Arthroscopy Sports Medicine and Rehabilitation最新文献

{"title":"Autologous Chondrocyte Implantation Is Not Better Than Arthroscopic Debridement for the Treatment of Symptomatic Cartilage Lesions of the Knee: Two-Year Results From a Randomized-Controlled Trial","authors":"Per-Henrik Randsborg Ph.D., M.D. ,&nbsp;Jan E. Brinchmann M.D., Ph.D. ,&nbsp;Christian Owesen M.D., Ph.D. ,&nbsp;Lars Engebretsen M.D., Ph.D. ,&nbsp;Thomas Birkenes M.D. ,&nbsp;Heidi Andreassen Hanvold P.T. ,&nbsp;Jūratė Šaltytė Benth M.S., Ph.D. ,&nbsp;Asbjørn Årøen M.D., Ph.D.","doi":"10.1016/j.asmr.2024.100909","DOIUrl":"10.1016/j.asmr.2024.100909","url":null,"abstract":"<div><h3>Purpose</h3><p>To compare the functional and patient-reported outcome measures after autologous chondrocyte implantation (ACI) and arthroscopic debridement (AD) in symptomatic, isolated cartilage injuries larger than 2 cm² in patients aged 18 to 50 years.</p></div><div><h3>Methods</h3><p>Twenty-eight patients were included and randomized to ACI (n = 15) or AD (n = 13) and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscale.</p></div><div><h3>Results</h3><p>The mean age at inclusion was 34.1 (standard deviation [SD] 8.5) years. There were 19 (68%) male patients. The mean size of the lesion was 4.2 (SD 1.7) cm². There was a statistically significant and clinically meaningful improvement in patient-reported outcome measures from baseline to 2 years in both groups. The improvement from baseline to final follow-up for the primary endpoint (the KOOS QoL subscale) was larger for the AD group (39.8, SD 9.4) compared with the ACI group (23.8, SD 6.7), but this difference was not statistically significant (<em>P</em> = .17). However, according to a mixed linear model there were statistically significantly greater scores in the AD group for several KOOS subscales at several time points, including KOOS QoL, KOOS pain, and KOOS sport and recreation at 2 years.</p></div><div><h3>Conclusions</h3><p>This study indicates that AD followed by supervised physiotherapy is equal to or better than ACI followed by supervised physiotherapy in patients with isolated cartilage lesions of the knee larger than 2 cm². The improvement in KOOS QoL score from baseline to 2 years was clinically meaningful for both groups (23.8 points for ACI and 39.8 points AD), and larger for the AD group by 16 points.</p></div><div><h3>Level of Evidence</h3><p>Level I, prospective randomized controlled trial.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 2","pages":"Article 100909"},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000270/pdfft?md5=24fab6e9c2e14b5169e9a48b1988c94b&pid=1-s2.0-S2666061X24000270-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139966251","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 Addition of a Pericapsular Nerve Group Block for Postoperative Pain Control Does Not Result in Less Narcotic Use After Hip Arthroscopy: A Systematic Review","authors":"Grace Tanguilig B.S. ,&nbsp;Jaydeep Dhillon B.S. ,&nbsp;Anthony J. Scillia M.D. ,&nbsp;Wendell M.R. Heard M.D. ,&nbsp;Matthew J. Kraeutler M.D.","doi":"10.1016/j.asmr.2024.100894","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100894","url":null,"abstract":"<div><h3>Purpose</h3><p>To perform a systematic review of clinical studies evaluating the pericapsular nerve group (PENG) block in patients undergoing hip arthroscopy.</p></div><div><h3>Methods</h3><p>A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify comparative studies of patients undergoing the PENG block before hip arthroscopy. The search phrase used was <em>hip arthroscopy pericapsular nerve block</em>. Patients were evaluated based on analgesic consumption, time to discharge from the postanesthesia care unit (PACU), and pain scores (Numeric Rating Scale and visual analog scale). The Modified Coleman Methodology Score was used to evaluate study methodology quality.