The latest medical research on Sports Medicine
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Request AccessOsteochondritis Dissecans of the Capitellum: Influence of Activity on Lesion Location Within a Zone of Propensity.
Am J Sports MedThere may be an association between repetitive stress on the elbow and capitellar osteochondritis dissecans (COCD). The influence of activity on the characteristics or specific location of the lesion within a capitellar zone of propensity remains unclear.
The purpose of this study was to evaluate COCD in gymnasts and baseball players compared with a non-upper extremity (non-UE) sport COCD cohort. It was hypothesized that activity would influence presentation and lesion location and characteristics.
Cross-sectional study, Level of evidence, 3.
Consecutive patients presenting with COCD treated in a tertiary sports medicine practice between March 2006 and March 2021 were reviewed. Demographic and imaging lesion characteristics were recorded. The sagittal inclination angle position of the lesion center relative to the humeral shaft was recorded. Intra- and interrater reliability was confirmed (intraclass correlation coefficient, 0.808; intraclass correlation coefficient, 0.824, respectively). Participants were analyzed by activity.
A total of 126 elbows were identified: 68 in gymnasts, 31 in baseball players, and 27 in patients with no history of UE sports. The mean age of the participants was 12.5 years (range, 8-18 years). All (100%) unilateral cases of osteochondritis dissecans (OCD) in baseball players occurred in the dominant throwing arm, compared with less hand-dominance correlation in gymnasts (64%) and non-UE athletes (67%). Significantly, 14 of the 20 (70%) patients with bilateral OCD were gymnasts (P = .036). In non-UE athletes, lesions occurred at a mean sagittal inclination angle of 52.7° (±13.8°), with a mean lateral containment of 4.7 (±2.1) mm. In gymnasts, lesions occurred more posteriorly at 41.2° (±14.9°), with a lateral containment of 3.6 (±1.9) mm. In baseball players, COCDs occurred at 55.1° (±11.9°), with a lateral containment of 2.5 (±1.6) mm. These more posterior lesion positions in gymnasts (P = .001) and lesser lesion containment noted in gymnasts (P = .015) and baseball players (P < .001) were significant.
Compared with COCD lesions in adolescents with no history of UE sports, gymnastics participation (impact weightbearing) correlated with a higher rate of bilateral lesion formation and a more posterior (extended) lesion position. Baseball participation (resulting in valgus shear forces in the elbow) resulted in a sagittal position similar to non-UE lesions, but more lateral and with less containment.
Higher isokinetic quadriceps peak force is associated with a patient-acceptable symptom-state 1 and 3 years after ACL reconstruction.
Knee Surg Sports Traumatol ArthroscThe main purpose was to determine cut-off values for absolute (QNm/kg) and relative (QLSI) isokinetic knee extensor (KE) strength for achieving a patient-acceptable symptom state (PASS) in the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and for different age groups to determine the association between QNm/kg and QLSI and PASS, at 1 and 3 years after an anterior cruciate ligament reconstruction (ACLR).
Level III.
Results from 755 and 145 patients (females = 51% and 52%; preinjury Tegner Activity level ≥6 = 82% and 74%) were used in the 1- and 3-year follow-up analyses. Reaching the cut-off values for the QNm/kg, ranging between ≥2.1 and ≥2.7, entailed between 2.09 and 5.12 times the odds of achieving PASS, across all groups at the 1-year follow-up. At the 3-year follow-up, the cut-off values of ≥3.4 and ≥2.6QNm/kg were associated with patients achieving PASS with acceptable accuracy (AUC = 0.700-0.780) in 16-41 year-old males and females.
At 1 year after ACLR, patients of both sexes and age groups reaching cut-off values for absolute KE strength had two to five times the odds, that were clinically relevant, to achieve PASS. Acceptable discriminative capacity was found for the absolute KE strength among male and female patients 16-24 years old, at 3 years after ACLR.
