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

{"title":"Arthroscopic Coracoclavicular Ligament Reconstruction with Double-Bundle Soft Tissue Allograft for Chronic Type V Acromioclavicular Dislocations Shows Excellent Patient Outcomes and Return to Duty and Sport at Minimum 10-year Follow-Up.","authors":"Alexis B Sandler, John P Scanaliato, Clare K Green, Cole M Patrick, Michael D Baird, Reuben Macias, John Tyler, Nata Parnes","doi":"10.1016/j.arthro.2025.05.008","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.008","url":null,"abstract":"<p><strong>Purpose: </strong>To report long-term outcomes at over 10 years of follow-up after arthroscopic coracoclavicular (CC) ligament reconstruction using a double-bundle soft tissue allograft coracoid cerclage technique for chronic (>4 weeks), high-grade (Type V) acromioclavicular (AC) dislocations in an active-duty military population.</p><p><strong>Methods: </strong>Patients undergoing arthroscopic CC ligament reconstruction for chronic Type V AC dislocations between March 2011 and December 2013 with minimum ten-year follow-up (range: 10-12.8 years) were eligible for inclusion in this retrospective case series. Outcomes measures included the pain visual analog scale (VAS), single assessment numeric evaluation (SANE), Constant score, American Shoulder and Elbow Surgeons Shoulder (ASES) Score, Simple Shoulder Test (SST); range of motion (ROM) including forward flexion (FF), external rotation (ER), and internal rotation (IR); and rates of return to active duty and sports participation.</p><p><strong>Results: </strong>Overall, 19 patients (average age of 26.1±6.7 years, 100% male) met inclusion criteria. The mean follow-up was 134.2±10.4 months. All patients demonstrated a profound decrease in pain as measured by the pain VAS and a marked, sustained improvement in functional outcomes at final follow-up as determined by the SANE, Constant, SST, and ASES scores (p value <0.0001 for all). There were no statistically significant differences between preoperative and postoperative ROM (FF: p=.3382, ER: p=.2350, IR: p=.2590). Overall, 94.7% (n=18/19) of patients were able to remain on active duty and 89.5% (n=17/19) of patients returned to sport, 94.1% (n=16/17) of whom were able to return to sport at prior levels. One patient experienced superficial wound infection, one developed AC osteoarthritis, and one progressed to asymptomatic loss of reduction.</p><p><strong>Conclusion: </strong>Outcomes after arthroscopic CC reconstruction for chronic Type V AC dislocations in an active-duty military patient population demonstrate sustained and statistically significant improvements in functional outcomes as well as high rates of return to sport and active-duty.</p><p><strong>Level of evidence: </strong>IV (Retrospective Case Series).</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082266","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":"Distal Tibial Allograft for the Treatment of Shoulder Instability Provides Excellent Results with Low Rates of Recurrent Instability - A Systematic Review of Clinical and Biomechanical Studies.","authors":"Samuel G Lorentz, Eoghan T Hurley, Alex M Meyer, Mark A Glover, Jonathan F Dickens, Matthew T Provencher","doi":"10.1016/j.arthro.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.007","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to systematically review the literature to evaluate the clinical and biomechanical results of distal tibial allograft (DTA) for shoulder instability.</p><p><strong>Methods: </strong>A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Clinical and biomechanical studies reporting DTA for shoulder instability were included. Qualitative and quantitative data were evaluated.</p><p><strong>Results: </strong>A total of nine clinical and seven biomechanical studies were included. A total of 341 patients with average age from 25.5 to 31 were included in the clinical analysis. Cohorts ranged from 61.9% to 100% male and average glenoid bone loss ranged from 20% to 33%. The recurrent dislocation rate following DTA ranged from 0% to 2.0%. Preoperative mean Single Assessment Numeric Evaluation (SANE) scores ranged from 32.2 to 50, while postoperative scores ranged from 85 to 91. Preoperative mean American Shoulder and Elbow Score (ASES) scores ranged from 40 to 63, while postoperative scores ranged from 90.5 to 92. Postoperative forward flexion ranged from 156.8° to 177°. Union rate on post-operative CT scan was 90.3% to 100%, with significant reportion (over 50%) ranging from 8.1-16%. Biomechanical studies demonstrated that the DTA resulted in improved contact pressures, contact areas, and stability when compared to those with simulated glenoid bone loss.</p><p><strong>Conclusion: </strong>The literature on DTA for the management of anterior shoulder instability with glenoid bone-loss shows overall excellent results with low rates of recurrent instability, and high patient reported outcomes. Biomechanical studies demonstrate that glenoid reconstruction with DTA provides near anatomic reconstruction leading to increased stability, improved contact area, and decreased loading pressures.