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

{"title":"Suture Anchor and Reverse Suture Anchor show Superior Biomechanical Efficacy to Transtibial Pull-out Repair for Posterior Medial Meniscus Root Tears in Porcine Model.","authors":"Chenyang Meng, Wei Feng, Lingyue Kong, Ming Liu, Bing Leng, Fujia Kang, Yizhong Ren, Yi Qiu, Changxu Han","doi":"10.1016/j.arthro.2025.03.013","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.013","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the biomechanical efficacy of the reverse suture anchor (RSA) technique compared with the transtibial pull-out (TP) and suture anchor (SA) techniques using in vitro porcine knee models of PMMRTs.</p><p><strong>Methods: </strong>32 fresh frozen porcine tibiae with medial meniscus intact were randomly assigned to four groups (eight specimens each). A standardized posterior medial meniscus root tear (PMMRT) was established in 24 specimens. SA, TP, and RSA techniques were used to repair PMMRTs in 8 specimens respectively, while the native posterior medial meniscus roots (PMMRs) were left intact as a control in eight specimens. Pressure sensitivity, stress, cyclic load and failure load tests were performed. To evaluate differences in group variables, ANOVA was used to compare differences among ≥ three groups and Tukey's test was used to compare data between two groups. Significance level was set at P < .05.</p><p><strong>Results: </strong>The SA and RSA groups had a wider contact area and higher pressure at the meniscus suture site and attachment area than the TP group (P < .001) while there was no significant difference in pressure sensitivity or stress between SA and RSA (P > .05). The SA, RSA and TP groups had significantly higher displacement during cyclic loading and significantly lower maximum load and stiffness during load-to-failure testing compared with the native PMMR (P < .05). The SA and RSA groups had significantly lower displacement after 100 (0.83 mm and 0.92 mm vs 1.77 mm, P < .01), 500 (1.64 mm and 1.52 mm vs 3.08 mm, P < .01), and 1000 cycles (2.22 mm and 1.91 mm vs 4.53 mm, P < .01) and significantly higher failure load compared with TP (114 N and 119 N vs 77 N, P < .01). No significant difference between SA, RSA and TP was observed for displacement at failure or stiffness (P > .05).</p><p><strong>Conclusion: </strong>The RSA repair technique has similar biomechanical efficacy to the SA technique. It offers better biomechanical efficacy than the TP technique for PMMRT repair, making it a feasible and effective surgical procedure. The three repair techniques did not reach the strength of the native PMMR.</p><p><strong>Clinical relevance: </strong>The RSA technique retrogradely implants anchors into the tibial bone tunnels to achieve a fixation effect comparable to that of traditional anchors, with shorter sutures in the bone tunnels and a more operable surgical procedure. The RSA technique not only provides satisfactory biomechanical properties for the repair of PMMRTs, but also greatly reduces the technical difficulty of surgery. However, repairing of PMMRTs still does not restore the strength of the repaired meniscal root to the native meniscus.</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":"143631077","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":"A Single Lateral Hinge Screw Increased Resistance to Varus Stress After Medial Opening-Wedge High Tibial Osteotomy in a Synthetic Bone Model: A Biomechanical Analysis.","authors":"Te-Feng Arthur Chou, Andrew Wright, Pooyan Abbasi, Wiemi A Douoguih","doi":"10.1016/j.arthro.2025.03.008","DOIUrl":"10.1016/j.arthro.2025.03.008","url":null,"abstract":"<p><strong>Purpose: </strong>To determine whether use of a tibial screw placed across the lateral tibial hinge results in significantly greater failure load compared with no lateral screw after medial opening wedge high tibial osteotomy (MOWHTO).</p><p><strong>Methods: </strong>Twelve Sawbone tibias were used for the study. A MOWHTO was performed in each specimen using a computed tomography-based patient specific correction guide, and 6 specimens received a lateral hinge screw. Cantilever varus bending load was applied to failure, and failure load, displacement at failure, and stiffness of the osteotomy before hinge failure were recorded.</p><p><strong>Results: </strong>Failure load was statistically higher in the hinge screw group compared to the control group, 437.0 ± 82.0 N vs 336.0 ± 55.9 N, P = .046 (mean ± standard deviation). This load to failure was 30% greater in MOWHTO using a hinge screw versus the control.