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

{"title":"Editorial Commentary: Machine Learning and 300,000 Simulations Confirm That Fragility Reflects the P Value, Not Trial Robustness: Taking Apart a Calculator to Reveal That 2 + 2 Equals 4.","authors":"Jacob F Oeding","doi":"10.1002/arj.70475","DOIUrl":"10.1002/arj.70475","url":null,"abstract":"<p><p>The fragility index continues to be promoted as a measure of trial robustness despite evidence that it is little more than statistical significance in a different form. Two misconceptions have been particularly persistent throughout the fragility literature: first, that the fragility index can be directly compared with patients lost to follow-up, and second, that fragility metrics provide unique insight into the robustness of randomized controlled trials. Both assumptions are flawed. Outcome reversals used to calculate the fragility index and the addition of patients lost to follow-up are fundamentally different mathematical operations and therefore should not be expected to have equivalent effects on statistical significance. Likewise, because fragility metrics are deterministic functions of variables already used to calculate the P value, it should not be surprising when statistical models identify P values, event counts, and sample size as their dominant determinants. In many ways, using machine learning to identify the factors that drive fragility metrics is analogous to taking apart a calculator to determine why 2 + 2 equals 4: the answer is technically correct but largely predetermined by the construction of the system itself. The more important question is not what determines fragility but whether fragility contributes meaningful information beyond conventional statistical outputs. If fragility metrics can be reconstructed almost entirely from variables already reported in every randomized controlled trial, then their incremental value becomes difficult to justify. After nearly a decade of fragility analyses reaching the same conclusions, it may be time to move beyond fragility metrics altogether and refocus on approaches that directly address uncertainty, bias, precision, and clinical relevance. Confidence intervals, risk of bias assessments, reproducibility, and thoughtful interpretation of effect estimates provide far greater insight into study credibility than another measure derived largely from the P value. It is time to move past fragility and return our attention to the factors that actually determine robustness.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":"2759-2762"},"PeriodicalIF":6.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148762975","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":"Establishing a Sustainable Artificial Intelligence Infrastructure for Health Care Systems Part II: Consideration of Key Regulatory and Bioethical Barriers to Implementation.","authors":"Kyle N Kunze, Ashis Barad","doi":"10.1002/arj.70231","DOIUrl":"10.1002/arj.70231","url":null,"abstract":"<p><p>Establishing an artificial intelligence (AI) infrastructure is contingent upon processes being conducted within structured regulatory frameworks that adhere to existing best practices. Institutional policies should include the development of an AI governance body with the goals of proactively monitoring deployed AI solutions for deviations in performance, responsibly scaling them, mitigating potential biases, and ensuring the fundamental principles of transparency and accountability are followed. Specific regulatory considerations include ensuring compliance with Food and Drug Administration regulations as well as ensuring data privacy and Health Insurance Portability and Accountability Act compliance. Implementation challenges that must be considered include workflow integration of AI solutions, user acceptance and trust, initiating a change in hospital culture toward embracing new technology, and building a sustainable technical foundation for maintenance and continuous learning. Emphasizing these considerations is essential to fostering compliant and responsible use of AI that maximizes value and quality of care delivered across a health care system. Likewise, a top-down focus on ethics surrounding responsible use of AI, measures toward the reduction in bias, and emphasizing explainability of AI decision-making will be critical for sustainable and trustworthy integration of systems-wide AI solutions. LEVEL OF EVIDENCE: Level V, expert opinion.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":"2834-2839"},"PeriodicalIF":6.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846668","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: Sunset View: Time to Retire Tibial Tubercle-Trochlear Groove Thresholds for Patellar Instability.","authors":"Mario Hevesi, Aaron J Krych","doi":"10.1002/arj.70665","DOIUrl":"10.1002/arj.70665","url":null,"abstract":"<p><p>Orthopaedic literature often establishes cutoffs when evaluating risk factors for an outcome of interest, whether patellar instability or most any other pathology. Although such cutoffs are intuitively easy to apply to clinical practice and testing situations, they leave much to be desired when it comes to nuanced patient care. As we increasingly recognize patient-to-patient differences, our approach to historic cutoffs such as tibial tubercle-trochlear groove distance merits a revisit. A reasonable first step is to adjust for patient-specific factors such as height and sex. However, as larger datasets and deeper mechanistic insights become available, we may ultimately move beyond simplistic thresholds altogether, advancing instead toward truly individualized precision medicine.