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

{"title":"Isolated Medial Patellofemoral Ligament Reconstruction under Increased Femoral Anteversion is Associated with Increased Contact Pressure of Medial Patellofemoral Facet at Deep Flexion Angle: A Cadaveric Study.","authors":"Jisu Park, Zhanguang Piao, Seonjin Shin, Tae Woo Kim, Moon Jong Chang, Darryl D D'Lima, Dai-Soon Kwak","doi":"10.1016/j.arthro.2025.03.040","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.040","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to analyze (1) whether isolated medial patellofemoral ligament (MPFL) reconstruction in increased femoral anteversion could replicate patellofemoral (PF) pressure pattern of a hypothetical normal population, and (2) the change of PF pressure according to MPFL state under the same anteversion setting.</p><p><strong>Methods: </strong>Ten fresh-frozen cadaveric knees were used. Experiments were performed from knee flexion 0° to 90° with three MPFL state (intact, released, and reconstructed) and three anteversion (initial state, 10° and 20° more increased). Medial and lateral PF joint contact pressures were measured at each point.</p><p><strong>Results: </strong>At 0° flexion, lateral PF pressure was increased to 62.1 ± 7.8 psi in 10° and 67.3 ± 13.5 psi in 20° more increased anteversion, compared to 43.2 ± 8.6 psi of hypothetical normal population (P-value 0.027 and 0.004, respectively). At 30° flexion, medial PF pressure was decreased to 31.3 ± 11.9 psi in 10° and 27.3 ± 17.5 psi in 20° more increased anteversion, compared to 44.1 ± 10.3 psi of hypothetical normal population (P-value 0.009 and 0.027, respectively). Within the same femoral anteversion, when anteversion was increased 10° and 20° more than the initial state, medial facet pressure after MPFL reconstruction at 90° flexion was increased from 28.7 ± 11.4 to 40.0 ± 9.9 psi and 16.7 ± 10.8 to 33.9 ± 15.0 psi compared to the intact MPFL (P-value 0.047 and <0.001, respectively).</p><p><strong>Conclusions: </strong>Biomechanically, isolated MPFL reconstruction under increased femoral anteversion was unable to replicate the state of a hypothetical normal population. Even when comparing within the same femoral anteversion, isolated MPFL reconstruction at increased femoral anteversion caused medial PF overpressure at 90° flexion angle.</p><p><strong>Clinical relevance: </strong>When performing MPFL reconstruction for recurrent patellar dislocation, femoral anteversion should be assessed. Increased femoral anteversion can cause overpressure on the medial facet following isolated MPFL reconstruction.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743907","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":"Guidelines for Designing and Conducting Delphi Consensus Studies: An Expert Consensus Delphi Study.","authors":"Erik Hohmann, Philippe Beaufils, Daniel Beiderbeck, Jorge Chahla, Andrew Geeslin, Samer Hasan, Susan Humphry-Murto, Eoghan Hurley, Rob LaPrade, Frank Martetschläger, Bogdan Matache, Gilbert Moatshe, Juan Carlos Monllau, Iain Murray, Marlen Niederberger, Urs Rüetschi, Zhida Shang, Stephen Weber, Ivan Wong, Nicholas Pj Perry","doi":"10.1016/j.arthro.2025.03.038","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.038","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to conduct a Delphi project to develop guidelines for the design and execution of Delphi studies within medical and surgical specialties.</p><p><strong>Methods: </strong>Open-ended questions in round 1 and open-ended and semi-open questions in round 2 were answered. The results of the first two rounds were used to develop a Likert style questionnaire for round 3. The level of agreement and consensus was defined as 80%. Consensus was further categorized into specific percentage ranges for clarity: 100% unanimous consensus, 90-99% very strong consensus, 80-89% consensus.</p><p><strong>Results: </strong>Consensus was achieved for 35 out of 63 items (56%). Unanimous agreement was reached for 4 items (6.3%), while very strong consensus was established for 12 items (19%). Consensus was reached for an additional 19 items (30.1%), and the panel remained undecided on 7 items (11.1%).</p><p><strong>Conclusion: </strong>Unanimous agreement was reached for iteration, the ability to establish treatment guidelines, a proven track record of panel members, and the requirement for at least one steering committee member to be a Delphi expert. Very strong consensus was reached on several key requirements: a clear definition of consensus, controlled feedback between rounds, precise definitions of expert and expertise, and the need for panel members to demonstrate experience through publications and clinical practice. Criteria for panel selection should ensure diversity and specialization, with steering committee members being content experts and a minimum of 20-30 panel members for broader topics. Regional experts should provide consensus on specific topics only. The steering committee should develop questions, with open-ended questions in Round 1 and both types in Round 2. Limiting the process to three rounds is advisable, aiming for at least 80% consensus in the final round.