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

{"title":"Increased Meniscal Extrusion at 1 Year After Surgery Is Associated With a Lower Likelihood of Substantial Mid-Term Patient-Perceived Improvement After MMRT Repair.","authors":"Hyun-Soo Moon, Min Jung, Chong-Hyuk Choi, Kwangho Chung, Se-Han Jung, Junwoo Byun, Hyeongwon Ham, Sung-Hwan Kim","doi":"10.1016/j.arthro.2025.04.058","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.04.058","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze factors influencing achievement of mid-term substantial clinical improvement after surgical repair for medial meniscus root tears (MMRT).</p><p><strong>Methods: </strong>Patients who underwent arthroscopic pull-out repair for MMRT between 2010 and 2018 with ≥5 years of follow-up were reviewed. Patients were classified into groups based on achieving substantial clinical improvement at 5 years using published SCB values: group 1 (improvement beyond SCB thresholds in both IKDC and Lysholm scores), group 2 (not improved in one or both scores). Additionally, secondary grouping was performed using MCID values based on the same criteria as SCB grouping. Comparative analyses were performed for both groupings, followed by regression analyses to identify factors influencing achievement of clinical improvement. In particular, SCB-based regression analyses employed multiple models using adjusted SCB thresholds.</p><p><strong>Results: </strong>Of 64 patients, 22 (34.4%) achieved SCB-level improvement and 36 (56.3%) achieved MCID-level improvement at 5 years postoperatively. Patients in group 2 showed significantly higher age, postoperative medial meniscus extrusion (MME) at 1 year, and ΔMME than group 1 (P = .005, .013, and .047, respectively). Group 2 also exhibited higher Kellgren-Lawrence grades and their progression at 5 years postoperatively (P = .003 and .015, respectively). Subsequently, peri-operative variables showing differences in between-group comparisons were included in the SCB-based regression analyses, with postoperative MME consistently identified across all models as a factor influencing the achievement of mid-term clinical improvement after surgical repair of MMRT (P = .015, .034, and .014 in Models 1, 2, and 3, respectively). The analysis based on secondary grouping using MCID values showed consistent results.</p><p><strong>Conclusion: </strong>The number of patients who perceived substantial clinical improvement 5 years after surgical repair for MMRT was relatively small. Notably, increased MME at 1 year postoperatively was associated with a lower likelihood of achieving patient-perceived substantial clinical improvement at 5 years.</p><p><strong>Level of evidence: </strong>Retrospective prognostic case series, IV.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175573","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":"Commercial Products Using Generative Artificial Intelligence Include Ambient Scribes, Automated Documentation and Scheduling, Revenue Cycle Management, Patient Engagement and Education, and Prior Authorization Platforms.","authors":"Kyle N Kunze, Jennifer Bepple, Asheesh Bedi, Prem N Ramkumar, Christian A Pean","doi":"10.1016/j.arthro.2025.05.021","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.021","url":null,"abstract":"<p><p>The integration of artificial intelligence (AI) into clinical practice is rapidly transforming healthcare workflows. At the forefront are large language models (LLMs), embedded within commercial and enterprise platforms to optimize documentation, streamline administration, and personalize patient engagement. The evolution of LLMs in healthcare has been driven by rapid advancements in natural language processing (NLP) and deep learning. Emerging commercial products include Ambient Scribes, Automated Documentation and Scheduling, Revenue Cycle Management, Patient Engagement and Education Assistants, and Prior Authorization Platforms. Ambient Scribes remain the leading commercial generative AI product, with approximately 90 platforms in existence to date. Emerging applications may improve provider efficiency and payer-provider alignment by automating the prior authorization process to reduce the manual labor burden placed on clinicians and staff. Current limitations include (1) lack of regulatory oversight, (2) existing biases, (3) inconsistent interoperability with EHRs, and (4) lack of physician and stakeholder buy-in due to lack of confidence in LLM outputs. Looking forward requires discussion of ethical, clinical, and operational considerations.