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

{"title":"Nationwide Database Analysis Shows Proximal Hamstring Repair in Adult Patients Is Associated With Lower Failure and Complication Rates Than Reconstruction.","authors":"Sophia J Wang, Ryan T Halvorson, Joshua Chung, Rachel Yu, C Benjamin Ma, Stephanie E Wong, Alan L Zhang","doi":"10.1016/j.arthro.2025.05.025","DOIUrl":"10.1016/j.arthro.2025.05.025","url":null,"abstract":"<p><strong>Purpose: </strong>To compare reoperation and complication rates after proximal hamstring repair and reconstruction in a large nationwide sample.</p><p><strong>Methods: </strong>This retrospective cross-sectional study used a large nationwide insurance claims database with deidentified data (PearlDiver). Adult patients undergoing proximal hamstring repair (Current Procedural Terminology code 27385) or reconstruction (Current Procedural Terminology code 27386) with a diagnosis of proximal hamstring tear (International Classification of Diseases, Tenth Revision code S7631X) were included. A minimum 2-year follow-up was required. Rates of reoperation, emergency department (ED) utilization, and major complications (venous thromboembolism [VTE], sciatic nerve injury, and deep postoperative infection) were tabulated. Complication rates and ED utilization were compared using the Fisher exact test, and reoperations were assessed using Kaplan-Meier analysis.</p><p><strong>Results: </strong>A total of 2,813 patients (54.2% female) were included, with 2,656 undergoing proximal hamstring repair and 157 undergoing proximal hamstring reconstruction from 2015 to 2022. Proximal hamstring repair patients showed a lower 2-year reoperation rate compared with reconstruction patients (2.8% vs 5.7%, P = .038). The overall rates of VTE, sciatic nerve injury, and infection were 2.73%, 0.76%, and 0.91%, respectively. Patients undergoing repair showed lower rates of infection (0.69% vs 4.55%, P < .001) but had similar rates of sciatic nerve injury (0.81% vs 0.0%, P = .263) and VTE (2.62% vs 4.55%, P = .156) compared with patients undergoing reconstruction. There were no significant differences in rates of postoperative hospitalization or ED utilization.</p><p><strong>Conclusions: </strong>Patients undergoing proximal hamstring repair showed lower reoperation and postoperative infection rates compared with patients undergoing proximal hamstring reconstruction.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192491","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":"Distal High Tibial Osteotomy Allows Improved Patellofemoral Joint Preservation but Results in Increased Posterior Tibial Slope Compared to Proximal High Tibial Osteotomy.","authors":"Yukio Akasaki, Yu Soejima, Satoshi Hamai, Shinya Kawahara, Taishi Sato, Yasuharu Nakashima","doi":"10.1016/j.arthro.2025.05.017","DOIUrl":"10.1016/j.arthro.2025.05.017","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the postoperative trajectory of posterior tibial slope (p-TS) after distal (DTO) versus proximal (PTO) biplanar open-wedge high tibial osteotomy performed with an identical, early weightbearing protocol.</p><p><strong>Methods: </strong>All consecutive open-wedge high tibial osteotomies performed from May 2015 to December 2020 were reviewed. Eligible knees had complete lateral radiographs (preoperative, 1 week, 1 month, 3 months, 6 months, 12 months) and a ≥24-month follow-up. p-TS and Caton-Deschamps index were measured. International Cartilage Repair Society cartilage grade at routine plate removal was recorded.</p><p><strong>Results: </strong>Thirty consecutive DTOs and 30 consecutive PTOs were retrospectively compared. The mean p-TS in the DTO group initially decreased after osteotomy but subsequently increased compared to the PTO group (P = .016). From 1 week to 12 months postoperatively, 9 of 30 knees (30%) that underwent DTO had a >2° increase in p-TS, compared with 2 of 30 knees (7%) that underwent PTO (P = .045). Of the 9 DTO knees with a >2° p-TS increase, 4 exhibited widening of the descending gap (the descending cut in the tibial tuberosity) and nonunion in the retrotubercle. The p-TS correction loss primarily occurred between 1 and 3 months postoperatively (P < .001). Arthroscopic assessment revealed patellofemoral cartilage deterioration in 8 of 28 knees (29%) in the PTO group, compared to only 1 of 28 knees (4%) in the DTO group (P = .024). A greater change in the Caton-Deschamps index was associated with patellofemoral cartilage deterioration at 12 months (P = .021).