American Journal of Sports Medicine

BACKGROUND: Dorsiflexion closing wedge metatarsal osteotomy (DCWMO) has been considered the traditional treatment of Freiberg disease. Several case reports presented osteochondral autologous transplantation (OAT) as an alternative treatment. PURPOSE/HYPOTHESIS: The purpose was to compare the results of DCWMO versus OAT for the treatment of Freiberg infraction in an athletic population. It was hypothesized that OAT was superior to DCWMO regarding functional outcomes, pain, and the time that the athletes returned to training and to previous sport level...

BACKGROUND: Few studies have examined morphological findings from preoperative magnetic resonance imaging (MRI) and arthroscopic findings as prognostic factors for outcomes 1 and 2 years after arthroscopic partial meniscectomy (APM). PURPOSE/HYPOTHESIS: The purpose was to evaluate prognostic factors of preoperative findings from MRI and arthroscopic evaluation on lower extremity performance at 1 year and patient-reported outcomes at 1 to 2 years after APM. The hypothesis was that medial compartment abnormalities would be prognostic for 1- and 2-year functional outcomes...

BACKGROUND: The asymmetry of the medial and lateral knee compartments contributes significantly to femorotibial biomechanics and pivoting, and it is reported to be a relevant risk factor for an anterior cruciate ligament (ACL) injury. PURPOSE: (1) To assess the role of femoral condyle sphericity as a risk factor for an ACL rupture and rerupture. (2) To compare the new risk factor with existing bony morphological risk factors via magnetic resonance imaging (MRI) and to assess the most predictive risk factor for an ACL rupture...

BACKGROUND: In osteoarthritis of the knee, subchondral bone marrow lesion (BML) is known to be significantly associated with the severity of pain. However, little is known about the influence of preoperative BML on postoperative outcomes after medial opening wedge high tibial osteotomy (MOWHTO). PURPOSE: To compare patient-reported outcomes for those who underwent MOWHTO according to the severity of BML based on magnetic resonance imaging. STUDY DESIGN: Cohort study; Level of evidence, 3...

BACKGROUND: Focal cartilage lesions in the patellofemoral (PF) joint are common. Several studies correlated PF risk factors with PF instability, anterior knee pain, and PF arthritis; however, there is a lack of evidence correlating those factors to PF focal cartilage lesions. PURPOSE: To evaluate the influence of the anatomic PF risk factors in patients with isolated focal PF cartilage lesions. STUDY DESIGN: Cross-sectional study; Level of evidence, 3...

BACKGROUND: Previous studies have not quantitatively analyzed the site of acute Achilles tendon rupture. PURPOSE: To investigate the site of acute Achilles tendon rupture via magnetic resonance imaging (MRI). STUDY DESIGN: Cross-sectional study; Level of evidence, 4. METHODS: The medical records and MRIs of 195 patients with acute Achilles tendon rupture were retrospectively reviewed. The rupture site was measured as the distance from the most distal fibers of the Achilles tendon at the calcaneal insertion to the proximal end of the distal stump...

BACKGROUND: There is a paucity of literature regarding risk factors and mechanisms of Achilles tendon (AT) ruptures in the National Basketball Association (NBA). PURPOSE: To identify the risk factors and outcomes of AT ruptures in NBA athletes. Furthermore, using video analysis, to characterize the mechanisms of rupture by identifying the most common playing situations and lower extremity positions at the time of injury. STUDY DESIGN: Descriptive epidemiology study...

BACKGROUND: Platelet-rich plasma (PRP) has emerged as the forerunner among disease-modifying treatment options for early osteoarthritis (OA) of the knee. However, no consensus is available regarding optimum dosing schedules. PURPOSE: To determine whether multiple injections of PRP (3 injections) provide better short-term and long-term results than a single injection of PRP in a guinea pig model of knee OA. STUDY DESIGN: Controlled laboratory study...

BACKGROUND: Autologous chondrocyte implantation, which uses passaged chondrocytes, commonly leads to the formation of fibrocartilage. When chondrocytes are passaged to increase cell numbers, they lose their phenotype and ability to form hyaline cartilage. The use of transforming growth factor β (TGFβ) to redifferentiate passaged chondrocytes has been validated in vitro; however, it is unknown if redifferentiated chondrocytes will enhance defect repair when implanted in vivo. Furthermore, fibrin gel is used in orthopaedic surgery as a fixative and scaffold and could be an appropriate carrier to enhance retention of cells in the repair site...

BACKGROUND: There is controversy about the benefit of arthroscopic partial meniscectomy (APM) for degenerative lesions in middle-aged patients. PURPOSE: To compare satisfaction with APM between middle-aged patients with no or mild knee osteoarthritis (OA) and a degenerative meniscal tear and those with a traumatic tear. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: A comparative prospective study at 5 years of middle-aged patients (45-60 years old) with no or mild OA undergoing APM for degenerative (n = 115) or traumatic (n = 143) tears was conducted...

