2015What’s New in Sports Medicine

Rotator cuff repairs
outcome
• A recent systematic review suggests that structural integrity（结构完整修复） of the repair does not seem to correlate with validated（有效） patient subjective outcome measures.
Shoulder
ROTATOR CUFF DISEASE AND SURGERY
肩袖损伤的流行病学调查
• Surgical repair of symptomatic tears may result in not only substantial societal savings, but also improved individual quality-adjusted life-years relative to nonoperative treatment.
Shoulder
ACROMIOCLAVICULAR JOINT
Concomitant Acromioclavicular Arthritis During Rotator Cuff Surgery
• Although it may be tempting to prophylactically treat(预防性治疗) the acromioclavicular arthritis with a distal clavicle excision at the time of the rotator cuff surgery, Oh et al. suggested that not only is this unnecessary, but it may also result in postoperative morbidity（并发症）. • The authors found that prophylactic distal clavicle excision … provided no additional improvement. Furthermore, they noted a 5% complication rate related to postoperative acromioclavicular joint pain or protuberance （凸起）with prophylactic distal clavicle excision.
Shoulder Instability
arthroscopy or open repairs
• Although the current trend is toward arthroscopic repairs, the literature continues to demonstrate the superiority of open repairs in high-risk individuals. • Mohtadi et al.demonstrated a recurrent dislocation rate of 23% in their arthroscopic repair group compared with 11% in their open repair group.
Risk Factors for ACL Outcomes
• Cox et al. found that Outerbridge grade-III and IV articular cartilage injuries and medial meniscal repair were associated with lower clinical scores, and knees with small, untreated lateral meniscal tears fared better at six years.
• A recent cross-sectional study … demonstrated that objective tear characteristics (i.e.,tear size, muscle atrophy, and retraction) did not correlate with patient pain symptoms. Rather, patient demographic characteristics(i.e., lower educational level, greater number of comorbidities（合并症）, and race) appeared to be associated with greater pain symptoms at initial presentation.
What’ New in Sports Medicine
2015 BY THE JOURNAL OF BONE AND JOINT SURGERY
• 本新进展基于三大运动医学杂志 JBJS、The American Journal of Sports Medicine和 Arthroscopy: The Journal of Arthroscopic and Related Surgery 2013 年 9 月至 2014 年 8 月 相关文章而成。 • 文章证据级别：a Level of Evidence grade of I or II
Rerupture rates
• One study …found only a 1.6% revision rate at two years, irrespective of autograft type, associated meniscal injury, or femoral fixation. • Paterno et al. reported that young patients involved in pivoting or cutting sports had a substantially higher rate (9%) of ACL retear following ACL reconstruction... • The youngest cohort … had an even higher rate (20.5%) of contralateral（对侧） ACL tear, six times higher than the age-matched controls.
knee
ANTERTERIOR CRUCIATE LIGAMENT (ACL)
ACL Outcomes
• …comparing single and double-bundle reconstruction with use of hamstring auto-graft, Ahld´en et al. found no differences in pivot shift or clinical scores at two years.
Repair outcome
• Additional indicated adjuncts to Bankart repairs, such as remplissage, may be able to reduce the redislocation rate following surgery. • Return to play was 90% in a cohort of 183 athletes; however, only 64% returned to the same level of play postoperatively. • The authors also reported better outcome with suture anchor-based repairs than anchorless capsulolabral plication（关节囊皱褶缝合术）.
Rotator cuff repairs
improve structural healing rates
• The efficacy of platelet-rich plasma as an augment in rotator cuff repair is still unclear.
• One clinical study suggested that microfracture of the rotator cuff footprint prior to repair may permit egress(渗出) of bone marrow elements and mesenchymal stem cells(间叶干细胞), which may aid rotator cuff healing in medium-sized tears (2 to 3 cm) and may reduce retear rates.
irreparable rotator cuff tears
• Latissimus dorsi transfers（背阔肌肌皮瓣转移） have been an option with good short-term to intermediate-term results. • Factors that were associated with poorer outcomes included subscapularis and teres minor insufficiency （功能不全） as well as large critical shoulder angles(方肩畸形？).
• The authors concluded that young male patients with visible Hill-Sachs lesions on radiographs may be better treated with open repairs than arthroscopic repairs.