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Immune Hypersensitivity Is Associated With Higher Graft Failure Rate After Osteochondral Allograft Transplantation of the Knee 免疫超敏与膝关节骨软骨异体移植物移植后较高的移植物失败率有关
Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.asmr.2024.100933
Michael Moore B.A., Luilly Vargas M.D., Idris Hanidu B.S., Samuel Zverev B.S., Andrew Bi M.D., Jairo Triana B.S., Guillem Gonzalez Lomas M.D., Laith Jazrawi M.D., Eric Strauss M.D., Kirk A. Campbell M.D.

Purpose

To analyze the effects of 1 or more patient-reported allergies on clinical outcomes, in particular graft failure rate, and patient-reported outcomes (PROs) following osteochondral allograft transplantation (OCA) of the knee.

Methods

Retrospective review of patients who underwent knee OCA from August 2010 to May 2021 with a minimum of 2-year follow-up. Patients were initially divided into 2 cohorts: those with at least 1 allergy and those without any allergies. Clinical outcomes assessed included graft failure, reoperation rates, deep vein thrombosis/pulmonary embolism, and manipulation under anesthesia/lysis of adhesions (MUA/LOA). PROs assessed, including the visual analog scale (VAS) for pain and satisfaction, the Knee injury and Osteoarthritis Outcome Score (KOOS), and return to sport rates, were compared.

Results

In total, 285 patients were included with a mean clinical follow-up of 4.8 ± 2.0 years. The allergy cohort had a significantly higher rate of graft failure (P = .008). In a regression analysis controlling for confounding variables, graft failure remained significantly associated with the presence of medication allergies (odds ratio [OR], 3.631; 95% CI, 1.139-11.577; P = .029). Furthermore, an increasing number of allergies were associated with an increased rate of graft failure (OR, 1.644; 95% CI, 1.074-2.515; P = .022). There was no difference in rate of reoperation, complications, infection, and MUA/LOA. Of the 100 patients who completed PROs, there was no difference in VAS satisfaction, pain, and any of the KOOS outcome scores or return to sport.

Conclusions

The presence of 1 or more patient-reported allergies was shown to be significantly associated with OCA graft failure. Furthermore, an increasing number of patient-reported allergies were associated with a higher rate of graft failure. However, there were no significant differences in VAS satisfaction or pain, KOOS symptom, quality of life, pain, or return to sport in patients with at least 1 patient-reported allergy and those without allergies.

Level of Evidence

Level III, retrospective cohort study.

目的分析膝关节骨软骨异体移植物移植(OCA)后患者报告的一种或多种过敏症对临床结果(尤其是移植物失败率)和患者报告结果(PROs)的影响。方法回顾性研究 2010 年 8 月至 2021 年 5 月期间接受膝关节 OCA 的患者,至少随访 2 年。最初将患者分为两组:至少有一种过敏症的患者和没有任何过敏症的患者。评估的临床结果包括移植物失败、再次手术率、深静脉血栓/肺栓塞、麻醉下操作/粘连溶解(MUA/LOA)。结果共纳入285名患者,平均临床随访时间为(4.8 ± 2.0)年。过敏人群的移植物失败率明显更高(P = .008)。在控制混杂变量的回归分析中,移植物失败仍与药物过敏显著相关(几率比 [OR],3.631;95% CI,1.139-11.577;P = .029)。此外,过敏次数的增加与移植物失败率的增加有关(OR,1.644;95% CI,1.074-2.515;P = .022)。再次手术率、并发症、感染和 MUA/LOA 没有差异。在 100 名填写了 PROs 的患者中,VAS 满意度、疼痛、任何 KOOS 结果评分或恢复运动能力均无差异。此外,患者报告的过敏次数越多,移植失败率越高。然而,在 VAS 满意度或疼痛、KOOS 症状、生活质量、疼痛或恢复运动方面,至少有 1 例患者报告过敏的患者与没有过敏的患者没有明显差异。
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引用次数: 0
Patient Interest in Quadriceps Autograft Anterior Cruciate Ligament Reconstruction Is Increasing Over Other Autograft Options: A 12-Year Google Trends Analysis 与其他自体移植方案相比,患者对股四头肌自体移植前交叉韧带重建术的兴趣与日俱增:12 年谷歌趋势分析
Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.asmr.2024.100942
Joseph C. Brinkman M.D. , M. Lane Moore B.S. , Cara Lai M.D. , Sailesh V. Tummala M.D. , Jordan R. Pollock B.S. , Kade S. McQuivey M.D. , Jeffrey D. Hassebrock M.D. , Adam B. Thompson B.S. , Anikar Chhabra M.D.

Purpose

To use Google trends to explore differences in public interest among types of anterior cruciate ligament (ACL) autografts, specifically quadriceps tendon, patellar tendon, and hamstring tendon autografts, between 2008 and 2019.

Methods

Data were obtained by querying Google Trends for key terms and phrases for online search data ranging from January 2008 to December 2019. Relative search volumes were created based on searches related to ACL reconstruction with comparative analysis generated for search terms related to quadriceps ACL, patellar tendon ACL, and hamstring ACL autografts. Statistical analysis included linear regression analysis, comparison of quarterly search volume trends over time, and comparison of cumulative annual search volumes for 2008 versus 2019.

