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Objective Measures for Assessing Readiness to Return to Sport After Shoulder Instability Procedures Are Not Standardized: A Systematic Review 评估肩关节失稳手术后是否准备好重返运动场的客观方法尚未标准化:系统回顾
Q3 Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100978

Purpose

To report objective measures utilized to assess readiness to return to sport after shoulder instability procedures.

Methods

Our systematic review included studies if they assessed active individuals after a shoulder instability procedure with at least 1 patient-reported outcome or physical performance measure. We excluded studies of atraumatic instability, studies only reporting imaging, or studies of biomechanics. Risk of bias was assessed with the Methodological Items for Non-Randomized Studies tool, and studies were further scored with the Return to Sport Value Assessment.

Results

Thirty-seven articles selected for inclusion scored a median of 18.5 (comparative) and 10.0 (noncomparative) on the Methodological Items for Non-Randomized Studies and a mean of 2.5 on the Return to Sport Value Assessment. Twelve patient-reported outcomes were utilized across 19 studies to assess pain, function, and psychological readiness, with the Western Ontario Shoulder Index and the Shoulder Instability Return to Sport Index reported most frequently. Eighteen studies reported strength, most commonly internal and external rotation, and 18 studies reported range of motion. Physical performance tests, 6 discrete tests and 1 composite score, were less frequently reported (8 studies), with the Closed Kinetic Chain Upper Extremity Stability Test, Y-Balance Test of the Upper Quarter, and Unilateral Seated Shot-Put Test reported in more than 1 study. Deficits in patient-reported outcomes and limb symmetry persisted at the time of return to sport.

Conclusions

Most patients undergoing shoulder stabilization procedures regained fundamental strength and range of motion. However, some studies noted difficulties in achieving sufficient performance metrics for athletic activities 6 months postsurgery. Due to lack of standardized measures, recommendations for specific test components and benchmark data for clinical decision-making are not available.

Level of Evidence

Level IV, systematic review of Level III and IV studies.
目的 报告用于评估肩关节不稳定术后恢复运动准备情况的客观测量方法。方法 我们的系统性综述纳入了对肩关节不稳定术后活跃个体进行评估的研究,这些研究至少包含一项患者报告的结果或身体表现测量方法。我们排除了非创伤性不稳定性研究、仅报告成像的研究或生物力学研究。结果37篇入选文章在 "非随机研究方法学项目 "中的得分中位数为18.5(比较)和10.0(非比较),在 "重返运动价值评估 "中的平均得分为2.5。19 项研究采用了 12 项患者报告结果来评估疼痛、功能和心理准备情况,其中以西安大略省肩关节指数和肩关节不稳定性恢复运动指数的报告最为常见。18 项研究报告了力量,其中最常见的是内旋和外旋,18 项研究报告了活动范围。体能测试(6 项离散测试和 1 项综合评分)的报告频率较低(8 项研究),但有 1 项以上的研究报告了闭合运动链上肢稳定性测试、上肢 Y 平衡测试和单侧坐姿投篮测试。结论大多数接受肩关节稳定手术的患者都恢复了基本力量和活动范围。结论大多数接受肩关节稳定术的患者都恢复了基本力量和活动范围,但一些研究指出,术后6个月内难以达到足够的运动表现指标。由于缺乏标准化的测量方法,因此无法为临床决策提供具体测试内容的建议和基准数据。证据级别IV级,对III级和IV级研究的系统性回顾。
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引用次数: 0
Continuous Meniscal Repair Technique Allows for Shorter Operative Time and Learning Curve Compared With Traditional Vertical Mattress Technique in Controlled Arthroscopic Training in Porcine Model 在可控关节镜训练中,与传统的垂直床垫技术相比,连续半月板修复技术可缩短手术时间和学习曲线
Q3 Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100957

Purpose

To compare the amount of time used to perform meniscal suturing on a standardized lesion using either a traditional or continuous arthroscopic suturing technique.

Methods

A preclinical study was carried out with 21 medical doctors who underwent training in the 2 modalities of meniscal repair by arthroscopy in an animal model laboratory. Participants performed both types of sutures with a previously standardized lesion. The execution time of the techniques was measured, and an experienced surgeon evaluated the stability of a meniscal tear after the repair. Data were analyzed using a t test for paired samples to calculate the difference between the execution times of the techniques.

Results

The time required to perform the continuous meniscal suture was shorter than that of the traditional suture. After statistical analysis, the time difference between the techniques was significant (mean difference 4:17 ± 5:30 minutes; 95% confidence interval, 1:46–6:46 minutes). Surgeons took less time than residents for the traditional suture (P = .036), but the times were similar for the continuous suture. This suggests that experience level has a greater effect on the time needed for the traditional suture than for the continuous suture.

Conclusions

The continuous suture technique was performed in a shorter time compared with the traditional suture technique in a porcine model.