</p></div><div><h3>Results</h3><p>Five studies (2 Level I, 3 Level III) met inclusion criteria. The 5 studies included the following comparison groups: 0.9% normal saline injection, general anesthesia alone, and general anesthesia with intraoperative pericapsular bupivacaine injection. The 2 randomized controlled trials included in this review reported no significant difference between groups regarding opioid consumption. One of these did not find any statistically significant differences in their secondary outcomes either, including patient satisfaction with analgesia, opioid-related adverse events, or persistent opioid use at 1 week. However, the other 3 studies found significantly lower opioid consumption in patients receiving the PENG block versus the control group intraoperatively, in the PACU, and/or postoperatively. Four studies reported significantly lower pain levels in the PENG block group compared with the control groups, measured differently in each study: 24 hours postoperatively, initial pain score in the PACU, mean score in the PACU, and highest score in the PACU. None of the studies found significantly worse outcomes in the PENG block group compared to the comparison group.</p></div><div><h3>Conclusions</h3><p>Systematic review of randomized controlled trials shows that patients undergoing hip arthroscopy who receive a PENG block do not consume fewer opioids for postoperative pain control than patients who do not receive the block.</p></div><div><h3>Level of Evidence</h3><p>Level III, systematic review of Level I-III studies.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 2","pages":"Article 100894"},"PeriodicalIF":0.0,"publicationDate":"2024-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000129/pdfft?md5=095c6224ea11425b83c8527e6d2f1124&pid=1-s2.0-S2666061X24000129-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139738117","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":"Low Tensile Strength Suture With Transosseous Tunnels and Suture Anchors 5 mm in Diameter or Greater Are Associated With Higher Failure Rates in Primary Patellar Tendon Repair","authors":"Mark S. Katsma D.O. ,&nbsp;Vaughn Land M.D. ,&nbsp;S. Hunter Renfro M.D. ,&nbsp;Hunter Culp M.D. ,&nbsp;George C. Balazs M.D.","doi":"10.1016/j.asmr.2024.100908","DOIUrl":"10.1016/j.asmr.2024.100908","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine the rate of and risk factors for clinical failure and return to military duty following primary patellar tendon repair with either transosseous trunnel repair or suture anchor repair.</p></div><div><h3>Methods</h3><p>The Military Health System Data Repository (MDR) was queried to identify all adult patients undergoing surgical treatment of a patellar tendon rupture in the Military Health System from 2014 to 2018. Patients who underwent either transosseous tunnel repair or suture anchor repair were included. Health records were examined to collect additional data. Univariate analysis and multivariate logistic regression models were used to determine independent risk factors for rerupture.</p></div><div><h3>Results</h3><p>A total of 450 knees in 437 patients were included. Transosseous tunnel repair was the most frequently used technique (314/450, 77%), followed by suture anchor repair (113/450, 25%). Rerupture occurred in 33 knees (7%). There was no difference in rerupture rate between transosseous tunnel repair and suture anchor repair (<em>P</em> = .15), and this result persisted within the multivariate logistic regression model. Among transosseous tunnel repairs, use of low tensile strength suture was an independent risk factor for repair failure (odds ratio [OR], 3.4; <em>P</em> = .016). Among suture anchor repairs, use of anchors 5.0 mm in diameter or greater (OR, 12.0; <em>P</em> = .027) was an independent risk factor for repair failure.</p></div><div><h3>Conclusions</h3><p>There is no statistically significant difference in failure rate between transosseous tunnel repair and suture anchor repair in primary patellar tendon ruptures. However, the use of low tensile strength suture with transosseous tunnels and the use of suture anchors 5.0 mm in diameter or greater resulted in significantly higher failure rates. These data suggest that use of high tensile strength suture in transosseous tunnel repair and use of suture anchors less than 5.0 mm in diameter in suture anchor repair result in lower failure rate in primary patellar tendon repair.