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152908","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: Osteochondral allograft outcomes are durable at longer follow-up and larger cohorts with robust study designs are necessary to help us improve outcomes.","authors":"Jelle P van der List, David C Flanigan","doi":"10.1016/j.arthro.2025.05.020","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.020","url":null,"abstract":"<p><p>Patients with chondral and osteochondral lesions often present with debilitating symptoms and several treatments are available, ranging from microfracture and autologous chondrocyte implantation to osteochondral autograft and osteochondral allograft transplantation (OCA). Over the last two decades, significant improvement in the indications, graft storage and surgical outcomes of OCA have been seen with excellent patient-reported outcome measures and reliable return to sports rates. Long-term studies identifying risk factors for graft failure or disappointing subjective outcomes are important to further understand the ideal candidate for OCA. Studies have identified coronal malalignment, ligament instability, meniscal insufficiency, higher body mass index, older age and longer duration of symptoms as risk factors for failure, and corresponding concomitant procedures are often performed with OCA to improve success rates. Future larger studies are needed to further identify predictors of success, preferably larger cohorts in which confounders and other factors can be accounted and corrected for. OCA remains an excellent treatment for osteochondral lesions with durable outcomes at long-term follow-up.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152833","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":"A contemporary international expert consensus statement on the evaluation, diagnosis, treatment, and rehabilitation of injuries to the posterolateral corner of the knee.","authors":"Robert F LaPrade, Cameron Gerhold, Kyle N Kunze, Andrew G Geeslin, Luke V Tollefson, Udit Dave, José Rafael Garcia, Björn Barenius, Charles Brown, Túlio Vinícius de Oliveira Campos, Moisés Cohen, Lars Engebretsen, Gonzalo Ferrer, Carlos E Franciozi, Brett A Fritsch, Karl-Heinz Frosch, Pablo E Gelber, Alan Getgood, Michael Hantes, Michael Held, F C Orth, Camilo P Helito, Eivind Inderhaug, Steinar Johansen, Koen Carl Lagae, Bruce A Levy, Martin Lind, Timothy Lording, Rodrigo Maestu, Fabrizio Margheritini, Jacques Menetrey, Gilbert Moatshe, Joan C Monllau, Iain R Murray, Roberto Negrín, David A Parker, Nicolas Pujol, James Robinson, Kristian Samuelsson, Ciara Stevenson, Maria J Tuca, Soshi Uchida, Wybren A van der Wal, Silvio Villascusa, Richard P B Von Bormann, Jorge Chahla","doi":"10.1016/j.arthro.2025.04.055","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.04.055","url":null,"abstract":"<p><strong>Purpose: </strong>To utilize a modified Delphi technique to generate an expert consensus statement on the evaluation, diagnosis, treatment, and rehabilitation of posterolateral corner(PLC) injuries of the knee.</p><p><strong>Methods: </strong>A five-individual working-group developed a list of 62 statements regarding PLC injuries for use in a three-round modified Delphi series. Ultimately 40 statements were retained, and a 100% participation rate was observed in all rounds. Consensus for each statement was quantified.</p><p><strong>Results: </strong>Overall, 82.5% of statements reached consensus. Consensus was reached regarding the following: (1) diagnostic utility of the dial, posterolateral drawer, and external rotation recurvatum tests, magnetic resonance imaging, varus-stress radiographs, and bilateral hip-to-ankle radiographs; (2) presence of concomitant meniscal pathology or neuromuscular injury influences surgical timing; (3) useful classification systems to guide treatment of PLC injuries currently do not exist; (4) acute soft tissue avulsions involving a single stabilizing structure can be repaired; (5) isolated repair of grade III PLC tears should not be performed without augmentation/reconstruction and complete grade III PLC injuries should undergo PLC reconstruction; (6) no universally-accepted PLC reconstruction technique exists, although the LaPrade technique (anatomic reconstruction of the FCL, PLT, and PFL using two grafts secured in two femoral tunnels, one fibular tunnel, and one tibial tunnel) may confer superior outcomes;and (7) there is no consensus on the utility of routine postoperative varus stress radiographs as an objective measure of surgical success.</p><p><strong>Conclusion: </strong>Statements that achieved unanimous consensus(all experts stating they \"strongly agree\"), concerned routine use of physical and radiographic evaluations to confirm varus laxity due to PLC injuries and bilateral hip-to-ankle radiographs in the setting of chronic PLC injuries. Individualized treatment based on the presence of concomitant injuries and staged rehabilitation programs are essential. The significance of a grade III posterolateral drawer test in detecting external rotational laxity and whether a common peroneal nerve neurolysis should be routinely performed remain in question. No single reconstruction technique confers optimal clinical outcomes. Postoperative varus stress radiographs are not reliable for determining residual laxity.</p><p><strong>Level of evidence: </strong>Level V; Consensus of expert opinion.