High Variability of Lateral Extra-articular Tenodesis Femoral Tunnel Position With Landmark-Based Techniques.
Am J Sports MedThe utilization of lateral extra-articular tenodesis (LET) augmentation for anterior cruciate ligament reconstruction has increased. Various fixation points have been recommended based on tactile and anatomic landmarks; however, there is limited reporting of the accuracy or precision of these techniques in clinical practice.
The purpose of this study was to evaluate whether LET fixation points identified using anatomic landmarks and tactile techniques would fall within a predefined radiographic zone. It was hypothesized that the majority of LET fixation points would be inside the radiographic zone.
Cross-sectional study; Level of evidence, 4.
Postoperative lateral knee radiographs of patients who underwent anterior cruciate ligament reconstruction with LET using a landmark-based technique without fluoroscopy between January 2018 and September 2023 were reviewed. Fixation points were measured by 2 raters based on their distance from an extension of the posterior femoral cortex line (PFCL) distally and a line perpendicular to the PFCL at the posterior condylar flare (PCF). Patients were excluded if the tunnel position could not be identified or if postoperative radiographs were malrotated. The mean LET position and percentage of points within the radiographic isometric zone, defined as 4 ± 4 mm posterior and 4 ± 3 mm anterior to the PFCL and 6 ± 4 mm distal and 20 ± 5 mm proximal to the PCF were calculated.
Complete data sets were obtained for 47 cases. The mean LET position was 6.4 ± 7.1 mm (range, -9 to 27.3 mm) anterior to the PFCL and 1.8 ± 7.6 mm (range, -16.7 to 12.6 mm) proximal to the PCF. Overall, 53% of LET fixation points were within the predefined radiographic zone. Of the malpositioned tunnels (n = 22), their locations relative to the radiographic zone were anterior (n = 18), posterior (n = 2), proximal (n = 1), and anterior and distal (n = 1).
This study found large variation in the location of LET fixation points, and almost half of fixation points were outside the predefined radiographic zone. Accurate and precise tunnel placement is one of multiple factors that may be important to minimize the risk of lateral compartment overconstraint, anterior cruciate ligament graft failure, and anisometry leading to LET graft loosening.
Kartogenin-Loaded Exosomes Derived From Bone Marrow Mesenchymal Stem Cells Enhance Chondrogenesis and Expedite Tendon Enthesis Healing in a Rat Model of Rotator Cuff Injury.
Am J Sports MedThe insufficient regeneration of fibrocartilage at the tendon enthesis is the primary cause of retearing after surgical reattachment of the rotator cuff. Exosomes derived from bone marrow-derived mesenchymal stem cells (BMSC-Exos) and kartogenin (KGN) have been demonstrated to induce fibrocartilage formation. Loading drugs into exosomes may lead to a synergistic effect, significantly enhancing the inherent activity of both components. However, further investigation is necessary to determine whether loading KGN into BMSC-Exos could yield superior efficacy in promoting tendon enthesis healing.
To study the effect and mechanism of KGN-loaded BMSC-Exos (Kl-BMSC-Exos) on tendon enthesis repair and biomechanical properties in a rat rotator cuff injury (RCI) model.
Controlled laboratory study.
The characteristics and in vivo retention of exosomes were demonstrated using nanoflow cytometry, transmission electron microscopy, and in vivo imaging of a small animal. The differentiation markers of BMSCs were assessed through quantitative polymerase chain reaction and immunofluorescence assays. Unilateral supraspinatus tenotomy and repair were performed in rats to establish the RCI model. Gelatin sponges were utilized to contain and deliver exosomes. In total, 44 rats were randomly assigned to 4 groups: sham, RCI, BMSC-Exos, and Kl-BMSC-Exos. Tendon enthesis regeneration and biomechanical properties were evaluated 8 weeks after surgery. RNA sequencing of BMSCs was performed to elucidate the underlying mechanism through which Kl-BMSC-Exos enhance tendon enthesis healing.
