骨科运动医学界的宝贵资源，_THE AMERICAN JOURNAL OF SPORTS MEDICINE_ 是同行评议的科学期刊，于 1972 年首次出版。它是 [AMERICAN ORTHOPEDIC SOCIETY FOR SPORTS MEDICINE (AOSSM)] 的官方出版物（HTTP: //WWW.SPORTSMED.ORG/）！该杂志是独立的骨科运动医学研究和教育的重要论坛，使临床从业者能够根据可靠的科学信息做出决定。该杂志是以下人士的必读之选：* 骨科外科医生和专家 * 运动医学医师 * 理疗师* 运动教练 * 团队医师 * 和物理治疗师

The American Journal of Sports Medicine is a valuable resource in the field of orthopedic sports medicine. First published in 1972, it is a peer-reviewed scientific journal and the official publication of the American Orthopedic Society for Sports Medicine (AOSSM). The journal serves as an important forum for independent research and education in orthopedic sports medicine, enabling clinicians to make informed decisions based on reliable scientific information. It is essential reading for orthopedic surgeons, sports medicine physicians, physical therapists, athletic trainers, team physicians, and physical therapists.

《美国运动医学杂志》是骨科运动医学领域的重要资源。该期刊自1972年首次出版，是同行评审的科学期刊，也是美国运动医学骨科协会（AOSSM）的官方出版物。该杂志为独立的骨科运动医学研究和教育提供了重要的平台，使临床从业者能够基于可靠的科学信息做出明智的决策。以下专业人士都应阅读该杂志：骨科外科医生、运动医学医生、理疗师、运动教练、团队医生和物理治疗师。

American Journal of Sports Medicine

Background: Poor healing of the tendon-bone interface after rotator cuff repair is one of the main causes of surgical failure. Previous studies demonstrated that demineralized cortical bone (DCB) could improve healing of the enthesis. Purpose: To evaluate the outcomes of hierarchically demineralized cortical bone (hDCB) coated with stem cell–derived extracellular matrix (hDCB-ECM) in the repair of the rotator cuff in a rabbit model. Study Design: Controlled laboratory study. Methods: Tendon-derived stem cells (TDSCs) were isolated, cultured, and identified. Then, hDCB was prepared by the graded demineralization procedure. Finally, hDCB-ECM was fabricated via 2-week cell culture and decellularization, and the morphologic features and biochemical compositions of the hDCB-ECM were evaluated. A total of 24 rabbits (48 samples) were randomly divided into 4 groups: control, DCB, hDCB, and hDCB-ECM. All rabbits underwent bilateral detachment of the infraspinatus tendon, and the tendon-bone interface was repaired with or without scaffolds. After surgery, 8 rabbits were assessed by immunofluorescence staining at 2 weeks, and the others were assessed by micro–computed tomography (CT) examination, immunohistochemical staining, histological staining, and biomechanical testing at 12 weeks. Results: TDSCs were identified to have universal stem cell characteristics including cell markers, clonogenicity, and multilineage differentiation. The hDCB-ECM contained 3 components (bone, partial DCB, and DCB coated with ECM) with a gradient of calcium and phosphorus elements, and the ECM had stromal cell-derived factor 1, biglycan, and fibromodulin. Macroscopic observations demonstrated the absence of infection and rupture around the enthesis. The results of immunofluorescence staining showed that hDCB-ECM promoted stromal cell recruitment. Results of micro-CT analysis, immunohistochemical staining, and histological staining showed that hDCB-ECM enhanced bone and fibrocartilage formation at the tendon-bone interface. Biomechanical analysis showed that the hDCB-ECM group had higher ultimate tensile stress and Young modulus than the DCB group. Conclusion: The administration of hDCB-ECM promoted healing of the tendon-bone interface. Clinical Relevance: hDCB-ECM could provide useful information for the design of scaffolds to repair the tendon-bone interface, and further studies are needed to determine its effectiveness.

