Arthroscopy Sports Medicine and Rehabilitation最新文献

{"title":"MRI Accurately Predicts Quadrupled Semitendinosus Autograft Size Using Posterior Hamstring Harvest for ACL Reconstruction","authors":"Erik Henkelman M.D. ,&nbsp;Jack M. Ayres M.D. ,&nbsp;Stephan L. Prô M.D.","doi":"10.1016/j.asmr.2023.100844","DOIUrl":"https://doi.org/10.1016/j.asmr.2023.100844","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine the effectiveness of preoperative magnetic resonance imaging (MRI) measurements of the cross-sectional area (CSA) of the semitendinosus tendon in predicting the intraoperative quadrupled semitendinosus graft diameter of a posteriorly harvested hamstring autograft for anterior cruciate ligament (ACL) reconstruction.</p></div><div><h3>Methods</h3><p>A retrospective review of patients who underwent ACL reconstruction with autograft using a posterior hamstring harvest was performed. Patient demographics and operative reports were reviewed, and measurements of the CSA of the semitendinosus on MRI were performed. Multiple linear regression was used to analyze the predictors for graft diameter. A <em>P</em> value &lt; .05 was considered statistically significant. Interrater and intrarater reliability were calculated.</p></div><div><h3>Results</h3><p>280 patients were included. Patient height (<em>P</em> &lt; .0001), and CSA of the semitendinosus (<em>P</em> &lt; .0001) were significant predictors. Patients shorter than 63 inches had an average graft diameter of 7.89 mm compared to 8.69 mm for patients above 63 in (<em>P</em> &lt; .001). The formula for the model is as follows: Graft diameter (mm²) = 2.74 + .067·Height (in) + .00009 · Weight (lbs) + .0018 · Age (years) +.12·Gender (1 if M, 0 if F) <em>+</em> 8.56 · CSA (cm²). The <em>R</em>² for the model (0.5620), was greater than models using only height (<em>R</em>² = .4092) or only CSA Semitendinosus (<em>R</em>² = .3932). None of the interaction terms between covariates (e.g., height, weight, age, gender) were significant. Age (<em>P</em> =.6400), weight (<em>P</em> = .9970), and gender (<em>P</em> = .6700) were not significant predictors. Both intraclass (ICC = 0.864, 95% CI=[0.791, 0.912]) and interclass correlation (ICC=0.827, 95% CI=[0.715, 0.894]) showed good reliability.</p></div><div><h3>Conclusion</h3><p>CSA semitendinosus tendon and patient height independently perform similarly as predictors of graft diameter. When used together, CSA and height accurately predict the graft diameter. In particular, for patients under 63 in tall who demonstrated an average graft diameter below the minimum 8 mm, as suggested by the literature, this may be a useful tool for preoperative planning of patients intending to undergo ACL reconstruction with posterior hamstring harvest.</p></div><div><h3>Level of Evidence</h3><p>Level III, diagnostic: retrospective cohort study.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X23001955/pdfft?md5=dc1bc8565a38b5530b3d4a1a7a8ed5c7&pid=1-s2.0-S2666061X23001955-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140644840","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}

{"title":"Anterior Cruciate Ligament Reconstruction in Patients Over 40 Years Old Shows Low Failure Rates: A Systematic Review","authors":"John Roberts IV B.A. ,&nbsp;Richard Puzzitiello M.D. ,&nbsp;Matthew Salzler M.D.","doi":"10.1016/j.asmr.2024.100899","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100899","url":null,"abstract":"<div><h3>Purpose</h3><p>To review the literature reporting on complications and failure rates after primary anterior cruciate ligament reconstruction (ACLR) in patients ≥40 years.</p></div><div><h3>Methods</h3><p>This was a secondary analysis from a prior systematic review of the MEDLINE, CINAHL, SportDiscus, Embase, Web of Science, and Cochrane databases on studies evaluating clinical outcomes in ACLR patients ≥40 years. Studies were included based on the following criteria: English-language studies reporting on postoperative complications and/or ACLR failure rates in patients ≥40 years. Case reports, technical notes, studies with duplicate reporting of patient cohorts, or studies using publicly available registry data were excluded. ACLR failure definitions, failure rates, graft rupture rates, revision ACLR and non-ACLR revision rates, and complication rates were recorded.</p></div><div><h3>Results</h3><p>Twenty-one studies were included following full-text review. Autografts were used in 89.0% of cases. Definitions for ACLR failure varied, ranging from (1) revision ACLR, (2) graft rupture, (3) clinical examination of increased knee laxity, and (4) postoperative arthrofibrosis requiring an additional surgery. The median ACLR failure rate was 5.0% (range, 0%-12.1%) among the 9 studies reporting this outcome, with only 4 of the studies providing explicit definitions of failure. The median ACLR revision surgery, graft rupture, and non-ACLR revision surgery rates were 0% (range, 0%-7.7%), 2.7% (range, 0%-9.1%), and 7.2% (range 0%-34.4%), respectively. Commonly reported complications included pain (range, 0%-14.0%), stiffness (range, 0%-12.7%), hematoma (range, 2.5%-8.8%), neurovascular (range, 0%-41.7%), and undefined (range, 0%-13.8%).