The American Journal of Sports Medicine最新文献

{"title":"Clinically Relevant Thresholds in Patient-Reported Outcomes: Do Patients’ Expectations Evolve Over Long-term Follow-up?","authors":"Elizabeth G. Walsh, Tyler R. McCarroll, Benjamin D. Kuhns, Ady H. Kahana-Rojkind, Roger Quesada-Jimenez, Benjamin G. Domb","doi":"10.1177/03635465251345823","DOIUrl":"https://doi.org/10.1177/03635465251345823","url":null,"abstract":"Background: Clinically relevant thresholds have been utilized to provide insight into postoperative functional status and patient satisfaction. Purpose: To define and evaluate the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) thresholds over the 2-, 5-, and 10-year timepoints for the modified Harris Hip Score (mHHS), Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and International Hip Outcome Tool (iHOT12). Study Design: Case series; Level of evidence, 4. Methods: Data were retrospectively reviewed for patients who underwent primary hip arthroscopy from 2008 to 2021. The inclusion criteria comprised complete patient-reported outcome scores with anchor questions at the 2-, 5-, or 10-year timepoints. Groups were propensity score–matched 1 to 1 to 1 for these 3 timepoints to limit confounding variables. The PASS, SCB, and MCID thresholds were defined using the anchor-based method for the mHHS, HOS-SSS, and iHOT12. Results: A total of 414 hips were included in the study. Area under the curve for all defined thresholds indicated acceptable to excellent discrimination. The thresholds for achieving the PASS, defined at the 2-, 5-, and 10-year respectively, were as follows: mHHS: 77.5, 85.5, and 78.5; HOS-SSS: 82.7, 76.4, and 67.7; and iHOT12: 67.4, 76.9, and 62.9. The percentage of patients achieving the PASS increased from 2 to 10 years, with the highest percentage at 10 years. The threshold for achieving the SCB was defined as follows: mHHS: 95, 99, and 88; HOS-SSS: 97, 80.9, and 90.5; and iHOT12: 89.4, 94.1, and 82.5. The percentage of patients achieving the SCB increased from 2 to 10 years. The mean changes required to achieve the MCID were defined as follows: mHHS: 7, 7.1, and 7.4; HOS-SSS: 10.6, 10.7, and 11.2; and iHOT12: (9.6, 9.7, -). The MCID and the percentage of patients achieving the MCID remained constant over 2 to 10 years. Conclusion: Patients met the MCID, PASS, and SCB thresholds at high rates over 10 years. Based on the PASS and SCB thresholds, patient expectations for function evolved. Lower expectations at long-term follow-ups may result in a higher percentage of patients meeting certain thresholds, as evidenced in the mHHS, HOS-SSS, and iHOT12 in this cohort. Understanding the evolution of patient expectations may help interpret clinically relevant thresholds in future studies.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"174 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144290047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining Clinically Important Outcomes for the Modified Harris Hip Score and Nonarthritic Hip Scope for Hip Arthroscopy to Treat Femoroacetabular Impingement at a Minimum 10-Year Follow-up","authors":"Emily Berzolla, Larry Chen, Griffith G. Gosnell, Nathaniel Mercer, Julian Seidenberg, Daniel J. Kaplan, Thomas Youm","doi":"10.1177/03635465251344594","DOIUrl":"https://doi.org/10.1177/03635465251344594","url":null,"abstract":"Background: The minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and substantial clinical benefit (SCB) are valuable clinical thresholds used to provide clinical relevance to patient outcome scores. In hip arthroscopy (HA) for femoroacetabular impingement (FAI) syndrome, these values have been defined for the short- and midterm postoperative period, but meaningful long-term thresholds have not been established. Purpose: To define the MCID, PASS, and SCB for the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) at a minimum follow-up of 10 years for patients who underwent HA for FAI syndrome. Study Design: Case series; Level of evidence, 4. Methods: A retrospective cohort study including all patients who underwent primary HA for FAI with a single surgeon from February 2010 to December 2013 was performed. Patient outcomes were assessed with an anchor question, mHHS, and NAHS at baseline and