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":"2682-2683"},"PeriodicalIF":6.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118522","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: Tibial Tubercle-Trochlear Groove Distance Should Be Prioritized Over Tibial Tubercle-Posterior Cruciate Ligament Distance, but the Source of Malalignment Must Guide Proximal or Distal Realignment.","authors":"David H Dejour, David Mazy","doi":"10.1002/arj.70656","DOIUrl":"10.1002/arj.70656","url":null,"abstract":"<p><p>Objective patellar instability results from the interaction of multiple anatomic abnormalities, including trochlear dysplasia, patella alta, tibial tubercle lateralization, and rotational malalignment. The tibial tubercle-trochlear groove distance integrates the relation between the tibial tubercle and the femoral trochlea, whereas the tibial tubercle-posterior cruciate ligament distance is restricted to tibial landmarks. Consequently, the tibial tubercle-posterior cruciate ligament distance may underestimate the functional extensor mechanism malalignment, particularly in patients with trochlear dysplasia. In our view, the tibial tubercle-trochlear groove distance should remain the preferred measurement when planning patellofemoral realignment. Nevertheless, an elevated value should not automatically prompt tibial tubercle osteotomy because it may result from tibial tubercle lateralization, medialization of the trochlear groove, tibiofemoral rotation, or a combination of these factors. Surgical planning should therefore identify the origin of the malalignment and distinguish between proximal realignment through trochleoplasty and distal realignment through tibial tubercle osteotomy. The tibial tubercle-posterior cruciate ligament distance may complement this assessment, but it should not replace the tibial tubercle-trochlear groove distance.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":"2587-2589"},"PeriodicalIF":6.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118799","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: Allograft Reconstruction in Chronic Proximal Hamstring Tendon Avulsions: Bridging the Gap May Not Equal a Full Return.","authors":"Joshua P Castle, Lafi S Khalil","doi":"10.1002/arj.70671","DOIUrl":"10.1002/arj.70671","url":null,"abstract":"<p><p>Proximal hamstring tendon avulsions are being treated surgically at rising rates, and although primary repair reliably restores function and return to sport in the acute setting, chronic and significantly retracted tears present a far more difficult problem. When direct repair is not feasible for a chronic, retracted proximal hamstring tendon avulsion, allograft reconstruction offers a bridge across a gap that would otherwise go unaddressed. However, significant chronicity and retraction are difficult challenges to overcome, and patient expectations must be appropriately counseled. As a salvage procedure, allograft reconstruction may improve patient outcomes significantly; however, it is not expected to restore full function, return athletic individuals to their baseline and preinjury level of sports participation, or match the success of primary repair. Allograft reconstruction may also carry more than double the risk of rerupture, which is important to discuss with patients up front. Graft choice and postoperative rehabilitation protocols remain heterogeneous across the limited available literature, and a validated tool to risk-stratify which chronic, retracted tears are best served by reconstruction versus continued nonoperative management does not yet exist. These findings suggest that allograft reconstruction is a viable and clinically meaningful option for a difficult, often nonoperatively unsalvageable problem, but surgeons should frame it for patients as a salvage procedure rather than a full restoration of function, and expectations should be set accordingly.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":"2517-2519"},"PeriodicalIF":6.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118944","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":"Commentary on Arthroscopy Editorial Commentaries With Gratitude to Our Authors.","authors":"Michael J Rossi, Matthew Salzler, Erik Hohmann","doi":"10.1002/arj.70703","DOIUrl":"10.1002/arj.70703","url":null,"abstract":"<p><p>Editorial Commentaries on new articles serve many roles; they highlight key findings, provide contemporary clinical context, assist in understanding the key strengths and limitations, identify areas of controversy, and stimulate debate. The November 2026 issue of Arthroscopy has its usual compliment of outstanding articles, and we call attention to the 33 outstanding commentaries from Arthroscopy reviewers, editors, authors, and thought leaders. We celebrate and thank all authors who have contributed Editorial Commentaries since their inception in 2015. Their willingness to share their experience and knowledge enriches our journal and strengthens the scientific dialogue.