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Proximal Hamstring Repair With All-Suture Anchors and an Accelerated Rehabilitation and Bracing Protocol Demonstrates Good Outcomes at 1-Year Follow-Up 采用全缝合锚和加速康复与支撑方案进行腘绳肌近端修复术,1 年随访结果良好
Q3 Medicine Pub Date : 2024-02-10 DOI: 10.1016/j.asmr.2024.100891
Stephanie E. Wong M.D. , Kaitlyn R. Julian B.S. , Jocelyn G. Carpio B.S. , Alan L. Zhang M.D.

Purpose

To evaluate patient-reported outcomes and risk for rerupture after surgical treatment of proximal hamstring tendon ruptures using all-suture anchors and a unique postoperative bracing strategy.

Methods

A retrospective review of a prospectively collected database was conducted of patients undergoing proximal hamstring repair or reconstruction from 2020 to 2022 at a tertiary, academic institution. Patients were included if they reached minimum 1-year follow-up and completed postoperative patient-reported outcomes. The surgical protocol for proximal hamstring repairs included all-suture anchors placed either in an open or endoscopic fashion in the ischial tuberosity. After surgery, all patients underwent an accelerated rehabilitation protocol, including 6 weeks touchdown weight-bearing in a hinged knee brace locked in extension for ambulation, allowing passive knee flexion to 90° while seated. Descriptive statistics were used to analyze the data.

Results

Twenty-one patients were included (mean age 50.4 ± 9.5 years, body mass index 24.4 ± 3.5, 66.7% female). Lower Extremity Functional Scale score achieved postoperatively was 74.2 ± 7.5 (out of 80). Patients had minimal pain (mean visual analog scale pain score of 0.9 ± 1.2). 61.9% of patients were able to return to the same level of activity after based on Tegner score by 1 year. Postoperative Single Assessment Numeric Evaluation activity of daily living was 94.3 ± 8.3, and Single Assessment Numeric Evaluation Sports was 82.3 ± 19.0. Mean Short Form Survey (SF-12) postoperative scores were 51.6 ± 6.8 for SF-12 Physical Component Score and 53.9 ± 9.7 for Mental Component Score. 95.2% (20 of 21) patients were satisfied with their outcome. There were no reruptures, infections, or reoperations. One patient of 21 (4.8%) incurred a postoperative deep venous thrombosis, which was treated with therapeutic anticoagulation for 3 months.

Conclusions

All-suture anchors for proximal hamstring repair with a unique accelerated postoperative rehabilitation and bracing protocol result in good outcomes and patient satisfaction with minimal risk of complications.

Level of Evidence

Level IV, case series, therapeutic.

目的评估使用全缝合固定器和独特的术后支撑策略手术治疗腘绳肌腱近端断裂后的患者报告结果和再断裂风险。方法对一家三级学术机构 2020 年至 2022 年期间接受腘绳肌腱近端修复或重建手术的患者的前瞻性数据库进行回顾性审查。患者随访至少1年,并完成术后患者报告结果,即被纳入其中。腘绳肌近端修复的手术方案包括在峡部结节以开放或内窥镜方式放置全缝合锚。术后,所有患者都接受了加速康复方案,包括在伸展锁定的铰链式膝关节支架上进行为期6周的触地负重行走,坐位时膝关节可被动屈曲至90°。结果21名患者(平均年龄50.4±9.5岁,体重指数24.4±3.5,66.7%为女性)被纳入其中。术后下肢功能量表评分为 74.2 ± 7.5(满分 80 分)。患者的疼痛感极低(平均视觉模拟量表疼痛评分为 0.9 ± 1.2)。根据 Tegner 评分,61.9% 的患者在术后 1 年能够恢复到相同的活动水平。术后单项数字评估日常生活活动能力为(94.3 ± 8.3),单项数字评估运动能力为(82.3 ± 19.0)。术后平均简表调查(SF-12)得分分别为:SF-12身体成分得分(51.6 ± 6.8)和心理成分得分(53.9 ± 9.7)。95.2%的患者(21 人中有 20 人)对手术结果表示满意。没有再破裂、感染或再次手术。21例患者中有1例(4.8%)术后发生了深静脉血栓,经过3个月的抗凝治疗后,患者恢复良好。
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引用次数: 0
Clinical and Radiologic Outcomes of Arthroscopic Rotator Cuff Repair in Medial Bursal-Side Fosbury Flop Tears Compared With Tendinous Avulsion Lesions 滑囊内侧福斯伯里翻转撕裂与肌腱撕脱伤相比,关节镜下肩袖修复的临床和放射学效果
Q3 Medicine Pub Date : 2024-02-09 DOI: 10.1016/j.asmr.2023.100879
Sean W.L. Ho M.D. , Tiago Martinho M.D. , Arash Amiri M.D. , Jeanni Zbinden M.D. , Xue Ling Chong M.D. , Hugo Bothorel M.E. , Philippe Collin M.D. , Alexandre Lädermann M.D.

