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

{"title":"Sex, Race, and Ethnic Diversity of the Emerging U.S. Orthopaedic Sports Medicine Workforce Is Limited.","authors":"Jason Silvestre, Harris S Slone, William N Newton, Oluwadamilola O Kolade, John D Kelly","doi":"10.1016/j.arthro.2024.10.043","DOIUrl":"10.1016/j.arthro.2024.10.043","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze the demographics and trends of orthopaedic surgeons entering the U.S. orthopaedic sports medicine workforce over the past decade.</p><p><strong>Methods: </strong>This was a cross-sectional study of allopathic medical students, orthopaedic surgery residents, and orthopaedic sports medicine fellows in the United States (2013-2022) that leveraged data from the Accreditation Council for Graduate Medical Education and American Medical Association. Disparities in demographic representation between orthopaedic sports medicine fellows and the 2020 U.S. population census were quantified with participation-to-prevalence ratios (PPRs). A PPR between 0.8 and 1.2 was classified as equivalent representation and a PPR<0.8 was classified as under-representation, relative to the U.S.</p><p><strong>Population: </strong></p><p><strong>Results: </strong>The representation of female, Hispanic, Black, and Asian trainees decreased at each stage of the training pipeline to orthopaedic sports medicine fellowship training. In contrast, the representation of White trainees increased at each stage of the training pipeline. Over the study period, there were modest increases in female (9.9% to 12.6%) and Hispanic (1.2% to 1.7%) trainee representation in orthopaedic sports medicine. In contrast, Asian (16.6% to 5.6%) and Black (5.1% to 1.9%) trainee representation decreased. Relative to the US population, female (PPR = 0.22), Black (PPR = 0.30), Hispanic (PPR = 0.19), Native Hawaiian/Pacific Islander (PPR = 0.01), and Native American/Alaskan Native (PPR = 0.00) trainees were under-represented. In contrast, male (PPR = 1.79), Asian (PPR = 1.96), and White (PPR = 1.36) trainees were over-represented in orthopaedic sports medicine.</p><p><strong>Conclusions: </strong>There is limited diversity in the emerging orthopaedic sports medicine workforce relative to the U.S.</p><p><strong>Population: </strong>Improvements in the representation of female, Black, and Hispanic trainees in orthopaedic sports medicine has been marginal relative to trends observed at U.S. allopathic medical schools.</p><p><strong>Clinical relevance: </strong>Promoting diversity and inclusion in the orthopaedic sports medicine workforce can create more surgical provider options for diverse patient populations in the United States.</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":"142632069","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":"Limited Use of Supervised Physical Rehabilitation Beyond Three Months After Arthroscopic Anterior Cruciate Ligament Reconstruction with Greater Utilization in Female and Younger Patients.","authors":"Ashley M Rosenberg, Justin Tiao, Brocha Z Stern, Timothy Hoang, Bashar Zaidat, David Kantrowitz, James N Gladstone, Shawn G Anthony","doi":"10.1016/j.arthro.2024.10.041","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.041","url":null,"abstract":"<p><strong>Purpose: </strong>1) Characterize initiation and utilization of supervised physical rehabilitation after arthroscopic anterior cruciate ligament reconstruction (ACLR), including overall duration of rehabilitation and number of rehabilitation visits and 2) describe demographic and clinical predictors of rehabilitation initiation and utilization characteristics.</p><p><strong>Methods: </strong>Patients aged 14 to 64 in the U.S. who underwent ACLR from 2017 to 2020 were identified using the Merative MarketScan Database. For patients initiating rehabilitation within 45 days postoperatively, the overall duration and number of visits within 1 year after surgery were determined. Visits were categorized into rehabilitation phases, with visits 0-90 days postoperatively categorized as Phase I, 91-180 days as Phase II, 181-270 days as Phase III, and 271-365 days as Phase IV. Multivariable regression models identified predictors of rehabilitation initiation, duration in days, and number of visits.