</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 2","pages":"Article 100908"},"PeriodicalIF":0.0,"publicationDate":"2024-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000269/pdfft?md5=10c587973fb95d67d80475e32cd14e5e&pid=1-s2.0-S2666061X24000269-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139874353","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":"Traumatic and Atraumatic Rotator Cuff Tears Have the Same Rates of Healing","authors":"Alberto Guevara-Alvarez M.D. ,&nbsp;Edwin A. Valencia-Ramon M.D. ,&nbsp;Hugo Bothorel M.Eng. ,&nbsp;Philippe Collin M.D. ,&nbsp;Jeanni Zbinden M.D. ,&nbsp;Alberto Guizzi M.D. ,&nbsp;Alexandre Lädermann M.D.","doi":"10.1016/j.asmr.2023.100867","DOIUrl":"https://doi.org/10.1016/j.asmr.2023.100867","url":null,"abstract":"<div><h3>Background</h3><p>To examine whether traumatic rotator cuff repairs (RCRs) differ in postoperative rotator cuff tendon integrity and functional outcomes from degenerative RCRs.</p></div><div><h3>Methods</h3><p>RCRs performed by a single surgeon were retrospectively identified. The inclusion criteria were repairable Goutallier grades 0 to 2 full-thickness rotator cuff tears. Demographic and clinical data as well as radiological results were compared. A multivariate logistic regression of the of patient acceptable symptom state for American Shoulder and Elbow Surgeons (ASES) score was performed to evaluate whether the origin of tear led to a different relative risk (RR) independently from tear and surgical characteristics.</p></div><div><h3>Results</h3><p>A total of 616 consecutive shoulders (304 traumatic and 312 degenerative) were finally included. Traumatic ruptures presented a greater distribution of male (72% vs 51%, <em>P</em> &lt; .001) and younger patients (53 vs 57 years, <em>P</em> &lt; .001), as well as earlier onset of symptoms (3 vs 15 months, <em>P</em> &lt; .001), reduced range of motion in preoperative assessment for forward elevation (130° vs 150°, <em>P</em> &lt; .001), and slightly greater preoperative ASES (46.5 ± 19.7 vs 50.0 ± 18.0, <em>P</em> = .022) and Constant (47.0 ± 20.2 vs 52.0 ± 18.9, <em>P</em> = .001) scores. Degenerative tears presented a lower proportion of grade 3 tendon coronal retraction (11% vs 18%, <em>P</em> = .031). Postoperative tendon integrity at 6 months was comparable for both groups, predominantly Sugaya types 1 and 2 (91% traumatic; 92% degenerative, <em>P</em> = .371). Both groups exhibited favorable outcomes in range of motion and postoperative functional scores at last follow-up. The multivariate regression confirmed that the tear origin was not significantly associated with patient acceptable symptom state achievement (<em>P</em> = .201) but rather with greater preoperative ASES score (RR, 1.01), men (RR, 1.16) and workers’ compensation (RR, 0.65) (<em>P</em> &lt; .05).</p></div><div><h3>Conclusions</h3><p>Traumatic cases were frequent, involved younger patients, more frequently affected the anterior rotator cuff, and were associated with more severe tendon retraction. Traumatic and degenerative RCRs lead to comparable clinical and radiologic results.</p></div><div><h3>Level of Evidence</h3><p>Level III, retrospective comparative study.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 2","pages":"Article 100867"},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X23002183/pdfft?md5=d8ed767671865c7928b411902f345957&pid=1-s2.0-S2666061X23002183-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139731596","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 Resilience Does Not Conclusively Affect Clinical Outcomes Associated With Arthroscopic Surgery but Substantial Limitations of the Literature Exist","authors":"Mikalyn T. DeFoor M.D. ,&nbsp;Daniel J. Cognetti M.D. ,&nbsp;Asheesh Bedi M.D. ,&nbsp;David B. Carmack Jr. M.D. ,&nbsp;Justin W. Arner M.D. ,&nbsp;Steven DeFroda M.D. ,&nbsp;Justin J. Ernat M.D., M.H.A. ,&nbsp;Salvatore J. Frangiamore M.D., M.S. ,&nbsp;Clayton W. Nuelle M.D. ,&nbsp;Andrew J. Sheean M.D.","doi":"10.1016/j.asmr.2023.100812","DOIUrl":"https://doi.org/10.1016/j.asmr.2023.100812","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine whether low resilience is predictive of worse patient-reported outcomes (PROs) or diminished improvements in clinical outcomes after joint preserving and arthroscopic surgery.