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

{"title":"Editorial Commentary: Anterior Cruciate Ligament Graft Selection Is Best Tailored to Individual Patient Sport and Activity Level","authors":"Clayton W. Nuelle M.D. (Editorial Board)","doi":"10.1016/j.arthro.2024.09.018","DOIUrl":"10.1016/j.arthro.2024.09.018","url":null,"abstract":"<div><div>Anterior cruciate ligament (ACL) reconstruction graft choice is a topic of ongoing debate. Literature shows allografts should be avoided in younger patients, and given this result, there has been a general trend toward increased use of autograft reconstruction in recent years, regardless of age. Almost concurrently, there has been an increased trend toward the use of quadriceps tendon as a primary or revision graft. In addition to these trends, more and more patients are remaining active at later ages, resulting in increased numbers of patients requiring ACL surgery at age 50 years and older. In this population, recent research shows equal outcomes with hamstring tendon and quadriceps tendon autografts, and lower return to skiing with hamstring grafts, indicating that graft choice should be tailored to the individual patient and their sport or activity level. Allografts (and any graft choice) may also show good outcomes in this age group.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 5","pages":"Pages 1521-1522"},"PeriodicalIF":4.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301713","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: Anatomic Tibiofibular and Partially Anatomic-Based Fibular Posterolateral Corner Reconstruction Techniques Are Biomechanically Superior to Nonanatomic Reconstruction Techniques: A Tibial Tunnel Is the Gold Standard for an Anatomic Reconstruction","authors":"Jay Moran M.D. ,&nbsp;Luke V. Tollefson B.S. ,&nbsp;Christopher M. LaPrade M.D. ,&nbsp;Robert F. LaPrade M.D., Ph.D.","doi":"10.1016/j.arthro.2024.11.053","DOIUrl":"10.1016/j.arthro.2024.11.053","url":null,"abstract":"<div><div>Nearly 2 decades ago, the posterolateral corner (PLC) was commonly referred to as the “dark side” of the knee because of our limited anatomical understanding, no anatomic-based reconstruction techniques, and high rates of clinical failures. During this time, nonanatomic PLC-reconstruction techniques, or “fibular slings,” gained popularity early on as a result of the ease of the procedure; however, clinical studies demonstrated residual varus gapping and external rotation laxity associated with these nonanatomic techniques that only reconstructed the fibular (lateral) collateral ligament. The term “anatomic” PLC reconstruction generally refers to a procedure that aims to restore the entirety of the 3 main PLC static stabilizers. Currently, the most commonly used PLC-reconstruction techniques have evolved to be either a complete anatomic reconstruction with a tibiofibular-based (LaPrade and Engebretsen) approach or a partial anatomic reconstruction through a fibular-based (Levy/Marx, Arciero) technique. Both reconstruction approaches incorporate the use of a second femoral tunnel for improved restoration of the femoral attachments of the fibular (lateral) collateral ligament and popliteus tendon and are biomechanically superior compared with the historic nonanatomic techniques. As such, these improved PLC-reconstruction techniques, whether tibiofibular-based or fibular-based, are strongly recommended over nonanatomic reconstruction techniques. Compared with the fibular-based approach, an anatomic tibiofibular-based PLC reconstruction more closely recreates the native architecture of the PLC with recreation of the popliteofibular ligament and use of a tibial tunnel to restore the static function of the popliteus tendon. In addition, certain conditions, such as concurrent proximal tibiofibular joint instability and asymmetric knee hyperextension, are contraindications to using fibular-based reconstructions and should always use a tibial tunnel.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 5","pages":"Pages 1578-1581"},"PeriodicalIF":4.