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

{"title":"Biceps Tenodesis and SLAP Repair Show Similar Outcomes in Overhead Throwing Athletes With Baseball Pitchers Exhibiting Worse Rates of Return to Sport: A Systematic Review.","authors":"Benjamin T Lack, Justin T Childers, Colton C Mowers, Rodrigo S Berreta, Garrett R Jackson, Steven F DeFroda, Derrick M Knapik, Nikhil N Verma","doi":"10.1016/j.arthro.2025.01.061","DOIUrl":"10.1016/j.arthro.2025.01.061","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical outcomes, return-to-play (RTP) outcomes, and incidence of postoperative complications in overhead throwing athletes with SLAP lesions undergoing SLAP repair versus biceps tenodesis (BT) with minimum 1-year follow-up.</p><p><strong>Methods: </strong>Using the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a literature search was conducted on July 9, 2024, by querying PubMed, Scopus, and EMBASE databases. Inclusion criteria consisted of Level I to IV human clinical studies reporting RTP rate, complications, and/or failure rates following SLAP repair versus BT for SLAP lesions in overhead throwing athletes with a minimum 1-year follow-up. Study quality was determined using the Methodological Index for Non-Randomized Studies criteria.</p><p><strong>Results: </strong>A total of 16 studies from 2005 to 2023, reporting on 547 patients with a mean age ranging from 17.4 to 36.0 years and a mean follow-up ranging from 2.7 to 7.2 years, met inclusion criteria. Twelve studies (n = 459 athletes) reported outcomes following SLAP repair and 5 (n = 88 athletes) following BT. A total of 15 studies reported on baseball players, 8 on softball players, and 2 on handball players. There were 220 pitchers who underwent SLAP repair compared to 34 pitchers who underwent BT. RTP rates for all throwers ranged from 37.5% to 94.7% following SLAP repair and 35.3% to 93.1% following BT. The RTP rate for pitchers and position players following SLAP repair ranged from 40% to 80% and 76.3% to 91.3%, respectively, compared to 16.7% and 80%, respectively, following BT. Complication rates ranged from 0% to 21.8% following SLAP repair compared to 0% following BT. Failure rates and revisions ranged from 7.5% to 12.5% for SLAP repair versus 0% for BT.</p><p><strong>Conclusions: </strong>In overhead throwing athletes with SLAP tears, an analysis of 547 patients from 16 studies shows variable RTP rates following SLAP repair and BT, with baseball pitchers having lower RTP rates compared to position players for both procedures. Outcomes for both SLAP repair and BT exhibit massive variability when treating SLAP tears in overhead throwers.</p><p><strong>Level of evidence: </strong>Level IV, systematic review of Level III and IV studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411692","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":"Experts Achieve Consensus on a Majority of Statements Regarding Ethics, Transparency, Regulation, and Best Practices for the Use of Orthobiologics.","authors":"Ron Gilat, Sarah A Muth, Eoghan T Hurley, Allen A Yazdi, Chloe H Franzia, Scott A Rodeo, Shane A Shapiro, Rachel M Frank, Brian J Cole","doi":"10.1016/j.arthro.2025.01.062","DOIUrl":"10.1016/j.arthro.2025.01.062","url":null,"abstract":"<p><strong>Purpose: </strong>To establish consensus statements via a modified Delphi process about ethics, transparency, regulation, and best practices for the use of orthobiologics in clinical practice for musculoskeletal pathology.</p><p><strong>Methods: </strong>A consensus process on the regulation of orthobiologics at the provider level was conducted using a modified Delphi technique. Twenty orthopaedic surgeons, sports medicine physicians, or basic scientists participated. Each participant was a Biologic Association member organization representative and asked to participate because of their active interest in the field of orthobiologics. Levels of consensus were delineated according to the number of votes for each statement: no consensus, <80%; consensus, 80% to 89%; strong consensus, 90% to 99%; unanimous, 100%.</p><p><strong>Results: </strong>The 26 consensus statements on orthobiologics resulted in 14 achieving unanimous consensus, 8 achieving strong consensus, 3 achieving consensus, and 1 did not achieve consensus. Overall, 85% of the statements reached either a unanimous or strong consensus. Of the statements regarding communication and transparency, 9 reached unanimous consensus, including information to convey and helpful tools to describe current orthobiologics, persistent misinformation, use of the word \"stem cells,\" \"off-label\" use, and problems with the present regulatory environment. Five statements discussing the regulation of novel orthobiologics achieved unanimous consensus. These statements highlighted research regulation, safety, and suggested improvements to regulatory issues. The statement that did not achieve any consensus was on the regulatory processes that should be in place by an institution providing novel orthobiologic treatments. No statement reached a unanimous agreement on cost or ethical considerations.