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The Journal of Bone & Joint Surgery最新文献

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Debridement of Unstable Chondral Lesions During Arthroscopic Partial Meniscectomy Provides No Long-Term Benefit: Patient Outcomes 9 Years After the Original ChAMP Trial. 关节镜下半月板部分切除术中不稳定软骨病变清创无长期益处:原ChAMP试验9年后的患者结果
Pub Date : 2025-09-25 DOI: 10.2106/jbjs.24.01196
Leslie Bisson,Kyle Flikkema,Paul Myers,Jacob E Geiger,Nomi S Weiss-Laxer,Zehua Zhou,Karim Belal,William Wind
BACKGROUNDArthroscopic partial meniscectomy (APM) for degenerative meniscal tears is one of the most common orthopaedic procedures. Surgeons often encounter chondral lesions during APM, and often debride them. The Chondral Lesions And Meniscus Procedures (ChAMP) trial found no benefit to debriding chondral lesions during APM at 1 and 5-year follow-up intervals. To gauge longer-term patient outcomes, we evaluated the original ChAMP trial patients 9 years after surgery.METHODSWe collected patient-reported outcome measures (PROMs) with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale for pain (VAS-Pain), and Short Form-36 (SF-36); performed a physical examination including evaluation of the range of motion, quadriceps circumference, and effusion; measured radiographic joint space narrowing; and recorded any subsequent surgery. We compared treatment groups (observation versus debridement) with t tests, multiple linear regression analysis, chi-square tests, and adjusted logistic regression. P values of <0.05 were considered significant. All analyses were completed using R statistical software.RESULTSOf the 190 patients in the original ChAMP trial, 140 (64 [69.6%] of those in the observation group and 76 [77.6%] of those in the debridement group; p = 0.278) were available for outcome collection at the 9-year follow-up. The majority of patients were male (62.6%), and the average age was 63.9 ± 7.2 years at the 9-year follow-up. Of those 140 patients, 25 (17.9%) had had subsequent surgery on the index knee. Of the remaining patients, 115 completed PROMs, 106 underwent the physical assessment, and 109 underwent radiographic examination. There were no differences between the treatment groups with regard to demographics, except for preoperative weight, which was adjusted for in the modeling. There were no significant differences between the groups with respect to the WOMAC pain score (p = 0.15), other PROMs, physical assessment measurements, radiographic measurements of joint-space narrowing in the surgically treated knees, or rates of subsequent surgery.CONCLUSIONSData collected at 9 years, including PROMs, findings on physical examination, joint space narrowing, and rates of subsequent surgery, indicated that there was no benefit to debriding unstable chondral lesions at the time of APM.LEVEL OF EVIDENCETherapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
