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

{"title":"Females Age ≥25 Show Slower Recovery During the First 2 Years After Anterior Cruciate Ligament Reconstruction but a Similar Outcome Compared to Those Who Are Younger.","authors":"Suhasini Gupta, Jillian L Mazzocca, Natalie A Lowenstein, Cale Jacobs, Elizabeth G Matzkin","doi":"10.1016/j.arthro.2025.02.017","DOIUrl":"10.1016/j.arthro.2025.02.017","url":null,"abstract":"<p><strong>Purpose: </strong>To determine if patient-reported outcome measures (PROMs) following anterior cruciate ligament reconstruction (ACLR) differ between female patients younger than 25 versus patients 25 years of age and older.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted using data collected between October 2012 and November 2022. Inclusion criteria encompassed patients undergoing a primary ACLR using a soft tissue graft with a 2-year follow-up. Demographic information and PROMs were collected preoperatively and at 3, 6, 12, and 24 months postoperatively and included visual analog scale for pain, Marx Activity Rating Scale, and the Knee injury and Osteoarthritis Outcome Score (KOOS), including Pain, Symptoms, Activities of Daily Living, Sports and Recreation, and Quality of Life subscales. PROMs were compared between the two age groups using 2 × 5 mixed-model analyses of variance (group × time).</p><p><strong>Results: </strong>Eighty-one female patients who met inclusion criteria were included in the analysis. At a mean 2-year follow-up, PROMs improved over time regardless of age group (P < .001), and the proportion of patients who achieved minimal clinically important differences in visual analog scale or KOOS scores did not differ between age groups (P values ranging from .28 to .99). KOOS Activities of Daily Living and Marx Activity Rating Scale were worse at every time point for the ≥25-year-old group, but the change in scores did not differ between the 2 age groups. Those aged <25 years recovered more quickly, having better scores at 3, 6, and 12 months, but then tended to plateau between 1 and 2 years. On the contrary, the ≥25-year-old group improved more slowly and more linearly over the 2 years, with outcome scores similar to the <25-year-old group.</p><p><strong>Conclusions: </strong>At 2 years after ACLR, KOOS Pain, KOOS Symptoms, and KOOS Sports and Recreation scores were similar in female patients regardless of age, but patients ≥25 years old take longer to achieve these outcomes.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517501","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: Biomechanical Data and Early Clinical Results Demonstrate an Emerging Strategy for Combining Superior Capsule Reconstruction and Lower Trapezius Transfer in the Management of Massive Irreparable Posterosuperior Rotator Cuff Tear.","authors":"Adnan Saithna","doi":"10.1016/j.arthro.2025.02.019","DOIUrl":"10.1016/j.arthro.2025.02.019","url":null,"abstract":"<p><p>Numerous biomechanical studies demonstrate that superior capsule reconstruction (SCR) improves glenohumeral superior translation and subacromial contact pressures in cadaveric models of massive irreparable rotator cuff tears (MIRCT) at time zero. These findings provide a logical basis for clinical observations of significant improvements in pain, range of motion, and patient-reported outcome measures at short-term follow-up. However, the efficacy of SCR at longer-term follow up is controversial, and a recent survey of AANA members demonstrates that there is decreasing use of SCR for MIRCTs as the result of concerns regarding poor clinical results, high failure rates, and high rates of progression of arthritis. To improve the outcomes of SCR, some authors have suggested a strategy of combining an SCR with a lower trapezius transfer (LTT). Biomechanical studies report improved restoration of shoulder kinematics and contact pressures compared with SCR or LTT alone. One of the risk factors for failure of SCR is infraspinatus atrophy. Because LTT has similar direction and excursion to the infraspinatus, LTT can abolish external rotation lag and improve external rotation strength; adding LTT to SCR might help restore the force couple. In addition, LTT provides a dynamic