Arthroscopy Sports Medicine and Rehabilitation最新文献

{"title":"ChatGPT-3.5 and -4.0 Do Not Reliably Create Readable Patient Education Materials for Common Orthopaedic Upper- and Lower-Extremity Conditions","authors":"Ryan S. Marder M.D. ,&nbsp;George Abdelmalek M.D. ,&nbsp;Sean M. Richards B.A. ,&nbsp;Nicolas J. Nadeau B.S. ,&nbsp;Daniel J. Garcia B.S. ,&nbsp;Peter J. Attia B.A. ,&nbsp;Gavin Rallis M.D. ,&nbsp;Anthony J. Scillia M.D.","doi":"10.1016/j.asmr.2024.101027","DOIUrl":"10.1016/j.asmr.2024.101027","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate whether ChatGPT-3.5 and -4.0 can serve as a viable tool to create readable patient education materials for patients with common orthopaedic upper- and lower-extremity conditions.</div></div><div><h3>Methods</h3><div>Using ChatGPT versions 3.5 and 4.0, we asked the artificial intelligence program a series of 2 questions pertaining to patient education for 50 common orthopaedic upper-extremity pathologies and 50 common orthopaedic lower-extremity pathologies. Two templated questions were created and used for all conditions. Readability scores were calculated using the Python library Textstat. Multiple readability test scores were generated, and a consensus reading level was created taking into account the results of 8 reading tests.</div></div><div><h3>Results</h3><div>ChatGPT-3.5 produced only 2% and 4% of responses at the appropriate reading level for upper- and lower-extremity conditions, respectively, compared with 54% produced by ChatGPT-4.0 for both upper- and lower-extremity conditions (both <em>P</em> &lt; .0001). After a priming phase, ChatGPT-3.5 did not produce any viable responses for either the upper- or lower-extremity conditions, compared with 64% for both upper- and lower-extremity conditions by ChatGPT-4.0 (both <em>P</em> &lt; .0001). Additionally, ChatGPT-4.0 was more successful than ChatGPT-3.5 in producing viable responses both before and after a priming phase based on all available metrics for reading level (all <em>P</em> &lt; .001), including the Automated Readability index, Coleman-Liau index, Dale-Chall formula, Flesch-Kincaid grade, Flesch Reading Ease score, Gunning Fog score, Linsear Write Formula score, and Simple Measure of Gobbledygook index.</div></div><div><h3>Conclusions</h3><div>Our results indicate that ChatGPT-3.5 and -4.0 unreliably created readable patient education materials for common orthopaedic upper- and lower-extremity conditions at the time of the study.</div></div><div><h3>Clinical Relevance</h3><div>The findings of this study suggest that ChatGPT, while constantly improving as evidenced by the advances from version 3.5 to version 4.0, should not be substituted for traditional methods of patient education at this time and, in its current state, may be used as a supplemental resource at the discretion of providers.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 1","pages":"Article 101027"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Return to Play and Variable Salary Impact After Hip Arthroscopy in National Hockey League Players","authors":"Michael A. Gaudiani M.D. ,&nbsp;Joshua P. Castle M.D. ,&nbsp;Muhammad J. Abbas M.D. ,&nbsp;Matthew J. Myhand B.S. ,&nbsp;Thomas J. Sprys-Tellner B.S. ,&nbsp;Jack T. McConnell B.S. ,&nbsp;Brittaney A. Pratt B.S. ,&nbsp;T. Sean Lynch M.D.","doi":"10.1016/j.asmr.2024.101006","DOIUrl":"10.1016/j.asmr.2024.101006","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the impact of hip arthroscopy for femoroacetabular impingement syndrome (FAIS) on National Hockey League (NHL) player performance, career length, and salary.</div></div><div><h3>Methods</h3><div>Through a retrospective review, all NHL players who underwent hip arthroscopy for FAIS from 2003 to 2023 were identified from a public online database. A 2:1 matched control cohort was used for comparison. Game use and performance metrics were collected and compared at 1 season and 3 seasons before and after the index season. Game use, performance, and salary were compared between operatively managed players and healthy controls. Performance measures and financial data were recorded.