</p><p><strong>Conclusions: </strong>Using a Sawbone model, the current data showed that placement of a lateral hinge screw significantly increased resistance to varus stress following MOWHTO compared with a construct having no tibial screw. Additionally, no significant difference in displacement or stiffness was observed between the hinge screw and the control groups.</p><p><strong>Clinical relevance: </strong>The current biomechanical findings suggest that the use of a laterally based proximal tibial screw can potentially reduce the risk of lateral hinge fracture and its associated morbidity after MOWHTO.</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":"143630928","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 Meniscal Ramp Tears in Patients With Anterior Cruciate Ligament Tears Undergoing Reconstruction: A Surgically Relevant Classification System Based on Tear Morphology.","authors":"Luke V Tollefson, Sachin Tapasvi, Romain Seil, Erik L Slette, Christopher M LaPrade, Robert F LaPrade","doi":"10.1016/j.arthro.2025.03.015","DOIUrl":"10.1016/j.arthro.2025.03.015","url":null,"abstract":"<p><strong>Purpose: </strong>To develop an anatomically and surgically relevant classification system for medial meniscal ramp tears from prospectively collected data from a consecutive series of patients undergoing anterior cruciate ligament reconstruction (ACLR) with ramp tears.</p><p><strong>Methods: </strong>A series of consecutive patients undergoing ACLR with medial meniscal ramp tears treated by 2 orthopaedic surgeons between June 2021 and May 2024 were included in this study. After arthroscopic confirmation of a medial meniscal ramp tear, the tear morphology and repair technique were noted using a ramp tear diagram, operative notes, and surgical photographs and/or videos. Tears were classified as partial or complete, stable or unstable, and superior or inferior, as well as based on whether they were in the capsule or within 3 mm of the meniscal rim.</p><p><strong>Results: </strong>A total of 115 patients with a mean age of 27.0 years (range, 13-52 years) were included and grouped into 5 distinct groups based on ramp tear morphology. Tear patterns were classified into partial stable tears (type 1; n = 8, 7.0%), partial unstable femoral-sided (meniscocapsular and superior meniscus) tears (type 2; n = 8, 7.0%), partial unstable tibial-sided (meniscotibial and inferior meniscus) tears (type 3; n = 31, 27.0%), complete separation tears (type 4; n = 46, 40.0%), and complex tears (type 5; n = 22, 19.1%).</p><p><strong>Conclusions: </strong>This study shows that it was possible to establish a medial meniscal ramp tear classification system for patients undergoing ACLR based on anatomic and arthroscopic morphologic tear documentation. In this study, tears were grouped into 5 distinct groups: partial stable ramp tears (type 1), partial unstable superior ramp tears (type 2), partial unstable inferior ramp tears (type 3), complete separation ramp tears (type 4), and complex ramp tears (type 5).</p><p><strong>Clinical relevance: </strong>Previous studies have highlighted the importance of the ramp attachment for stability and the prevention of anterior cruciate ligament graft failure. Our classification system is based on a prospectively collected patient population and incorporates assessment of the tear for stability to probing, identification of the location of the tear, and a surgically relevant tear progression. With the described classification system, we hope to optimize repair techniques and improve outcomes associated with different ramp tear types.</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":"143631074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regarding \"Arthroscopic Bankart Repair Using 1 Anterior Portal Has a Shorter Surgical Time and Comparable Clinical Results with the Standard 2-Portal Technique\".","authors":"Kushtrim Grezda","doi":"10.1016/j.arthro.2025.03.018","DOIUrl":"10.1016/j.arthro.2025.03.018","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":"143631076","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":"Computer-Assisted Surgery Has Already Arrived in Sports Medicine, and Robots Are Next.","authors":"George C Balazs","doi":"10.1016/j.arthro.2025.03.006","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.006","url":null,"abstract":"<p><p>Robot-assisted surgery (RAS) is a procedure in which a computerized system actively interacts with surgical instruments to perform specific tasks independent of the human surgeon. This is distinguished from computer-aided navigation (CAN) by the independence of the computer