Purpose

To determine the clinical and radiologic outcomes after surgical repair of medial bursal-side Fosbury flop rotator cuff tears compared with traditional avulsion of tendinous attachments lesions.

Methods

A retrospective cohort study was performed. All patients who had undergone arthroscopic posterosuperior repair were recruited. Patients with previous shoulder rotator cuff surgery were excluded. Recruited patients were divided into 2 groups: one presenting Fosbury flop tears and the other presenting with standard avulsion lesions. Preoperative demographics such as age, gender, and arm dominance were recorded. Range of motion (ROM), visual analog scale (VAS) for pain and satisfaction, Constant score, Single Alpha-Numeric Evaluation score, and American Shoulder and Elbow Surgeons score were evaluated at 3 points in time: preoperatively, and at 6 months and minimum 1-year postoperatively. The healing of repaired cuffs was evaluated by ultrasound at 6 months.

Results

Two hundred thirty-six patients were recruited, with 27 (11.4%) Fosbury flop tears and 209 (88.6%) tendon avulsions. Although there was no significant difference in gender or arm dominance between the groups, Fosbury flop tears had significantly older patients (P < .05) with a mean age 61.6 years (standard deviation 9.0), compared with tendon avulsions with a mean age of 56.1 years (standard deviation 9.1). There was no significant difference in tendon retraction between the groups. Both groups demonstrated significant improvement in ROM, visual analog scale, American Shoulder and Elbow Surgeons, Single Alpha-Numeric Evaluation, and Constant score postoperatively at 6 months and minimum 1 year. The groups demonstrated no significant difference in the ROM and clinical scores. There was a nonsignificant difference in re-tear rate of 7.4% (2/27) in Fosbury flop tears compared with 2.8% (6/209) in tendon avulsions (P = .361).

Conclusions

Arthroscopic rotator cuff repair of medial bursal side Fosbury Flop rotator cuff tears results in favorable clinical and radiologic outcomes at 4 years after surgery. These outcomes are comparable with surgically repaired avulsion lesions, with an acceptable retear rate after arthroscopic repair.

Level of Evidence

Level III, retrospective comparative prognostic trial.

目的确定内侧滑囊侧 Fosbury 翻转肩袖撕裂手术修复后的临床和放射学结果,并与传统的肌腱附件撕脱病变进行比较。方法进行了一项回顾性队列研究。研究招募了所有接受过关节镜后上方修复术的患者。曾接受过肩关节肩袖手术的患者除外。招募的患者分为两组:一组为Fosbury翻转撕裂,另一组为标准撕脱性损伤。术前记录了患者的年龄、性别和手臂优势等人口统计学特征。在术前、术后 6 个月和至少 1 年的 3 个时间点对患者的活动范围(ROM)、疼痛和满意度视觉模拟量表(VAS)、常量评分、单字母数字评估评分和美国肩肘外科医生评分进行评估。结果共招募了 236 例患者,其中 27 例(11.4%)为 Fosbury 翻转撕裂,209 例(88.6%)为肌腱撕脱。虽然两组患者的性别或手臂优势无明显差异,但 Fosbury 翻转撕裂患者的年龄明显较大(P < .05),平均年龄为 61.6 岁(标准差 9.0),而肌腱撕脱患者的平均年龄为 56.1 岁(标准差 9.1)。两组在肌腱回缩方面没有明显差异。两组患者的 ROM、视觉模拟量表、美国肩肘外科医生(American Shoulder and Elbow Surgeons)单字母数字评估和恒定评分在术后 6 个月和至少 1 年都有明显改善。两组的 ROM 和临床评分无明显差异。Fosbury Flop撕裂的再撕裂率为7.4%(2/27),而肌腱撕脱的再撕裂率为2.8%(6/209),两者差异不显著(P = .361)。这些结果与手术修复的撕脱性损伤相当,关节镜修复后的再撕裂率可接受。
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引用次数: 0
Three-Dimensional Reconstruction of Computed Tomography Imaging Is Not Reliable in Assessing Acetabular Rim Osteophytes or Acetabular Rim Pathology in Patients With Femoroacetabular Impingement 计算机断层扫描成像的三维重建在评估股骨髋臼撞击症患者髋臼边缘骨质增生或髋臼边缘病变方面并不可靠
Q3 Medicine Pub Date : 2024-02-09 DOI: 10.1016/j.asmr.2024.100892
Hanmei Dong M.D. , Maihemuti Maimaitimin M.D. , Chenbo Jiao , Yuhao Liu , Guanying Gao M.D. , Tongchuan He M.D. Ph, D. , Yan Xu M.D.