</p></div><div><h3>Methods</h3><p>A comprehensive search of PubMed, Medline, Embase, and Science Direct was performed on September 28, 2022, for studies investigating the relationship between resilience and PROs after arthroscopic surgery in accordance with the Preferred Reported Items for Systematic Reviews and Meta-analyses guidelines.</p></div><div><h3>Results</h3><p>Nine articles (level II-IV studies) were included in the final analysis. A total of 887 patients (54% male, average age 45 years) underwent arthroscopic surgery, including general knee (n = 3 studies), ACLR-only knee (n = 1 study), rotator cuff repair (n = 4 studies), and hip (n = 1 study). The Brief Resilience Scale was the most common instrument measuring resilience in 7 of 9 studies (78%). Five of 9 studies (56%) stratified patients based on high, normal, or low resilience cohorts, and these stratification threshold values differed between studies. Only 4 of 9 studies (44%) measured PROs both before and after surgery. Three of 9 studies (33%) reported rates of return to activity, with 2 studies (22%) noting high resilience to be associated with a higher likelihood of return to sport/duty, specifically after knee arthroscopy. However, significant associations between resilience and functional outcomes were not consistently observed, nor was resilience consistently observed to be predictive of subjects’ capacity to return to a preinjury level of function.</p></div><div><h3>Conclusions</h3><p>Patient resilience is inconsistently demonstrated to affect clinical outcomes associated with joint preserving and arthroscopic surgery. However, substantial limitations in the existing literature including underpowered sample sizes, lack of standardization in stratifying patients based on pretreatment resilience, and inconsistent collection of PROs throughout the continuum of care, diminish the strength of most conclusions that have been drawn.</p></div><div><h3>Level of Evidence</h3><p>Level IV, systematic review of level II-IV studies.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 2","pages":"Article 100812"},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X23001633/pdfft?md5=f4471676e664bad91596904c13e74b20&pid=1-s2.0-S2666061X23001633-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139732585","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":"An All-Suture–Based Technique for Meniscal Repair Is Cost-Effective in Comparison to Partial Meniscectomy for Horizontal Cleavage Tears","authors":"Seth L. Sherman M.D. ,&nbsp;Neil Askew M.Sc. ,&nbsp;Leo M. Nherera Ph.D. ,&nbsp;Richard J. Searle Ph.D. ,&nbsp;David C. Flanigan M.D.","doi":"10.1016/j.asmr.2023.100847","DOIUrl":"https://doi.org/10.1016/j.asmr.2023.100847","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine the cost-effectiveness of meniscal repair (MR) using an all-suture–based technique when compared to partial meniscectomy (PM) for horizontal cleavage tears (HCTs) from a payor’s perspective in the United States.</p></div><div><h3>Methods</h3><p>A state-transition model and cost-utility analysis were developed from a US payor’s perspective to project treatment costs and quality-adjusted life-years (QALYs) in a cohort of 35-year-old patients without osteoarthritis at baseline and presenting with either a lateral or medial HCT. Two outpatient costing perspectives were used, namely ambulatory surgical centers (ASCs) and hospitals. The state-transition model had 7 health states with transition probabilities, costs, and utilities obtained from the existing literature. Cost-effectiveness was assessed using a willingness-to-pay threshold of $100,000/QALY, and sensitivity analysis considered the effects of parameter uncertainty on model results. MR failure rates were focused on an all-suture–based technique; however, in a separate scenario, this study considered effectiveness data from various MR techniques and devices.