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

{"title":"Alan L. Zhang, M.D., F.A.A.O.S., F.A.A.N.A., Associate Editor, Arthroscopy Techniques.","authors":"James H Lubowitz","doi":"10.1016/j.arthro.2024.10.011","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.011","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481626","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":"Arthroscopically Assisted Pectoralis Minor Transfer for Anterosuperior Massive Rotator Cuff Tear With Irreparable Subscapularis Tears Leads to Significant Improvement in Pain and Function at Short-Term Follow-Up.","authors":"Kotaro Yamakado","doi":"10.1016/j.arthro.2024.10.013","DOIUrl":"10.1016/j.arthro.2024.10.013","url":null,"abstract":"<p><strong>Purpose: </strong>To report the results of an arthroscopically assisted pectoralis minor transfer with an expanded indication to include Lafosse type 4 cases. In addition, prognostic factors for pectoralis minor transfer, including the Lafosse classification, were explored.</p><p><strong>Methods: </strong>Outcomes of arthroscopically assisted pectoralis minor tendon transfer for anterosuperior massive rotator cuff tear with irreparable subscapularis tears with a minimum follow-up of 24 months were retrospectively reviewed. Severe pseudoparesis with flexion of less than 30° was not indicated. All patients were evaluated preoperatively and postoperatively using a modified University of California Los Angeles (UCLA) score, active range of motion, and the visual analog pain scale. Multiple regression models were used to determine predictors for UCLA score and elevation.</p><p><strong>Results: </strong>Seventy-four consecutive patients (mean, 69.4 years; 65 men) were evaluated. The mean UCLA score increased from 15.3 preoperatively to 30.9 postoperatively (P < .001). The mean active elevation increased from 104° preoperatively to 148° postoperatively (P < .001). The mean active external rotation increased from 47° preoperatively to 57° postoperatively (P < .001). The visual analog pain scale improved from 62 to 11 mm postoperatively (P < .001). There were no serious complications, but 1 was revised with reverse shoulder due to ongoing pain. In multiple regression analysis, the positive predictors of UCLA and elevation were the preoperative external rotation angle (P = .0028) and elevation angle (P = .00067), respectively. Lafosse classification was not a significant factor.</p><p><strong>Conclusions: </strong>Arthroscopically assisted pectoralis minor transfer led to significant improvement in overall shoulder pain and function. Better preoperative range of motion was a significant predictor of better clinical outcomes; Lafosse classification was not significant as a prognostic factor.</p><p><strong>Level of evidence: </strong>Level IV, retrospective therapeutic case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481628","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: Offloading Patellofemoral Chondral Defects Requires Tailored Tibial Tuberosity Osteotomy Procedures.","authors":"Miho J Tanaka","doi":"10.1016/j.arthro.2024.10.012","DOIUrl":"10.1016/j.arthro.2024.10.012","url":null,"abstract":"<p><p>The presence of patellofemoral chondral defects is common in the setting of patellar instability. Multiple procedures have been described to address concomitant chondral defects including autologous chondrocyte implantation (ACI) and osteochondral allograft (OCA) transplantation, with lack of consensus on the optimal management of such defects. Regardless of the technique used to address the cartilage lesion, offloading the defect with a tibial tuberosity osteotomy (TTO) and stabilizing the patella through medial patellofemoral ligament reconstruction are important components of patellofemoral joint preservation surgeries. Identifying the specific location of the chondral defect allows us to tailor the TTO when offloading the lesion and addressing instability. By specifying the precise amount of tuberosity medialization needed to correct the TTTG distance and the amount of anteriorization to correct the anterior-posterior TTTG (or sagittal TTTG) distance, combined with the amount of distalization needed to correct patellar height, we have been able to improve the way we address the coronal and sagittal alignment of the knee. By improving the precision with which we measure and compare defects based on each patient's morphology and specific injury patterns, we can tailor procedures to each individual to optimize the management of chondral pathology in the setting of patellar instability.