Clinical Relevance

The results of this preclinical study suggest that the continuous vertical inside-out meniscal suture technique can enhance surgical procedures for longitudinal tears requiring ≥4 stitches, offering a faster and more intuitive learning curve compared with the traditional inside-out suture technique.
目的 比较使用传统或连续性关节镜缝合技术对标准化病灶进行半月板缝合所需的时间。方法 对 21 名医生进行了临床前研究,他们在动物模型实验室接受了两种关节镜半月板修复方式的培训。参加者对事先标准化的病灶进行了两种缝合。对技术的执行时间进行了测量,并由一名经验丰富的外科医生对半月板撕裂修复后的稳定性进行了评估。采用配对样本 t 检验对数据进行分析,以计算两种技术执行时间的差异。经过统计分析,两种技术的时间差异显著(平均差异为 4:17 ± 5:30 分钟;95% 置信区间为 1:46-6:46 分钟)。外科医生比住院医生在传统缝合法上花费的时间更短(P = 0.036),但在连续缝合法上花费的时间相近。临床相关性这项临床前研究结果表明,与传统的内向外缝合技术相比,连续垂直内向外半月板缝合技术可以提高需要缝合≥4针的纵向撕裂的手术效果,提供更快、更直观的学习曲线。
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引用次数: 0
Spin Bias Is Common in the Abstracts and Main Body of Systematic Reviews and Meta-analyses of Hip Arthroscopy in the Setting of Borderline Hip Dysplasia 在边缘性髋关节发育不良情况下进行髋关节镜手术的系统综述和荟萃分析的摘要和正文中普遍存在旋转偏差
Q3 Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100971

Purpose

To assess the quality and presence of spin bias in the abstracts of systematic reviews and meta-analyses that evaluated the outcomes of using hip arthroscopy for the treatment of hip pathology in the setting of borderline hip dysplasia.

Methods

PubMed and Embase were searched using the terms “borderline hip dysplasia” and “systematic review” or “meta-analysis.” Forty-one initial studies were identified, and 12 met the inclusion criteria. Study characteristics were then collected, and each study was evaluated for the 15 most common types of bias and study quality using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) rating system. Inclusion criteria included a systematic review with or without meta-analysis, published in a peer-reviewed journal, accessible in English, with outcomes after hip arthroscopy for borderline hip dysplasia.

Results

The 12 reviewed studies were published between 2016 and 2023, and 10 of the studies represented Level IV evidence (2 studies were Level III evidence). At least 1 form of spin was identified in 83% (10/12) of the included studies. Regarding the specific categories of spin type, misleading interpretation was identified in 58% (7/12) of the studies, misleading reporting in 67% (8/12) of the studies, and inappropriate extrapolation in 50% (6/12) of the studies. On the basis of the AMSTAR 2 assessment, 92% (11/12) were categorized as either low quality or critically low quality, with 1 study being categorized as moderate.

Conclusions

Spin bias is frequently encountered in the abstracts for systematic reviews and meta-analyses that evaluate outcomes after hip arthroscopy for the treatment of hip pathology in the setting of borderline hip dysplasia.

Level of Evidence

Level IV, systematic review of Level III and IV studies.
目的评估系统综述和荟萃分析摘要的质量以及是否存在旋转偏倚,这些摘要评估了在边缘性髋关节发育不良的情况下使用髋关节镜治疗髋关节病变的结果。方法使用 "边缘性髋关节发育不良"、"系统综述 "或 "荟萃分析 "等术语检索了PubMed和Embase。初步确定了 41 项研究,其中 12 项符合纳入标准。随后收集了研究特征,并使用系统综述评估工具 2 (AMSTAR 2) 评级系统对每项研究进行了 15 种最常见的偏倚和研究质量评估。纳入标准包括带或不带荟萃分析的系统综述,发表在同行评审期刊上,以英语发表,内容为髋关节镜手术治疗边缘性髋关节发育不良后的结果。结果12项综述研究发表于2016年至2023年,其中10项研究为IV级证据(2项研究为III级证据)。在纳入的研究中,83%(10/12)的研究确定了至少一种旋转形式。在特定的旋转类型中,58%(7/12)的研究发现了误导性解释,67%(8/12)的研究发现了误导性报告,50%(6/12)的研究发现了不恰当的外推。根据 AMSTAR 2 评估,92%(11/12 项)的研究被归类为低质量或极低质量,1 项研究被归类为中等质量。结论在系统综述和荟萃分析的摘要中经常出现旋转偏倚,这些综述和荟萃分析评估了在边缘性髋关节发育不良的情况下进行髋关节镜手术治疗髋关节病变后的结果。
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引用次数: 0
The Definition of Failure in Hip Arthroscopy May Include Factors Outside of Reoperation: A Systematic Review 髋关节镜手术失败的定义可能包括再手术以外的因素:系统回顾
Q3 Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100962

Purpose

To perform a systematic review about the varying definitions of “failure” of hip arthroscopy (HA) in the current literature and to provide a recommendation for the standardization of defining failure of HA.

Methods

A systematic search of electronic databases was conducted to identity Level I-IV clinical studies on HA failure published between January 2016 and July 2021 according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Inclusion criteria consisted of studies of patients who underwent an arthroscopic hip procedure and included a definition of failure. Studies with patients who underwent open hip procedures and non–full-text articles were excluded.

Results

Of 1,290 titles, 85 (6.6%) met inclusion criteria and were analyzed in this review. The most common definition of HA failure used was the need for any subsequent ipsilateral hip surgery (80/85, 94.1%). Among studies that noted reoperation as a cause for failure, conversion to total hip arthroplasty was most frequently cited (66/85, 77.6%) followed by any other reoperation on the ipsilateral hip, including repeat HA, hip resurfacing, and hip periacetabular osteotomy (65/85, 76.5%). Multiple studies used subjective patient-reported outcomes, with use of the modified Harris Hip Score being the most common (17/85, 20%).

