Arthroscopy-The Journal of Arthroscopic and Related Surgery最新文献

{"title":"Increased Utilization of Hip Arthroscopy in the United States from 2015 to 2023 and Projected Growth through 2030.","authors":"Jeremy M Adelstein, Parshva A Sanghvi, Kira Smith, Robert J Burkhart, Andrew J Moyal, Luc M Fortier, Bhargavi Maheshwer, Jacob G Calcei, James E Voos, Michael J Salata","doi":"10.1016/j.arthro.2025.03.034","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.034","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to assess hip arthroscopy epidemiology in the United States (US) from 2015-2023 and provide projections through 2030, as well as analyze rates of postoperative complications.</p><p><strong>Methods: </strong>The TriNetX/U.S. Collaborative Networks database was utilized to identify patients aged 10-89 who underwent hip arthroscopy in the US from 2015 to 2023. Demographic information, such as age, sex, body mass index (BMI), was analyzed. Prevalence (P), incidence proportion (IP), and incidence rate (IR) were measured. Regression modeling was used to project through 2030. Complications such as femoral neck fracture (FNFx), hemarthrosis, septic arthritis, hip dislocation/instability, avascular necrosis (AVN), osteoarthritis (OA), and conversion to total hip arthroplasty (THA) were also analyzed.</p><p><strong>Results: </strong>In TriNetX, 25,903 patients underwent hip arthroscopy in the US from 2015-2023. In 2023, 2,427 hip arthroscopies occured, a 97% increase compared to 1,236 in 2015. Annual database incidence is projected to rise to over 4,800 cases by 2030. In 2023, prevalence was highest in females aged 20-24, while incidence was highest in females aged 15-19. FNFx, hip dislocation, septic arthritis, and AVN occurred in <1% of patients within 2- and 5-years post-operatively. Males had higher risk for all complications aside from hemarthrosis and trochanteric bursitis which were higher in females at 5 years. 17% developed OA, with 9.8% requiring conversion to THA within 5 years. Majority (>80%) who converted to THA were over the age of 30 at time of hip arthroscopy. There were no sex-based differences in conversion to THA.</p><p><strong>Conclusion: </strong>Our analysis reveals a substantial rise in hip arthroscopy with projections indicating a continued surge. Despite low complication rates, males were found to be at higher risk of most complications aside from hemarthrosis and trochanteric bursitis which were higher in females. The incidence of developing OA and conversion to THA remains significant.</p><p><strong>Level of evidence: </strong>IV (retrospective case series).</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733384","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Varying Definitions of Return to Sport, Study Quality, and Outcome Measurements Limit Comparison of Primary ACL Reconstruction with Quadriceps Tendon Autografts to Hamstring and Bone-Patellar Tendon-Bone Autografts: A Systematic Review.","authors":"A Scott Emmert, Isaac Hale, Logan P Lake, Paul McMillan, Brian M Johnson, Sarah C Kurkowski, Henry A Kuechly, Brian M Grawe","doi":"10.1016/j.arthro.2025.03.036","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.036","url":null,"abstract":"<p><strong>Purpose: </strong>To systematically review the existing literature on RTS outcomes for QT autografts compared to HT and/or BPTB autografts for primary ACLR.</p><p><strong>Methods: </strong>PubMed/Medline, Scopus, Embase, and Cochrane Library databases were queried for studies comparing RTS data for ACLR with QT autografts versus HT and/or BPTB autografts in accordance with PRISMA guidelines. Inclusion criteria were randomized and non-randomized prospective or retrospective studies evaluating primary ACLR containing RTS data for QT autograft and at least one other graft type. Exclusion criteria included patients <18 years of age, patients undergoing revision ACLR, cadaveric/animal studies, and studies lacking graft outcome data. Included studies were analyzed for methodological data, RTS data, quality, and risk of bias.</p><p><strong>Results: </strong>Ten articles (two RCTs, three prospective studies, and five retrospective studies) comprising 1006 reconstructions with a level of evidence of II-III and average follow-up of 8-120 months were included. Non-randomized studies most frequently possessed a MINORS quality rating of \"moderate,\" while half of the randomized studies had a Risk of Bias 2.0 rating of \"some concern of bias.