Purpose

To determine the reliability of 3-dimensional (3D) reconstruction of computed tomography (CT) imaging in evaluating acetabular rim morphology or acetabular rim osteophyte (ARO) existence and to group patients with femoroacetabular impingement (FAI) by ARO extent on coronal sections of CT and further compare clinical differences among groups.

Methods

Patients who underwent primary hip arthroscopy for FAI by the same surgeon between August 2016 and December 2018 with minimum 2-year follow-up were enrolled. The ARO was evaluated both on the acetabular gross anatomy (AGA) and coronal sections of CT, for its position, width (unit: mm), area (unit: mm2), and CT value (unit: HU). Patients were divided into 4 groups based on the extent of ARO on coronal CT: group A (ARO anterior to 12 o’clock), group P (ARO posterior to 12 o’clock), group AP (ARO across 12 o’clock), and group N (no ARO). Inter- and intraobserver correlation was analyzed. Demographic data, FAI deformity indicators on imaging, quantitative measurements of ARO, and pre- and postoperative patient-reported outcomes were compared among groups.

Results

There were 229 patients (229 hips) enrolled in total, 122 male (53.3%) and 107 female (46.7%), with a mean age of 37.2 ± 10.2 years. The correlation between 2 observers for grouping ARO using AGA was positive but poor (Kendall Tau-b coefficient = 0.157, P = .008). Moderate correlation was found between grouping based on AGA and coronal CT by the same observer (Kendall Tau-b coefficient = 0.482, P = .000). The patients were divided into 4 groups: 84 patients (36.7%) in group N, 2 patients (0.9%) in group A, 69 patients (30.1%) in group P, and 74 patients (32.3%) in group AP. Group N was younger in age (35.4 ± 10.7 years) than group P (39.6 ± 10.2 years) (P = 0.012) and had a larger proportion of women (57.1%) than group AP (36.5%) (χ2 = 6.869, P = .032). There was a greater proportion of positive posterior wall sign in group P (52.2%) than 48.6% for group AP and 33.3% for group N (χ2 = 6.397, P = .041). Group N had 61 (72.6%) Tönnis grade 0 hips compared with 37 (50%) in group AP (P = .014). No statistical significance was found among groups in pre- and postoperative α angle, lateral center-edge angle, and patient-reported outcomes. The widths of ARO in group AP for the 3 marked points from anterior to posterior were 3.88 ± 1.86, 4.84 ± 2.72, and 6.66 ± 3.18, separately (P<.001); 15.73 ± 21.46, 19.22 ± 18.86, and 29.96 ± 17.05 for area (P<.01); and 652.67 ± 214.12, 677.10 ± 274.81, and 728.84 ± 232.39 for CT value (P<.05). For the ARO posterior to 12 o’clock, the group AP showed a larger width (6.66 ± 3.18), area (29.96 ± 17.05), and CT value (728.84 ± 232.39) than group P of (4.70 ± 2.25), (20.15 ± 12.91), and (641.84 ± 183.33) (P<.001).

