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

{"title":"Slope reducing proximal tibial osteotomy improves outcomes in ACL reconstruction patients with elevated posterior tibial slope, especially revisions and PTS ≥ 12°.","authors":"Luke V Tollefson, Matthew T Rasmussen, Grace Guerin, Christopher M LaPrade, Robert F LaPrade","doi":"10.1016/j.arthro.2024.10.048","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.048","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this systematic review was to explore the indications, outcomes, and complications related to slope reducing osteotomies in the setting of anterior cruciate ligament (ACL) tears or graft failure. A secondary aim was to create an algorithm based on the current literature and authors' opinions.</p><p><strong>Methods: </strong>This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies were included if they reported on outcomes related to slope reducing osteotomies both for primary ACL tears and revision ACL graft tears. The studies were analyzed to determine the radiographic outcomes, patient reported outcomes (PROs), physical exam findings, and complications. Statistical analysis could not be performed due to the heterogeneity between studies.</p><p><strong>Results: </strong>A total of 148 studies were screened for inclusion in this systematic review and after full-text review, a total of 16 studies were included in this systematic review. Fourteen of the studies reported on pre- vs. postoperative PTS and all but one reported significant decrease in posterior tibial slope. Seven studies reported on pre- vs. postoperative PROs and all studies reported significant improvements in postoperative scores. Anterior tibial translation (ATT) was measured in 8 studies, and all reported a significant decrease in ATT postoperatively. The most common complication was postoperative hyperextension and hardware irritation. Hardware irritation was only reported in studies that used plates to fixate the osteotomy.</p><p><strong>Conclusions: </strong>In conclusion, slope reducing proximal tibial osteotomies performed concurrently or as a second stage surgery with an ACLR resulted in improved patient reported outcomes and decreased ACLR failure rates. Slope reducing proximal tibial osteotomies are an important treatment consideration for those patients with an increased PTS, especially for patients with a failed ACLR and a PTS ≥ 12° to reduce the risk of ACLR failure.</p><p><strong>Level of evidence: </strong>IV.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632265","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 Opening Wedge (MOW) Versus Lateral Closing Wedge (LCW) High Tibial Osteotomies for Knee Medial Compartment Osteoarthritis Show Similar Outcomes and Survivorship, While MOW Has Higher Rates of Tibial Fracture and LCW Has Higher Rates of Nerve Injury and Conversion to Total Knee.","authors":"Luke V Tollefson, Dustin Lee, Taidhgin Keel, Christopher M LaPrade, Robert F LaPrade","doi":"10.1016/j.arthro.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.11.002","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this systematic review was to compare the clinical and radiographic outcomes and complications between medial opening wedge and lateral closing wedge high tibial osteotomies in the setting of medial compartment osteoarthritis with genu varus alignment.</p><p><strong>Methods: </strong>This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies that reported on MOW- or LCWHTOs in the setting of medial compartment osteoarthritis were included. Analysis was performed based on radiographic and patient reported outcomes (PROs) and complications.</p><p><strong>Results: </strong>A total of 40 studies were included. Hip-knee-ankle (HKA) angles and PROs including Lysholm and VAS showed significant improvements postoperatively for both MOW- and LCWHTO for all included studies. For the studies that reported on it, posterior tibial slope (PTS) was significantly increased in 4 of the 9 MOW studies and significantly decreased in 8 of the 9 LCW studies, and patellar height was significantly decreased in 4 of the 5 MOW studies, while none of the 4 LCW studies reported any changes. Three comparison studies reported a higher conversion to total knee arthroplasty (TKA) in the LCW cohort, otherwise, survivorship at 10-years was comparable between studies. The MOW cohort had higher rates of tibial fractures while the LCW cohort had higher rates of nerve injuries.