Arthroscopy Sports Medicine and Rehabilitation最新文献

{"title":"Immune Hypersensitivity Is Associated With Higher Graft Failure Rate After Osteochondral Allograft Transplantation of the Knee","authors":"Michael Moore B.A.,&nbsp;Luilly Vargas M.D.,&nbsp;Idris Hanidu B.S.,&nbsp;Samuel Zverev B.S.,&nbsp;Andrew Bi M.D.,&nbsp;Jairo Triana B.S.,&nbsp;Guillem Gonzalez Lomas M.D.,&nbsp;Laith Jazrawi M.D.,&nbsp;Eric Strauss M.D.,&nbsp;Kirk A. Campbell M.D.","doi":"10.1016/j.asmr.2024.100933","DOIUrl":"10.1016/j.asmr.2024.100933","url":null,"abstract":"<div><h3>Purpose</h3><p>To analyze the effects of 1 or more patient-reported allergies on clinical outcomes, in particular graft failure rate, and patient-reported outcomes (PROs) following osteochondral allograft transplantation (OCA) of the knee.</p></div><div><h3>Methods</h3><p>Retrospective review of patients who underwent knee OCA from August 2010 to May 2021 with a minimum of 2-year follow-up. Patients were initially divided into 2 cohorts: those with at least 1 allergy and those without any allergies. Clinical outcomes assessed included graft failure, reoperation rates, deep vein thrombosis/pulmonary embolism, and manipulation under anesthesia/lysis of adhesions (MUA/LOA). PROs assessed, including the visual analog scale (VAS) for pain and satisfaction, the Knee injury and Osteoarthritis Outcome Score (KOOS), and return to sport rates, were compared.</p></div><div><h3>Results</h3><p>In total, 285 patients were included with a mean clinical follow-up of 4.8 ± 2.0 years. The allergy cohort had a significantly higher rate of graft failure (<em>P</em> = .008). In a regression analysis controlling for confounding variables, graft failure remained significantly associated with the presence of medication allergies (odds ratio [OR], 3.631; 95% CI, 1.139-11.577; <em>P</em> = .029). Furthermore, an increasing number of allergies were associated with an increased rate of graft failure (OR, 1.644; 95% CI, 1.074-2.515; <em>P</em> = .022). There was no difference in rate of reoperation, complications, infection, and MUA/LOA. Of the 100 patients who completed PROs, there was no difference in VAS satisfaction, pain, and any of the KOOS outcome scores or return to sport.</p></div><div><h3>Conclusions</h3><p>The presence of 1 or more patient-reported allergies was shown to be significantly associated with OCA graft failure. Furthermore, an increasing number of patient-reported allergies were associated with a higher rate of graft failure. However, there were no significant differences in VAS satisfaction or pain, KOOS symptom, quality of life, pain, or return to sport in patients with at least 1 patient-reported allergy and those without allergies.</p></div><div><h3>Level of Evidence</h3><p>Level III, retrospective cohort study.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 3","pages":"Article 100933"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000518/pdfft?md5=a7824285ab6ea684b2c637422cdf54b0&pid=1-s2.0-S2666061X24000518-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140406753","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":"Patient Interest in Quadriceps Autograft Anterior Cruciate Ligament Reconstruction Is Increasing Over Other Autograft Options: A 12-Year Google Trends Analysis","authors":"Joseph C. Brinkman M.D. ,&nbsp;M. Lane Moore B.S. ,&nbsp;Cara Lai M.D. ,&nbsp;Sailesh V. Tummala M.D. ,&nbsp;Jordan R. Pollock B.S. ,&nbsp;Kade S. McQuivey M.D. ,&nbsp;Jeffrey D. Hassebrock M.D. ,&nbsp;Adam B. Thompson B.S. ,&nbsp;Anikar Chhabra M.D.","doi":"10.1016/j.asmr.2024.100942","DOIUrl":"10.1016/j.asmr.2024.100942","url":null,"abstract":"<div><h3>Purpose</h3><p>To use Google trends to explore differences in public interest among types of anterior cruciate ligament (ACL) autografts, specifically quadriceps tendon, patellar tendon, and hamstring tendon autografts, between 2008 and 2019.