</p><p><strong>Clinical relevance: </strong>The findings of the biomechanical review demonstrate that DTA provides highly congruent grafts for glenoid reconstruction. This is important for short term outcomes including re-dislocations and PRO's, as well as longer term outcomes including osteoarthritis. Our review of Level III and IV clinical studies shows the clinical implications with low rates of recurrent instability and high patient reported outcomes.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082269","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":"Combined Transosseous and Capsular Repair Improves Grip Strength in Triangular Fibrocartilage Complex Tears: A Randomized Controlled Trial.","authors":"Lutian Liao, Fei Xiong, Fengming Gu, Xiaodong Fang, Qiuwen Ying, Xiaoyun Pan, Jingyi Mi","doi":"10.1016/j.arthro.2025.05.005","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.005","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the clinical outcomes of arthroscopically assisted transosseous repair versus combined transosseous and capsular repair for triangular fibrocartilage complex (TFCC) tears in patients with distal radioulnar joint (DRUJ) instability.</p><p><strong>Methods: </strong>Patients treated for TFCC injuries (Atzei class 2) causing DRUJ instability between September 2020 and September 2022 were prospectively randomized into two treatment groups based on the surgical approach: Group A (transosseous repair, n=20) and Group B (combined transosseous and capsular repair, n=20). Preoperative and postoperative follow-up data of patients were recorded, including DRUJ stability; visual analog scale (VAS) scores; disabilities of the arm, shoulder, and hand (DASH) scores; modified Mayo wrist scores (MMWS); wrist range of motion (ROM; flexion and extension, radial-ulnar deviation, and forearm rotation); and grip strength ratio (compared with the contralateral side). Complications were recorded.</p><p><strong>Results: </strong>Forty participants were enrolled in this prospective RCT. All patients completed the mandated minimum 24-month follow-up (median: 36 months; range: 24-48). Concerning grip strength recovery, group B (94.2%±4.2%) had significantly better outcomes than group A (84.2%±4.3%; P<0.001). Clinically meaningful improvements were observed in grip strength ratio (100%). Group B demonstrated superior grip strength recovery (P< 0.001). Regarding DRUJ stability grades, group B included 15 patients with grade 0 and five patients with grade 1, whereas group A included 10 patients with grade 0 and 10 patients with grade 1 (P=0.102). No statistically significant differences were observed between groups A and B in wrist flexion-extension, forearm rotation, and ulnar radial deviation ROM (P>0.05 for all comparisons). The differences in VAS score, DASH score, and MMWS were not statistically significant (all P>0.05).</p><p><strong>Conclusions: </strong>Arthroscopy-assisted transosseous with capsular repair augmentation demonstrated significantly superior grip strength recovery compared with transosseous repair; both achieved significant improvements in postoperative functional outcomes, pain reduction, MMWS scores, and wrist ROM.</p><p><strong>Level of evidence: </strong>Level Ⅰ, Randomized controlled trial.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082268","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: Adductor Canal Peripheral Nerve Blocks Have Minimal Effect on Pain Control in the Immediate Postoperative Period Among Patients Undergoing Anterior Cruciate Ligament Reconstruction.","authors":"Andrew J Sheean","doi":"10.1016/j.arthro.2025.03.028","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.028","url":null,"abstract":"<p><p>Minimizing opioid dosing in the perioperative period is important to providing safe and effective analgesia for patients undergoing anterior cruciate ligament reconstruction. The use of peripheral nerve blocks is common, as in multimodal regimens, focused on managing patients' postoperative pain. Recent research suggests that the addition of adductor canal peripheral nerve blocks to local infiltration analgesia injection at the surgical sites in bone-patellar tendon-bone and quadriceps tendon autograft anterior cruciate ligament reconstruction does not affect the dosage of opioid medication administered in the immediate postoperative period.