</p></div><div><h3>Conclusions</h3><p>ACLR in patients over 40 years old shows low failure rates.</p></div><div><h3>Level of Evidence</h3><p>Level IV, systematic review of Level II-IV studies.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000178/pdfft?md5=a6b2a53394bc1199a8582951d07fc6fe&pid=1-s2.0-S2666061X24000178-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140644860","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}

{"title":"High Rates of Return to Play and Low Recurrence Rate After Arthroscopic Latarjet Procedure for Anterior Shoulder Instability in Rugby Players","authors":"Mark Mouchantaf M.D. ,&nbsp;Claire Bastard M.D. ,&nbsp;Simon Corsia M.D. ,&nbsp;Pierre Métais M.D. ,&nbsp;Geoffroy Nourissat M.D., Ph.D.","doi":"10.1016/j.asmr.2024.100912","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100912","url":null,"abstract":"<div><h3>Purpose</h3><p>To analyze the rate of return to play, changes in athletic level, and recurrence rate and to report subjective outcomes in a series of rugby players with anterior shoulder instability who underwent an arthroscopic Latarjet procedure.</p></div><div><h3>Methods</h3><p>A multicenter retrospective study done in 2 centers on rugby players who were operated on between January 2011 and December 2020 was performed. Rugby players who underwent arthroscopic Latarjet procedure for anterior shoulder stabilization with a minimum follow-up period of 2 years were included. Rugby players were grouped according to their competitive level in their country (recreational, regional, national, and international). Data collected included return to sport after surgery, time to return to rugby, athletic level before and after surgery, patient satisfaction, and subjective scores. Recurrence and apprehension rates were also evaluated.</p></div><div><h3>Results</h3><p>A total of 73 subjects were included. Mean age at time of surgery was 23 ± 5 years. Mean duration of follow-up was 5 ± 2.6 years. Eighty-four percent of rugby players returned to rugby within a mean period of 6.6 months. Initial athletic level was a significant factor (<em>P</em> = .012) for not returning to sport, with 67% of patients who initially played at a recreational level not returning to rugby and 33% of patients who initially played at a regional league level not returning. All national and international players returned to play. Of the 12 non-returning rugby players, only 30% did not return because of their shoulder. Mean Subjective Shoulder Value was 90 ± 9%. Recurrence rate was 7%.</p></div><div><h3>Conclusions</h3><p>Arthroscopic Latarjet procedure proved its efficacy in managing recurrent anterior shoulder instability in rugby players. Return to play was achieved in almost all cases, with low recurrence rates. Despite high global return to the same level of sport, the higher the level of competition, the harder it is for rugby players to resume sport at the same level.</p></div><div><h3>Level of Evidence</h3><p>Level IV, therapeutic case series<strong>.</strong></p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000300/pdfft?md5=7da803dbcbc97e18df70d3336a249567&pid=1-s2.0-S2666061X24000300-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140344777","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}

{"title":"Depression Scores Decrease After Hip Arthroscopy for Femoroacetabular Impingement Syndrome","authors":"Anthony J. Zacharias M.D. ,&nbsp;Matthew Dooley B.S. ,&nbsp;Samuel Mosiman M.S. ,&nbsp;Andrea M. Spiker M.D.","doi":"10.1016/j.asmr.2023.100871","DOIUrl":"https://doi.org/10.1016/j.asmr.2023.100871","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate clinical depression scores and functional outcomes following arthroscopic treatment of femoroacetabular impingement syndrome in patients with elevated preoperative depressive symptoms as defined by Patient-Reported Outcomes Measurement Information System for Depression (PROMIS-D).</p></div><div><h3>Methods</h3><p>Patients with femoroacetabular impingement syndrome completed the PROMIS-D Computer Adaptive Test and additional patient-reported outcome (PRO) measures preoperatively and at the time of postoperative visits. Patients were categorized into preoperative clinically depressed (CD) and nonclinically depressed (NCD) groups based on preoperative PROMIS-D scores. Scores ≥55 correlate to mild clinical depression, and this cutoff was used to determine preoperative depression status. PROMIS-D scores and functional outcome scores were assessed at 6 months and a minimum of 1-year postoperatively.