Conclusions

There are numerous definitions of the term “failure” of HA used by authors in the peer-reviewed literature. A standardized definition of HA failure should be multifactorial. It may include any unplanned subsequent procedures; patient-reported outcomes with emphasis on minimal clinically important difference, substantial clinical benefit, and/or patient acceptable symptom state values; and the inability to return to normal function or sports.

Level of Evidence

Level IV, systematic review of Level III and IV studies.
目的 对现有文献中关于髋关节镜手术(HA)"失败 "的不同定义进行系统综述,并为HA失败定义的标准化提供建议。方法 根据《系统综述和荟萃分析首选报告项目》指南,对电子数据库进行系统检索,以识别2016年1月至2021年7月间发表的关于HA失败的I-IV级临床研究。纳入标准包括对接受关节镜髋关节手术的患者进行的研究,并包含失败的定义。结果 在1290篇文章中,有85篇(6.6%)符合纳入标准,并在本综述中进行了分析。HA失败最常见的定义是需要随后进行同侧髋关节手术(80/85,94.1%)。在将再次手术作为失败原因的研究中,最常提到的是转为全髋关节置换术(66/85,77.6%),其次是同侧髋关节的任何其他再次手术,包括重复HA、髋关节置换和髋关节胫骨周围截骨术(65/85,76.5%)。多项研究使用了患者主观报告的结果,其中使用改良的 Harris 髋关节评分最为常见(17/85,20%)。HA失败的标准化定义应该是多因素的。它可能包括任何计划外的后续手术;患者报告的结果,重点是最小临床重要性差异、实质性临床获益和/或患者可接受的症状状态值;以及无法恢复正常功能或运动。
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引用次数: 0
Arthroscopic Margin Convergence Repair Without Suture Anchors Improves Clinical Outcomes for Full- and Partial-Thickness Rotator Cuff Tears 不使用缝合锚的关节镜边缘收敛修复术改善了全厚和部分厚肩袖撕裂的临床疗效
Q3 Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100955

Purpose

To evaluate the clinical outcome scores of an arthroscopic margin convergence technique without the use of suture anchors to repair different types of rotator cuff tears and to determine whether the type or extent of the tear has an effect on clinical outcome scores after this procedure.

Methods

Patients receiving arthroscopic margin convergence repair without suture anchors for rotator cuff tears from 2013 to 2018 were retrospectively analyzed. Arthroscopically determined partial- or full-thickness rotator cuff tears with a minimum follow-up period of 20 months were included. Outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) shoulder score; University of California, Los Angeles (UCLA) shoulder score; and visual analog scale (VAS) score. A 2-tailed distribution paired t test was used to determine statistical significance (P < .05) between preoperative scores and scores at final follow-up. Correlation tests and linear regression analysis were used to determine the correlation between various clinical variables and outcomes. A cohort-specific minimal clinically important difference analysis was performed for each outcome score, calculated as one-half of the standard deviation of the delta score.

Results

A total of 38 patients were included for analysis: 12 with partial-thickness tears and 26 with full-thickness tears. The mean postoperative follow-up period was 33.9 months (range, 22.2-94.5 months), with a minimum follow-up period of 22 months. The mean age of the patients was 62 ± 15.1 years. The minimal clinically important difference values for the ASES, UCLA, and VAS scores were 9.68, 2.92, and 1.13, respectively. There were significant improvements in the ASES (from 29.3 ± 18.3 preoperatively to 93.7 ± 8.3 postoperatively, P = .001), UCLA (from 14.3 ± 6.2 to 32.8 ± 2.6, P = .001), and VAS (from 7.37 ± 1.8 to 0.63 ± 1.02, P = .001) clinical outcome scores. However, patients with either Patte stage 3 retraction (P = .033 for ASES score and P = .020 for UCLA score) or U-shaped tears (P = .047 for ASES score and P = .050 for UCLA score) had significantly lower clinical outcome scores than patients with less severe retraction or differently shaped tears.

Conclusions

The arthroscopic margin convergence technique without the use of suture anchors may be a suitable option in patients with partial- or full-thickness rotator cuff tears.

