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

{"title":"Hip Arthroscopy for Global Acetabular Overcoverage Demonstrates Favorable Patient-Reported Outcome Scores and Low to Moderate Rates of Revision and Conversion to Total Hip Arthroplasty: A Systematic Review.","authors":"Muzammil Akhtar, Mustafa Jundi, Sonia Aamer, Noorhan Amani, Malik Oda, Trevor Shelton, Dean Wang","doi":"10.1016/j.arthro.2025.02.028","DOIUrl":"10.1016/j.arthro.2025.02.028","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate clinical outcomes of hip arthroscopy for patients with global acetabular overcoverage, as defined by a lateral center-edge angle (LCEA) >40° with coxa profunda, acetabular protrusio, and/or a negative Tönnis angle.</p><p><strong>Methods: </strong>A search following guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-analyses was performed in the PubMed, Embase, and Scopus databases in July 2024. Studies were included if they had a minimum 2-year follow-up and reported on outcomes of hip arthroscopy for patients with global acetabular overcoverage, which was defined as a LCEA >40° with coxa profunda, acetabular protrusio, and/or a negative Tönnis angle. The primary evaluated outcomes included patient-reported outcomes (PROs) and rates of revision and conversion to total hip arthroplasty (THA).</p><p><strong>Results: </strong>Eight studies comprising 369 hips (58.5% female; age range: 31.2-42.4 years; follow-up range, 24.0-73.2 months) with global acetabular overcoverage treated with arthroscopy were included. For labral management, 0-30% of patients underwent debridement, 65-100% underwent repair, and 0-100% underwent reconstruction. Femoroplasty and acetabuloplasty were performed in 73.3-100% and 94.7-100% of patients, respectively. Six studies reporting both preoperative and postoperative PROs reported significant improvements in all PROs. Rates of revision and conversion to THA ranged from 1.5 to 27.3% and from 1.8 to 13.6%, respectively. Of studies comparing outcomes between patients with global overcoverage versus normal coverage, there were no significant differences in any PROs (4/5 studies), revision rates (5/5 studies), and conversion to THA rates (3/5 studies).</p><p><strong>Conclusions: </strong>Hip arthroscopy for global acetabular overcoverage can allow patients to achieve significant improvements in PROs along with low to moderate rates of revision and conversion to THA that are comparable to patients with normal acetabular coverage LEVEL OF EVIDENCE: Level IV, a systematic review of Level III and Level IV studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588257","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: Lateral Femoral Notch Sign Is a Marker of Past Pivot Trauma Rather Than a Predictor of Future Anterior Cruciate Ligament Failure.","authors":"Rachit Saggar, Vikram A Mhaskar","doi":"10.1016/j.arthro.2025.02.025","DOIUrl":"10.1016/j.arthro.2025.02.025","url":null,"abstract":"<p><p>Predicting anterior cruciate ligament (ACL) reconstruction failure remains a challenge, shaped by anatomic, biomechanical, surgical, and rehabilitation factors. The lateral femoral notch sign (LFNS), present in 6% to 52% of ACL injuries, is linked to lateral meniscal tears (40%-67%), steeper posterior tibial slope (2.7° higher), and cartilage degradation. However, despite its correlation with injury severity, the LFNS has limited value in predicting ACL graft failure or postoperative instability. Recent studies reinforce that the LFNS is a marker of past pivot trauma, not a predictor of future ACL failure. While a deeper LFNS (>2 mm) correlates with more severe initial injury, it does not influence long-term graft survival or knee stability. Research shows that the LFNS resolves over time in pediatric patients, fails to correlate with residual tibial laxity or rotational instability, and is associated with nonprogressive chondral lesions. In contrast, modifiable factors-such as achieving optimal tunnel positioning and effectively managing rotational instability-play a far more decisive role in determining ACL reconstruction success than static imaging markers such as LFNS. Ultimately, the LFNS is a historical remnant, not a clinical decision-making tool in ACL failure risk assessment. It reminds us that successful outcomes hinge on a comprehensive approach rather than isolated imaging findings. Such imaging signs show scars of battles lost but often do not predict the outcome of the war.