stabilizer effect whereas SCR predominantly provides a static stabilizer effect. In high abduction angles (greater than graft fixation angles) the SCR graft can no longer act to prevent humeral head migration because it is lax. Addition of a dynamic stabilizer could improve shoulder biomechanics. However, clinical efficacy is not well defined, and concerns exist regarding the considerable additional cost of the procedure in terms of operative time and the use of additional grafts and implants. Furthermore, the role of the procedure in the management of MIRCTs is unclear because comparative studies against other procedures such as debridement alone, partial repair, independent SCR or tendon transfer, subacromial balloon spacer, biologic tuberoplasty, acromial resurfacing, and reverse shoulder arthroplasty are lacking.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484696","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":"Operative Treatment has Greater Expected Value than Nonoperative Treatment for First-Time Patellar Dislocations: A Meta-Analysis and Expected Value Decision Analysis.","authors":"Andrew J Recker, Thomas W Mason, Jelle P van der List, Garrett Bullock, Nicholas A Trasolini, Brian R Waterman","doi":"10.1016/j.arthro.2025.02.013","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.02.013","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study is to use expected value decision analysis to determine the optimal treatment for first time patellar dislocations.</p><p><strong>Methods: </strong>A meta-analysis according to PRISMA guidelines and expected-value decision analysis were performed. A decision tree addressing the clinical question (operative vs. non-operative) was created, and a meta-analysis was performed to assess the probability of outcomes after operative versus non operative treatment. 70 patients were assessed regarding potential outcome preferences to a hypothetical injury. An expected-value decision analysis was performed to systematically quantify the clinical decision. Statistical fold back analysis calculated optimal treatment, and a sensitivity analysis was performed to determine the effect of changing redislocation rates on the expected value.</p><p><strong>Results: </strong>Forty-five participants (mean age 20 years [range 12-33], 58% male, 71% athletes) met inclusion criteria. Meta-analysis of 10 randomized controlled trials with 624 patients revealed the probability of a \"well\" outcome was significantly greater for operative treatment (59.3%, 95% CI 53.7% - 64.7%) than nonoperative treatment (44.7%, 95% CI 39.0% - 50.5%). Subsequent redislocation rates with operative treatment were significantly lower (29.8%, 95% CI 24.5% - 35.17%) compared to nonoperative treatment (44.7%, 95% CI 39.0% - 50.5%). MPFL reconstruction showed an 88% probability of a \"well\" outcome, and a 3% redislocation rate. Operative management had a higher chance of a well outcome (RR: 1.43 (95% CI: 1.12, 1.83), p = 0.005). The overall expected value for operative treatment was 6.09 versus 4.96 for nonoperative treatment. Secondary analysis of 27 articles for solely MPFL reconstruction demonstrated an expected value of 7.80 for operative treatment.</p><p><strong>Conclusions: </strong>Meta-analysis demonstrated more frequent favorable outcomes and lower subsequent dislocation rates with operative treatment. Decision analysis based on healthy patient responses to hypothetical scenarios demonstrates that operative treatment has a higher expected value for first time patellar dislocations than non-operative treatment.</p><p><strong>Level of evidence: </strong>Level IV, economic study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473218","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":"Arthroscope-Assisted Lower Trapezius Tendon Transfer Using Achilles Tendon Allograft for Irreparable Rotator Cuff Tears Demonstrates Excellent Short-Term Outcomes in the Setting of Concomitant Subscapularis Repair.","authors":"Berkcan Akpinar, Sarah M Koljaka, Matthew N Galati, Ryan Lohre, Bassem Elhassan, Jon J P Warner","doi":"10.1016/j.arthro.2025.02.008","DOIUrl":"10.1016/j.arthro.2025.02.008","url":null,"abstract":"<p><strong>Purpose: </strong>To quantify the improvement of patients undergoing scope-assisted lower trapezius tendon transfer (SALTT) for irreparable rotator cuff tears (IRCTs) and whether intraoperative subscapularis management affected these outcomes.