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

{"title":"Combined medial meniscus repair, centralization, and high tibial osteotomy are associated with improved clinical, radiological, and arthroscopic outcomes in patients with posterior root tears and varus alignment.","authors":"Yasumasa Tokumoto, Yusuke Nakagawa, Tomomasa Nakamura, Nobutake Ozeki, Takashi Hoshino, Ichiro Sekiya, Hideyuki Koga","doi":"10.1016/j.arthro.2025.07.003","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.07.003","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the radiological, clinical, and arthroscopic outcomes following meniscal centralization combined with pull-out repair and open-wedge high tibial osteotomy (OWHTO) in patients with medial meniscal posterior root tear (MMPRT) and varus alignment.</p><p><strong>Methods: </strong>We retrospectively analyzed patients who underwent OWHTO between 2017 and 2022, including those with MMPRT and varus alignment who received meniscal centralization and transtibial pull-out repair, with a minimum 2-year follow-up. Clinical and radiographic outcomes, including medial joint space width (mJSW) in the Rosenberg view, were evaluated. Second-look arthroscopy, performed at the time of plate removal (1 year after surgery), evaluated meniscal healing and cartilage status. Medial meniscus extrusion (MME) was classified at the initial surgery and second-look arthroscopy. The cohort-specific minimal clinically important difference (MCID) was calculated.</p><p><strong>Results: </strong>Of the 48 eligible patients, 37 were available for follow-up and were included in the analysis, with a mean follow-up of 45.7 ± 12.0 months (range: 24-71 months). The flexion angle and all clinical scores were significantly improved. MCID was achieved in 92.9% of patients, according to the International Knee Documentation Committee (IKDC), and in >80% of patients for all Knee Injury and Osteoarthritis Outcome Score (KOOS) subscales, except for the KOOS Sport. mJSW increased from 2.7 ± 1.0 mm before surgery to 2.9 ± 1.0 mm at 2 years after surgery (p = .046). Complete meniscal healing was observed in 80.6%, with significant improvements in the International Cartilage Repair Society scores for medial femoral condyle and medial tibial plateau (p = .011, p = .006). MME was improved in 83.3% of patients.</p><p><strong>Conclusion: </strong>Combined with pull-out repair, meniscal centralization and OWHTO significantly improved clinical, radiological, and arthroscopic outcomes at short-term follow-up, with a high proportion of patients achieving MCID thresholds in the Lysholm score, IKDC subjective score, and KOOS subscales.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661103","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":"Performing A Concomitant Lateral Extra-Articular Procedure Is A Dominant Cost-Effective Strategy Over Isolated ACL Reconstruction Due To Higher Quality of Life and Lower Overall Costs.","authors":"Adnan Saithna","doi":"10.1016/j.arthro.2025.07.009","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.07.009","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661104","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":"There Is Mounting Evidence for Use of Distal Tibial Allograft in Shoulder Instability in Cases With Substantial Glenoid Bone Loss.","authors":"Sarah B Shubert","doi":"10.1016/j.arthro.2025.07.006","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.07.006","url":null,"abstract":"<p><p>The patient with anterior instability of the shoulder and substantial glenoid bone loss presents a challenging situation to the surgeon. Most often, this occurs in young patients, when it is even more crucial that the surgeon choose the procedure with the greatest chance of success. The ideal surgical treatment for any orthopedic condition is safe, pragmatic, inexpensive and proven to be effective in both clinical and biomechanical studies. Distal tibia allograft (DTA) was first introduced as a surgical technique to address shoulder instability in the setting of glenoid bone loss, approximately 10 years ago. Although Latarjet remains a reliable option, mounting evidence has demonstrated that DTA delivers comparable or improved rates of stability and patient-reported outcomes. Although the cost of DTA remains a consideration, its lower risk of complications and proven success has established this as a technique that rivals the traditional gold standard.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651306","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":"The Presence or Absence of Cartilage Regeneration Following Medial Open-Wedge High Tibial Osteotomy Does Not Predict Long-term Outcomes.","authors":"Kang-Il Kim, Sang-Hak Lee, Jun-Ho Kim","doi":"10.1016/j.arthro.2025.07.004","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.07.004","url":null,"abstract":"<p><strong>Purpose: </strong>The study aims to assess the whether the patients who showed mature cartilage regeneration in the medial compartment in a second look arthroscopy have better clinical and radiologic long-term outcomes and survivorship compared to immature cartilage regeneration following medial open-wedge high tibial osteotomy (MOWHTO).