Arthroscopy Sports Medicine and Rehabilitation最新文献_第7页

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

Arthroscopy Sports Medicine and Rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100970

Bruno Capurro M.D., Ph.D. , Reagan S. Chapman M.D., M.S. , Daniel J. Kaplan M.D. , Omair Kazi M.S. , Alexander B. Alvero M.D. , Tai C. Holland M.D. , Morgan Rice M.D. , Shane J. Nho M.D., M.S.

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。

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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

Arthroscopy Sports Medicine and Rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100968

Miguel A. Diaz M.S. , Eric A. Branch M.D. , Jacob G. Dunn D.O. , Anthony Brothers M.D. , Steve E. Jordan M.D.

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

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

Arthroscopy Sports Medicine and Rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100972

Matthew Quinn M.D. , Alex Albright M.D. , Victoria Kent B.S. , Patrick Morrissey M.D. , Luca Katz B.S. , Michael Kutschke M.D. , Nicholas Lemme M.D. , Ramin R. Tabaddor M.D.

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

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

Arthroscopy Sports Medicine and Rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100965

Hussein Elkousy M.D. , Davin K. Fertitta B.S. , Laith Elkousy , Maudood Rana , Allyson N. Pfeil B.S. , Corey F. Hryc Ph.D.

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":"Hussein Elkousy M.D. , Davin K. Fertitta B.S. , Laith Elkousy , Maudood Rana , Allyson N. Pfeil B.S. , Corey F. Hryc Ph.D.","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 <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> < .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> < .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":"6 5","pages":"Article 100965"},"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

Concomitant Popliteomeniscal Fascicles Tears Are Found in 21% of Professional Soccer Players With Acute Anterior Cruciate Ligament Injuries 在 21% 急性前十字韧带损伤的职业足球运动员中发现了同时存在的腘绳肌撕裂

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100956

Purpose

To investigate the incidence of popliteomeniscal fascicles (PMF) tears in anterior cruciate ligament (ACL) rupture in professional soccer players, to describe arthroscopic and magnetic resonance imaging (MRI) findings and treatment of these lesions with clinical outcomes, and to evaluate the incidence of subsequent lateral meniscus tears and ACL reinjury.

Methods

ACL reconstructions on soccer players were retrospectively analyzed, and among them, a cohort of patients with PMFs tears was reviewed. The cohort was assessed with MRI examination, arthrometric testing, Lysholm score, and International Knee Documentation Committee score. The occurrence of subsequent lateral meniscus tears and ACL reinjury were evaluated.

Results

A total of 208 ACL reconstructions were identified. From these, 43 male and 3 female subjects with a mean age of 24 ± 4.2 years were included. Median time from injury to surgery was 5 days. Preoperative MRI showed a tear of posterior PMFs in 24 of 47 knees (51.1%). The mean preoperative arthrometric measured laxity was 4.3 ± 1.65 mm, and postoperatively 0.1 ± 1.1 mm. Preoperative Lysholm score and International Knee Documentation Committee score were, respectively, 50.4 ± 25.4 and 39.6 ± 5, and postoperatively 98 ± 2.4 and 73.6 ± 1.2. Mean time to return to play, at the same preoperative level for all patients, was 184 ± 41.7 days. One patient underwent ACL revision due to a reinjury 9 months after surgery, whereas no lateral meniscus tears occurred in the follow-up period.

Conclusions

PMF tears are found in approximately 20% of professional soccer players with acute ACL injuries. After ACL reconstruction and PMFs repair, outcomes including return to play are good, ACL retear is low, and recurrent lateral meniscus tears were not observed.

Level of Evidence

Level IV, therapeutic case series.