</p></div><div><h3>Results</h3><p>In total, 100 patients were included with complete PROs at a minimum of 1-year follow-up. Of those included, 21 (21%) were categorized with preoperative CD. There were no differences in demographic or radiographic variables between the preoperative CD and NCD groups. At 6 months and 12 months postoperatively, the percentage of patients in the preoperative CD group with continued depression was 33.3% and 23.8%, respectively. Overall, 1-year change in PROMIS-D score for the CD group was –9.1 versus –0.8 in the NCD group (<em>P</em> = .001). There was no significant difference in rates of patients achieving patient acceptable symptom state between the preoperative CD and NCD groups.</p></div><div><h3>Conclusions</h3><p>Patients with symptoms of preoperative CD, as defined by the PROMIS-D score, demonstrated significant improvement in depressive symptoms following hip arthroscopy. In addition, patients with CD preoperatively did not show decreased rates of achieving minimum clinically important difference or patient acceptable symptom state on postoperative PROs compared with patients with NCD.</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":"2024-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X23002225/pdfft?md5=6da4e04c439221f03adb23c462944ad9&pid=1-s2.0-S2666061X23002225-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140103971","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}

{"title":"Both Quadriceps and Bone–Patellar Tendon–Bone Autografts Improve Postoperative Stability and Functional Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review","authors":"Udit Dave B.S. ,&nbsp;Sione A. Ofa M.D. ,&nbsp;Victoria K. Ierulli M.S. ,&nbsp;Andre Perez-Chaumont M.D. ,&nbsp;Mary K. Mulcahey M.D.","doi":"10.1016/j.asmr.2024.100919","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100919","url":null,"abstract":"<div><h3>Purpose</h3><p>To compare postoperative knee stability, functional outcomes, and complications after anterior cruciate ligament (ACL) reconstruction using bone–patellar tendon–bone (BPTB) versus quadriceps tendon autograft.</p></div><div><h3>Methods</h3><p>In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, the PubMed, Embase, and Cochrane Library databases were searched for studies published in 2002 or later. Studies were included if they met the following criteria: randomized controlled trials that included patients who underwent ACL reconstruction with BPTB or quadriceps tendon autograft including all soft tissue and bone–quadriceps tendon and in which measures of postoperative stability and functional outcomes were reported. Studies that were not written in English and those that analyzed animals or cadavers, were not randomized controlled trials, or used other grafts (e.g., hamstring) were excluded.</p></div><div><h3>Results</h3><p>The initial search identified 348 studies, 6 of which were included in this systematic review. Two of the six studies found no significant difference in performance outcomes or complications between quadriceps and BPTB autografts. One study found that patients receiving quadriceps autograft self-reported improved knee functional status compared with those receiving BPTB autograft. Another study found that quadriceps autograft resulted in a significantly reduced Quadriceps Index postoperatively compared with BPTB autograft (69.5 vs 82.8, <em>P</em> = .01) but found no difference in postoperative quadriceps strength. An additional study found that the outcomes of quadriceps tendon and BPTB autografts were equivalent per the International Knee Documentation Committee scale, but anterior knee pain was less severe in patients with quadriceps tendon autograft. Furthermore, one study revealed the overall International Knee Documentation Committee score was reported as normal significantly more often in patients who underwent ACL reconstruction with BPTB autograft (85% vs 50%, <em>P</em> &lt; .001) and that donor-site morbidity was greater in patients with quadriceps autograft. No significant difference was found in complications requiring reoperation across studies.</p></div><div><h3>Conclusions</h3><p>Patients undergoing ACL reconstruction with either BPTB or quadriceps tendon autograft reported improved postoperative knee stability and functional outcomes. There is no significant difference in complications between quadriceps autograft use and BPTB autograft use.</p></div><div><h3>Level of Evidence</h3><p>Level III, systematic review of Level III retrospective studies.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000373/pdfft?md5=015db8cfafd67a66342f1c3b75471b3d&pid=1-s2.0-S2666061X24000373-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140163392","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}