system. Navigation tells the surgeon what to do, whereas RAS does (some of) it. Both RAS and CAN are simply two sub-components of computer-assisted surgery (CAS). CAS is the application of digital technology to improve surgical precision through improved training/education, surgical planning, anatomic alteration, and/or implant placement. Everything from arthroscopic simulators (and eventually, virtual reality) used to train residents, to patient-specific implants (for knee osteotomies), to augmented reality headsets to guide minimally invasive procedures, to RAS and CAN, fall under the umbrella of CAS. The eventual adoption of robot-assisted surgery for orthopaedic sports medicine and arthroscopy procedures is inevitable and will dramatically improve the precision with which we perform surgery.</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":"143630989","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":"Posterior tibial slope (PTS) reducing osteotomy should be considered in patients having primary ACL reconstruction if PTS is greater than 12-14 degrees.","authors":"David H Dejour, Michael J Dan, Nicolas Cance","doi":"10.1016/j.arthro.2025.03.004","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.03.004","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626986","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: Upper-Extremity Limb Asymmetry May Complicate Objective Evaluation of Criteria on the Basis of Return to Sport Evaluation After Arthroscopic Bankart Repair.","authors":"Patrick M Ryan","doi":"10.1016/j.arthro.2025.02.035","DOIUrl":"10.1016/j.arthro.2025.02.035","url":null,"abstract":"<p><p>Although there are many reported postoperative rehabilitation protocols after arthroscopic Bankart repair, significant variability exists within each protocol, leaving a lack of consensus or standardized evaluation of return to play. As such, criteria-based return to sport protocols have been established in an attempt to normalize the rehabilitation while reducing the recurrence rate after this procedure. This type of protocol has been published with promising results, but validation of the protocol has been difficult. Using the contralateral upper extremity as the \"uninjured\" extremity has resulted in healthy volunteers failing to pass the criteria on the basis of return to sport testing. Using the contralateral extremity, especially in the upper extremities, may not be the most accurate or appropriate control, however, and additional studies are needed in the search for an objective benchmark to return following arthroscopic Bankart repair.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627051","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":"Glenoid Labral Articular Disruption Lesions in the Setting of First-Time Anterior Shoulder Instability.","authors":"Jenna L Dvorsky, Ryan T Lin, Confidence Njoku-Austin, Yunseo Linda Park, Sophia McMahon, Zachary J Herman, Rajiv P Reddy, Ehab M Nazzal, Matthew Como, Albert Lin","doi":"10.1016/j.arthro.2025.02.030","DOIUrl":"10.1016/j.arthro.2025.02.030","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the clinical outcomes and rates of recurrent instability in patients after arthroscopic Bankart repair with and without glenolabral articular disruption (GLAD) lesions in the setting of first-time anterior instability events.</p><p><strong>Methods: </strong>This was a retrospective comparative case series of consecutive patients with GLAD lesions in the setting of first-time anterior instability events who underwent arthroscopic Bankart repair. Patients with GLAD lesions (cases) were matched at a 1:3 ratio for sex, age, body mass index, and sports participation to those without GLAD lesions (controls). Primary outcomes included postoperative range of motion (forward elevation and external rotation) and patient-reported outcomes: Subjective Shoulder Value, visual analog scale score, and Western Ontario Shoulder Instability Index. Rates of recurrent instability after primary arthroscopic stabilization were also collected. Statistical analysis was performed to compare outcomes between the control and GLAD groups, with significance set to P ≤ 0.05.</p><p><strong>Results: </strong>A total of 56 patients undergoing arthroscopic anterior stabilization between 2012 and 2020 were included for analysis, of whom 14 had GLAD lesions whereas the remaining 42 were controls. The average follow-up time from surgery in controls was 8.2 years (range, 3.1-11.7 years), whereas the average follow-up time in patients with GLAD lesions was 7.6 years (range, 3.8-11.8 years). There were no differences in postoperative forward flexion or external rotation, Subjective Shoulder Value, visual analog scale score, or Western Ontario Shoulder Instability Index. The rate of recurrent instability was found to be the same in both the control and GLAD groups (7% and 7%, respectively; P = .16).