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

{"title":"Increased Lateral Posterior Tibial Slope is Associated with a Higher Rate of Lateral Meniscal Injury in Acute Noncontact Anterior Cruciate Ligament Ruptures.","authors":"Ryan R Thacher, Julia Retzky, Janet Hsu, Paley G Arnone, Joseph T Nguyen, Harry G Greditzer, Danyal H Nawabi, Robert G Marx","doi":"10.1016/j.arthro.2025.03.011","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.011","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to determine whether there was an association between increasing posterior tibial slope and meniscal tears in a group of patients with isolated, noncontact and acute ACL ruptures from a large ACL registry.</p><p><strong>Methods: </strong>Our institution's ACL Registry was consulted to identify patients between the age of 18 and 45 who underwent primary ACL reconstruction between Jan 2019 and July 2022 for acute, noncontact ACL rupture. Patients with pre-existing meniscal pathology, chronic ACL reconstructions, revisions, and multi-ligament knee injuries were excluded. Preoperative MRIs were used to measure lateral and medial posterior tibial slope. Meniscal injuries seen during arthroscopy were recorded based on operative reports. Independent cohorts were created based on the presence or absence of a meniscal tear. Two-tailed student's t tests were used to compare average medial and lateral posterior tibial slopes between groups. Separate analyses were performed for the presence of isolated lateral meniscal tears, isolated medial meniscal tears and both medial and lateral meniscal tears. Multivariable logistic regression models were generated to evaluate other potential risk factors for each tear outcome, including age, gender and BMI. Receiver Operating Characteristic (ROC) curve analysis was conducted to explore the potential of identifying an optimal threshold for predicting the presence of a meniscal tear based on lateral posterior tibial slope.</p><p><strong>Results: </strong>1056 patients ultimately met inclusion criteria. There were 498 (47%) patients with any meniscal tear, 346 (33%) patients with lateral meniscus tears, 245 (23%) patients with medial meniscus tears and 93 (9%) patients with both medial and lateral tears. The average lateral and medial posterior tibial slopes were 5.5° (-4.2° to 13.4°) and 5.7° (0° to 15.7°), respectively. Increased lateral tibial slope was associated with a statistically significant increase in rate of any meniscal tear (aOR: 1.10, 95% CI: 1.04-1.16, p<0.001) and lateral meniscal tear, specifically (aOR: 1.11, 95%CI: 1.04-1.18, p<0.001). In regression analysis, male sex and BMI≥35 were found to increase the risk of all meniscal tear types. With a ROC curve analysis identifying LPTS threshold values that resulted AUC ranges from 0.55 to 0.57, we were unable to identify an optimal threshold for posterior tibial slope in predicting meniscal tears.</p><p><strong>Conclusions: </strong>In this single institution registry-based study, increasing lateral posterior tibial slope was associated with a higher rate of meniscus injury in acute ACL ruptures whereas medial tibial slope demonstrated no correlation. No optimal threshold of posterior slope could be identified above which the odds of a meniscal tear were significantly elevated. Regression analysis identified BMI>35 and male sex as independent risk factors for meniscal tear in this select population.","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Reply to \"Regarding 'One-Year Follow-Up Does Not Determine Rotator Cuff Repair Long-Term Outcome'\".","authors":"Michaela E Corvi, Eoghan T Hurley, Tom R Doyle, Samuel G Lorentz, John J Corvi, Jonathan F Dickens, Oke Anakwenze, Christopher S Klifto","doi":"10.1016/j.arthro.2025.02.037","DOIUrl":"10.1016/j.arthro.2025.02.037","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630931","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":"Obese Patients Have Inferior 10-Year Patient-Reported Outcomes and Higher Rates of Conversion to Total Hip Arthroplasty After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.","authors":"Emily Berzolla, Nicole D Rynecki, Griffith G Gosnell, Allison M Morgan, Daniel Kaplan, Thomas Youm","doi":"10.1016/j.arthro.2025.03.012","DOIUrl":"10.1016/j.arthro.2025.03.012","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate patient-reported outcomes (PROs) and survivorship in obese patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at 10-year follow-up.</p><p><strong>Methods: </strong>A retrospective review was conducted of patients who underwent arthroscopy for FAIS from 2011 to 2013. Patients were assessed at baseline, 1 month, 6 months, 1 year, 2 years, 5 years, and 10 years using the modified Harris hip score (mHHS) and nonarthritic hip score (NAHS). Patients were categorized on the basis of BMI into normal, overweight, and obese cohorts. Minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) were calculated for both PROs. Improvements from baseline were analyzed, and differences between groups were evaluated while controlling for age. Survival to revision surgery was assessed with Kaplan-Meier survival curves.