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

{"title":"Editorial Commentary: Arthroscopic Lower Trapezius Tendon Transfer Using Achilles Tendon Allograft for Isolated, Irreparable Infraspinatus Musculotendinous Tear Is Durable.","authors":"Ayham Jaber, Christopher J Hawryluk, Peter J Millett","doi":"10.1016/j.arthro.2025.03.032","DOIUrl":"10.1016/j.arthro.2025.03.032","url":null,"abstract":"<p><p>Tendon transfers represent a reconstructive option for irreparable rotator cuff tears and certain neurologic deficiencies. Arthroscopically assisted lower trapezius tendon (aLTT) transfer using Achilles tendon allograft is effective in restoring external rotation and relieving excessive loading on the teres minor. It has shown good results in patients with brachial plexus injuries and posterosuperior irreparable rotator cuff tears. Isolated infraspinatus musculotendinous tears present distinct characteristics compared with other rotator cuff tears, as these lesions cause rapid atrophy and significant fatty infiltration within the muscle, making direct surgical repair less feasible. Tears of the infraspinatus tendon usually are associated with other rotator cuff injuries but can be isolated injuries, and tear at the musculotendinous junction of the tendon is a less common. Existing literature predominantly focuses on nerve-related causes of infraspinatus deficiency, such as in Parsonage-Turner syndrome or suprascapular nerve entrapment, which may be secondary to ganglion cysts along the nerve's path as well as other space-occupying lesions like tumors or vascular malformations. Infraspinatus muscle tendon injuries also can result from steroid injections and lead to severe pain and weakness during external rotation. Primary repair of the tear is a first choice if nonsurgical treatment is unsuccessful and if tear morphology and fatty infiltration allow. However, repair has a low success rate because of the aforementioned features. For older, low-demand patients, subacromial debridement or the use of a biodegradable subacromial balloon spacer can provide pain relief and functional improvement. In younger, more active patients, aLTT transfer using Achilles tendon allograft, although technically demanding and uncommonly performed, is a durable solution for this pathology when glenohumeral osteoarthritis and joint arthropathy are absent, offering sustained benefits at midterm follow-up. Other alternatives include latissimus dorsi tendon transfer, lower trapezius transfer (which may be biomechanically superior to latissimus dorsi tendon transfer), and reverse total shoulder arthroplasty. We thus consider aLTT to be a strong option for the right patient, performed by a skilled surgeon who can execute the procedure properly.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding \"The 6-O'clock Anchor Increases Labral Repair Strength in a Biomechanical Shoulder Instability Model\".","authors":"Jakob Oury","doi":"10.1016/j.arthro.2025.03.031","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.031","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694605","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":"Reflecting on the Need to Predict Knee Instability Early in Patients Undergoing Arthroscopic ACL Reconstruction.","authors":"Francesco Pegreffi, Giuseppe Gianluca Costa, Arcangelo Russo","doi":"10.1016/j.arthro.2025.03.030","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.030","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694591","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 as a Tool to Mitigate Administrative Burden, Optimize Billing, Reduce Insurance and Credentialing-Related Expenses, and Improve Quality Assurance within Healthcare Systems.","authors":"Ophelie Lavoie-Gagne, Joshua J Woo, Riley J Williams, Benedict U Nwachukwu, Kyle N Kunze, Prem N Ramkumar","doi":"10.1016/j.arthro.2025.02.038","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.02.038","url":null,"abstract":"<p><p>Despite spending $4.3 trillion annually in healthcare with $3.4 trillion ($10,193 per capita) attributed to care delivery, the United States (U.S.) still experiences the worst health outcomes among high-income countries. Administrative costs are the second largest contributor with $353 billion ($1,055 per capita) spent annually. Addressing clinical and administrative fragmentation can reduce annual costs by up to $265 million and increase healthcare productivity, both of which contribute to care delivery that is necessary, effective, equitable, and fiscally responsible. In the advent of electronic health records (EHRs), big data, and artificial intelligence (AI), there is an unprecedented opportunity to leverage these tools to drive meaningful improvements in high-value care delivery and reduce both clinical/non-clinical administrative costs. Physician engagement to develop comprehensive musculoskeletal data management systems is a critical