Topics of interest in the new JBJS Guest Editorial “What’s New in Sports Medicine” include opioid-sparing analgesia, risk of graft failure following meniscal allograft transplantation, and more. Here, we highlight the 5 most impactful studies, as selected by co-author Cassandra A. Lee, MD.
Anterior Cruciate Ligament (ACL)
ACL reconstruction alone (hamstring or bone-patellar tendon-bone) was compared with ACL reconstruction plus lateral extra-articular tenodesis (LEAT) in a Level-I systematic review and meta-analysis1. Rerupture was 3 times less likely in the LEAT group than in the non-LEAT group. The LEAT group also had a lower revision rate (1.4% vs. 5.4%) and significantly less residual positive pivot shift.
In a meta-analysis of 36 studies involving 2,604 patients total, the outcomes of meniscal allograft transplantation were compared by type of fixation: suture only, bone plug, or bone bridge2. Graft failure was defined as requiring revision meniscal allograft transplantation, conversion to joint arthroplasty, or allograft removal. The bone bridge group had the highest rates of graft failure (9.3%) and reoperation (32.6%), whereas the bone plug group had the lowest rates (graft failure, 6.2%; reoperation, 5.2%). MRI-assessed graft extrusion did not differ significantly between the 3 groups.
In another study, the outcomes of degenerative meniscal tears treated with either partial meniscectomy or physical therapy were assessed in 278 patients with a mean follow-up of 5 years3. The initial radiographic assessments and progression of knee osteoarthritis were comparable between the 2 treatment groups, and there were no significant differences in patient-reported pain, quality of life, and IKDC (International Knee Documentation Committee) knee function scores. As noted by Guest Editorial authors Dr. Lee et al., these findings demonstrate that “physical therapy is not inferior to partial meniscectomy for patients with degenerative meniscal tears.”
The outcomes of patients who underwent early surgical stabilization were compared with those who underwent nonoperative treatment with immobilization in a Level-I systematic review and meta-analysis4. The 5 included studies evaluated 259 patients (15 to 39 years old) treated for first-time anterior shoulder location. Patients treated operatively experienced significantly lower rates of recurrent instability (6.3% vs. 46.6%) and required significantly fewer subsequent instability surgical procedures (4.0% vs. 30.8%) than patients treated nonoperatively initially.
Multimodal Pain Regimens
In a Level-I randomized controlled trial, 62 patients undergoing ACL reconstruction (hamstring or bone-patellar tendon-bone) were prospectively randomized either to a traditional opioid regimen or to a scheduled multimodal nonopioid medication regimen of ketorolac (followed by meloxicam), diazepam, gabapentin, and acetaminophen5. The 2 groups had comparable outcomes over time. Additionally, the multimodal regimen group reported significantly lower VAS pain scores in the early postoperative period. These findings suggest that “pain after ACL reconstruction can be effectively managed without the use of opioids,” according to Dr. Lee et al.
“What’s New in Sports Medicine” is freely available at JBJS.org.
What’s New by Subspecialty
Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the “What’s New by Subspecialty” collection at JBJS.org.
- Onggo JR, Rasaratnam HK, Nambiar M, Onggo JD, Pai V, Damasena I, Riazi A, Babazadeh S. Anterior cruciate ligament reconstruction alone versus with lateral extra-articular tenodesis with minimum 2-year follow-up: a meta-analysis and systematic review of randomized controlled trials. Am J Sports Med. 2022 Mar;50(4):1137-45.
- Ow ZGW, Cheong CK, Hai HH, Ng CH, Wang D, Krych AJ, Saris DBF, Wong KL, Lin HA. Securing transplanted meniscal allografts using bone plugs results in lower risks of graft failure and reoperations: a meta-analysis. Am J Sports Med. 2022 Dec;50(14):4008-18.
- Noorduyn JCA, van de Graaf VA, Willigenburg NW, Scholten-Peeters GGM, Kret EJ, van Dijk RA, Buchbinder R, Hawker GA, Coppieters MW, Poolman RW; ESCAPE Research Group. Effect of physical therapy vs arthroscopic partial meniscectomy in people with degenerative meniscal tears: five-year follow-up of the ESCAPE randomized clinical trial. JAMA Netw Open. 2022 Jul 1;5(7):e2220394.
- Belk JW, Wharton BR, Houck DA, Bravman JT, Kraeutler MJ, Mayer B, Noonan TJ, Seidl AJ, Frank RM, McCarty EC. Shoulder stabilization versus immobilization for first-time anterior shoulder dislocation: a systematic review and meta-analysis of Level 1 randomized controlled trials. Am J Sports Med. 2022 Feb 11:3635465211065403.
- Moutzouros V, Jildeh TR, Tramer JS, Meta F, Kuhlmann N, Cross A, Okoroha KR. Can we eliminate opioids after anterior cruciate ligament reconstruction? A prospective, randomized controlled trial. Am J Sports Med. 2021 Dec;49(14):3794-801.