No discernible disparities in fundamental characteristics were evident between BMSC-Exos and Kl-BMSC-Exos. Incorporating exosomes into a gelatin sponge extended the in vivo retention time from 7 to 14 days. Kl-BMSC-Exos were more effective in inducing differentiation markers of BMSCs, improving fibrocartilage regeneration, organizing collagen fiber arrangement, and enhancing the biomechanical properties of tendon enthesis. Furthermore, transcriptomics suggested that Mospd1 was involved in Kl-BMSC-Exos-mediated tendon enthesis healing by enhancing fibrocartilage regeneration.
The incorporation of exosomes into a gelatin sponge significantly enhances their in vivo retention time. Kl-BMSC-Exos can expedite the healing of RCI by enhancing chondrogenesis and fibrocartilage regeneration, providing more organized collagen fiber arrangement and superior biomechanical properties of the rotator cuff enthesis. The promotion of rotator cuff enthesis regeneration may contribute to enhancing the chondrogenic potential in BMSCs through Kl-BMSC-Exos-mediated upregulation of Mospd1.
As a cell-free therapeutic approach, Kl-BMSC-Exos displayed a better therapeutic effect on tendon enthesis healing than BMSC-Exos did, and these can be used as a biologic augmentation to enhance the healing of rotator cuff enthesis.
Sex-Differences in Characteristics and Factors Associated With New Running-Related Injuries Among Recreational Runners.
Scandinavian J Med Sci SportsPrevious findings of sex-differences in type, location, consequences, and risk factors of running-related injuries (RRIs) are contradictory. We aim...
Association of cardiorespiratory fitness with dementia risk across different levels of genetic predisposition: a large community-based longitudinal study.
Brit J Sports MedWe aimed to investigate the association of cardiorespiratory fitness (CRF) with cognitive function and dementia risk, taking genetic predisposition for dementia into account.
Within the UK Biobank, 61 214 dementia-free participants aged 39-70 years were followed for up to 12 years. CRF score was estimated using a 6 min submaximal exercise test on a stationary bike and divided into tertiles (ie, low, moderate, and high; standardised by age and sex). Global cognitive function was evaluated at baseline. Dementia was identified based on medical history and medical records. Genetic predisposition for dementia was estimated using the polygenic risk score for Alzheimer's disease (PRSAD), tertiled as low, moderate, or high. Data were analysed using linear regression, Poisson regression, and Laplace regression.
Compared with low CRF, high CRF was related to better global cognitive function (β=0.05, 95% CI 0.04 to 0.07). Over the follow-up period, 553 individuals developed dementia. Compared with low CRF, the incidence rate ratio (IRR) of all dementia was 0.60 (95% CI 0.48 to 0.76) for high CRF, and the onset of all dementia was delayed by 1.48 (95% CI 0.58 to 2.39) years among people with high versus low CRF. Among people with a moderate/high polygenic risk score, high CRF attenuated all dementia risk by 35% (IRR 0.65, 95% CI 0.52 to 0.83).
High CRF is associated with better cognitive performance at baseline, and lower dementia risk long-term. High CRF could mitigate the impact of genetic predisposition on the development of dementia by 35%.
Anatomic Risk Factors for Initial and Secondary Noncontact Anterior Cruciate Ligament Injury: A Prospective Cohort Study in 880 Female Elite Handball and Soccer Players.
Am J Sports MedAnterior cruciate ligament (ACL) injury is one of the most severe injuries for athletes. It is important to identify risk factors because a better understanding of injury causation can help inform athletes about risk and increase their understanding of and motivation for injury prevention.
To investigate the relationship between anatomic factors and risk for future noncontact ACL injuries.
Cohort study; Level of evidence, 2.