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144055625","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":"Measure Labral Height Using MRI Prior to Hip Arthroscopy: A Diminutive Labrum Should Be Reconstructed with a Graft to Restore the Suction Seal.","authors":"Thomas Youm","doi":"10.1016/j.arthro.2025.05.009","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.009","url":null,"abstract":"<p><p>The acetabular labrum deepens the hip socket and provides a suction seal to the femoral head. Anatomic restoration of the suction seal is the goal of hip labral repair. Labral debridement outcomes are inferior to labral repair because this suction seal is disrupted. Labral height, surface area, and volume contribute to the suction seal and are important to consider in order to restore hip stability. Labral height should be measured on MRI prior to arthroscopy. If the labrum is insufficient, surgeons should plan labral augmentation and reconstruction using a graft. Labral reconstruction can lead to successful outcomes in cases of short labral height or hypoplastic labrum by restoring the suction seal.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082270","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":"To minimize glenoid bone graft resorption, bone block size must match glenoid bone loss for patients with shoulder instability.","authors":"James P Leonard","doi":"10.1016/j.arthro.2025.05.010","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.010","url":null,"abstract":"<p><p>Despite having similar clinical outcomes, allograft bone blocks have higher resorption rates when compared to autograft bone block (approximately 75% versus 15%) for treating glenoid bone loss and recurrent anterior shoulder instability. The resorption of both autografts and allografts are based on Wolff's Law of bone remodeling. The physiological loading of the humeral head on the glenoid will strengthen bone blocks lying within the normal glenoid surface area. Any bone graft outside of this area will not be placed under any load and will be resorbed. Several studies have shown significant graft resorption of excess bone block over the first 6-12 months postoperatively, followed by a stable glenoid construct similar in size to that of the native glenoid. To minimize graft resorption, the size of the bone block, autograft, or allograft should be size matched to the amount of glenoid bone loss. The tendency to oversize bone blocks to maximize glenoid surface area and prevent instability should be avoided. Excess bone graft beyond the normal glenoid surface will be resorbed. Because allograft bone blocks tend to be larger than autograft, this is likely why resorption rates are so much higher for allografts. Since both grafts will eventually remodel to the native glenoid width, outcomes will be the same, and excessive graft resorption can lead to complications.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082284","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":"Measurement of Sagittal Tibial Tubercle Trochlear-Groove Distance Using Computed Tomography versus Magnetic Resonance Imaging Yields Different Results.","authors":"Anthony Zacharias","doi":"10.1016/j.arthro.2025.04.056","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.04.056","url":null,"abstract":"<p><p>The concept of anterior to posterior alterations of the tibial tubercle in reference to the trochlear groove (sTTTG) has become a recent point of interest. These alterations have been noted in patellar instability and have been found to have implications for patellofemoral contact pressures. In characterizing pathology, it is critical to understand the limitations and differences between imaging modalities. Both computed tomography (CT) and magnetic resonance imaging (MRI) are two options to evaluate three-dimensional pathology regarding patella instability. However, it is evident these measurements are not interchangeable and a firm understanding of both imaging modality and knee flexion angles are important as we continue to understand this measurement and how we can use this for surgical planning for treatment of patellar instability.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144058852","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: Deteriorated Quality and Medial Retraction of Tendon Following Acute Traumatic Rotator Cuff Tear Are Predictors of Retear After Arthroscopic Repair.","authors":"Tyler J Uppstrom, Ayham Jaber, Peter J Millett","doi":"10.1016/j.arthro.2025.04.057","DOIUrl":"10.1016/j.arthro.2025.04.057","url":null,"abstract":"<p><p>Rotator cuff tears are a common cause of shoulder pain and dysfunction, affecting up to 33% of the population, and approximately 250,000 arthroscopic rotator cuff repairs are performed each year in the United States. Arthroscopic rotator cuff repair is the gold standard for surgical management of full-thickness rotator cuff tears and is associated with postoperative improvements in pain and function. However, reported retear rates based on postoperative magnetic resonance imaging vary from 7% to 90% following arthroscopic rotator cuff repair. Despite variations in repair techniques, implant technology, biologic and patch augmentation, and postoperative rehabilitation algorithms, retear rates following rotator cuff repair have remained high over the past several decades. As a result, there