</p><p><strong>Conclusions: </strong>This systematic review found comparable HKA angle correction and PROs between patients undergoing MOW- or LCWHTOs to treat medial compartment osteoarthritis. Survivorship at 10-years was comparable between MOW- and LCWHTOs; however, some MOW- and LCWHTO comparison studies reported higher conversion to TKA for LCWHTO. Medial opening wedge HTO typically results in an increased PTS, decreased patellar height, and tibial fractures, while LCWHTO typically results in decreased PTS, no change in patellar height, and common peroneal nerve injuries.</p><p><strong>Level of evidence: </strong>Level IV, systematic review of Level I to IV studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631608","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":"Favorable Outcomes Following Elbow Ulnar Collateral Ligament Reconstruction and Repair, Though Repair Associated with Increased Risk of Revision Surgery.","authors":"Nathan H Varady, Suhas Parise, Kyle N Kunze, Christopher M Brusalis, Riley J Williams, David W Altchek, Joshua S Dines","doi":"10.1016/j.arthro.2024.10.049","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.049","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the risk of revision surgery following repair versus reconstruction of the medial ulnar collateral ligament (UCL) of the elbow in a national sample of patients in the United States.</p><p><strong>Methods: </strong>This was a retrospective cohort study of young patients (≤35 years old) who underwent primary UCL reconstruction or repair for an isolated medial UCL injury of the elbow from October 2015 through October 2022 in a large national database (PearlDiver). Patient demographic data, comorbidities, surgical details, and concomitant ulnar nerve procedures were collected. Time-to-event analyses were used to assess the risk of revision UCL surgery between groups. Two-year complication rates, including ulnar neuropathy, were also assessed.</p><p><strong>Results: </strong>In total, 1,820 patients (69.9% reconstruction, 30.1% repair) with an average follow-up of 2.9 years met inclusion criteria. The estimated 2-year revision-free survival (95% confidence interval [CI]) was 99.5% (99.1%-99.9%) for UCL reconstruction compared to 97.9% (96.4%-99.3%) for UCL repair (unadjusted Log-rank p=0.032). UCL repair remained associated with an increased risk of revision UCL surgery after adjusting for confounding variables (hazard ratio 2.94, 95% CI 1.07-8.09, p=0.037). Complication rates were similar between reconstruction and repair, including the incidence of ulnar neuropathy (13.8% vs. 14.5%, p=0.78).</p><p><strong>Conclusion: </strong>In this study, we found that UCL repair was associated with a significantly higher risk of revision UCL surgery than UCL reconstruction in a national sample. Importantly, however, overall failure rates were low and complication rates were similar between procedures. These findings support the overall favorable outcomes of UCL repair, while suggesting it may not necessarily be the optimal treatment for all patients.</p><p><strong>Level of evidence: </strong>3 - retrospective cohort study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633859","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: Younger Age, Early Repair Surgery and Proximal Avulsion Tear with Good ACL Stump Are Factors Affection Positive the Ligament Healing with Primary Anterior Cruciate Ligament Tear.","authors":"Jon Karlsson, Thorkell Snaebjörnsson","doi":"10.1016/j.arthro.2024.11.005","DOIUrl":"10.1016/j.arthro.2024.11.005","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632537","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":"Clinically Important Outcome Values (Thresholds) are Specific to the Patient Population Studied.","authors":"Tyler N Sharp, Justin J Greiner","doi":"10.1016/j.arthro.2024.10.047","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.047","url":null,"abstract":"<p><p>Patient Reported Outcome (PRO) measures are critical to understand the influence and benefits of orthopedic surgery. While clinically important outcome values (CIOVs) have been developed to allow clinical interpretation of PRO values, gaps in outcome metrics still remain. The CIOVs can be utilized to describe specific populations of interest, such as in patients with hip dysplasia undergoing combined hip arthroscopy and periacetabular osteotomy. With differing populations, however, the presence and/or absence of modifying factors limits cross-comparison of CIOVs. Utilizing a different perspective, such as the use of simple questions that are important for both the patient and the surgeon, can provide important information that helps fill in the gaps left from traditional PROs.