Outcomes Following Anterior Cruciate Ligament Reconstruction with Patellar Tendon vs Hamstring Autografts: A Systematic Review of Randomized Controlled Trials with a Mean Follow-up of 15 Years

BACKGROUND: The two most common surgical treatment modalities for anterior cruciate ligament reconstruction (ACL), patellar tendon (PT) and hamstring tendon (HS) autografts, have been shown to have outcomes that are both similar and favorable; however, many of these are short or intermediate-term. The objective of this systematic review is to evaluate randomized controlled trials (RCTs) with a minimum 10-year follow-up data to compare the long-term outcomes of ACL reconstructions performed using PT and HS autografts. METHODS: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A search of three databases (PubMed, Cochrane and EMBASE) was performed to identify RCTs with a minimum of 10-year follow-up that compared clinical and/or functional outcomes between PT and HS autografts. RESULTS: Four RCTs with a total of 299 patients were included in the study. The mean follow-up ranged from 10.2 to 17 years (mean, 14.79 years). No significant differences in knee laxity or clinical outcome scores were demonstrated in any of the studies. One study found that PT autografts were significantly more likely to have osteoarthritis identified by radiographic findings. Two studies found that patients with PT autografts reported increase kneeling pain, while none of the four studies reported a difference in anterior knee pain. There were no significant differences in graft failure rates. CONCLUSION: This review demonstrates no long-term difference in clinical or functional outcomes between PT and HS autografts. However, radiographic and subjective outcomes indicate that patients with PT autografts may experience greater kneeling pain and osteoarthritis. Therefore, orthopedic surgeons should consider patient-centric factors when discussing graft options with patients

Rising Trends in Wrestling-associated Injuries in Females Presenting to US Emergency Departments

Introduction: Wrestling is one of the fastest-growing sports among females in the United States (US). However, female wrestling injuries remain poorly characterized. In this study we describe historical and projected national estimates of female wrestling injuries, and compare injury characteristics with those of male wrestlers.Methods: We queried the National Electronic Injury Surveillance System (NEISS) database (2005-2019) to compare national weighted estimates and injury characteristics of male vs female wrestlers presenting to US emergency departments (ED) and projected annual female wrestling injuries expected by 2030.Results: Our analyses demonstrated a significant (P < 0.001) increase in female wrestling injuries between 2005 (N = 1500; confidence interval [CI], 923 – 2,078) and 2019 (N = 3,404; CI 2,296 – 4,513). Linear regression (R2 = 0.69; P < 0.001) projected 4,558 (CI, 3104 – 6033) such injuries in 2030. Of female wrestling injuries 50.1% (CI, 44.1 – 56.2) occurred in patients 14-18 years of age. Compared with age-matched males, female wrestlers were significantly less likely to present with fractures (Female [F]: 10.6%; CI 7.5% – 13.7%; Male [M]: 15.7%; CI 14.7% – 16.7%; P = 0.003) or head/neck injuries (F: 18.5%; CI 13.2% – 23.9%; M: 24.6%; CI 23.2% – 26.0%; P = 0.018), and significantly more likely to present with strains/sprains (F: 48.8%; CI, 41.2% – 56.3%; M: 34.4%; CI 31.6% – 37.1%; P < 0.001).Conclusion: Males and females possess distinctly unique physiology and anatomy, such as variances in ligamentous and muscular strength, which may help to explain differences in wrestling injury characteristics. Prompt management of injuries and specific training strategies aimed at prevention may help to reduce the projected increase of female wrestling-associated injuries as the popularity of the sport continues to rise

Rising Trends in Wrestling-associated Injuries in Females Presenting to US Emergency Departments

Introduction: Wrestling is one of the fastest-growing sports among females in the United States (US). However, female wrestling injuries remain poorly characterized. In this study we describe historical and projected national estimates of female wrestling injuries, and compare injury characteristics with those of male wrestlers.Methods: We queried the National Electronic Injury Surveillance System (NEISS) database (2005-2019) to compare national weighted estimates and injury characteristics of male vs female wrestlers presenting to US emergency departments (ED) and projected annual female wrestling injuries expected by 2030.Results: Our analyses demonstrated a significant (P < 0.001) increase in female wrestling injuries between 2005 (N = 1500; confidence interval [CI], 923 – 2,078) and 2019 (N = 3,404; CI 2,296 – 4,513). Linear regression (R2 = 0.69; P < 0.001) projected 4,558 (CI, 3104 – 6033) such injuries in 2030. Of female wrestling injuries 50.1% (CI, 44.1 – 56.2) occurred in patients 14-18 years of age. Compared with age-matched males, female wrestlers were significantly less likely to present with fractures (Female [F]: 10.6%; CI 7.5% – 13.7%; Male [M]: 15.7%; CI 14.7% – 16.7%; P = 0.003) or head/neck injuries (F: 18.5%; CI 13.2% – 23.9%; M: 24.6%; CI 23.2% – 26.0%; P = 0.018), and significantly more likely to present with strains/sprains (F: 48.8%; CI, 41.2% – 56.3%; M: 34.4%; CI 31.6% – 37.1%; P < 0.001).Conclusion: Males and females possess distinctly unique physiology and anatomy, such as variances in ligamentous and muscular strength, which may help to explain differences in wrestling injury characteristics. Prompt management of injuries and specific training strategies aimed at prevention may help to reduce the projected increase of female wrestling-associated injuries as the popularity of the sport continues to rise

The Comma Sign: An Anatomic Study.

The comma sign is a comma-shaped arc of tissue located at the superolateral edge of the subscapularis at its insertion on the humeral head. It consists of the coracohumeral ligament (CHL) and the superior glenohumeral ligament (SGHL). It was recently recognized as an important landmark to aid surgeons in identifying the edge of a torn subscapularis tendon. The exact proportion of CHL and SGHL has not been precisely defined. The goal of this study was to dissect and more accurately define the composition of the comma tissue and its exact relationship to the subscapularis tendon. A total of 8 fresh frozen cadaveric shoulder specimens (mean age, 74 years; 5 male, 3 female) were dissected via a wide deltopectoral approach. Anatomic landmarks were identified, and measurements were taken with a digital caliper. The midpoint width of the SGHL and CHL and the composite insertion width of the subscapularis were measured. Measurements were taken 3 times each and averaged to calculate mean width. Mean midpoint width of the SGHL, CHL, and composite insertion was 5.99 mm (range, 5.25-6.91 mm), 5.13 mm (range, 4.28-5.72 mm), and 9.93 mm (range, 6.69-12.05 mm), respectively. The comma sign consists of approximately half SGHL (54%) and half CHL (46%) at its insertion to the subscapularis tendon, with an approximate width of 1 cm. With the increase in arthroscopic subscapularis repairs, knowledge of these dimensions will aid surgeons in discerning the comma tissue from other capsular elements and ultimately help in surgical restoration of native anatomy.