</div></div><div><h3>Results</h3><div>Of the 75 NHL players who underwent hip arthroscopy, 66 (88%) returned to play and were matched to 132 healthy controls. At 1 season after the index season, the operative cohort of NHL players showed a significantly decreased Corsi percentage compared with the year prior (48.4% ± 5.2% vs 50.8% ± 4.2%, <em>P</em> = .024). The control cohort showed an increased Corsi percentage (51.6% ± 5.1% vs 48.9% ± 8.1%, <em>P</em> = .011) and increased Fenwick percentage (51.3% ± 4.6% vs 48.8% ± 8.0%, <em>P</em> = .013) at 1 season after the index season. On financial analysis, by season, injured players in the lower salary group showed lower earnings at season 2 ($1,360,000 ± $910,000 vs $3,950,000 ± $3,300,000; <em>P</em> = .012). However, by cumulative earnings, the total injured cohort showed higher earnings at season 4 ($17,300,000 ± $7,760,000 vs $12,960,000 ± $8,100,000; <em>P</em> = .041), driven by higher cumulative earnings in the highest salary group in seasons 3 and 4.</div></div><div><h3>Conclusions</h3><div>After hip arthroscopy for FAIS, 88% of NHL players successfully return to play. Career length was found to be similar between the injured and matched groups. One season after surgery, NHL players showed worse performance compared with their prior season, but this returned to baseline 3 seasons after surgery. Lower-salary players in the injured group showed decreased salaries at 2 seasons after the index season compared with controls, whereas no differences were found in cumulative salaries.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective cohort study.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 1","pages":"Article 101006"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of Asymptomatic Hip Joint Abnormalities Among Adult Professional Soccer Players and Their Association With Age and Limb Dominance","authors":"Eduard Bezuglov Ph.D., M.D. ,&nbsp;Georgiy Malyakin M.D. ,&nbsp;Andrey Sereda D.Med.Sc., M.D. ,&nbsp;Sergey Izmailov M.D. ,&nbsp;Alesya Grinchenko M.D. ,&nbsp;Gleb Chernov M.D. ,&nbsp;Elizaveta Kapralova M.D. ,&nbsp;Anastasiya Lyubushkina M.D. ,&nbsp;Evgeny Goncharov Ph.D., M.D.","doi":"10.1016/j.asmr.2024.101004","DOIUrl":"10.1016/j.asmr.2024.101004","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the prevalence of asymptomatic hip joint abnormalities among adult professional soccer players and to determine the relationship between the number of these abnormalities with age and limb dominance as well as the relationship between those abnormalities themselves.</div></div><div><h3>Methods</h3><div>Adult male professional soccer players from 1 top-division soccer club in a European country underwent magnetic resonance imaging using 1.5 Tesla scanners, the results of which were analyzed independently by 2 experienced radiologists. The incidence of hip osteoarthritis according to the Kellgren-Lawrence and Scoring Hip Osteoarthritis Using MRI classifications, femoroacetabular impingement, hip dysplasia, and presence of os acetabuli was analyzed.</div></div><div><h3>Results</h3><div>A total of 47 patients were included (age 24.5 ± 5.4 years, height 181.5 ± 5.7 cm, body mass index 22.8 ± 1.3). One to 5 magnetic resonance imaging abnormalities were detected in 63 (67%) hip joints. Osteoarthritis of the first and second degree was determined in 46.8% and 18.1% of all hip joints accordingly. The overall prevalence of femoroacetabular impingement was 32%, with pincer-type femoroacetabular impingement occurring in 27.7% of cases, cam type in 11.7%, and mixed type in 6.4% of images. These abnormalities were not related to the dominant leg. Significant correlations were found between cam-type femoroacetabular impingement and osteoarthritis (<em>P</em> = .007), as well as between pincer-type femoroacetabular impingement and osteoarthritis (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>Femoroacetabular impingement was found among one-third of the soccer players with no hip complaints. Additionally, a correlation between the presence of femoroacetabular impingement and hip osteoarthritis was observed. However, these abnormalities do not appear to be associated with leg dominance.</div></div><div><h3>Level of Evidence</h3><div>Level IV, prognostic study.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 1","pages":"Article 101004"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical Malpractice Lawsuits Against Team Physicians in the National Football League Increased Between 1971 and 2020 But Remain Low Overall","authors":"Kaitlynn Littleford B.S. ,&nbsp;Jantz J. Arbon M.D. ,&nbsp;Mikalyn T. DeFoor M.D. ,&nbsp;Daniel J. Cognetti M.D.","doi":"10.1016/j.asmr.2024.101013","DOIUrl":"10.1016/j.asmr.2024.101013","url":null,"abstract":"<div><h3>Purpose</h3><div>To examine malpractice lawsuits filed by National Football League (NFL) players against team physicians to understand the factors involved with medical liability in the context of professional football.