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633856","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":"Inferior Clinical Outcomes Following Endoscopic Proximal Hamstring Repair in Patients with Chronic Degenerative Tears Despite the use of Dermal Allograft Augmentation.","authors":"Sean M Richards, Ryan S Marder, Sydney M Fasulo, Nicolas J Nadeau, Matthew J Kraeutler, Anthony J Scillia","doi":"10.1016/j.arthro.2024.10.046","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.046","url":null,"abstract":"<p><strong>Purpose: </strong>To compare clinical outcomes in patients undergoing endoscopic proximal hamstring repair with and without dermal allograft augmentation.</p><p><strong>Methods: </strong>A retrospective review of prospectively collected data was performed on patients undergoing endoscopic proximal hamstring repair (PHR) and proximal hamstring repair with dermal allograft augmentation (PHR-A) by a single surgeon between 2016 and 2023. Augmentation was utilized for cases of chronic degenerative tears (> 6 weeks from the time of initial injury) where hamstring tissue quality was deemed poor intraoperatively. A survey of patient-reported outcome measures (PROMs) was completed at a minimum of 1 year postoperatively. PROMs included a Visual Analogue Scale (VAS) for pain; University of California, Los Angeles (UCLA) Activity Scale; modified Harris Hip Score (mHHS); Hip Outcome Score-Sports-Specific Subscale (HOS-SSS); and a Single Assessment Numeric Evaluation (SANE). The proportion of patients achieving the minimal clinically important difference (MCID), patient acceptable symptom state (PASS), and substantial clinical benefit (SCB) for PROMs were compared between groups.</p><p><strong>Results: </strong>Sixty-four patients were included (42 PHR, 22 PHR-A). No differences were seen between the PHR and PHR-A groups in terms of age at surgery (49 ± 12 vs. 54 ± 9, p=0.08), sex, or body-mass index (BMI). There was a significantly longer time to follow-up (41.5±23.4 vs. 20.1±10.2 months, p<0.001) in the PHR group. There were significantly greater postoperative mHHS (82.7±15.1 vs. 72.0±18.0, p=0.02) and SANE (89.6±9.9 vs. 73.6±22.5, p=0.002) scores in the PHR group. There were no significant differences in postoperative VAS, UCLA, or HOS-SSS between groups. A greater proportion of patients in the PHR group achieved a SCB for mHHS (71% vs. 36%, p=0.008).</p><p><strong>Conclusions: </strong>Our study demonstrates inferior clinical outcomes in patients undergoing endoscopic proximal hamstring repair with dermal allograft augmentation compared to patients undergoing endoscopic proximal hamstring repair without augmentation.</p><p><strong>Level of evidence: </strong>III, retrospective comparative case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633873","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":"There Is No Difference in Clinical Outcomes Between Early or Late Weight-Bearing After Autologous Osteochondral Transplantation for Osteochondral Lesion of the Talus: A Systematic Review.","authors":"Choon Chiet Hong, Chen Xi Kasia Chua, Brjan Kaiji Betzler, Sheng Yang Lim, Si Heng Sharon Tan, Christopher Jon Pearce","doi":"10.1016/j.arthro.2024.10.045","DOIUrl":"10.1016/j.arthro.2024.10.045","url":null,"abstract":"<p><strong>Purpose: </strong>To provide a comprehensive systematic review to determine the impact of early weight-bearing compared with late weight-bearing on the clinical outcomes of patients who underwent osteochondral lesion of the talus (OLT) and were treated with autologous osteochondral transplantation (AOT) and to review the rate of return to sports and/or activities, patient satisfaction, and complications.</p><p><strong>Methods: </strong>A systematic review of the PubMed, Embase, and The Cochrane Library databases was performed according to the Preferred Reporting Items for Systemic Reviews and Meta-Analyses guidelines. Publications were divided into group A, in which patients were allowed early weight-bearing within the first 6 weeks, whereas group B consisted of patients who were only allowed weight-bearing after 6 weeks. Unweighted estimates were calculated instead of quantitative random-effects meta-analysis due to the high heterogeneity and low level of evidence of the included studies.</p><p><strong>Results: </strong>In total, 44 studies with 1,838 ankles were included. There were 25 studies in group A and 19 studies in group B. Both the American Orthopaedic Foot and Ankle Society and visual analog scale scores were not affected by early weight-bearing after AOT for OLT. There were similar rates of return to sports and/or activities (71.4%-100% vs 71.4%-100%) and patient satisfaction (71.4%-100% vs 65.7%-100%). Notably, late weight-bearers had lower rates of postoperative knee symptoms (0-30% vs 0-39.1%) despite more late weight-bearers presenting with complication rates >20% compared with early weight-bearers (20% vs 14.3%) respectively. Late weight-bearers also had greater rates of repeat surgery (0-26% vs 0-18.2%) compared with early weight-bearers, with the most common cause for repeat surgery being arthroscopic debridement for postoperative impingement pain.