</p><p><strong>Methods: </strong>From 2015 to 2023, patients undergoing primary SALTT for IRCTs without osteoarthritis or brachial plexopathy with serial follow-up at 6 months and a minimum of 12 months postoperatively were identified. Subjective shoulder value (SSV) scores, active forward elevation (FE), external rotation (ER) lag, and cuff strength were recorded. Continuous variables were analyzed with 1-way or repeated-measures analysis of variance, and a multivariate linear regression was performed evaluating demographic, radiographic, and intraoperative variable effects on SSV and ER lag.</p><p><strong>Results: </strong>Seventy-six (mean age: 56.5 ± 8.1 years; body mass index: 29.0 ± 4.3; 73% male) patients, operated on by 4 surgeons (A: 66%; B: 15%; C: 13%; D: 4%), had significant improvement in baseline SSV scores (mean: 23.9 ± 13.1) to 6-month (mean: 73.5 ± 10.6, 91% minimal clinically important difference achievement, P < .001) and final (mean: 43.5 ± 29.5 months) follow-up scores (mean: 79.9 ± 16.5, 92% minimal clinically important difference achievement, P < .001; n = 45/122: 37% 2-year inclusion rate). Regression analysis for final SSV showed age (β: 0.8, P = .017) to have a positive effect and subscapularis fatty infiltration (β: -10.6, P < .001) to have a negative effect. Active FE improved from 6-month (139° ± 23.8°) to final (146° ± 23.0°, P = .013) follow-up while ER lag (17° ± 17°) improved as well (6-month mean: 3° ± 7.8°, P < .001; final: 3° ± 5.6°, P < .001). Regression analysis revealed subscapularis fatty infiltration (β: -11.6, P = .003) had a negative effect on final active FE, while infraspinatus fatty infiltration (β: -1.2, P = .048) and concomitant subscapularis repair (β: -5.0, P = .023) had a negative effect on final ER lag. Presence of subscapularis tears alone (β: 4.5, P = .030) had a positive effect on ER lag. Overall, 5 (7%) patients underwent reoperations.</p><p><strong>Conclusions: </strong>Patients with IRCT undergoing SALTT with or without subscapularis tears requiring repair achieve excellent short-term clinical outcomes while improving from an examination standpoint.</p><p><strong>Level of evidence: </strong>Level III, retrospective case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473194","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 Nationwide Analysis Shows Anxiety Disorders Are Associated With Higher Rates of Pneumonia, Pulmonary Embolism, Deep Vein Thrombosis, and Acute Renal Failure After Hip Arthroscopy for Femoral Acetabular Impingement Syndrome: A Matched-Control Analysis.","authors":"Ajit M Vakharia, Luc M Fortier, Andrew Paliobeis, Alexander Hallwachs, Marsalis Brown, Michael Salata","doi":"10.1016/j.arthro.2025.01.068","DOIUrl":"10.1016/j.arthro.2025.01.068","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To use a nationwide administrative database (PearlDiver) to investigate whether patients with generalized anxiety disorder (GAD) undergoing primary hip arthroscopy for femoral acetabular impingement syndrome (FAIS) have (1) higher rates of medical complications, (2) higher readmission rates, and (3) higher costs of care as compared with patients without GAD.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Using the PearlDiver database, we performed a retrospective query from January 1, 2010, to March 31, 2020, to include all patients who underwent hip arthroscopy for FAIS. From this base population, patients with a diagnosis of GAD were identified and designated as the study group. The study group was matched at a 1:5 ratio by age, sex, and multiple comorbidities (depression, hypertension, diabetes mellitus, and tobacco use) to a control group of patients without GAD who underwent hip arthroscopy for FAIS. The primary outcomes analyzed included 90-day medical complications, 90-day readmission rates, and 90-day costs of care. χ&lt;sup&gt;2&lt;/sup&gt; Analyses were used to compare patient demographic characteristics. Logistic regression analyses were used to calculate odds ratios (ORs) of medical complications and readmissions. The Welch t test was used to compare costs. Bonferroni correction was performed to reduce the probability of a type I error. This was achieved by taking the standard P value of .05 and dividing it by the total number of dependent variables analyzed in the study. As such, P &lt; .005 was considered statistically significant.