</p><p><strong>Results: </strong>144 patients (65.2% female) with a mean age of 38.8 ± 13.0 years and an average follow-up of 11.6 (range: 10.0-13.8) years were included, and categorized into normal weight (59.7%), overweight (26.4%), and obese (13.9%). All groups showed significant improvement in PROs at 10 years compared to baseline (P = .007). Obese patients had lower postoperative scores (mHHS: 72.8 vs 90.1; P = .009; NAHS: 68.4 vs 88.6; P = .003) and improvement in scores from baseline (mHHS: 23.4 vs 37.7; P = .013; NAHS: 18.4 vs 40.0; P = .004) at 10-year follow-up, as well as lower achievement of mHHS PASS (60.0% vs 87.2%; P = .015), NAHS PASS (50.0% vs 89.5%; P < .001) and NAHS MCID (70.0% vs 93.0%; P = .008). Obese patients also had a higher rate of conversion to THA (17.4% vs 3.3%; P = .012). The overall complication rate was 4.2% compared to 10% in the obese group, with obese patients experiencing a superficial infection more frequently (P = .002).</p><p><strong>Conclusions: </strong>Although obese patients still have significantly improved outcomes compared to baseline, at 10-year follow-up they have inferior outcomes compared to nonobese patients and higher rates of conversion to THA.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author reply to «Postoperative Immobilization Strategies Following Arthroscopic Rotator Cuff Repair: A Clinical and Sociological Perspective. ».","authors":"Florian Schönweger, Francesco Marbach, Pietro Feltri, Stamen Roumenov Milev, Giuseppe Filardo, Christian Candrian","doi":"10.1016/j.arthro.2025.03.016","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.016","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143630935","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":"Letter to the Editor Regarding \"One-Year Follow-up is Sufficient Time for Patient-Reported Outcomes following Rotator Cuff Repair: A Systematic Review and Meta-analysis\".","authors":"Shubham Kumar, Nosaibah Razaqi, Rachana Mehta, Ranjana Sah","doi":"10.1016/j.arthro.2025.02.036","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.02.036","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631072","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":"Intraoperative periarticular injection may improve postoperative pain scores and reduce opioid consumption in arthroscopic anterior cruciate ligament reconstruction surgery.","authors":"Hsuan-Hsiao Ma, Kun-Hui Chen, En-Rung Chiang, Hsiao-Li Ma","doi":"10.1016/j.arthro.2025.03.014","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.014","url":null,"abstract":"<p><strong>Purpose: </strong>The study aimed to evaluate efficacy of an intraoperative periarticular injection (PAI) in improving postoperative outcomes, including pain relief and reducing opioid consumption in patients undergoing arthroscopic anterior cruciate ligament reconstruction (aACLR) with hamstring tendon autograft.</p><p><strong>Methods: </strong>This prospective, assessor-blinded, two-surgeon clinical trial was conducted from. March 20^th , 2022 to June 20^th, 2022. A total of 320 patients were initially. Included, and after screening and exclusions, 300 patients undergoing aACLR were randomized to receive either PAI or were assigned to the nPAI group. Inclusion criteria consisted of patients aged 18 years or older undergoing primary aACLR, with or without a concomitant meniscus procedure for knee instability, who agreed to participate and provided informed consent for randomization into the PAI or nPAI group. The minimum follow-up period was two weeks postoperatively. The primary outcome was decreased visual analogue scale (VAS scores) and cumulative Morphine Milligram Equivalents (MME). The secondary outcome parameters included decrease in narcotic-related adverse effects.</p><p><strong>Results: </strong>142 patients in the PAI group and 146 patients in the nPAI group were analyzed. In the PAI group, a lower VAS score at immediate postoperative period and postoperative 4-hour and 24-hour 24 was observed compared with the nPAI group. Proportions of patients achieving MCID were higher in the PAI group at all time points compared to nPAI. Cumulative morphine consumption was significantly reduced in the PAI group (p<0.001).</p><p><strong>Conclusions: </strong>PAI during aACLR with hamstring autograft significantly improved pain scores and reduced opioid consumption compared to nPAI. While statistical differences were found, cohort-specific MCID analysis showed a clinically relevant benefit at 24 hours, with 54.2% of the PAI group achieving meaningful pain relief versus 23.3% in the nPAI group. These results suggest that PAI offers time-dependent, patient-specific benefits and supports its role in multimodal analgesia.</p><p><strong>Level of evidence: </strong>Level II - Randomized controlled trials.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631070","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":"Knee Arthroplasty Risk After Arthroscopy in Patients Over Age 50 Correlates with the Presence of Diagnosis Codes for Osteoarthritis and Obesity.","authors":"Charles C Lin, Neel Vallurupalli, Utkarsh Anil, Zachariah Samuel, Noah Kirschner, Matthew T Kingery, Joseph A Bosco","doi":"10.1016/j.arthro.2025.03.007","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.007","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to assess the 10-year arthroplasty-free survivorship of patients over 50 years of age who underwent knee arthroscopy and to assess whether this survivorship is affected by the diagnoses of knee osteoarthritis (OA) or obesity at the time of arthroscopy.</p><p><strong>Methods: </strong>The New York Statewide Planning and Research Cooperative System (SPARCS) administrative database from 2010 to 2020 was queried to identify all patients over the age of 50 who underwent knee arthroscopy. Kaplan-Meier survival analysis was used to assess arthroplasty-free survivorship. Cox proportional hazards models were performed to assess the effect of the diagnoses of knee OA and obesity at the time of arthroscopy based on ICD-9 and 10 codes.