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

{"title":"Editorial Commentary: The Ideal Treatment Option for Hip Cartilage Repair Remains Elusive and Requires Consideration of Individual Patient Factors.","authors":"Alexander Zimmerer","doi":"10.1016/j.arthro.2024.09.044","DOIUrl":"10.1016/j.arthro.2024.09.044","url":null,"abstract":"<p><p>Arthroscopic treatment of hip chondral lesions is a challenge. Recent research shows arthroscopic debridement with preservation of the subchondral bone plate shows superior results compared with microfracture. The results of microfracture can be unpredictable, largely because of the formation of fibrocartilage, which lacks the durability of hyaline cartilage. Autologous matrix-induced chondrogenesis has emerged as a promising alternative. This technique combines microfracture or abrasion with the application of a collagen membrane and aims to enhance the quality of the repair tissue. Autologous matrix-induced chondrogenesis not only improves patient-reported outcomes but also decreases the rate of conversion to total hip arthroplasty when compared with microfracture. Yet, the results remain only fair and variable. Autologous chondrocyte implantation, which involves the cultivation and reimplantation of chondrocytes, although more labor-intensive, may lead to a more robust and durable repair. In addition, newer methods like minced cartilage implantation show encouraging early results. We are in the early stages of understanding cartilage repair, and individual patient factors, such as size of the lesion, patient age, activity level, and coexisting conditions all require consideration.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332997","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: Magnetic Resonance Imaging Reveals Rotator Cuff Tear Size, Retraction, Length, and Geometry; Muscle Volume and Degeneration; and Tendon Quality.","authors":"Samer S Hasan","doi":"10.1016/j.arthro.2024.09.041","DOIUrl":"10.1016/j.arthro.2024.09.041","url":null,"abstract":"<p><p>Magnetic resonance imaging (MRI) of the shoulder is commonly used for evaluating muscle bulk and fatty degeneration, as well as tendon tear size, geometry, retraction, and length. However, MRI can also be used to evaluate tendon quality. Increased rotator cuff tendon signal on T2-weighted fat-suppressed MRI appears to be a marker of tendon degeneration and potentially of impaired healing potential. Tendon signal intensity merits closer attention and may be especially relevant when selecting chronic degenerative tears for repair in patients with other risk factors for nonhealing.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333006","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":"Autograft and Allograft Anterior Cruciate Ligament Reconstruction in Patients Older Than 40 Years Have Similar Short-Term Patient-Reported Outcomes With Greater Rates of Anterior Cruciate Ligament Graft Failure in Patients Who Receive Allograft.","authors":"Rebekah M Kleinsmith, Stephen A Doxey, Fernando A Huyke-Hernández, Arthur J Only, Christopher Y Kweon, Brian P Cunningham","doi":"10.1016/j.arthro.2024.09.034","DOIUrl":"10.1016/j.arthro.2024.09.034","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate short-term patient-reported outcomes (PROs) in patients aged 40 years and older after primary anterior cruciate ligament reconstruction (ACLR) between patients who received allograft or autograft. Secondary aims included assessing the effect of preexisting osteoarthritis on short-term PROs.</p><p><strong>Methods: </strong>A retrospective review of an ambulatory surgery center's electronic medical record was conducted for patients who underwent primary ACLR between 2009 and 2022. Patients aged younger than 40 years, those who underwent index revision procedures and/or concomitant ligament repair/reconstructions, and those with incomplete baseline or short-term (1- or 2-year) Knee Injury and Osteoarthritis Outcomes Score (KOOS) scores were excluded. Patients who received allograft or autograft were matched according to sex and body mass index in a 2:1 fashion. PROs used included KOOS and Single Assessment Numeric Evaluation (SANE) at baseline and short-term follow-up (minimum of 1 year). Minimum clinically important difference was calculated in a distribution-based fashion. Osteoarthritis severity was determined on the basis of Kellgren-Lawrence (KL) grading of perioperative knee radiographs. Preexisting osteoarthritis was defined as KL grade 1 or more.</p><p><strong>Results: </strong>A total of 331 patients were included after matching (215 allograft and 116 autograft patients). The average age was 47.7 ± 6.0 years (range 40-66 years). Age differed significantly between the 2 groups, with the allograft cohort having an average age of 48.6 ± 6.0 years and the autograft cohort having an average age of 46.1 ± 5.7 years (P < .001). Short-term change in KOOS and SANE scores did not differ by graft type (P = .154, P = .556, respectively). Sixty-seven percent of all patients met minimum clinically important difference for KOOS and 82% of patients with complete baseline and short-term SANE scores met minimum clinically important difference for SANE. There was a statistically significant difference in rupture rates between the allograft and autograft cohorts (n = 9 allograft vs n = 0 autograft; P = .030). There was no difference in reoperation rates between the autograft and allograft cohorts (P = .453). Perioperative KL grading did not affect outcomes for either graft type (allograft: P = .905 vs autograft: P = .522).</p><p><strong>Conclusions: </strong>Middle-aged patients undergoing ACLR with allograft or autograft demonstrate similar short-term PROs. Preexisting osteoarthritis similarly did not significantly affect short-term outcomes. However, rerupture rates were significantly greater in the allograft cohort than the autograft cohort.