</p><p><strong>Methods: </strong>Patients who underwent MOWHTO using a medial locked plate system were retrospectively reviewed between February 2008 and December 2012. All included patients had no concomitant cartilage-restoring procedures, underwent second-look arthroscopy at 2 years postoperatively, and were followed for at least 10 years. Based on arthroscopic findings in the medial femoral condyle, patients were classified into mature and immature cartilage regeneration groups. Clinical outcomes, including the primary outcome of total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, were compared between the groups using patient-reported outcome measures. The minimal clinically important difference (MCID) was assessed to determine clinical significance. Radiologic progression of osteoarthritis was evaluated using serial changes in the Kellgren-Lawrence grade, and survivorship, defined as conversion to arthroplasty, was analyzed using the Kaplan-Meier method.</p><p><strong>Results: </strong>A total of 83 consecutive knees were included, with 34 in the mature group and 49 in the immature group. The mean follow-up period was 12.1 years (range, 10-15.2 years). No significant differences were observed in clinical outcomes or the proportion of patients achieving minimal clinically important difference (MCID) on the WOMAC scale (MCID 9.1; Group M 93.9% vs. Group I 97.9%, P=.564). Radiologic progression showed a trend of progressing more slowly in the mature group than in the immature group without significance at the latest follow-up(P=.113). The 10-year survival rate was 100% in the mature group and 95.6% in the immature group (P = .099).</p><p><strong>Conclusion: </strong>The presence or absence of cartilage regeneration in the medial compartment does not predict better long-term outcomes, including radiologic progression, the achievement of MCID in clinical outcomes, or survivorship following MOWHTO.</p><p><strong>Level of evidence: </strong>IV, Retrospective comparative case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144651305","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":"Tibial Osteotomies: No Perfect Road, All Detours Have Their Own Potholes.","authors":"Ta'avili Taylor, Luke V Tollefson, Nicholas I Kennedy","doi":"10.1016/j.arthro.2025.07.005","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.07.005","url":null,"abstract":"<p><p>When it comes to surgical interventions for varus malalignment and medial compartment osteoarthritis, proximal tibial osteotomy (PTO) continues to be a cornerstone procedure-offering biomechanical correction, symptom relief, and a welcome detour from the highway to total knee arthroplasty. But as with all detours, the path is not without its own potholes: loss of correction, patella baja, and increased posterior tibial slope (PTS) remain persistent issues, particularly with the traditional medial opening wedge technique. Attempts to avoid these complications can be done by taking special considerations into the type of osteotomy (medial opening wedge vs. lateral closing wedge), fixation modality, the size of the opening wedge (or closing wedge), location and angles of the osteotomy cuts, and the use of allograft or autograft to fill in osteotomy site. However, each new technique that is presented comes with its own unique set of complications making a recommendation of one technique for all patients nearly impossible. Further inquiry into a one-size fits all technique may be futile and the future may lie in patient-specific osteotomy techniques.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638748","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":"Promising Early Results of Inferior Glenohumeral Ligament Reconstruction In Patients With Multidirectional and Predominantly Inferior Shoulder Instability Require Further Validation.","authors":"Adnan Saithna","doi":"10.1016/j.arthro.2025.07.002","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.07.002","url":null,"abstract":"<p><p>Multidirectional shoulder instability (MDI) is a complex condition. A plethora of surgical treatment options exists including labral repair, IGHL repair/reconstruction, inferior capsular shift, capsular plication/capsulorraphy, capsular reconstruction, rotator interval closure, subscapularis tenodesis, bone block transfer, and glenohumeral arthrodesis. Regardless of procedure choice, the odds of undergoing subsequent surgery are typically greater than those among patients without known connective tissue disorders. Since most treatment failures