Level of Evidence

Level IV, therapeutic case series.
目的 评估不使用缝合锚的关节镜边缘融合技术修复不同类型肩袖撕裂的临床结果评分,并确定撕裂的类型或程度是否会影响术后的临床结果评分。方法 回顾性分析2013年至2018年接受不使用缝合锚的关节镜边缘融合修复术治疗肩袖撕裂的患者。纳入的患者均在关节镜下确定为部分或全厚肩袖撕裂,随访时间至少为 20 个月。结果采用美国肩肘外科医生(ASES)肩关节评分、加州大学洛杉矶分校(UCLA)肩关节评分和视觉模拟量表(VAS)评分进行评估。采用双尾分布配对 t 检验来确定术前评分与最终随访评分之间的统计学意义(P <.05)。相关性测试和线性回归分析用于确定各种临床变量与结果之间的相关性。结果 共有 38 名患者被纳入分析:12 名患者为部分厚度撕裂,26 名患者为全厚度撕裂。术后平均随访时间为 33.9 个月(22.2-94.5 个月),最短随访时间为 22 个月。患者的平均年龄为 62 ± 15.1 岁。ASES、UCLA 和 VAS 评分的最小临床重要差异值分别为 9.68、2.92 和 1.13。ASES(从术前的 29.3 ± 18.3 到术后的 93.7 ± 8.3,P = .001)、UCLA(从 14.3 ± 6.2 到 32.8 ± 2.6,P = .001)和 VAS(从 7.37 ± 1.8 到 0.63 ± 1.02,P = .001)临床结果评分均有明显改善。然而,Patte 3期回缩(ASES评分P = .033,UCLA评分P = .020)或U形撕裂(ASES评分P = .047,UCLA评分P = .050)患者的临床结果评分明显低于回缩程度较轻或撕裂形状不同的患者。结论不使用缝合锚的关节镜边缘收敛技术可能是肩袖部分或全厚撕裂患者的合适选择。
{"title":"Arthroscopic Margin Convergence Repair Without Suture Anchors Improves Clinical Outcomes for Full- and Partial-Thickness Rotator Cuff Tears","authors":"","doi":"10.1016/j.asmr.2024.100955","DOIUrl":"10.1016/j.asmr.2024.100955","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the clinical outcome scores of an arthroscopic margin convergence technique without the use of suture anchors to repair different types of rotator cuff tears and to determine whether the type or extent of the tear has an effect on clinical outcome scores after this procedure.</div></div><div><h3>Methods</h3><div>Patients receiving arthroscopic margin convergence repair without suture anchors for rotator cuff tears from 2013 to 2018 were retrospectively analyzed. Arthroscopically determined partial- or full-thickness rotator cuff tears with a minimum follow-up period of 20 months were included. Outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) shoulder score; University of California, Los Angeles (UCLA) shoulder score; and visual analog scale (VAS) score. A 2-tailed distribution paired <em>t</em> test was used to determine statistical significance (<em>P</em> &lt; .05) between preoperative scores and scores at final follow-up. Correlation tests and linear regression analysis were used to determine the correlation between various clinical variables and outcomes. A cohort-specific minimal clinically important difference analysis was performed for each outcome score, calculated as one-half of the standard deviation of the delta score.</div></div><div><h3>Results</h3><div>A total of 38 patients were included for analysis: 12 with partial-thickness tears and 26 with full-thickness tears. The mean postoperative follow-up period was 33.9 months (range, 22.2-94.5 months), with a minimum follow-up period of 22 months. The mean age of the patients was 62 ± 15.1 years. The minimal clinically important difference values for the ASES, UCLA, and VAS scores were 9.68, 2.92, and 1.13, respectively. There were significant improvements in the ASES (from 29.3 ± 18.3 preoperatively to 93.7 ± 8.3 postoperatively, <em>P</em> = .001), UCLA (from 14.3 ± 6.2 to 32.8 ± 2.6, <em>P</em> = .001), and VAS (from 7.37 ± 1.8 to 0.63 ± 1.02, <em>P</em> = .001) clinical outcome scores. However, patients with either Patte stage 3 retraction (<em>P</em> = .033 for ASES score and <em>P</em> = .020 for UCLA score) or U-shaped tears (<em>P</em> = .047 for ASES score and <em>P</em> = .050 for UCLA score) had significantly lower clinical outcome scores than patients with less severe retraction or differently shaped tears.</div></div><div><h3>Conclusions</h3><div>The arthroscopic margin convergence technique without the use of suture anchors may be a suitable option in patients with partial- or full-thickness rotator cuff tears.</div></div><div><h3>Level of Evidence</h3><div>Level IV, therapeutic case series.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142529084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
All-Suture Anchor Techniques for Biceps Tenodesis Are Noninferior in End-Cycle Stiffness to an Interference Screw Technique; However, Secondary Outcomes, Such as Ultimate Failure Load, Yield Load, Creep, and Load-to-Failure Stiffness, Are Inferior in an Ovine Model 肱二头肌腱膜修补术的全缝合锚固技术在终末周期刚度方面并不逊色于干扰螺钉技术;但在膀胱模型中,最终破坏载荷、屈服载荷、蠕变和破坏载荷刚度等次要结果却不如干扰螺钉技术。
Q3 Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100960

Purpose

To assess the biomechanical performance of 2 simplified loop-and-tack biceps tenodesis techniques, all-suture anchor and all-suture anchor with a button, compared with the interference screw technique in an ovine model.

Methods

Twenty-one biceps tenodesis procedures were executed on the humeri and flexor digitorum profundus tendons of skeletally mature, female sheep. Limbs were evenly randomized into 2 experimental groups (all-suture anchor with or without button) and 1 control group (interference screw). Cyclic loading followed by a load-to-failure test was conducted. The primary outcome metric was end-cycle stiffness, or stiffness measured at the end of cyclic loading, because it modeled the resistance of the construct to the lower-force activities of postoperative physical therapy. Secondary metrics included ultimate failure load (UFL), yield load, creep, and load-to-failure stiffness. End-cycle stiffness difference-of-means testing was conducted with a minimal clinically important difference threshold of –15 N/mm (–1.5 kg/mm). Groups were compared using analysis of variance for all recorded variables.

Results

Both the all-suture anchor techniques, without a button and with a button, were found to be noninferior in end-cycle stiffness to the interference screw technique (–5.2 N/mm [95% confidence interval, –13.6 to 3.3 N/mm] and –3.8 N/mm [95% confidence interval, –12.5 to –4.9 N/mm], respectively) with a minimal clinically important difference of –15 N/mm. The all-suture techniques showed significantly lower UFL, lower yield load, greater creep, and lower load-to-failure stiffness (P < .001, P < .001, P = .002, and P < .001, respectively). Tendon dimensions did not vary significantly across groups.

Conclusions

Under subfailure loading conditions, the all-suture anchor techniques with a button and without a button showed end-cycle stiffness noninferiority to an interference screw technique; however, these techniques were inferior in all secondary outcomes, including significantly lower UFL, lower yield load, greater creep, and lower load-to-failure stiffness.

