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

{"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":"https://doi.org/10.1016/j.arthro.2025.03.025","url":null,"abstract":"<p><p>Rotator cuff re-tears remain the most frequently observed complication following arthroscopic cuff repair with tendon non-healing 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. Prior 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 are necessary and when we only consider full thickness re-tears, 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}

{"title":"Medial Meniscus Root Tears: Anatomy, Repair Options, and Outcomes","authors":"Cameron Gerhold B.S.,&nbsp;Udit Dave B.S.,&nbsp;Andrew S. Bi M.D.,&nbsp;Jorge Chahla M.D., Ph.D.","doi":"10.1016/j.arthro.2025.01.005","DOIUrl":"10.1016/j.arthro.2025.01.005","url":null,"abstract":"<div><h3>Abstract</h3><div>Meniscal root tears are defined as complete avulsions of the meniscus at the site of tibial attachment or meniscal tears within 1 cm of the meniscotibial attachment sites. This injury often is seen in individuals older than the age of 50 years who have a sedentary lifestyle and can lead to the progression of osteoarthritis if not treated properly; in contrast, a traumatic etiology may be observed in younger individuals. Recent literature has defined the association between medial meniscal root tears and meniscal extrusion, defined by &gt;2 mm of overhang of the medial meniscus over the medial border of the tibial plateau. Surgical repair often is indicated for unstable meniscal root tears, as these injuries are functionally equivalent to a total meniscectomy because of a complete loss of circumferential fibers and hoop stresses. There are 2 main repair techniques: transtibial pullout and suture anchor repairs. Repair using the transtibial pullout technique involves drilling a tunnel from the anterior proximal tibia to the anatomic insertion site of the meniscal root. Sutures are then passed through the medial root, retrieved through the tunnel, and secured with a cortical button or suture anchor on the anterior tibial cortex. Suture anchor repairs either involve passing sutures through the meniscal root and into a suture anchor at the footprint. A supplemental centralization technique is a new advancement designed to reduce meniscal extrusion and involves fixation of the meniscal body with a suture anchor at the peripheral medial plateau. Medial meniscal root repair is associated with improved patient-reported outcomes and a reduced rate of knee replacement.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 4","pages":"Pages 871-873"},"PeriodicalIF":4.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143642974","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(25)00091-X","DOIUrl":"10.1016/S0749-8063(25)00091-X","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 4","pages":"Page A18"},"PeriodicalIF":4.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143643120","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":"Tranexamic Acid Has A Limited Role in Improving Visual Clarity and Pain in Arthroscopic Shoulder Surgery: A Systematic Review and Meta-Analysis.","authors":"Danielle Dagher, Imad Kashir, Osman Mahboob, Nasser Al-Turki, Moin Khan","doi":"10.1016/j.arthro.2025.03.009","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.009","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this systematic review was to evaluate the effects of tranexamic acid (TXA) compared to placebo or other comparators with regard to visual clarity, pain, total operative time, and volume of blood loss in patients undergoing arthroscopic shoulder surgery.</p><p><strong>Methods: </strong>CENTRAL, EMBASE, and MEDLINE were searched from inception until January 4th, 2025. Study selection and data extraction were carried out in duplicate. Randomized controlled trials that compared TXA versus placebo or another comparator in patients undergoing arthroscopic shoulder surgery were included. All outcomes were assessed in duplicate for risk of bias (RoB) using the RoB-2 tool and for certainty of evidence using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) approach. Results were pooled in a meta-analysis using a random-effects model when appropriate or were synthesized narratively when data could not be pooled.</p><p><strong>Results: </strong>Overall, 12 randomized controlled trials involving 1009 patients were included. The pooled estimate for visual clarity shows a slight increase in visual clarity (Standardized Mean Difference 0.64 [0.05, 1.24]). The pooled estimate for pain shows a mean difference of a reduction of pain by 0.38 points in the TXA group on a visual analog scale of 0 to 10 (0 = no pain) (Mean Difference -0.38 [-0.76, 0.00]).</p><p><strong>Conclusions: </strong>There is moderate-certainty evidence suggesting that TXA likely results in a slight increase in visual clarity. The evidence also suggests that TXA has little to no difference in pain, operative time, and volume of blood loss.</p><p><strong>Level of evidence: </strong>Level I, systematic review of Level I studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665442","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}