at 1, 5, and 10 years of follow-up. MCID was calculated using the distribution-based method at all time points, using 0.5 standard deviations as the threshold. The anchor-based MCID, PASS, and SCB were calculated at 10 years using thresholds representing the optimal cutoff on a receiver operating characteristic curve. Correlations between baseline characteristics and achievement of the MCID, PASS, and SCB were assessed with binomial logistic regressions. Results: The 154 patients included in the study had a mean age of 38.8 ± 13.0 years, a mean body mass index of 24.6 ± 3.9 kg/m <jats:sup>2</jats:sup> , and 63.6% were female. The distribution-based MCID values for 1-year, 5-year, and 10-year scores were 7.8, 8.3, and 9.5 for mHHS and 9.5, 10.4, and 10.2 for NAHS, respectively. The anchor-based MCID was 20.3 for mHHS and 24.4 for NAHS. The PASS was 81.9 for mHHS and 83.1 for NAHS. The SCB values were 34.0 and 41.9 for mHHS and NAHS, respectively. Increased body mass index was associated with decreased achievement of SCB for mHHS ( <jats:italic>P</jats:italic> = .03) and NAHS ( <jats:italic>P</jats:italic> = .04), as well as NAHS PASS ( <jats:italic>P</jats:italic> = .01) and anchor-based MCID ( <jats:italic>P</jats:italic> = .01). Conclusion: The establishment of the MCID, SCB, and PASS for the NAHS and mHHS provides a valuable clinical context for improvements in outcome scores after HA. Anchor-based calculations were consistently higher than distribution-based calculations.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144290046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contribution of Labrum and Cartilage to Joint Surface in Different Hip Deformities: An Automatic Deep Learning–Based 3-Dimensional Magnetic Resonance Imaging Analysis","authors":"Malin K. Meier, Jose A. Roshardt, Adrian C. Ruckli, Nicolas Gerber, Till D. Lerch, Bernd Jung, Moritz Tannast, Florian Schmaranzer, Simon D. Steppacher","doi":"10.1177/03635465251339758","DOIUrl":"https://doi.org/10.1177/03635465251339758","url":null,"abstract":"Background: Multiple 2-dimensional magnetic resonance imaging (MRI) studies have indicated that the size of the labrum adjusts in response to altered joint loading. In patients with hip dysplasia, it tends to increase as a compensatory mechanism for inadequate acetabular coverage. Purpose: To determine the differences in labral contribution to the joint surface among different hip deformities as well as which radiographic parameters influence labral contribution to the joint surface using a deep learning–based approach for automatic 3-dimensional (3D) segmentation of MRI. Study Design: Cross-sectional study; Level of evidence, 4. Methods: This retrospective study was approved by the local ethics committee with waiver for informed consent. A total of 98 patients (100 hips) with symptomatic hip deformities undergoing direct hip magnetic resonance arthrography (3 T) between January 2020 and October 2021 were consecutively selected (mean age, 30 ± 9 years; 64% female). The standard imaging protocol included proton density–weighted turbo spin echo images and an axial-oblique 3D T1-weighted MP2RAGE sequence. According to acetabular morphology, hips were divided into subgroups: dysplasia (lateral center-edge [LCE] angle, &lt;23°), normal coverage (LCE, 23°-33°), overcoverage (LCE, 33°-39°), severe overcoverage (LCE, &gt;39°), and retroversion (retroversion index &gt;10% and all 3 retroversion signs positive). A previously validated deep learning approach for automatic segmentation and software for calculation of the joint surface were used. The labral contribution to the joint surface was defined as follows: labrum surface area/(labrum surface area + cartilage surface area). One-way analysis of variance with Tukey correction for multiple comparison and linear regression analysis was performed. Results: The mean labral contribution of the joint surface of dysplastic hips was 26% ± 5% (95% CI, 24%-28%) and higher compared with all other hip deformities ( <jats:italic>P</jats:italic> value range, .001-.036). Linear regression analysis identified LCE angle (β = −.002; <jats:italic>P</jats:italic> &lt; .001) and femoral torsion (β = .001; <jats:italic>P</jats:italic> = .008) as independent predictors for labral contribution to the joint surface with a goodness-of-fit <jats:italic>R</jats:italic> <jats:sup>2</jats:sup> value of 0.35. Conclusion: The labral contribution to the joint surface differs among hip deformities and is influenced by lateral acetabular coverage and femoral torsion. This study paves the way for a more in-depth understanding of the underlying pathomechanism and a reliable 3D analysis of the hip joint that can be indicative for surgical decision-making in patients with hip deformities.