Results

Linear models for respective search terms were statistically significant for the quadriceps (P < .001) and patellar (P = .007) tendon autograft groups but not the hamstring group (P = .129). The quadriceps autograft group demonstrated a 12-year search volume trend change of 0.56, which was significantly greater than the hamstring (0.07; P < .001) and patellar tendon (0.168; P < .001) groups. There was no significant difference in the trend change between hamstring and patellar tendon groups (P = .20). Percent change in cumulative relative annual search volumes between 2008 and 2019 was 112% for the quadriceps tendon group, 12.9% for the hamstring group, and 18.6% for the patellar tendon group.

Conclusions

This study indicates a consistently increasing public interest in quadriceps tendon autograft for ACL reconstruction. The quadriceps autograft group demonstrated a significantly greater 12-year online search volume, greater linear correlation, and larger percent change between 2008 and 2019 compared with patellar tendon or hamstring autograft groups.

Clinical Relevance

Awareness of patient perceptions has value in informing shared decision-making, aligning patient expectations, and guiding areas of future research. Each of these has an impact on patient care. Being aware of patient interest and expectations is particularly important in areas with controversial or emerging research.

目的利用谷歌趋势探索 2008 年至 2019 年间公众对前交叉韧带(ACL)自体移植类型(尤其是股四头肌腱、髌腱和腘绳肌腱自体移植)的兴趣差异。方法通过查询谷歌趋势中 2008 年 1 月至 2019 年 12 月在线搜索数据的关键术语和短语获得数据。根据与前交叉韧带重建相关的搜索创建相对搜索量,并对与股四头肌前交叉韧带、髌腱前交叉韧带和腘绳肌前交叉韧带自体移植相关的搜索词进行比较分析。统计分析包括线性回归分析、季度搜索量随时间变化趋势的比较,以及 2008 年与 2019 年累积年度搜索量的比较。结果对于股四头肌组(P <.001)和髌腱自体移植组(P = .007),各自搜索词的线性模型具有统计学意义,但对于腘绳肌组(P = .129)则无意义。股四头肌自体移植组 12 年搜索量趋势变化为 0.56,明显高于腘绳肌组(0.07;P <;.001)和髌腱组(0.168;P <;.001)。腘绳肌腱组和髌骨肌腱组的趋势变化无明显差异(P = .20)。2008年至2019年期间,股四头肌腱组的累积相对年搜索量变化百分比为112%,腘绳肌腱组为12.9%,髌骨肌腱组为18.6%。结论本研究表明,公众对股四头肌腱自体移植用于前交叉韧带重建的兴趣持续上升。与髌腱组或腘绳肌自体移植组相比,股四头肌自体移植组的 12 年在线搜索量明显更大,线性相关性更高,2008 年至 2019 年间的百分比变化也更大。这些都会对患者护理产生影响。了解患者的兴趣和期望对于有争议或新兴的研究领域尤为重要。
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引用次数: 0
Biocomposite Anchors Have Greater Yield Load and Energy Compared With All-Suture Anchors in an In Vitro Ovine Infraspinatus Tendon Repair Model 在体外绵羊冈下肌腱修复模型中,与全缝合锚相比,生物复合锚具有更高的屈服载荷和能量
Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.asmr.2024.100938
Robert A. Walton M.D. , Lindsey Liuzza M.D. , Catherine Takawira M.S. , Claudia Leonardi Ph.D. , Mandi J. Lopez D.V.M., M.S., Ph.D.

Purpose

To compare tensile fatigue and strength measures of biocomposite and all-suture anchors in an ovine humerus-infraspinatus tendon model of rotator cuff repair.

Methods

Infraspinatus tendons on adult ovine humeri were sharply transected at the insertion. One of each pair was assigned randomly for fixation with 2 biocomposite or all-suture anchors. Constructs were tested with 200 cycles of 20 to 70 N tensile load, and gap formation was measured at the incised tendon end every 50 cycles. They were subsequently tested to failure. Outcome measures including fatigue stiffness, hysteresis, creep, and gap formation and tensile stiffness, and yield and failure displacement, load, and energy were compared between anchors.

Results

Biocomposite anchors had greater yield load (134.1 ± 6.5 N, P < .01) and energy (228.6 ± 85.7 J, P < .03) than all-suture anchors (104.7 ± 6.5 N, 169.8 ± 85.7 J). Fatigue properties were not different between anchors, but stiffness and gap formation increased and hysteresis and creep decreased significantly with increasing cycle number.

Conclusions

Although the yield displacement of both anchors was within the range of clinical failure, the tensile yield load and energy of ovine infraspinatus tendons secured to the humerus with 2 single-loaded all-suture anchors in a single row were significantly lower than those secured with 2 biocomposite anchors in the same configuration.

Clinical Relevance

It is important to understand the biomechanical properties for selecting anchors for rotator cuff repair. A direct comparison of fatigue testing followed by failure strength of infraspinatus tendon fixation with all-suture and biocomposite anchors could help guide anchor selection and postoperative mobility recommendations.