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142644849","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: Pain Relief Following a Preoperative Diagnostic Hip Injection Does Not Predict 2-Year Outcomes After Hip Arthroscopy for Femoral Acetabular Impingement Syndrome","authors":"Robert Kollmorgen D.O., F.A.A.O.S., F.A.O.B.O.S. (Associate Editor)","doi":"10.1016/j.arthro.2024.09.037","DOIUrl":"10.1016/j.arthro.2024.09.037","url":null,"abstract":"<div><div>For decades, hip preservationists have utilized intra-articular preoperative injections for diagnostic and therapeutic reasons. In the presence of typical or atypical hip pain, impingement, instability, and torsional abnormalities, hip preservationists are challenged with consistently educating ourselves and patients on interventions that can predict long-term relief. Current evidence on the predictive postoperative value of a positive injection response is mixed. Injection results can show whether the patient’s symptoms are coming from the hip and to what extent, but they may not predict future outcomes. The patient is more complicated than a positive or negative injection response, and the decision for surgery should be taken in context to all clinical factors, imaging findings, and patient expectations. Proper rehabilitation is also vital. Finally, a negative injection response in a patient diagnosed with femoral acetabular impingement syndrome should not deter the decision for surgery. With the correct diagnosis and procedure, patients can do well.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 5","pages":"Pages 1379-1380"},"PeriodicalIF":4.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332996","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 Large Language Model ChatGPT-4 Exhibits Excellent Triage Capabilities and Diagnostic Performance for Patients Presenting With Various Causes of Knee Pain","authors":"Kyle N. Kunze M.D. ,&nbsp;Nathan H. Varady M.D., M.B.A. ,&nbsp;Michael Mazzucco B.S. ,&nbsp;Amy Z. Lu B.S. ,&nbsp;Jorge Chahla M.D., Ph.D. ,&nbsp;R. Kyle Martin M.D., F.R.C.S.C. ,&nbsp;Anil S. Ranawat M.D. ,&nbsp;Andrew D. Pearle M.D. ,&nbsp;Riley J. Williams III M.D.","doi":"10.1016/j.arthro.2024.06.021","DOIUrl":"10.1016/j.arthro.2024.06.021","url":null,"abstract":"<div><h3>Purpose</h3><div>To provide a proof-of-concept analysis of the appropriateness and performance of ChatGPT-4 to triage, synthesize differential diagnoses, and generate treatment plans concerning common presentations of knee pain.</div></div><div><h3>Methods</h3><div>Twenty knee complaints warranting triage and expanded scenarios were input into ChatGPT-4, with memory cleared prior to each new input to mitigate bias. For the 10 triage complaints, ChatGPT-4 was asked to generate a differential diagnosis that was graded for accuracy and suitability in comparison to a differential created by 2 orthopaedic sports medicine physicians. For the 10 clinical scenarios, ChatGPT-4 was prompted to provide treatment guidance for the patient, which was again graded. To test the higher-order capabilities of ChatGPT-4, further inquiry into these specific management recommendations was performed and graded.</div></div><div><h3>Results</h3><div>All ChatGPT-4 diagnoses were deemed appropriate within the spectrum of potential pathologies on a differential. The top diagnosis on the differential was identical between surgeons and ChatGPT-4 for 70% of scenarios, and the top diagnosis provided by the surgeon appeared as either the first or second diagnosis in 90% of scenarios. Overall, 16 of 30 diagnoses (53.3%) in the differential were identical. When provided with 10 expanded vignettes with a single diagnosis, the accuracy of ChatGPT-4 increased to 100%, with the suitability of management graded as appropriate in 90% of cases. Specific information pertaining to conservative management, surgical approaches, and related treatments was appropriate and accurate in 100% of cases.</div></div><div><h3>Conclusions</h3><div>ChatGPT-4 provided clinically reasonable diagnoses to triage patient complaints of knee pain due to various underlying conditions that were generally consistent with differentials provided by sports medicine physicians. Diagnostic performance was enhanced when providing additional information, allowing ChatGPT-4 to reach high predictive accuracy for recommendations concerning management and treatment options. However, ChatGPT-4 may show clinically important error rates for diagnosis depending on prompting strategy and information provided; therefore, further refinements are necessary prior to implementation into clinical workflows.</div></div><div><h3>Clinical Relevance</h3><div>Although ChatGPT-4 is increasingly being used by patients for health information, the potential for ChatGPT-4 to serve as a clinical support tool is unclear. In this study, we found that ChatGPT-4 was frequently able to diagnose and triage knee complaints appropriately as rated by sports medicine surgeons, suggesting that it may eventually be a useful clinical support tool.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 5","pages":"Pages 1438-1447.e14"},"PeriodicalIF":4.