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"36 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term Outcomes of Hip Arthroscopy for the Treatment of Femoroacetabular Impingement and Labral Tears in Underweight Patients","authors":"Roger Quesada-Jimenez, Jessica C. Keane, Ady H. Kahana-Rojkind, Yasemin E. Kingham, Matthew J. Strok, Benjamin G. Domb","doi":"10.1177/03635465251343299","DOIUrl":"https://doi.org/10.1177/03635465251343299","url":null,"abstract":"Background: Being underweight or malnourished has been recognized as an adverse prognostic factor in various surgical orthopaedic interventions. Purpose: (1) To report minimum 2-year outcomes of underweight patients who underwent primary hip arthroscopy for femoroacetabular impingement (FAI) and labral tears and (2) to compare these results with a propensity-matched control group of patients with normal weight. Study Design: Case series; Level of evidence, 4. Methods: Data were retrospectively analyzed for patients with a body mass index (BMI) ≤18.5 kg/m <jats:sup>2</jats:sup> who underwent primary hip arthroscopy by the senior surgeon at a single institution as treatment for FAI and labral tears between August 2008 and January 2022. Included patients had complete pre- and postoperative patient-reported outcomes (PROs) and visual analog scale (VAS) score for pain at minimum 2-year follow-up. Clinically important thresholds for hip arthroscopy, revision surgery, and conversion to total hip arthroplasty were included in the analysis. Patients were propensity matched to a control group of normal weight patients (BMI, 18.6-24.99 kg/m <jats:sup>2</jats:sup> ) in a 1:2 ratio based on sex, age at surgery, acetabular Outerbridge grade, labral treatment, and capsular treatment. Results: A total of 234 patients were included in the study. Underweight patients displayed significant improvements across all PROs and high patient satisfaction. When underweight patients were compared with a benchmark control group, similar magnitudes of improvement were observed at a minimum 2-year follow-up for modified Harris Hip Score, Nonarthritic Hip Score, International Hip Outcome Tool-12, and VAS. Furthermore, the study cohort had a lower magnitude of improvement for the Hip Outcome Score–Sports-Specific Subscale (HOS-SSS) ( <jats:italic>P</jats:italic> &lt; .05). The study group reached Patient Acceptable Symptom State for HOS-SSS at lower rates. Underweight patients had a higher frequency of revision hip arthroscopy with a relative risk of 2.16 ( <jats:italic>P</jats:italic> &lt; .05). Conclusion: Hip arthroscopy for the treatment of FAI and labral tear in underweight patients yielded significant short-term improvements in PROs, which, except for postoperative VAS pain score and change in HOS-SSS, were comparable with a benchmark matched control group of normal weight patients. However, underweight patients had a 2.16-fold increased relative risk for revision hip arthroscopy. Underweight patients may benefit from preoperative nutritional evaluation.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144237337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neurocognitive Challenges During Drop Vertical Jumps Increase Sensitivity to Differentiate Atypical Landing Mechanics and Jump Height in Individuals With Anterior Cruciate Ligament Reconstruction","authors":"Andrew Strong, Jonas L. Markström","doi":"10.1177/03635465251346145","DOIUrl":"https://doi.org/10.1177/03635465251346145","url":null,"abstract":"Background: Athletes with anterior cruciate ligament reconstruction (ACLR) have high rates of secondary injury. Insufficient return-to-sport screening may be due to standard functional tests not resembling chaotic sporting environments