{"title":"Arthroscopic Saucerization of Discoid Lateral Meniscus, With Meniscus Repair as Indicated, Results in Excellent Outcomes in Pediatric Patients Younger Than 12 Years of Age","authors":"George A. Rublev M.D. ,&nbsp;Levan Natchkebia M.D. ,&nbsp;Vazha Gaprindashvili M.D. ,&nbsp;Mohamed Ahmed Mohamed M.D. ,&nbsp;Tamaz Tamazishvili M.D. ,&nbsp;Irakli Kartozia M.D. ,&nbsp;Mikheil Zimlitski M.D.","doi":"10.1016/j.asmr.2024.100915","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100915","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the experiences and outcomes of arthroscopic partial meniscectomy in symptomatic non-Wrisberg discoid lateral meniscus in children younger than 12 years old at a single center.</p></div><div><h3>Methods</h3><p>We retrospectively reviewed the medical records of all pediatric patients who were treated for non-Wrisberg discoid meniscus at our institute between 2013 and 2021. Patients were separated into 2 groups: Patients who underwent partial resection with saucerization (group A) or patients who underwent saucerization, tear repair, and fixation (group B). Clinical outcomes were compared between the 2 groups.</p></div><div><h3>Results</h3><p>A total of 20 patients (22 knees) were treated for non-Wrisberg discoid meniscus and included in this study. Nine patients underwent partial resection with saucerization (group A) whereas 11 patients underwent saucerization, tear repair, and fixation (group B). The average follow-up was 3 years (range 2-10 years). The results showed that 17 of the 20 patients had excellent outcomes whereas the other 3 had good outcomes after a minimum follow-up of 2 years. The average Knee Injury and Osteoarthritis Outcome Score for Children score was 93.</p></div><div><h3>Conclusions</h3><p>Arthroscopic saucerization of symptomatic non-Wrisberg discoid lateral meniscus, with additional repair as indicated results in excellent or good outcomes in children younger than 12 years of age.</p></div><div><h3>Level of Evidence</h3><p>Level III, case–control study.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000336/pdfft?md5=a98c04a3ad08dfba9d5237c1b8ae7266&pid=1-s2.0-S2666061X24000336-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140145409","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}

{"title":"Combined, Single-Anchor Subscapularis Tendon Repair and Proximal Biceps Tenodesis Leads to Improved Function and Decreased Pain at 1 Year","authors":"Lucas Bartlett D.O. ,&nbsp;Brandon Klein D.O., M.B.A ,&nbsp;Christopher Brancato M.S., M.P.H. ,&nbsp;Sam Akhavan M.D. ,&nbsp;James M. Paci M.D.","doi":"10.1016/j.asmr.2024.100920","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100920","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the 1-year clinical outcomes of patients treated with combined proximal biceps tenodesis and repair of type II to III subscapularis tendon (SST) injuries according to Lafosse et al., using the Loop ‘N’ Tack (LNT) technique.</p></div><div><h3>Methods</h3><p>All patients undergoing proximal biceps tenodesis and rotator cuff repair between March 1, 2020, and January 30, 2022, were retrospectively identified. Only patients undergoing combined proximal biceps tenodesis and repair of grade II or III SST injuries with a minimum follow-up of 1 year were included. All patients underwent combined single-anchor proximal biceps tenodesis and SST repair using the LNT technique. The following outcome scores were recorded at a final follow-up of 1 year postoperatively and compared with baseline, preoperative values: American Shoulder and Elbow Score (ASES), Single Assessment Numerical Evaluation (SANE), Veterans Rand 12 Item Health Survey (VR-12), and visual analog scale (VAS). The minimal clinically important difference (MCID) for all outcome indices was determined with a distribution-based method.</p></div><div><h3>Results</h3><p>A total of 41 consecutive patients were included. The MCID values for VAS pain, ASES, SANE, and VR-12 mental scores were 0.97, 8.5, 10.9, and 6.0 respectively. At 1-year final follow-up, approximately 95% (39/41) of patients exceeded the MCID for VAS pain scores, 90% (37/41) of patients for ASES scores, 85.4% (34/41) of patients for SANE scores, and 75.6% (31/41) of patients for VR-12 mental health scores. On average, ASES and SANE scores improved by 37 (preoperatively: 45.2, 1 year: 82.4, <em>P</em> &lt; .001) and 38 points (preoperatively: 38.0, 1 year: 75.7, <em>P</em> &lt; .001), respectively, while VAS scores decreased by 4 points (preoperatively: 5.49, 1 year: 1.48, <em>P</em> &lt; .001). Approximately 88% (36/41) of patients were satisfied at 1 year postoperatively. Treatment failure was observed in 1 patient (2.4%).