</div></div><div><h3>Methods</h3><div>A comprehensive review of publicly available legal databases, court records, and news archives was conducted in August 2023 to identify and analyze malpractice lawsuits involving NFL players, teams, and team physicians. Data on case demographics, physician subspecialty, allegations, and outcomes, including monetary amounts, were collected and analyzed. Linear regression was used to assess for a temporal relation with the number of lawsuits.</div></div><div><h3>Results</h3><div>There were 273 physicians identified, of whom 190 were orthopaedic surgeons. There were 28 lawsuits filed by NFL players against physicians, and a significant increase in lawsuits was identified from 1971 to 2020 (<em>P</em> = .0086, <em>R</em>² = 0.60). The most common anatomic locations of injury in the lawsuits were the knee (n = 11), spine (n = 4), and foot/ankle (n = 4). Other lawsuits included a lawsuit for wrongful death resulting from a heat-related injury, as well as a class action lawsuit regarding pain medication prescribing practices and other individual lawsuits over anti-inflammatory use. The highest amount for which a lawsuit was filed was $180 million, with at least 6 lawsuits filed for over $1 million, although many settlements and final verdicts were not available or were sealed.</div></div><div><h3>Conclusions</h3><div>There was an increase in the number of medical malpractice lawsuits filed by professional athletes against team physicians in the NFL between 1971 and 2020, but the overall number remains low.</div></div><div><h3>Clinical Relevance</h3><div>Understanding the frequency and characteristics of medical malpractice lawsuits is essential for physicians, sports organizations, and policymakers to help guide appropriate health care delivery and risk management strategies for athletes in the NFL.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 1","pages":"Article 101013"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Similar Rates of Return to Play After Operative and Nonoperative Management of Physeal Nonunions and Stress Fractures of the Proximal Ulna in Athletes: A Systematic Review of 174 Patients","authors":"Jacob S. Borgida B.S. ,&nbsp;Rik J. Molenaars M.D. ,&nbsp;Huub H. de Klerk B.S. ,&nbsp;Bert Berenschot M.S. ,&nbsp;Job N. Doornberg M.D., Ph.D. ,&nbsp;Denise Eygendaal M.D., Ph.D. ,&nbsp;Thuan V. Ly M.D. ,&nbsp;Michel P.J. van den Bekerom M.D., Ph.D.","doi":"10.1016/j.asmr.2024.101019","DOIUrl":"10.1016/j.asmr.2024.101019","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze the clinical and demographic presentation, treatment strategies, and outcomes of athletes who sustained proximal ulna stress injuries and elucidate the available evidence on management and anatomic variation.</div></div><div><h3>Methods</h3><div>A literature search was performed on the basis of the medical databases MEDLINE/PubMed and Embase. Articles reporting on sports-related physeal injuries and stress fractures of the proximal ulna were eligible for inclusion. Outcome variables included clinical presentation, imaging assessments, management, and complications.</div></div><div><h3>Results</h3><div>A total of 40 studies were included with 174 athletes who sustained physeal injuries or stress fractures of the proximal ulna. The age ranges of the 74 patients with physeal injuries and 100 patients with stress fractures were 11-26 years and 14-30 years, respectively. Of the studies reporting on clinical symptoms, athletes most commonly presented with olecranon tenderness to palpation and swelling. All athletes with physeal injuries were diagnosed with plain radiographs, whereas 47 athletes who underwent radiography for olecranon stress fractures required additional advanced imaging. Studies on nonoperative management reported return to play rates from 67% to 100% (median, 100% [interquartile range, 100-100%]) and 2 complications were reported (chondromalacia of the trochlear notch and occasional symptomology). One hundred twenty-six patients were treated operatively, of which failure of conservative management was reported in 15 of 40 studies, including 61 athletes. The return to play rates ranged from 67% to 100% (median, 100% [interquartile range, 100-100%]) and 20 complications were reported, most commonly hardware irritation (n = 15).</div></div><div><h3>Conclusions</h3><div>Proximal ulna stress injuries in athletes can be managed either nonoperatively or operatively, with both showing satisfactory rates of return to play. Although operative management was more common, almost one half of these athletes failed an initial trial of nonoperative management.</div></div><div><h3>Level of Evidence</h3><div>Level IV, systematic review of Level III-IV studies.