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144407","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 Pittsburgh Instability Tool (PIT) Score Predicts Outcomes Following Arthroscopic Anterior Shoulder Stabilization in Patients with Subcritical Bone Loss.","authors":"Shaquille Charles, Stephen Marcaccio, Ryan T Lin, Stephanie Boden, Ehab M Nazzal, Jonathan D Hughes, Adam Popchak, Bryson P Lesniak, Albert Lin","doi":"10.1016/j.arthro.2025.04.023","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.04.023","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate rates of recurrent anterior glenohumeral instability among patients with \"on-track\" HSL who underwent either arthroscopic Bankart repair (ABR) alone or arthroscopic Bankart repair with remplissage augmentation (ABR+R) and develop a risk assessment tool for recurrent anterior glenohumeral instability as well as evaluate the role of remplissage augmentation for on-track shoulders to predict outcomes following arthroscopic stabilization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively reviewed prospectively collected data of patients aged 14-40 years who underwent ABR or ABR+R between 2013-2021. Chart review was performed to gather patient-specific risk factors such as patient age, gender, sport-specific participation, number of preoperative dislocations, shoulder laxity, while imaging measurements were used to gather glenoid bone loss and distance-to-dislocation. Recurrent anterior glenohumeral instability was defined as recurrent dislocation and/or subjective subluxation postoperatively. Exclusion criteria included: revision procedure, less than 2-year follow-up, presence of an \"off-track\" Hill Sachs lesion, documented connective tissue disorder, concomitant rotator cuff tear, missing data, or presence of glenoid bone loss &gt;20%. Multivariate hazard ratio estimates were utilized to create a risk assessment tool and correlated with patient-specific risk via post-estimation analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 170 patients were included for analysis (ABR:116 | ABR+R:54) with an average age of 21.5 ± 6.2 years and an average follow-up of 5.1 years (2.0-9.0 years). Near-track lesions (\"on-track\" lesions with a distance-to-dislocation value less than 10mm), presence of hyperlaxity, younger age, 2+ preoperative recurrent instability episodes, contact sport athlete status, and increasing glenoid bone loss were independent risk factors for ABR failure based on a final multivariate model predicting postoperative failure. Furthermore, patients undergoing ABR alone had a greater risk of recurrent instability than those undergoing ABR+R. From the final multivariate model utilizing these prognostic factors, the hazard ratios were utilized to create the Pittsburgh Instability Tool (PIT) and was subsequently used to create risk-stratifying subgroups: Low-risk (0 - 3), Moderate-risk (4 - 8), High-risk (9 - 13), Extreme-risk (14+). Remplissage augmentation lowered the PIT score by 8 points. Recurrent instability rates range from 2.2% among low-risk groups to 51.3% among extreme-risk groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The current study indicates that arthroscopic Bankart repair with remplissage augmentation can lower the rate of recurrent instability in patients with high-risk \"on-track\" lesions. Surgeons can utilize the PIT tool to identify suitable candidates who may or may not benefit from arthroscopic Bankart repair with or without remplissage augmentation by computing PIT scores for both scena","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144414","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":"Complications of Platelet Rich Plasma Injection for Knee Osteoarthritis are Similar to Corticosteroids and Hyaluronic Acid, but are Significantly Greater than Placebo Injections: A Meta-Analysis of Randomized Controlled Trials.","authors":"Stephen P Fucaloro, Jack Bragg, Makeda Berhane, Meghan Mulvey, Laura Krivicich, Thomas Zink, Matthew Salzler","doi":"10.1016/j.arthro.2025.05.018","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.018","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this review was to investigate complications of platelet rich plasma (PRP) injections for knee osteoarthritis (OA) compared to other injected substances including hyaluronic acid (HA), corticosteroids, and placebo saline.</p><p><strong>Methods: </strong>PubMed, Embase, Web of Science, and Cochrane databases were searched to identify randomized control trials (RCTs) comparing PRP to another injectable treatment for knee osteoarthritis with documented complications. Studies not mentioning complications or utilizing PRP during surgery were excluded. Complications were pooled to determine overall complication rate and the number needed to harm (NNH). Subgroup analyses were performed for studies comparing PRP to hyaluronic acid, corticosteroids, and placebo saline using DerSimonian-Laird random-effects models displaying odds ratios (OR).</p><p><strong>Results: </strong>Twenty-four RCTs were identified with 2751 total patients, 1318 of whom received PRP injections. There was a total of 246 complications in the PRP group and 131 in the comparison cohort (18.66% vs. 9.14%, respectively p < 0.01). The NNH was 11. Subgroup analysis showed no difference in odds of complications when PRP was compared to HA and corticosteroids (OR 1.33, p = 0.22 I² = 0.0% and OR 3.07, p = 0.35, I² = 63.49%, respectively), but significantly more complications compared to placebo (OR 4.88, p < 0.01, I² = 0.00%). Only one patient reported severe pain; however all other complications were described as moderate or mild and self-limiting.