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460937","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: Medial Meniscal Root Repair Should Be Combined With High Tibial Osteotomy in Cases of Meniscal Extrusion","authors":"Jesús Alfaro-Adrián MD, DPhil (Oxon) (Editorial Board)","doi":"10.1016/j.arthro.2024.08.027","DOIUrl":"10.1016/j.arthro.2024.08.027","url":null,"abstract":"<div><div>Medial meniscus extrusion (MME) is classically defined as radial displacement of ≥3 mm outside the tibial border. MME is usually seen in middle-aged patients, and it is strongly associated with medial meniscus root (MMR) pathology and medial femorotibial compartment degenerative change. MMR tears are associated with cartilage defects of the medial femoral condyle (89%) and MME ≥3 mm (67%). If MMR tears are associated with MME, high tibial osteotomy combined with MMR repair may reduce MME and protect the medial compartment. Recent research shows combined MMR repair and high tibial osteotomy yield improved radiographic and functional outcomes.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 5","pages":"Pages 1472-1473"},"PeriodicalIF":4.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146954","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":"Preoperative Hip Injection Response Does Not Reliably Predict 2-Year Postoperative Outcomes After Hip Arthroscopy for Femoroacetabular Impingement","authors":"Lejla Pepic B.S.,&nbsp;Alexander R. Markes M.D.,&nbsp;Hayden Sampson B.S.,&nbsp;Kylen K.J. Soriano M.D.,&nbsp;Stephanie E. Wong M.D.,&nbsp;Alan L. Zhang M.D.","doi":"10.1016/j.arthro.2024.07.025","DOIUrl":"10.1016/j.arthro.2024.07.025","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine whether response to preoperative local anesthetic or corticosteroid intra-articular injections can predict 2-year postoperative outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS).</div></div><div><h3>Methods</h3><div>We performed a retrospective analysis of patients undergoing hip arthroscopy for FAIS at a single institution from 2014 to 2020. Patients who underwent preoperative intra-articular hip injections were classified based on injection type (local anesthetic or corticosteroid) and whether they experienced pain relief after injection (responders or nonresponders). Responders were matched 2:1 to nonresponders by age, body mass index, and sex. Patient-reported outcomes (PROs) including the Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-Item Short-Form Health Survey (SF-12) Mental Component Summary score, SF-12 Physical Component Summary score, and visual analog scale pain score were collected preoperatively and 2 years postoperatively. Mean score change and minimal clinically important difference (MCID) achievement were calculated and compared between groups.</div></div><div><h3>Results</h3><div>The matched cohort included 126 total patients (42 nonresponders and 84 responders; 74.6% female sex; age [mean ± standard deviation], 30.9 ± 9.9 years; body mass index, 24.7 ± 3.7) with no differences in demographic or radiographic hip variables. Both groups showed significant 2-year postoperative score improvements across all PROs, except the SF-12 Mental Component Summary score, which remained unchanged. There was no difference in mean score change or MCID achievement across all PROs between the corticosteroid injection responder and nonresponder groups. In the local anesthetic group, MCID achievement was similar across all PROs, except the visual analog scale pain score, which showed a greater percentage of MCID achievement among local anesthetic nonresponders (89.5%) than in responders (55.0%, <em>P</em> = .03). Significant ceiling effects were most readily apparent within the injection responder group, with greater percentages of patients achieving maximal 2-year postoperative survey scores (HOOS-Activities of Daily Living, 36.9%; HOOS-Pain, 19.0%; HOOS-Quality of Life, 15.5%; and HOOS-Sport, 32.1%).</div></div><div><h3>Conclusions</h3><div>Response to preoperative injection with either corticosteroid or local anesthetic did not predict 2-year outcomes after hip arthroscopy in patients with FAIS.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective matched-cohort study.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 5","pages":"Pages 1369-1378.e1"},"PeriodicalIF":4.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918144","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":"Rebound Pain After Arthroscopic Cuff Repair With Interscalene Brachial Plexus Block Anesthesia Is Reduced by Surgeon-Administered Multimodal Shoulder Injections: A Prospective Randomized Controlled Trial","authors":"Ki-Bong Park M.D. ,&nbsp;Hyun-Oh Cho M.D ,&nbsp;Min Seok Kim M.D. ,&nbsp;Young Dae Jeon M.D.","doi":"10.1016/j.arthro.2024.07.029","DOIUrl":"10.1016/j.arthro.2024.07.029","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the effects of additional multimodal shoulder injections on postoperative rebound pain in patients undergoing arthroscopic rotator cuff repair (ASRCR) under interscalene brachial plexus block (ISBPB) anesthesia.