目的研究职业足球运动员前十字韧带（ACL）断裂时腘绳肌筋膜（PMF）撕裂的发生率，描述这些病变的关节镜和磁共振成像（MRI）检查结果和治疗方法以及临床疗效，并评估后续外侧半月板撕裂和 ACL 再损伤的发生率。通过核磁共振成像检查、关节测量、Lysholm评分和国际膝关节文献委员会评分对该组患者进行了评估。对随后发生的外侧半月板撕裂和前交叉韧带再损伤进行了评估。其中，男性 43 例，女性 3 例，平均年龄为 24 ± 4.2 岁。从受伤到手术的中位时间为 5 天。术前磁共振成像显示，47个膝关节中有24个（51.1%）后PMF撕裂。术前关节测量的平均松弛度为（4.3 ± 1.65）毫米，术后为（0.1 ± 1.1）毫米。术前Lysholm评分和国际膝关节文献委员会评分分别为（50.4 ± 25.4）和（39.6 ± 5），术后分别为（98 ± 2.4）和（73.6 ± 1.2）。所有患者恢复到术前水平的平均时间为 184 ± 41.7 天。一名患者在术后9个月因再次受伤而接受了前十字韧带翻修手术，而在随访期间没有发生外侧半月板撕裂。前交叉韧带重建和PMFs修复后，包括重返赛场在内的效果良好，前交叉韧带再撕裂率低，未发现复发性外侧半月板撕裂。

{"title":"Concomitant Popliteomeniscal Fascicles Tears Are Found in 21% of Professional Soccer Players With Acute Anterior Cruciate Ligament Injuries","authors":"","doi":"10.1016/j.asmr.2024.100956","DOIUrl":"10.1016/j.asmr.2024.100956","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the incidence of popliteomeniscal fascicles (PMF) tears in anterior cruciate ligament (ACL) rupture in professional soccer players, to describe arthroscopic and magnetic resonance imaging (MRI) findings and treatment of these lesions with clinical outcomes, and to evaluate the incidence of subsequent lateral meniscus tears and ACL reinjury.</div></div><div><h3>Methods</h3><div>ACL reconstructions on soccer players were retrospectively analyzed, and among them, a cohort of patients with PMFs tears was reviewed. The cohort was assessed with MRI examination, arthrometric testing, Lysholm score, and International Knee Documentation Committee score. The occurrence of subsequent lateral meniscus tears and ACL reinjury were evaluated.</div></div><div><h3>Results</h3><div>A total of 208 ACL reconstructions were identified. From these, 43 male and 3 female subjects with a mean age of 24 ± 4.2 years were included. Median time from injury to surgery was 5 days. Preoperative MRI showed a tear of posterior PMFs in 24 of 47 knees (51.1%). The mean preoperative arthrometric measured laxity was 4.3 ± 1.65 mm, and postoperatively 0.1 ± 1.1 mm. Preoperative Lysholm score and International Knee Documentation Committee score were, respectively, 50.4 ± 25.4 and 39.6 ± 5, and postoperatively 98 ± 2.4 and 73.6 ± 1.2. Mean time to return to play, at the same preoperative level for all patients, was 184 ± 41.7 days. One patient underwent ACL revision due to a reinjury 9 months after surgery, whereas no lateral meniscus tears occurred in the follow-up period.</div></div><div><h3>Conclusions</h3><div>PMF tears are found in approximately 20% of professional soccer players with acute ACL injuries. After ACL reconstruction and PMFs repair, outcomes including return to play are good, ACL retear is low, and recurrent lateral meniscus tears were not observed.</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":"6 5","pages":"Article 100956"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141401035","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

Graft Type and Diameter Are Predictors of Reinjury After Transphyseal Anterior Cruciate Ligament Reconstruction in Pediatric and Adolescent Patients 预测儿科和青少年患者经骺前十字韧带重建术后再次损伤的移植物类型和直径

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100964

Luca Rigamonti M.D. , Nathaniel Bates Ph.D. , Nathan Schilaty Ph.D. , Bruce Levy M.D. , Todd Milbrandt M.D. , Marco Bigoni M.D. , Michael Stuart M.D. , Aaron J. Krych M.D.