</p></div><div><h3>Methods</h3><p>Data were obtained by querying Google Trends for key terms and phrases for online search data ranging from January 2008 to December 2019. Relative search volumes were created based on searches related to ACL reconstruction with comparative analysis generated for search terms related to quadriceps ACL, patellar tendon ACL, and hamstring ACL autografts. Statistical analysis included linear regression analysis, comparison of quarterly search volume trends over time, and comparison of cumulative annual search volumes for 2008 versus 2019.</p></div><div><h3>Results</h3><p>Linear models for respective search terms were statistically significant for the quadriceps (<em>P</em> &lt; .001) and patellar (<em>P</em> = .007) tendon autograft groups but not the hamstring group (<em>P</em> = .129). The quadriceps autograft group demonstrated a 12-year search volume trend change of 0.56, which was significantly greater than the hamstring (0.07; <em>P</em> &lt; .001) and patellar tendon (0.168; <em>P</em> &lt; .001) groups. There was no significant difference in the trend change between hamstring and patellar tendon groups (<em>P</em> = .20). Percent change in cumulative relative annual search volumes between 2008 and 2019 was 112% for the quadriceps tendon group, 12.9% for the hamstring group, and 18.6% for the patellar tendon group.</p></div><div><h3>Conclusions</h3><p>This study indicates a consistently increasing public interest in quadriceps tendon autograft for ACL reconstruction. The quadriceps autograft group demonstrated a significantly greater 12-year online search volume, greater linear correlation, and larger percent change between 2008 and 2019 compared with patellar tendon or hamstring autograft groups.</p></div><div><h3>Clinical Relevance</h3><p>Awareness of patient perceptions has value in informing shared decision-making, aligning patient expectations, and guiding areas of future research. Each of these has an impact on patient care. Being aware of patient interest and expectations is particularly important in areas with controversial or emerging research.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 3","pages":"Article 100942"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000609/pdfft?md5=8243baa053d0d31e71f1e983c11a4385&pid=1-s2.0-S2666061X24000609-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140787081","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":"Biocomposite Anchors Have Greater Yield Load and Energy Compared With All-Suture Anchors in an In Vitro Ovine Infraspinatus Tendon Repair Model","authors":"Robert A. Walton M.D. ,&nbsp;Lindsey Liuzza M.D. ,&nbsp;Catherine Takawira M.S. ,&nbsp;Claudia Leonardi Ph.D. ,&nbsp;Mandi J. Lopez D.V.M., M.S., Ph.D.","doi":"10.1016/j.asmr.2024.100938","DOIUrl":"10.1016/j.asmr.2024.100938","url":null,"abstract":"<div><h3>Purpose</h3><p>To compare tensile fatigue and strength measures of biocomposite and all-suture anchors in an ovine humerus-infraspinatus tendon model of rotator cuff repair.</p></div><div><h3>Methods</h3><p>Infraspinatus tendons on adult ovine humeri were sharply transected at the insertion. One of each pair was assigned randomly for fixation with 2 biocomposite or all-suture anchors. Constructs were tested with 200 cycles of 20 to 70 N tensile load, and gap formation was measured at the incised tendon end every 50 cycles. They were subsequently tested to failure. Outcome measures including fatigue stiffness, hysteresis, creep, and gap formation and tensile stiffness, and yield and failure displacement, load, and energy were compared between anchors.</p></div><div><h3>Results</h3><p>Biocomposite anchors had greater yield load (134.1 ± 6.5 N, <em>P</em> &lt; .01) and energy (228.6 ± 85.7 J, <em>P</em> &lt; .03) than all-suture anchors (104.7 ± 6.5 N, 169.8 ± 85.7 J). Fatigue properties were not different between anchors, but stiffness and gap formation increased and hysteresis and creep decreased significantly with increasing cycle number.</p></div><div><h3>Conclusions</h3><p>Although the yield displacement of both anchors was within the range of clinical failure, the tensile yield load and energy of ovine infraspinatus tendons secured to the humerus with 2 single-loaded all-suture anchors in a single row were significantly lower than those secured with 2 biocomposite anchors in the same configuration.