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目的 确定计算机断层扫描(CT)成像的三维(3D)重建在评估髋臼边缘形态或髋臼边缘骨质增生(ARO)存在方面的可靠性,并根据CT冠状切片上的ARO范围对股骨髋臼撞击症(FAI)患者进行分组,进一步比较各组之间的临床差异。方法 纳入2016年8月至2018年12月期间由同一外科医生接受初级髋关节镜手术治疗FAI且随访至少2年的患者。在髋臼大体解剖(AGA)和 CT 冠状切片上对 ARO 的位置、宽度(单位:mm)、面积(单位:mm2)和 CT 值(单位:HU)进行评估。根据冠状 CT 上 ARO 的范围将患者分为 4 组:A 组(ARO 位于 12 点钟方向前方)、P 组(ARO 位于 12 点钟方向后方)、AP 组(ARO 穿过 12 点钟方向)和 N 组(无 ARO)。分析了观察者之间和观察者内部的相关性。对各组的人口统计学数据、影像学显示的FAI畸形指标、ARO的定量测量结果以及术前术后患者报告的结果进行了比较。 结果共有229名患者(229个髋关节)入组,其中男性122人(53.3%),女性107人(46.7%),平均年龄(37.2±10.2)岁。在使用 AGA 对 ARO 进行分组时,两名观察者之间的相关性为正但较差(Kendall Tau-b coefficient = 0.157,P = .008)。根据 AGA 和同一观察者的冠状 CT 进行分组之间存在中度相关性(Kendall Tau-b coefficient = 0.482,P = .000)。患者被分为 4 组:N 组 84 人(36.7%),A 组 2 人(0.9%),P 组 69 人(30.1%),AP 组 74 人(32.3%)。N 组的年龄(35.4 ± 10.7 岁)小于 P 组(39.6 ± 10.2 岁)(P = 0.012),女性比例(57.1%)大于 AP 组(36.5%)(χ2 = 6.869,P = 0.032)。P 组(52.2%)后壁征阳性的比例高于 AP 组(48.6%)和 N 组(33.3%)(χ2 = 6.397,P = .041)。N 组有 61 个(72.6%)Tönnis 0 级髋关节,而 AP 组有 37 个(50%)(P = .014)。各组在术前、术后α角、外侧中心边缘角和患者报告结果方面均无统计学意义。AP 组从前方到后方 3 个标记点的 ARO 宽度分别为(3.88 ± 1.86)、(4.84 ± 2.72)和(6.66 ± 3.18)(P<.001);AP 组从前方到后方 3 个标记点的 ARO 宽度分别为(15.面积分别为 15.73 ± 21.46、19.22 ± 18.86 和 29.96 ± 17.05(P<.01);CT 值分别为 652.67 ± 214.12、677.10 ± 274.81 和 728.84 ± 232.39(P<.05)。对于 12 点钟后方的 ARO,AP 组的宽度(6.66 ± 3.18)、面积(29.96 ± 17.05)和 CT 值(728.84 ± 232.39)均大于 P 组(4.70 ± 2.25)、(20.15 ± 12.91)和(641.84 ± 183.33)(P<.001)。沿髋臼边缘从前方到后方,ARO 有体积增大和密度增加的趋势。年龄较小、女性、Tönnis分级较低、后壁征阴性的患者发生ARO的比例较低。
{"title":"Three-Dimensional Reconstruction of Computed Tomography Imaging Is Not Reliable in Assessing Acetabular Rim Osteophytes or Acetabular Rim Pathology in Patients With Femoroacetabular Impingement","authors":"Hanmei Dong M.D. ,&nbsp;Maihemuti Maimaitimin M.D. ,&nbsp;Chenbo Jiao ,&nbsp;Yuhao Liu ,&nbsp;Guanying Gao M.D. ,&nbsp;Tongchuan He M.D. Ph, D. ,&nbsp;Yan Xu M.D.","doi":"10.1016/j.asmr.2024.100892","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100892","url":null,"abstract":"<div><h3>Purpose</h3><p>To determine the reliability of 3-dimensional (3D) reconstruction of computed tomography (CT) imaging in evaluating acetabular rim morphology or acetabular rim osteophyte (ARO) existence and to group patients with femoroacetabular impingement (FAI) by ARO extent on coronal sections of CT and further compare clinical differences among groups.</p></div><div><h3>Methods</h3><p>Patients who underwent primary hip arthroscopy for FAI by the same surgeon between August 2016 and December 2018 with minimum 2-year follow-up were enrolled. The ARO was evaluated both on the acetabular gross anatomy (AGA) and coronal sections of CT, for its position, width (unit: mm), area (unit: mm<sup>2</sup>), and CT value (unit: HU). Patients were divided into 4 groups based on the extent of ARO on coronal CT: group A (ARO anterior to 12 o’clock), group P (ARO posterior to 12 o’clock), group AP (ARO across 12 o’clock), and group N (no ARO). Inter- and intraobserver correlation was analyzed. Demographic data, FAI deformity indicators on imaging, quantitative measurements of ARO, and pre- and postoperative patient-reported outcomes were compared among groups.