</p><p><strong>Conclusions: </strong>The p-TS changes during the postoperative course occurred more frequently in DTO compared to PTO. In DTO, p-TS increased for up to 12 months postoperatively, with the most substantial changes occurring between 1 and 3 months. While DTO has the advantage of preserving the patellofemoral joint, the increase in p-TS may require careful attention, as it could adversely impact bone union in the retrotubercle.</p><p><strong>Level of evidence: </strong>Level III, retrospective comparative case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175273","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":"Allografts and Autografts in Primary Hip Labral Reconstruction Result in Improved Postoperative Outcomes, With Autografts Demonstrating Lower Revision and Complication Rates: A Systematic Review.","authors":"Colton C Mowers, Justin T Childers, Benjamin T Lack, Ariel S Hus, Matthew T McKinley, Garrett R Jackson, Steven F DeFroda","doi":"10.1016/j.arthro.2025.05.023","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.05.023","url":null,"abstract":"<p><strong>Purpose: </strong>To compare patient-reported outcomes, complications and revision rates following the use of autograft versus allograft for primary arthroscopic hip labral reconstruction.</p><p><strong>Methods: </strong>The PubMed, Scopus, and Embase databases were queried following the 2020 PRISMA guidelines to identify human clinical studies reporting outcomes following primary arthroscopic hip labral reconstruction with a minimum follow-up of two years. Studies that did not report graft type or outcomes were excluded. Studies were separated into two cohorts based on graft type, allograft or autograft. The mean delta (change from preoperative to postoperative values) was calculated for each patient reported outcome score and compared between cohorts. The MINORS criteria was used to evaluate bias.</p><p><strong>Results: </strong>Seventeen studies (allograft=9 studies, autograft=11 studies) of 756 patients were included. Mean follow-up for the allograft cohort was 37 months (mean range, 25.5-66.1) compared to 38.3 months (mean range, 25.4-80.8) for the autograft cohort. At final follow-up, delta values for modified Harris Hip Score ranged from 18.2-34 (allograft) versus 9.4-31.7 (autograft), HOS-Sports scale ranged from 24.2-39.7 (allograft) versus 21.4-41.3 (autograft), Visual Analog Pain scale ranged from -5.7 to -1.7 (allograft) versus -5.7 to -2.4 (autograft), and delta values for the Non-Arthritic Hip score ranged from 19.7-31.3 (allograft) versus 16.6-35.4 (autograft). Postoperative complication rates ranged from 0.0% to 17.6% (allograft) versus 0.0% to 9.1% (autograft). The most common complication for the allograft cohort was numbness (n=2) versus heterotopic ossification (n=6) in the autograft cohort. Rates of arthroscopic revision surgery were 0.0% to 5.9% (allograft) versus 0.0% to 9.1% (autograft), while conversion to total hip arthroplasty ranged from 0.0% to 17.6% (allograft) versus 0.0% to 8.3% (autograft).</p><p><strong>Conclusion: </strong>The use of allografts and autografts in primary hip labral reconstruction results in improved postoperative outcomes. However, allografts were associated with higher rates of complications with worse graft survivorship.</p><p><strong>Level of evidence: </strong>IV, Systematic Review of Level of Evidence III-IV Studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183283","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":"Transosseous Tunnel Suture Fixation Results in Similar Rerupture Rates and Patient-Reported Outcome Measures Compared to Suture Anchors for Primary Quadriceps Tendon Repair: A Systematic Review.","authors":"Nicholas B VanDerwerker, Alec E Winzenried, Samuel J Mosiman, Brian F Grogan, Geoffrey S Baer, Eric J Cotter","doi":"10.1016/j.arthro.2025.04.059","DOIUrl":"10.1016/j.arthro.2025.04.059","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the clinical outcomes of transosseous tunnel (TO) techniques to suture anchor (SA) techniques for the primary repair of unilateral quadriceps tendon ruptures (QTRs).</p><p><strong>Methods: </strong>A systematic review of the PubMed database was performed for studies containing rerupture and/or patient-reported outcome measure (PROM) outcome data of primary QTR repairs utilizing TO and/or SA techniques. Included studies were evaluated using the Methodological Index for Nonrandomized Studies scoring system.