</p></div><div><h3>Clinical Relevance</h3><p>It is important to understand the biomechanical properties for selecting anchors for rotator cuff repair. A direct comparison of fatigue testing followed by failure strength of infraspinatus tendon fixation with all-suture and biocomposite anchors could help guide anchor selection and postoperative mobility recommendations.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 3","pages":"Article 100938"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000567/pdfft?md5=28620415db532a670d4d39ab724898b0&pid=1-s2.0-S2666061X24000567-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140792447","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 Use of Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia Is Increasing and Has Low Complication Rates","authors":"Juan Serna B.S.,&nbsp;Kira Furie B.S.,&nbsp;Stephanie E. Wong M.D.,&nbsp;Ishaan Swarup M.D.,&nbsp;Alan L. Zhang M.D.,&nbsp;Mohammad Diab M.D.","doi":"10.1016/j.asmr.2024.100929","DOIUrl":"10.1016/j.asmr.2024.100929","url":null,"abstract":"<div><h3>Purpose</h3><p>To analyze the annual use of hip arthroscopy (HA) and Bernese periacetabular osteotomy (PAO) for the treatment of hip dysplasia (HD), as well as postoperative outcomes, including ipsilateral reoperations.</p></div><div><h3>Methods</h3><p><em>International Classification of Diseases</em>, <em>Ninth</em> and <em>Tenth Revision</em>, codes were used to query the PearlDiver Mariner database from January 2010 through January 2022 to identify patients aged 10 to 59 years who had a presenting diagnosis of HD and subsequently underwent (1) HA; (2) PAO; or (3) combined HA and PAO (HA-PAO, defined as PAO on the same day or within 28 days after HA). We analyzed annual rates for each treatment, as well as rates of postoperative emergency visits, readmissions, and 5-year ipsilateral secondary operations (determined via Kaplan-Meier analysis).</p></div><div><h3>Results</h3><p>There were 32,068 patients who underwent surgical treatment of HD. For HA, PAO, and HA-PAO, there were 29,700, 2,083, and 285 patients, respectively. All operations had the greatest percent-increase from 2015 to 2016. HA and HA-PAO peaked in 2021, whereas PAO peaked in 2019. For HA, PAO, and HA-PAO, most cases were performed in female patients and patients aged 30 to 49 years, 10 to 19 years, and 10 to 29 years, respectively. The 5-year incidence of ipsilateral secondary operations, which include revision HA, PAO, or conversion to total hip arthroplasty, was 9.2% (95% confidence interval 8.6%-9.8%) in the HA group and 6.5% (95% confidence interval 4.1%-8.8%) in the PAO group. Combining HA with PAO resulted in so few secondary operations that Kaplan-Meier analysis was infeasible. The PAO cohort had the greatest 30-day emergency visit and 90-day readmission rates, with infection as the most common cause for readmission.</p></div><div><h3>Conclusions</h3><p>HA is more frequently performed than PAO for hip dysplasia. HA-PAO is increasing at the greatest rate, demonstrating fewer complications and reoperations.</p></div><div><h3>Level of Evidence</h3><p>Level III, retrospective comparative trial.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 3","pages":"Article 100929"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000476/pdfft?md5=bd5ead04aa96f69021acc7fd81c6181a&pid=1-s2.0-S2666061X24000476-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400463","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":"Arthroscopic Partial Meniscectomy in Patients With Kellgren-Lawrence Grade 3 Osteoarthritis Shows Clinically Meaningful Improvement in Outcomes","authors":"Tyler Warner B.S. ,&nbsp;Natalie Lowenstein M.P.H. ,&nbsp;Jillian Mazzocca B.A. ,&nbsp;Jamie Collins Ph.D. ,&nbsp;Elizabeth Matzkin M.D.","doi":"10.1016/j.asmr.2024.100926","DOIUrl":"10.1016/j.asmr.2024.100926","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate patient-reported outcome measures (PROMs) following arthroscopic partial meniscectomy (APM) in patients with Kellgren-Lawrence (KL) grade 3 on preoperative knee radiographs and a symptomatic meniscal tear.