</p><p><strong>Conclusion: </strong>The use of PRP for knee OA is not innocuous with a significantly higher rate of complications compared to placebo. However, most complications were reported as mild to moderate, and the odds of complications are similar to that of HA or corticosteroid injections. Compared to all other injectables, the NNH for PRP is 11, which is important for physicians to consider prior to PRP therapy.</p><p><strong>Level of evidence: </strong>Level II, meta-analysis of Level I and II RCTs.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133204","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":"Male sex, Younger age, Lower BMI, Athletes, Shorter Time from Injury to Surgery and Non-Contact Injury Are Associated with Achieving the Substantial Clinical Benefits for Patient-Reported Outcome Measures after Primary ACL Reconstruction.","authors":"Zhi-Yu Zhang, Wei-Li Shi, Yong Ma, Xi Gong, Ping Liu, Jia-Ning Wang, Xin Zhang, Hong-Jie Huang, Cheng Wang, Jian-Quan Wang","doi":"10.1016/j.arthro.2025.05.016","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.016","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the substantial clinical benefits (SCBs) for patient-reported outcome measures (PROMs) and to identify potential factors associated with achieving the SCBs after primary anterior cruciate ligament (ACL) reconstruction.</p><p><strong>Method: </strong>Patients who underwent primary single-bundle ACL reconstruction using hamstring tendon autografts at our institute were included. The collected PROMs include the Visual Analogue Scale for Pain (VAS), Tegner Activity Score (Tegner score), modified Lysholm Knee Scoring Scale (Lysholm score), and International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC score). The SCBs for PROM improvements and raw postoperative PROMs were determined based on patient responses to an anchor question. Multivariable logistic regression analyses were performed to identify factors associated with achieving the SCBs.</p><p><strong>Results: </strong>A total of 382 patients with a minimum of 4-year follow-up were included in this study. The SCBs for PROM improvements and raw postoperative PROMs were determined as 2 and 1.5 for VAS, 3 and 3.5 for Tegner score, 24.2 and 81.5 for Lysholm score, and 27.2 and 77.6 for IKDC score, respectively. Male sex (p=0.0050 for raw postoperative), younger age (p=0.0249 for improvement, p=0.0075 for raw postoperative), athletes (p=0.0001 for improvement) and non-contact injury (p=0.0034 for raw postoperative) were associated with increased odds of achieving the SCBs for Tegner score. Higher BMI was associated with decreased odds of achieving the SCBs for both raw postoperative Lysholm score (p = 0.0009) and its improvement (p = 0.0036). A longer time from injury to surgery was associated with decreased odds of achieving the SCB for IKDC score improvement (p = 0.0006).</p><p><strong>Conclusion: </strong>The SCBs for PROM improvements and raw postoperative PROMs were determined after primary ACL reconstruction. Male sex, younger age, lower BMI, athletes, shorter time from injury to surgery and non-contact injury were associated with increased odds of achieving the SCBs.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133234","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":"Patch Augmentation in the Treatment of Partial Thickness Rotator Cuff Tears Facilitates Tendon Healing and Improves Patient Outcomes: A Systematic Review.","authors":"Ryne Jenkins, Nwe Oo Mon, Charles Ruotolo","doi":"10.1016/j.arthro.2025.05.014","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.014","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to assess outcomes and complications of patch augmentation in the treatment of partial thickness rotator cuff tears (PTRCT).</p><p><strong>Methods: </strong>A systematic review was conducted identifying studies assessing outcomes following surgical treatment of PTRCT with patch augmentation and 6-month follow-up. Clinical studies with full-text manuscripts were identified using Embase, PubMed, Web of Science and Cochrane databases between January 1980 and December 2023. Postoperative tendon thickness on MRI was assessed as well as complications and reoperation rates. Forest plots and 95% confidence intervals were generated from mean differences (MD) in pre-post outcome data.</p><p><strong>Results: </strong>Seven studies met study criteria and only one study had a control group (one level III, six level IV). 514 total patients were enrolled. 482 utilized a bioinductive collagen patch. Of those, 446(93%) underwent debridement, and 36(7%) underwent take down and repair (TDR). 32 served as a control without augmentation, however only complications were assessed. 14(44%) underwent debridement alone and 18(56%) underwent TDR. American Shoulder and Elbow Surgeons (ASES) shoulder scores improved with MD ) of 16.9-41.3 in patients undergoing augmentation. The ASES shoulder function score improved with MD of 8.2-12.0. The ASES shoulder pain score improved with a MD of 3.5- 4.4. 