目的比较生物复合材料锚和全缝线锚在雌性肱骨-冈肌腱模型肩袖修复中的拉伸疲劳和强度测量方法将成年雌性肱骨上的冈肌腱在插入处锐利横切。随机分配每对肌腱中的一条,用两种生物复合材料或全缝合锚固定。用 20 到 70 牛顿的拉伸载荷对构建物进行 200 次循环测试,每 50 次循环测量切口肌腱末端的间隙形成情况。随后对其进行失效测试。结果生物复合锚的屈服载荷(134.1 ± 6.5 N,P < .01)和能量(228.6 ± 85.7 J,P < .03)均大于全缝合锚(104.7 ± 6.5 N,169.8 ± 85.7 J)。不同锚固件的疲劳特性没有差异,但刚度和间隙形成随着循环次数的增加而增加,滞后和蠕变随着循环次数的增加而显著减少。结论虽然两种锚的屈服位移都在临床失效范围内,但用 2 个单排单载荷全缝合锚固定在肱骨上的绵羊冈下肌腱的拉伸屈服载荷和能量明显低于用相同配置的 2 个生物复合锚固定的绵羊冈下肌腱。对使用全缝合锚和生物复合锚固定冈下肌腱的疲劳测试和破坏强度进行直接比较,有助于指导锚的选择和术后活动建议。
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引用次数: 0
The Use of Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia Is Increasing and Has Low Complication Rates 髋关节镜和髋关节周围截骨术联合治疗髋关节发育不良的应用越来越多,且并发症发生率低
Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.asmr.2024.100929
Juan Serna B.S., Kira Furie B.S., Stephanie E. Wong M.D., Ishaan Swarup M.D., Alan L. Zhang M.D., Mohammad Diab M.D.

Purpose

To analyze the annual use of hip arthroscopy (HA) and Bernese periacetabular osteotomy (PAO) for the treatment of hip dysplasia (HD), as well as postoperative outcomes, including ipsilateral reoperations.

Methods

International Classification of Diseases, Ninth and Tenth Revision, codes were used to query the PearlDiver Mariner database from January 2010 through January 2022 to identify patients aged 10 to 59 years who had a presenting diagnosis of HD and subsequently underwent (1) HA; (2) PAO; or (3) combined HA and PAO (HA-PAO, defined as PAO on the same day or within 28 days after HA). We analyzed annual rates for each treatment, as well as rates of postoperative emergency visits, readmissions, and 5-year ipsilateral secondary operations (determined via Kaplan-Meier analysis).

Results

There were 32,068 patients who underwent surgical treatment of HD. For HA, PAO, and HA-PAO, there were 29,700, 2,083, and 285 patients, respectively. All operations had the greatest percent-increase from 2015 to 2016. HA and HA-PAO peaked in 2021, whereas PAO peaked in 2019. For HA, PAO, and HA-PAO, most cases were performed in female patients and patients aged 30 to 49 years, 10 to 19 years, and 10 to 29 years, respectively. The 5-year incidence of ipsilateral secondary operations, which include revision HA, PAO, or conversion to total hip arthroplasty, was 9.2% (95% confidence interval 8.6%-9.8%) in the HA group and 6.5% (95% confidence interval 4.1%-8.8%) in the PAO group. Combining HA with PAO resulted in so few secondary operations that Kaplan-Meier analysis was infeasible. The PAO cohort had the greatest 30-day emergency visit and 90-day readmission rates, with infection as the most common cause for readmission.

Conclusions

HA is more frequently performed than PAO for hip dysplasia. HA-PAO is increasing at the greatest rate, demonstrating fewer complications and reoperations.

Level of Evidence

Level III, retrospective comparative trial.

目的分析每年使用髋关节镜(HA)和伯尔尼髋臼周围截骨术(PAO)治疗髋关节发育不良(HD)的情况以及术后结果,包括同侧再手术。方法使用《国际疾病分类》第九版和第十版修订代码查询 PearlDiver Mariner 数据库(2010 年 1 月至 2022 年 1 月),以确定年龄在 10 岁至 59 岁之间、确诊为 HD 且随后接受了 (1) HA;(2) PAO;或 (3) HA 和 PAO 联合手术(HA-PAO,定义为 HA 后同一天或 28 天内进行 PAO)的患者。我们分析了每种治疗方法的年率以及术后急诊就诊率、再入院率和 5 年同侧二次手术率(通过 Kaplan-Meier 分析确定)。接受HA、PAO和HA-PAO手术的患者分别为29700人、2083人和285人。从2015年到2016年,所有手术的增幅最大。HA 和 HA-PAO 在 2021 年达到峰值,而 PAO 在 2019 年达到峰值。就HA、PAO和HA-PAO而言,大多数病例由女性患者实施,患者年龄分别为30至49岁、10至19岁和10至29岁。同侧二次手术(包括翻修HA、PAO或转为全髋关节置换术)的5年发生率在HA组为9.2%(95%置信区间为8.6%-9.8%),在PAO组为6.5%(95%置信区间为4.1%-8.8%)。将 HA 与 PAO 结合使用导致二次手术数量极少,因此无法进行 Kaplan-Meier 分析。PAO组的30天急诊就诊率和90天再入院率最高,感染是最常见的再入院原因。证据级别III级,回顾性比较试验。
{"title":"The Use of Combined Hip Arthroscopy and Periacetabular Osteotomy for Hip Dysplasia Is Increasing and Has Low Complication Rates","authors":"Juan Serna B.S.,&nbsp;Kira Furie B.S.,&nbsp;Stephanie E. Wong M.D.,&nbsp;Ishaan Swarup M.D.,&nbsp;Alan L. Zhang M.D.,&nbsp;Mohammad Diab M.D.","doi":"10.1016/j.asmr.2024.100929","DOIUrl":"10.1016/j.asmr.2024.100929","url":null,"abstract":"<div><h3>Purpose</h3><p>To analyze the annual use of hip arthroscopy (HA) and Bernese periacetabular osteotomy (PAO) for the treatment of hip dysplasia (HD), as well as postoperative outcomes, including ipsilateral reoperations.</p></div><div><h3>Methods</h3><p><em>International Classification of Diseases</em>, <em>Ninth</em> and <em>Tenth Revision</em>, codes were used to query the PearlDiver Mariner database from January 2010 through January 2022 to identify patients aged 10 to 59 years who had a presenting diagnosis of HD and subsequently underwent (1) HA; (2) PAO; or (3) combined HA and PAO (HA-PAO, defined as PAO on the same day or within 28 days after HA). We analyzed annual rates for each treatment, as well as rates of postoperative emergency visits, readmissions, and 5-year ipsilateral secondary operations (determined via Kaplan-Meier analysis).</p></div><div><h3>Results</h3><p>There were 32,068 patients who underwent surgical treatment of HD. For HA, PAO, and HA-PAO, there were 29,700, 2,083, and 285 patients, respectively. All operations had the greatest percent-increase from 2015 to 2016. HA and HA-PAO peaked in 2021, whereas PAO peaked in 2019. For HA, PAO, and HA-PAO, most cases were performed in female patients and patients aged 30 to 49 years, 10 to 19 years, and 10 to 29 years, respectively. The 5-year incidence of ipsilateral secondary operations, which include revision HA, PAO, or conversion to total hip arthroplasty, was 9.2% (95% confidence interval 8.6%-9.8%) in the HA group and 6.5% (95% confidence interval 4.1%-8.8%) in the PAO group. Combining HA with PAO resulted in so few secondary operations that Kaplan-Meier analysis was infeasible. The PAO cohort had the greatest 30-day emergency visit and 90-day readmission rates, with infection as the most common cause for readmission.</p></div><div><h3>Conclusions</h3><p>HA is more frequently performed than PAO for hip dysplasia. HA-PAO is increasing at the greatest rate, demonstrating fewer complications and reoperations.</p></div><div><h3>Level of Evidence</h3><p>Level III, retrospective comparative trial.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000476/pdfft?md5=bd5ead04aa96f69021acc7fd81c6181a&pid=1-s2.0-S2666061X24000476-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400463","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
Arthroscopic Partial Meniscectomy in Patients With Kellgren-Lawrence Grade 3 Osteoarthritis Shows Clinically Meaningful Improvement in Outcomes 对 Kellgren-Lawrence 3 级骨关节炎患者进行关节镜下半月板部分切除术,可显著改善临床疗效
Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.asmr.2024.100926
Tyler Warner B.S. , Natalie Lowenstein M.P.H. , Jillian Mazzocca B.A. , Jamie Collins Ph.D. , Elizabeth Matzkin M.D.