remains significant interest in identifying predictive factors of retear after rotator cuff repair. That said, numerous well-designed studies have demonstrated a poor correlation between postoperative magnetic resonance imaging findings and functional outcomes. Regardless, intraoperative evaluation of tendon quality, tear pattern, and tissue mobility is essential to predicting the likelihood of successful rotator cuff repair, although at the current time, this evaluation is largely subjective, and few validated assessment tools exist. As such, future objective research is required to improve our assessment and documentation of these intraoperative factors, with artificial intelligence and machine learning models possibly serving as useful tools for identifying meaningful intraoperative patterns predictive of postoperative outcomes in the future.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027874","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: Various High Tibial Osteotomy Techniques Show High Survivorship, Medial Opening-Wedge Technique Has Risks, and Patient-Specific Instrumentation Shows Promise.","authors":"Adam V Daniel, Matthew J Wagner, Bruce A Levy","doi":"10.1016/j.arthro.2025.05.004","DOIUrl":"10.1016/j.arthro.2025.05.004","url":null,"abstract":"<p><p>Valgus-producing high tibial osteotomy (HTO) is a treatment for medial compartment knee osteoarthritis. There has been much debate about which type of osteotomy is the \"best.\" Many techniques, including medial opening-wedge, lateral closing-wedge, dome, and chevron-type osteotomies, have proven track records, with survival rates free of conversion to total knee replacement ranging from 85% to 93% at 8 years or more in some series. One of the main drawbacks to medial opening-wedge HTO is the effect on tibial slope and patellar height. These osteotomies tend to open more in the anterior aspect of the osteotomy, resulting in an increased posterior tibial slope. This can lead to strain on the anterior cruciate ligament, so there is interest in avoiding this in the setting of anterior cruciate ligament reconstruction. If there is a significant increase in posterior tibial slope, a \"bony\" flexion deformity might even occur. Another potential issue with medial opening-wedge HTO is a change in patellar height leading to patella infera, which may negatively impact the extensor mechanism and quadriceps function, lead to altered patellofemoral contact pressures, and theoretically, even cause accelerated rates of patellofemoral osteoarthritis. Patient-specific cutting guides developed with precise preoperative planning, using computed tomography, can guide everything from desired correction in 1 or multiple planes to positioning of the hinge pin. The data are so precise that the cutting jigs can determine the exact depth of the saw cut in each region of the bone, patient-specific plates can be precontoured to match the patient's bony anatomy after the osteotomy, and even the screw lengths for the plate can be determined. Initial data are quite encouraging; for example, a laboratory study has shown superior accuracy and decreased radiation exposure compared with the traditional freehand technique.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144042947","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: Excitement Regarding Commercially Available Exosome Products Is High but Concerns Include Misinformation and Limited Evidence of Efficacy.","authors":"Adnan Saithna","doi":"10.1016/j.arthro.2025.05.003","DOIUrl":"10.1016/j.arthro.2025.05.003","url":null,"abstract":"<p><p>Exosomes are a subtype of extracellular vesicles. They act as carriers for intercellular communication, transferring molecules between cells and influencing their behavior. They play roles in various physiological processes, including tissue repair. Several basic science studies have evaluated the role of extracellular vesicles in animal models of rotator cuff pathology and have shown potential benefits, including improved structural and biomechanical properties (including greater load to failure, better tendon-to-bone healing, and prevention of muscle atrophy and fatty infiltration). However, clinical studies are lacking, and there are currently no US Food and Drug Administration-approved exosome products. Despite that, exosome products are available to patients, but the information available to them, especially through direct marketing and social media, can lack transparency and be misleading. As the exosome market continues to grow rapidly, it is likely that patients will be seeking information regarding them with increasing frequency. It is therefore important for sports medicine surgeons to understand the evolving landscape for biological augmentation of rotator cuff injuries and provide accurate and evidence-based recommendations to their patients.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063324","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}