</p><p><strong>Results: </strong>Of 20,097 ACLR patients, 88.1% (n=17,704) initiated postoperative rehabilitation, receiving Phase I services. Additionally, 55.0% (n=11,053) received Phase II services, 17.0% (n=3,417) Phase III services, and 3.9% (n=779) Phase IV services. The median duration was 104 days (IQR 63-157), and the median number of visits was 21 (IQR 12-32). Multiple significant predictors of rehabilitation initiation, duration, and number of visits were found.</p><p><strong>Conclusion: </strong>While the majority of patients utilize supervised physical rehabilitation after ACLR, only 55% receive rehabilitation beyond 3 months and only 17% beyond 6 months after surgery. There are several significant drivers of rehabilitation initiation, overall duration, and number of visits. Female and younger patients have greater utilization of rehabilitation, and notable regional differences suggest an opportunity to improve standardization of care.</p><p><strong>Level of evidence: </strong>Level III (Retrospective Descriptive 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":"142630934","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":"Staged Hip Arthroscopy and Periacetabular Osteotomy in Active Patients 45 Years and Older Produces Comparable Improvements in Outcome Scores to Younger Patients.","authors":"Jessica H Lee, Nicholas G Girardi, Matthew J Kraeutler, Carson Keeter, James W Genuario, Tigran Garabekyan, Omer Mei-Dan","doi":"10.1016/j.arthro.2024.10.039","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.039","url":null,"abstract":"<p><strong>Purpose: </strong>To determine staged hip arthroscopy and periacetabular osteotomy (PAO) mid-term outcomes in active patients aged 45 years and older compared with a younger group.</p><p><strong>Materials and methods: </strong>All patients aged ≥45 years old who underwent staged arthroscopy and PAO between 2015 and 2021 were retrospectively analyzed and compared to a case-matched control of younger patients. All patients underwent at least 6 months of non-operative management prior to surgery. Prior to PAO, all patients underwent hip arthroscopy to address any intra-articular pathology. The experimental group consisted of dysplastic patients >45 years of age without significant osteoarthritis who underwent PAO and reported a minimum of 1-year postoperative PROs. Patient-reported outcomes (PROs) were quantified using the International Hip Outcomes Tool (iHOT-12) and Non-Arthritic Hip Score (NAHS).</p><p><strong>Results: </strong>The cohort consisted of 35 patients (44 hips) with a mean age of 49.4 ± 3.8 years. The lateral center edge angle significantly improved from preoperatively (20.1 ± 4.5 degrees) to postoperatively (33.2 ± 3.2 degrees) (p<0.001). Mean follow up in the PAO ≥45 cohort was 2.80 (±1.3) years postoperatively. Patients reported significant improvement of iHOT-12 (preoperative: 36.6 ± 14.1, latest follow-up: 81.2 ± 21.0; p<0.001) and NAHS scores (preoperative: 59.2 ± 15.5, latest follow-up: 87.4 ± 13.1; p<0.001). Compared to the control, the older cohort did not report significantly different iHOT-12 scores between groups at any point, and age did not significantly affect either outcome score (p>0.05).</p><p><strong>Conclusions: </strong>Patients ≥45 years of age reported a statistically significant improvement in hip function and pain following staged hip arthroscopy and PAO, with outcome scores comparable to a younger cohort. Our findings demonstrate that appropriately selected older dysplastic patients without significant preexisting hip osteoarthritis experience clinically meaningful improvements in hip pain and function following hip preservation surgery.</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":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632272","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":"Radiographs Underestimate Lateral Center Edge Angle and Tonnis Angle Measurements Compared to CT Scan in Assessment of Borderline and Frank Acetabular Dysplasia.","authors":"Julio Nerys-Figueroa, Ady H Kahana-Rojkind, Ali Parsa, Elizabeth G Walsh, Floor Lambers, Benjamin G Domb","doi":"10.1016/j.arthro.2024.10.038","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.038","url":null,"abstract":"<p><strong>Purpose: </strong>To compare lateral center-edge angle (LCEA) and Tönnis angle (TA) values measured in radiographs and CT scans with commercially available software and to determine the degree of concurrence in the classification of acetabular dysplasia as depicted in radiographs and CT scans.