Purpose

To evaluate patient-reported outcome measures (PROMs) following arthroscopic partial meniscectomy (APM) in patients with Kellgren-Lawrence (KL) grade 3 on preoperative knee radiographs and a symptomatic meniscal tear.

Methods

This was a retrospective study design using prospectively collected data from a single institution. Patients were included if they had KL grade 3 osteoarthritis on preoperative radiographs of the knee and completed a trial of nonoperative treatment for at least 6 weeks prior to APM. Patients were excluded if they had inflammatory arthritis, incomplete preoperative and/or 1-year postoperative follow-up data, repeat knee arthroscopy, and concomitant ligamentous injury. Statistical analyses used PROMs, preoperatively and up to 2 years postoperatively, to assess improvement utilizing scales with previously established thresholds, including minimal clinically important difference (MCID) and substantial clinical benefit (SCB).

Results

Eighty-two patients met the eligibility criteria (49 women [60%], mean [SD] age, 53.1 [9.3] years). At the 1-year follow-up, most patients achieved MCID: 73% in Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain, 66% in KOOS Symptoms, and 78% in KOOS Activities of Daily Living (ADL). These improvements were similar at the 2-year follow-up: 75%, 72%, and 79% in each subscale, respectively. SCB was also demonstrated 1 year postoperatively, with 56%, 73%, and 71% achieving SCB for the KOOS Pain, Symptoms, and ADL subscales, respectively. These results largely persisted at the 2-year follow-up. Visual analog scale scores for pain also improved at 1- and 2-year postoperative periods with mean improvements from baseline of 2.80 and 2.87 points, respectively. Marx Activity Score decreased on average from baseline to 1- and 2-year follow-up.

Conclusions

At a minimum of 1-year follow-up, most patients with KL grade 3 and a meniscal tear achieved MCID and SCB in KOOS Pain, KOOS Symptoms, and KOOS ADL, indicating meaningful outcome improvement for these patients.

Level of Evidence

Level IV, therapeutic case series.

