Co-author Rachel M. Frank, MD summarizes the 5 most compelling findings from among the studies highlighted in the new “What’s New in Sports Medicine” in JBJS.
Anterior Cruciate Ligament (ACL) Injuries
– A recent systematic review and meta-analysis evaluated the incidence of radiographic posttraumatic osteoarthritis after transtibial vs. anteromedial femoral tunnel positioning during ACL reconstruction¹. A total of 16 studies with 1,546 patients were included (783 patients who underwent transtibial and 763 who underwent anteromedial ACL reconstruction). Patients were followed for a mean of 10.9 years. Higher overall rates of radiographic posttraumatic osteoarthritis were found for transtibial ACL reconstruction, including when stratified by the duration of follow-up.
– Another systematic review and meta-analysis compared the outcomes of early operative treatment (≤12 weeks from the time of injury), delayed operative treatment (>12 weeks), and nonoperative treatment of ACL injuries in pediatric and adolescent patients². The analysis included 30 studies with a total of 1,176 patients ≤19 years of age. Overall, the authors recommended ACL reconstruction within 3 months of the initial injury, as this leads to better return-to-sport rates and can play an important role in preserving the joint.
Anterior Shoulder Instability
– A randomized controlled trial (RCT) evaluated arthroscopic Bankart repair with and without remplissage for the treatment of anterior shoulder instability with a Hill-Sachs lesion of any size and <15% of anterior glenoid bone loss³. Fifty-four patients were in each group and were followed for 2 years. The patients who underwent Bankart repair with remplissage had significantly lower rates of redislocation and revision procedures. The 2 groups did not differ significantly in terms of patient-reported outcomes, posterior shoulder pain, and the ability to participate in sports at 24 months.
–A systematic review and meta-analysis evaluated arthroscopic Bankart repair (2,791 patients) vs. the Latarjet procedure (484 patients) in the treatment of recurrent anterior shoulder instability4. Follow-up ranged from 30 days to 10 years. Bankart repair was associated with a higher incidence of recurrence, and when taking into consideration the durations of follow-up, the Latarjet procedure was superior between 6 and 10 years after the initial surgery. Bankart repair was associated with a higher risk of dislocation, particularly between 6 and 10 years.
Acetabular Labral Tears
– A recent RCT compared arthroscopy with physical therapy vs. physical therapy alone in the treatment of symptomatic acetabular labral tears in patients >40 years of age with little to no evidence of femoroacetabular osteoarthritis5. Of the 90 included patients (46 in the arthroscopy group and 44 in the physical therapy group), a total of 81 patients completed 1-year follow-up and were included in the analysis. Of note, 28 of the 44 in the physical therapy group crossed over to arthroscopy, at a mean of 190 days. The intention-to-treat analysis showed significantly higher mean overall scores on the iHOT-33 (International Hip Outcome Tool) and mHHS (modified Harris hip score) in the arthroscopy group. The authors concluded that an age of >40 years should not be considered a contraindication to arthroscopic acetabular labral repair.
To access the full text of the JBJS Guest Editorial “What’s New in Sports Medicine” click here.
Every month, JBJS publishes a review of the most pertinent and impactful studies from the orthopaedic literature during the previous year in 14 subspecialty areas. The JBJS.org collection of “What’s New” articles by subspecialty can be found here.
- Cinque ME, Kunze KN, Williams BT, Moatshe G, LaPrade RF, Chahla J. Higher incidence of radiographic posttraumatic osteoarthritis with transtibial femoral tunnel positioning compared with anteromedial femoral tunnel positioning during anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Am J Sports Med. 2022 Jan;50(1):255-63.
- James EW, Dawkins BJ, Schachne JM, Ganley TJ, Kocher MS, Anderson CN, Busch MT, Chambers HG, Christino MA, Cordasco FA, Edmonds EW, Green DW, Heyworth BE, Lawrence JTR, Micheli LJ, Milewski MD, Matava MJ, Nepple JJ, Parikh SN, Pennock AT, Perkins CA, Saluan PM, Shea KG, Wall EJ, Willimon SC, Fabricant PD; PLUTO Study Group. Early operative versus delayed operative versus nonoperative treatment of pediatric and adolescent anterior cruciate ligament injuries: a systematic review and meta-analysis. Am J Sports Med. 2021 Dec;49(14):4008-17.
- MacDonald P, McRae S, Old J, Marsh J, Dubberley J, Stranges G, Koenig J, Leiter J, Mascarenhas R, Prabhakar S, Sasyniuk T, Lapner P. Arthroscopic Bankart repair with and without arthroscopic infraspinatus remplissage in anterior shoulder instability with a Hill-Sachs defect: a randomized controlled trial. J Shoulder Elbow Surg. 2021 Jun;30(6):1288-98.
- Imam MA, Shehata MSA, Martin A, Attia H, Sinokrot M, Bahbah EI, Gwilym S, Jacob J, Narvani AA, Meyer DC. Bankart repair versus Latarjet procedure for recurrent anterior shoulder instability: a systematic review and meta-analysis of 3275 shoulders. Am J Sports Med. 2021 Jun;49(7):1945-53.
- Martin SD, Abraham PF, Varady NH, Nazal MR, Conaway W, Quinlan NJ, Alpaugh K. Hip arthroscopy versus physical therapy for the treatment of symptomatic acetabular labral tears in patients older than 40 years: a randomized controlled trial. Am J Sports Med. 2021 Apr;49(5):1199-208.