Shu-Kun He

Liang-Ju Ning

Xuan Yao

Ruo-Nan Hu

Jing Cui

Yi Zhang

Wei Ding

Jing-Cong Luo

Ting-Wu Qin

The American Journal of Sports Medicine

Hierarchically Demineralized Cortical Bone Combined With Stem Cell–Derived Extracellular Matrix for Regeneration of the Tendon-Bone Interface

分层脱矿皮质骨与干细胞衍生的细胞外基质联合用于肌腱-骨界面再生的研究

Chronic full-thickness rotator cuff tears (FTRCTs) represent a major clinical concern because they show highly compromised healing capacity.To evaluate the efficacy of using a 3-dimensional (3D) bioprinted scaffold with human umbilical cord blood (hUCB)-mesenchymal stem cells (MSCs) for regeneration of chronic FTRCTs in a rabbit model.Controlled laboratory study.A total of 32 rabbits were randomly assigned to 4 treatment groups (n = 8 per group) at 6 weeks after a 5-mm FTRCT was created on the supraspinatus tendon. Group 1 (G1-SAL) was transplanted with normal saline. Group 2 (G2-MSC) was transplanted with hUCB-MSCs (0.2 mL, 1 × 106) into FTRCTs. Group 3 (G3-3D) was transplanted with a 3D bioprinted construct without MSCs, and group 4 (G4-3D+MSC) was transplanted with a 3D bioprinted construct containing hUCB-MSCs (0.2 mL, 1 × 106 cells) into FTRCTs. All 32 rabbits were euthanized at 4 weeks after treatment. Examination of gross morphologic changes and histologic results was performed on all rabbits after sacrifice. Motion analysis was also performed before and after treatment.In G4-3D+MSC, newly regenerated collagen type 1 fibers, walking distance, fast walking time, and mean walking speed were greater than those in G2-MSC based on histochemical and motion analyses. In addition, when compared with G3-3D, G4-3D+MSC showed more prominent regenerated tendon fibers and better parameters of motion analysis. However, there was no significant difference in gross tear size among G2-MSC, G3-3D, and G4-3D+MSC, although these groups showed significant decreases in tear size as compared with the control group (G1-SAL).Findings of this study show that a tissue engineering strategy based on a 3D bioprinted scaffold filled with hUCB-MSCs can improve the microenvironment for regenerative processes of FTRCT without any surgical repair.In the case of rotator cuff tear, the cell loss of the external MSCs can be increased by exposure to synovial fluid. Therefore, a 3D bioprinted scaffold in combination with MSCs without surgical repair may be effective in increasing cell retention in FTRCT.

Dong Rak Kwon

Seungman Jung

Jinah Jang

Gi-Young Park

Yong Suk Moon

Sang Chul Lee

A 3-Dimensional Bioprinted Scaffold With Human Umbilical Cord Blood–Mesenchymal Stem Cells Improves Regeneration of Chronic Full-Thickness Rotator Cuff Tear in a Rabbit Model