</p><p><strong>Methods: </strong>Retrospectively collected data from patients undergoing preoperative CT protocol and X-rays for hip arthroscopy from June 2019 to December 2021. The preoperative anteroposterior supine view of the pelvis was utilized to measure LCEA and TA, and measurements were compared to CT scan views through commercially available software.</p><p><strong>Results: </strong>In total, 323 patients (371 hips) were included, with 216 females (67%) and a mean patient age of 35.3±14.5. There was a statistically significant difference (P<0.001) in LCEA and TA measurements between X-ray and CT scan, with CT yielding higher mean ± SD values (LCEA: 32.9 ± 7.3, TA: 8.2 ± 5.9) compared to X-ray (LCEA: 30.3 ± 6.3, TA: 4.8 ± 4.6). The absolute mean difference between CT and X-ray was 4.1 for LCEA and 4.4 for TA. When defining dysplasia as LCEA<25°, 77 (21.8%) hips were dysplastic by X-rays (odds ratio, 2.0), and 43 (11.6%) by CT (P<0.001). Using a threshold of >10° for TA, 71 (19.1%) hips were dysplastic by X-rays (odds ratio, 0.5) and 118 (32%) by CT (P<0.001). A strong correlation was obtained between radiographs and CT on measured LCEA (r=0.78) and TA (r=0.67).</p><p><strong>Conclusion: </strong>Measuring with X-ray underestimates both LCEA and TA values compared to CT. Hip dysplasia diagnosis was twice as likely with LCEA, and half as likely with TA when measured through X-rays. CT scans with commercially available software offer an alternative viewpoint for assessing acetabular dysplasia and can serve as a valuable complement when used in addition to X-ray measurements.</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":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631885","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":"Adductor tubercle appears more posterior on radiographs of knees with trochlear dysplasia.","authors":"Miho J Tanaka, Maria V Velasquez Hammerle, Patrick Howard, Nikitha Crasta, Fang Liu","doi":"10.1016/j.arthro.2024.10.037","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.037","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to compare the radiographic positions of commonly utilized landmarks between symptomatic and normal knees and to assess the influence of morphologic risk factors.</p><p><strong>Methods: </strong>3D models were created from knees of patients with patellar instability and compared to control knees. On the 3D models, the adductor tubercle, medial epicondyle and gastrocnemius tubercle were marked. A 2D view was created from these models to simulate radiographs, and the radiographic location of each landmark was described with respect to the anteroposterior relation to the posterior cortical line, and proximal-distal relationship to the posterior condylar line. The position of each landmark was compared between symptomatic and control groups and assessed for variations in position with severity of anatomic risk factors.</p><p><strong>Results: </strong>40 patients were included in this study. On the 2D views, the medial epicondyle was found to be more posterior and more distal than in the control group. Association between severity of trochlear dysplasia and posterior position of the adductor tubercle trended toward significance (R=0.43, R2=0.18, p=0.058). In symptomatic knees with trochlear dysplasia, the radiographic landmark for the medial epicondyle was posterior by 3.3mm (p=0.052), adductor tubercle by 2.7mm (p=0.009), and gastrocnemius tubercle by 3.9mm (p=0.010) when compared to symptomatic knees without dysplasia.</p><p><strong>Conclusion: </strong>This study demonstrates that commonly utilized anatomic landmarks are more posterior and distal on radiographs in knees with patellar instability when compared to normal knees. Trochlear dysplasia is associated with the radiographic landmarks of the adductor and gastrocnemius tubercles appearing 3mm posterior to those without dysplasia, and its severity is associated with posterior radiographic appearance of the adductor tubercle.</p><p><strong>Level of evidence: </strong>III, Retrospective Case Control.