Clinical Relevance

The all-suture anchor approaches with a button and without a button may retain the natural length-tension dynamics of the long head of the biceps tendon because fixation can occur before the release of the tendon origin. Additionally, they may offer a simpler and more cost-effective alternative to prevailing arthroscopic methods.
目的在绵羊模型中评估全缝合锚定和带扣全缝合锚定这两种简化的环扎二头肌腱膜绷带技术与过盈螺钉技术的生物力学性能比较。方法在骨骼成熟的雌性绵羊的肱骨和屈指肌腱上实施了 21 例二头肌腱膜绷带手术。将肢体平均随机分为 2 个实验组(带或不带按钮的全缝合锚)和 1 个对照组(干扰螺钉)。实验组先进行循环加载,然后进行加载至破坏试验。主要结果指标是循环末期刚度,即在循环加载结束时测量的刚度,因为它模拟了结构对术后物理治疗的低力活动的阻力。次要指标包括极限破坏载荷(UFL)、屈服载荷、蠕变和载荷至破坏刚度。末周期刚度均值差异测试的最小临床重要差异阈值为-15 N/mm(-1.5 kg/mm)。结果发现不带按钮和带按钮的全缝合锚固技术的终末周期刚度均不劣于干扰螺钉技术(分别为-5.2 N/mm [95% 置信区间,-13.6 至 3.3 N/mm]和-3.8 N/mm [95% 置信区间,-12.5 至 -4.9 N/mm]),最小临床重要差异为-15 N/mm。全缝合技术显示出明显较低的 UFL、较低的屈服载荷、较大的蠕变和较低的载荷-破坏刚度(分别为 P <.001、P <.001、P = .002 和 P <.001)。结论在亚失效加载条件下,带按钮和不带按钮的全缝合锚固技术的终末周期刚度不劣于干扰螺钉技术;但是,这些技术在所有次要结果上都不如干扰螺钉技术,包括明显较低的 UFL、较低的屈服载荷、较大的蠕变和较低的加载-失效刚度。临床意义带按钮和不带按钮的全缝合锚方法可保留肱二头肌长头肌腱的自然长度-张力动态,因为固定可在肌腱起源释放之前进行。此外,它们还可以提供一种更简单、更具成本效益的方法来替代现有的关节镜方法。
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引用次数: 0
Mini-Open Technique for Gluteus Medius Tendon Repairs Is Associated With Low Complication Rates and Sustained Improvement in Patient Reported Outcomes at 2-Year Follow-Up 臀中肌腱修复的迷你开放技术并发症发生率低,两年随访后患者报告结果持续改善
Q3 Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100972

Purpose

To evaluate the efficacy of the senior author’s hybrid “mini-open” technique for abductor tendon repair at 2-year follow-up.

Methods

After institutional review board approval, we performed a retrospective review of prospectively collected data for all patients undergoing isolated mini-open gluteus medius tendon repairs from January 2018 to January 2022. Inclusion criteria included ongoing abductor pain refractory to nonoperative management, magnetic resonance imaging demonstrating gluteus medius/minimus tear, completion of preoperative patient-reported outcome measures (PROMs) including Modified Harris Hip Score (mHHS), Hip Outcome Score for Activities of Daily Living (HOS-ADL), Hip Outcome Score for Sports-Related Activities (HOS-SS), and visual analog scale (VAS) for pain and minimum 2-year follow-up. PROMs were assessed at preoperative, 6-month, 1-year, and 2-year postoperative intervals. Paired-sample t tests were used to compare the change in each outcome measure. The minimal clinically important difference (MCID) was calculated, and complications were recorded.

Results

Sixty-one patients (59 female, 96.7%) with an average age of 61.4 ± 1.3 years were included. The mean follow-up was 25.9 ± 1.13 months. mHHS improved from a mean of 47.2 preoperatively to 68.9 at 2 years (P < 0.001), HOS-ADL from 54 to 78.9 (P < 0.001), HOS-SS from 37 to 66.5 (P = 0.015), and VAS from 13.3 to 7.4 (P = 0.001). The MCIDs for mHHS, HOS-ADL, HOS-SS, and VAS were 11.1 (60% achievement), 6.1 (78.6% achievement), 9.7 (80.3% achievement), and 14.5 (75.4% achievement), respectively. Two patients experienced retears (3.2%), with no other complications reported.

Conclusions

The mini-open technique for abductor tendon repair provides sustained improvement in both pain and function-related PROMs at 2-year follow-up with comparable complication rates to endoscopic and open techniques in 1 surgeon’s practice.