83% to 93% of patients met a clinically important difference (MCID) in ASES scores at one year. 100% of patients with intermediate grade tears and 79.0% with high-grade tears met a MCID at two years. Tendon thickness increased ranging from 0.8 mm to 2.0 mm. Postoperative complication rates varied ranging from 3% to 25%. and reoperation rates ranging from 0% to 19%.. Reported complications varied;however stiffness/adhesive capsulitis was the most prevalent complication occurring in 0% to 25% of patients.</p><p><strong>Conclusions: </strong>Augmentation was associated with increased tendon thickness and improved functional scores with 79% to 100% of patients meeting a MCID in outcome scores.</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":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133238","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":"Perioperative Leukocyte-Poor Platelet-Rich Plasma Associated with Reduced Risk of Retear After Arthroscopic Rotator Cuff Repairs: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Samuel Hovland, Vraj Amin, Jason Liu, Matthew Aceto, Vonda Wright","doi":"10.1016/j.arthro.2025.05.015","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.015","url":null,"abstract":"<p><strong>Purpose: </strong>To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) in the literature to ascertain the clinical efficacy of leukocyte-poor platelet-rich plasma (LP-PRP) in arthroscopic rotator cuff repair.</p><p><strong>Methods: </strong>A through literature search was performed from databases such as PubMed, SCOPUS, Embase, Cochrane Library, and Google Scholar using keywords. Eligible studies must be randomized controlled trials with Level I or II evidence, ≥80% follow-up rate, at least 12 months of follow-up, use of leukocyte-poor PRP in arthroscopic rotator cuff repair, and report of postoperative outcomes.</p><p><strong>Results: </strong>Our literature search yielded nine randomized-controlled trials consisting of 743 patients, with 380 patients receiving LP-PRP and 363 patients receiving a control or placebo. Postoperative outcomes analyzed were rotator cuff retear rates, VAS Pain Scores, ASES Scores, UCLA Scores, and Constant Scores. Retear rates were significantly lower in the LP-PRP treated group compared to controls (RR = 0.54; CI: [0.41, 0.71]; P < 0.00001), VAS Pain scores were significantly lower in the LP-PRP treated group compared to controls (MD = -0.12; CI: [-0.24, -0.01]; P < 0.04), ASES scores were significantly higher in the LP-PRP treated group compared to controls (MD = 1.88; CI: [0.46, 3.31]; P < 0.01), Constant scores were significantly higher in the LP-PRP treated group compared to controls (MD = 2.58; CI: [1.28, 3.89]; P < 0.0001), and UCLA scores were significantly higher in the LP-PRP treated group compared to controls (MD = 1.16; CI: [0.17, 2.16]; P < 0.02). Retear rates showed a relative risk reduction of about 46% in patients who received LP-PRP compared to controls, and while VAS Pain Scores, ASES Scores, Constant Scores, and UCLA Scores all were significantly improved, these clinical outcomes scores did not meet the minimal clinical important difference established within the literature.</p><p><strong>Conclusion: </strong>Administration of LP-PRP is associated with significantly reduced post-operative retear rates at minimum 12 months follow up compared to a saline injection control group. However, its use did not demonstrate clinically meaningful effects on postoperative pain or patient-reported outcomes, highlighting its primary benefit as enhancing structural healing.</p><p><strong>Level of evidence: </strong>Systematic Review and meta-analysis,of Level I and II Studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144133241","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: Open Distal Tibial Allograft with Screw Fixation for Distal Tibial Allograft Glenoid Reconstruction in Patients with Shoulder Instability May Result in Lower Recurrence Rates than Button Fixation.","authors":"Phob Ganokroj, Nate Dickinson, Matthew T Provencher","doi":"10.1016/j.arthro.2025.05.013","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.013","url":null,"abstract":"<p><p>The glenoid rim is altered in up to 90% of shoulders with recurrent instability. Distal tibial allograft (DTA), an option for anatomic glenoid reconstruction (AGR), has excellent mid-term outcomes and low recurrence and resorption rates using open or arthroscopic technique. Optimal graft position in both the medial-lateral and vertical axes, adequate fixation, and restoration of soft-tissue balance is the key to successful outcomes. Regarding fixation methods, metal screw fixation is a standard for AGR with free bone block or Latarjet procedure. The main disadvantage of screw fixation is hardware prominence and irritation to surrounding bone and soft tissue (6.5%), the leading cause of revision surgery. Button fixation may mitigate hardware complications, but lead to greater graft malposition, resorption, and recurrence rates. The authors used an open approach with screw fixation for AGR with DTA, and restoration of the capsulolabral complex to reduce recurrent instability after surgery.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103259","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}