</p><p><strong>Results: </strong>Twelve studies including 600 patients met inclusion criteria for the systematic review. The level of evidence for these studies ranged from III to IV, with most (n = 10; 83.3%) being retrospective case series. Within included studies, TO repairs accounted for 79.5% of patients (n = 477), while 20.5% (n = 123) underwent repair using SA. All publications using SAs reported placing 2 to 3 anchors for the primary QTR repair. Studies reporting using TO methods mostly placed 3 patellar drill holes, although 1 study only used 2 drill holes, 2 studies used 3 to 4 drill holes, and 3 studies did not report this information. QTR rerupture rates varied between 0% and 16.7% for TO techniques and between 0% and 14.7% for SA techniques. PROM collection varied widely, with limited data to clearly show the superiority of TO or SA techniques. The methodologic quality for noncomparative studies was moderate, with a mean score of 10.2 ± 1.3 (range, 8-12), and was moderate for comparative studies, with a mean score of 15.7 ± 2.1 (range, 14-18).</p><p><strong>Conclusions: </strong>Rerupture rates were similar between TO and SA repair methods for primary QTR repairs. Some data indicate that SA techniques might show superior outcomes based on PROMs between SA and TO methods for the primary repair of QTRs, but high-quality evidence is lacking.</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":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183475","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":"Biceps Tenodesis/Tenotomy Disrupts Biomechanical Glenohumeral Stability in the Setting of Superior Labrum Anteroposterior Tear and Repair.","authors":"Hayk Stepanyan, Aaron T Hui, Victor T Hung, Michelle H McGarry, Charles Long, Gregory J Adamson, Thay Q Lee","doi":"10.1016/j.arthro.2025.05.022","DOIUrl":"10.1016/j.arthro.2025.05.022","url":null,"abstract":"<p><strong>Purpose: </strong>To compare the biomechanical stability of the glenohumeral joint both before and after a SLAP tear to: (1) posterior SLAP repair, (2) posterior plus anterior SLAP repair, (3) biceps tenodesis with SLAP repair, and (4) biceps tenodesis without SLAP repair.</p><p><strong>Methods: </strong>Eight cadaveric shoulders were tested using a custom testing system. Twenty-two-Newton glenohumeral compressive force and 5-N biceps load was applied. All testing was performed in 30° and 60° of glenohumeral abduction. Humeral rotational range of motion was measured with 2.2 Nm torque. Glenohumeral anteroposterior (AP) and superoinferior (SI) translation was measured in 45° and 90° external rotation with 10 and 15 N loads. Six conditions were tested: intact; SLAP tear (10:00 to 2:00 o'clock); posterior SLAP repair (2 anchors at 10:30 and 11:30); posterior plus anterior SLAP repair (an additional anchor at 1:30); simulated biceps tenodesis with SLAP repair; and simulated biceps tenodesis without SLAP repair. Repeated measures analysis of variance with Tukey post hoc test was used for statistical analysis.</p><p><strong>Results: </strong>There were no significant differences with SLAP tear or repair in AP/SI translation or range of motion compared with intact. Both simulated tenodesis conditions increased max external rotation compared with intact (P < .006). Simulated tenodesis with SLAP repair significantly increased AP (6/8 positions) and SI translation (2/8 positions) compared with intact. Simulated tenodesis without SLAP repair significantly increased AP (all positions) and SI translation (3/8 positions) compared with intact.</p><p><strong>Conclusions: </strong>The long head of the biceps has a pertinent biomechanical role in glenohumeral stability regardless of the condition of the superior labrum. The addition of an anterior anchor for SLAP repair did not restrict external rotation in this cadaveric model.</p><p><strong>Clinical relevance: </strong>The potential contribution of the biceps to biomechanical stability should be a consideration when treating biceps pathology.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175265","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":"Increased Meniscal Extrusion at 1 Year After Surgery Is Associated With a Lower Likelihood of Substantial Mid-Term Patient-Perceived Improvement After Medial Meniscal Root Tear Repair.","authors":"Hyun-Soo Moon, Min Jung, Chong-Hyuk Choi, Kwangho Chung, Se-Han Jung, Junwoo Byun, Hyeongwon Ham, Sung-Hwan Kim","doi":"10.1016/j.arthro.2025.04.058","DOIUrl":"10.1016/j.arthro.2025.04.058","url":null,"abstract":"<p><strong>Purpose: </strong>To analyze factors influencing achievement of mid-term substantial clinical improvement after surgical repair of medial meniscal root tears (MMRTs).