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607548","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":"Erect weight-bearing pelvic radiographs are superior to supine radiographs for diagnosis of mixed type acetabular retroversion plus developmental dysplasia hip deformity.","authors":"Xi Chen, Mingke You, Kai Zhou, Lingcheng Wang, Gang Chen, Jian Li","doi":"10.1016/j.arthro.2024.10.035","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.035","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study focused on the mixed-type deformities of acetabular retroversion (AR) and developmental dysplasia hip deformity (DDH) and aimed to ascertain the changes in pelvic tilt from a supine to a standing position in these cases and identify potential underlying mechanisms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective study was conducted on cases with symptomatic DDH from January 1, 2019, to April 30, 2023. DDH was defined as LCEA &lt; 20°. AR was diagnosed by using a crossover index threshold of 0.2 in standing pelvic X-ray. Two observers assessed the supine and weight-bearing pelvic radiographs, along with computed tomography (CT) scans. The evaluated parameters included pelvic tilt (sacrofemoral-pubic angle (SFP), symphysis to sacrococcygeal distance (PSSC), pubic symphysis to sacroiliac (PSSI)), acetabular retroversion (crossover index, posterior wall sign), acetabular coverage (lateral center-edge angle (LCEA), ischial spine sign (ISS)), and axial rotation of the hemipelvis (pelvic width index, obturator index, and ilio-ischial angle). Acetabular orientation and coverage was measured by CT through anterior sector angle (ASA), posterior sector angle (PSA) and acetabular anteversion (AA). Cases with acetabular retroversion plus DDH were defined as the mixed-type deformity. Comparative analyses between mixed-type deformities and DDH cases were performed along with subgroup and correlation analyses within mixed-type cases. Inter-observer and intra-observer reliabilities were assessed using intraclass correlation coefficients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 85 were included. 26 cases (30.59%) had mixed-type deformity, where transition from the supine to standing position led to an increased posterior pelvic tilt (SFP (supine: 64.35±4.6°, standing: 74.75±4.16°, p&lt;0.001), PSSC (supine: 6.37±2.47, standing: 2.08±1.32, p&lt;0.001) and PSSI (supine: 9.47±1.66, standing: 6.33±1.08, p&lt;0.001)). Compared to cases with DDH, CT examination revealed a significantly greater anterior acetabular coverage and less posterior superior coverage, with smaller posterior sector angle and greater anterior sector angle (ASA) (p&lt;0.05) for cases with AR. The superior iliac wing angle (mixed type: 45.63±9.22°, isolated type: 50.70±8.77°, p=0.013), inferior iliac wing angle(mixed type: 60.77±8.24°, isolated type: 65.24±8.02°, p=0.013), and ischiopubic angle (IPA) (mixed type: 32.27±3.19°, isolated type: 36.71±5.38°, p&lt;0.001) were significantly reduced in AR cases, suggesting external rotation of the hemipelvis. Subgroup analysis showed that cases with a higher crossover index had a significantly higher PSSC and a significantly lower IPA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;AR was observed in 31% of DDH cases and was associated with a notable posterior pelvic tilt during postural transitions. This tilt appeared to be a compensatory mechanism affecting the AR diagnosis. Key changes in the acetabular coverage, including increased anterior","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607488","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":"Persistence of Labral Tears and Resolution of Paralabral Cysts with 2-year MRI analysis after Periacetabular Osteotomy (PAO) for Hip Dysplasia.","authors":"Fan Yang, Jiayi Shao, Hongjie Huang, Yan Xu, Jianquan Wang, Xiaodong Ju","doi":"10.1016/j.arthro.2024.10.036","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.036","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the labrum status and paralabral cysts on preoperative and postoperative magnetic resonance imaging (MRI) in patients with developmental dysplasia of the hip (DDH) who underwent periacetabular osteotomy (PAO).</p><p><strong>Methods: </strong>A retrospective review was conducted using prospectively collected data from patients who had undergone primary PAO between June 1, 2021 and May 30, 2022. Inclusion criteria were an age range of 16 to 55 years and a minimum follow-up of two years. MRI was utilized to evaluate the preoperative and postoperative conditions of the labrum and the presence of paralabral cysts. Furthermore, the correlations between the presence of paralabral cysts and demographic and radiographic variables were investigated. Additionally, patient-reported outcomes (PROs), minimal clinically important difference (MCID), and complications were reported during the final follow-up evaluation.