occur during the first three-years post-operatively, careful consideration should be given to minimum follow up periods in future studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144627823","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":"Editorial Commentary: Preoperative Mental Health Screening, Early Identification, and Utilization of Multi-Disciplinary Patient-Specific Care May Help Improve Postoperative Outcomes in Patients with Mental Health Disorders Undergoing Anterior Cruciate Ligament Reconstruction.","authors":"Jay Moran, Jorge Chahla","doi":"10.1016/j.arthro.2025.07.001","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.07.001","url":null,"abstract":"<p><p>Within the field of sports medicine, it is estimated that over 200,000 anterior cruciate ligament (ACL) tears occur every year and nearly half of these patients will undergo ACL reconstruction (ACLR) surgery. While ACLR remains the gold standard for treatment and has demonstrated widely successful outcomes over the years, a small percentage of patients will experience postoperative complications such as instability, persistent knee pain, osteoarthritis, graft rupture, infection, and/or knee stiffness that may impact function and quality of life. Despite the overall success of the procedure, a better understanding of the modifiable risk factors for postoperative complications following ACLR is still needed. Specifically, a high percentage of depression and anxiety has been reported after ACL injury and ACLR, with some studies reporting clinically significant depression in up to 42% of patients. These patient-specific psychological factors can lead to fear of reinjury, low rehabilitation participation, pain catastrophizing, and/or a low internal health locus of control that can negatively impact the postoperative recovery. While higher-level studies are still warranted to elucidate the underlying mechanisms, recent reports have demonstrated that patients with existing preoperative mental health comorbidities, such as depression and/or anxiety, are at an increased risk for postoperative complications and inferior functional outcomes following ACLR. As such, early identification of at-risk patients using validated mental health screening tools can assist in facilitating multi-disciplinary patient-specific interventions that may improve postoperative optimization, patient-centered care, and ultimately, functional outcomes after ACLR. Overall, it is essential to understand that the mental health status of our patients can greatly influence physical recovery after ACLR and action towards optimization must be taken in these at-risk patients.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621163","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":"Female athletes may have a greater challenge in returning to sport after contemporary cartilage procedures in the knee: A systematic review and meta-analysis.","authors":"Andromahi Trivellas, Cooper Williams, Aaron Therien, Samantha Kaplan, Stephanie Hendren, Brian Lau","doi":"10.1016/j.arthro.2025.06.037","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.06.037","url":null,"abstract":"<p><strong>Purpose: </strong>The goal of this systematic review is to assess the current literature for differences in return to sport (RTS) rates between male and female athletes after common cartilage procedures in the knee including autologous chondrocyte implantation (ACI), matrix-induced autologous chondrocyte implantation (MACI), osteochondral autograft transplantation (OAT), and osteochondral allograft transplantation (OCA).</p><p><strong>Methods: </strong>Electronic databases were searched from inception to November 2024. Two independent reviewers screened 2,482 articles. The inclusion criteria were: studies from 2004 to present, level of evidence 1-4, reporting RTS data and sex specific outcomes after OAT, MACI, ACI, or OCA of the knee, with minimum follow-up of 12 months. The main outcome was difference in RTS rate among male and female athletes. RTS was defined as the percentage able to resume sport or military duty, and the percentage able to return to their pre-injury level (RPL) or full duty. A meta-analysis was conducted using the inverse variance method with a random-effects model to account for both within- and between-study variability to identify sex differences in RTS. Statistical analyses were conducted using R (Version 2024.09.0+375).</p><p><strong>Results: </strong>Twenty-two primary studies encompassing 1,468 athletes after OAT, MACI, ACI, or OCA, reported sex specific outcomes. Fifteen of these reported no statistically significant difference in RTS in females vs. males. Five studies reported better RTS in males, and one reported better RTS in females. Only one study reported specific sex differences in RPL. Meta-analysis identified RTS rate of 75% for males and 56% for females.