</div></div><div><h3>Methods</h3><div>A single-blind randomized controlled trial was conducted with 67 patients between April and December 2023. Patients undergoing ASRCR who received ISBPB anesthesia, rather than general anesthesia, with a minimum follow-up period of 48 hours were included. The injection group received 40 mL of 0.75% ropivacaine, 20 mg morphine, 1:200,000 epinephrine, and saline solution, totaling 100 mL. After surgery, the injection was administered to the subacromial space (50 mL) with blind suprascapular nerve block (25 mL) and blind axillary nerve block (25 mL). Control subjects received 100 mL of saline solution. Intravenous patient-controlled analgesia (IV-PCA) was used as adjuvant analgesia for all patients. The primary outcome was evaluated using the visual analog scale (VAS) pain score at 12 hours after surgery, with secondary outcomes of the incidence of rebound pain and VAS pain scores at 0, 2, 4, 8, 24, 36, and 48 hours postoperatively. Fentanyl in the IV-PCA and rescue analgesic amounts, complications, and patient satisfaction were recorded.</div></div><div><h3>Results</h3><div>Sixty-seven patients (32 in the injection group, 35 in the control group) with a mean age of 61.1 ± 9.0 years were included. The primary outcome assessment, VAS pain score at 12 hours, significantly favored the injection group (2.7 ± 0.93 vs 4.1 ± 1.70, <em>P</em> &lt; .001). The incidence of rebound pain was 18.8% and 65.7% in the injection and control groups, respectively (18.8% vs 65.7%, <em>P</em> &lt; .001). The injection group reported better VAS pain scores at 24, 36, and 48 hours and lower fentanyl use over the 48-hour postoperative period (<em>P</em> = .014). The use of rescue analgesics was similar between groups, and no complications were associated with multimodal shoulder injections. Satisfaction levels were similar in both groups.</div></div><div><h3>Conclusions</h3><div>The present study found that patients who underwent multimodal shoulder injections during ASRCR under ISBPB anesthesia had significantly lower VAS pain scores at 12 hours postoperatively and reduced incidence of rebound pain compared with the control group. Pain levels were consistently lower from 12 to 48 hours postoperatively. Additionally, the injection group had reduced opioid consumption within the first 48 hours postoperatively, with no complications observed.</div></div><div><h3>Level of Evidence</h3><div>Level I, randomized controlled trial</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 5","pages":"Pages 1291-1298"},"PeriodicalIF":4.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918145","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":"Repair of Isolated Subscapularis Tears With Concurrent Biceps Tenodesis Using a Single Anchor Results in Satisfactory Clinical Outcomes: Minimum 2-Year Follow-Up","authors":"Ethem Burak Oklaz M.D. ,&nbsp;Asim Ahmadov M.D. ,&nbsp;Furkan Aral M.D. ,&nbsp;Muhammed Furkan Tosun M.D. ,&nbsp;İnci Hazal Ayas M.S. ,&nbsp;Ulunay Kanatli M.D.","doi":"10.1016/j.arthro.2024.07.026","DOIUrl":"10.1016/j.arthro.2024.07.026","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the clinical outcomes of patients treated with isolated subscapularis tear repair and biceps tenodesis using a single anchor.</div></div><div><h3>Methods</h3><div>Patients diagnosed with subscapularis tear and who underwent arthroscopic surgery by a single surgeon between February 2017 and January 2022 were evaluated retrospectively. Inclusion criteria were patients who underwent repair of isolated subscapularis tear along with tenodesis for long head of the biceps tendon pathologies such as SLAP lesion, instability, partial tear, or tenosynovitis, with a minimum follow-up of 24 months. Assessment included active and passive range of motion, single-assessment numeric evaluation (SANE), visual analog scale (VAS), Constant-Murley score (CMS), and specific subscapularis and biceps tests. Improvements were analyzed using minimum clinically important difference (MCID) values.</div></div><div><h3>Results</h3><div>A total of 20 patients were included. The mean age was 48.5 ± 7 years, and the follow-up period was 43.1 ± 12.7 months. Significant improvements were observed at the final follow-up in active forward flexion, active abduction, active internal rotation, as well as VAS, SANE, and CMS (<em>P</em> &lt; .001). The MCID analysis showed that 100% of patients met the MCID for CMS, 90% for SANE, and 100% for VAS.