Purpose

To report the rate of anterior cruciate ligament (ACL) graft failure by physis status (open, closing, closed) and to analyze which factors were associated with higher risk of ACL graft failure.

Methods

Patients younger than 18 years who underwent transphyseal ACL reconstruction (ACLR) between 2000 and 2018 at a single institution were reviewed at minimum 2 years after ACLR. Patient records were reviewed for anthropometrics, surgical techniques, and ACL graft failure. Patients were subsequently stratified based on physis status (open, closing, closed) and analyzed.

Results

A total of 272 patients (mean age of 15.4 ± 1.3 years) were assessed. The transtibial technique was used in 63.6% of cases. A hamstring autograft was used exclusively in the open physis group. A patellar tendon autograft was used in 65.9% of patients with a closing physis and 80.9% of patients with a closed physis. The overall graft failure rate was 13.2%, with a contralateral ACL injury rate of 11.0%. Kaplan-Maier analysis by physis status showed different injury free from ACL reinjury (P < .001). An open physis was associated with increased risk of ACL reinjury (hazard ratio, 5.2; P < .001) when compared to a closed physis. A closing physis presented a higher hazard ratio but was not statistically significant (hazard ratio, 2.6; P = .08). Hamstring graft type (P = .03) and lower graft diameter (P = .04) were significantly related to higher ACL reinjury after adjusting for physis status.

Conclusions

Transphyseal ACLR is a safe procedure in pediatric patients. The rate of reinjury was 13.2%. This rate decreases with skeletal maturity, use of patellar tendon autograft, and a larger graft diameter.

Level of Evidence

Level III, retrospective cohort study.

目的报告按韧带状态（开放、闭合、封闭）分类的前交叉韧带（ACL）移植物失败率，并分析哪些因素与前交叉韧带移植物失败的高风险相关。方法对 2000 年至 2018 年期间在一家机构接受经骨前交叉韧带重建术（ACLR）的 18 岁以下患者在 ACLR 术后至少 2 年进行复查。回顾了患者的人体测量学、手术技术和前交叉韧带移植失败的记录。随后根据假体状态（开放、闭合、封闭）对患者进行分层并进行分析。63.6%的病例采用了经胫骨技术。开放髋关节组仅使用了腘绳肌自体移植。65.9%的闭合髋关节患者和80.9%的闭合髋关节患者使用了髌腱自体移植物。总体移植失败率为13.2%，对侧前交叉韧带损伤率为11.0%。按韧带状态进行的 Kaplan-Maier 分析显示，前交叉韧带再损伤的免伤率存在差异（P < .001）。与闭合髋臼相比，开放髋臼增加了前交叉韧带再损伤的风险（危险比，5.2；P <.001）。闭合式髋关节的危险比更高，但无统计学意义（危险比为 2.6；P = .08）。腘绳肌移植物类型（P = .03）和较低的移植物直径（P = .04）与较高的前交叉韧带再损伤率有显著相关性（调整髋臼状态后）。再损伤率为13.2%。随着骨骼的成熟、髌腱自体移植物的使用以及移植物直径的增大，再损伤率会降低。

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引用次数: 0

Between 2008 and 2022, Lower-Extremity Injuries Declined in Male Rugby Players, Whereas Noncontact Knee Injuries Showed No Decline in Female Rugby Players 2008 年至 2022 年间，男性橄榄球运动员的下肢损伤有所减少，而女性橄榄球运动员的非接触膝部损伤没有减少

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100967

Avanish Yendluri B.S. , Zachary S. Gallate M.S. , Rohit R. Chari B.S. , Auston R. Locke M.P.H. , Kyle K. Obana , David P. Trofa M.D. , Rachel M. Frank M.D. , Robert L. Parisien M.D.

Purpose

To assess the distribution and mechanisms of lower-extremity injuries among high school and college age rugby players presenting to U.S. emergency departments (EDs) from 2008 to 2022.