三维生物打印支架结合人脐带血间充质干细胞促进兔模型中慢性全层肩袖撕裂的再生

Background: Graft bridging is used in massive rotator cuff tear (MRCT); however, the integration of graft-tendon and graft-bone is still a challenge. Hypothesis: A co-electrospinning nanoscaffold of polycaprolactone (PCL) with an “enthesis-mimicking” (EM) structure could bridge MRCT, facilitate tendon regeneration, and improve graft-bone healing. Study Design: Controlled laboratory study. Methods: First, we analyzed the cytocompatibility of the electrospinning nanoscaffolds, including aligned PCL (aPCL), nonaligned PCL (nPCL), aPCL–collagen I, nPCL–collagen II, and nPCL-nanohydroxyapatite (nHA). Second, for the EM condition, nPCL–collagen II and nPCL-nHA were electrospun layer by layer at one end of the aPCL–collagen I; for the control condition, the nPCL was electrospun on the aPCL. In 40 mature male rats, resection of both the supraspinatus and infraspinatus tendons was performed to create MRCT, and the animals were divided randomly into EM and control groups. In both groups, one end of the layered structure was fixed on the footprint of the rotator cuff, whereas the other end of the layered structure was sutured with the tendon stump. The animals were euthanized for harvesting of tissues for histologic and biomechanical analysis at 4 weeks or 8 weeks postoperatively. Results: All scaffolds showed good cytocompatibility in vitro. The graft-tendon tissue in the EM group had more regularly arranged cells, denser tissue, a significantly higher tendon maturing score, and more birefringence compared with the control group at 8 weeks after operation. Newly formed fibrocartilage could be observed at the graft-bone interface in both groups by 8 weeks, but the EM group had a higher graft-bone healing score and significantly more newly formed fibrocartilage than the control group. An enthesis-like structure with transitional layers was observed in the EM group at 8 weeks. Biomechanically, the values for maximum failure load and stiffness of the tendon-graft-bone complex were significantly higher in the EM group than in the control group at 8 weeks. Conclusion: The co-electrospinning nanoscaffold of aPCL–collagen I could be used as a bridging graft to improve early graft-tendon healing for MRCT in a rat model and enhance early enthesis reconstruction in combination with a multilayered structure of nPCL–collagen II and nPCL-nHA. Clinical Relevance: We constructed a graft to bridge MRCT, enhance graft-tendon healing and graft-bone healing, and reconstruct the enthesis structure.

Shuang Cong

Yaying Sun

Jinrong Lin

Shaohua Liu

Jiwu Chen

Am J Sports Med

A Synthetic Graft With Multilayered Co-Electrospinning Nanoscaffolds for Bridging Massive Rotator Cuff Tear in a Rat Model

用于桥接大鼠模型中巨大肩袖撕裂的多层共静电纺纳米支架合成移植物

Background: Owing to limited self-healing capacity, failure of rotator cuff tendon healing is a common complication after surgery. Biological scaffolds have garnered attention owing to their potential to enhance healing outcomes. Purpose: To verify the effect of the decellularized umbilical cord Wharton jelly (DUCWJ) scaffold as a bridging scaffold in a rabbit model of acute rotator cuff tendon defect. Study Design: Controlled laboratory study. Methods: We fabricated a DUCWJ scaffold using a physicochemical decellularized method, evaluating changes in the umbilical cord Wharton jelly before and after decellularization. Scanning electron microscopy and biomechanical testing were performed to determine the microstructure and mechanical properties. We assessed cytocompatibility and cell regulatory behavior of the scaffold toward tendon stem/progenitor cells (TSPCs). A supraspinatus tendon defect was created in 54 New Zealand White rabbits, allocated to the DUCWJ scaffold repair group and the negative control group (without scaffold). Histology, reverse transcription polymerase chain reaction, and biomechanical tensile strength were assessed at 4, 8, and 12 weeks postoperatively. Results: Decellularization completely removed cells from the umbilical cord Wharton jelly, retained a considerable amount of glycosaminoglycan and collagen, and preserved the microstructure and tensile strength. The DUCWJ scaffold facilitated migration and proliferation of TSPCs in vitro. Tendon-related gene expression revealed that the DUCWJ scaffold could maintain the tenocyte phenotype of TSPCs. In the in vivo study, the DUCWJ scaffold improved tendon healing and enhanced the biomechanical strength of repaired tendons. Histological evaluation scores of the DUCWJ group were significantly higher than those of the negative control at 4, 8, and 12 weeks after surgery ( P &lt; .05). In repaired tendon tissues, reverse transcription polymerase chain reaction findings revealed that the DUCWJ scaffold stimulated tendon development and maturation. Furthermore, an overall increase in ultimate load and tensile modulus was noted over time; the DUCWJ group presented better results than the negative control group ( P &lt; .05). Conclusion: The DUCWJ scaffold has an excellent 3-dimensional porous structure, good biocompatibility, and fundamental biomechanical characteristics, and it promotes migration, attachment, and proliferation of TSPCs. The in vivo animal study demonstrated that the DUCWJ scaffold has potential for tendon regeneration in an acute rotator cuff tendon defect model Clinical Relevance: DUCWJ scaffolds have potential as a regenerative material to augment rotator cuff healing in the clinical setting.