目的评估术前膝关节X光片显示凯尔格伦-劳伦斯(Kellgren-Lawrence,KL)3级且有症状的半月板撕裂患者行关节镜下半月板部分切除术(APM)后的患者报告结果指标(PROMs)。如果患者术前膝关节X光片显示有KL 3级骨关节炎,并在APM前完成了至少6周的非手术治疗试验,则将其纳入研究范围。如果患者患有炎症性关节炎、术前和/或术后1年随访数据不完整、重复进行膝关节镜检查以及合并韧带损伤,则排除在外。统计分析使用术前和术后2年的PROMs来评估改善情况,使用的量表是之前确定的阈值,包括最小临床重要性差异(MCID)和实质性临床获益(SCB)。结果82名患者符合资格标准(49名女性[60%],平均[标码]年龄为53.1[9.3]岁)。随访 1 年时,大多数患者都达到了 MCID:膝关节损伤和骨关节炎结果评分 (KOOS) 疼痛 73%、KOOS 症状 66% 和 KOOS 日常生活活动 (ADL) 78%。这些改善在 2 年的随访中表现相似:各分量表的改善率分别为 75%、72% 和 79%。术后 1 年的 SCB 也得到了证实,在 KOOS 疼痛、症状和 ADL 分量表中,分别有 56%、73% 和 71% 达到了 SCB。这些结果在两年的随访中基本保持不变。术后 1 年和 2 年的疼痛视觉模拟量表评分也有所改善,与基线相比,平均改善幅度分别为 2.80 分和 2.87 分。结论在至少1年的随访中,大多数KL 3级和半月板撕裂的患者在KOOS疼痛、KOOS症状和KOOS ADL方面都达到了MCID和SCB,这表明这些患者的治疗效果得到了显著改善。
{"title":"Arthroscopic Partial Meniscectomy in Patients With Kellgren-Lawrence Grade 3 Osteoarthritis Shows Clinically Meaningful Improvement in Outcomes","authors":"Tyler Warner B.S. ,&nbsp;Natalie Lowenstein M.P.H. ,&nbsp;Jillian Mazzocca B.A. ,&nbsp;Jamie Collins Ph.D. ,&nbsp;Elizabeth Matzkin M.D.","doi":"10.1016/j.asmr.2024.100926","DOIUrl":"10.1016/j.asmr.2024.100926","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate patient-reported outcome measures (PROMs) following arthroscopic partial meniscectomy (APM) in patients with Kellgren-Lawrence (KL) grade 3 on preoperative knee radiographs and a symptomatic meniscal tear.</p></div><div><h3>Methods</h3><p>This was a retrospective study design using prospectively collected data from a single institution. Patients were included if they had KL grade 3 osteoarthritis on preoperative radiographs of the knee and completed a trial of nonoperative treatment for at least 6 weeks prior to APM. Patients were excluded if they had inflammatory arthritis, incomplete preoperative and/or 1-year postoperative follow-up data, repeat knee arthroscopy, and concomitant ligamentous injury. Statistical analyses used PROMs, preoperatively and up to 2 years postoperatively, to assess improvement utilizing scales with previously established thresholds, including minimal clinically important difference (MCID) and substantial clinical benefit (SCB).</p></div><div><h3>Results</h3><p>Eighty-two patients met the eligibility criteria (49 women [60%], mean [SD] age, 53.1 [9.3] years). At the 1-year follow-up, most patients achieved MCID: 73% in Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain, 66% in KOOS Symptoms, and 78% in KOOS Activities of Daily Living (ADL). These improvements were similar at the 2-year follow-up: 75%, 72%, and 79% in each subscale, respectively. SCB was also demonstrated 1 year postoperatively, with 56%, 73%, and 71% achieving SCB for the KOOS Pain, Symptoms, and ADL subscales, respectively. These results largely persisted at the 2-year follow-up. Visual analog scale scores for pain also improved at 1- and 2-year postoperative periods with mean improvements from baseline of 2.80 and 2.87 points, respectively. Marx Activity Score decreased on average from baseline to 1- and 2-year follow-up.</p></div><div><h3>Conclusions</h3><p>At a minimum of 1-year follow-up, most patients with KL grade 3 and a meniscal tear achieved MCID and SCB in KOOS Pain, KOOS Symptoms, and KOOS ADL, indicating meaningful outcome improvement for these patients.</p></div><div><h3>Level of Evidence</h3><p>Level IV, therapeutic case series.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000440/pdfft?md5=4701d54bda6c2a9399dbcd106ffc223a&pid=1-s2.0-S2666061X24000440-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140278337","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
Tunnel Overlap Occurs 25% of the Time With Simultaneous Anterior Cruciate Ligament Reconstruction and Lateral Meniscal Root Repair 同时进行前交叉韧带重建和外侧 2 半月板根部修复时,隧道重叠发生率为 25
Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.asmr.2024.100917
Steven DeFroda M.D., M.Eng. , João Bourbon de Albuquerque II M.D., M.B.A., M.Sc., Ph.D. , Will Bezold B.S. , Cristi R. Cook D.V.M. , Clayton W. Nuelle M.D. , James P. Stannard M.D. , James L. Cook D.V.M., Ph.D.

Purpose

To assess the risk of socket-tunnel overlap for posterior medial or lateral meniscal root repair combined with anterior cruciate ligament reconstruction (ACLR) using artificial tibias and computed tomography scans for 3-dimensional modeling.

Methods

Artificial tibias (n = 27; n = 3/subgroup) were allocated to groups based on inclination of socket-tunnels (55°, 60°, 65°) created for posterior root of the medial meniscus (MMPR) and lateral meniscus posterior root (LMPR) repair, and ACLR. Three standardized socket-tunnels were created: one for the ACL and one for each posterior meniscal root insertion. Computed tomography scans were performed and sequentially processed using computer software to produce 3-dimensional models for assessment of socket-tunnel overlap. Statistical analysis was performed with Kruskal-Wallis and Mann-Whitney U tests. Significance was set at P < .05.

Results

The present study found no significant risk of tunnel overlap when drilling for combined ACLR and MMPR repair, whereas 7 cases of tunnel overlap occurred between ACL tunnels and LMPR (25.9% of cases). No subgroup or specific pattern of angulation consistently presented significantly safer distances than other subgroups for all distances measured.

Conclusions

This study demonstrated 25.9% rate of overlap for combined LMPR repair and ACLR, compared with 0% for MMPR repair with ACLR. Lower ACL drilling angle (55 or 60°) combined with greater lateral meniscus drilling angle (65°) produced no socket-tunnel overlap.