</p><p><strong>Level of evidence: </strong>Level III, therapeutic, retrospective, case control study.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332993","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: Suture Tape Augmentation Enhances Recovery After Anterior Cruciate Ligament Surgery and Is Cost-Effective, While Biologic Augmentation Requires Well-Powered Controlled Trials.","authors":"Patrick A Smith","doi":"10.1016/j.arthro.2024.09.042","DOIUrl":"10.1016/j.arthro.2024.09.042","url":null,"abstract":"<p><p>Adding a biologic \"mix\" to facilitate anterior cruciate ligament (ACL) graft healing in bone tunnels is a promising option. Of course, optimization of graft healing in the femoral and tibial tunnels may or may not translate into a better biologic ACL graft. Specifically, after biologic tunnel augmentation, does the graft itself revascularize and remodel more rapidly to allow early return to sport earlier, which could justify the increased cost of biologic augmentation? This remains an unknown. While biologics require further investigation, what is known is that suture tape augmentation protects ACL grafts at higher loads by increasing construct stiffness to avoid elongation, whereas most low loads enhancing graft incorporation and healing are experienced by the grafts. Clinically, recent research shows that suture tape augmentation of ACL quadriceps autograft (without biologics) in young athletes (with an average age of 17) showed no graft retears at a 3-year follow-up and 90% return to sport, and suture tape augmentation is inexpensive.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333011","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: Anterior Cruciate Ligament Tear Treatment Requires Consideration of Physical Examination, Graft Selection, Surgical Technique, Rehabilitation, and Expected Outcomes With a Primary Goal of Prevention of Failure or Revision Surgery.","authors":"Periklis Giannakis, Sophia T Zhuang, Robert G Marx","doi":"10.1016/j.arthro.2024.09.040","DOIUrl":"10.1016/j.arthro.2024.09.040","url":null,"abstract":"<p><p>Appropriate graft sizing is imperative for the success of anterior cruciate ligament reconstruction and is more challenging for hamstring autografts than grafts with bone plugs. It is important to select the optimal graft for each patient on the basis of their characteristics. When researching anterior cruciate ligament reconstruction outcomes, we prefer a holistic approach, assessing many variables, including appropriate graft selection and sizing, surgical technique, physical examination, rehabilitation milestones, patient-reported outcomes, and return to sport, to view the whole picture. However, the most significant outcome for us is arguably failure and/or revision rates, as they have major consequences to the patients.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332989","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":"Compression of an Autograft Biceps Into an Augmentation Patch Does Not Cause Mechanical Damage to the Tenocyte.","authors":"Joseph C Brinkman, Justin L Makovicka, Patrick J Denard, Gregory P Colbath, Jeremy Mercuri, John M Tokish","doi":"10.1016/j.arthro.2024.09.029","DOIUrl":"10.1016/j.arthro.2024.09.029","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the effects of this graft preparation technique on histologic evidence of tenocyte mechanical damage.</p><p><strong>Methods: </strong>A consecutive series of patients undergoing biceps tenodesis for shoulder pathology were evaluated. After suprapectoral tenodesis, 27 mm of the long head of the biceps was secured for compression into the patch. The remaining length of the residual tendon was longitudinally split, resulting in 2 equal lengths of remnant tendon from the same zone. One sample was sent to pathology with no preparation, and the other was prepared as a compressed biceps autograft patch according to the manufacturer's recommendations. Both grafts were sent to pathology for evaluation of tenocyte morphology. Records were reviewed to determine if compression resulted in mechanical damage to the tenocytes at the time of biceps augmentation.</p><p><strong>Results: </strong>Fifty-five shoulder procedures and 110 samples were sent for pathology analysis. Forty-two of the 55 (76%) specimens demonstrated morphologically normal tenocytes in both the compressed and noncompressed groups, and 7 (13%) cases showed evidence of tenocyte necrosis or mechanical damage in both groups. The difference in abnormal tenocyte morphology between the compressed and native groups was not statistically significant (P = .625).</p><p><strong>Conclusions: </strong>Autograft biceps compression into a point-of-care patch did not result in mechanical damage to tenocyte morphology at the time of insertion for augmentation of rotator cuff pathology.</p><p><strong>Clinical relevance: </strong>Free proximal biceps tendon compression can result in a patch that does not mechanically damage the tenocyte. The patch can be used as a biologic autograft to enhance shoulder rotator cuff repair, as well as subscapularis repair in the setting of shoulder arthroplasty.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332995","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: Meniscus Allograft Transplantation With Concomitant High Tibial Osteotomy and Cartilage Restoration Risks Reoperations and Potential Worsening Outcomes Following Subsequent Total Knee Arthroplasty.","authors":"Molly M Piper, Robert A Gallo","doi":"10.1016/j.arthro.2024.09.035","DOIUrl":"10.1016/j.arthro.2024.09.035","url":null,"abstract":"<p><p>The management of the 25- to 45-year-old patient with meniscal deficiency, chondral degeneration, and pain remains challenging. With the potential of a knee replacement in the future, the question I wrestle with is, \"When is enough enough?