Level of Evidence

Level IV, therapeutic retrospective case series.
目的评估资深作者的混合 "小开腹 "技术用于内收肌腱修复的疗效(随访 2 年)。方法经机构审查委员会批准后,我们对 2018 年 1 月至 2022 年 1 月期间接受孤立小开腹臀中肌腱修复术的所有患者的前瞻性数据进行了回顾性审查。纳入标准包括非手术治疗难治的持续内收肌疼痛、磁共振成像显示臀中肌/臀肌腱撕裂、完成术前患者报告结果测量(PROMs),包括改良哈里斯髋关节评分(mHHS)、日常生活活动髋关节结果评分(HOS-ADL)、运动相关活动髋关节结果评分(HOS-SS)和疼痛视觉模拟量表(VAS),以及至少 2 年的随访。PROM分别在术前、术后6个月、1年和2年进行评估。采用配对样本 t 检验比较各结果指标的变化。结果共纳入 61 名患者(59 名女性,96.7%),平均年龄(61.4 ± 1.3)岁。mHHS 从术前的平均 47.2 改善到 2 年后的 68.9(P < 0.001),HOS-ADL 从 54 改善到 78.9(P < 0.001),HOS-SS 从 37 改善到 66.5(P = 0.015),VAS 从 13.3 改善到 7.4(P = 0.001)。mHHS、HOS-ADL、HOS-SS 和 VAS 的 MCID 分别为 11.1(达到 60%)、6.1(达到 78.6%)、9.7(达到 80.3%)和 14.5(达到 75.4%)。结论在一名外科医生的临床实践中,内收肌肌腱修复的小开腹技术在2年随访时可持续改善疼痛和功能相关的PROM,并发症发生率与内窥镜和开腹技术相当。
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引用次数: 0
The Genitofemoral Nerve Is the Structure Closest to the Tendon Footprint and Is Most at Risk for Iatrogenic Injury During Proximal Adductor Longus Repair: A Cadaveric Anatomy Study 股生殖神经是最靠近肌腱足印的结构,在近端内收肌修复过程中最易受到先天性损伤:尸体解剖研究
Q3 Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100970

Purpose

To identify structures at risk during proximal adductor longus repair and to report observed distances between these structures and the adductor longus (AL) footprint.

Methods

Eight hemipelves from fresh cadaver whole-body specimens were dissected using a previously established surgical approach. The tendinous attachment of the AL was scored into the underlying bone and the footprint size was measured in millimeters. A guidewire was placed at the footprint center along the longitudinal axis of the resected AL muscle. Utilizing a digital caliper, the proximity of key anatomic structures was measured as the radial distance from the guidewire and distance distal to the footprint along the guidewire axis.

Results

The AL footprint was on average 16.95 ± 3.02 mm wide by 9.36 ± 1.66 mm high. The ilioinguinal nerve was 27.10 ± 7.25 mm distal to the AL footprint and 31.75 ± 7.51 mm medial, with a resulting mean surface area of 158.12 ± 39.90 (110.9-230.2). mm2 The genital branch of the genitofemoral nerve was found 7.79 ± 4.05 mm proximal and 15.37 ± 4.54 mm medial. The round ligament (n = 6) was 14.00 ± 2.75 mm and the spermatic cord (n = 2) was 13.57 ± 3.02 mm directly superficial to the AL footprint. The obturator nerve was 63.98 ± 4.57 mm distal as it crossed the adductor brevis muscle laterally. The location of the external pudendal artery was variable but was found to have a mean distance of 37.01 ± 17.97 mm distal and immediately deep to the AL.

Conclusions

When repairing AL tendon injuries, the genitofemoral nerve is the structure anatomically nearest the footprint of the tendon, and this structure is most at risk for iatrogenic injury.

Clinical Relevance

This study investigates the structures at risk during AL repair and seeks to define their location relative to the footprint. These findings will assist surgeons in identifying the crucial anatomic structures at risk to safely perform an anatomic repair of the tendon and avoid iatrogenic complications.
目的确定内收肌近端修复过程中存在风险的结构,并报告观察到的这些结构与内收肌(AL)足印之间的距离。方法采用先前确定的手术方法,从新鲜尸体全身标本中解剖出八个半腓骨。将内收肌的肌腱附着点划入下层骨骼,并以毫米为单位测量足印大小。沿着切除 AL 肌肉的纵轴,在脚印中心放置一根导丝。利用数字卡尺测量主要解剖结构的距离,即距导丝的径向距离和沿导丝轴线到足迹的远端距离。髂腹股沟神经在AL足印远端为(27.10 ± 7.25)毫米,内侧为(31.75 ± 7.51)毫米,因此平均表面积为(158.12 ± 39.90)(110.9-230.2)毫米2 股神经生殖器分支在近端为(7.79 ± 4.05)毫米,内侧为(15.37 ± 4.54)毫米。圆韧带(n = 6)为(14.00 ± 2.75)毫米,精索(n = 2)为(13.57 ± 3.02)毫米,直接位于 AL 脚印的表层。闭孔神经的远端为(63.98 ± 4.57)毫米,因为它横向穿过了内收肌。结论在修复AL肌腱损伤时,股神经是解剖学上最靠近肌腱足印的结构,该结构最容易受到先天性损伤。这些发现将有助于外科医生确定面临风险的关键解剖结构,从而安全地进行肌腱解剖修复,避免先天性并发症。
{"title":"The Genitofemoral Nerve Is the Structure Closest to the Tendon Footprint and Is Most at Risk for Iatrogenic Injury During Proximal Adductor Longus Repair: A Cadaveric Anatomy Study","authors":"","doi":"10.1016/j.asmr.2024.100970","DOIUrl":"10.1016/j.asmr.2024.100970","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify structures at risk during proximal adductor longus repair and to report observed distances between these structures and the adductor longus (AL) footprint.</div></div><div><h3>Methods</h3><div>Eight hemipelves from fresh cadaver whole-body specimens were dissected using a previously established surgical approach. The tendinous attachment of the AL was scored into the underlying bone and the footprint size was measured in millimeters. A guidewire was placed at the footprint center along the longitudinal axis of the resected AL muscle. Utilizing a digital caliper, the proximity of key anatomic structures was measured as the radial distance from the guidewire and distance distal to the footprint along the guidewire axis.</div></div><div><h3>Results</h3><div>The AL footprint was on average 16.95 ± 3.02 mm wide by 9.36 ± 1.66 mm high. The ilioinguinal nerve was 27.10 ± 7.25 mm distal to the AL footprint and 31.75 ± 7.51 mm medial, with a resulting mean surface area of 158.12 ± 39.90 (110.9-230.2). mm<sup>2</sup> The genital branch of the genitofemoral nerve was found 7.79 ± 4.05 mm proximal and 15.37 ± 4.54 mm medial. The round ligament (n = 6) was 14.00 ± 2.75 mm and the spermatic cord (n = 2) was 13.57 ± 3.02 mm directly superficial to the AL footprint. The obturator nerve was 63.98 ± 4.57 mm distal as it crossed the adductor brevis muscle laterally. The location of the external pudendal artery was variable but was found to have a mean distance of 37.01 ± 17.97 mm distal and immediately deep to the AL.</div></div><div><h3>Conclusions</h3><div>When repairing AL tendon injuries, the genitofemoral nerve is the structure anatomically nearest the footprint of the tendon, and this structure is most at risk for iatrogenic injury.</div></div><div><h3>Clinical Relevance</h3><div>This study investigates the structures at risk during AL repair and seeks to define their location relative to the footprint. These findings will assist surgeons in identifying the crucial anatomic structures at risk to safely perform an anatomic repair of the tendon and avoid iatrogenic complications.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141709420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Whipstitch and Locking Stitch Show Equivalent Elongation and Load to Failure Across 3 Suture Systems in a Biomechanical Model of Quadriceps Tendon Grafts for Anterior Cruciate Ligament Reconstruction 在用于前十字韧带重建的股四头肌肌腱移植物生物力学模型中,鞭状缝合和锁定缝合在三种缝合系统中显示出相同的伸长率和破坏载荷
Q3 Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100968