where injuries occur. Neurocognitive deficits among individuals with ACLR indicate that cognitive challenges during screening tests may better reveal atypical movement mechanics. Hypothesis: Adding secondary cognitive tasks to drop vertical jumps (DVJs) would increase between-group differences in landing mechanics and jump height compared with the standard DVJ. Study Design: Controlled laboratory study. Methods: Forty sports-active individuals 24.9 ± 16.1 months after unilateral ACLR and 40 uninjured controls (both groups 50% female) performed DVJs; downward- or upward-pointing arrows indicated whether to drop only or complete the vertical jump. Conditions were (1) black arrow presented before drop and (2) black or red arrow presented during drop (red arrow pointing in opposite direction of requested motor action) together with a memory task involving letter recalling. Jump height and biomechanical time-series data from an 8-camera motion capture system and 2 force plates during the first 100 ms of landing were compared between groups using conventional and functional <jats:italic>t</jats:italic> tests, respectively. Results: For the standard DVJ, the ACLR group had significantly less hip power and more hip abduction moment for the injured leg and uninjured leg, respectively, compared with controls. For the DVJ with secondary cognitive tasks, the ACLR group again showed significantly less hip power and more hip abduction moment but also less knee power, knee flexion moment, ankle power, and ankle dorsiflexion moment and lower jump height than controls. Conclusion: The addition of secondary cognitive tasks during DVJs elicited further significant differences in landing mechanics and jump performance among athletes with ACLR compared with uninjured athletes than were found for the standard DVJ. The aberrant biomechanical outcomes for the ACLR group indicate an incomplete rehabilitation. Clinical Relevance: The greater between-group differences in landing mechanics and jump height when adding secondary cognitive tasks to a DVJ indicate a need to provide neurocognitive challenges in rehabilitation and return-to-sport screening as a first step toward improved rehabilitation outcomes and more ecologically valid testing.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Utilization of Patient-Reported Outcome Measures in Assessing the Treatment of Osteochondral Lesions of the Ankle Versus the Knee","authors":"Darius Luke Lameire, Caroline Cristofaro, Jong Min Lee, Kathrine Bhargava, Shgufta Docter, David Wasserstein, Sam Si-Hyeong Park","doi":"10.1177/03635465251333088","DOIUrl":"https://doi.org/10.1177/03635465251333088","url":null,"abstract":"Background: When assessing the outcomes of ankle and knee osteochondral lesions (OCLs), there are numerous patient-reported outcome measures (PROMs) that are used; however, not all are validated. Purpose: To compare the utilization of PROMs in assessing the treatment of ankle OCLs versus knee OCLs. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic search of Embase, MEDLINE, and CINAHL was conducted to identify all observational or experimental studies from January 1, 2014 to December 31, 2023 that used PROMs to assess the treatment of ankle or knee OCLs. The frequency of the use of specific validated PROMs between the ankle OCL and knee OCL literature was compared using an independent <jats:italic>t</jats:italic> -test. Correlation coefficients were calculated to assess differences based on journal impact factor (divided into quartiles), publication year, or level of evidence. Results: A total of 233 eligible ankle OCL studies and 211 knee OCL studies were identified. Validated clinical outcome measures were used in 41.2% of ankle OCL studies compared with 87.7% of knee OCL studies ( <jats:italic>P</jats:italic> &lt; .001). There were a total of 44 outcome measures used in ankle OCL studies, with the majority of studies (67.8%) utilizing the AOFAS (American Orthopaedic Foot and Ankle Society) score. There were no correlations between the use of validated outcome measures in the ankle OCL studies and journal impact factor ( <jats:italic>P</jats:italic> = .78), publication year ( <jats:italic>P</jats:italic> = .16), or level of evidence ( <jats:italic>P</jats:italic> = .45). Similarly, there were no correlations for the knee OCL studies based on journal impact factor ( <jats:italic>P</jats:italic> = .60), publication year ( <jats:italic>P</jats:italic> = .25), or level of evidence ( <jats:italic>P</jats:italic> = .55). Conclusion: Validated clinical outcome measures were more frequently utilized in knee OCL studies compared with ankle OCL studies. The low frequency of validated outcome measures used within the ankle literature may limit how well treatment effectiveness in the management of ankle OCLs is evaluated.