Methods

The National Electronic Injury Surveillance System was queried for lower-extremity rugby injuries (ages 14-23 years) from January 2008 to December 2022. Patient demographics, injury location, diagnosis, and disposition were extracted for each case. Linear regression analysis assessed differences over time. Injury distribution for male versus female players was evaluated using Pearson χ² analysis.

Results

An estimated 31,318 (845 National Electronic Injury Surveillance System cases) high school and college-age rugby players presented to U.S. EDs with a lower-extremity injury during the study period. Male players accounted for 66.9% of the injuries. Linear regression analysis revealed a significant decrease in the annual frequency of lower-extremity injuries presenting to U.S. EDs from 2008 to 2022 (P = .001). The most common injury mechanism was overwhelmingly a noncontact twisting motion (11,108, 35.5%) followed by a hit/collision (5,298, 16.9%). Strains/sprains were the most common diagnosis (17,243, 55.1%). Injuries most commonly occurred at the ankle (12,659, 40.4%) and knee (11,016, 35.2%). In a sex-specific linear regression analysis, there was a significant decrease in lower-extremity injuries sustained by male players (P = .001) but no significant decrease among female players (P = .112). Furthermore, χ² analysis revealed that female players sustained a significantly greater proportion of knee injuries secondary to twists (15.9% for female vs 9.0% for male players, P = .01).

Conclusions

Lower-extremity injuries are declining among high school and college-age male rugby players. However, there has not been a corresponding decrease among female rugby players. Furthermore, female players are disproportionately affected by noncontact twisting knee injuries.

Level of Evidence

Level III, retrospective comparative study.

目的评估 2008 年至 2022 年期间在美国急诊科（ED）就诊的高中和大学年龄段橄榄球运动员下肢损伤的分布情况和机制。方法对 2008 年 1 月至 2022 年 12 月期间的下肢橄榄球损伤（14-23 岁）查询全国电子损伤监测系统。提取了每个病例的患者人口统计学特征、受伤部位、诊断和处置情况。线性回归分析评估了不同时期的差异。结果在研究期间，约有 31,318 名（845 例全国电子伤害监测系统病例）高中和大学年龄段的橄榄球运动员因下肢受伤而前往美国急诊室就诊。男性球员占受伤人数的 66.9%。线性回归分析表明，从 2008 年到 2022 年，每年到美国急诊室就诊的下肢受伤病例明显减少（P = .001）。最常见的受伤机制绝大多数是非接触性扭转运动（11108 例，35.5%），其次是撞击/碰撞（5298 例，16.9%）。拉伤/扭伤是最常见的诊断结果（17243 例，55.1%）。最常见的受伤部位是踝关节（12659 人，40.4%）和膝关节（11016 人，35.2%）。在针对不同性别的线性回归分析中，男性球员的下肢受伤率显著下降（P = .001），但女性球员的下肢受伤率没有显著下降（P = .112）。此外，χ2 分析表明，女队员因扭转而造成的膝关节损伤比例明显更高（女队员为 15.9%，男队员为 9.0%，P = .01）。结论高中和大学年龄段的男性橄榄球运动员的下肢损伤正在减少，但女性橄榄球运动员的下肢损伤并没有相应减少。此外，女性球员受非接触性扭转膝关节损伤的影响尤为严重。

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引用次数: 0

Medial Patellofemoral Ligament Augmented With a Reinforced Bioinductive Implant Is Biomechanically Similar to the Native Medial Patellofemoral Ligament at Time Zero in a Cadaveric Model 在尸体模型中，使用增强型生物感应植入物增强的髌股内侧韧带 (MPFL) 在零时的生物力学特性与原生 MPFL 相似

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100975

Sean Mc Millan D.O. , Seth Sherman M.D. , Zachary R. Brown M.S. , Erik Brewer Ph.D. , Elizabeth Ford D.O.

Purpose

To biomechanically compare primary medial patellofemoral ligament (MPFL) repair (MPFLr) augmented with a reinforced bioinductive implant (RBI) to the native MPFL ligament and a semitendinosus (semi-T) MPFL reconstruction (MPFLR) at time zero.