</p><p><strong>Results: </strong>A total of 23 patients were included in the final analysis, with an average follow-up of 26.6 ± 3.4 months (range, 24-32 months). All patients diagnosed with symptomatic DDH exhibited labrum tears. MRI scans revealed paralabral cysts in ten out of twenty-four (41.6%) patients, with a significant correlation noted between the presence of cysts and preoperative LCEA (ρ=-0.649; P=0.001), ACEA (ρ=-0.637; P=0.001), Tönnis angle (ρ=0.593; P=0.002) and age (ρ=-0.444; P=0.034). Postoperative MRI scans at one year showed resolution of all paralabral cysts, while labral tears were found to persist. At the end of the follow-up period, most patients improved considerably in PROs compared to preoperative values. The probabilities of achieving the MCID were 91.3% on the HOS-ADL, 78.2% on the HOS-SSS, 91.3% on the mHHS, 73.9% on the iHOT-12, and 69.6% on the VAS pain scale.</p><p><strong>Conclusion: </strong>All symptomatic patients with DDH had labral tears and a high prevalence of paralabral cysts, which were corrected with reduced acetabular coverage. After PAO surgery, patients experienced notable enhancements in PROs, with resolution of paralabral cysts but persistence of labral tears.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607489","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":"Prescription Testosterone is Associated with an Increased Risk of Anterior Cruciate Ligament Injury.","authors":"Joseph C Brinkman, Alejandro M Holle, Ben R Paul, Camryn S Payne, Sailesh V Tummala, Jack M Haglin, Anikar Chhabra","doi":"10.1016/j.arthro.2024.10.032","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.032","url":null,"abstract":"<p><strong>Purpose: </strong>To characterize the relationship between testosterone replacement therapy (TRT) and anterior cruciate ligament (ACL) injuries.</p><p><strong>Methods: </strong>A retrospective cohort study using a large insurance database was conducted. Patients who were prescribed TRT for at least 3 months were matched with controls who were not prescribed TRT. Rates of ACL tears were compared between the cohorts. Multiple subgroups were created based on age (<25 years, 25-35, 36-45, 46-55, 56-65, and 65+). Multivariable logistic regressions were performed to determine the association of TRT with ACL tears while accounting for demographic variables and comorbidities.</p><p><strong>Results: </strong>After matching, there were 160,839 patients in both the TRT cohort and control cohort. The incidence of ACL injuries was 17.8 per 10,000 person-years (95% CI: 16.4-19.2) for patients who were prescribed TRT and 4.9 per 10,000 person-years (95% CI: 4.1-5.7) for controls (p<0.001). Within 2 years of filling a testosterone prescription for at least 3 months, 572 (0.35%) patients experienced an ACL injury compared to only 157 (0.10%) controls during the same follow-up period (OR: 2.77; 95% CI: 2.26-3.42, p<0.001). When stratified by age, all groups except the <25 years of age group demonstrated significantly higher rate of ACL tears (OR 3.91-12.3, p<0.001-0.009). When separated by sex, males on TRT were 3.13 (95% CI: 2.50-3.93, p<0.001) times more likely while females on TRT were 1.94 (95% CI: 1.13-3.41, p=0.018) times more likely to experience an ACL injury compared to controls.</p><p><strong>Conclusion: </strong>This study found that patients prescribed at least three months of TRT had a significantly higher incidence of ACL injuries compared to controls within a 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":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607490","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":"Culture Expansion Alters Human Bone Marrow Derived Mesenchymal Stem Cell Production of Osteoarthritis-relevant Cytokines and Growth Factors.","authors":"James E Voos, Andrew Moyal, Ryan Furdock, Arnold I Caplan, Tracey L Bonfield, Jacob G Calcei","doi":"10.1016/j.arthro.2024.10.034","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.034","url":null,"abstract":"<p><strong>Purpose: </strong>The purposes of this study were to characterize the human bone marrow derived mesenchymal stem cells (BM-MSCs) production of osteoarthritis-relevant cytokines and growth factors as they are purified and multiplied, a process termed culture expansion, and to compare the immunomodulatory potential of BM-MSCs based on source and medium used for culture expansion.