</p></div><div><h3>Results</h3><p>MR dominated PM over a lifetime horizon, increasing QALYs by 0.43 per patient and decreasing the cost by $12,227 per patient within a hospital setting (and by $12,570 within an ASC). MR with an all-suture–based technique continued to be the dominant treatment when age at primary treatment was varied between 30 and 60 years. Sensitivity analysis showed that MR was not cost-effective in year 1, was cost-effective from year 2, and was cost-saving from year 6 onward from both ASC and hospital perspectives. Probabilistic sensitivity analysis found that MR was cost-effective over a lifetime horizon in 99% of 10,000 iterations on base-case analysis.</p></div><div><h3>Conclusions</h3><p>Using a lifetime horizon, this study found that from a payor’s perspective, MR is a cost-saving intervention when compared with PM in patients with an HCT.</p></div><div><h3>Level of Evidence</h3><p>Level III, economic analysis.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 2","pages":"Article 100847"},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X23001980/pdfft?md5=70342cde14a2ae0deb821c8ae9672ff5&pid=1-s2.0-S2666061X23001980-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139732517","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":"ChatGPT Can Offer Satisfactory Responses to Common Patient Questions Regarding Elbow Ulnar Collateral Ligament Reconstruction","authors":"William L. Johns M.D. ,&nbsp;Alec Kellish M.D. ,&nbsp;Dominic Farronato B.S. ,&nbsp;Michael G. Ciccotti M.D. ,&nbsp;Sommer Hammoud M.D.","doi":"10.1016/j.asmr.2024.100893","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100893","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine whether ChatGPT effectively responds to 10 commonly asked questions concerning ulnar collateral ligament (UCL) reconstruction.</p></div><div><h3>Methods</h3><p>A comprehensive list of 90 UCL reconstruction questions was initially created, with a final set of 10 “most commonly asked” questions ultimately selected. Questions were presented to ChatGPT and its response was documented. Responses were evaluated independently by 3 authors using an evidence-based methodology, resulting in a grading system categorized as follows: (1) excellent response not requiring clarification; (2) satisfactory requiring minimal clarification; (3) satisfactory requiring moderate clarification; and (4) unsatisfactory requiring substantial clarification.</p></div><div><h3>Results</h3><p>Six of 10 ten responses were rated as “excellent” or “satisfactory.” Of those 6 responses, 2 were determined to be “excellent response not requiring clarification,” 3 were “satisfactory requiring minimal clarification,” and 1 was “satisfactory requiring moderate clarification.” Four questions encompassing inquiries about “What are the potential risks of UCL reconstruction surgery?” “Which type of graft should be used for my UCL reconstruction?” and “Should I have UCL reconstruction or repair?” were rated as “unsatisfactory requiring substantial clarification.”</p></div><div><h3>Conclusions</h3><p>ChatGPT exhibited the potential to improve a patient’s basic understanding of UCL reconstruction and provided responses that were deemed satisfactory to excellent for 60% of the most commonly asked questions. For the other 40% of questions, ChatGPT gave unsatisfactory responses, primarily due to a lack of relevant details or the need for further explanation.</p></div><div><h3>Clinical Relevance</h3><p>ChatGPT can assist in patient education regarding UCL reconstruction; however, its ability to appropriately answer more complex questions remains to be an area of skepticism and future improvement.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 2","pages":"Article 100893"},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000117/pdfft?md5=2050f137b07df1e314a24ed314d80097&pid=1-s2.0-S2666061X24000117-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139725918","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":"Smokers Achieved Minimal Clinically Important Difference for Visual Analog Scale and American Shoulder and Elbow Surgeons Scores at a Lower Rate Than Nonsmokers Even When Repaired Supraspinatus Tendons Were Intact on Postoperative Magnetic Resonance Imaging","authors":"W P Yau M.B.B.S., F.R.C.S.Ed., F.R.C.S.Ed. (Ortho.), F.H.K.C.O.S., F.H.K.A.M. (Orthopaedic Surgery)","doi":"10.1016/j.asmr.2023.100877","DOIUrl":"https://doi.org/10.1016/j.asmr.2023.100877","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate the impact of smoking on clinical outcomes after repair of supraspinatus tendon in patients who had an intact repair found on postoperative magnetic resonance imaging.