Zhiguo Yuan

Fuyang Cao

Cangjian Gao

Zhen Yang

Quanyi Guo

You Wang

Decellularized Human Umbilical Cord Wharton Jelly Scaffold Improves Tendon Regeneration in a Rabbit Rotator Cuff Tendon Defect Model

脱细胞人脐带华通胶支架改善兔肩袖肌腱缺损模型中的肌腱再生

Background: Unrepairable massive rotator cuff tears (UMRCTs) are challenging to surgeons owing to the severely retracted rotator cuff musculotendinous tissues and extreme defects in the rotator cuff tendinous tissues. Purpose: To fabricate a tendon stem cell–derived exosomes loaded scaffold (TSC-Exos-S) and investigate its effects on cellular bioactivity in vitro and repair in a rabbit UMRCT model in vivo. Study Design: Controlled laboratory study. Methods: TSC-Exos-S was fabricated by loading TSC-Exos and type 1 collagen (COL-I) into a 3-dimensional bioprinted and polycaprolactone (PCL)–based scaffold. The proliferation, migration, and tenogenic differentiation activities of rabbit bone marrow stem cells (BMSCs) were evaluated in vitro by culturing them in saline, PCL-based scaffold (S), COL-I loaded scaffold (COL-I-S), and TSC-Exos-S. In vivo studies were conducted on a rabbit UMRCT model, where bridging was repaired with S, COL-I-S, TSC-Exos-S, and autologous fascia lata (FL). Histological and biomechanical analyses were performed at 8 and 16 weeks postoperatively. Results: TSC-Exos-S exhibited reliable mechanical strength and subcutaneous degradation, which did not occur before tissue regeneration. TSC-Exos-S significantly promoted the proliferation, migration, and tenogenic differentiation of rabbit BMSCs in vitro. In vivo studies showed that UMRCT repaired with TSC-Exos-S exhibited significant signs of tendinous tissue regeneration at the bridging site with regard to specific collagen staining. Moreover, no significant differences were observed in the histological and biomechanical properties compared with those repaired with autologous FL. Conclusion: TSC-Exos-S achieved tendinous tissue regeneration in UMRCT by providing mechanical support and promoting the trend toward tenogenic differentiation. Clinical Relevance: The present study proposes a potential strategy for repairing UMRCT with severely retracted musculotendinous tissues and large tendinous tissue defects.

Xuancheng Zhang

Yuxu Wu

Kang Han

Zhaoyi Fang

Eunshinae Cho

Yihe Hu

Xiaoqiao Huangfu

Jinzhong Zhao

3-Dimensional Bioprinting of a Tendon Stem Cell–Derived Exosomes Loaded Scaffold to Bridge the Unrepairable Massive Rotator Cuff Tear

三维生物打印载 tendon stem cell-衍生外泌体的支架以桥接不可修复的大面积肩袖撕裂

David Holmgren

Shiba Noory

Eva Moström

Hege Grindem

Anders Stålman

Tobias Wörner

Strengthening the Evidence: Addressing Biases in Anterior Cruciate Ligament Reconstruction Studies: Response

加强证据：解决前交叉韧带重建研究中的偏倚问题：回应

Bruce Reider

In Gratitude

感恩

Dean C. Taylor

Presidential Address of the American Orthopaedic Society for Sports Medicine

美国骨科运动医学学会主席致辞

Jiawei Du

Jinghua Hou

Strengthening the Evidence: Addressing Biases in Anterior Cruciate Ligament Reconstruction Studies: Letter to the Editor