</p><p><strong>Conclusions: </strong>This study successfully identified key consensus statements emphasizing the importance of ethics, transparency, and regulation in the use of orthobiologics, with 85% of statements reaching unanimous or strong consensus. These findings underscore the need for standardized communication, improved regulatory frameworks, and enhanced safety measures while highlighting persistent challenges in addressing cost and ethical considerations.</p><p><strong>Level of evidence: </strong>Level V, expert opinion.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143411693","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: Utility of Bone Marrow Aspirate Concentrate in Orthopaedic Surgery Remains Questionable.","authors":"Carl K Schillhammer","doi":"10.1016/j.arthro.2025.01.060","DOIUrl":"10.1016/j.arthro.2025.01.060","url":null,"abstract":"<p><p>Despite multiple advancements in rotator cuff repair fixation and technique that have allowed for stronger and more anatomic constructs, failure remains commonplace. As is a common theme throughout orthopaedics, both biomechanics and biology play a role in successful healing. The new frontier in tendon-to-bone healing appears to be pairing biologic augmentation, such as bone marrow aspirate concentrate (BMAC), with previous biomechanical advancements. However, only 8 studies have specifically investigated the utility of BMAC in rotator cuff repair, and as of yet, there are minimal data to suggest that recent biologic technologies have shown clinical effectiveness. The technology has been more comprehensively studied in knee arthritis with similarly disappointing clinical results. Rotator cuff repair outcomes are dependent on many factors inherent to the injury (e.g., chronicity, bone quality, tendon quality, retraction), the patient (e.g., age, smoking, diabetes, adherence to postoperative protocol), and the surgeon (e.g., quality of technique, repair tension, patient education). Trying to decide the efficacy of BMAC or other cell-based technology is going to be very difficult.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400755","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":"Cover Image & Video Link","authors":"","doi":"10.1016/S0749-8063(24)01099-5","DOIUrl":"10.1016/S0749-8063(24)01099-5","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 3","pages":"Page A16"},"PeriodicalIF":4.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372115","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: Concomitant Stabilization Is Recommended When Treating Osteochondral Lesions of the Talus in Patients With Chronic Lateral Ankle Instability.","authors":"Quinten G H Rikken, Jari Dahmen, Gino M M J Kerkhoffs","doi":"10.1016/j.arthro.2025.02.005","DOIUrl":"10.1016/j.arthro.2025.02.005","url":null,"abstract":"<p><p>Osteochondral lesions of the talus are commonly encountered in, and can be caused by, chronic lateral ankle instability. From a clinical and biomechanical point of view, treating chronic lateral ankle instability simultaneously during treatment of osteochondral lesions of the talus is paramount in optimizing patient outcomes, protecting the (repaired) ankle cartilage, and stopping the cascade of ankle cartilage damage. Preventing recurrent (micro)instability minimizes (shear) forces and further degeneration of ankle cartilage.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392273","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":"Generative Versus Nongenerative Artificial Intelligence","authors":"Sayyida S. Hasan B.S. ,&nbsp;Joshua J. Woo B.A. ,&nbsp;Mark P. Cote P.T., D.P.T., M.S.C.T.R. ,&nbsp;Prem N. Ramkumar M.D., M.B.A.","doi":"10.1016/j.arthro.2024.12.001","DOIUrl":"10.1016/j.arthro.2024.12.001","url":null,"abstract":"<div><h3>Abstract</h3><div>Artificial intelligence (AI) is a colossal buzzword, a confusing subject matter, but also an inevitable reality. Generative and nongenerative AI are the 2 core subtypes of AI. Generative AI uses current data to understand patterns and generate new information, and it is especially valuable in producing synthetic medical images, enhancing surgical simulations, and expanding training datasets. Techniques such as generative adversarial networks (GANs), large language models (LLMs), and variational autoencoders (VAEs) allow for the creation of realistic simulations, text, and models that can be used for perioperative communication and planning. Conversely, nongenerative AI is centered on the examination and categorization of pre-existing data to formulate predictions or decisions—the most popular denomination namely machine learning. This approach is instrumental in tasks such as forecasting surgical outcomes, segmenting medical images, and determining patient risk profiles. Models such as convolutional neural networks (CNNs), random forests, and support vector