2024 Sep 17;7(1):100997. doi: 10.1016/j.asmr.2024.100997. eCollection 2025 Feb.

ABSTRACT

PURPOSE: To compare the clinical outcomes of rotator cuff repair using a double-row modified Mason-Allen stitch (DR-MA) with those repaired with a double-row suture bridge (DR-SB).

METHODS: A retrospective case-control matching study was conducted to compare the results of patients who received complete supraspinatus tendon repair using a DR-MA configuration and a DR-SB pattern between 2009 and 2020. Exact matching was performed for patients with intact rotator cuff repair at postoperative magnetic resonance imaging. The matching criteria included sex, workers’ compensation, smoking status, hyperlipidemia, size and retraction of tear, and acromioplasty. Clinical outcomes, including visual analog scale (VAS), American Shoulder and Elbow Surgeon (ASES) score, and active shoulder forward flexion (FF), were documented at the 2-year follow-up. The percentage of patients who achieved minimum clinically important difference (MCID) was reported.

RESULTS: A total of 64 patients, including 28 men and 36 women, were matched, and the 2-year follow-up rate was 100%. All patients received postoperative magnetic resonance imaging at 19 ± 11 months. Significant improvement in all clinical outcomes was observed, regardless of the repair pattern (P < .001). The 2-year VAS was better in the DR-MA group compared to the DR-SB group (1.5 ± 2.0 and 2.9 ± 2.6, respectively; P = .009). At the 2-year follow-up, 91%, 90%, and 63% of patients in the DR-MA group achieved MCID in VAS, ASES, and FF, respectively. There was no difference in the proportion of patients achieving MCID between the 2 treatment arms. However, a more substantial improvement in VAS (P = .008), ASES (P = .014), and FF (P = .039) between preoperation and the 2-year follow-up was noted in the DR-MA group.

CONCLUSIONS: No clinical differences in pain or function were found between DR-MA and DR-SB despite small and statistically significant differences in favor of DR-MA.

LEVEL OF EVIDENCE: Level III, retrospective cohort study.

PMID:40041822 | PMC:PMC11873470 | DOI:10.1016/j.asmr.2024.100997

Arthrosc Sports Med Rehabil. 2024 Sep 27;7(1):101014. doi: 10.1016/j.asmr.2024.101014. eCollection 2025 Feb.

ABSTRACT

PURPOSE: To analyze the etiology, diagnosis, and incidence of head and neck (HN) injuries among ocean surfers.

METHODS: The National Electronic Injury Surveillance System database was queried for surfing HN injuries presenting to United States emergency departments (EDs) between January 2003 and December 2022. Date of presentation, age, sex, race, injured body part, injury diagnosis, and disposition, as well as a brief injury narrative, were included in the data. National estimates (NEs) were calculated using the associated statistical weight of the reporting hospital.

RESULTS: A total of 1,359 surfing-related HN injuries (NE, 90,872) were included in this study. The average age at presentation was 29.2 ± 13.8 years (range, 3 to 81 years). The most commonly specified mechanisms of injury were impact with board (NE, 48,360 [53%]) and impact with ocean floor (NE, 8,690 [10%]). Concussions represented 5% of surfing HN injuries and occurred at a higher rate (8%) in the age group younger than 20 years. There were statistically significant decreases in overall HN injuries (P < .01) (coefficient, -270; 95% confidence interval [CI], -355 to -206), lacerations (P < .01) (coefficient, -208; 95% CI, -258 to -158), and impact-with-board injuries (P < .01) (coefficient, -177; 95% CI, -327 to -117) presenting to United States EDs from 2003 to 2022.

CONCLUSIONS: Although surfing HN injury ED presentations decreased from 2003 to 2022, the rate of surfing-related concussions presenting to EDs remained steady. Concussions therefore remain a significant concern in surfing, especially among surfers under 20 years of age.

CLINICAL RELEVANCE: As the sport of surfing has increased in popularity, it is important to understand the range of surfing injuries seen in EDs. HN injuries, especially concussions, should be thoroughly investigated to better understand the risks of ocean surfing, to advise athletes, and to develop effective injury prevention strategies.

PMID:40041821 | PMC:PMC11873521 | DOI:10.1016/j.asmr.2024.101014

Arthrosc Sports Med Rehabil. 2024 Sep 26;7(1):101010. doi: 10.1016/j.asmr.2024.101010. eCollection 2025 Feb.

ABSTRACT

PURPOSE: To examine a method to visualize a 3-dimensional (3D) rendered distal femur using 3D curvature analysis and to compare models of patellofemoral instability (PFI) with controls to study the reliability of the entry point to trochlear groove angle (EPTG) metric.

METHODS: The 3D models of patients with recurrent patellar instability, defined by at least 2 reported patellar dislocation events, and age- and sex-matched controls were created from computed tomography scans. Curvature was calculated to highlight the proximal trochlear ridges and the trochlear groove by overlaying them on the 3D models. Anteroposterior views with and without curvature visualization were created and used for qualitative comparison and to measure the EPTG. The EPTG was measured by 2 raters with and without the aid of the curvature maps. Significant differences between patients with PFI and controls were compared with a Mann-Whitney U test. Inter-rater reliability was calculated using interclass correlation coefficients, classified according to literature and compared using a permutation test. Significance was assumed at .05.