Methods

Four fresh-frozen matched pair cadavers (8 knees) were used to biomechanically compare the native MPFL to augmented MPFLr (n = 4) and semi-T MPFLR (n = 4). The native MPFL (n = 8) was isolated, preserving the femoral and patellar attachments, and pulled to failure. The semi-T was harvested from 1 of the matched pairs and whipstitched, as was a 250-mm × 5-mm RBI. A standard double-bundle docking technique was utilized. The patella was potted and mechanically pulled parallel to the transverse axis until failure in both cohorts. Cyclic creep, load and displacement at failure, failure mode, and stiffness were recorded.

Results

Failure load was highest in the RBI with repair group (287 ± 130 N) compared to the native MPFL (219 ± 64 N) and the semi-T group (84 ± 29 N). No statistically significant difference in failure load between the RBI augmentation with repair group and the native ligament (P = .19) were found. The semi-T reconstruction group failed at the least amount of displacement (7.93 ± 3.4 mm) compared to the native MPFL (20.9 ± 9 mm) (P < .01) and the RBI with repair group (33.2 ± 17.7 mm) (P < .02). At 10 mm of displacement, the RBI group (8.3 ± 1.2 N/mm) demonstrated stiffness in the midrange compared to the native MPFL (14.1 ± 7.1 N/mm). Early anchor/tendon pullout failure on the patella side was noted in the semi-T group compared to the RBI group. One reconstruction was excluded from analysis due to poor bone quality.

Conclusions

No statistically significant difference was seen between the augmented MPFL repair and the native MPFL in load-to-failure testing. The augmented MPFL repair was observed to have biomechanical properties similar to the native MPFL. MPFLr with RBI augmentation provided consistent stiffness at clinically relevant displacement.

Clinical Relevance

Primary MPFL repair and reconstruction using the semi-T graft, while effective, are nevertheless imperfect procedures. MPFL repair has been shown to have higher instability recurrence rates, while the stiffness profile of MPFLR with semi-T is higher than the native MFPL and may lead to knee stiffness, loss of motion, or cartilage damage. The results of this time-zero biomechanical study indicate that the use of an RBI for augmentation of a primary MPFL repair may be a viable alternative to traditional MPFL repair or reconstruction using a semi-T graft.

目的比较使用增强型生物诱导植入物（RBI）增强的初级髌股内侧韧带（MPFL）修复术（MPFLr）与原生MPFL韧带和半腱肌（semi-T）MPFL重建术（MPFLR）在零时的生物力学效果。方法使用四具新鲜冷冻的配对尸体（8个膝盖），比较原生MPFL与增强型MPFLr（n = 4）和半腱肌MPFLR（n = 4）的生物力学效果。对原生 MPFL（n = 8）进行分离，保留股骨和髌骨附着处，并将其拉至失效。从其中一对匹配的患者身上取下半T型，然后鞭状缝合，并缝合一个250毫米×5毫米的RBI。采用标准的双束对接技术。在两个组群中，髌骨都被灌注并平行于横轴进行机械牵拉，直至失效。结果与原生 MPFL（219 ± 64 N）和半 T 组（84 ± 29 N）相比，带修复的 RBI 组的破坏载荷最高（287 ± 130 N）。在统计学上，RBI 增强修复组与原生韧带组的失败载荷没有明显差异（P = 0.19）。与原生 MPFL（20.9 ± 9 mm）（P <.01）和带修复的 RBI 组（33.2 ± 17.7 mm）（P <.02）相比，半 T 重建组在最小位移量（7.93 ± 3.4 mm）时失效。与原生 MPFL（14.1 ± 7.1 N/mm）相比，在 10 mm 位移时，RBI 组（8.3 ± 1.2 N/mm）显示出中等硬度。与 RBI 组相比，半 T 组的髌骨侧出现了早期锚/肌腱拉出失败。结论增强型 MPFL 修复与原生 MPFL 在负载-失效测试中没有明显的统计学差异。据观察，增强型 MPFL 修复的生物力学特性与原生 MPFL 相似。使用 RBI 增强的 MPFLr 在临床相关位移时具有一致的硬度。已证明 MPFL 修复术的不稳定性复发率较高，而使用半 T 的 MPFLR 的硬度曲线高于原生 MFPL，可能会导致膝关节僵硬、运动功能丧失或软骨损伤。这项零时生物力学研究结果表明，使用 RBI 增强初级 MPFL 修复可能是使用半 T 移植物进行传统 MPFL 修复或重建的可行替代方案。