</p></div><div><h3>Results</h3><p>There were 229 patients (229 hips) enrolled in total, 122 male (53.3%) and 107 female (46.7%), with a mean age of 37.2 ± 10.2 years. The correlation between 2 observers for grouping ARO using AGA was positive but poor (Kendall Tau-b coefficient = 0.157, <em>P</em> = .008). Moderate correlation was found between grouping based on AGA and coronal CT by the same observer (Kendall Tau-b coefficient = 0.482, <em>P</em> = .000). The patients were divided into 4 groups: 84 patients (36.7%) in group N, 2 patients (0.9%) in group A, 69 patients (30.1%) in group P, and 74 patients (32.3%) in group AP. Group N was younger in age (35.4 ± 10.7 years) than group P (39.6 ± 10.2 years) (<em>P</em> = 0.012) and had a larger proportion of women (57.1%) than group AP (36.5%) (χ<sup>2</sup> = 6.869, <em>P</em> = .032). There was a greater proportion of positive posterior wall sign in group P (52.2%) than 48.6% for group AP and 33.3% for group N (χ<sup>2</sup> = 6.397, <em>P</em> = .041). Group N had 61 (72.6%) Tönnis grade 0 hips compared with 37 (50%) in group AP (<em>P</em> = .014). No statistical significance was found among groups in pre- and postoperative α angle, lateral center-edge angle, and patient-reported outcomes. The widths of ARO in group AP for the 3 marked points from anterior to posterior were 3.88 ± 1.86, 4.84 ± 2.72, and 6.66 ± 3.18, separately (<em>P</em><.001); 15.73 ± 21.46, 19.22 ± 18.86, and 29.96 ± 17.05 for area (<em>P</em><.01); and 652.67 ± 214.12, 677.10 ± 274.81, and 728.84 ± 232.39 for CT value (<em>P</em><.05). For the ARO posterior to 12 o’clock, the group AP showed a larger width (6.66 ± 3.18), area (29.96 ± 17.05), and CT value (728.84 ± 232.39) than group P of (4.70 ± 2.25), (20.15 ± 12.91), and (641.84 ± 183.33) (<em>P</em><.001).</p></div><div><","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000105/pdfft?md5=af9a44455e6f0803b785b08afeafc843&pid=1-s2.0-S2666061X24000105-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139714579","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
The Insertion of a Subacromial Balloon Spacer Can Provide Symptom Relief and Functional Improvement at a Minimum 5-Year Follow-Up in Patients With Massive Irreparable Rotator Cuff Tears 植入肩峰下球囊垫片可在至少 5 年的随访中缓解肩袖大面积不可修复性撕裂患者的症状并改善其功能
Q3 Medicine Pub Date : 2024-02-08 DOI: 10.1016/j.asmr.2024.100907
Mohamad Y. Fares M.D., M.Sc., Jonathan Koa B.Sc., Jaspal Singh M.D., Joseph A. Abboud M.D.