</div></div><div><h3>Conclusions</h3><div>In the presence of an isolated subscapularis tear associated with long head of the biceps tendon pathologies, favorable clinical outcomes could be achieved by performing both tear repair and biceps tenodesis with a double-loaded single anchor. Most patients (&gt;90%) achieved the MCID for the CMS, SANE, and VAS, indicating significant clinical improvement and satisfactory patient outcomes.</div></div><div><h3>Level of Evidence</h3><div>Level IV, case series.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 5","pages":"Pages 1268-1276"},"PeriodicalIF":4.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918147","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 in Commercial Industry: Serving the End-to-End Patient Experience Across the Digital Ecosystem","authors":"Michael J. Ormond M.Sc. ,&nbsp;Eric H. Garling Ph.D. ,&nbsp;Joshua J. Woo B.A. ,&nbsp;Ishan T. Modi B.S. ,&nbsp;Kyle N. Kunze M.D. ,&nbsp;Prem N. Ramkumar M.D., M.B.A.","doi":"10.1016/j.arthro.2025.01.064","DOIUrl":"10.1016/j.arthro.2025.01.064","url":null,"abstract":"<div><h3>Abstract</h3><div>The purpose of this article is to evaluate the application of artificial intelligence (AI) from the perspective of the orthopaedic industry with respect to the specific opportunities offered by AI. It is clear that AI has the potential to impact the entire continuum of musculoskeletal and orthopaedic care. The following areas may experience improvements from integrating AI into surgical applications: surgical trainees can learn more easily at lower costs in extended reality simulations; physicians can receive support in decision-making and case planning; efficiencies can be driven with improved case management and hospital episodes; performing surgery, which until recently was the only element industry engaged with, can benefit from intraoperative AI-derived inputs; and postoperative care can be tailored to the individual patient and their circumstances. AI delivers the potential for industry to offer valuable augments to patient experience and enhanced surgical insights along the digital episode of care. However, the true value is in considering not just how AI can be applied in each silo but also across the patient’s entire continuum of care. This opportunity was first opened with the advent of robotics. The data derived from the robotic systems have added something akin to a black box flight recorder to the operation, which now offers 2 critical outcomes for industry. First, together we can now start to stitch preoperative elements like demographics, morphological phenotyping, and pathology that can be integrated with intraoperative elements to produce surgical plans and on-the-fly anatomic data like ligament tension. Second, postoperative elements such as recovery protocols and outcomes can be considered through the lens of the intraoperative experience. In forming this bridge, AI can accelerate the development of a truly integrated digital ecosystem, facilitating a shift from providing implants to providing patient experience pathways.</div></div><div><h3>Level of Evidence</h3><div>Level V, expert opinion.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 5","pages":"Pages 1683-1690"},"PeriodicalIF":4.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143460805","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: Varus Recurrence After Medial Opening-Wedge High Tibial Osteotomy","authors":"Seth L. Sherman M.D. ,&nbsp;Robert M. Putko M.D.","doi":"10.1016/j.arthro.2024.08.042","DOIUrl":"10.1016/j.arthro.2024.08.042","url":null,"abstract":"<div><div>Medial opening-wedge high tibial osteotomy (MOWHTO) is a powerful tool in the surgical armamentarium to correct varus malalignment in patients with symptomatic medial compartment disease. This procedure has demonstrated proven results and long-term survivorship. Complications include cortical hinge fracture, symptomatic hardware, infection, delayed or nonunion, and nerve injury. Varus recurrence is a known complication after MOWHTO. Risk factors are multifactorial and thought to include degree of alignment correction, extent of meniscus and cartilage pathology, and effectiveness of soft-tissue balancing. Medial meniscus extrusion has been implicated in meniscus dysfunction and progression of degenerative joint disease. It is a recognized issue after meniscus-preserving and transplant procedures that may have long-term sequela. This loss of hoop stress can lead to increased contact pressure, putting the diseased compartment at further risk. Although it is certainly possible that extrusion matters for varus recurrence after MOWHTO, its role must be considered in the context of multiple other confounding factors.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 5","pages":"Pages 1530-1531"},"PeriodicalIF":4.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142156718","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}