BACKGROUND: The ability of lateral meniscal allograft transplantation (MAT) to improve knee stability and the meniscal load-bearing function in patients after meniscectomy is critical for surgical success. PURPOSE: To compare the effects of 2 lateral MAT fixation techniques-bone block and suture only-on knee kinematics and forces. STUDY DESIGN: Controlled laboratory study. METHODS: With a robotic testing system, loads were applied during flexion on 10 fresh-frozen cadaveric knees: 134-N anterior tibial load + 200-N axial compression, 5-N·m internal tibial + 5-N·m valgus torques, and 5-N·m external tibial + 5-N·m valgus torques...

BACKGROUND: It has been believed that a Hill-Sachs lesion (HSL) is created with the arm in abduction and external rotation at the time of dislocation. However, no studies have clarified the arm position in which an HSL is created. PURPOSE: To determine the arm position in which an HSL is created. STUDY DESIGN: Descriptive laboratory study. METHODS: The computed tomography images of 100 shoulders of 100 patients (72 males and 28 females; mean age, 30 years old) with recurrent anterior dislocation of the shoulder were investigated using an image analyzing software...

BACKGROUND: The treatment strategy for anterior talofibular ligament (ATFL) injury is usually determined by the ATFL remnant condition during surgery. Preoperative magnetic resonance imaging (MRI)-based signal intensity of the ATFL remnant, represented by the signal/noise ratio (SNR) value, can reveal the ATFL remnant condition. Thus far, there is a lack of evidence regarding the relationship between the ATFL remnant condition and functional outcomes. PURPOSE/HYPOTHESIS: The purpose was to quantitatively evaluate whether the MRI-based ATFL ligament SNR value is related to functional outcomes after ATFL repair for ankles with chronic lateral ankle instability...

BACKGROUND: The repair of porcine articular cartilage defects by using particulated juvenile allograft cartilage (PJAC) has demonstrated good short-term clinical efficacy, but the repair process and mechanism have not been fully elucidated. PURPOSE: To study the efficacy of PJAC in repairing full-thickness cartilage defects and to provide an experimental basis for its clinical application. STUDY DESIGN: Controlled laboratory study. METHODS: Thirty Guizhou minipigs were randomly divided into an experimental group and control group...

BACKGROUND: Most lateral extra-articular tenodesis (LET) procedures rely on passing a strip of the iliotibial band (ITB) under the fibular (lateral) collateral ligament and fixing it proximally to the femur. The Ellison procedure is a distally fixed lateral extra-articular augmentation procedure with no proximal fixation of the ITB. It has the potential advantages of maintaining a dynamic element of control of knee rotation and avoiding the possibility of overconstraint. HYPOTHESIS: The modified Ellison procedure would restore native knee kinematics after sectioning of the anterolateral capsule, and closure of the ITB defect would decrease rotational laxity of the knee...

BACKGROUND: Female athletes are 2 to 8 times more prone to anterior cruciate ligament (ACL) rupture than males. Furthermore, reinjury to the ipsilateral or contralateral knee can occur in >20% of athletes. Female sex and younger age are known risk factors for graft failure. The optimal graft choice for young females remains unknown and poorly studied. PURPOSE/HYPOTHESIS: The authors aimed to compare clinical outcomes in young females who underwent ACL reconstruction (ACLR) with bone-patellar tendon-bone (BTB) and quadrupled hamstring (HS) autografts...

BACKGROUND: Recruitment of endogenous stem cells has been considered an alternative to cell injection/implantation in articular cartilage repair. PURPOSE: (1) To develop a cartilage tissue-engineering scaffold with clinically available biomaterials and functionalize the scaffold with an aptamer (Apt19s) that specifically recognizes pluripotent stem cells. (2) To determine whether this scaffold could recruit joint-resident mesenchymal stem cells (MSCs) when implanted into an osteochondral defect in a rabbit model and to examine the effects of cartilage regeneration...

BACKGROUND: Osteochondritis dissecans (OCD) of the humeral trochlea is very rare. It may cause pain, mechanical symptoms, and loss of elbow motion, typically in the adolescent athlete. However, little published information is available regarding this condition. PURPOSE: To describe the clinical presentation, radiographic features, and prognosis of trochlear OCD. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Over a 10-year period, 28 patients presented to a tertiary pediatric hospital with trochlear OCD...

BACKGROUND: The acetabular labrum plays important roles in proprioception, nociception, synovial fluid seal effect, and static and dynamic joint stability and as a shock absorber. Clinical and radiographic risk factors for unsalvageable labral tear in femoroacetabular impingement (FAI) are not well established. PURPOSE: To identify predictors of unsalvageable labral tear during initial hip arthroscopic management of FAI. STUDY DESIGN: Case-control study; Level of evidence, 3...

BACKGROUND: The perioperative withdrawal of aspirin increases the risk of cardiac, neurologic, and vascular thromboembolic events. The safety of continuing aspirin in patients undergoing knee arthroscopy is unknown. HYPOTHESIS: Perioperative continuation of aspirin does not increase surgical complications or worsen outcomes in patients 50 years of age and older undergoing knee arthroscopy. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This is a single-center, institutional review board-approved, prospective matched dual-cohort study comparing the surgical complication rates and postoperative outcomes of patients taking daily aspirin with those of unmedicated controls...