Purpose

To examine long-term patient-reported outcomes and range of motion in patients with massive irreparable rotator cuff tears (MIRCTs) who underwent subacromial balloon spacer implantation.

Methods

A retrospective review of all patients who underwent subacromial balloon placement procedure for MIRCTs at our institution was conducted. Patients with adequate preoperative and postoperative data, with at least 5 years of follow-up, were included in our study. Outcome measures were range of motion (forward elevation), American Shoulder and Elbow Surgeon (ASES) score, and visual analog scale (VAS) score. Independent t test was conducted to check for statistically significant differences between preoperative and postoperative outcome scores, with P < .05 deemed significant.

Results

Ten patients were identified: 4 were lost to follow-up beyond 2 years and were excluded. One was converted to an arthroplasty at the 1-year mark and was then lost to follow-up (conversion rate: 16.6%). Five patients had at least 5 years of follow-up after the balloon procedure and were involved in our case series analysis. Mean age was 63.1 years, and mean follow-up was 5.8 years (range, 5-7 years). Preoperatively, mean forward elevation was 110 degrees, mean ASES score was 40.68, and mean VAS score was 6.2. On follow-up, mean forward elevation was 163 degrees (P = .007), mean ASES score was 90.97 (P = .001), and mean VAS score was 0.9 (P = .004). All patients showed significant improvements in all outcome measures, and none had any significant complications.

Conclusions

In this study, we found that the use of a subacromial balloon spacer can lead to good outcomes at a minimum 5-year follow-up in patients with MIRCTs.

Level of Evidence

Level IV, therapeutic case series.

目的研究接受肩峰下球囊垫片植入术的肩袖大面积撕裂(MIRCT)患者的长期患者报告结果和活动范围。方法回顾性分析本院所有接受肩峰下球囊植入术治疗肩袖大面积撕裂的患者。研究对象包括术前和术后数据充分、随访至少 5 年的患者。结果测量指标包括活动范围(向前抬高)、美国肩肘外科医生(ASES)评分和视觉模拟量表(VAS)评分。采用独立 t 检验检查术前和术后结果评分之间是否存在统计学差异,P < .05 为显著差异:其中 4 名患者随访时间超过 2 年,被排除在外。一名患者在 1 年后转为关节成形术,随后失去了随访机会(转换率:16.6%)。五名患者在球囊手术后接受了至少五年的随访,并参与了我们的病例系列分析。平均年龄为 63.1 岁,平均随访时间为 5.8 年(5-7 年不等)。术前,平均向前抬高 110 度,平均 ASES 评分 40.68 分,平均 VAS 评分 6.2 分。随访时,患者的平均前抬度为 163 度(P = .007),平均 ASES 评分为 90.97 分(P = .001),平均 VAS 评分为 0.9 分(P = .004)。结论在这项研究中,我们发现使用肩峰下球囊垫片可使 MIRCTs 患者在至少 5 年的随访中获得良好的治疗效果。
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引用次数: 0
Arthroscopic Coracoid Transfer in the Lateral Decubitus Position is Safe and Effective at Short-Term Follow-Up 外侧卧位下的关节镜下冠状带转移术在短期随访中安全有效
Q3 Medicine Pub Date : 2024-02-08 DOI: 10.1016/j.asmr.2024.100884
Varun Singla M.D., Michael B. Banffy M.D.

Purpose

To report on operative and clinical outcomes in a series of shoulders treated with arthroscopic Latarjet performed in the lateral decubitus position.

Methods

Patients with shoulders that underwent arthroscopic Latarjet in the lateral decubitus position were identified. Data were retrospectively collected, including patient demographics, operative times, intra- and postoperative complications, and clinical and functional outcomes. Descriptive statistics were performed.

Results

Eighteen shoulders in 17 patients were included in the study with a mean follow-up of 14 ± 12.1 months (range, 4-39 months). The mean operative time for all procedures was 132.2 ± 18.0 minutes, and the mean operative time for the first half of the cohort was significantly longer than that of the second half (141.6 ± 14.2 minutes vs 122.8 ± 17.0 minutes, P = .02). There were no intraoperative complications, and no patients required a conversion to open surgery. One patient experienced a recurrent dislocation after a traumatic event but was able to be treated nonoperatively. Preoperative and postoperative patient-reported outcome measures (PROMs) were able to be collected on 8 of 18 patients (44.4%). Although all PROMs demonstrated improvements postoperatively, only the Single Assessment Numeric Evaluation score and American Shoulder and Elbow Surgeons Shoulder Index displayed a statistically significant increase (P < .05). Five of 8 (62.5%) shoulders demonstrated bony fusion on postoperative computed tomography scan. Of those eligible, 100% of patients returned to sport or felt that they could return if they wanted to.