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 1","pages":"Article 101019"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386634","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial Meniscal Posterior Root Tears Are Associated With Steeper Medial Posterior Tibial Slope and Varus Alignment","authors":"Felicitas Allende M.D. ,&nbsp;José Rafael García B.S. ,&nbsp;Salvador González Ayala B.S. ,&nbsp;Lika Dzidzishvili M.D., Ph.D. ,&nbsp;Gonzalo Quiroga M.D. ,&nbsp;Sachin Allahabadi M.D. ,&nbsp;Jorge Chahla M.D., Ph.D.","doi":"10.1016/j.asmr.2024.100998","DOIUrl":"10.1016/j.asmr.2024.100998","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze a series of cases with and without medial meniscal posterior root tears (MMPRTs) to determine whether varus alignment and increased sagittal medial tibial slope (MTS) are risk factors for MMPRTs.</div></div><div><h3>Methods</h3><div>The study evaluated 2 groups of patients: The tear group included patients with arthroscopically confirmed MMPRTs, and the no-tear group consisted of control patients matched to the tear group who underwent similar imaging but did not have meniscal root tears. Age, sex, side of injury, and body mass index were recorded for all cases. Preoperative joint space height and Kellgren-Lawrence grade were measured on radiographs. Group matching was performed based on demographic factors (age, sex, and body mass index), joint space height, and Kellgren-Lawrence grade. Mechanical axis measurements were determined from full-limb-length radiographs. MTS was analyzed on preoperative magnetic resonance imaging. Two observers performed the measurements on 2 separate occasions, and intraobserver reliability and interobserver reliability were analyzed using the intraclass correlation coefficient (ICC). Multivariate regression analysis was performed to identify potential risk factors associated with MMPRTs.</div></div><div><h3>Results</h3><div>Of the 142 matched patients included, 76 had root tears (tear group) and 66 did not (no-tear group). Both mechanical axis (183.2° ± 3.2° vs 181.2° ± 2.3°) and MTS (4° ± 1.9° vs 2.4° ± 2.5°) measurements were significantly greater in the tear group (<em>P</em> &lt; .01 for each). However, despite the statistical significance, the small degrees of difference between the groups raises questions about the clinical significance. The intraobserver ICCs were 0.98 and 0.99 for mechanical axis and 0.87 and 0.98 for MTS. The interobserver ICCs showed excellent reliability for mechanical axis (0.95) and good reliability for MTS (0.77). The lower intraobserver and interobserver reliabilities for MTS measurements also suggest a higher likelihood of error. The multivariate logistic regression model indicated that the risk of sustaining an MMPRT increased with varus alignment (odds ratio, 1.268; 95% confidence interval, 1.104-1.478; <em>P</em> = .001) and increased MTS (odds ratio, 1.364; 95% confidence interval, 1.137-1.677; <em>P</em> = .002).</div></div><div><h3>Conclusions</h3><div>In this study, MMPRTs were associated with varus alignment and steeper MTS. However, the clinical significance of these associations may be limited owing to the small differences between the groups.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective case-control study.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 1","pages":"Article 100998"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Screw Length of 14 mm Is Sufficient to Avoid the Physis During Juvenile Osteochondritis Dissecans Lesion Repair but This Can Vary Based on Age and Region of the Distal Femur","authors":"Patrick A. Massey M.D., M.B.A. ,&nbsp;Gabriel Sampognaro M.D. ,&nbsp;Lincoln Andre M.D. ,&nbsp;Bradley Nelson M.D. ,&nbsp;Robert Rutz M.D. ,&nbsp;Henry Craighead B.S. ,&nbsp;Alberto Simoncini M.D.","doi":"10.1016/j.asmr.2024.101011","DOIUrl":"10.1016/j.asmr.2024.101011","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the safest screw length that will avoid penetrating the femoral physis for surgical fixation of juvenile osteochondritis dissecans lesions and to compare the safe screw lengths for different regions in the condyles.</div></div><div><h3>Methods</h3><div>After institutional review board approval, we retrospectively reviewed T1-weighted magnetic resonance images of pediatric patients. Longitudinal axis reference lines were made on the femur. Lines were then placed at 45° anterior and posterior to this axis to simulate screw start points. From these points, we measured the shortest distance from the articular surface to the physis, noting the shortest distances. These measurements simulated screw lengths in the anterior, posterior, and central regions on both the medial and lateral condyle. Statistical analysis was performed to determine the 95% confidence interval for all measurements. Analysis of variance was performed to compare different regions.