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引用次数: 0

Most Systematic Reviews and Meta-analyses Reporting Clinical Outcomes of the Remplissage Procedure Have at Least 1 Form of Spin 大多数报告再植手术临床结果的系统综述和荟萃分析至少有一种旋转形式

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100969

Tom R. Doyle M.B., M.Ch. , Martin S. Davey M.Ch., M.R.C.S. , Thomas K. Moore M.B., M.Ch. , Max White M.B. , Eoghan T. Hurley M.B., M.Ch., Ph.D. , Christopher S. Klifto M.D. , Jonathan F. Dickens M.D. , Hannan Mullett M.Ch., F.R.C.S.

Purpose

To determine the prevalence of spin in systematic reviews (SRs) and meta-analyses of clinical studies of the remplissage procedure.

Methods

Two reviewers independently performed a literature search of the PubMed, Scopus, and Embase databases using the search term “remplissage” in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The full article of each included SR was assessed for the presence of the 15 most common types of spin. Methodologic quality was assessed using the second version of A Measurement Tool to Assess Systematic Reviews (AMSTAR 2).

Results

A total of 15 SRs (8 accompanied by meta-analyses; 6 Level III and 9 Level IV) were included. Overall, 13 SRs (86.7%) contained at least 1 form of spin, with 33 unique instances of spin recorded; the mean frequency was 2.2 ± 1.3 (range, 0-4). The most prevalent form of spin, present in 11 studies (73%), was type 9 (“conclusion claims the beneficial effect of the experimental treatment despite reporting bias”). There were 14 uses of spin classified as misleading reporting, 16 classified as misleading interpretation, and 3 classified as inappropriate extrapolation. The mean 5-year impact factor of the publishing journals was 4.4 ± 0.9 (range, 0-6.1), the mean number of citations per SR was 33.3 ± 24.9 (range, 0-55), and the mean number of citations per month since publication was 0.68 ± 0.44 (range, 0-1.48). According to the AMSTAR 2 assessment, confidence in the results of the SRs was rated as critically low for 20% of reviews, low for 33.3%, and moderate for 46.7%.

Conclusions

Most SRs of the remplissage procedure are affected by the presence of spin. Favorable reporting was observed in the absence of definite findings, as was minimization of drawbacks for certain populations.

Level of Evidence

Level IV, systematic review of Level III and IV studies.

目的确定再植手术临床研究的系统综述（SR）和荟萃分析中自旋的发生率。方法两位审稿人根据系统综述和荟萃分析首选报告项目（PRISMA）指南，使用检索词 "再植 "对 PubMed、Scopus 和 Embase 数据库进行了独立的文献检索。对每篇纳入的 SR 全文进行了评估，以确定是否存在 15 种最常见的旋转类型。结果共纳入了 15 篇系统综述（8 篇附有荟萃分析；6 篇三级，9 篇四级）。总体而言，13 篇 SR（86.7%）包含至少一种形式的自旋，记录了 33 个独特的自旋实例；平均频率为 2.2 ± 1.3（范围为 0-4）。最常见的自旋形式是第 9 种（"尽管存在报告偏差，但结论声称实验治疗具有有益效果"），共有 11 项研究（占 73%）采用了这种形式。有 14 项自旋被归类为误导性报告，16 项被归类为误导性解释，3 项被归类为不恰当的外推。发表期刊5年的平均影响因子为4.4±0.9（范围0-6.1），每篇SR的平均引用次数为33.3±24.9（范围0-55），发表后每月的平均引用次数为0.68±0.44（范围0-1.48）。根据 AMSTAR 2 评估，20% 的综述对再植手术结果的置信度为极低，33.3% 为低，46.7% 为中等。证据级别IV级，III级和IV级研究的系统综述。