Conclusions

The arthroscopic Latarjet is an effective procedure for managing glenohumeral instability and can safely be performed in the lateral decubitus position.

Level of Evidence

Level IV, therapeutic case series.

目的 报告一系列在侧卧位接受关节镜 Latarjet 治疗的肩关节患者的手术和临床效果。回顾性收集数据,包括患者的人口统计学特征、手术时间、术中和术后并发症以及临床和功能结果。研究纳入了 17 名患者的 18 个肩关节,平均随访时间为 14 ± 12.1 个月(4-39 个月)。所有手术的平均手术时间为 132.2 ± 18.0 分钟,前半部分的平均手术时间明显长于后半部分(141.6 ± 14.2 分钟 vs 122.8 ± 17.0 分钟,P = .02)。术中没有出现并发症,也没有患者需要转为开放手术。一名患者在外伤后再次发生脱位,但能够接受非手术治疗。18名患者中有8名(44.4%)能够收集到术前和术后患者报告结果(PROMs)。虽然所有的 PROMs 在术后都有所改善,但只有单一评估数值评价得分和美国肩肘外科医生肩关节指数出现了统计学意义上的显著增长(P < .05)。术后计算机断层扫描显示,8 个肩部中有 5 个(62.5%)出现骨融合。结论关节镜下的 Latarjet 是治疗盂肱关节不稳定的有效方法,可在侧卧位安全进行。
{"title":"Arthroscopic Coracoid Transfer in the Lateral Decubitus Position is Safe and Effective at Short-Term Follow-Up","authors":"Varun Singla M.D.,&nbsp;Michael B. Banffy M.D.","doi":"10.1016/j.asmr.2024.100884","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100884","url":null,"abstract":"<div><h3>Purpose</h3><p>To report on operative and clinical outcomes in a series of shoulders treated with arthroscopic Latarjet performed in the lateral decubitus position.</p></div><div><h3>Methods</h3><p>Patients with shoulders that underwent arthroscopic Latarjet in the lateral decubitus position were identified. Data were retrospectively collected, including patient demographics, operative times, intra- and postoperative complications, and clinical and functional outcomes. Descriptive statistics were performed.</p></div><div><h3>Results</h3><p>Eighteen shoulders in 17 patients were included in the study with a mean follow-up of 14 ± 12.1 months (range, 4-39 months). The mean operative time for all procedures was 132.2 ± 18.0 minutes, and the mean operative time for the first half of the cohort was significantly longer than that of the second half (141.6 ± 14.2 minutes vs 122.8 ± 17.0 minutes, <em>P</em> = .02). There were no intraoperative complications, and no patients required a conversion to open surgery. One patient experienced a recurrent dislocation after a traumatic event but was able to be treated nonoperatively. Preoperative and postoperative patient-reported outcome measures (PROMs) were able to be collected on 8 of 18 patients (44.4%). Although all PROMs demonstrated improvements postoperatively, only the Single Assessment Numeric Evaluation score and American Shoulder and Elbow Surgeons Shoulder Index displayed a statistically significant increase (<em>P</em> &lt; .05). Five of 8 (62.5%) shoulders demonstrated bony fusion on postoperative computed tomography scan. Of those eligible, 100% of patients returned to sport or felt that they could return if they wanted to.</p></div><div><h3>Conclusions</h3><p>The arthroscopic Latarjet is an effective procedure for managing glenohumeral instability and can safely be performed in the lateral decubitus position.</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":"2024-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000026/pdfft?md5=0a7d7e567a0a2c8b34ff80a16184f34c&pid=1-s2.0-S2666061X24000026-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139709898","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
Anterior Cruciate Ligament Reconstruction Using Allograft in Adults Older Than the Age of 40 Years Shows Similar Patient-Reported Outcomes Between Male and Female Patients 在 40 岁以上成年人中使用同种异体移植进行前十字韧带重建术,男性和女性患者报告的结果相似
Q3 Medicine Pub Date : 2024-02-07 DOI: 10.1016/j.asmr.2023.100882
Sean Hazzard P.A., M.B.A. , Blake Bacevich B.S. , Nicholas Perry M.D. , Varun Nukala B.S. , Peter Asnis M.D.