</div></div><div><h3>Results</h3><div>A total of 97 knee magnetic resonance images from patients aged 6 to 17 years were reviewed. The safe screw lengths among all samples were 14.1 mm, 20.9 mm, 18.2 mm, 14.4 mm, 17.5 mm, and 14.1 mm for the anteromedial, central medial, posteromedial, anterolateral, central lateral, and posterolateral regions, respectively. There was a difference in simulated screw lengths among all 6 groups (<em>P</em> &lt; .001). There was a moderate correlation between increasing age of the patient and increasing screw length (<em>r</em> = .397, <em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>While a screw length of 14 mm appears to be safe in all ages and regions of the distal femur, safe screw length varies based on age and location of the lesion. The posteromedial region has a safe length of 18 mm.</div></div><div><h3>Clinical Relevance</h3><div>Surgeons must respect the physis when repairing knee osteochondritis dissecans lesions in pediatric patients. Fluoroscopic confirmation should be used to confirm safe screw lengths, and surgeons should use caution when using screws longer than 14 mm (or 18 mm posteromedially), particularly in younger patients.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 1","pages":"Article 101011"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Perineal Post for Hip Arthroscopy Is Dead—Or at Least It Should Be","authors":"Matthew J. Kraeutler M.D.","doi":"10.1016/j.asmr.2024.101068","DOIUrl":"10.1016/j.asmr.2024.101068","url":null,"abstract":"<div><div>Traditionally, distraction of the hip joint during hip arthroscopy has been achieved with the use of a perineal post, which acts as a counterforce. However, our knowledge of the potential complications related to the use of a perineal post continues to grow. Although pudendal neurapraxia is the most common of these potential complications, the perineal post also may cause skin tears of the perineum, erectile dysfunction and, in rare cases, permanent pudendal nerve injury. In response, several techniques for performing postless hip arthroscopy have been developed in recent years. Although some of these techniques are commercially available and some are “do-it-yourself,” preliminary evidence has shown minimal risk of groin-related complications with these postless techniques. In addition to reducing complication rates, our research revealed significantly better patient-reported outcomes with postless compared with post-assisted hip arthroscopy at a minimum 1-year follow-up. Groin-related complications during hip arthroscopy are confusing and anxiety-producing to patients. Hip arthroscopy is an elective procedure, and patients do not expect to have any groin symptoms after a hip surgery. Because this is a sensitive issue, the potential for groin-related complications is rarely discussed with patients preoperatively. In addition, patients often are confused and reluctant to mention groin-related complications to their surgeon, especially if these symptoms are short-lived. Postless hip arthroscopy is a readily accessible, safe alternative to using a perineal post and should be adopted as the standard of care sooner rather than later.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 1","pages":"Article 101068"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Female Sex, Fibromyalgia Diagnosis, Obesity, Tobacco Use, Preoperative Opioid Use, and Postoperative Recurrent Instability Are Risk Factors for Return to the Emergency Department 1 Year After Arthroscopic Shoulder Stabilization","authors":"Jacqueline M. Brady M.D.,&nbsp;Isaac Lapite M.D.,&nbsp;Albert Yim B.S.,&nbsp;Jung U. Yoo M.D.","doi":"10.1016/j.asmr.2024.101016","DOIUrl":"10.1016/j.asmr.2024.101016","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify risk factors for return to the emergency department (ED) 1 year after arthroscopic shoulder stabilization and to evaluate secondary outcomes related to postoperative opioid use and recurrent shoulder instability.</div></div><div><h3>Methods</h3><div>We retrospectively identified patients aged 18 to 30 years old undergoing first-time arthroscopic shoulder stabilization (Current Procedural Terminology code 29806). The PearlDiver database was queried for patients between 2017 and 2019 with minimum of 3 months preoperatively to 24 months postoperative assessment, to analyze returns to the emergency department (ED), 1-year postsurgery opioid use, and recurrent instability.