precursor for subsequent application of AI analytics. Incorporation of AI tools developed from these data systems both within-organizations and seismically across the healthcare system can: (1) promote transparency via payer/provider data-sharing platforms; (2) automate routine, evidence-based care to reduce ineffective, inefficient, and inconsistent medical decisions; (3) align incentives of key stakeholders by incorporating epidemiological informatic insights and individual patient-centered value quantification to inform physician-patient decision-making; (4) mitigate care delays from prior authorization (PA) and claims processing via centralized digital-claims clearinghouses; (5) guide payment model evolution to accurately and transparently reflect costs of care for patients with different risk profiles (6) harmonize quality control reporting for comparability; (7) simplify and standardize PA processes to reduce administrative complexity; and (8) automate non-clinical repetitive work (i.e. credentialing, quality assurance, etc.). Adoption of these tools can eliminate $168 billion in annual administrative costs. While no single solution will perfectly transform healthcare, the strategic and responsible use of AI technologies could lead to transcendent improvements in delivery of healthcare that is patient-centered, equitable, efficient, and fiscally responsible.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694588","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: Patients Don't Care About Physician Social Media Presence.","authors":"Ishan T Modi, Prem N Ramkumar","doi":"10.1016/j.arthro.2025.03.029","DOIUrl":"10.1016/j.arthro.2025.03.029","url":null,"abstract":"<p><p>The presence and perceptions of orthopaedic surgeons on social media demonstrates a disconnect in the content shared. Oftentimes, surgeons use social media for professional networking, research dissemination, and academic engagement. Although this may increase cache among peers, it does not translate for patients who seek education and simple explanations. Generating patient referrals or engagement from social media may or may not even be the goal for surgeons, but if digital clout among patients is the primary aspiration for some, then the recipe is clear: educate and explain. Ancillary streams, direct revenue, and indirect opportunities from the influencer lifestyle are unknown, but be prepared for patients to be unimpressed with the accolades other surgeons may find notable.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694589","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":"Outcome of hip arthroscopy is determined by diverse intrinsic and extrinsic factors in addition to capsular closure.","authors":"Mo Saffarini, Sonia Ramos-Pascual, Alexis Nogier","doi":"10.1016/j.arthro.2025.03.024","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.024","url":null,"abstract":"<p><p>There are contrasting findings between randomized controlled trials and systematic reviews that investigate capsular closure during arthroscopic treatment of femoroacetabular impingement syndrome (FAIS). Some surgeons advocate that capsular closure is beneficial, as it reduces risks of instability and degeneration, while others argue that capsular closure could lead to joint stiffness and/or fibrosis, in addition to increased surgical time. Although unrepaired periportal or interportal capsulotomies may (or may not) compromise outcomes, it is beneficial to close larger incisions and extensions of T-type capsulotomies, especially in patients with high risk of instability (concomitant borderline dysplasia, hyperlaxity, young age, etc.). Most studies focused on the effect of capsular closure do not identify other intrinsic and extrinsic factors-factors that could influence outcomes. Intrinsic factors include patient age, sex, type of FAIS (cam-, pincer-, or mixed-), Tönnis grade, and presence of concomitant hypermobility or dysplasia. Extrinsic factors include surgeon experience, surgical technique, adjuvant procedures (such as labral repair), as well as type of capsulotomy (periportal, interportal, T-type).</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674166","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":"Hip Pathology in Males and Females Deviate, but Outcomes after Appropriately Planned Hip Arthroscopy Are Acceptable Regardless of Sex.","authors":"Derek Ochiai","doi":"10.1016/j.arthro.2025.03.026","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.026","url":null,"abstract":"<p><p>Males and females have a preponderance of different pathologies that can require hip arthroscopic intervention. Males tend to have larger alpha angles, more complex labral tears, and more acetabular chondral damage; females tend to have more psoas involvement and micro-instability. While individual patient pathology can differ from the norm, recognizing these differences can help with pre-operative planning. Hip pathology in males and females deviate, but outcomes after appropriately planned hip arthroscopy are acceptable regardless of sex.