</p><p><strong>Conclusions: </strong>Protocols allowing for early weight-bearing after AOT for OLT yielded similarly good outcomes in terms of American Orthopaedic Foot and Ankle Society, visual analog scale for pain score, return to sports and/or daily activities, and patient satisfaction when compared with late weight-bearing. Although the differences in ranges for postoperative complications were not exceedingly different, late weight-bearers have slightly lower rates of postoperative knee symptoms and marginally greater rates of repeat surgery, with the most common cause for repeat surgery being arthroscopic debridement for postoperative impingement pain, similar to the studies with a low level of evidence appraised. The strength of these conclusions is limited because of the high level of heterogeneity, low level of evidence and high risk of bias in the literature reviewed.</p><p><strong>Level of evidence: </strong>Level IV, systematic review of Level I to Level IV studies with predominantly Level IV studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632504","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":"Generalized Joint Laxity Increases the Risk of Recurrence of Distal Radio-Ulnar Joint Instability after Arthroscopic Foveal Repair of the Triangular Fibrocartilage Complex.","authors":"Ji Sup Kim, Kyeong-Eon Kim, Shin-Woo Lee, Soyoung Jeon, Hyejin Yang, Yun-Rak Choi","doi":"10.1016/j.arthro.2024.10.040","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.040","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the clinical results of the arthroscopic foveal repair of the triangular fibrocartilage complex (TFCC) for distal radio-ulnar joint (DRUJ) instability in patients with or without generalized joint laxity.</p><p><strong>Methods: </strong>Patients who underwent arthroscopic transosseous foveal TFCC repair of Palmer 1B foveal TFCC tears (Atzei classification class II or III) from January 2018 to October 2021 were identified. Patients treated for symptomatic DRUJ instability for more than 3 months, and with at least 2 years of follow-up, were included. Patients were categorized into two groups based on the Beighton and Horan criteria: those with generalized joint laxity (group L) and those without (group N). Clinical outcomes were measured by the Disabilities of the Arm, Shoulder, and Hand (DASH) score, modified Mayo wrist score (MMWS), wrist range of motion (ROM), grip strength, sports/recreation activity level, recurrent DRUJ instability, and achievement of minimal clinically important differences (MCID).</p><p><strong>Results: </strong>One-hundred-and-twenty patients (Group L, 51 patients; Group N, 69 patients) were included. Both groups showed significant improvements in preoperative DASH and MMWS at the final follow-up. Overall, 103 patients (85.8%) achieved MCID, with 82.4% in Group L and 88.4% in Group N, and no significant differences between the two groups (P = .347). At the final follow-up, ROM and sports/recreation activity levels were similar between the groups. Significantly, the rates of postoperative DRUJ instability recurrence were 17.7% in group L (9/51) and 5.8% in group N (4/69) (P=0.039). Beighton scores were an independent risk factor for recurrent DRUJ instability in the multivariable analysis (P=0.024; odds ratio=1.62).</p><p><strong>Conclusions: </strong>Clinical outcomes after arthroscopic TFCC foveal repair in patients with generalized joint laxity are comparable to those without, with 82.4% achieving MCID. Generalized joint laxity impacts DRUJ instability recurrence over a minimum two-year follow-up period.</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":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633861","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":"Custom Large Language Models Improve Accuracy: Comparing Retrieval Augmented Generation and Artificial Intelligence Agents to Non-Custom Models for Evidence-Based Medicine.","authors":"Joshua J Woo, Andrew J Yang, Reena J Olsen, Sayyida S Hasan, Danyal H Nawabi, Benedict U Nwachukwu, Riley J Williams, Prem N Ramkumar","doi":"10.1016/j.arthro.2024.10.042","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.042","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of the study is to demonstrate the value of custom methods, namely Retrieval Augmented Generation(RAG)-based Large Language Models(LLMs) and Agentic Augmentation, over standard LLMs in delivering accurate information using an anterior cruciate ligament(ACL) injury case.