machines (SVMs) are widely used for these purposes, demonstrating high accuracy and reliability in clinical decision making. Although generative AI offers innovative tools for creating new data and simulations, nongenerative AI excels in analyzing existing data to inform patient care. Both approaches have the potential of supporting clinical workflows to automate redundancies and improve efficiencies. However, there are also limitations in the application of AI in orthopaedics, including the potential for bias in models, the challenge of interpreting AI-driven insights, and the ethics of oversight. As the integration of AI in orthopaedics continues to grow, it is essential for practitioners to understand these technologies' capabilities and limitations to harness their full potential and establish appropriate governance.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 3","pages":"Pages 545-546"},"PeriodicalIF":4.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143372117","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: Early Postoperative Stiffness After Rotator Cuff Repair Is Often a Good Thing.","authors":"Brian C Werner","doi":"10.1016/j.arthro.2025.01.059","DOIUrl":"10.1016/j.arthro.2025.01.059","url":null,"abstract":"<p><p>Early postoperative stiffness after rotator cuff (RC) repair is not uncommon and can be frustrating for patients and physical therapists, as well as surgeons, as it has the potential to lengthen the recovery process, and in rare instances, can lead to additional interventions such as injections or surgery. Many risk factors for early postoperative stiffness after RC repair have been identified, including duration of immobilization and timing of rehabilitation, size of tear, preoperative stiffness, and diabetes mellitus and, according to recent research, fatty infiltration of the RC muscles. Yet, there are potential benefits to early postoperative stiffness after RC repair, as research has shown that stiffness at 6 and 12 weeks postoperatively correlates with rotator cuff integrity at 6 months postoperatively, and stiffness generally resolves. At present, I do not worry about early stiffness after RC repair and do not adjust rehabilitation or intervene at an early time point except in extreme instances. I worry more about patients with extremely good motion at early time points. Future studies must focus on discerning \"good\" stiffness from \"bad\" stiffness.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143392248","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":"Author Reply to \"Regarding 'Arthroscopic Bankart Repair Using 1 Anterior Portal Has a Shorter Surgical Time and Comparable Clinical Results With the Standard 2-Portal Technique'\".","authors":"Ali Okan Gazeloglu, Abdurrahman Yilmaz, Egemen Turhan, Filippo Familiari, Gazi Huri","doi":"10.1016/j.arthro.2025.02.004","DOIUrl":"10.1016/j.arthro.2025.02.004","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383982","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 Suprapectoral Biceps Tenodesis Using an Onlay Technique-Letter to the Editor.","authors":"Chih-Chien Wang, Zhi-Hong Zheng","doi":"10.1016/j.arthro.2025.01.052","DOIUrl":"10.1016/j.arthro.2025.01.052","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375090","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: Biologics for Knee Cartilage Regeneration Show Modest Symptom-Reducing Efficacy.","authors":"Mina Entessari, Nicholas A Trasolini","doi":"10.1016/j.arthro.2025.01.058","DOIUrl":"10.1016/j.arthro.2025.01.058","url":null,"abstract":"<p><p>Biologic solutions for articular cartilage degeneration and focal chondral defects show modest symptom-reducing efficacy using bone marrow aspirate concentrate, adipose-derived stem cells, and platelet-rich plasma. However, regrowth of healthy hyaline cartilage within diseased areas remains elusive. Recent research proposes allogenic human umbilical cord blood-derived mesenchymal stem cells as another cell-based biologics approach. A benefit of this technique would be the availability of viable \"off-the-shelf\" undifferentiated cells, obviating the need for bone marrow aspiration or adipose cell harvest. Findings included improved Magnetic Resonance Observation Cartilage Repair Tissue, which correlated negatively with defect size and improved patient-reported outcomes in terms of symptom reduction. High tibial osteotomy, which is known to result in improved outcomes in patients with cartilage degeneration (and malalignnment), is a confounder. This illustrates the importance of evaluating and treating the whole knee, and the whole patient, including extremity alignment, meniscal status, stability, body mass, and the synovial fluid environment. Cell-based treatments may be a piece of that puzzle. In addition to indeterminate outcomes and indications, barriers to adoption include cost and access.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143375096","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}