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743199","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 and Language Learning Models Can Be Improved By Curated Input of Medical Training Data But Still Face The Limitations of Available Literature And Require Continued Human Oversight.","authors":"Farah Selman, Kristine Obletz, Valeria Vismara, Robert Putko, Nicholas P J Perry","doi":"10.1016/j.arthro.2025.03.042","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.042","url":null,"abstract":"<p><p>Artificial intelligence (AI) and Language Learning Models (LLM) are rapidly evolving. Several popular and easily accessible platforms, like ChatGPT and Gemini, are increasingly being explored by clinicians and patients for their utility in clinical decision-making. While these tools provide rapid access to information, their inconsistent adherence to evidence-based guidelines raises concerns. A potential solution is to generate more specialized LLM's for orthopaedics. A curated database of validated orthoapediic literature can be used as input, in order to address concerns about the quality of input data. However, a curated LLM may still have limitations of selection bias and limited high-quality literature. In additionally, patients using these models may possess limited health literacy. LLM's represent an advancement and potentially powerful clinical tool but still require ongoing evaluation, refinement, and validation. AI should continued to be viewed as an evolving resource rather than a replacement for clinical judgment.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744442","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":"High Repair Tension and Advanced Age Negatively Affect Subscapularis Healing Status Following Arthroscopic Rotator Cuff Repair.","authors":"Kai-Lan Hsu, Fa-Chuan Kuan, Yueh Chen, Chih-Kai Hong, Hao-Chun Chuang, Pei-Fang Su, Chin-Chun Chen, Wei-Ren Su","doi":"10.1016/j.arthro.2025.03.041","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.041","url":null,"abstract":"<p><strong>Purpose: </strong>The study aim to (1) investigate the relationship between repair tension and radiological outcomes, and (2) identify cutoff values of associated factors that predict both radiological and clinical outcomes following arthroscopic subscapularis (SSC) repair.</p><p><strong>Methods: </strong>This retrospective study included patients who underwent SSC repair and completed a 2-year follow-up between September 2020 and March 2022. Intraoperative evaluations examined the retraction length, repaired tendon, and Lafosse's classification. Magnetic resonance imaging was performed before surgery and 6 months postoperatively to evaluate the severity of the tear, fatty infiltration, and healing status of the SSC and supraspinatus Functional scores and internal rotation strength were measured before surgery and at 6, 12, and 24 months postoperatively. Multiple logistic regression identified variables associated with poor healing, with receiver operating characteristic curves determining cutoff values.</p><p><strong>Results: </strong>A total of 67 patients was included. The mean SSC repair tension was 3.72 ± 1.48 kg. Poor healing was observed in 25.4% of the patients, with significant differences in age (p = 0.004), repair tension (p = 0.002), retraction length (p = 0.033), and Lafosse's classification (p = 0.035) observed between the adequate and poor healing groups. Multiple logistic regression revealed significantly increased odds ratios (ORs) for poor SSC healing in patients over 65 years and in those with repair tension exceeding 4 kg for poor SSC healing.</p><p><strong>Conclusion: </strong>Poor SSC healing is associated with advanced age, increased repair tension, greater retraction length, and more severe Lafosse classification. Patients over the age of 65 and those with a repair tension exceeding 4 kg are at a significantly higher risk of poor SSC healing. Furthermore, patients with poor SSC healing exhibit significantly reduced internal rotation strength at 24 months postoperatively. However, no significant decline was observed in shoulder function scores or in the achievement of minimal clinically important difference.</p><p><strong>Study design: </strong>Retrospective cohort study; Level of evidence, 3.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743817","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":"Increased Labral Height is Associated with Greater Distractive Stability of the Hip: An In Vivo Analysis.","authors":"Alexander J Mortensen, Benjamin T Johnson, Joseph Featherall, Megan K Mills, Allan K Metz, Devin L Froerer, Stephen K Aoki","doi":"10.1016/j.arthro.2025.03.039","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.039","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the relationship of labral height measured on magnetic resonance imaging (MRI) and resistance to axial distraction in patients with femoroacetabular impingement (FAI) syndrome.