Purpose

To compare the biomechanical properties of quadriceps tendon (QT) graft stitch methods using 3 different suture systems for anterior cruciate ligament reconstruction.

Methods

A total of 48 QTs were harvested from cadaveric knee specimens (age: 73 ± 7 years; range, 66-86 years). Samples were randomly divided into 3 groups where different suture needle systems were used to create 2 stitch methods: whipstitch (WS) and locking stitch (LS). Surgeons performed each technique to 5 stitches, each 0.5 cm apart. Stitching time was recorded. Samples were preconditioned and then underwent cyclic loading, followed by load to failure. Stiffness (N/mm), ultimate failure load (N), peak-to-peak displacement (mm), elongation (mm), and failure displacement (mm) were recorded.

Results

WS and LS were equivalent across stiffness, ultimate load, and peak-to-peak displacement within groups 2 and 3. In group 1, the LS was stiffer than the WS, but the WS achieved a higher ultimate load. For all groups, the LS achieved lower elongation and failure displacement than the WS, with significant differences in groups 1 and 2. Within each stitching method, equivalence was determined for total elongation and ultimate failure load for all 3 suture system groups. For WS samples, group 1 all failed from suture breakage, and both groups 2 and 3 had instances of failure from suture pull-through. All LS samples failed from suture breakage.

Conclusions

Both LS and WS provide adequate mechanical properties in each of the 3 suture systems. Differences in performance do exist; however, each method shows equivalent total elongation and ultimate failure load for all 3 suture systems. LS may be preferred over WS due to lower mean elongation and failure displacement.

Clinical Relevance

There is an increased use of QT grafts in for anterior cruciate ligament reconstruction. However, there have been a limited number of studies comparing various stitching methods and optimizing techniques for QT graft fixation. This study may provide important information to surgeons about which suture techniques have better biomechanical profiles.
目的比较使用 3 种不同缝合系统进行前交叉韧带重建的股四头肌腱(QT)移植缝合方法的生物力学特性。方法从尸体膝关节标本(年龄:73 ± 7 岁;范围:66-86 岁)中获取 48 块 QT。样本被随机分为 3 组,使用不同的缝合针系统进行 2 种缝合方法:鞭状缝合(WS)和锁定缝合(LS)。外科医生采用每种技术缝合 5 针,每针间距 0.5 厘米。记录缝合时间。对样本进行预处理,然后进行循环加载,最后加载至失效。记录了刚度(牛顿/毫米)、极限破坏荷载(牛顿)、峰-峰位移(毫米)、伸长率(毫米)和破坏位移(毫米)。在第 2 组和第 3 组中,ResultsWS 和 LS 在刚度、极限荷载和峰-峰位移方面相当。在第 1 组中,LS 的硬度高于 WS,但 WS 达到的极限载荷更高。在所有组别中,LS 的伸长率和破坏位移均低于 WS,但在第 1 组和第 2 组中差异显著。在每种缝合方法中,确定了所有 3 组缝合系统的总伸长率和极限破坏载荷相等。对于 WS 样品,第 1 组全部因缝线断裂而失效,第 2 组和第 3 组均有缝线拉穿失效的情况。所有 LS 样品均因缝线断裂而失效。两种方法的性能确实存在差异,但在所有 3 种缝合系统中,每种方法都显示出相同的总伸长率和最终失效载荷。由于平均伸长率和失效位移较低,LS 可能比 WS 更受青睐。然而,比较各种缝合方法和优化 QT 移植物固定技术的研究数量有限。这项研究可为外科医生提供重要信息,让他们了解哪种缝合技术具有更好的生物力学特性。
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引用次数: 0
Arthroscopic Debridement After Total Knee Arthroplasty Is More Effective for Synovitis Than for Ankylosis 全膝关节置换术后关节镜清创治疗滑膜炎比治疗强直更有效
Q3 Medicine Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100965

Purpose

To investigate the effects of arthroscopy surgery on ankylosis and synovitis after total knee arthroplasty (TKA), with patient satisfaction as the main outcome measure.