</div></div><div><h3>Results</h3><div>Among 12,223 patients, 2,643 (21.6%) patients had at least 1 ED visit within 1-year postoperation. Factors significantly associated (<em>P</em> &lt; .01) included sex (odds ratio [OR] 0.65), obesity (OR 1.71), tobacco use (OR 3.57), perioperative interscalene nerve block (OR 1.23), and recurrent instability (OR 1.49). When the analysis was carried out in the 642 (5.3%) patients with 3 or more postoperative ED visits, significant predictors (<em>P</em> &lt; .01) were female sex (OR 0.49), fibromyalgia (OR 1.42), obesity (OR 1.96), tobacco use (OR 4.25), preoperative opioid use (OR 1.53), nerve block (OR, 1.36), and recurrent instability (OR 2.19). At 1 year postoperative, 2,160 (17.7%) patients were still taking opioids, with significant predictors (<em>P</em> &lt; .01) of age (OR 1.02), sex (OR 0.58), fibromyalgia (OR 1.46), obesity (OR 1.24), tobacco use (OR 1.60), and preoperative opioid use (OR, 1.86). Recurrent instability was found in 1,012 (8.3%) patients, and tobacco use (OR, 1.60) and preoperative opioid use (OR, 1.29) were significantly predictive (<em>P</em> &lt; .01).</div></div><div><h3>Conclusions</h3><div>Factors predictive of return to ED 1 year after arthroscopic shoulder stabilization included female sex, fibromyalgia diagnosis, obesity, tobacco use, preoperative opioid use, and postoperative recurrent instability. Factors predictive of opioid use 1 year postoperatively included female sex, obesity, tobacco use, and recurrent instability but not preoperative opioid use. Factors predictive of recurrent instability included female sex and tobacco use.</div></div><div><h3>Level of Evidence</h3><div>Level IV, prognostic study.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 1","pages":"Article 101016"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of Surgical Treatment for High-Grade Acromioclavicular Joint Injuries Does Not Affect Functional Outcomes","authors":"Ryan W. Paul B.S. ,&nbsp;Nathaniel Tchangou B.S. ,&nbsp;Krysten Floyd B.S. ,&nbsp;Matthew Sabitsky B.S. ,&nbsp;Gregory Connors B.S. ,&nbsp;Bryson Kemler M.D. ,&nbsp;John Hayden Sonnier M.D. ,&nbsp;Fotios P. Tjoumakaris M.D. ,&nbsp;Kevin B. Freedman M.D.","doi":"10.1016/j.asmr.2024.101017","DOIUrl":"10.1016/j.asmr.2024.101017","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine, using multivariate regression, whether patient-reported outcomes are associated with surgical timing to account for differences between groups.</div></div><div><h3>Methods</h3><div>Patients who underwent acromioclavicular (AC) joint surgery from 2010 to 2019 were included if they underwent primary AC joint surgery for a Rockwood grade III-V AC joint separation. Chart review was conducted to determine time from injury to surgery, Rockwood injury grade, and surgical technique. Postoperative complications, revisions, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) scores, and radiographic outcomes were collected. Radiographic outcomes were determined by measuring coracoclavicular (CC) distance on preoperative, immediate postoperative, and all follow-up anterior-posterior views of the operative shoulder. Multivariate regressions were conducted with postoperative ASES, SANE, and CC distance as the outcomes of interest.</div></div><div><h3>Results</h3><div>Overall, 221 patients (104 early, 117 delayed) with an average age of 40 ± 15 years were included in this study. Significant differences in patient age, body mass index, injury grade, surgical technique used, and preoperative CC distance were observed between groups (all <em>P</em> &lt; .05). After we controlled for confounding variables such as age, sex, body mass index, injury grade, and surgical technique, multivariate regression found that time from injury to surgery was not related to postoperative ASES score (R² = 0.137, <em>P</em> = .563) or postoperative SANE score (R² = 0.087, <em>P</em> = .441). Female patients had lower ASES scores than male patients (estimate: −8.25, 95% confidence interval −15.99 to −0.050, <em>P</em> = .039); however, no other significant relationships were identified from multivariate regression.</div></div><div><h3>Conclusions</h3><div>The timing of AC joint surgery did not affect functional outcomes in patients with AC joint separation.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective cohort study.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"7 1","pages":"Article 101017"},"PeriodicalIF":0.0,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}