Clinical Relevance

Socket-tunnel overlap during meniscal root repair combined with ACLR may compromise graft integrity and lead to impaired fixation and treatment failure of either the ACL, the meniscus, or both. Despite this, risk for socket-tunnel overlap has not been well characterized.

目的使用人工胫骨和计算机断层扫描进行三维建模,评估后内侧或外侧半月板根部修复联合前交叉韧带重建术(ACLR)出现套筒-隧道重叠的风险。方法根据为内侧半月板后根(MMPR)和外侧半月板后根(LMPR)修复以及前交叉韧带重建创建的套筒隧道的倾斜度(55°、60°、65°),将人工胫骨(n = 27;n = 3/子组)分配到各组。创建了三个标准化套筒隧道:一个用于前交叉韧带,另一个用于半月板后根插入。进行计算机断层扫描并使用计算机软件按顺序处理,以生成三维模型,用于评估套筒-隧道重叠情况。统计分析采用 Kruskal-Wallis 和 Mann-Whitney U 检验。结果本研究发现,在联合 ACLR 和 MMPR 修复钻孔时,隧道重叠的风险并不显著,而在 ACL 隧道和 LMPR 之间发生隧道重叠的病例有 7 例(占病例总数的 25.9%)。在测量的所有距离中,没有任何亚组或特定角度模式的距离明显比其他亚组安全。较小的前交叉韧带钻孔角度(55 或 60°)加上较大的外侧半月板钻孔角度(65°)不会产生套筒-隧道重叠。尽管如此,承插口-隧道重叠的风险还没有得到很好的描述。
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引用次数: 0
Effect of Age and Sex on Anterior Cruciate Ligament Functional Tests Approximately 6 Months After Anterior Cruciate Ligament Reconstruction 前十字韧带重建术后五到八个月的功能测试未发现年龄或性别差异
Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.asmr.2024.100897
Dai Sugimoto Ph.D., A.T.C. , Matthew D. Milewski M.D. , Kathryn A. Williams M.S. , Ryan P. Coene M.S. , Kianna D. Nunally B.A. , Mininder S. Kocher M.D., M.P.H. , Dennis E. Kramer M.D. , Lyle J. Micheli M.D. , Yi-Meng Yen M.D., Ph.D. , Melissa A. Christino M.D.

Purpose

To examine age- and sex-related differences in postoperative functional outcomes at approximately 6 months after anterior cruciate ligament reconstruction (ACLR).

Methods

In this study, patients who underwent primary ACLR performed a series of return-to-sport functional tests at 5 to 8 months after surgery. Functional tests included strength tests (knee extensors, knee flexors, hip abductors, and hip extensors), a balance test (Y-balance composite score), and hop tests (single, triple, crossover, and 6-m timed hop tests). Limb symmetry was calculated to compare the reconstructed limb with the uninvolved limb. A 2-way multivariate analysis of covariance was used, and effect size was calculated for data analysis.

Results

A total of 176 subjects were included in this study. There were no significant interaction between age and sex on return-to-sport functional tests after ACLR. Also, no main effects of age and sex on return-to-sport functional tests were found in our data.

Conclusions

Age and sex do not significantly affect functional test performance after ACLR 6 months postoperatively.

Level of Evidence

Level III, retrospective review of prospective cohort study.

目的 研究前交叉韧带重建(ACLR)术后约 6 个月时,术后功能结果中与年龄和性别相关的差异。方法 在这项研究中,接受初级 ACLR 的患者在术后 5 到 8 个月时进行了一系列恢复运动功能测试。功能测试包括力量测试(膝关节伸肌、膝关节屈肌、髋关节外展肌和髋关节伸肌)、平衡测试(Y-平衡综合评分)和跳跃测试(单跳、三跳、交叉跳和6米计时跳跃测试)。通过计算肢体对称性来比较重建肢体与未受影响肢体。数据分析采用双向多变量协方差分析法,并计算效应大小。年龄和性别在前交叉韧带置换术后恢复运动功能测试中没有明显的交互作用。结论前交叉韧带置换术后 6 个月,年龄和性别对功能测试成绩无明显影响。
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引用次数: 0
Anterior Mobility of the Posterior Horn of the Lateral Meniscus Is Associated With Abnormal Magnetic Resonance Imaging Findings of Anteroinferior Popliteomeniscal Fascicle and Posterosuperior Popliteomeniscal Fascicle as Well as a Clinical History of Catching or Locking Symptoms 外侧半月板后角的前方活动度与腘绳肌前筋膜和腘绳肌后上筋膜的异常磁共振成像结果以及捕捉或锁定症状的临床病史有关
Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.asmr.2024.100922
Jun Suganuma M.D. , Ryuta Mochizuki M.D.

Purpose

To identify predictors of anterior mobility of the posterior horn of the lateral meniscus (PHLM) among patient demographics (age, sex), clinical characteristics (a history of catching or locking symptoms [CLS], body mass index, alignment of limb), and magnetic resonance imaging (MRI) findings of 4 restraints: anteroinferior popliteomeniscal fascicle (aiPMF), posterosuperior popliteomeniscal fascicle (psPMF), posteroinferior popliteomeniscal fascicle (piPMF), and meniscofibular ligament (MFibL).

Methods

Between October 2010 and December 2014, patients who underwent arthroscopic measurement of mobility of the PHLM were identified. The Sakai classification was used to classify aiPMF and psPMF on MRI into the following 3 types: type A, the fascicle was depicted with obvious continuity and with a low-intensity band; type B, depicted with continuity but with an ambiguous intensity structure; and type C, depicted with discontinuity or not visible. Magnetic resonance images of the piPMF and MFibL were evaluated as presence or absence. The mobility of the PHLM was measured arthroscopically at traction forces of 10 and 20 N.