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引用次数: 0

The Top-20 Studies About Anterior Shoulder Instability From an Altmetric Analysis Had Higher Levels of Evidence Than Those From a Traditional Bibliometric Analysis Altmetric 分析得出的关于肩关节前方失稳的前 20 篇研究的证据等级高于传统文献计量分析得出的研究的证据等级

Q3 Medicine

Arthroscopy Sports Medicine and Rehabilitation

Pub Date : 2024-10-01 DOI: 10.1016/j.asmr.2024.100974

Liam O’Dwyer B.Sc. , Conor Ledingham M.B., B.Ch., M.Ch. , Martin S. Davey M.B., B.Ch., B.A.O., M.Ch., M.R.C.S. , Austin Kerin B.Sc. , Azim Huszar B.Sc. , J. Tristan Cassidy M.B., B.Ch., M.Ch., F.R.C.S.I. (Tr & Orth)

Purpose

To compare the characteristics of the top-20 studies about anterior shoulder instability according to the Altmetric Attention Score (AAS) with total citation counts.

Methods

Two separate searches were performed for articles related to anterior shoulder instability. The Altmetric search identified the top-20 articles according to AAS. A bibliometric search using Web of Science identified the top-20 most-cited articles. Altmetric criteria were applied to the bibliometric list and vice versa.

Results

The AAS from the Altmetric list ranged from 44 to 432. The highest AAS from the bibliometric search was 70. One study appeared in both lists. Most online mentions were from X (formerly Twitter). The geographical breakdown of X mentions saw 71 countries appearing in the Altmetric search versus 21 in the bibliometric search. The total citations in the bibliometric list ranged from 91 to 358 versus 0 to 121 for the Altmetric list. The Altmetric top-20 list contained 8 studies that were Level II or higher versus 3 in the bibliometric list.

Conclusions

The top-20 studies according to AAS or citation count are not the same. The top-20 studies by AAS are composed of studies at higher levels of evidence versus the top-20 studies when listed by citation count.

Clinical Relevance

Electronic searches are an important way to access information in the modern world. Different search options generate results according to different parameters and may generate different results for the same query. It is important to understand these differences so that users have a better understanding of where the most clinically useful information can be found, especially regarding medical conditions.

目的比较根据Altmetric关注度评分（AAS）排在前20位的肩关节前侧不稳定性研究的特点和总引用次数。方法对与肩关节前侧不稳定性相关的文章分别进行了两次检索。Altmetric 搜索根据 AAS 确定了排名前 20 的文章。使用Web of Science进行的文献计量学搜索确定了被引用次数最多的前20篇文章。结果Altmetric列表中的AAS从44到432不等。文献计量学搜索的最高 AAS 为 70。有一项研究同时出现在两个列表中。大多数在线提及来自 X（原 Twitter）。从 X 提及的地域分布来看，Altmetric 搜索中出现了 71 个国家，而文献计量学搜索中出现了 21 个国家。文献计量学列表中的总引用次数从 91 到 358 不等，而 Altmetric 列表中的总引用次数从 0 到 121 不等。Altmetric排名前20的研究中有8项为二级或二级以上，而文献计量学排名中只有3项。按AAS排序的前20名研究与按引用次数排序的前20名研究相比，前者的证据级别更高。不同的搜索选项会根据不同的参数生成不同的结果，而且同一查询可能会生成不同的结果。了解这些差异非常重要，这样用户就能更好地了解在哪里可以找到对临床最有用的信息，尤其是有关医疗条件的信息。

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引用次数: 0