A total of 870, excluding 9 players with a new contact ACL injury and a player with a new noncontact ACL injury just before the testing, female elite handball and soccer players-86 of whom had a history of ACL injury-underwent measurements of anthropometrics, alignment, joint laxity, and mobility, including leg length, knee alignment, knee anteroposterior laxity, generalized joint hypermobility, genu recurvatum, and hip anteversion. All ACL injuries among the tested players were recorded prospectively. Welch t tests and chi-square tests were used for comparison between the groups (new injury group, which sustained a new ACL injury in the follow-up period, and no new injury group).
An overall 64 new noncontact ACL injuries were registered. No differences were found between athletes with and without a new ACL injury among most of the measured variables. However, static knee valgus was significantly higher in the new injury group than in the no new injury group among all players (mean difference [MD], 0.9°; P = .007), and this tendency was greater in players with a previous ACL injury (MD, 2.1°; P = .002). Players with secondary injury also had a higher degree of knee hyperextension when compared with those previously injured who did not have a secondary injury (MD, 1.6°; P = .007).
The anatomic factors that we investigated had a weak or no association with risk for an index noncontact ACL injury. Increased static knee valgus was associated with an increased risk for noncontact ACL injury, in particular for secondary injury. Furthermore, hyperextension of the knee was a risk factor for secondary ACL injury.
Total knee arthroplasty: The need for better patient selection.
Knee Surg Sports Traumatol ArthroscTotal knee arthroplasty (TKA) is a widely performed surgical intervention designed to relieve pain and restore function in patients with severe kne...
Adapting the Dejour classification of trochlear dysplasia from qualitative radiograph- and CT-based assessments to quantitative MRI-based measurements.
Knee Surg Sports Traumatol ArthroscTo adapt the current D. Dejour trochlear dysplasia classification (v2.0) to only rely on quantitative magnetic resonance imaging (MRI) measurements (v3.0) to maximize objectivity and repeatability.
Level III.
The regression tree models produced thresholds of ≥157° for sulcus angle and <14° for LTI to distinguish OPI from controls. 'Sulcus angle ≥157° OR LTI < 14°' yielded the highest sensitivity (87%) to diagnose OPI. The quantitative MRI classification was sulcus angle <157° AND LTI ≥ 14° for Type 0 (No dysplasia); (sulcus angle ≥ 157° OR LTI < 14°) AND central bump <5 mm for Type 1 (Low-grade dysplasia); (sulcus angle OR LTI are 'unmeasurable') AND central bump <5 mm for Type 2 (Moderate-grade dysplasia); (sulcus angle ≥ 157° OR 'unmeasurable' OR LTI < 14° OR 'unmeasurable') AND central bump ≥5 mm for Type 3 (High-grade dysplasia).
This MRI classification depends exclusively on quantitative measurements, has excellent interobserver agreement, and yields high sensitivity to diagnose OPI. The MRI imaging protocol with MPR mode and standardized measurements could be quickly adopted and correctly applied by clinicians worldwide in any type of institution to determine the ideal treatment plan.
Sling Results in Better Sleep Quality and Less Anxiety Early After Arthroscopic Rotator Cuff Repair: A Randomized Single-Blinded Trial.
Am J Sports MedSleep disturbance is commonly reported by patients wearing an abduction brace after arthroscopic rotator cuff repair (ARCR). Although a sling has been proven noninferior to an abduction brace for function and repair integrity, there is no evidence-based medical support for the advantage of the sling in improving sleep quality compared with a brace.
This study aimed to compare the effects of a sling and an abduction brace on sleep quality and clinical outcomes after ARCR. It was hypothesized that immobilization in a sling would result in better sleep quality while not deteriorating clinical outcomes and bone-tendon healing compared with an abduction brace.
Randomized controlled trial; Level of evidence, 1.