</p><p><strong>Methods: </strong>Patients who underwent primary hip arthroscopy for FAI syndrome between March 2020 and August 2020 were enrolled in the study traction protocol. Prior to any operative instrumentation, fluoroscopic images were taken of the native hip joint at 12.5 lb intervals between 0-100 lbs of axial traction on a postless traction table. Distraction was calculated as the difference between the total joint space at each traction interval and the baseline joint space. Labral height was measured on MRI sagittal reformats at approximately 1:30 on the acetabular clockface by a musculoskeletal fellowship-trained radiologist who was blinded to the traction data. Descriptive statistics, independent samples t-tests, Pearson chi-square tests, and Fisher's exact tests were utilized in analysis.</p><p><strong>Results: </strong>Forty-three hips in 42 patients were included. Labral height was <6 mm in 19 (44%) patients and ≥6 mm in 24 (56%) patients. No statistically significant differences in age, sex, body mass index, alpha angle, Tönnis grade, lateral center edge angle, Beighton score, or presence of labral tears were observed between patients with <6 and ≥6 mm of labral height (P > 0.05). A greater percentage of patients with a labral height <6 mm broke their suction seal relative to patients with a labral height of ≥6 mm at 62.5 lbs (42% v. 4%; P=0.003) and 100 lbs (95% v. 67%; p=0.027).</p><p><strong>Level of evidence: </strong>III, retrospective cohort study CONCLUSIONS: Anterosuperior labral height ≥6 mm is associated with increased resistance to axial distraction on an exam under anesthesia in patients undergoing primary hip arthroscopy for FAI syndrome.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743876","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":"Deteriorated Quality and Media Retraction of Tendon Following Acute Traumatic Rotator Cuff Tear are Predictors of Retear After Arthroscopic Repair.","authors":"Su Cheol Kim, Hyun Gon Kim, Jong Hyun Lee, Seung Je Kim, Sang Min Lee, Jae Chul Yoo","doi":"10.1016/j.arthro.2025.03.037","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.037","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the structural outcomes of arthroscopic repair of traumatic rotator cuff (RC) tears and analyze the factors related to retears, focusing on tendon quality observed using arthroscopy.</p><p><strong>Methods: </strong>This retrospective study included patients who had undergone arthroscopic repair of traumatic full-thickness RC tears between 2014 and 2021. Traumatic RC tears were defined as the sudden onset or worsening of shoulder pain or function within 3 years following a slip or fall. Gross tendon quality was assessed using arthroscopic imaging and categorized as none, mild, or advanced, which corresponded to grades 0, 1, and 2, respectively. RC retear was assessed using magnetic resonance imaging (MRI) at 6 months and clinically evaluated at least 1 year after surgery.</p><p><strong>Results: </strong>A total of 121 patients were included in the study, and the RC retear rate was 27.3% (33/121). RC retears were significantly associated with medial supraspinatus retraction (P = 0.015), atrophy with fatty infiltration (P = 0.010) on MRI, tendon deterioration (P < 0.001), and anterior rotator cable rupture (P = 0.034) observed during arthroscopy. In multivariable analysis, advanced tendon deterioration (grade 1 vs. 0: odds ratio [OR] 0.3, 95% confidence interval [CI] 0.1-1.3, P = 0.117; grade 2 vs. 0: OR 6.3, 95% CI 1.9-21.2, P = 0.003) and the absence of initial pseudoparesis (OR 0.1, 95% CI 0.02-1.0, P = 0.045) were identified as significant predictors of retear. Additionally, supraspinatus medial retraction (OR 1.5, 95% CI 1.0-2.2, P = 0.056) was identified as a potential predictor of retear. The final function visual analog scale was significantly lower in the RC retear group than in the intact group (7.1 ± 1.8 vs. 8.0 ± 1.2, P = 0.013), whereas other shoulder function parameters were similar between the groups. Final shoulder function was not significantly affected by tendon quality.</p><p><strong>Conclusions: </strong>Gross tendon quality, as assessed during arthroscopy, along with supraspinatus medial retraction and the absence of initial pseudoparesis, were predictors of retear in the repair of traumatic RC tears. Intraoperative assessment of tendon quality would be important for predicting surgical outcomes in traumatic RC tear repair.</p><p><strong>Level of evidence: </strong>Level IV, Retrospective case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744443","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":"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}