Results

A total of 73 patients (47 men, mean age 41.8 ± 19.3 years) were included. Multivariate regression analyses revealed aiPMF type C and psPMF types B and C to be independent factors associated with mobility at both traction forces, and CLS was an independent factor at a traction force of 20 N. Compared with that of type A, the increased mobility of aiPMF type C was 5.0 mm (P = .019) and 5.6 mm (P = .011) at 10 and 20 N, respectively; the increased mobility of psPMF type B was 2.5 mm (P = .007) and 3.5 mm (P = .0003), respectively; and the increased mobility of psPMF type C was 3.3 mm (P = .021) and 3.6 mm (P = .014), respectively. The increased mobility associated with CLS was 3.5 mm at 20 N (P = .022).

Conclusions

Anterior displacement of the PHLM induced by an external traction force at 90° of flexion of the knee joint was associated with abnormal MRI findings of the anteroinferior popliteomeniscal fascicle and posterosuperior popliteomeniscal fascicle, as well as a history of catching or locking symptoms.

Clinical Relevance

Understanding signs and symptoms and associated pathology in patients with symptomatic anterior mobility of the posterior horn of the lateral meniscus may help guide best treatment.

目的在患者人口统计学特征(年龄、性别)、临床特征(抓握或锁定症状[CLS]病史、体重指数、肢体排列)和磁共振成像(MRI)结果的 4 个限制因素中,确定外侧半月板后角(PHLM)前方活动度的预测因素:腘绳肌前筋膜(aiPMF)、腘绳肌后上筋膜(psPMF)、腘绳肌后下筋膜(piPMF)和半月板腓肠肌韧带(MFibL)。方法对 2010 年 10 月至 2014 年 12 月间接受关节镜测量 PHLM 活动度的患者进行鉴定。采用 Sakai 分类法将 MRI 上的 aiPMF 和 psPMF 分为以下 3 种类型:A 型,筋膜带具有明显的连续性,且呈低强度带;B 型,筋膜带具有连续性,但强度结构模糊;C 型,筋膜带不连续或不可见。对 piPMF 和 MFibL 的磁共振图像评估为存在或不存在。在关节镜下测量 PHLM 的活动度,牵引力分别为 10 N 和 20 N。结果 共纳入 73 名患者(47 名男性,平均年龄为 41.8 ± 19.3 岁)。多变量回归分析显示,aiPMF C型和psPMF B型和C型是在两种牵引力下与活动度相关的独立因素,而CLS是在20 N牵引力下的独立因素。0 mm (P = .019) 和 5.6 mm (P = .011);psPMF B 型增加的活动度分别为 2.5 mm (P = .007) 和 3.5 mm (P = .0003) ;psPMF C 型增加的活动度分别为 3.3 mm (P = .021) 和 3.6 mm (P = .014)。结论膝关节屈曲90°时,外牵引力引起的PHLM前移位与腘绳肌前筋膜和腘绳肌后筋膜的MRI异常发现以及抓握或锁定症状病史有关。临床意义了解有症状的外侧半月板后角前移患者的症状和体征及相关病理变化有助于指导最佳治疗。
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引用次数: 0
Segond Fractures Can Be Identified With Excellent Accuracy Utilizing Deep Learning on Anteroposterior Knee Radiographs 利用深度学习技术在膝关节前路X光片上准确识别椎体骨折
Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.asmr.2024.100940
Jacob F. Oeding M.S. , Ayoosh Pareek M.D. , Kyle N. Kunze M.D. , Benedict U. Nwachukwu M.D., M.B.A. , Harry G. Greditzer IV M.D. , Christopher L. Camp M.D. , Bryan T. Kelly M.D. , Andrew D. Pearle M.D. , Anil S. Ranawat M.D. , Riley J. Williams III M.D. , HSS ACL Reconstruction Registry

Purpose

To develop a deep learning model for the detection of Segond fractures on anteroposterior (AP) knee radiographs and to compare model performance to that of trained human experts.

Methods

AP knee radiographs were retrieved from the Hospital for Special Surgery ACL Registry, which enrolled patients between 2009 and 2013. All images corresponded to patients who underwent anterior cruciate ligament reconstruction by 1 of 23 surgeons included in the registry data. Images were categorized into 1 of 2 classes based on radiographic evidence of a Segond fracture and manually annotated. Seventy percent of the images were used to populate the training set, while 20% and 10% were reserved for the validation and test sets, respectively. Images from the test set were used to compare model performance to that of expert human observers, including an orthopaedic surgery sports medicine fellow and a fellowship-trained orthopaedic sports medicine surgeon with over 10 years of experience.

Results

A total of 324 AP knee radiographs were retrieved, of which 34 (10.4%) images demonstrated evidence of a Segond fracture. The overall mean average precision (mAP) was 0.985, and this was maintained on the Segond fracture class (mAP = 0.978, precision = 0.844, recall = 1). The model demonstrated 100% accuracy with perfect sensitivity and specificity when applied to the independent testing set and the ability to meet or exceed human sensitivity and specificity in all cases. Compared to an orthopaedic surgery sports medicine fellow, the model required 0.3% of the total time needed to evaluate and classify images in the independent test set.

Conclusions

A deep learning model was developed and internally validated for Segond fracture detection on AP radiographs and demonstrated perfect accuracy, sensitivity, and specificity on a small test set of radiographs with and without Segond fractures. The model demonstrated superior performance compared with expert human observers.