RESULTS: Qualitive analysis between 30 PFI patient knees (age: 23.9 ± 8.4 years, female/male: 24/6) and 30 control knees (age: 21.8 ± 5.6 years, female/male: 22/8) showed that in general, patients with PFI have a lateralized medial ridge and trochlear groove, with the trochlear groove being shorter and shallower. Qualitatively, differences between patients with PFI and controls were significant for measurements both with and without the aid of the curvature maps. Inter-rater reliability was significantly (P = .0349) better when using the curvature visualization.

CONCLUSIONS: Curvature-based visualization aids overlain on a 3D model have the power to increase the information gained from 3D imaging and corresponding 3D models, amplifying their potential value in clinical decision-making. Such visualizations facilitate both the identification of qualitative differences between patient and control morphology and improve the reliability of the EPTG trochlear dysplasia metric.

LEVEL OF EVIDENCE: Level III, retrospective cohort study.

PMID:40041820 | PMC:PMC11873473 | DOI:10.1016/j.asmr.2024.101010

Arthrosc Sports Med Rehabil. 2024 Oct 15;7(1):101008. doi: 10.1016/j.asmr.2024.101008. eCollection 2025 Feb.

ABSTRACT

PURPOSE: To investigate the changes in minimum joint space width (mJSW) caused by superficial medial collateral ligament (sMCL) transection during open-wedge high tibial osteotomy (OWHTO).

METHODS: This study included consecutive patients with a diagnosis of medial unicompartmental knee osteoarthritis who were scheduled for OWHTO between September 2020 and August 2022. Intraoperative fluoroscopic evaluations of mJSW were performed under neutral, valgus stress, and varus stress positions in knee extension and 20° of flexion before sMCL transection, after transection, and after plate fixation. Changes in mJSW and increases in valgus stress were calculated and compared using analysis of variance. Linear regression analysis was performed to investigate the related factors for increased mJSW after transection.

RESULTS: We included 44 knees in 43 patients in the final statistical analysis. The maximum mJSW occurred during valgus stress after sMCL transection at 20° of flexion and returned to baseline after plate fixation. Under the valgus stress condition, mean mJSW before transection was 5.1 ± 0.9 mm in extension and 5.5 ± 1.1 mm at 20° of flexion. It increased significantly after transection to 7.8 ± 1.4 mm (P < .001) and 9.2 ± 2.1 mm (P < .001), respectively. Regression analysis showed that increased mJSW after transection in extension positively correlated with the knee extension angle (P = .032). Overall, mJSW increased with sMCL transection regardless of the preoperative condition.

CONCLUSIONS: Transection of the sMCL in OWHTO effectively enlarged the mJSW to 9.2 mm, which was 3.8 mm greater than that before transection, facilitating medial meniscal procedures. After plate fixation, the mJSW returned to pre-transection levels.

LEVEL OF EVIDENCE: Level Ⅳ, therapeutic case series.

PMID:40041818 | PMC:PMC11873491 | DOI:10.1016/j.asmr.2024.101008

J Orthop. 2025 Feb 7;68:96-104. doi: 10.1016/j.jor.2025.01.039. eCollection 2025 Oct.

ABSTRACT

PURPOSE: Computer-assisted technology offers better component alignment and surgical precision than conventional TKA. However, whether robotic-assisted total knee arthroplasty (RA-TKA) shows clear benefits over navigation-assisted total knee arthroplasty (NA-TKA) is still contentious. Therefore, we aimed to perform a meta-analysis exploring the accuracy and safety of RA-TKA compared to NA-TKA in patients with knee osteoarthritis.

METHODS: We systematically searched PubMed, Scopus, Web of Science, and Cochrane Library for studies comparing RA-TKA with NA-TKA. We assessed radiological alignment outliers, polyethylene (PE) insert thickness, surgical time, and safety outcomes. Statistical analyses were performed using RevMan Web. Odds ratios (ORs) and mean differences (MDs) with 95 % confidence intervals (CIs) were pooled for dichotomous and continuous endpoints, respectively. A random-effects model was used due to anticipated heterogeneity and measured with the I² test.

RESULTS: We included 19,209 patients from sixteen studies, of whom 3764 (19.6 %) were assigned to the RA-TKA. We found no statistically significant difference between RA-TKA and NA-TKA in terms of hip-knee-ankle angle outliers (OR 0.91; 95 % CI 0.56 to 1.48; p = 0.71; I² = 25 %), femoral coronal angle outliers (OR 0.46; 95 % CI 0.16 to 1.38; p = 0.17; I² = 60 %), tibial coronal angle outliers (OR 0.51; 95 % CI 0.13 to 2.08; p = 0.09; I² = 58 %), periprosthetic joint infection (OR 0.76; 95 % CI 0.27 to 2.15; p = 0.61; I² = 0 %), and length of stay MD -0.17 days; 95 % CI -1.08 to 0.74; p = 0.72; I² = 98 %). RA-TKA used 1.03 mm thinner PE inserts compared with NA-TKA (MD -1.03 mm; 95 % CI -1.60 to -0.46; p = 0.71; I² = 98 %), whereas surgical time was 9.87 min shorter with NA-TKA (MD 9.87 min; 95 % CI 0.62 to 19.11; p = 0.04; I² = 99 %).

CONCLUSIONS: RA-TKA and NA-TKA had comparable radiological alignment. While RA-TKA allows for thinner polyethylene inserts, it requires longer surgical time than NA-TKA. These findings suggest that both techniques are adequate, with specific differences that may influence surgical decision-making.

PMID:40041811 | PMC:PMC11875737 | DOI:10.1016/j.jor.2025.01.039