A total of 142 consecutive patients with rotator cuff tears were randomly assigned to 2 groups: (1) the brace group, receiving abduction brace immobilization for 6 weeks, and (2) the sling group, receiving sling immobilization after ARCR for 6 weeks. The primary outcome was the Pittsburgh Sleep Quality Index at 6 weeks postoperatively. Secondary outcomes-American Shoulder and Elbow Surgeons score, Self-rating Anxiety Scale, pain, satisfaction, and tendon healing (using ultrasonography)-were evaluated until 1 year postoperatively.
Complete outcome measurements were obtained for 131 patients. The Pittsburgh Sleep Quality Index at 6 weeks was 11.1 ± 2.7 for the brace group and 9.2 ± 2.3 for the sling group (P < .001), indicating a statistically significant advantage for the sling group. The sling group also reported significantly lower Self-rating Anxiety Scale, lower pain level, and higher satisfaction scores at 6 weeks. No significant difference was observed in outcome measures between groups at 1 year. The tendon healing rates (91% vs 88%, respectively) were comparable between the brace and sling groups within the first 1 year (risk ratio, 1.03 [95% CI, 0.92-1.16]; P = .59).
The use of a sling resulted in better sleep quality, less anxiety, and higher satisfaction compared with an abduction brace in the first 6 weeks after ARCR; nevertheless, functional outcomes and repair integrity were similar at 1 year postoperatively between the 2 groups. These findings indicate that a sling is appropriate for the postoperative care of ARCR. However, caution should be used when interpreting these results because the clinical relevance of sling-related benefits warrants further investigation.
ChiCTR2200059967 (Chinese Clinical Trial Registry).
Exploring Peak Concentric Force and Zero Velocity Synchronization in the Drop Jump.
Scandinavian J Med Sci SportsThe application of force is a key aspect of performance during athletic activities. In jumping, the timing and magnitude of force application are i...
Treatment and Early Outcomes of Capitellar Osteochondritis Dissecans.
Am J Sports MedTreatment for osteochondritis dissecans (OCD) of the humeral capitellum has been predominantly guided by fragment stability and articular cartilage integrity. Nonoperative management is recommended for stable lesions, whereas surgical intervention is indicated for unstable lesions and those that fail nonoperative care. Several surgical options may be considered, although limited information is available regarding indications for specific surgical techniques and comparative postoperative results.
To assess surgical outcomes of patients with capitellar OCD treated according to a decision-making approach focused on subchondral bone involvement.
Cohort study; Level of evidence, 3.
Patients diagnosed with capitellar OCD at a tertiary academic center were enrolled in a prospective longitudinal cohort study. Patient information was collected at the time of enrollment, and OCD lesions were classified according to the Nelson grade. Clinical and radiologic data were collected both pre- and postoperatively for those undergoing surgical treatment. Surgical procedures were performed based on an evolving treatment framework that included considerations specifically for lesion containment and depth of subchondral bone disease. Timmerman scores were obtained to assess patient functional outcomes.
A total of 154 patients were prospectively enrolled, 19 of whom had bilateral disease. The mean age at presentation was 13.7 years; 39% were gymnasts and 28.5% were primary baseball or softball athletes. Surgery was performed on 145 elbows, including 43 drilling/microfracture procedures, 21 internal fixations, and 63 autologous osteochondral grafting (OG) procedures. Clinically, there were significant improvements in pain, elbow motion, and mechanical symptoms. Timmerman scores significantly improved after each type of surgical procedure. A total of 76% of patients returned to their primary sport. When stratified by the Nelson grade, patients with OG had lower revision surgery rates than those treated with drilling/microfracture and fixation. Furthermore, for Nelson grade 2 lesions, patients treated with OG had significantly better postoperative elbow motion and higher Timmerman scores compared with those treated with other procedures.
Using a treatment framework incorporating lesion containment and depth of subchondral bone disease, surgery for capitellar OCD provides clinical, radiologic, and functional improvements. Patients treated with OG may have lower revision rates and better functional outcomes compared with those treated with other surgical techniques, with OG warranting consideration even for lower-grade OCD lesions.