</p></div><div><h3>Methods</h3><p>Patients who received primary complete repair of supraspinatus tendon tear between 2014 and 2020 were retrospectively identified. Patients were excluded if a postoperative magnetic resonance imaging scan was not available or if the follow-up was less than 2 years. Visual analog score (VAS), American Shoulder and Elbow Surgeons (ASES) score, and active forward flexion were assessed at the 2-year follow-up. The percentage of patients acquiring minimal clinically important difference (MCID) was reported.</p></div><div><h3>Results</h3><p>One hundred primary supraspinatus tendon repairs were included. The healing rate was 77% in smokers and 90% in nonsmokers. Smoking was the independent predictor of a poorer 2-year VAS (<em>P</em> &lt; .001) and ASES (<em>P</em> &lt; .001) scores. Significant improvement in clinical outcomes was observed between preoperation and the 2-year follow-up, regardless of the integrity of the repair or smoking status (<em>P</em> &lt; .001). When the repaired tendon was intact, nonsmokers had a greater chance of achieving MCID in 2-year VAS and ASES scores than smokers. Ninety-nine percent of nonsmokers, compared with 82% of smokers, achieved MCID in VAS at the 2-year follow-up (<em>P</em> = .023). The corresponding figures for ASES were 98% and 71%, respectively (<em>P</em> = .004).</p></div><div><h3>Conclusions</h3><p>In this study, smoking was associated with poorer clinical outcomes, including a greater 2-year VAS pain score and a lower 2-year ASES score, when compared with nonsmokers, even in cases in which there was no full-thickness retear of the repaired supraspinatus tendon.</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 2","pages":"Article 100877"},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X23002286/pdfft?md5=2533962af1c98fae08d08669522a3c2d&pid=1-s2.0-S2666061X23002286-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139731597","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":"Tibial Tubercle Trochlear Groove Distance Does Not Correlate With Patellar Tendon Length in Patients Who Underwent Anterior Cruciate Ligament Reconstruction","authors":"Emma E. Johnson M.D.,&nbsp;William L. Johns M.D.,&nbsp;Bryson Kemler M.D.,&nbsp;Rahul Muchintala B.S.,&nbsp;Ryan W. Paul B.S.,&nbsp;Manoj Reddy M.D.,&nbsp;Brandon J. Erickson M.D.","doi":"10.1016/j.asmr.2023.100870","DOIUrl":"https://doi.org/10.1016/j.asmr.2023.100870","url":null,"abstract":"<div><h3>Purpose</h3><p>To examine the relationship between tibial tubercle–trochlear groove (TT-TG) distance and patellar tendon length.</p></div><div><h3>Methods</h3><p>All healthy athletes who underwent anterior cruciate ligament reconstruction who had a magnetic resonance imaging (MRI) study of the knee on file between July 2018 and June 2019 at a single institution were retrospectively reviewed. Exclusion criteria included patients without an MRI study of the knee on file or with an MRI of insufficient quality precluding reliable calculation of TT-TG and patellar tendon length. MRIs were reviewed to calculate TT-TG, patellar tendon length, and Caton–Deschamps Index (CDI). Patient charts were reviewed to obtain anthropometric characteristics including sex, concomitant injuries, and previous knee procedures as well as age at time of MRI. Spearman correlations were used to assess the relationship between TT-TG, patellar tendon length, and CDI, with regression analysis performed to assess for relationships between TT-TG, patellar tendon length, and patient-specific factors.