\" Meniscus allograft transplantation, when combined with osteotomy and/or cartilage restoration procedures, improves functional outcomes compared to preoperative levels but has not been demonstrated to delay progression of osteoarthritis and often leads to reoperations. Moreover, concomitant procedures do not show improved survivorship of the meniscal allograft. While many undergoing these procedures return to active lifestyles, many do not return to preinjury levels. Balanced clinical-patient discussions are needed about the benefits, limitations, and expectations of meniscus allograft transplantation and associated procedures on not only the current condition of the knee but also the future implications, including reoperations and potential worsening outcomes following total knee arthroplasty. Notably, meniscal allograft transplantation and concomitant procedures lead to additional surgeries, with up to a 59% reoperation rate at an average of 43 months. In some, more surgery does not necessarily lead to improved outcomes, and caution should be exercised; only 44% return to preinjury activity level after meniscus allograft transplantation and high tibial osteotomy. Forty percent are disappointed by level and type of sports participation following meniscus allograft transplantation, but only 14% of those patients would not undergo the procedure again.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333005","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: Arthroscopic Superior Capsular Reconstruction Acts as a Biologic Spacer by Increasing Acromiohumeral Distance.","authors":"Albert Lin, Matthew Kolevar","doi":"10.1016/j.arthro.2024.09.032","DOIUrl":"10.1016/j.arthro.2024.09.032","url":null,"abstract":"<p><p>Massive rotator cuff tears can be successfully treated with a wide variety of surgical procedures depending on many patient factors. The arthroscopic superior capsular reconstruction (SCR) is a good procedure for a younger patient with pseudoparesis, no lag signs, and a primary complaint of pain. How does the SCR work to achieve a good clinical outcome? One theory is that it restores the force couple and normal kinematics of the shoulder, but more evidence supports the theory that it acts as a biologic spacer. Differences in success of autograft versus allograft is likely due to graft thickness. Recent studies have shown that 6- to 8-mm fascia lata autograft has better outcomes than 2- to 4-mm dermal allograft. Improving the acromiohumeral distance and tissue healing to the tuberosity is important because this may prevent painful impingement. In our experience, when a patient has painful impingement and preserved motion or pseudoparesis, we will routinely offer a soft tissue procedure that can increase the acromiohumeral distance, acting as a spacer to prevent the greater tuberosity from contacting the acromion.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the Editor Regarding Systematic Reviews and Meta-analyses in Arthroscopy: The Difficult Balance Between Accuracy and Clinical Usefulness.","authors":"Jelle P van der List","doi":"10.1016/j.arthro.2024.09.038","DOIUrl":"10.1016/j.arthro.2024.09.038","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333000","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":"Bioinductive Collagen Implant Has Potential to Improve Rotator Cuff Healing: A Systematic Review.","authors":"Eoghan T Hurley, Jack Twomey-Kozack, Tom R Doyle, Lucy E Meyer, Alex M Meyer, Samuel G Lorentz, Kendall E Bradley, Jonathan F Dickens, Christopher S Klifto","doi":"10.1016/j.arthro.2024.09.028","DOIUrl":"10.1016/j.arthro.2024.09.028","url":null,"abstract":"<p><strong>Purpose: </strong>To systematically review the literature to evaluate the clinical studies on bioinductive collagen implant (BCI) for the treatment of rotator cuff tears.</p><p><strong>Methods: </strong>A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies reporting BCI for rotator cuff tears were included. Quantitive and qualitative data were evaluated.</p><p><strong>Results: </strong>A total of 21 studies were included. In patients with full-thickness tears, 7 of the 8 studies with pre- to postoperative American Shoulder and Elbow Surgeons (ASES) scores demonstrated statistically significant improvements in mean pre- to postoperative ASES scores, with 75% to 100% of patients meeting the minimal clinically important difference. In those with partial-thickness tears, 7 of the 8 studies with pre- to postoperative ASES scores demonstrated statistically significant improvements in mean pre- to postoperative ASES scores, with 54.4% to 100% of patients meeting the minimal clinically important difference. For studies that quantified percent increases in tendon thickness, the reported increases ranged from 13% to 44% in full-thickness tears and 14% to 60% in partial-thickness tears. Six studies evaluated rotator cuff retears after BCI treatment in the full-thickness cohort, with rates reported ranging from 0% to 9%. Five studies evaluated rotator cuff retears after BCI treatment in the partial-thickness cohort, with rates reported ranging from 0% to 18%. Two of the included studies found that BCI was cost-effective due to the increased tendon healing, with cost savings of $5,338 to $13,061 per healed rotator cuff tendon.</p><p><strong>Conclusions: </strong>The literature on rotator cuff tear augmentation with BCI has shown consistently reported good results. Additionally, there was evidence of low retear rates and consistently improved tendon thickness with BCI, with 2 randomized controlled trials showing improved tendon healing with BCI. However, there appears to be a higher rate of adhesive capsulitis reported.</p><p><strong>Level of evidence: </strong>Level IV, systematic review of Level I, III, and IV studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332994","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}