</p><p><strong>Methods: </strong>A set of 100 questions and answers based on the 2022 AAOS ACL guidelines were curated. Closed-source(Open AI GPT4/GPT 3.5 and Anthropic's Claude3) and open-source models(LLama3 8b/70b and Mistral8x7b) were asked questions in base form and again with AAOS guidelines embedded into a RAG system. The top-performing models were further augmented with Artificial Intelligence(AI) Agents and re-evaluated. Two fellowship-trained surgeons blindly evaluated the accuracy of the responses of each cohort. ROUGE and METEOR scores were calculated to assess semantic similarity in the response.</p><p><strong>Results: </strong>All non-custom LLM models started below 60% accuracy. Applying RAG improved the accuracy of every model by an average 39.7%. The highest performing model with just RAG was Meta's Open-Source Llama3 70b(94%). The highest performing model with RAG and AI Agents was Open AI's GPT4(95%).</p><p><strong>Conclusion: </strong>RAG improved accuracy by an average of 39.7%, with the highest accuracy rate of 94% in the Meta Llama3 70b. Incorporating AI agents into a previously RAG-augmented LLM improved ChatGPT4 accuracy rate to 95%. Thus, Agentic and RAG augmented LLMs can be accurate liaisons of information, supporting our hypothesis.</p><p><strong>Clinical relevance: </strong>Despite literature surrounding the use of LLM in medicine, there has been considerable and appropriate skepticism given the variably accurate response rates. This study establishes the groundwork to identify whether custom modifications to LLMs using RAG and Agentic augmentation can better deliver accurate information in orthopaedic care. With this knowledge, online medical information commonly sought in popular LLMs, such as ChatGPT, can be standardized and provide relevant online medical information to better support shared decision making between surgeon and patient.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633857","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":"Higher Posterior Tibial Slope and Lower Medial Proximal Tibial Angle of the Knee Are Associated with Delayed Graft Maturation after ACL Reconstruction Surgery with Hamstring Autograft.","authors":"Dai Sato, Misung Han, Brian T Feeley, C Benjamin Ma, Sharmila Majumdar, Drew A Lansdown","doi":"10.1016/j.arthro.2024.10.044","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.044","url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to relate bone shape with anterior cruciate ligament (ACL) graft maturation, as evaluated by quantitative magnetic resonance imaging (MRI).</p><p><strong>Methods: </strong>We retrospectively evaluated patients aged 18-60 years who underwent ACL reconstruction with a hamstring autograft with doubled semitendinosus and gracilis at our institution between 2018 and 2020 with isolated ACL injuries. All patients had a minimum follow-up period of 2 years. To evaluate alignment, radiographs of the knee were taken preoperatively. Postoperative 3T magnetic resonance imaging (MRI) and patient-reported outcomes (PRO) scores were acquired at 2 years after surgery. A combined T1ρ/T2 quantification sequence and a 3D multi-echo ultrashort echo-time (UTE) Cones sequence were obtained in a sagittal-oblique plane for better assessment of the ACL graft. After acquiring images, a manual segmentation for ACL graft was performed to assess T1ρ, T2 and UTE T2* relaxation times. Correlations between radiographic parameters or PRO scores and T1ρ, T2 and UTE T2* values were tested with Pearson correlation coefficients. Significance was defined as p<0.05.</p><p><strong>Results: </strong>Subjects were 28 patients (12 males and 16 females) and had an average age of 34.3 years (SD=8.5 years) and a BMI of 24.4 kg/m2 (SD=4.5 kg/m2). A significant correlation was found between the preoperative PTS and the T1ρ, T2 and UTE T2* relaxation times (r=0.41; p=0.033, r =0.47; p=0.014 and r =0.41; p=0.030), indicating inferior graft maturation in patients with higher PTS. Furthermore, a negative correlation was identified between the preoperative MPTA and the T1ρ, T2 and UTE T2* relaxation times (r=-0.39; p=0.039, r =-0.46; p=0.018 and r =-0.43; p=0.024), indicating inferior graft maturation in patients with greater varus knee alignment.</p><p><strong>Conclusion: </strong>The study findings suggest that an increased PTS and lower MPTA are associated with inferior graft maturation as per T1ρ, T2 and UTE T2* imaging at 2 years post-ACL reconstruction.</p><p><strong>Level of evidence: </strong>Level IV retrospective case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633870","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}