</p><p><strong>Methods: </strong>BM-MSCs were obtained from iliac crest bone marrow aspirates of four healthy donors. These four BM-MSC cell lines underwent four rounds, or \"passages,\" of the institutional culture expansion protocol, using institutional culture media. The secretory molecules known to play a role in OA-related inflammatory immune response, cartilage degradation and patient symptoms, together called the BM-MSC \"secretome,\" were measured at each passage. Three lines of commercially available BM-MSCs from healthy donors underwent culture expansion by the same protocol, using commercial culture media. The commercial BM-MSCs secretome and the institutional BM-MSCs secretome were compared at each passage. Significance was set at p<0.05.</p><p><strong>Results: </strong>Institutional BM-MSCs produced less IL-6 at passages 3 (237±113 pg/mL) and 4 (237±113 pg/mL) compared to passages 1 (884±97 pg/mL) and 2 (1071±129 pg/mL; p<0.01). Institutional BM-MSCs produced more MIP-3α at passage 4 than at passage 1 (106±41 vs 32±7 pg/mL; p<0.01). Across passages of culture expansion, institutional BM-MSCs grown on institutional medium expressed more IL-6 (P<0.001), IL-10 (P<0.001), IL-1β (P<0.001), TNFα (P=0.004), and VEGF-C (P=0.003) than commercially available BM-MSCs grown on commercial medium.</p><p><strong>Conclusion: </strong>Culture expansion alters key molecules within the BM-MSC secretome. Additionally, differences in BM-MSC source and culture medium alter the BM-MSC secretome and its immunomodulatory potential.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592231","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 Knee Anterolateral Ligament is Present in 82% of North American and 65% of European But Only in 46% of Asian Studies: A Systematic Review of Frequency and Anatomy.","authors":"Erik Hohmann, Natalie Keough, Maketo Molepo, Robert Arciero, Andreas Imhoff","doi":"10.1016/j.arthro.2024.10.029","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.029","url":null,"abstract":"<p><strong>Purpose: </strong>To perform an updated systematic review on the prevalence and morphological characteristics of the anterolateral ligament (ALL) in human cadaveric specimens.</p><p><strong>Methods: </strong>Medline, Embase, Scopus, and Google Scholar were searched for studies from 2012 to 2024 describing the morphology. Study quality was assessed using CASP checklist and QUACS scale. Heterogeneity was analysed with the I² statistic, funnel plot, and Q-test. Mean effect size and 95% prediction intervals were calculated. Prevalence and anatomical measurements (length, width, thickness) were analysed using mean and standard deviations.</p><p><strong>Results: </strong>Thirty studies were included. CASP identified three low-quality studies. Twelve studies met the QUACS quality threshold. The prevalence of the ALL was 61.7% (82% North America, 64.9% Europe, 45.8% Asia). The femoral insertion showed variability near the lateral femoral epicondyle and lateral collateral ligament, while the tibial insertion was midway between Gerdy's tubercle and fibular head. Histological analysis revealed 60% of studies identified ligamentous tissue similar to the ACL. The mean ALL length was 39.7 mm, width 5.5 mm, and thickness 1.5 mm, with no significant morphological differences among populations.</p><p><strong>Conclusion: </strong>This systematic review reveals that the ALL is present in 61.7%, with prevalence rates of 82% in North American studies, 65% in European studies, and 46% in Asian studies. The femoral insertion exhibited substantial variability at/around the lateral femoral epicondyle and LCL, lacking consistency. The tibial insertion was more consistently described as being located about halfway between Gerdy's tubercle and the fibular head. Histological analysis showed that 60% of the included studies identified the ALL as containing ligament-like or ligamentous tissue. The mean length of the ALL was 39.9 mm (range 31-59 mm), the mean width was 5.7 mm (range 2.2-9.0 mm), and the mean thickness was 1.5 mm (range 1.3-2.7 mm). No significant ethnic population differences were observed in the morphological measures.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142592246","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}