Methods

A single surgeon’s database was queried for all knee arthroscopy procedures done from 2002 to 2024 using the International Classification of Diseases, Ninth and Tenth Revision, codes for ankylosis or synovitis and Current Procedural Terminology codes 29884 and 29876. Patients were excluded if they did not have a previous TKA, had a TKA but arthroscopy was done for multiple or other indications, were <2 months from TKA, lacked medical records, or were worker’s compensation cases. Patients were separated into either the ankylosis group or the synovitis group. A patient satisfaction survey was collected at first and last follow-up and asked individuals to rate their condition as “better,” “unchanged,” or “worse” after arthroscopy. A total of 199 subjects were included: 48 in the ankylosis group and 151 in the synovitis group.

Results

The mean initial follow-up time was 5.2 and 7.2 months for the ankylosis and synovitis groups, respectively. The mean final follow-up time was 3.7 and 4.8 years, respectively. For initial follow-up, the ankylosis group reported 31% better, 56% unchanged, and 13% worse, whereas the synovitis group reported 69% better, 29% unchanged, and 2% worse (P < .001). For final follow-up, the ankylosis group reported 44% better, 41% unchanged, and 15% worse, whereas the synovitis group reported 78% better, 10% unchanged, and 12% worse (P < .001).

Conclusions

After TKA, arthroscopic surgery can reduce symptoms and improve satisfaction for patients with ankylosis or synovitis. Patient satisfaction is improved in a greater percentage of patients with synovitis compared with ankylosis.

Level of Evidence

Level III, retrospective, comparative study.
目的 研究关节镜手术对全膝关节置换术(TKA)后强直和滑膜炎的影响,并将患者满意度作为主要结果衡量指标。方法 使用《国际疾病分类》第九版和第十版修订版中的强直或滑膜炎代码以及《现行手术术语》代码 29884 和 29876,对 2002 年至 2024 年期间完成的所有膝关节镜手术进行查询。如果患者既往未进行过 TKA,或虽进行过 TKA 但因多种或其他适应症进行了关节镜检查,或距 TKA 术后 2 个月,或缺乏医疗记录,或属于工伤病例,则将其排除在外。患者被分为强直组和滑膜炎组。在首次和最后一次随访时收集了一份患者满意度调查表,要求患者将关节镜手术后的情况评为 "好转"、"不变 "或 "恶化"。共纳入了 199 名受试者:结果 关节强直组和滑膜炎组的平均首次随访时间分别为 5.2 个月和 7.2 个月。最终平均随访时间分别为 3.7 年和 4.8 年。在最初的随访中,强直组好转了31%,不变了56%,恶化了13%,而滑膜炎组好转了69%,不变了29%,恶化了2%(P< .001)。结论TKA术后,关节镜手术可减轻强直或滑膜炎患者的症状并提高其满意度。与强直相比,滑膜炎患者的满意度提高的比例更大。
{"title":"Arthroscopic Debridement After Total Knee Arthroplasty Is More Effective for Synovitis Than for Ankylosis","authors":"","doi":"10.1016/j.asmr.2024.100965","DOIUrl":"10.1016/j.asmr.2024.100965","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the effects of arthroscopy surgery on ankylosis and synovitis after total knee arthroplasty (TKA), with patient satisfaction as the main outcome measure.</div></div><div><h3>Methods</h3><div>A single surgeon’s database was queried for all knee arthroscopy procedures done from 2002 to 2024 using the <em>International Classification of Diseases</em>, <em>Ninth</em> and <em>Tenth Revision</em>, codes for ankylosis or synovitis and Current Procedural Terminology codes 29884 and 29876. Patients were excluded if they did not have a previous TKA, had a TKA but arthroscopy was done for multiple or other indications, were &lt;2 months from TKA, lacked medical records, or were worker’s compensation cases. Patients were separated into either the ankylosis group or the synovitis group. A patient satisfaction survey was collected at first and last follow-up and asked individuals to rate their condition as “better,” “unchanged,” or “worse” after arthroscopy. A total of 199 subjects were included: 48 in the ankylosis group and 151 in the synovitis group.</div></div><div><h3>Results</h3><div>The mean initial follow-up time was 5.2 and 7.2 months for the ankylosis and synovitis groups, respectively. The mean final follow-up time was 3.7 and 4.8 years, respectively. For initial follow-up, the ankylosis group reported 31% better, 56% unchanged, and 13% worse, whereas the synovitis group reported 69% better, 29% unchanged, and 2% worse (<em>P</em> &lt; .001). For final follow-up, the ankylosis group reported 44% better, 41% unchanged, and 15% worse, whereas the synovitis group reported 78% better, 10% unchanged, and 12% worse (<em>P</em> &lt; .001).</div></div><div><h3>Conclusions</h3><div>After TKA, arthroscopic surgery can reduce symptoms and improve satisfaction for patients with ankylosis or synovitis. Patient satisfaction is improved in a greater percentage of patients with synovitis compared with ankylosis.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective, comparative study.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Arthroscopy Sports Medicine and Rehabilitation
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