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The query yielded 7,631 patients with GAD undergoing hip arthroscopy for FAIS. These patients were compared with 38,145 matched controls without GAD. Patients with anxiety were at significantly higher risk of postsurgical complications, with the highest risks observed for pneumonia (1.0% vs 0.4%; OR, 2.57; 95% confidence interval [CI], 1.97-3.35; P = .004) and deep vein thrombosis (0.36% vs 0.15%; OR, 2.42; 95% CI, 1.52-3.76; P = .002). Other significant risks included acute renal failure (0.46% vs 0.21%; OR, 2.13; 95% CI, 1.42-3.15; P = .002) and pulmonary embolism (0.21% vs 0.13%; OR, 1.66; 95% CI, 0.92-2.87; P = .001). There was no statistically significant difference in readmission rates within 90 days (1.46% vs 1.24%; OR, 2.38; 95% CI, 2.13-2.67; P = .02) or 90-day total costs of care ($4,812 ± $1,292 vs $4,076 ± $1,179; P = .73) between the 2 groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;After adjusting for age, sex, and medical comorbidities, this study found that GAD was associated with significantly higher rates of pneumonia, deep vein thrombosis, acute renal failure, and pulmonary embolism after hip arthroscopy for FAIS. There were no significant differences in 90-day readmission rates or 90-day total costs of care. Considering the relatively high prevalence of anxiety and the increasing rate of hip arthroscopy, preoperative screening for anxiety may help surgeons id","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473188","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":"Early Intra-articular Hyaluronic Acid Injection After Anterior Cruciate Ligament Reconstruction Provides Short-Term Pain Relief and Improves Early Postoperative Function With No Clinical Benefits at 6 and 12 Months: A Randomized Controlled Trial.","authors":"Raghavendra Balagod, Sujit Kumar Tripathy, Siddharth Satyakam Pradhan, Paulson Varghese, Mathan Kumar Ramasubbu, Anand Srinivasan, Gunjar Jain, Mantu Jain","doi":"10.1016/j.arthro.2025.02.010","DOIUrl":"10.1016/j.arthro.2025.02.010","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the safety and effectiveness of intra-articular hyaluronic acid (HA) when administered at various time points after arthroscopic anterior cruciate ligament reconstruction (ACLR) surgery.</p><p><strong>Methods: </strong>Ninety patients with anterior cruciate ligament tears undergoing arthroscopic ACLR were divided into 1 of 3 groups: The early HA group received HA on day 2 and saline solution at 2 months, the late HA group received saline solution on day 2 and HA at 2 months, and the placebo group received saline solution at both times. Clinical variables (range of motion [ROM], knee circumference, Lysholm score, International Knee Documentation Committee [IKDC] score, visual analog scale [VAS] score, EQ-5D-5L [EuroQol 5-dimension 5-level questionnaire] score, and Tegner score) and blood parameters (erythrocyte sedimentation rate and C-reactive protein level) were assessed at baseline, monthly up to 6 months, and at 12 months. The synovial tumor necrosis factor α level was measured at baseline, on day 2, and at 3 months.</p><p><strong>Results: </strong>The early HA group showed significantly better ROM than the placebo group (P = .041) and late HA group (P = .029) at 1 and 2 months after surgery. Pain was significantly lower in the early HA group at 1 month compared with the placebo group (P = .033). The early HA group achieved a faster median recovery time to a Lysholm score greater than 83 (P = .01) and had superior Lysholm scores at 2 months. In addition, EQ-5D-5L and IKDC scores were significantly better at 1 and 2 months in the early HA group. There were no differences in erythrocyte sedimentation rate and C-reactive protein level between the groups at any follow-up. However, both HA groups showed a significant decrease in tumor necrosis factor α level from baseline (P < .05). No adverse events were reported. The minimal clinically important difference (MCID) for the VAS score at 1 month was achieved by 93.3%, 60.7%, and 65.5% of participants in the early HA group, late HA group, and placebo group, respectively (P < .01). However, no significant differences were observed between the groups in the percentage of patients achieving the MCID for the VAS score at 1 year or the MCIDs for the IKDC and Lysholm scores at 1 month, 2 months, and 1 year.