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

{"title":"Author Reply: \"Mid-Term Outcome of Superior Capsular Reconstruction Using Fascia Lata Autograft (At Least 6 mm in Thickness) Results in High Retear Rate and No Improvement in Muscle Strength\".","authors":"Chang Hee Baek","doi":"10.1016/j.arthro.2024.09.050","DOIUrl":"10.1016/j.arthro.2024.09.050","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382555","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 Baek et al: ''Mid-Term Outcome of Superior Capsular Reconstruction Using Fascia Lata Autograft (At Least 6 mm in Thickness) Results in High Retear Rate and No Improvement in Muscle Strength''.","authors":"Mark Mouchantaf, Gregorio Secci, Manon Biegun, Philipp Schippers, Pascal Boileau","doi":"10.1016/j.arthro.2024.09.049","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.09.049","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382554","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: Off-the-Shelf Large Language Models Are of Insufficient Quality to Provide Medical Treatment Recommendations, While Customization of Large Language Models Results in Quality Recommendations.","authors":"Prem N Ramkumar, Andrew F Masotto, Joshua J Woo","doi":"10.1016/j.arthro.2024.09.047","DOIUrl":"10.1016/j.arthro.2024.09.047","url":null,"abstract":"<p><p>The content accuracy of off-the-shelf large language models (LLMs) mirrors the content accuracy of the unregulated Internet from which these generative artificial intelligence models are supplied. With error rates approximating 30% in terms of treatment recommendations for the management of common musculoskeletal conditions, seeking expert opinion remains paramount. However, custom LLMs represent an excellent opportunity to infuse niche, bespoke expertise from the many specialties and subspecialties within medicine. Methods of customizing these generative models broadly fall under the categories of prompt engineering; \"retrieval-augmented generation\" prioritizing retrieval of relevant information from a specific domain of data; \"fine-tuning\" of a basic pretrained model into one that is refined for health care-related vernacular and acronyms; and \"agentic augmentation\" including software that breaks down complex tasks into smaller ones, recruiting multiple LLMs (with or without retrieval-augmented generation), optimizing the output, internally deciding whether the response is appropriate or sufficient, and even passing on an unmet outcome to a human for supervision (\"phone a friend\"). Custom LLMs offer physicians and their associated organizations the rare opportunity to regain control of our profession by re-establishing authority in our increasingly digital landscape.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378570","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: Spine Pathology May Improve or Worsen Outcomes After Hip Arthroscopy: Patient Evaluation and Indications Are Critical.","authors":"Thomas Youm","doi":"10.1016/j.arthro.2024.09.046","DOIUrl":"10.1016/j.arthro.2024.09.046","url":null,"abstract":"<p><p>Compared with total hip arthroplasty, hip arthroscopy is a relatively new procedure, and as such, hip-spine syndrome in young adults is an emerging topic of research. In the past decade, our understanding of spinopelvic alignment has improved the stability and survivorship of hip replacements in patients with prior lumbar fusions. Obviously, the hip affects the spine and the spine affects the hip. In terms of hip arthroscopy, just as older patients and patients with cartilage damage have inferior outcomes, patients with spine pathology are at risk for postoperative worsening spinal symptoms, including sciatica. In addition, back and radicular pain may limit postoperative hip rehabilitation. Yet other patients show resolution of back symptoms after hip arthroscopy. Today, surgeons indicating hip arthroscopy must first investigate patient sagittal balance, which includes pelvis tilt, pelvic incidence, and sacral slope. When properly indicated, hip-spine pain patients show greater percentage improvement with no increased failure risk compared with patients with isolated FAIS. Exceptions include patients with concomitant lumbar stenosis or lumbar fusion. Rate of revision hip arthroscopy and conversion to total hip replacement is 2-fold compared with controls if patients had prior 1-2 level fusion and 3-fold if 3 or more levels are fused. Our understanding of hip-spine patients with regard to arthroscopy outcomes continues to develop. In addition to a comprehensive spine exam, the patient's spine surgical history and current spine symptoms must be investigated to predict the efficacy of hip arthroscopy. If patients have both hip and spine symptoms, a diagnostic hip injection to determine the prime pain generator is essential. If the hip is the source of pain, patients should be counseled that back symptoms will likely improve after hip arthroscopy but not in all cases. EOS imaging to measure sagittal balance may allow the surgeon to predict if impingement measurements on hip radiographs may be underestimated in the setting of a stiff spine. If the patient has multiple risk factors for poor outcomes such as advancing age, articular cartilage damage, borderline dysplasia, or hypermobility, on top of a history of multilevel lumbar fusion or spinal deformity, hip arthroscopy may not be ideal, and hip arthroplasty should be considered. Clearly, the spine may not be ignored in patients with femoroacetabular impingement.