</p></div><div><h3>Methods</h3><p>This was a retrospective study design using prospectively collected data from a single institution. Patients were included if they had KL grade 3 osteoarthritis on preoperative radiographs of the knee and completed a trial of nonoperative treatment for at least 6 weeks prior to APM. Patients were excluded if they had inflammatory arthritis, incomplete preoperative and/or 1-year postoperative follow-up data, repeat knee arthroscopy, and concomitant ligamentous injury. Statistical analyses used PROMs, preoperatively and up to 2 years postoperatively, to assess improvement utilizing scales with previously established thresholds, including minimal clinically important difference (MCID) and substantial clinical benefit (SCB).</p></div><div><h3>Results</h3><p>Eighty-two patients met the eligibility criteria (49 women [60%], mean [SD] age, 53.1 [9.3] years). At the 1-year follow-up, most patients achieved MCID: 73% in Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain, 66% in KOOS Symptoms, and 78% in KOOS Activities of Daily Living (ADL). These improvements were similar at the 2-year follow-up: 75%, 72%, and 79% in each subscale, respectively. SCB was also demonstrated 1 year postoperatively, with 56%, 73%, and 71% achieving SCB for the KOOS Pain, Symptoms, and ADL subscales, respectively. These results largely persisted at the 2-year follow-up. Visual analog scale scores for pain also improved at 1- and 2-year postoperative periods with mean improvements from baseline of 2.80 and 2.87 points, respectively. Marx Activity Score decreased on average from baseline to 1- and 2-year follow-up.</p></div><div><h3>Conclusions</h3><p>At a minimum of 1-year follow-up, most patients with KL grade 3 and a meniscal tear achieved MCID and SCB in KOOS Pain, KOOS Symptoms, and KOOS ADL, indicating meaningful outcome improvement for these patients.</p></div><div><h3>Level of Evidence</h3><p>Level IV, therapeutic case series.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 3","pages":"Article 100926"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000440/pdfft?md5=4701d54bda6c2a9399dbcd106ffc223a&pid=1-s2.0-S2666061X24000440-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278337","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":"Tunnel Overlap Occurs 25% of the Time With Simultaneous Anterior Cruciate Ligament Reconstruction and Lateral Meniscal Root Repair","authors":"Steven DeFroda M.D., M.Eng. ,&nbsp;João Bourbon de Albuquerque II M.D., M.B.A., M.Sc., Ph.D. ,&nbsp;Will Bezold B.S. ,&nbsp;Cristi R. Cook D.V.M. ,&nbsp;Clayton W. Nuelle M.D. ,&nbsp;James P. Stannard M.D. ,&nbsp;James L. Cook D.V.M., Ph.D.","doi":"10.1016/j.asmr.2024.100917","DOIUrl":"10.1016/j.asmr.2024.100917","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the risk of socket-tunnel overlap for posterior medial or lateral meniscal root repair combined with anterior cruciate ligament reconstruction (ACLR) using artificial tibias and computed tomography scans for 3-dimensional modeling.</p></div><div><h3>Methods</h3><p>Artificial tibias (n = 27; n = 3/subgroup) were allocated to groups based on inclination of socket-tunnels (55°, 60°, 65°) created for posterior root of the medial meniscus (MMPR) and lateral meniscus posterior root (LMPR) repair, and ACLR. Three standardized socket-tunnels were created: one for the ACL and one for each posterior meniscal root insertion. Computed tomography scans were performed and sequentially processed using computer software to produce 3-dimensional models for assessment of socket-tunnel overlap. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney <em>U</em> tests. Significance was set at <em>P</em> &lt; .05.</p></div><div><h3>Results</h3><p>The present study found no significant risk of tunnel overlap when drilling for combined ACLR and MMPR repair, whereas 7 cases of tunnel overlap occurred between ACL tunnels and LMPR (25.9% of cases). No subgroup or specific pattern of angulation consistently presented significantly safer distances than other subgroups for all distances measured.