Clinical Relevance

Deep learning can be used for automated Segond fracture identification on radiographs, leading to improved diagnosis of easily missed concomitant injuries, including lateral meniscus tears. Automated identification of Segond fractures can also enable large-scale studies on the incidence and clinical significance of these fractures, which may lead to improved management and outcomes for patients with knee injuries.

目的开发一种深度学习模型,用于检测膝关节前后位(AP)X光片上的Segond骨折,并将模型性能与训练有素的人类专家的性能进行比较。所有图像都与接受前交叉韧带重建术的患者相对应,这些患者由注册数据中的 23 名外科医生中的 1 名进行了手术。根据 Segond 骨折的放射学证据,图像被分为两类中的一类,并进行人工标注。70%的图像用于填充训练集,20%和 10%的图像分别用于验证集和测试集。测试集中的图像用于将模型性能与人类专业观察者的性能进行比较,人类专业观察者包括一名矫形外科运动医学研究员和一名受过研究培训、拥有 10 年以上经验的矫形外科运动医学外科医生。结果 共检索到 324 张 AP 膝关节 X 光片,其中 34 张(10.4%)图像显示有 Segond 骨折的证据。总体平均精确度(mAP)为 0.985,在赛刚骨折类别上保持了这一精确度(mAP = 0.978,精确度 = 0.844,召回率 = 1)。该模型在应用于独立测试集时,准确率达到 100%,具有完美的灵敏度和特异性,在所有情况下都能达到或超过人类的灵敏度和特异性。与一名骨科外科运动医学研究员相比,该模型评估和分类独立测试集中的图像所需的总时间仅为0.3%。结论开发了一种深度学习模型,并对其进行了内部验证,用于在AP射线照片上检测Segond骨折,该模型在有Segond骨折和无Segond骨折的小型射线照片测试集中表现出完美的准确性、灵敏度和特异性。该模型的性能优于人类专家观察者。临床意义深度学习可用于在X光片上自动识别Segond骨折,从而提高对容易漏诊的并发损伤(包括外侧半月板撕裂)的诊断率。Segond骨折的自动识别还有助于对这些骨折的发生率和临床意义进行大规模研究,从而改善膝关节损伤患者的管理和治疗效果。
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引用次数: 0
Responses From ChatGPT-4 Show Limited Correlation With Expert Consensus Statement on Anterior Shoulder Instability ChatGPT-4 的回复与肩关节前方不稳专家共识声明的相关性有限
Q3 Medicine Pub Date : 2024-06-01 DOI: 10.1016/j.asmr.2024.100923
Alexander Artamonov M.D. , Ira Bachar-Avnieli M.D. , Eyal Klang M.D. , Omri Lubovsky M.D. , Ehud Atoun M.D. , Alexander Bermant M.D. , Philip J. Rosinsky M.D.

Purpose

To compare the similarity of answers provided by Generative Pretrained Transformer-4 (GPT-4) with those of a consensus statement on diagnosis, nonoperative management, and Bankart repair in anterior shoulder instability (ASI).

Methods

An expert consensus statement on ASI published by Hurley et al. in 2022 was reviewed and questions laid out to the expert panel were extracted. GPT-4, the subscription version of ChatGPT, was queried using the same set of questions. Answers provided by GPT-4 were compared with those of the expert panel and subjectively rated for similarity by 2 experienced shoulder surgeons. GPT-4 was then used to rate the similarity of its own responses to the consensus statement, classifying them as low, medium, or high. Rates of similarity as classified by the shoulder surgeons and GPT-4 were then compared and interobserver reliability calculated using weighted κ scores.

Results

The degree of similarity between responses of GPT-4 and the ASI consensus statement, as defined by shoulder surgeons, was high in 25.8%, medium in 45.2%, and low 29% of questions. GPT-4 assessed similarity as high in 48.3%, medium in 41.9%, and low 9.7% of questions. Surgeons and GPT-4 reached consensus on the classification of 18 questions (58.1%) and disagreement on 13 questions (41.9%).

Conclusions

The responses generated by artificial intelligence exhibit limited correlation with an expert statement on the diagnosis and treatment of ASI.

Clinical Relevance

As the use of artificial intelligence becomes more prevalent, it is important to understand how closely information resembles content produced by human authors.

目的比较生成式预训练转换器-4(GPT-4)与关于肩关节前不稳定(ASI)的诊断、非手术治疗和Bankart修复的共识声明所提供答案的相似性。方法回顾了Hurley等人于2022年发表的关于ASI的专家共识声明,并提取了向专家小组提出的问题。使用相同的问题集对 ChatGPT 的订阅版本 GPT-4 进行了查询。GPT-4 提供的答案与专家小组提供的答案进行了比较,并由两名经验丰富的肩部外科医生对相似度进行了主观评分。然后,GPT-4 用于评定自己的回答与共识声明的相似度,将其分为低、中、高三个等级。然后比较肩部外科医生和 GPT-4 的相似度,并使用加权 κ 分数计算观察者之间的可靠性。结果根据肩部外科医生的定义,GPT-4 和 ASI 共识声明之间的相似度在 25.8% 的问题中为高、45.2% 为中、29% 为低。GPT-4 对相似性的评估为高的问题占 48.3%,中等的问题占 41.9%,低的问题占 9.7%。外科医生和 GPT-4 就 18 个问题(占 58.1%)的分类达成了共识,就 13 个问题(占 41.9%)的分类存在分歧。
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引用次数: 0
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Arthroscopy Sports Medicine and Rehabilitation
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