背景:关节镜下半月板部分切除术(APM)治疗退行性半月板撕裂是最常见的矫形手术之一。外科医生在APM术中经常遇到软骨病变,并经常对其进行清创。软骨病变和半月板手术(ChAMP)试验发现,在1年和5年的随访间隔中,APM期间清除软骨病变没有任何益处。为了评估患者的长期预后,我们对最初的ChAMP试验患者进行了术后9年的评估。方法:我们收集了患者报告的预后指标(PROMs),包括西安大略省和麦克马斯特大学骨关节炎指数(WOMAC)、膝关节损伤和骨关节炎结局评分(oos)、疼痛视觉模拟量表(VAS-Pain)和SF-36;进行体格检查,包括评估活动范围、股四头肌围度和积液;x线测量关节间隙变窄;并记录所有后续手术。我们采用t检验、多元线性回归分析、卡方检验和校正logistic回归对治疗组(观察组与清创组)进行比较。P值<0.05为显著性。所有分析均采用R统计软件完成。结果在最初的ChAMP试验的190例患者中,140例(观察组64例[69.6%],清创组76例[77.6%],p = 0.278)在9年随访时可用于结局收集。患者以男性居多(62.6%),9年随访时平均年龄63.9±7.2岁。在这140例患者中,25例(17.9%)随后在膝关节上进行了手术。在剩余的患者中,115人完成了PROMs, 106人进行了身体评估,109人进行了放射检查。除术前体重外,治疗组之间在人口统计学方面没有差异,这在建模中进行了调整。两组在WOMAC疼痛评分(p = 0.15)、其他PROMs、物理评估测量、手术治疗膝关节关节间隙狭窄的x线测量或后续手术率方面无显著差异。结论9年收集的数据,包括PROMs,体格检查结果,关节间隙狭窄和后续手术率,表明在APM时清除不稳定软骨病变没有好处。证据级别:治疗性i级。参见《作者说明》获得证据级别的完整描述。
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引用次数: 0
Working to Mitigate Bias in ABOS Board Certification and Recertification. 努力减少ABOS董事会认证和再认证中的偏见。
Pub Date : 2025-09-17 DOI: 10.2106/jbjs.24.00636
Charles L Nelson,April D Armstrong
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引用次数: 0
Use of Network Meta-Analysis to Compare the Efficacy of Osteobiologics in Spinal Fusion: Commentary on an article by Luca Ambrosio, MD, et al.: "Efficacy and Safety of Osteobiologics for Lumbar Spinal Fusion. A Systematic Review and Network Meta-Analysis". 使用网络荟萃分析比较骨生物制剂在脊柱融合术中的疗效:对Luca Ambrosio, MD等人的一篇文章的评论:“腰椎融合术中骨生物制剂的疗效和安全性。系统评价与网络元分析”。
Pub Date : 2025-09-17 DOI: 10.2106/jbjs.25.00440
Thomas W Bauer
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引用次数: 0
ABOS Maintenance of Certification: Past, Present, and Future. 认证维护:过去、现在和未来。
Pub Date : 2025-09-17 DOI: 10.2106/jbjs.24.00621
Marybeth Ezaki,John M Flynn
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引用次数: 0
Moving from Knowledge to Intervention to Improve Patient Health and Well-Being: Commentary on an article by Carol A. Mancuso, MD, et al.: "Behavioral Intervention to Foster Healthy Lifestyle Physical Activity After Complex Lumbar Surgery. A Randomized Controlled Trial". 从知识到干预改善患者健康和福祉:Carol A. Mancuso, MD等人的文章评论:“复杂腰椎手术后促进健康生活方式的行为干预。”随机对照试验”。
Pub Date : 2025-09-17 DOI: 10.2106/jbjs.25.00877
David N Bernstein
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引用次数: 0
The Development and Evolution of Hand Surgery Subspecialty Certification: A Unique Collaboration. 手外科专科认证的发展与演变:一种独特的合作。
Pub Date : 2025-09-17 DOI: 10.2106/jbjs.24.00707
Peter Murray,Michelle A James
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引用次数: 0
The 90th Anniversary of the American Board of Orthopaedic Surgery. 美国整形外科委员会成立90周年。
Pub Date : 2025-09-17 DOI: 10.2106/jbjs.25.00908
David W Elstein,David F Martin,Marc F Swiontkowski,Mohit Bhandari
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引用次数: 0
The American Board of Orthopaedic Surgery: The Past, Present, and Future. 美国骨科外科委员会:过去,现在和未来。
Pub Date : 2025-09-17 DOI: 10.2106/jbjs.24.00633
Kevin L Garvin,Scott E Porter,James D Kang
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引用次数: 0
The Role of the Public Member at the ABOS. 公众成员在卫生局的角色。
Pub Date : 2025-09-17 DOI: 10.2106/jbjs.24.00699
Eric L Conley,John H Erbland,Jack B Evans,David W Elstein
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引用次数: 0
Orthopaedic Sports Medicine Subspecialty Certification: Past, Present, and Future. 骨科运动医学亚专业认证:过去,现在和未来。
Pub Date : 2025-09-17 DOI: 10.2106/jbjs.24.00782
Christopher D Harner,Terry L Thompson
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引用次数: 0
期刊
The Journal of Bone & Joint Surgery
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