</p><p><strong>Conclusions: </strong>Early intra-articular HA injection after ACLR effectively reduced pain and improved ROM during the early postoperative period, leading to enhanced functional outcomes and quality of life. However, these benefits were not sustained beyond 2 months, and no clinical benefits were noted at 6- and 12-month follow-up. The treatment was found to be safe and well tolerated for postoperative use. Notably, there was no significant difference in the number of patients achieving the MCIDs for functional scores, except for pain at 1 month.</p><p><strong>Level of evidence: </strong>Level I, double-blind randomized controlled study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473215","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":"Patients With Seizure Disorders Undergoing Surgery for Recurrent Anterior Shoulder Instability Show Variable Rates of Recurrence With Seizures as the Most Common Cause of Failure: A Systematic Review.","authors":"Scott Fong, Fabrizio Darby, Seema Patel, James D Fox, Michael S Lee, Jay Moran, Stephen M Gillinov, Mackenzie Norman, Justin Zhu, Ronak J Mahatme, John M Apostolakos, Andrew E Jimenez","doi":"10.1016/j.arthro.2025.02.009","DOIUrl":"10.1016/j.arthro.2025.02.009","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate postoperative outcomes of patients with seizure disorder undergoing stabilization surgery for the treatment of recurrent anterior shoulder instability.</p><p><strong>Methods: </strong>PubMed, Cochrane Center for Register of Controlled Trials (Cochrane Center for Register of Controlled Trials), and Scopus were searched in January 2024 for articles using the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Articles were included if they evaluated postoperative functional, clinical, or recurrence/reoperation outcomes after surgical stabilization in patients with a history of seizures and recurrent anterior shoulder instability. For postoperative outcomes reported in 3 or more studies with mean and standard deviation, forest plots were generated, and I² was calculated.</p><p><strong>Results: </strong>A total of 8 studies were included: 7 studies focused on the Latarjet or other bone block augmentation procedures and 1 study focused on a soft tissue-only stabilization procedure. There were a total of 157 Latarjet or bone block augmentation surgeries (143 patients: 124 male [86.7%], 19 female [13.3%]) and 29 soft tissue-only stabilization surgeries (27 patients: 23 male [85.2%], 4 female [14.8%]). Recurrent dislocation or subluxation rates ranged from 0% to 43%. Of the 5 studies that reported the cause of postoperative dislocation or instability, 4 identified seizures as the cause of all cases. In studies comparing Latarjet outcomes between patients with versus without seizure disorders, instability recurrence ranged from 1.8% to 9.5% in the nonseizure group and from 9% to 40% in the seizure group.</p><p><strong>Conclusions: </strong>The recurrence of anterior shoulder instability after surgical stabilization in patients with seizure disorders was variable across studies, ranging from 0% to 43%. Seizure was the most common reported cause for recurrent instability after surgery.</p><p><strong>Level of evidence: </strong>Level IV, systematic review of Level III and IV studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473235","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":"Use of Hormonal Contraceptives Is Associated With Decreased Incidence of Anterior Cruciate Ligament Injuries Requiring Reconstruction in Female Patients.","authors":"Sydney A Fry, Ankit Hirpara, Kaitlyn E Whitney, Carson L Keeter, Evangelia P Constantine, Kyle G Williams, Jason L Dragoo","doi":"10.1016/j.arthro.2025.02.012","DOIUrl":"10.1016/j.arthro.2025.02.012","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate associations between hormonal contraceptive use and female patients who had sustained an anterior cruciate ligament (ACL) injury requiring reconstruction.