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":"2385-2390"},"PeriodicalIF":6.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149118962","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":"Hill-Sachs Lesion Size Is Not Associated With Chronicity of Anterior Shoulder Instability But Is Larger After Anterior Shoulder Dislocation Versus Subluxation.","authors":"Sahil Dadoo, Ryan T Lin, Tyler C Williams, Ryan Gilbert, Luilly Vargas, Maite Jaspers, Adam Popchak, Bryson P Lesniak, Mark Rodosky, Jonathan D Hughes, Albert Lin","doi":"10.1002/arj.70484","DOIUrl":"10.1002/arj.70484","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate preoperative factors associated with Hill-Sachs lesion (HSL) size at the time of imaging, including chronicity, number, and type (dislocation vs subluxation) of prior anterior shoulder instability events.</p><p><strong>Methods: </strong>All patients undergoing arthroscopic Bankart repair between 2007 and 2023 were retrospectively reviewed. Exclusion criteria included age <14 years, revision surgery, glenoid bone loss >20%, unavailable magnetic resonance imaging, and lack of HSL. Patients were grouped based on chronicity of instability (acute ≤6 months vs chronic >6 months), 1 versus multiple prior instability events, and dislocation versus subluxation. HSL width and length were measured on axial and sagittal magnetic resonance imaging, respectively. HSL area (recorded in mm²) was calculated as HSL width time length. Imaging variables were compared between groups, and multivariable regression evaluated predictors of larger HSL area and smaller distance to dislocation (DTD). Significance was set to P < .050.</p><p><strong>Results: </strong>After exclusion criteria, 255 patients (age: 22 ± 8 years; 24% female) were included for analysis. There was no association between acute versus chronic anterior shoulder instability and HSL width (11.6 vs 12.4 mm; P = .196), length (16.4 vs 16.7 mm; P = .521), or area (201.6 vs 215.7 mm²; P = .154). Patients who experienced dislocation versus subluxation had larger HSL length (16.7 vs 13.4 mm; P < .001) and HSL area (201.9 vs 150.7mm²; P = .012). Female sex (B: -74.5; P = .001) and glenohumeral dislocation (B: 49.5; P = .037) were predictors of smaller and larger HSL area, respectively, whereas chronic anterior shoulder instability was a predictor of DTD < 8 mm (odds ratio: 2.2; P = .008).</p><p><strong>Conclusions: </strong>Chronic anterior shoulder instability did not influence HSL size at the time of imaging but was found to be a predictor of DTD < 8 mm. Conversely, glenohumeral dislocation was a significant predictor of larger HSL area. This indicates that HSL size may be influenced more by type of instability event, whereas DTD may be more influenced by chronicity of anterior shoulder instability.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":"2444-2453"},"PeriodicalIF":6.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148876707","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: \"Which Skin Preparation Do You Prefer Doctor?\" Turns Out It Does Not Matter! Instead, Focus on Minimizing the Surgical Time to Reduce Contamination in Arthroscopic Cuff Repair.","authors":"Mustafa S Rashid, Christopher Roberts","doi":"10.1002/arj.70636","DOIUrl":"10.1002/arj.70636","url":null,"abstract":"<p><p>Deep infection after arthroscopic rotator cuff repair surgery is a rare yet devastating complication. During everyday practice, we focus on techniques that will help to mitigate this, deploying techniques such as different skin preparations in the hope of minimizing contamination at the time of surgery. It turns out, however, that this is less important than how long it takes us to complete the surgery and how long the sutures are exposed. Although skin preparation is therefore important, recent literature suggests that we should turn our attention to employing techniques that will reduce our surgical time.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":"2417-2418"},"PeriodicalIF":6.9,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026940","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":"Greater Glenoid Chondral Lesion Extent and Lack of Labral Coverage Are Associated With the Development of Radiographic Osteoarthritis After Arthroscopic Bankart Repair.","authors":"Kyeong-Eon Kim, Sang-Jin Shin","doi":"10.1002/arj.70668","DOIUrl":"https://doi.org/10.1002/arj.70668","url":null,"abstract":"<p><strong>Purpose: </strong>To classify glenoid chondral lesions based on their spatial relation to the glenoid bare area and to investigate the association between lesion extent, postoperative coverage status, and radiographic glenohumeral osteoarthritis after arthroscopic Bankart repair.