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481631","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: Timely Treatment of Femoroacetabular Impingement Syndrome Both Treats Ongoing Hip Symptoms and Mitigates Future Cartilage Damage and Osteoarthritis.","authors":"Michael P McCabe","doi":"10.1016/j.arthro.2024.10.014","DOIUrl":"10.1016/j.arthro.2024.10.014","url":null,"abstract":"<p><p>Patients with femoroacetabular impingement syndrome (FAIS) present with ongoing symptoms in a painful hip. Insightful patients or family members often express concern about similar pathology, and associated risk of arthritis, in their less or asymptomatic hip, and recent research shows that patients with increased alpha angles are associated with more advanced cartilage damage, particularly in males. The ultimate question, for surgeons and patients, is: Can we predict chondral pathology based on preoperative variables alone, and should we intervene prior to symptoms? Yet, FAIS is multifactorial, not simply anatomic, and cam-type FAI can have a high prevalence in asymptomatic hips in some populations. Thus, today, prophylactic hip preservation surgery cannot be generally recommended, but in the future, an individualized treatment algorithm may result in precise prediction of which patients might benefit from earliest intervention to help reduce the incidence of premature hip osteoarthritis. In the interim, when timely intervention is in the best interest of the patient, insurance denials that delay indicated surgery must not be tolerated. One of the most rewarding and unique aspects of managing FAIS is that we have the opportunity to both treat ongoing hip symptoms and mitigate future pathology, sometimes even in the contralateral hip.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481637","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: Biomedical Research Investigating Artificial Intelligence Large Language Models Needs to Move Beyond Measuring Accuracy and Focus on Improving Patient Care.","authors":"George C Balazs","doi":"10.1016/j.arthro.2024.10.010","DOIUrl":"10.1016/j.arthro.2024.10.010","url":null,"abstract":"<p><p>Orthopaedic surgeons are fascinated with artificial intelligence (AI). Since the release of ChatGPT to the general public on November 30, 2022, there have been a flurry of articles regarding use of large language models (LLMs) in our field. Most of these revolve around the accuracy of the models regarding orthopaedic topics (spoiler alert: the accuracy is good, yet unreliable, but improving). Unfortunately, the research around LLM is largely repetitive, applying the LLMs to the same essential tasks. LLM AI systems show amazing capabilities in data processing, collating and organizing and recognizing patterns. Now, research scientists need to innovate. Journals must encourage authors to investigate how AI systems can improve patient care.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481629","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":"Partial Meniscectomy Yields Comparable Outcomes and Failure Rates to Meniscal Repair for Horizontal Cleavage Tears, with Fewer Complication Rates but Greater Progression of Degenerative Changes.","authors":"Felicitas Allende, Lika Dzidzishvili, Jose Rafael Garcia, Salvador Gonzalez Ayala, Colton Mowers, Divesh Sachdev, Sachin Allahabadi, Jorge Chahla","doi":"10.1016/j.arthro.2024.10.009","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.009","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the clinical outcomes, failure rates, surgical complications, and postoperative radiographic changes following partial meniscectomy versus meniscal repair for horizontal cleavage tears (HCTs).</p><p><strong>Methods: </strong>A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using the Scopus, PubMed, and Embase computerized databases. Clinical studies evaluating partial meniscectomy or meniscal repair for HCTs were included. Demographic characteristics, surgical techniques, clinical outcomes, failure rates, complications, and radiographic assessments were recorded.</p><p><strong>Results: </strong>A total of 18 studies comprising of 833 patients with HCT were included, of which 562 patients (67.5%) were treated with partial meniscectomy and 271 (32.5%) with meniscal repair. Both types of treatments reported improved clinical outcomes, including IKDC, Lysholm, KOOS, and Tegner scores. Failure rates were reported to range between 0 to 15% following partial meniscectomy, and between 0 to 17.6% following repair; and complications were 7.5% after partial meniscectomy, and between 3.8 to 21.4% following meniscal repair. Patients undergoing meniscectomy demonstrated progression of degenerative changes on radiographic assessments.</p><p><strong>Conclusion: </strong>Repair of HCTs in the appropriately indicated patient can result in similar patient outcomes and failure rates compared to partial meniscectomy. However, especially in patients aged 42 years and younger, a greater complication rate can be expected with repair, while a greater degree of ipsilateral compartment degeneration is seen after partial meniscectomy.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Glossary of Terms in Artificial Intelligence for Healthcare.","authors":"S Shamtej Singh Rana, Jacob S Ghahremani, Joshua J Woo, Ronald A Navarro, Prem N Ramkumar","doi":"10.1016/j.arthro.2024.08.010","DOIUrl":"10.1016/j.arthro.2024.08.010","url":null,"abstract":"<p><p>In recent decades, artificial intelligence (AI) has infiltrated a variety of domains, including media, education, and medicine. There exists no glossary, lexicon, or reference for the uninitiated medical professional to explore the new terminology. As AI-driven technologies and applications become more available for clinical use in healthcare settings, an understanding of basic components, models, and tasks related to AI is crucial for clinical and academic appraisal. Here, we present a glossary of AI definitions that healthcare professionals can utilize to augment personal understanding of AI during this fourth industrial revolution. LEVEL OF EVIDENCE: Level V, expert opinion.