\" Four subjective definitions of RTS were identified: (1) return to pre-injury activity level based on the Tegner activity scale; (2) return to play; (3) return to level I/II (cutting) sports; and (4) return to pre-injury sports. RTS and mean time to RTS rates ranged from 16-100% and 8.4-11.1 months for QT autografts, 32-100% and 8.8 months for HT autografts, and 64-85% and 8.1 months for BPTB autografts.</p><p><strong>Conclusions: </strong>Primary ACLR with QT autografts demonstrates similar overall RTS rates and mean time to RTS as HT and BPTB autografts. However, insufficient quality and quantity of studies investigating RTS outcomes for QT autografts underscores the unreliability of the current literature and need for high-quality, prospective studies.</p><p><strong>Level of evidence: </strong>Level III, systematic review of Level II and III studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mitochondria-Rich Extracellular Vesicles from Bone Marrow Stem Cells Mitigate Muscle Degeneration in Rotator Cuff Tears in a Rat Model through Macrophage M2 Phenotype Conversion.","authors":"Xing Gao, Yuanyuan Chen, Jingzeng Wang, Jian Xu, Hu Wan, Xiao Li, Yulong Shi","doi":"10.1016/j.arthro.2025.03.033","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.033","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the protective effects of extracellular vesicles derived from bone marrow stem cells (BMSC-EVs) on muscle degeneration in a rat model of rotator cuff tendon and suprascapular nerve (SSN) transection (termed the RCT-SSN model), focusing on mitochondrial transfer.</p><p><strong>Methods: </strong>The EVs were identified and characterized. RCT-SSN model was established by transecting the supraspinatus, infraspinatus tendons, and suprascapular nerve. Ninety-six rats were divided into four groups (n=24 each): sham surgery, RCT-SSN treated with BMSC-EVs, RCT-SSN treated with EVs from Rhodamine-6G-pretreated BMSCs (Rho-EVs), or phosphate-buffered saline (PBS). Intramuscular injections were administered every two weeks. After 12 weeks, supraspinatus muscles were analyzed for atrophy, fibrosis, oxidative stress, macrophage phenotypes, serum cytokines, and mitochondrial characteristics. In vitro experiments included EVs tracking in macrophages, macrophage phenotype characterization, and inflammatory cytokine profiling.</p><p><strong>Results: </strong>BMSC-EVs and Rho-EVs displayed similar morphology, but only BMSC-EVs contained functional mitochondria. BMSC-EVs significantly reduced muscle weight loss (0.047 ± 0.010% vs. 0.145 ± 0.013%, P < 0.001), increased muscle fiber cross-sectional area (2037 ± 231.9 μm² vs. 527.9 ± 92.01 μm², P < 0.001), and decreased fibrosis (12.09 ± 3.31% vs. 25.69 ± 4.84%, P < 0.001) compared to PBS. BMSC-EVs enhanced superoxide dismutase activity (93.3 ± 11.8 U/mg protein vs. 53.4 ± 8.0 U/mg protein, P < 0.001), improved mitochondrial function, density and structure, and induced an anti-inflammatory macrophage shift, suppressing proinflammatory cytokines in vitro and in vivo. Rho-EVs showed no such effects.</p><p><strong>Conclusions: </strong>This study showed that transecting the supraspinatus, infraspinatus tendons, and suprascapular nerve in a rat model induced muscle degeneration and fibrosis. BMSC-EVs, but not Rho-EVs, mitigated these effects by promoting an anti-inflammatory macrophage phenotype and protecting mitochondrial function through mitochondrial transfer.</p><p><strong>Clinical relevance: </strong>Mitochondrial transfer via BMSC-EVs may offer a therapeutic strategy to prevent muscle degeneration in rotator cuff tear patients.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Lower Trapezius Tendon Transfer using Achilles Tendon Allograft For Isolated, Irreparable Infraspinatus Musculotendinous Tear Is Durable.","authors":"Ayham Jaber, Christopher J Hawryluk, Peter J Millett","doi":"10.1016/j.arthro.2025.03.032","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.032","url":null,"abstract":"<p><p>Tendon transfers represent a reconstructive option for irreparable rotator cuff tears and certain neurologic deficiencies. Arthroscopically-assisted lower trapezius tendon (aLTT) transfer using Achilles tendon allograft is effective in restoring external rotation and relieving excessive loading on the teres minor. It has shown good results in patients with brachial plexus injuries and posterosuperior irreparable rotator