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588275","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: Tranexamic Acid Does Not Improve Visualization During Hip Arthroscopy, But Other Techniques Do Help.","authors":"Derek Ochiai","doi":"10.1016/j.arthro.2025.02.026","DOIUrl":"10.1016/j.arthro.2025.02.026","url":null,"abstract":"<p><p>Visualization during hip arthroscopy can be challenging, particularly owing to a bloody arthroscopic image. Tranexamic acid is not effective in improving arthroscopic visualization, but techniques such as using epinephrine-impregnated irrigation fluid, administering controlled hypotensive anesthesia, and safely establishing a second outflow portal and using radiofrequency to control capsular bleeding are effective.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574698","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":"Corrigendum.","authors":"","doi":"10.1016/j.arthro.2025.02.006","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.02.006","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525070","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":"Imaging Results in Data Usefully Analyzed by Artificial Intelligence Machine Learning.","authors":"Mark P Cote, Alireza Gholipour","doi":"10.1016/j.arthro.2025.02.024","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.02.024","url":null,"abstract":"<p><p>Many artificial intelligence (AI) machine learning (ML) papers focused on clinical outcomes use registry data inadequate for predictive modeling. In contrast, diagnostic imaging is an area where available information (pixels, etc.) can result in a reliable, clinically relevant, and accurate model. The use of deep learning for image analysis can reduce interobserver variability, and highlight subtle and meaningful features. AI augments, rather than replaces, clinical expertise, allowing faster, more consistent, and potentially more accurate diagnostic information. This is especially relevant when imaging data is abundant, as continuous model training can further refine diagnostic precision. An effective 3-step approach includes: 1) an efficient \"detector\" to determine where to look; 2) computational ability to focus on key features of the image and \"blur out\" background noise (\"attention module\"); and 3) interpreted key features (\"explainability\"). Next, the larger process of developing and employing a predictive model needs to be externally validated, to determine the extent to which these results will generalize outside of a single institution. Outside this setting, i.e., external validity, needs to be determined.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532166","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: Tension of the Repair During Rotator Cuff Surgery Appears to Matter More Than Medial-Lateral Footprint Coverage.","authors":"Michelle Xiao, Geoffrey D Abrams","doi":"10.1016/j.arthro.2025.02.022","DOIUrl":"10.1016/j.arthro.2025.02.022","url":null,"abstract":"<p><p>The ideal rotator cuff repair construct has low tension, maximizes footprint coverage, is biomechanically strong, and optimizes tendon-to-bone healing. However, these principles are not always feasible, especially with larger tear patterns and poor tendon quality, factors that are also associated with higher retear rates. There is a constant effort with often opposing priorities to achieve a tension-free rotator cuff repair while also achieving maximal footprint coverage. This is not always possible, and there are few data to guide surgeons on which factor-tension-free repair or footprint coverage-should be prioritized. Recent studies have reported that achieving a tension-free repair with incomplete medial-to-lateral footprint coverage leads to similar functional and radiographic outcomes to complete footprint coverage using a transosseous-equivalent repair with bone marrow stimulation. Many factors affect rotator cuff tendon-to-bone healing, most notably tear size and retraction, tendon quality/preoperative fatty infiltration, repair construct, patient age, and medical comorbidities. In terms of these factors, achieving a tension-free repair and achieving maximal footprint coverage are some of the only factors we can control during surgery. However, although we may be able to pull the torn tendon edge all the way over to the lateral aspect of the footprint during our reduction maneuver, we know that fixing the tendon in this location creates a significant risk of a type 2 retear due to high tension. In the end, achieving a tension-free repair is probably the most important factor during rotator cuff repair-even if it comes at the cost of a smaller amount of medial-to-lateral footprint coverage.