</p></div><div><h3>Conclusions</h3><p>This study demonstrated 25.9% rate of overlap for combined LMPR repair and ACLR, compared with 0% for MMPR repair with ACLR. Lower ACL drilling angle (55 or 60°) combined with greater lateral meniscus drilling angle (65°) produced no socket-tunnel overlap.</p></div><div><h3>Clinical Relevance</h3><p>Socket-tunnel overlap during meniscal root repair combined with ACLR may compromise graft integrity and lead to impaired fixation and treatment failure of either the ACL, the meniscus, or both. Despite this, risk for socket-tunnel overlap has not been well characterized.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 3","pages":"Article 100917"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X2400035X/pdfft?md5=141be985b10378c4768cd82cb9991f3c&pid=1-s2.0-S2666061X2400035X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140467124","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":"Effect of Age and Sex on Anterior Cruciate Ligament Functional Tests Approximately 6 Months After Anterior Cruciate Ligament Reconstruction","authors":"Dai Sugimoto Ph.D., A.T.C. ,&nbsp;Matthew D. Milewski M.D. ,&nbsp;Kathryn A. Williams M.S. ,&nbsp;Ryan P. Coene M.S. ,&nbsp;Kianna D. Nunally B.A. ,&nbsp;Mininder S. Kocher M.D., M.P.H. ,&nbsp;Dennis E. Kramer M.D. ,&nbsp;Lyle J. Micheli M.D. ,&nbsp;Yi-Meng Yen M.D., Ph.D. ,&nbsp;Melissa A. Christino M.D.","doi":"10.1016/j.asmr.2024.100897","DOIUrl":"10.1016/j.asmr.2024.100897","url":null,"abstract":"<div><h3>Purpose</h3><p>To examine age- and sex-related differences in postoperative functional outcomes at approximately 6 months after anterior cruciate ligament reconstruction (ACLR).</p></div><div><h3>Methods</h3><p>In this study, patients who underwent primary ACLR performed a series of return-to-sport functional tests at 5 to 8 months after surgery. Functional tests included strength tests (knee extensors, knee flexors, hip abductors, and hip extensors), a balance test (Y-balance composite score), and hop tests (single, triple, crossover, and 6-m timed hop tests). Limb symmetry was calculated to compare the reconstructed limb with the uninvolved limb. A 2-way multivariate analysis of covariance was used, and effect size was calculated for data analysis.</p></div><div><h3>Results</h3><p>A total of 176 subjects were included in this study. There were no significant interaction between age and sex on return-to-sport functional tests after ACLR. Also, no main effects of age and sex on return-to-sport functional tests were found in our data.</p></div><div><h3>Conclusions</h3><p>Age and sex do not significantly affect functional test performance after ACLR 6 months postoperatively.</p></div><div><h3>Level of Evidence</h3><p>Level III, retrospective review of prospective cohort study.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 3","pages":"Article 100897"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000154/pdfft?md5=17de1effa74f069f360eb25db83bf8a3&pid=1-s2.0-S2666061X24000154-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140516492","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":"Anterior Mobility of the Posterior Horn of the Lateral Meniscus Is Associated With Abnormal Magnetic Resonance Imaging Findings of Anteroinferior Popliteomeniscal Fascicle and Posterosuperior Popliteomeniscal Fascicle as Well as a Clinical History of Catching or Locking Symptoms","authors":"Jun Suganuma M.D. ,&nbsp;Ryuta Mochizuki M.D.","doi":"10.1016/j.asmr.2024.100922","DOIUrl":"10.1016/j.asmr.2024.100922","url":null,"abstract":"<div><h3>Purpose</h3><p>To identify predictors of anterior mobility of the posterior horn of the lateral meniscus (PHLM) among patient demographics (age, sex), clinical characteristics (a history of catching or locking symptoms [CLS], body mass index, alignment of limb), and magnetic resonance imaging (MRI) findings of 4 restraints: anteroinferior popliteomeniscal fascicle (aiPMF), posterosuperior popliteomeniscal fascicle (psPMF), posteroinferior popliteomeniscal fascicle (piPMF), and meniscofibular ligament (MFibL).