</p></div><div><h3>Conclusions</h3><p>Patients treated with combined, single-anchor SST repair and LNT proximal biceps tenodesis achieved significant improvements in function, high satisfaction, and low rates of reoperation at 1 year postoperatively. Additionally, 76% to 95% of patients met the MCID for VAS pain, ASES, SANE, and VR-12 mental health scores.</p></div><div><h3>Level of Evidence</h3><p>Level IV, retrospective case series.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000385/pdfft?md5=c59917207e02150f2206855564ea0bbd&pid=1-s2.0-S2666061X24000385-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140187187","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}

{"title":"Access to an Educational Video Preoperatively Has No Effect on Postoperative Opioid Use After Arthroscopic Partial Meniscectomy of the Knee: A Prospective Cohort Study","authors":"Marc G. Lubitz M.D. ,&nbsp;Luke Latario M.D. ,&nbsp;Oghomwen Ogbeide-Latario B.Sc. ,&nbsp;Kevin Hughes M.D. ,&nbsp;Stephanie Clegg M.D. ,&nbsp;Vadim Molla M.D. ,&nbsp;Michael Brown M.D. ,&nbsp;Brian Busconi M.D. ,&nbsp;Nicola DeAngelis M.D.","doi":"10.1016/j.asmr.2024.100885","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100885","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine whether access to a website with an educational video would decrease postoperative opioid use in patients undergoing arthroscopic partial meniscectomy.</p></div><div><h3>Methods</h3><p>Enrolled patients who underwent arthroscopic partial meniscectomy at a single center were randomized to either the intervention or control group prior to surgery. The intervention group received a card with access to an online educational video regarding opioids with their postoperative instructions; the control group did not. The online video was just over 5 minutes long and contained general information about the dangers of opioid use, how to safely dispose of unused opioids, and local support contact information. Data were collected by telephone 10 to 14 days postoperatively and analyzed with GraphPad Prism version 9.5.0. Patient characteristics including age, sex, body mass index, allergies, smoking, depression, alcohol abuse, American Society of Anesthesiologists level, diagnosis of chronic obstructive pulmonary disease, hypertension, diabetes, substance abuse, employment status, workers’ compensation, and sports participation were analyzed and correlated with postoperative opioid use.</p></div><div><h3>Results</h3><p>A total of 166 patients were included in this study, with 78 in the control group and 88 in the intervention group. Mean number of pills consumed was 3 in the control group and 2.2 in the intervention group. This difference did not reach statistical significance. Patients who were obese, smokers, or diagnosed with depression both consumed more opioids and were less likely to take no narcotics postoperatively. Patients who participated in sports consumed fewer total opioids on average than those who did not. Subgroup analysis of patients with higher risk factors did not show a difference between the control and intervention groups in the average amount of opioid used or the likelihood of using no narcotics. Among all patients, 82 (49%) used no narcotics postoperatively and 90% used 8 or fewer tablets.</p></div><div><h3>Conclusions</h3><p>Directing patients to an educational website and video is not an effective tool in decreasing opioid consumption. Patients undergoing arthroscopic meniscectomy who are obese, active smokers, and clinically depressed or do not participate in sports are likely to use more postoperative narcotics. Regardless of access to the online educational video, half of patients used no narcotics.</p></div><div><h3>Level of Evidence</h3><p>Level II, prospective cohort.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000038/pdfft?md5=55b4d315487b2c5a3620f3d3423298ab&pid=1-s2.0-S2666061X24000038-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139986440","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}