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532186","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":"Unhealed and healed capsules after hip arthroscopy can have similar outcomes, but the preponderance of evidence still favors closure.","authors":"Derek Ochiai","doi":"10.1016/j.arthro.2025.02.023","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.02.023","url":null,"abstract":"<p><p>Routine capsular closure following hip arthroscopy remains controversial. The hip capsule is important for hip stability, but this can sometimes heal after a small periportal or intraportal capsulotomy without closure. While reliable healing of intraportal capsulotomies can be achieved with capsular closure, multiple systematic reviews show improved outcomes and less revision surgery after capsular closure. In my practice, I do an interportal capsulotomy in all patients, and I close or plicate the capsule.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532188","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 Pelvic Tilt Allows for Increased Hip Motion, While Anterior Pelvic Tilt Decreases Joint Stress: A Systematic Review of Biomechanical and Motion Analyses.","authors":"Benjamin D Kuhns, Ady H Kahana-Rojkind, Ali Parsa, Tyler R McCarroll, Drashti Sikligar, Benjamin G Domb","doi":"10.1016/j.arthro.2025.02.021","DOIUrl":"10.1016/j.arthro.2025.02.021","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this systematic review was to evaluate the effect of pelvic tilt on hip joint contact forces and range of motion in patients with femoroacetabular impingement (FAI) and acetabular dysplasia.</p><p><strong>Methods: </strong>A literature review querying the U.S. National Library of Medicine (PubMed/MEDLINE), EMBASE, SCOPUS, and Cochrane Databases using the key words (\"Femoroacetabular Impingement\" OR \"Hip Dysplasia\") AND (((((\"Pelvic Tilt\") OR (Joint Contact) OR (Kinetics) OR (\"Pelvic Incidence\") OR (Lumbar Lordosis)))). 14 studies were included in the review with methodological quality evaluated through the Methodological Index for Non-Randomized Studies (MINORS) and Risk of Bias in Non-Randomized Studies- of Interventions (ROBINS-I) criteria.</p><p><strong>Results: </strong>There were 474 total patients (577 hips) in the 14 studies reviewed. Two studies focused on hip joint contact forces and femoral head coverage in acetabular dysplasia. These found that posterior pelvic tilt was associated with decreased hip joint contact area (range: 490-581 mm² vs 919-1094 mm²), increased joint contact pressure (range: 3.9-7.3 mPa vs 1.8-3.5 mPa), and decreased femoral head coverage (range: 30.2-43.4% vs 38.9-50.3%) in dysplastic subjects compared to control populations. Twelve studies evaluated the range of hip motion in FAI populations undergoing different functional maneuvers. Posterior pelvic tilt in FAI patients was found to increase hip range of motion to impingement on supine testing and biomechanical modeling (Internal rotation in flexion range: -6.5° to 15.5° with anterior tilt, 12.9° to 31.4° with posterior tilt). With dynamic maneuvers, FAI patients had decreased pelvic mobility (range: 7.2°-14.7° vs 12.7°-24.2°) and decreased posterior pelvic tilt (range: 3.4°-15.9° vs 9.8°-21.1°) compared to patients without FAI.</p><p><strong>Conclusions: </strong>Hip joint stress is increased with posterior pelvic tilt in dysplastic patients, while increasing posterior pelvic tilt increases hip range of motion to impingement in patients with FAI. During weight-bearing exercises, the ability for FAI patients to posteriorly tilt the pelvis is restricted compared to a control population.</p><p><strong>Clinical relevance: </strong>Spinopelvic kinematics and alignment affect composite hip motion and play a critical role in bipedal locomotion. The influence of spinopelvic parameters on treatment outcomes for acetabular dysplasia and FAI is controversial and currently limited by an imperfect understanding of the hip-spine relationship as it relates to nonarthritic hip disease. The present systematic review provides a summary of the results of biomechanical studies investigating pelvic tilt in this population.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143532168","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":"Postoperative Corticosteroid Injection After Arthroscopic Rotator Cuff Repair in Patients With Stiffness Has Similar Clinical Outcome Compared With Repair Combined With Capsular Release: A Prospective Randomized Clinical Trial.","authors":"Hyo-Jin Lee, Eun-Ji Yoon, Jung-Woo Lee, Jong-Ik Kim, Jong-Ho Kim","doi":"10.1016/j.arthro.2025.02.014","DOIUrl":"10.1016/j.arthro.2025.02.014","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate whether 2 months of a postoperative intra-articular corticosteroid injection after arthroscopic rotator cuff repair (ARCR) in rotator cuff tear (RCT) patients with stiffness would improve the functional scores and range of motion of the operated shoulder without capsular release during ARCR.