</p><p><strong>Conclusions: </strong>Patients with GLAD lesions in the setting of first-time anterior instability had comparable patient-reported outcomes, forward flexion, and external rotation postoperatively to control patients. In addition, the presence of a GLAD lesion did not influence the rate of recurrent instability.</p><p><strong>Level of evidence: </strong>Level IV, retrospective comparative case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143627040","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: Hormonal Contraceptives May Provide Protection From Knee Ligament Injury Requiring Surgery-An Unexpected Benefit of Hormonal Birth Control.","authors":"Mark G Siegel","doi":"10.1016/j.arthro.2025.03.002","DOIUrl":"10.1016/j.arthro.2025.03.002","url":null,"abstract":"<p><p>Women taking hormonal birth control have a statistically decreased risk of experiencing an anterior cruciate ligament injury requiring surgery. The protective effect of hormonal birth control is evident irrespective of whether by device, oral medication, or systemic administration. Additionally, the benefits are seen with diverse products. Owing to the complexity and interactions of hormones on physiology, the mechanism of this protection is unclear due to the complexity and interactions of hormones on physiology. it has been shown that hormonal fluctuations has multiple affects including postural stability, cognitive performance, and brain function including risk aversion. Finally, this effect is not seen in female individuals aged between 15 and 19 years, although data collection on this topic in this age group may be poor.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588259","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":"Screw Fixation Has Better Outcomes, Lower Incidence of Redislocation, and Lower Bone Resorption Than Button Fixation for Arthroscopic Anatomic Glenoid Reconstruction With Distal Tibia Allograft: A Matched Cohort Analysis.","authors":"Devan Pancura, Felicia Licht, Ivan Wong","doi":"10.1016/j.arthro.2025.02.034","DOIUrl":"10.1016/j.arthro.2025.02.034","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the clinical outcomes between patients who received arthroscopic anatomic glenoid reconstruction (AAGR) using distal tibia allograft with button fixation versus screw fixation.</p><p><strong>Methods: </strong>A retrospective chart review was conducted for all patients who underwent AAGR with button or screw fixation between 2012 and 2021. Patients were matched at a 1:1 ratio on the basis of sex, type of surgery, and time since surgery. All patients who were included had a minimum clinical follow-up of 2 years. Study outcomes compared Western Ontario Shoulder Instability (WOSI) Index scores, recurrence of instability, incidence of revision surgeries, and computed tomography readings.</p><p><strong>Results: </strong>In total, 44 patients were included with 22 patients in each group. The preoperative glenoid bone loss was 22.57 ± 8.06% in the screw group and 22.92 ± 8.84% in the button group (P = .898). Both groups demonstrated a significant improvement in WOSI from preoperative to latest follow-up; however, patients in the screw group demonstrated significantly better WOSI scores at both 2-year (P = .003) and latest follow-up (P = .019) compared with the button group. Recurrent dislocation was observed in 9 patients (40.9%), all of whom underwent button fixation (P < .001). Two patients in the screw group experienced hardware complications (P = .488). Individuals who underwent button fixation were significantly more likely to undergo a revision surgery for recurrent instability (P = .011). Individuals in the button group demonstrated a significantly smaller mean graft anteroposterior diameter postoperatively (P < .001).</p><p><strong>Conclusions: </strong>AAGR with both screw fixation results in significantly improved WOSI scores at minimum 2-year follow-up. Button fixation has a significantly greater incidence of redislocation. Radiographic findings suggest that on average, button fixation results in greater-grade bone resorption and subsequently smaller postoperative glenoid anteroposterior width than screw fixation.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588262","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}