</p><p><strong>Methods: </strong>Patients who underwent arthroscopic Bankart repair between 2015 and 2022 were included retrospectively. Patients were eligible if they had symptomatic recurrent anterior shoulder instability and completed at least a 2-year follow-up. All patients had no radiographic osteoarthritis preoperatively. Glenoid chondral lesions were classified by anterior extension relative to the bare area arthroscopically. A reference line was defined connecting the bare area to the 3-o'clock position of the glenoid, and a perpendicular line at the midpoint of this distance was used to demarcate the anterior half; lesions confined within this boundary were classified as group 1, lesions extending beyond this boundary but remaining anterior to the bare area were classified as group 2, and lesions extending beyond the bare area were classified as group 3. Postoperative labral coverage status was assessed. Radiographic osteoarthritis was defined as Samilson-Prieto grade ≥1.</p><p><strong>Results: </strong>Glenoid chondral lesions were present in 165 of 293 shoulders (56.3%). Compared with those without lesions, patients were older (P = .001), had more dislocations (P = .001), and had higher rates of bony Bankart lesions (P = .001). After repair, all group 1 lesions (n = 144) were covered by the repaired labrum, whereas 73.3% of group 2 (n = 15) and all group 3 (n = 6) remained uncovered (P = .001). At a mean follow-up of 27.1 ± 7.6 months (range, 24-47 months), radiographic osteoarthritis developed in 6.9% of group 1, 40.0% of group 2, and 66.7% of group 3 (P = .001). Multivariate analysis showed that older age (P = .005), greater lesion extent (P < .001), and uncovered lesions (P < .001) were independent predictors of radiographic osteoarthritis.</p><p><strong>Conclusions: </strong>The extent of glenoid chondral lesions and lack of postoperative labral coverage were associated with the development of radiographic osteoarthritis after arthroscopic Bankart repair at a minimum of 2-year follow-up.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149302316","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":"Teres Minor Fatty Degeneration Progression by Magnetic Resonance Imaging Analysis Is Associated With Graft Failure After Arthroscopic Superior Capsule Reconstruction.","authors":"Hidenori Miyauchi, Norimasa Takahashi, Keisuke Matsuki, Shota Hoshika, Hideki Kamijo, Hiroyuki Sugaya, Itaru Kawashima","doi":"10.1002/arj.70693","DOIUrl":"https://doi.org/10.1002/arj.70693","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate risk factors, including rotator cuff fatty degeneration, for postoperative graft failure within 1 year after arthroscopic superior capsule reconstruction using a fascia lata autograft in shoulders with an intact or reparable subscapularis tendon.</p><p><strong>Methods: </strong>Patients who underwent arthroscopic superior capsule reconstruction for massive or irreparable rotator cuff tears between June 2016 and December 2022, with a minimum 12-month follow-up, were retrospectively reviewed. Radiological evaluations included measurement of acromiohumeral distance and fatty degeneration of the rotator cuff muscles using the Goutallier classification. The Goutallier grades were classified into none-to-mild (grades 0-1) and moderate-to-severe fatty infiltration (grades 2-4). Graft integrity was assessed using the Sugaya classification on postoperative magnetic resonance imaging obtained 1 year after surgery, and patients were categorized into a nonfailure group (Group I) and graft failure group (Group GF). Univariate and multivariate logistic regression analyses were performed to identify the significant risk factors for graft failure.</p><p><strong>Results: </strong>Eighty-seven shoulders were included: 70 in Group I and 17 in Group GF. The mean radiological follow-up (range) was 22.2 (12-72) in Group I versus 25.5 (12-65) months in Group GF (P = .163). Similarly, patient-reported outcome measure follow-up was 22.3 (12-48) versus 22.6 (12-47) months (P = .839). Group GF showed significantly greater fatty degeneration of the teres minor and a higher prevalence of moderate-to-severe fatty infiltration (58.8% vs 25.7%, P = .012). Multivariate logistic regression identified teres minor fatty degeneration and the preoperative acromiohumeral distance as risk factors for graft failure. Clinical outcomes improved significantly in both groups, although the magnitude was lower in Group GF.</p><p><strong>Conclusions: </strong>This study showed that moderate-to-severe fatty degeneration of the teres minor and a smaller preoperative acromiohumeral distance are significant risk factors for graft failure after arthroscopic superior capsule reconstruction in shoulders with an intact or reparable subscapularis tendon.</p><p><strong>Level of evidence: </strong>Level III, retrospective cohort study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":6.9,"publicationDate":"2026-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149302430","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}