</p><p><strong>Methods: </strong>Patients who underwent arthroscopic pullout repair of MMRTs between 2010 and 2018 with minimum 5-year follow-up were reviewed. Patients were classified into 2 groups based on achieving substantial clinical improvement at 5 years using published substantial clinical benefit (SCB) values: Group 1 showed improvement beyond the SCB thresholds in both the International Knee Documentation Committee subjective score and Lysholm score, whereas group 2 did not reach the SCB threshold for one or both scores. Additionally, secondary grouping was performed using minimal clinically important difference (MCID) values based on the same criteria as SCB grouping. Comparative analyses were performed for both groupings, followed by regression analyses to identify factors influencing achievement of clinical improvement. In particular, SCB-based regression analyses were performed using multiple models with adjusted SCB thresholds.</p><p><strong>Results: </strong>Of 64 patients, 22 (34.4%) achieved SCB-level improvement and 36 (56.3%) achieved MCID-level improvement at 5 years postoperatively. Age, postoperative medial meniscal extrusion (MME) at 1 year, and preoperative-to-postoperative difference in MME were significantly higher in group 2 patients than in group 1 patients (P = .005, P = .013, and P = .047, respectively). Group 2 also exhibited higher Kellgren-Lawrence grades and greater progression of Kellgren-Lawrence grades at 5 years postoperatively (P = .003 and P = .015, respectively). Subsequently, perioperative variables showing differences in between-group comparisons were included in the SCB-based regression analyses, with postoperative MME consistently identified across all models as a factor influencing the achievement of mid-term clinical improvement after surgical repair of MMRTs (P = .015, P = .034, and P = .014 in models 1, 2, and 3, respectively). The analysis based on secondary grouping using MCID values showed consistent results.</p><p><strong>Conclusions: </strong>The number of patients who perceived substantial clinical improvement 5 years after surgical repair of MMRTs was relatively small. Notably, increased MME at 1 year postoperatively was associated with a lower likelihood of achieving patient-perceived substantial clinical improvement at 5 years.</p><p><strong>Level of evidence: </strong>Level IV, retrospective prognostic case series.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175573","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":"Commercial Products Using Generative Artificial Intelligence Include Ambient Scribes, Automated Documentation and Scheduling, Revenue Cycle Management, Patient Engagement and Education, and Prior Authorization Platforms.","authors":"Kyle N Kunze, Jennifer Bepple, Asheesh Bedi, Prem N Ramkumar, Christian A Pean","doi":"10.1016/j.arthro.2025.05.021","DOIUrl":"10.1016/j.arthro.2025.05.021","url":null,"abstract":"<p><p>The integration of artificial intelligence into clinical practice is rapidly transforming health care workflows. At the forefront are large language models (LLMs), embedded within commercial and enterprise platforms to optimize documentation, streamline administration, and personalize patient engagement. The evolution of LLMs in health care has been driven by rapid advancements in natural language processing and deep learning. Emerging commercial products include ambient scribes, automated documentation and scheduling, revenue cycle management, patient engagement and education assistants, and prior authorization platforms. Ambient scribes remain the leading commercial generative artificial intelligence product, with approximately 90 platforms in existence to date. Emerging applications may improve provider efficiency and payer-provider alignment by automating the prior authorization process to reduce the manual labor burden placed on clinicians and staff. Current limitations include (1) lack of regulatory oversight, (2) existing biases, (3) inconsistent interoperability with electronic health records, and (4) lack of physician and stakeholder buy-in due to lack of confidence in LLM outputs. Looking forward requires discussion of ethical, clinical, and operational considerations.