</p></div><div><h3>Results</h3><p>Overall, 235 patients (99 female [42.1%], 136 male [57.9%]; mean age: 30.0 years [23.0; 40.0]) were included. Inter-rater reliability between the 2 reviewers was 0.888 for TT-TG, 0.804 for patellar tendon length, and 0.748 for CDI, indicating strong agreement. The correlation between TT-TG and patellar tendon length was 0.021, indicating no true relationship. The correlation between TT-TG and CDI was –0.048 and that of patellar tendon length and CDI was 0.411, indicating a weak positive relationship. Regression analysis found that male sex is strongly correlated with a longer patellar tendon length (odds ratio 2.65, 95% confidence interval 1.33-3.97, <em>P</em> &lt; .001).</p></div><div><h3>Conclusions</h3><p>In this study, no correlation was found between TT-TG and patellar tendon length or CDI. Male sex was correlated with a longer patellar length.</p></div><div><h3>Level of Evidence</h3><p>Level III.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 2","pages":"Article 100870"},"PeriodicalIF":0.0,"publicationDate":"2024-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X23002213/pdfft?md5=9428cdbf0a9b9f5563389a0972b2c011&pid=1-s2.0-S2666061X23002213-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139731595","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":"Bioabsorbable Screw Fixation Provides Good Results With Low Failure Rates at Mid-term Follow-up of Stable Osteochondritis Dissecans Lesions That Do Not Improve With Initial Conservative Treatment","authors":"Ryan Quigley M.D.,&nbsp;Sachin Allahabadi M.D.,&nbsp;Allen A. Yazdi B.S.,&nbsp;Landon P. Frazier B.S.,&nbsp;Katie J. McMorrow B.S.,&nbsp;Zachary D. Meeker B.S.,&nbsp;Kyle R. Wagner M.D.,&nbsp;Jimmy Chan M.D.,&nbsp;Brian J. Cole M.D., M.B.A.","doi":"10.1016/j.asmr.2023.100863","DOIUrl":"https://doi.org/10.1016/j.asmr.2023.100863","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the clinical and radiographic outcomes of patients who have undergone bioabsorbable screw fixation for intact, stable grade I and II osteochondritis dissecans (OCD) lesions for which at least 6 months of conservative management has failed.</p></div><div><h3>Methods</h3><p>A retrospective review of prospectively collected data from a single institution was performed to identify patients who underwent internal fixation of stable grade I and II OCD lesions (according to the Guhl classification) between January 2010 and January 2020. Patients were included regardless of the presence of concomitant procedures. The inclusion criteria consisted of (1) primary surgery, (2) failure of at least 6 months of conservative management, (3) the use of a bioabsorbable screw (or screws), and (4) minimum 2-year clinical follow-up. Radiographs were obtained at a minimum of 1 year postoperatively. Patient demographic characteristics, clinical patient-reported outcomes, complications, and failure rates were noted.</p></div><div><h3>Results</h3><p>Twenty-four knees among 23 patients (96% follow-up) were analyzed and followed up for 6.36 ± 3.42 years (range, 2.0-12.7 years). Patients showed statistically significant postoperative improvements in all patient-reported outcomes including the Lysholm score, International Knee Documentation Committee score, and Knee Injury and Osteoarthritis Outcome Score subscales (<em>P</em> &lt; .05). In 3 knees (12%), a reoperation was required due to failure at an average of 3.64 years after the index procedure. No specific complications were attributed to the use of bioabsorbable screws. Patients in whom primary surgical treatment failed did not differ in demographic characteristics, arthroscopic findings, or surgical treatment from those who had successful treatment.</p></div><div><h3>Conclusions</h3><p>Internal fixation of stable grade I and II OCD lesions with bioabsorbable screws produces reliable results with a 12% rate of failure in appropriately indicated patients in whom at least 6 months of conservative management has failed. Clinical outcomes improved significantly during the mid-term follow-up period.</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 2","pages":"Article 100863"},"PeriodicalIF":0.0,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X23002146/pdfft?md5=c97fb04b460a898e9f17a14573429923&pid=1-s2.0-S2666061X23002146-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139719514","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}