cuff tears. Isolated infraspinatus musculotendinous tears present distinct characteristics compared to other rotator cuff tears, as these lesions cause rapid atrophy and significant fatty infiltration within the muscle, making direct surgical repair less feasible. Tears of the infraspinatus tendon are usually associated with other rotator cuff injuries but can be isolated injuries, and tear at the musculotendinous junction of the tendon is a less common. Existing literature predominantly focuses on nerve-related causes of infraspinatus deficiency such as in Parsonage-Turner syndrome or suprascapular nerve entrapment, which may be secondary to ganglion cysts along the nerve's path as well as other space-occupying lesions like tumors or vascular malformations. Infraspinatus muscle tendon injuries can also result from steroid injections and lead to severe pain and weakness during external rotation. Primary repair of the tear is a first choice, if non-surgical treatment fails and if tear morphology and fatty infiltration allow. However, repair has a low success rate because of the aforementioned features. For older, low-demand patients, subacromial debridement or the use of a biodegradable subacromial balloon spacer can provide pain relief and functional improvement. In younger, more active patients, aLTT transfer using Achilles tendon allograft, although technically demanding and uncommonly performed, is a durable solution for this pathology when glenohumeral osteoarthritis and joint arthropathy are absent offering sustained benefits on mid-term follow-up. Other alternatives include Latissimus Dorsi Tendon Transfer (LDTT), lower trapezius transfer which may be biomechanically superior to LDTT, and reverse total shoulder arthroplasty. We thus consider aLTT to be a strong option for the right patient, performed by a skilled surgeon who can execute the procedure properly.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding \"The 6-O'clock Anchor Increases Labral Repair Strength in a Biomechanical Shoulder Instability Model\".","authors":"Jakob Oury","doi":"10.1016/j.arthro.2025.03.031","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.031","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reflecting on the Need to Predict Knee Instability Early in Patients Undergoing Arthroscopic ACL Reconstruction.","authors":"Francesco Pegreffi, Giuseppe Gianluca Costa, Arcangelo Russo","doi":"10.1016/j.arthro.2025.03.030","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.030","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artificial Intelligence as a Tool to Mitigate Administrative Burden, Optimize Billing, Reduce Insurance and Credentialing-Related Expenses, and Improve Quality Assurance within Healthcare Systems.","authors":"Ophelie Lavoie-Gagne, Joshua J Woo, Riley J Williams, Benedict U Nwachukwu, Kyle N Kunze, Prem N Ramkumar","doi":"10.1016/j.arthro.2025.02.038","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.02.038","url":null,"abstract":"<p><p>Despite spending $4.3 trillion annually in healthcare with $3.4 trillion ($10,193 per capita) attributed to care delivery, the United States (U.S.) still experiences the worst health outcomes among high-income countries. Administrative costs are the second largest contributor with $353 billion ($1,055 per capita) spent annually. Addressing clinical and administrative fragmentation can reduce annual costs by up to $265 million and increase healthcare productivity, both of which contribute to care delivery that is necessary, effective, equitable, and fiscally responsible. In the advent of electronic health records (EHRs), big data, and artificial intelligence (AI), there is an unprecedented opportunity to leverage these tools to drive meaningful improvements in high-value care delivery and reduce both clinical/non-clinical administrative costs. Physician engagement to develop comprehensive musculoskeletal data management systems is a critical precursor for subsequent application of AI analytics. Incorporation of AI tools developed from these data systems both within-organizations and seismically across the healthcare system can: (1) promote transparency via payer/provider data-sharing platforms; (2) automate routine, evidence-based care to reduce ineffective, inefficient, and inconsistent medical decisions; (3) align incentives of key stakeholders by incorporating epidemiological informatic insights and individual patient-centered