加强证据：解决前交叉韧带重建研究中的偏倚问题：致编辑的信

Background: Osteochondritis dissecans (OCD) of the knee is a focal idiopathic alteration of subchondral bone and/or its precursor with risk for instability and disruption of adjacent cartilage. Treatment options focused on preventing premature osteoarthritis vary depending on multiple patient and lesion characteristics, including lesion mobility. Purpose: To differentiate lesion mobility before arthroscopy using a multivariable model that includes patient demographic characteristics and physical examination findings. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: Demographic, preoperative physical examination, and radiographic data were collected from a multicenter national prospective cohort of patients with OCD of the knee. Inclusion criteria included patients &lt;19 years of age and patients with arthroscopically confirmed mobility status based on the Research on Osteochondritis Dissecans of the Knee arthroscopy classification. Multivariable logistic regression analysis using stepwise model selection was used to determine factors associated with the likelihood of a mobile versus an immobile lesion. A 75% partition of the data was used for model training, and 25% was used as a validation cohort. Quantitative model fit statistics were computed using the holdout data, including sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC), along with the corresponding 95% CI. Results: A total of 407 patients in the prospective cohort met inclusion criteria, and 62% were male. The mean ± SD age was 13.7 ± 2.2 years, height 161.8 ± 5.3 cm, and weight 59.2 ± 42.2 kg. Arthroscopic evaluation yielded 235 immobile and 172 mobile lesions. Multivariable analysis determined that the best model to predict lesion mobility included chronologic age ≥14 years ( P &lt; .001), effusion on physical examination ( P &lt; .001), and any loss of range of motion on physical examination ( P = .07), while controlling for male sex ( P = .38) and weight &gt;54.4 kg ( P = .12). In the 25% holdout validation sample (n = 102), a sensitivity of 83%, a specificity of 82%, and an AUC of 0.89 (95% CI, 0.82-0.95) were achieved with these predictive factors. Conclusion: Age, effusion, and loss of motion can predict knee OCD lesion mobility at the time of arthroscopy. Education about lesion mobility can help with surgical planning and patient and family counseling.

Matthew D. Milewski

Patricia E. Miller

Emma C. Gossman

Ryan P. Coene

Marc A. Tompkins

Christian N. Anderson

Kathryn Bauer

Michael T. Busch

James L. Carey

Sasha Carsen

Henry G. Chambers

Eric W. Edmonds

Jutta Ellermann

Henry B. Ellis Jr

John Erickson

Peter D. Fabricant

Theodore J. Ganley

Daniel W. Green

Benton E. Heyworth

James Hoi Po Hui

Mininder S. Kocher

Aaron J. Krych

Kevin Latz

Roger M. Lyon

Stephanie Mayer

Bradley J. Nelson

Jeffrey J. Nepple

Jie C. Nguyen

Carl W. Nissen

James Lee Pace

Mark V. Paterno

Andrew T. Pennock

Crystal Perkins

John D. Polousky

Paul Saluan

Kevin G. Shea

Eric J. Wall

Jennifer M. Weiss

Clifton Willimon

Philip Wilson

Rick W. Wright

Andy Zbojniewicz

Gregory D. Myer

A Simple Clinical Predictive Model for Arthroscopic Mobility of Osteochondritis Dissecans Lesions of the Knee

膝关节剥脱性骨软骨炎关节镜下活动度的简易临床预测模型

Abbreviation	Am J Sports Med
Journal Impact	4.26
Quartiles(Global)	SPORT SCIENCES(Q1)

ISSN	0363-5465, 1552-3365
h-index	266
Top Journals	Yes

Publication Information	Publisher: SAGE Publications Inc.，Publishing cycle: Bimonthly，Journal Type: journal，Open Access Journals: No
Basic data	Year of publication: 1973，Proportion of original research papers: 91.42%，Self Citation Rate:11.90%， Gold OA Rate: 7.37%
Average review cycle	网友分享经验：较快,2-4周
Average recruitment ratio	网友分享经验：很难

American Journal of Sports Medicine

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