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"34 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical Analysis of Posterior Segmental Medial Meniscal Transplantation in a Human Cadaveric Model","authors":"Mark E. Cinque, Wyatt H. Buchalter, Justin F.M. Hollenbeck, Jonathan D. Haskel, Bradley M. Kruckeberg, Matthew T. Provencher, Jonathan A. Godin","doi":"10.1177/03635465251339068","DOIUrl":"https://doi.org/10.1177/03635465251339068","url":null,"abstract":"Background: Partial meniscectomy provides short-term symptom relief but may accelerate the development of knee arthritis due to meniscal deficiency and altered joint biomechanics. While meniscal allograft transplantation (MAT) addresses complete meniscal loss, segmental meniscal transplantation may be an option for segmental loss. Purpose: To evaluate the biomechanical effect of segmental posterior medial meniscal transplantation on knee joint loading characteristics and compare it with the states of both intact meniscus and full MAT. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen human cadaveric knees (mean age, 54.3 years) were tested under 4 conditions: intact meniscus, segmental medial meniscal loss, segmental posterior horn MAT, and full MAT. The knees were subjected to a 500-N compressive load at 0°, 30°, 60°, and 90° of knee flexion. Medial meniscal extrusion, contact area, mean contact pressure, and peak contact pressure were measured. Statistical analyses included 2-way repeated measures analysis of variance to assess the effects of meniscal state and knee flexion on biomechanical outcomes. Results: Segmental medial meniscal deficiency significantly increased extrusion (+1.32 mm at 0°; +1.45 mm at 30°; +1.42 mm at 60°; and +1.67 mm at 90°) and mean pressure compared with the intact meniscus across all flexion angles. Both segmental transplantation and full transplantation restored extrusion to intact levels, with full transplantation demonstrating superior improvement in peak pressure at flexion angles &gt;60° compared with segmental transplantation. Both segmental and full transplantation restored peak pressure to levels comparable with the intact meniscus at flexion angles ≥30°. Conclusion: Both segmental and full meniscal transplantation tested at the time of surgery restored meniscal extrusion and contact pressure to the intact state. Clinical Relevance: Segmental transplantation may offer a promising approach for managing posterior medial meniscal deficiencies by restoring knee joint function and reducing meniscal extrusion.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgeon-Driven Variation in the Cost of Hip Arthroscopic Surgery for Labral Tears: A Time-Driven Activity-Based Costing Analysis","authors":"Michael C. Dean, Nathan J. Cherian, Ana Paula Beck da Silva Etges, Kieran S. Dowley, Kaveh A. Torabian, Zachary L. LaPorte, Scott D. Martin","doi":"10.1177/03635465251341463","DOIUrl":"https://doi.org/10.1177/03635465251341463","url":null,"abstract":"Background: Amid mounting pressure to reduce health care spending, strategies for identifying and eliminating unwarranted variation in costs have garnered significant attention. Previous studies have characterized intersurgeon variation in costs for common orthopaedic procedures, but such variation remains unexplored in the context of hip arthroscopic surgery. Purpose: To (1) characterize variation in the cost of hip arthroscopic surgery between surgeons using time-driven activity-based costing (TDABC) and (2) identify patient characteristics, intraoperative findings, and operative procedures underlying such intersurgeon variation in costs. Study Design: Cohort study; Level of evidence, 3. Methods: Employing