value quantification to inform physician-patient decision-making; (4) mitigate care delays from prior authorization (PA) and claims processing via centralized digital-claims clearinghouses; (5) guide payment model evolution to accurately and transparently reflect costs of care for patients with different risk profiles (6) harmonize quality control reporting for comparability; (7) simplify and standardize PA processes to reduce administrative complexity; and (8) automate non-clinical repetitive work (i.e. credentialing, quality assurance, etc.). Adoption of these tools can eliminate $168 billion in annual administrative costs. While no single solution will perfectly transform healthcare, the strategic and responsible use of AI technologies could lead to transcendent improvements in delivery of healthcare that is patient-centered, equitable, efficient, and fiscally responsible.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients Really Don't Care About Your Social Media Presence.","authors":"Ishan T Modi, Prem N Ramkumar","doi":"10.1016/j.arthro.2025.03.029","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.029","url":null,"abstract":"<p><p>The presence and perceptions of orthopaedic surgeons on social media demonstrates a disconnect in the content shared. Often times, surgeons use social media for professional networking, research dissemination, and academic engagement. While this may increase cache among peers, it does not translate for patients who seek education and simple explanations. Generating patient referrals or engagement from social media may or may not even be the goal for surgeons, but if digital clout among patients is the primary aspiration for some then the recipe is clear: educate and explain. Ancillary streams, direct revenue, and indirect opportunities from the influencer lifestyle is unknown, but be prepared for patients to be unimpressed with the accolades other surgeons may find notable.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcome of hip arthroscopy is determined by diverse intrinsic and extrinsic factors in addition to capsular closure.","authors":"Mo Saffarini, Sonia Ramos-Pascual, Alexis Nogier","doi":"10.1016/j.arthro.2025.03.024","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.024","url":null,"abstract":"<p><p>There are contrasting findings between randomized controlled trials and systematic reviews that investigate capsular closure during arthroscopic treatment of femoroacetabular impingement syndrome (FAIS). Some surgeons advocate that capsular closure is beneficial, as it reduces risks of instability and degeneration, while others argue that capsular closure could lead to joint stiffness and/or fibrosis, in addition to increased surgical time. Although unrepaired periportal or interportal capsulotomies may (or may not) compromise outcomes, it is beneficial to close larger incisions and extensions of T-type capsulotomies, especially in patients with high risk of instability (concomitant borderline dysplasia, hyperlaxity, young age, etc.). Most studies focused on the effect of capsular closure do not identify other intrinsic and extrinsic factors-factors that could influence outcomes. Intrinsic factors include patient age, sex, type of FAIS (cam-, pincer-, or mixed-), Tönnis grade, and presence of concomitant hypermobility or dysplasia. Extrinsic factors include surgeon experience, surgical technique, adjuvant procedures (such as labral repair), as well as type of capsulotomy (periportal, interportal, T-type).</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hip Pathology in Males and Females Deviate, but Outcomes after Appropriately Planned Hip Arthroscopy Are Acceptable Regardless of Sex.","authors":"Derek Ochiai","doi":"10.1016/j.arthro.2025.03.026","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.026","url":null,"abstract":"<p><p>Males and females have a preponderance of different pathologies that can require hip arthroscopic intervention. Males tend to have larger alpha angles, more complex labral tears, and more acetabular chondral damage; females tend to have more psoas involvement and micro-instability. While individual patient pathology can differ from the norm, recognizing these differences can help with pre-operative planning. Hip pathology in males and females deviate, but outcomes after appropriately planned hip arthroscopy are acceptable regardless of sex.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}