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376378","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: Microfragmented Adipose Tissue May Provide an Effective Injection Treatment Modality for Arthritic Knee Pain With 1-Year Improvement in Pain and Function.","authors":"Mark Girard Siegel","doi":"10.1016/j.arthro.2024.09.048","DOIUrl":"10.1016/j.arthro.2024.09.048","url":null,"abstract":"<p><p>Injectable treatments for arthritic knee pain continue to evolve. This is significant, considering that osteoarthritis is the most common orthopaedic pathology in adult patients. The Centers for Disease Control and Prevention report that 16.9% of all adults are affected, and by age 65 years, almost one-half of the population will experience pain related to cartilage degradation. Steroid injections show only short-term improvements. Both viscosupplementation using hyaluronates and platelet-rich plasma injection show inconsistent long-term results. Recently microfragmented adipose tissue injections in the office setting have been shown to provide symptomatic improvement at 6 and 12 months in patients with knee pain from degenerative joint disease. Additional studies are needed to confirm the reproducibility of this finding. Most of all, study of injections for knee arthritis must include a placebo control (saline injection) to truly demonstrate efficacy.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376377","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: Diminished Hip Hypoplastic Labrum Predicts Poor Patient Outcomes After Non-augmented Primary Repair","authors":"","doi":"10.1016/j.arthro.2024.03.027","DOIUrl":"10.1016/j.arthro.2024.03.027","url":null,"abstract":"<div><div>Diminished hip labral size and tissue quality may be a predictor of poor patient outcomes when a non-augmented primary labral repair is performed. Labral augmentation is an option for patients with hypoplastic or degenerative labral tissue. The optimal graft for augmentation has yet to be identified, and biomechanical research shows no difference in force to suction-seal disruption between dermal allograft and iliotibial band allograft when used to augment the labrum. However, time-zero biomechanical studies do not reflect the biological ability of the graft to heal to surrounding structures, revascularization of the graft, durability of the graft, hip capsular status, and response to functional demands of the patient.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307971","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":"Capsular Repair, Labral Repair, and Femoroplasty With Postless Traction Are Increasingly Performed for the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome","authors":"","doi":"10.1016/j.arthro.2024.01.025","DOIUrl":"10.1016/j.arthro.2024.01.025","url":null,"abstract":"<div><h3>Purpose</h3><div>To provide an updated assessment of hip arthroscopy<span> use by using an institutional database that is specific to the treatment of femoroacetabular impingement syndrome (FAIS).</span></div></div><div><h3>Methods</h3><div><span>All patients undergoing hip arthroscopy for the treatment of FAIS were retrospectively identified between the years 2014 and 2022 via Current Procedural Terminology<span> coding in a multi-institutional, single health system database. A longitudinal analysis was performed to identify trends in the use of arthroscopic techniques including capsular and labral treatment, </span></span>osteoplasty, and traction set-up.</div></div><div><h3>Results</h3><div>During the study, 789 arthroscopic hip procedures in 733 patients were analyzed (56 staged bilateral). Between 2016 and 2022, the number of hip arthroscopies performed each year increased by 1,490% (R² = 0.87, <em>P</em> = .001). Capsular repair (R² = 0.92, <em>P</em> &lt; .001), labral repair (R² = 0.75, <em>P</em> = .002), and femoroplasty (R² = 0.70, <em>P</em><span> = .004) were performed in an increasing proportion of cases over our study period whereas labral debridement (R</span>² = –0.84, <em>P</em> &lt; .001) became less used. Postless traction systems were employed in 84% (663/789) of hip arthroscopies overall, were used in at least 70% of hip arthroscopies each year, and did not undergo any significant changes in use (R² = 0.02, <em>P</em> = .73).</div></div><div><h3>Conclusions</h3><div>Capsular repair, labral repair, and femoroplasty were increasingly performed for the arthroscopic treatment of FAIS whereas the use of labral debridement decreased significantly over our study period. Postless traction systems were used in the majority of cases each year.</div></div><div><h3>Clinical Relevance</h3><div>As comparative literature continues to define the safety and efficacy of hip arthroscopy, understanding how novel techniques or procedures are incorporated in clinical practice is important.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139664755","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":"Lateral Extra-articular Tenodesis Does Not Decrease Graft Failure in Revision Anterior Cruciate Ligament Reconstruction When Combined With Quadriceps or Patellar Tendon Grafts","authors":"","doi":"10.1016/j.arthro.2024.01.034","DOIUrl":"10.1016/j.arthro.2024.01.034","url":null,"abstract":"<div><h3>Purpose</h3><div><span>To compare return-to-sport (RTS) rates, graft failure<span> rates, and clinical outcomes in patients who underwent revision anterior cruciate ligament reconstruction (R-ACLR) with additional lateral extra-articular </span></span>tenodesis (LET) versus isolated R-ACLR.</div></div><div><h3>Methods</h3><div><span><span>A retrospective review of the medical records of patients who underwent R-ACLR with or without a modified Lemaire LET procedure was performed. Seventy-four patients with at least 2 years of follow-up who had high-grade positive pivot-shift test findings were included. Concomitant procedures such as </span>meniscectomy and </span>meniscal repair<span> were collected, along with any complications and/or graft failure. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee Subjective Knee Form score were collected. The ability to RTS was defined as fully, partially, or not returned.</span></div></div><div><h3>Results</h3><div>Of the patients, 39 underwent isolated R-ACLR (mean age ± standard deviation, 29.2 ± 12.2 years) whereas 35 underwent an additional LET procedure (mean age, 24.6 ± 7.4 years). The mean length of follow-up in the R-ACLR group was 56.6 ± 26.5 months compared with 44.3 ± 17.6 months in the R-ACLR–LET group (<em>P</em><span> = .02) (range, 24-120 months). Patient-reported outcome measures were higher in the R-ACLR–LET group, with the KOOS Activities of Daily Living (93.5 ± 2.0 vs 97.2 ± 1.6, </span><em>P</em> = .03) and KOOS Sport (63.0 ± 3.6 vs 74.3 ± 3.8, <em>P</em> = .05) subdomain scores reaching the level of statistical significance. No differences were found in the other KOOS subdomain scores or the International Knee Documentation Committee scores. Failure rates were not significantly different between the groups (12.8% for R-ACLR vs 11.4% for R-ACLR–LET, <em>P</em> = .99). There were 13 patients (72.2%) in the R-ACLR group and 14 patients (60.8%) in the R-ACLR–LET group who did not RTS.</div></div><div><h3>Conclusions</h3><div>R-ACLR with additional LET showed similar failure and RTS rates to isolated R-ACLR after failed ACLR. The R-ACLR–LET group showed better functional results with significantly higher KOOS subdomain scores for activities of daily living, as well as sports and recreation. However, this study was unable to recommend the modified Lemaire LET procedure to be routinely used in R-ACLR patients.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective comparative therapeutic trial.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708613","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: Knee Lateral Extra-articular Tenodesis Procedures: Appropriate Study Design Is Essential for Reducing Conflicting Findings and Unnecessary Controversy in the Orthopaedic Literature","authors":"","doi":"10.1016/j.arthro.2024.02.041","DOIUrl":"10.1016/j.arthro.2024.02.041","url":null,"abstract":"<div><div>Knee lateral extra-articular tenodesis procedures (LEAPs) reduce graft rupture rates when performed at the time of anterior cruciate ligament (ACL) reconstruction. However, in the setting of revision ACL reconstruction, LEAPs are less studied and remain controversial. Many studies support combined procedures (ACL + LEAP), yet others do not. When the literature comprises small patient cohorts and short follow-up periods, conflicting results often arise. The controversy surrounding them may be unnecessarily generated by the publication of low-quality studies. Future studies should focus on adequate power; appropriate design and methodology, including matching or randomization to account for potential confounding factors; proper statistical analyses; and avoidance of spin bias.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137456","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":"Concomitant Biceps Tenodesis Does Not Compromise Arthroscopic Rotator Cuff Repair Outcomes","authors":"","doi":"10.1016/j.arthro.2024.02.035","DOIUrl":"10.1016/j.arthro.2024.02.035","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare outcomes of patients who underwent rotator cuff<span> repair (RCR) with concomitant biceps tenodesis with those who underwent an isolated RCR.</span></div></div><div><h3>Methods</h3><div><span><span>Exclusion criteria included previous ipsilateral shoulder surgery, irreparable rotator cuff tears, rotator cuff </span>arthropathy, calcific </span>tendinitis<span><span><span>, adhesive capsulitis requiring a </span>capsular release, or advanced </span>osteoarthritis<span><span> of the glenohumeral joint. Patients were indicated for biceps tenodesis if they had any degree of tendon tearing, moderate-to-severe </span>tenosynovitis<span><span>, instability, or a significant degenerative SLAP tear. Primary outcome measures included American Shoulder and Elbow Surgeons score<span>, Simple Shoulder Test, EuroQoL 5-Dimension 5-Level visual analog scale, EuroQoL 5-Dimension 5-Level, and a site-specific questionnaire, which focused on surgical expectations, satisfaction, and complications. </span></span>Multivariate analysis of variance to analyze descriptive statistics and determine significant differences between the patient groups for subjective and objective outcome measures were performed.</span></span></span></div></div><div><h3>Results</h3><div>There were no significant differences for pain/visual analog scale (0.34 ± 0.09 vs 0.47 ± 0.09, <em>P</em> = .31), American Shoulder and Elbow Surgeons score (96.69 ± 0.87 vs 94.44 ± 0.91, <em>P</em> = .07), and Simple Shoulder Test (11.42 ± 0.17 vs 10.95 ± 0.18, <em>P</em> = .06) between the RCR with concomitant biceps tenodesis and isolated RCR at a minimum of 2 years’ postoperatively. This is despite the RCR with concomitant biceps tenodesis group having significantly larger rotator cuff tears (4.25 ± 0.30 cm² vs 2.80 ± 0.32 cm², <em>P</em> = .001) than the isolated RCR group.</div></div><div><h3>Conclusions</h3><div>This study revealed that concomitant biceps tenodesis does not compromise outcomes when compared with an isolated RCR at 2-year follow-up, despite this group having larger rotator cuff tears.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective case study.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121471","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}