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481625","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 Fragility Index Minimally Improves Interpretation of the Medical Literature: A Boat Made of Bricks in a Sea of Uncertainty.","authors":"Mark P Cote, Augustus D Mazzocca, Jon P Warner","doi":"10.1016/j.arthro.2024.10.007","DOIUrl":"https://doi.org/10.1016/j.arthro.2024.10.007","url":null,"abstract":"<p><p>The fragility index (FI) is statistical significance in a costume. Perhaps attractive and amusing, but behind the mask it's nothing more than spin, dichotomizing results as \"statistically significant\" versus \"not\". In the medical literature, we must stop dichotomizing and start measuring the magnitude of effect and the uncertainty in this estimate. Statistical significance is thought stifling. Yet, it is the tool with which the medical research community has been provided. No wonder we dichotomize results; we've been encouraged to do so. The question is, \"Will we recognize the folly in this exercise and move on to more critical questions of relevance and accuracy of published research?\" The FI is heralded as a metric that provides insight beyond statistical significance. Rather than provide a measure of uncertainty, which is what fragility implies, it quantifies the number of patients needed to produce a p-value that's greater than 0.05. Unfortunately, while well intended the FI is not a surrogate for robustness of clinical trial data, nor the underlying statistical analysis. In contrast, reporting and interpreting a confidence interval more effectively provides a sense of uncertainty. While far from perfect, the confidence interval provides a range of values that are compatible with the observed study data. This makes the uncertainty of the data transparent. Advancing our understanding of the data starts with stepping away from statistical significance.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481636","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: Rate of Meniscal Repair Versus Meniscectomy Has Improved and Should Continue to Improve.","authors":"Vivek Jha","doi":"10.1016/j.arthro.2024.10.006","DOIUrl":"10.1016/j.arthro.2024.10.006","url":null,"abstract":"<p><p>As a result of research supporting meniscus preservation, evidence shows that internationally, there has been a rise in rates of meniscus repair, especially in younger population, and a decline in rates of partial meniscectomy. The decline in partial meniscectomy has been rather rapid and has outpaced the rise in meniscal repair, likely due to increasing evidence against routine partial meniscectomy in degenerative tears with coexistent arthritis. However, despite the rise in meniscus repair, close to 95% of meniscus surgeries are still partial meniscectomies. The partial meniscectomy to meniscus repair ratio seems to be rather high. Optimistically, this will improve because successful repair outcomes have been demonstrated in situations previously considered \"high-risk,\" including complex patterns, central tears, radial tears, and root and ramp tears. This may be due to multiple factors, many of which may be beyond the control of surgeons, including the fact that as many as 25% of repairs fail to heal. Yet, with improved techniques and instrumentation, the success rate of repair is improving. The cost of repair may be a limiting factor, especially in low-income countries with poor health insurance penetration and unfavorable reimbursement of repair cost. Every effort must be made to repair a tear, which has potential to heal.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":5.4,"publicationDate":"2024-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481634","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: Preferred Strategies to Avoid Collision Between Tunnels for Lateral Extra-articular Procedures and Anterior Cruciate Ligament Reconstruction Include Outside-In Drilling, Cortical Fixation, and Use of a Single Femoral Tunnel.","authors":"Adnan Saithna","doi":"10.1016/j.arthro.2024.10.005","DOIUrl":"10.1016/j.arthro.2024.10.005","url":null,"abstract":"<p><p>When performing lateral extra-articular procedures (LEAPs) at the time of anterior cruciate ligament (ACL) reconstruction, it is essential to be aware of the possibility of tunnel collision and understand strategies to avoid it. The risk of tunnel collision is high, especially if an anteromedial portal ACL femoral tunnel is drilled. Tunnel collision can be avoided by using a single femoral tunnel for both procedures, outside-in femoral tunnel drilling to place the ACL tunnel a safe distance away from the LEAP, and cortical fixation techniques. Other strategies that have been explored have included anteromedial portal drilling in low degrees of flexion, anterior angulation of LEAP tunnels, and the use of an \"anterior Lemaire\" position. These alternative strategies are not preferred because they are associated with an increased risk of iatrogenic injuries to important posterolateral structures, penetration of trochlea articular cartilage, and overconstraint, respectively.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481633","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}