The American journal of sports medicine
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The young athletic population makes up the largest portion of shoulder instability and, when treated nonoperatively, has a recurrent dislocation rate as high as 71%. It is unknown how the outcomes of those who have a recurrent dislocation are affected versus those who have a stabilization procedure after a first-time dislocation. ⋯ Patients with first-time dislocations had lower postoperative instability rates and reoperation rates when compared with patients with recurrent dislocations before surgery. Young patients with shoulder instability should be offered early surgical intervention to lower the risk of postoperative instability and reoperation.
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Quantitative muscle fat-fraction magnetic resonance (MR) imaging techniques correlate with semiquantitative Goutallier scores with failure after rotator cuff (RC) repair. ⋯ MR imaging-derived RC muscle PDFF is associated with isometric strength independent of muscle atrophy and tendon rupture in shoulders with early and advanced degenerative changes. It therefore provides complementary, clinically relevant information in tracking RC muscle composition on a quantitative level.
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Graft failure and low rates of return to sport are major concerns after anterior cruciate ligament (ACL) reconstruction, particularly in a population at risk. ⋯ In a high-risk population of young patients participating in pivoting sports, the rate of graft failure with HT+ALL grafts was 2.5 times less than with B-PT-B grafts and 3.1 times less than with 4HT grafts. The HT+ALL graft is also associated with greater odds of returning to preinjury levels of sport when compared with the 4HT graft.
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The treatment of symptomatic cartilage defects of the patella is particularly challenging, and no gold standard is currently available. ⋯ The implantation of a cell-free collagen-hydroxyapatite osteochondral scaffold provided a clinical improvement at short-term follow-up for the treatment of patellar cartilage defects. Women had lower outcomes, and the need for realignment procedures led to a slower recovery. MRI evaluation showed some abnormal findings with the presence of bone overgrowth, but no correlation has been found with the clinical outcome.
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Femoroacetabular impingement (FAI) most commonly manifests as anterior groin pain. Patients occasionally have posterior pain but otherwise have clinical and radiographic evidence of FAI. ⋯ Atypical posterior hip pain is an uncommon presentation of FAI. Patients demonstrate similar significant improvements after hip arthroscopy in outcome scores, postoperative pain, and satisfaction compared with patients who have classic anterior groin pain.