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152908","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: Osteochondral Allograft Outcomes Are Durable at Longer Follow-Up.","authors":"Jelle P van der List, David C Flanigan","doi":"10.1016/j.arthro.2025.05.020","DOIUrl":"10.1016/j.arthro.2025.05.020","url":null,"abstract":"<p><p>Patients with chondral and osteochondral lesions often present with debilitating symptoms. Several treatments are available, ranging from microfracture and autologous chondrocyte implantation to osteochondral autograft and osteochondral allograft transplantation (OCA). Over the last 2 decades, significant improvement in the indications, graft storage and surgical outcomes of OCA have been seen with excellent patient-reported outcome measures and reliable return-to-sports rates. Long-term studies identifying risk factors for graft failure or disappointing subjective outcomes are important to further understand the ideal candidate for OCA. Studies have identified coronal malalignment, ligament instability, meniscal insufficiency, higher body mass index, older age, and longer duration of symptoms as risk factors for failure, and corresponding concomitant procedures often are performed with OCA to improve success rates. Future larger studies are needed to further identify predictors of success, preferably larger cohorts in which confounders and other factors can be accounted and corrected for. OCA remains an excellent treatment for osteochondral lesions with durable outcomes at long-term follow-up.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152833","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 Contemporary International Expert Consensus Statement on the Evaluation, Diagnosis, Treatment, and Rehabilitation of Injuries to the Posterolateral Corner of the Knee.","authors":"Robert F LaPrade, Cameron Gerhold, Kyle N Kunze, Andrew G Geeslin, Luke V Tollefson, Udit Dave, José Rafael Garcia, Björn Barenius, Charles Brown, Túlio Vinícius de Oliveira Campos, Moisés Cohen, Lars Engebretsen, Gonzalo Ferrer, Carlos E Franciozi, Brett A Fritsch, Karl-Heinz Frosch, Pablo E Gelber, Alan Getgood, Michael Hantes, Michael Held, Camilo P Helito, Eivind Inderhaug, Steinar Johansen, Koen Carl Lagae, Bruce A Levy, Martin Lind, Timothy Lording, Rodrigo Maestu, Fabrizio Margheritini, Jacques Menetrey, Gilbert Moatshe, Joan C Monllau, Iain R Murray, Roberto Negrín, David A Parker, Nicolas Pujol, James Robinson, Kristian Samuelsson, Ciara Stevenson, Maria J Tuca, Soshi Uchida, Wybren A van der Wal, Silvio Villascusa, Richard P B Von Bormann, Jorge Chahla","doi":"10.1016/j.arthro.2025.04.055","DOIUrl":"10.1016/j.arthro.2025.04.055","url":null,"abstract":"<p><strong>Purpose: </strong>To use a modified Delphi technique to generate an expert consensus statement on the evaluation, diagnosis, treatment, and rehabilitation of posterolateral corner (PLC) injuries of the knee.</p><p><strong>Methods: </strong>A 5-individual working group developed a list of 62 statements regarding PLC injuries for use in a 3-round modified Delphi series. Ultimately, 40 statements were retained, and a 100% participation rate was observed in all rounds. Consensus for each statement was quantified.</p><p><strong>Results: </strong>Overall, 82.5% of statements reached consensus. Consensus was reached regarding the following: (1) The dial, posterolateral drawer, and external rotation recurvatum tests, magnetic resonance imaging, varus-stress radiographs, and bilateral hip-to-ankle radiographs have diagnostic utility. (2) The presence of concomitant meniscal pathology or neuromuscular injury influences surgical timing. (3) Useful classification systems to guide treatment of PLC injuries currently do not exist. (4) Acute soft-tissue avulsions involving a single stabilizing structure can be repaired. (5) Isolated repair of grade III PLC tears should not be performed without augmentation or reconstruction, and complete grade III PLC injuries should undergo PLC reconstruction. (6) No universally accepted PLC reconstruction technique exists, although the LaPrade technique (anatomic reconstruction of the fibular collateral ligament, popliteus tendon, and popliteofibular ligament using 2 grafts secured in 2 femoral tunnels, 1 fibular tunnel, and 1 tibial tunnel) may confer superior outcomes. (7) There is no consensus on the utility of routine postoperative varus stress radiographs as an objective measure of surgical success.