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143673666","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: Bone Marrow Stimulation Provides Little Benefit for Repair of Full-Thickness Rotator Cuff Tears.","authors":"Peter Lapner","doi":"10.1016/j.arthro.2025.03.025","DOIUrl":"10.1016/j.arthro.2025.03.025","url":null,"abstract":"<p><p>Rotator cuff retears remain the most frequently observed complication after arthroscopic cuff repair, with tendon nonhealing rates reported between 20% and 68%. Biological solutions to improve healing rates are needed, and bone marrow stimulation (also known as trephination, microfracture, and crimson duvet) is an elegant solution to improving healing rates, given its efficiency and low cost-if it works. Previous randomized trials have not shown any significant benefit to microfracture in the setting of cuff repair in terms of functional outcomes or healing rates compared with treatment with cuff repair alone. Recent research suggests that healing rates may be improved with bone marrow stimulation. However, strict adherence to definitions of tendon disruption is necessary and when we only consider full-thickness retears, there does not appear to be any clinical benefit to this treatment approach.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675082","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: Outcomes After SLAP Repair and Biceps Tenodesis Are Unpredictable for Throwing Athletes With SLAP Lesions.","authors":"Patrick J Tansey","doi":"10.1016/j.arthro.2025.03.022","DOIUrl":"10.1016/j.arthro.2025.03.022","url":null,"abstract":"<p><p>SLAP tears have been associated with pain, poor performance, and missed playing time for decades. Treatment of SLAP tears in the throwing athlete, particularly baseball pitchers, remains a significant challenge. As few as 7% of baseball players are able to return to elite-level performance after a SLAP repair. The throwing athlete must repeatedly orchestrate a sequence of rotational, accelerating, and decelerating movements to produce a throw with sufficient velocity and control to perform at an elite level. Repetitive overhead stress leads to physiologic adaptations in shoulder motion and structure but can also generate biceps labral complex pathology. Recommendations of SLAP repair for young competitive athletes and biceps tenodesis for middle-aged recreational athletes or salvage cases may be grounded in dogma more than evidence. The line between the young and middle-aged athlete may be blurring; many world-class athletes compete into their late 30s and early 40s. Current literature shows massive variability in outcomes after each procedure. Return to sport for throwers after SLAP repair or biceps tenodesis remains completely unpredictable.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143675084","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: Hip arthroscopy in patients with symptomatic spine pathology: Patient education supported by diagnostic injections is the key to satisfactory outcomes.","authors":"Christopher M Larson","doi":"10.1016/j.arthro.2025.03.023","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.023","url":null,"abstract":"<p><p>Concomitant correctable and uncorrectable pathologies can impact outcomes after any orthopedic procedure. The relationship between hip joint disorders and spine related disorders have been increasingly recognized and reported in the literature. A number of studies have reported poorer outcomes in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) with associated symptomatic low back and sacroiliac dysfunction. A few studies, however, have noted that the magnitude of improvement after hip arthroscopy is similar between patients with and without spine pathology despite inferior outcomes associated with symptomatic spine disease. A couple of studies have contradicted this data and noted comparable outcomes after hip arthroscopy for isolated hip pain vs those with hip and spine pain. This is clearly a complex kinetic chain association, and the contradicting literature might be more about how we evaluate the data, set appropriate physician / patient expectations, perform a thorough work up including diagnostic injections, and carefully navigate our way through this patient population rather than buying into a concrete conclusion one way or another. When faced with a patient population riddled with hip and spine related pathology, we are walking through a mine field of unpredictable patient related outcomes. We need to use our evidence and experience-based map to avoid these mines of failure and safely march towards a successful outcome.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671895","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}