TDABC, the authors determined the intraoperative cost of 890 outpatient hip arthroscopic surgery cases performed by 5 surgeons at 4 surgery centers from 2015 to 2022. All costs were calculated in United States dollars. Costs were normalized to protect the confidentiality of internal hospital cost data. Surgeon-specific mean costs were calculated with and without adjustment for patient characteristics, surgical personnel, operative factors, and surgery center. Finally, to elucidate the sources of surgeon-driven cost variation, the authors estimated the proportion of variation attributable to different cost subcategories, including labor, implant/allograft, and other supply costs. Results: The intraoperative cost per patient ranged from 38.2 to 212.8 normalized cost units (mean, 100.0 ± 26.5), with a 1.6-fold variation in the mean cost between the highest and lowest cost surgeons. Operating surgeon alone explained 53.4% of the observed variation in costs. Controlling for case-specific features significantly improved the explanatory power to 91.8% ( <jats:italic>P</jats:italic> &lt; .001), but the adjusted variation in costs between surgeons remained essentially unchanged (decreased by &lt;3%). Each of the 5 surgeons generated costs that deviated significantly from those predicted based on case-specific factors, with mean surgeon deviations ranging from −5.0% to 21.8% ( <jats:italic>P</jats:italic> &lt; .001 for all). Drivers of cost variation differed substantially between surgeons but generally stemmed from labor or other supply costs rather than implant/allograft costs. Conclusion: The cost of outpatient hip arthroscopic surgery varied widely between surgeons; the cause of this deviation was multifactorial and surgeon specific. While within-surgeon cost variation was effectively explained by patient and operative characteristics, most between-surgeon variability remained unexplained by observable factors. These insights may support individual surgeons in cost reduction efforts and, more importantly, may enable the alignment of reimbursement rates with costs.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"402 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144228498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Adjunctive Platelet-Rich Plasma for Healing During Arthroscopic Release and Repair for Recalcitrant Lateral Epicondylitis: A Prospective, Double-Blind, Randomized Controlled Trial","authors":"Shangzhe Li, Guang Yang, Renjie Chen, Xu Li, Yi Lu","doi":"10.1177/03635465251341458","DOIUrl":"https://doi.org/10.1177/03635465251341458","url":null,"abstract":"Background: Whether the use of platelet-rich plasma (PRP) as an adjuvant to extensor carpi radialis brevis (ECRB) repair in recalcitrant lateral epicondylitis (RLE) promotes tendon healing and improves clinical outcomes remains unclear. Purpose: To evaluate the tendon healing and clinical outcomes of arthroscopic ECRB repair combined with PRP injection and compared with arthroscopic ECRB repair alone at early-term follow-up in patients with RLE. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A consecutive series of 80 patients with RLE were enrolled and randomized to the PRP group (arthroscopic ECRB repair followed by 1 PRP injection; n = 40) and the control group (arthroscopic ECRB repair alone; n = 40). Magnetic resonance imaging was performed to assess tendon healing at 3, 6, and 12 months. The visual analog scale (VAS) for pain, the Mayo Elbow Performance Score (MEPS), the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Patient-Rated Tennis Elbow Evaluation (PRTEE) scale, range of motion, and muscle strength were evaluated at preoperative and follow-up points. The time to return to work was also compared between the 2 groups. Patients and assessors were blinded to the intervention. Results: A total of 80 patients who met the inclusion criteria were enrolled between July 2020 and July 2023, and 73 patients completed follow-up. The PRP group contained 35 patients, 11 men and 24 women, with a mean age of 47.8 ± 8.8 years. The control group contained 38 patients, 13 men and 25 women, with a mean age of 44.5 ± 5.8 years. No significant differences were found in magnetic resonance imaging classification and functional