</p><p><strong>Conclusion: </strong>There is a paucity of available data on RTS based on sex following contemporary cartilage procedures for chondral injuries of the knee. Meta-analysis of available data suggests females may have more difficulty with returning to sport than males.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621164","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":"\"Isolated arthroscopic-assisted posterior latissimus dorsi transfer may not be sufficient treatment for posterosuperior irreparable rotator cuff tears\".","authors":"Matthias Brockmeyer","doi":"10.1016/j.arthro.2025.06.016","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.06.016","url":null,"abstract":"<p><p>Posterosuperior irreparable rotator cuff tears (PSIRCTs) are challenging to treat by conservative as well as surgical approaches. Patients with PSIRCTs have often a high burden of suffering with regard to pain level and functional impairments. Different surgical treatment options are available for PSIRCTs depending on age, functional requirements, and grade of osteoarthritis: joint-preserving procedures such as arthroscopic debridement, partial repair with or without augmentation, superior capsular reconstruction, and subacromial balloon spacer for young and active patients and joint-replacing surgery such as reverse shoulder arthroplasty in elderly patients with osteoarthritis. Additionallly, tendon transfer surgeries are also a reliable treatment method for patients with PSIRCTs and without osteoarthritis. Various tendon transfer techniques are known. The traditional latissimus dorsi transfer (LDT) or the combination of latissimus dorsi and teres major transfer are frequently done in PSIRCTs patients. More recent transfer techniques make use of the lower trapezius tendon with promising clinical results. Apart from pain reduction another important aim of all tendon transfer methods is the functional improvement especially for activities of daily living such as eating, drinking, or combing the hair by reinforcing the forward elevation and external rotation.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621162","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":"Remplissage During Primary Arthroscopic Bankart Repair is Highly Cost-Effective for On-Track Hill-Sachs Lesions and Variably Cost-Effective for Off-Track Hill-Sachs Lesions with Glenoid Bone Loss Below 15.","authors":"Gabriella Schreiner, Stephen Fucaloro, Madison Hayes-Lattin, Jack Bragg, Matthew Salzler","doi":"10.1016/j.arthro.2025.06.021","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.06.021","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to assess the cost-effectiveness of performing a remplissage at the time of primary arthroscopic labral repair (ALR) for shoulder dislocations with on- and off-track Hill-Sachs Lesions (HSLs).</p><p><strong>Methods: </strong>Baseline costs for ALR, remplissage, revision surgery, and initial failure rate were collected from the literature for both on- and off-track HSLs. All referenced studies included patients with subcritical glenoid bone loss less than 15%. The initial failure rate was defined as the rate of revision surgery for shoulder re-dislocation. Break-even economic analysis was used to assess the cost-effectiveness of adding remplissage to a primary ALR. To account for the variability in the cost, initial failure rates, and procedural differences across institutions, a wide range of values were used to calculate the absolute risk reduction (ARR) and number needed to treat (NNT) to achieve cost-effectiveness. To provide alternate scenarios, sub-analyses with revision remplissage and revision latarjet were also performed.</p><p><strong>Results: </strong>Primary remplissage was cost-effective for off-track HSLs if it prevents one revision for every 15 primary ALRs (ARR 6.8%, NNT=15), assuming primary remplissage costs of $982 and revision surgery costs $14,498. With an initial failure rate of 14.0%, primary remplissage is cost-effective for off-track HSLs when the cost of revision surgery exceeds $7,000 or when primary remplissage costs less than $2,750. For on-track lesions, remplissage is cost-effective at revision surgery costs exceeding $9,632 or when remplissage costs less than $2,000. Sub-analysis of revision latarjet similarly demonstrated cost-effectiveness.</p><p><strong>Conclusions: </strong>Remplissage is a highly cost-effective intervention for off-track HSLs for a wide range of primary and revision surgery costs according to this break-even economic analysis. Remplissage is cost-effective for on-track lesions when the cost of revision surgery is greater than $9,632 or when remplissage costs less than $2,000.</p><p><strong>Level of evidence: </strong>IV, economic analysis.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144621252","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}