</p><p><strong>Methods: </strong>Deidentified data collected from female patients aged 15 to 35 years between 2011 and 2024 were obtained from the Colorado Health Data Compass database. The study patients were separated into female patients who sustained an ACL injury that was treated by arthroscopic ACL reconstruction and female patients without a history of ACL injury. Among these groups, non-contraceptive users, total hormonal systemic contraceptive users (including oral contraceptive pills [OCPs], implants, rings, injections, and patches), and OCP users (including formulations of norethindrone [NE] only, drospirenone plus ethinyl estradiol (EE), NE plus EE, and norgestimate plus EE) were included in the analysis.</p><p><strong>Results: </strong>The 2,120,628 female patients in the systemic hormonal contraceptive use group had a lower incidence of ACL injury (0.079%; 95% confidence interval [CI], 0.075%-0.083%) than the 12,766,138 female patients in the non-contraceptive use group (0.12%; 95% CI, 0.118%-0.121%). In addition, the 745,062 female patients in the OCP use group had a lower ACL injury incidence (0.088%; 95% CI, 0.081%-0.095%), suggesting an association between contraceptive use and ACL injury. When data were stratified by 5-year age intervals, the 15- to 19-year-old group showed no difference in the ACL injury incidence between the OCP use group (0.101%; 95% CI, 0.081%-0.125%) and the non-contraceptive use group (0.118%; 95% CI, 0.114%-0.122%), whereas all other age groups showed a lower ACL injury incidence in the OCP use group. All age groups in the systemic hormonal contraceptive use group had a lower ACL injury incidence than the non-contraceptive use group. Additionally, different contraceptive formulations showed a similar injury incidence, with a lower proportion of ACL injuries in NE-only users (0.03%) compared with norgestimate-EE users (0.093%), NE-EE users (0.099%), and drospirenone-EE users (0.096%).</p><p><strong>Conclusions: </strong>Systemic hormonal contraceptive use is associated with a lower incidence of ACL injury requiring ACL reconstruction compared with no contraceptive use in female patients aged 15 to 35 years, with a stronger association with progestin-only OCPs. Female patients aged 15 to 19 years showed no difference in the association with the ACL injury incidence between OCP use and no contraceptive use.</p><p><strong>Level of evidence: </strong>Level III, prognostic retrospective comparative study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473248","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":"Patients With Mood Disorders Have Higher Rates of Health Care Utilization, Medical Complications, Opioid Prescriptions, and Subsequent Knee Surgery After Arthroscopic Partial Meniscectomy.","authors":"Ankit Hirpara, Christopher Bine, Kyle G Williams, Sydney A Fry, Kaitlyn Whitney, Jason L Dragoo","doi":"10.1016/j.arthro.2025.01.067","DOIUrl":"10.1016/j.arthro.2025.01.067","url":null,"abstract":"<p><strong>Purpose: </strong>To compare rates of postoperative complications, health care utilization, opioid prescribing patterns, and secondary knee surgery in patients with versus without a pre-existing anxiety or depressive disorder (ADD) undergoing isolated primary arthroscopic partial meniscectomy (APM).</p><p><strong>Methods: </strong>The TriNetX database was queried from inception to compare patients older than 18 years who underwent isolated primary APM with versus without a pre-existing ADD. Patients were matched in a 1:1 ratio based on demographic factors and comorbidities, including diabetes and hypertension. The following outcomes were collected: (1) postoperative complications and health care utilization within 90 days, (2) proportion of patients prescribed an opioid within 1 year, and (3) subsequent knee surgery within 2 years, specifically ipsilateral or contralateral meniscus surgery or total knee arthroplasty. Two subgroup analyses were conducted. Opioid-naive patients with and without an ADD were compared based on the proportion of patients prescribed an opioid within 1 year of APM. Rates of revision meniscus surgery on the ipsilateral knee were also compared within 2 years of APM.