</p><p><strong>Methods: </strong>From March 2020 to September 2021, a total of 73 patients who had RCT with stiffness and were scheduled for ARCR were enrolled prospectively and randomly allocated into 2 groups. The patients who underwent ARCR with capsular release were allocated to group 1 (n = 37). The patients who underwent ARCR without capsular release and were injected with 1 mL triamcinolone acetate (40 mg/1 cc) into the glenohumeral joint 2 months after surgery were allocated to group 2 (n = 36). Functional scores and shoulder range of motion were evaluated before surgery; 3, 6, and 12 months after surgery; and at the last follow-up. Magnetic resonance imaging was performed at 12 months postoperatively.</p><p><strong>Results: </strong>The mean follow-up period was 26.5 months. The functional and visual analog score (VAS) pain scores in both groups were significantly improved at the last follow-up (P < .001). The 3-month postoperative VAS pain score of group 2 was significantly lower than that of group 1 (group 1, 3.4 ± 1.5; group 2, 2.1 ± 1.0; P <.001). VAS pain scores at 6 months or 12 months or at the last follow-up and functional scores and ROM at 3, 6, or 12 months or at the last follow-up were not significantly different between the 2 groups (P > .05). The retear rate of repaired rotator cuff during follow-up was not significantly different between the 2 groups (P = .71).</p><p><strong>Conclusions: </strong>Corticosteroid injection in the glenohumeral joint performed 2 months after ARCR in RCT patients with stiffness is as effective as capsular release during ARCR for improving the clinical outcome of the operated shoulder.</p><p><strong>Level of evidence: </strong>Level I, prospective randomized clinical trial.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525249","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":"Evaluating the Impact of Graft Tensioning and Leg Positioning in Medial Patellofemoral Ligament Reconstruction on Patellofemoral Pressure Profile: A Systematic Review and Meta-analysis.","authors":"Yosef Sourougeon, Gilad Nesher, Hesham Younis, Asaf Bloch, Sharif Garra, Dan Prat, Ran Thein","doi":"10.1016/j.arthro.2025.01.066","DOIUrl":"10.1016/j.arthro.2025.01.066","url":null,"abstract":"<p><strong>Purpose: </strong>To systematically review the effects of pretension on patellofemoral pressure distribution and determine which flexion angle at fixation allows for the most reliable restoration of patellofemoral kinematics and mechanics.</p><p><strong>Methods: </strong>This systematic review and meta-analysis adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and included studies from PubMed, EMBASE, and Scopus from January 2000 to July 2024. We focused on cadaveric studies measuring patellofemoral pressure after medial patellofemoral ligament (MPFL) reconstruction. Two authors extracted data independently, and the risk of bias was assessed using the Quality Appraisal for Cadaveric Studies scale. Statistical analyses used fixed- and random-effect models to compare patellofemoral pressure at various flexion angles (30°, 60°, 90°) and pretension levels (2 N, 10 N, 10+ N).</p><p><strong>Results: </strong>Thirteen studies met the inclusion criteria, with 8 qualifying for quantitative analysis. No significant difference in patellofemoral pressure was found between native and reconstructed knees across all flexion angles and pretension levels. Increased medial patellofemoral pressure was shown in the 10+ N pretension group, particularly at 90° of flexion; however, no statistically significant differences were found. Most studies reported graft fixation at 30° of knee flexion, effectively restoring native patellofemoral mechanics.</p><p><strong>Conclusions: </strong>MPFL reconstruction at various angles of knee flexion and pretension levels showed no statistically significant differences in patellofemoral pressure compared to the native state. CLINICAL RELEVANCE: Understanding the optimal graft pretension and knee flexion angle for MPFL reconstruction can help surgeons more accurately and reliably restore native patellofemoral biomechanics and kinematics.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517483","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}