scores between groups at preoperative and follow-up periods. VAS, MEPS, DASH, and PRTEE scores and muscle strength showed significant improvement at 12 months in both groups ( <jats:italic>P</jats:italic> &lt; .001). However, the PRP group showed a significant improvement in grip and wrist extension muscle strength at 6 weeks postoperatively ( <jats:italic>P</jats:italic> = .008 and <jats:italic>P</jats:italic> &lt; .001, respectively), whereas the control group did not ( <jats:italic>P</jats:italic> = .583 and .056). No complications were associated with PRP injection. Conclusion: PRP used as an adjuvant to ECRB repair did not show a difference in tendon healing and functional outcomes compared with ECRB repair alone for RLE at 12-month follow-up. However, PRP treatment showed a difference in muscle strength at 6-week follow-up compared with ECRB repair alone. Registration: NCT04556825 (ClinicalTrials.gov).","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"134 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144188968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-Year Outcomes Predict 10-Year Outcomes in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement","authors":"Emily Berzolla, Katherine L. Esser, Griffith G. Gosnell, Nathaniel Mercer, Daniel J. Kaplan, Thomas Youm","doi":"10.1177/03635465251342119","DOIUrl":"https://doi.org/10.1177/03635465251342119","url":null,"abstract":"Background: While both short- and long-term outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) have been reported, the predictive relationship between the two has yet to be established. Purpose: To determine whether the degree of improvement in patient-reported outcomes observed at 1 year postoperatively predicts long-term outcomes at 10 years after primary hip arthroscopy for FAIS. Study Design: Cohort study; Level of evidence, 3 Methods: Patients who underwent primary hip arthroscopy for FAIS by a single surgeon at a single institution with 10-year follow-up were identified. Outcomes were assessed using the modified Harris Hip Score (mHHS) and Nonarthritic Hip Score (NAHS) at baseline and 1, 2, 5, and 10 years postoperatively. Patients were classified as either high improvement (HI) or low improvement (LI) based on if they achieved the median 1-year change in mHHS from baseline. Chart review was performed to collect surgical details such as operative procedures, complications, and revision surgery. Outcomes were compared between groups over time using repeated-measures analysis of variance. Failure rates were determined using Kaplan-Meier and Mantel-Cox log-rank analyses. Results: A total of 129 patients with a mean age of 41.0 ± 13.5 years and mean body mass index of 25.0 ± 4.3 kg/m <jats:sup>2</jats:sup> were included. Both the HI and LI groups demonstrated significant improvement in mHHS and NAHS from baseline at all follow-up time points ( <jats:italic>P</jats:italic> &lt; .001). The HI group had significantly higher outcome scores at all time points up to 10 years after arthroscopy compared with the LI group ( <jats:italic>P</jats:italic> = .018). Additionally, a greater proportion of patients in the HI group achieved the Patient Acceptable Symptom State and minimal clinically important difference compared with the LI group at the 10-year follow-up ( <jats:italic>P</jats:italic> = .018). Rates of overall complications, revision arthroscopy, and conversion to total hip arthroscopy were significantly higher in the LI group ( <jats:italic>P</jats:italic> = .013, <jats:italic>P</jats:italic> = .009, and <jats:italic>P</jats:italic> = .004, respectively). The mean hip survival time after the index operation was shorter for the LI group (11.9 ± 0.5 years) than for the HI group (13.2 ± 0.2 years) ( <jats:italic>P</jats:italic> = .002). Conclusion: Patients who experienced greater improvement in the first year after hip arthroscopy had superior 10-year outcome scores, fewer complications, and lower rates of reoperation compared with those who experienced minimal improvement in the same period.","PeriodicalId":517411,"journal":{"name":"The American Journal of Sports Medicine","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144176522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}