{"title":"Degenerative Meniscus Tears Treated Nonoperatively With Platelet-Rich Plasma Yield Variable Clinical and Imaging Outcomes: A Systematic Review","authors":"Varun Gopinatth B.S. ,&nbsp;Anjay K. Batra B.S. ,&nbsp;Jorge Chahla M.D., Ph.D. ,&nbsp;Matthew V. Smith M.D. ,&nbsp;Matthew J. Matava M.D. ,&nbsp;Robert H. Brophy M.D. ,&nbsp;Derrick M. Knapik M.D.","doi":"10.1016/j.asmr.2024.100916","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100916","url":null,"abstract":"<div><h3>Purpose</h3><p>To perform a systematic review on clinical and radiologic outcomes for meniscus tears treated nonoperatively with platelet-rich plasma (PRP).</p></div><div><h3>Methods</h3><p>A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using keywords and Boolean operators in SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials in April 2023. Inclusion criteria were limited to Level I to IV human studies reporting on outcomes of meniscus tears treated nonoperatively with PRP.</p></div><div><h3>Results</h3><p>A total of 6 studies, consisting of 184 patients, were identified. There was 1 Level I study and 5 Level IV studies. Mean patient age was 47.8 ± 7.9 years, with 62% (n = 114/184) being female. The medial meniscus was treated in 95.7% (n = 157/164) of patients. Mean follow-up ranged from 75.9 days to 31.9 months. Meniscus tears were generally described as chronic, degenerative, or intrasubstance. In 4 studies, magnetic resonance imaging revealed variable improvement in meniscus grade with complete healing in 0% to 44% of patients and partial healing in 0% to 40% of patients. Four of 5 studies reported significant statistical improvement in pain from baseline to final follow-up. Studies reporting on clinical outcomes showed significant improvements Lysholm score (2 studies), Knee injury and Osteoarthritis Outcome Score total score (2 studies), and Tegner score (1 study). Successful return to sport occurred in 60% to 100% of patients. Two studies reported that most patients were either very satisfied or satisfied following treatment.</p></div><div><h3>Conclusions</h3><p>The use of PRP injections for the treatment of meniscus tears led to variable results based on postoperative magnetic resonance evaluation and improvements in clinical outcomes, although the clinical significance remains unclear. The heterogeneity of PRP protocols, short-term follow-up, and lack of comparative studies limit findings.</p></div><div><h3>Level of Evidence</h3><p>Level IV, systematic review of Level I to IV studies.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000348/pdfft?md5=1f576547d3219ff9778c7217d18f1ce1&pid=1-s2.0-S2666061X24000348-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140163347","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}

{"title":"Autologous Chondrocyte Implantation Is Not Better Than Arthroscopic Debridement for the Treatment of Symptomatic Cartilage Lesions of the Knee: Two-Year Results From a Randomized-Controlled Trial","authors":"Per-Henrik Randsborg Ph.D., M.D. ,&nbsp;Jan E. Brinchmann M.D., Ph.D. ,&nbsp;Christian Owesen M.D., Ph.D. ,&nbsp;Lars Engebretsen M.D., Ph.D. ,&nbsp;Thomas Birkenes M.D. ,&nbsp;Heidi Andreassen Hanvold P.T. ,&nbsp;Jūratė Šaltytė Benth M.S., Ph.D. ,&nbsp;Asbjørn Årøen M.D., Ph.D.","doi":"10.1016/j.asmr.2024.100909","DOIUrl":"10.1016/j.asmr.2024.100909","url":null,"abstract":"<div><h3>Purpose</h3><p>To compare the functional and patient-reported outcome measures after autologous chondrocyte implantation (ACI) and arthroscopic debridement (AD) in symptomatic, isolated cartilage injuries larger than 2 cm² in patients aged 18 to 50 years.</p></div><div><h3>Methods</h3><p>Twenty-eight patients were included and randomized to ACI (n = 15) or AD (n = 13) and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscale.</p></div><div><h3>Results</h3><p>The mean age at inclusion was 34.1 (standard deviation [SD] 8.5) years. There were 19 (68%) male patients. The mean size of the lesion was 4.2 (SD 1.7) cm². There was a statistically significant and clinically meaningful improvement in patient-reported outcome measures from baseline to 2 years in both groups. The improvement from baseline to final follow-up for the primary endpoint (the KOOS QoL subscale) was larger for the AD group (39.8, SD 9.4) compared with the ACI group (23.8, SD 6.7), but this difference was not statistically significant (<em>P</em> = .17). However, according to a mixed linear model there were statistically significantly greater scores in the AD group for several KOOS subscales at several time points, including KOOS QoL, KOOS pain, and KOOS sport and recreation at 2 years.</p></div><div><h3>Conclusions</h3><p>This study indicates that AD followed by supervised physiotherapy is equal to or better than ACI followed by supervised physiotherapy in patients with isolated cartilage lesions of the knee larger than 2 cm². The improvement in KOOS QoL score from baseline to 2 years was clinically meaningful for both groups (23.8 points for ACI and 39.8 points AD), and larger for the AD group by 16 points.</p></div><div><h3>Level of Evidence</h3><p>Level I, prospective randomized controlled trial.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000270/pdfft?md5=24fab6e9c2e14b5169e9a48b1988c94b&pid=1-s2.0-S2666061X24000270-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139966251","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}