</p><p><strong>Results: </strong>A total of 300,587 patients aged 50 years or older underwent knee arthroscopy. The arthroplasty-free survivorship rate following knee arthroscopy is 83.0% at 5 years. However, at 10 years, the arthroplasty-free survivorship decreased to 66.6%. Patients without knee OA nor obesity had an arthroplasty-free survivorship of 84.1% at 5 years and 68.5% at 10 years. However, patients with a diagnosis of both knee OA and obesity based on ICD-9 and 10 codes had an arthroplasty-free survivorship of 66.2% at 5 years and 15.4% at 10 years. (HR: 2.38; 95% CI: 2.18, 2.60; p < 0.001) CONCLUSION: At five years there is an 83% rate of arthroplasty-free survivorship. This effect deteriorates at the 10-year mark, and many are eventually destined for knee arthroplasty. Presence of diagnosis codes for both knee OA and obesity are risk factors for knee arthroplasty following knee arthroscopy in patients 50 years and older.</p><p><strong>Level of evidence: </strong>IV, Prognostic, Case Series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631071","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 addition of LET improves hamstring autograft ACL reconstruction, but bone-patellar tendon-bone autograft is better.","authors":"Dustin Volkmer","doi":"10.1016/j.arthro.2025.03.017","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.017","url":null,"abstract":"<p><p>The optimal graft choice for ACL reconstruction remains a hotly debated topic. Recent evidence continues to make a case against hamstring autograft, especially in high-risk populations (females, elite athletes, generalized hyperlaxity), due to higher re-tear rates and increased risk of persistent laxity. Quadriceps tendon autograft (quad) is gaining more support with favorable biomechanic characteristics (tensile strength and increased cross-sectional area) and re-tear rates similar to the \"gold-standard\" bone-patellar tendon-bone graft (BTB). In addition, the reemergence of lateral extra-articular tenodesis as an augmentation technique has demonstrated some protective effects in the setting of revisions and high-risk patients. Combined procedures are likely to be the most reliable way to provide stable long-term outcomes, especially with hamstring autograft, but BTB and quad is more robust. I resolved to fix it in a nearly, but not quite, straight position with a strong flat steel spring.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631079","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":"Little Agreement Between Preoperative Kellgren-Lawrence Classification and Intraoperative Outerbridge Score in Patients Undergoing Arthroscopic Partial Meniscectomy.","authors":"C Christian D Rich, Logan Huff, Natalie A Lowenstein, Jillian L Mazzocca, Cale A Jacobs, Elizabeth G Matzkin","doi":"10.1016/j.arthro.2025.03.010","DOIUrl":"10.1016/j.arthro.2025.03.010","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether there is a correlation between preoperative Kellgren-Lawrence (KL) grade and intraoperative Outerbridge score, which are both tools used to assess knee osteoarthritis.</p><p><strong>Methods: </strong>Patients undergoing knee arthroscopy and partial meniscectomy procedures with or without chondroplasty between August 2012 and October 2020 were enrolled in this study. Preoperative KL grades were recorded, and Outerbridge scores were obtained intraoperatively for each of the 6 joint surfaces (medial and lateral femoral condyle, medial and lateral tibial plateau, patella, and trochlea). The total Outerbridge score was then calculated by summing the grades for the 6 joint surfaces. The level of agreement between KL grade and Outerbridge score was assessed using Cohen weighted κ values, with 0 to 0.20 indicating no or slight agreement; 0.21 to 0.40, fair agreement; 0.41 to 0.60, moderate agreement; 0.61 to 0.80, substantial agreement; and greater than 0.80, almost perfect agreement.</p><p><strong>Results: </strong>A total of 468 patients were included in this study (271 women [58%] and 197 men [42%]; mean age, 49 years [standard deviation, 10.35 years]; mean body mass index, 30.5 [standard deviation, 7]). There was slight agreement between KL grade and total Outerbridge score (κ = 0.05), as well as between KL grade and Outerbridge score for individual joint surfaces (κ range, 0.04-0.20). Similar results were found when we individually analyzed female patients (κ range, 0.06-0.22) and male patients (κ range, 0-0.17) and when we compared patients younger than 40 years (κ range, 0.02-0.19) with those aged 40 years or older (κ range, 0.04-0.15).</p><p><strong>Conclusions: </strong>There is little agreement between the radiographic KL grade and the intraoperative Outerbridge classification system. Thus, the association between radiographic assessments and cartilage health may need to be reconsidered owing to this lack of correlation.</p><p><strong>Level of evidence: </strong>Level IV, retrospective therapeutic case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arthroscopic Bankart Repair Using 1 Anterior Portal Has a Shorter Surgical Time and Comparable Clinical Results With the Standard 2-Portal Technique-Reply.","authors":"Ali Okan Gazeloglu, Abdurrahman Yilmaz, Egemen Turhan, Filippo Familiari, Gazi Huri","doi":"10.1016/j.arthro.2025.03.019","DOIUrl":"10.1016/j.arthro.2025.03.019","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631081","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}