</p></div><div><h3>Methods</h3><p>Between October 2010 and December 2014, patients who underwent arthroscopic measurement of mobility of the PHLM were identified. The Sakai classification was used to classify aiPMF and psPMF on MRI into the following 3 types: type A, the fascicle was depicted with obvious continuity and with a low-intensity band; type B, depicted with continuity but with an ambiguous intensity structure; and type C, depicted with discontinuity or not visible. Magnetic resonance images of the piPMF and MFibL were evaluated as presence or absence. The mobility of the PHLM was measured arthroscopically at traction forces of 10 and 20 N.</p></div><div><h3>Results</h3><p>A total of 73 patients (47 men, mean age 41.8 ± 19.3 years) were included. Multivariate regression analyses revealed aiPMF type C and psPMF types B and C to be independent factors associated with mobility at both traction forces, and CLS was an independent factor at a traction force of 20 N. Compared with that of type A, the increased mobility of aiPMF type C was 5.0 mm (<em>P</em> = .019) and 5.6 mm (<em>P</em> = .011) at 10 and 20 N, respectively; the increased mobility of psPMF type B was 2.5 mm (<em>P</em> = .007) and 3.5 mm (<em>P</em> = .0003), respectively; and the increased mobility of psPMF type C was 3.3 mm (<em>P</em> = .021) and 3.6 mm (<em>P</em> = .014), respectively. The increased mobility associated with CLS was 3.5 mm at 20 N (<em>P</em> = .022).</p></div><div><h3>Conclusions</h3><p>Anterior displacement of the PHLM induced by an external traction force at 90° of flexion of the knee joint was associated with abnormal MRI findings of the anteroinferior popliteomeniscal fascicle and posterosuperior popliteomeniscal fascicle, as well as a history of catching or locking symptoms.</p></div><div><h3>Clinical Relevance</h3><p>Understanding signs and symptoms and associated pathology in patients with symptomatic anterior mobility of the posterior horn of the lateral meniscus may help guide best treatment.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 3","pages":"Article 100922"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000403/pdfft?md5=fe5f094bfd65a4a8b1f05a1e70370de1&pid=1-s2.0-S2666061X24000403-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140275067","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":"Segond Fractures Can Be Identified With Excellent Accuracy Utilizing Deep Learning on Anteroposterior Knee Radiographs","authors":"Jacob F. Oeding M.S. ,&nbsp;Ayoosh Pareek M.D. ,&nbsp;Kyle N. Kunze M.D. ,&nbsp;Benedict U. Nwachukwu M.D., M.B.A. ,&nbsp;Harry G. Greditzer IV M.D. ,&nbsp;Christopher L. Camp M.D. ,&nbsp;Bryan T. Kelly M.D. ,&nbsp;Andrew D. Pearle M.D. ,&nbsp;Anil S. Ranawat M.D. ,&nbsp;Riley J. Williams III M.D. ,&nbsp;HSS ACL Reconstruction Registry","doi":"10.1016/j.asmr.2024.100940","DOIUrl":"10.1016/j.asmr.2024.100940","url":null,"abstract":"<div><h3>Purpose</h3><p>To develop a deep learning model for the detection of Segond fractures on anteroposterior (AP) knee radiographs and to compare model performance to that of trained human experts.</p></div><div><h3>Methods</h3><p>AP knee radiographs were retrieved from the Hospital for Special Surgery ACL Registry, which enrolled patients between 2009 and 2013. All images corresponded to patients who underwent anterior cruciate ligament reconstruction by 1 of 23 surgeons included in the registry data. Images were categorized into 1 of 2 classes based on radiographic evidence of a Segond fracture and manually annotated. Seventy percent of the images were used to populate the training set, while 20% and 10% were reserved for the validation and test sets, respectively. Images from the test set were used to compare model performance to that of expert human observers, including an orthopaedic surgery sports medicine fellow and a fellowship-trained orthopaedic sports medicine surgeon with over 10 years of experience.