</p><p><strong>Conclusions: </strong>Statements that achieved unanimous consensus (all experts stating they \"strongly agree\") concerned routine use of physical and radiographic evaluations to confirm varus laxity due to PLC injuries and bilateral hip-to-ankle radiographs in the setting of chronic PLC injuries. Individualized treatment based on the presence of concomitant injuries and staged rehabilitation programs are essential. The significance of a grade III posterolateral drawer test in detecting external rotational laxity and whether common peroneal nerve neurolysis should be routinely performed remain in question. No single reconstruction technique confers optimal clinical outcomes. Postoperative varus stress radiographs are not reliable for determining residual laxity.</p><p><strong>Level of evidence: </strong>Level V, consensus of expert opinion.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144407","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 Pittsburgh Instability Tool Score Predicts Outcomes After Arthroscopic Anterior Shoulder Stabilization in Patients With Subcritical Bone Loss.","authors":"Shaquille Charles, Stephen Marcaccio, Ryan T Lin, Stephanie Boden, Ehab M Nazzal, Jonathan D Hughes, Adam Popchak, Bryson P Lesniak, Albert Lin","doi":"10.1016/j.arthro.2025.04.023","DOIUrl":"10.1016/j.arthro.2025.04.023","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To evaluate rates of recurrent anterior glenohumeral instability among patients with \"on-track\" Hill-Sachs lesions who underwent either arthroscopic Bankart repair (ABR) alone or arthroscopic Bankart repair with remplissage augmentation (ABR+R) and develop a risk assessment tool for recurrent anterior glenohumeral instability as well as evaluate the role of remplissage augmentation for on-track shoulders to predict outcomes after arthroscopic stabilization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We retrospectively reviewed prospectively collected data of patients aged 14 to 40 years who underwent ABR or ABR+R between 2013 and 2021. Chart review was performed to gather patient-specific risk factors such as patient age, gender, sport-specific participation, number of preoperative dislocations, and shoulder laxity, whereas imaging measurements were used to gather glenoid bone loss and distance-to-dislocation. Recurrent anterior glenohumeral instability was defined as recurrent dislocation and/or subjective subluxation postoperatively. Exclusion criteria included revision procedure, less than 2-year follow-up, presence of an \"off-track\" Hill-Sachs lesion, documented connective tissue disorder, concomitant rotator cuff tear, missing data, or the presence of glenoid bone loss &gt;20%. Multivariate hazard ratio estimates were used to create a risk assessment tool and correlated with patient-specific risk via postestimation analysis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 170 patients were included for analysis (ABR: 116, ABR+R: 54) with an average age of 21.5 ± 6.2 years and an average follow-up of 5.1 years (2.0-9.0 years). Near-track lesions (\"on-track\" lesions with a distance-to-dislocation value less than 10 mm), presence of hyperlaxity, younger age, 2+ preoperative recurrent instability episodes, contact sport athlete status, and increasing glenoid bone loss were independent risk factors for ABR failure on the basis of a final multivariate model predicting postoperative failure. Furthermore, patients undergoing ABR alone had a greater risk of recurrent instability than those undergoing ABR+R. From the final multivariate model using these prognostic factors, the hazard ratios were used to create the Pittsburgh Instability Tool (PIT) and was subsequently used to create risk-stratifying subgroups: low-risk (0-3), moderate-risk (4-8), high-risk (9-13), extreme-risk (14+). Remplissage augmentation lowered the PIT score by 8 points. Recurrent instability rates range from 2.2% among low-risk groups to 51.3% among extreme-risk groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The current study indicates that arthroscopic Bankart repair with remplissage augmentation can lower the rate of recurrent instability in patients with high-risk \"on-track\" lesions. Surgeons can use the PIT tool to identify suitable candidates who may or may not benefit from arthroscopic Bankart repair with or without remplissage augmentation by computing PIT scores f","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144414","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}