</p><p><strong>Results: </strong>Within 90 days, patients with a pre-existing ADD (n = 26,507), compared to those without (n = 26,507), had higher rates of health care utilization, including readmission (P < .001), and medical complications, like cerebrovascular accident (P = .002). A greater proportion of patients with an ADD were prescribed opioids at all chosen time points within 1 year of APM. Similarly, a greater proportion of opioid-naive patients with an ADD were prescribed opioids within 6 months (P < .001) and 1 year (P < .001). Patients with an ADD also had higher rates of total knee arthroplasty (P = .001) and ipsilateral revision meniscus surgery (left knee: P = .020; right knee: P = .019) within 2 years.</p><p><strong>Conclusions: </strong>Patients with an anxiety or depressive disorder have higher rates of health care utilization, medical complications, opioid prescriptions, and subsequent knee surgery after isolated primary arthroscopic partial meniscectomy.</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":4.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473230","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":"Delayed Anterior Cruciate Ligament Reconstruction Is Associated With Lower Odds of Returning to Preinjury Physical Activity Level at 12 Months Follow-Up.","authors":"Johan Högberg, Emily Fridh, Ramana Piussi, Rebecca Hamrin Senorski, Riccardo Cristiani, Kristian Samuelsson, Roland Thomeé, Eric Hamrin Senorski","doi":"10.1016/j.arthro.2025.02.011","DOIUrl":"10.1016/j.arthro.2025.02.011","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the effects of timing of anterior cruciate ligament (ACL) reconstruction on the odds to recover muscle (quadriceps and hamstring) strength, return to preinjury physical activity level, and achieve rehabilitation goals at 12 months follow-up.</p><p><strong>Methods: </strong>Data were extracted from a local rehabilitation registry in Sweden in November 2023. Patients ≥16 years old who underwent primary ACL reconstruction with hamstring tendon autografts, who underwent isokinetic muscle strength assessment, and responded to patient-reported outcomes 12 months after surgery were included. A multivariable logistic regression analysis was used to analyze the association between timing of ACL reconstruction and the recovery of muscle strength, return to preinjury physical activity level, and achievement of rehabilitation goals. The results of the logistic regression analysis were expressed as odds ratios for every 1-unit increase in the predictor variable (months between ACL injury and reconstruction).</p><p><strong>Results: </strong>In total, 715 patients were included, of whom 53.4% (n = 383) were women. The mean age at ACL reconstruction was 28.3 ± 10.5 years, and the median time between ACL injury to reconstruction was 4.9 months (interquartile range [IQR] 2.9-9.4). Delayed ACL reconstruction significantly decreased the odds of returning to preinjury physical activity level at 12 months in patients with a Tegner score of 6-10 (odds ratio 0.97; 95% confidence interval 0.94-0.99, P = .009), regardless of age. Shorter median time in months from ACL injury to reconstruction was observed for patients who returned to preinjury physical activity level, especially in younger patients (16-30 years old) (3.9 [IQR 2.5, 6.5] vs 4.7 [IQR 2.9, 9.1], P = .007) and in patients who participated in pivoting activities (Tegner scale 6-10) preinjury (3.4 [IQR 2.3, 6.2] vs 5.0 [IQR 2.9, 9.7], P < .001).</p><p><strong>Conclusions: </strong>Delayed ACL reconstruction reduces the odds of returning to preinjury physical activity level in patients active in pivoting activities preinjury (Tegner 6-10), regardless of age, 12 months after surgery.</p><p><strong>Level of evidence: </strong>Level III, retrospective study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-02-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143473213","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}