</p></div><div><h3>Results</h3><p>A total of 324 AP knee radiographs were retrieved, of which 34 (10.4%) images demonstrated evidence of a Segond fracture. The overall mean average precision (mAP) was 0.985, and this was maintained on the Segond fracture class (mAP = 0.978, precision = 0.844, recall = 1). The model demonstrated 100% accuracy with perfect sensitivity and specificity when applied to the independent testing set and the ability to meet or exceed human sensitivity and specificity in all cases. Compared to an orthopaedic surgery sports medicine fellow, the model required 0.3% of the total time needed to evaluate and classify images in the independent test set.</p></div><div><h3>Conclusions</h3><p>A deep learning model was developed and internally validated for Segond fracture detection on AP radiographs and demonstrated perfect accuracy, sensitivity, and specificity on a small test set of radiographs with and without Segond fractures. The model demonstrated superior performance compared with expert human observers.</p></div><div><h3>Clinical Relevance</h3><p>Deep learning can be used for automated Segond fracture identification on radiographs, leading to improved diagnosis of easily missed concomitant injuries, including lateral meniscus tears. Automated identification of Segond fractures can also enable large-scale studies on the incidence and clinical significance of these fractures, which may lead to improved management and outcomes for patients with knee injuries.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 3","pages":"Article 100940"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000580/pdfft?md5=08c9d375b9d6d728f6d38e20ff69efbe&pid=1-s2.0-S2666061X24000580-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140768316","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":"Responses From ChatGPT-4 Show Limited Correlation With Expert Consensus Statement on Anterior Shoulder Instability","authors":"Alexander Artamonov M.D. ,&nbsp;Ira Bachar-Avnieli M.D. ,&nbsp;Eyal Klang M.D. ,&nbsp;Omri Lubovsky M.D. ,&nbsp;Ehud Atoun M.D. ,&nbsp;Alexander Bermant M.D. ,&nbsp;Philip J. Rosinsky M.D.","doi":"10.1016/j.asmr.2024.100923","DOIUrl":"10.1016/j.asmr.2024.100923","url":null,"abstract":"<div><h3>Purpose</h3><p>To compare the similarity of answers provided by Generative Pretrained Transformer-4 (GPT-4) with those of a consensus statement on diagnosis, nonoperative management, and Bankart repair in anterior shoulder instability (ASI).</p></div><div><h3>Methods</h3><p>An expert consensus statement on ASI published by Hurley et al. in 2022 was reviewed and questions laid out to the expert panel were extracted. GPT-4, the subscription version of ChatGPT, was queried using the same set of questions. Answers provided by GPT-4 were compared with those of the expert panel and subjectively rated for similarity by 2 experienced shoulder surgeons. GPT-4 was then used to rate the similarity of its own responses to the consensus statement, classifying them as low, medium, or high. Rates of similarity as classified by the shoulder surgeons and GPT-4 were then compared and interobserver reliability calculated using weighted κ scores.</p></div><div><h3>Results</h3><p>The degree of similarity between responses of GPT-4 and the ASI consensus statement, as defined by shoulder surgeons, was high in 25.8%, medium in 45.2%, and low 29% of questions. GPT-4 assessed similarity as high in 48.3%, medium in 41.9%, and low 9.7% of questions. Surgeons and GPT-4 reached consensus on the classification of 18 questions (58.1%) and disagreement on 13 questions (41.9%).</p></div><div><h3>Conclusions</h3><p>The responses generated by artificial intelligence exhibit limited correlation with an expert statement on the diagnosis and treatment of ASI.</p></div><div><h3>Clinical Relevance</h3><p>As the use of artificial intelligence becomes more prevalent, it is important to understand how closely information resembles content produced by human authors.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 3","pages":"Article 100923"},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000415/pdfft?md5=64dacbe11c8dcaec53b3b836778ff98c&pid=1-s2.0-S2666061X24000415-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140273860","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}