Purpose

To evaluate patient-reported outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction using allograft in patients 40 years of age or older divided by sex.

Methods

Patients age 40 years of age or older who underwent ACL reconstruction by the same surgeon using allograft via anteromedial portal technique were retrospectively identified. Patient-reported outcomes (International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Score, Tegner, Lysholm, Marx, and Single Assessment Numeric Evaluation) were evaluated and recorded, and outcomes were analyzed by sex.

Results

In total, 159 patients undergoing primary ACL reconstruction were reviewed. Two-year outcomes were obtained. All patients noted improvement in patient-reported outcome measures. Male patients had overall greater postoperative patient-reported outcomes measures at all time points for IKDC, Tegner, Lysholm, Marx, and Single Assessment Numeric Evaluation scores; however, the only significant time points were IKDC 6 months (P = .016), 1 year (P = .012) and Marx 1 year (P = .007) and 2 year (P = .016). Knee Injury and Osteoarthritis Outcome Score scores similarly showed greater postoperative scores at all time points and statistical significance at 3 months (P = .002), 6 months (P = .033), and 1 year (P = .031).

Conclusions

ACL reconstruction in individuals older than the age of 40 years using allograft results in good outcomes compared with preoperative status. Patient-reported outcomes were similar between male and female patients regarding most patient-reported outcome measures.

Level of Evidence

Level III, retrospective cohort study.

目的 对使用同种异体移植物进行前交叉韧带(ACL)重建的 40 岁及以上患者的患者报告结果进行评估,并按性别进行分类。方法 回顾性地确定了由同一外科医生使用同种异体移植物通过前内侧门技术进行 ACL 重建的 40 岁及以上患者。对患者报告的结果(国际膝关节文献委员会[IKDC]、膝关节损伤和骨关节炎结果评分、Tegner、Lysholm、Marx和单一评估数值评价)进行评估和记录,并按性别对结果进行分析。结果共对 159 名接受初级前交叉韧带重建术的患者进行了复查,并获得了两年的治疗结果。所有患者的患者报告结果均有所改善。男性患者在所有时间点的IKDC、Tegner、Lysholm、Marx和单次评估数值评价得分中,术后患者报告的结果指标总体上都更高,但唯一显著的时间点是IKDC 6个月(P = .016)和1年(P = .012),以及Marx 1年(P = .007)和2年(P = .016)。膝关节损伤和骨关节炎结果评分在所有时间点都显示出更高的术后评分,并且在3个月(P = .002)、6个月(P = .033)和1年(P = .031)时具有统计学意义。在大多数患者报告的结果指标方面,男性和女性患者的结果相似。
{"title":"Anterior Cruciate Ligament Reconstruction Using Allograft in Adults Older Than the Age of 40 Years Shows Similar Patient-Reported Outcomes Between Male and Female Patients","authors":"Sean Hazzard P.A., M.B.A. ,&nbsp;Blake Bacevich B.S. ,&nbsp;Nicholas Perry M.D. ,&nbsp;Varun Nukala B.S. ,&nbsp;Peter Asnis M.D.","doi":"10.1016/j.asmr.2023.100882","DOIUrl":"https://doi.org/10.1016/j.asmr.2023.100882","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate patient-reported outcomes in patients undergoing anterior cruciate ligament (ACL) reconstruction using allograft in patients 40 years of age or older divided by sex.</p></div><div><h3>Methods</h3><p>Patients age 40 years of age or older who underwent ACL reconstruction by the same surgeon using allograft via anteromedial portal technique were retrospectively identified. Patient-reported outcomes (International Knee Documentation Committee [IKDC], Knee Injury and Osteoarthritis Outcome Score, Tegner, Lysholm, Marx, and Single Assessment Numeric Evaluation) were evaluated and recorded, and outcomes were analyzed by sex.</p></div><div><h3>Results</h3><p>In total, 159 patients undergoing primary ACL reconstruction were reviewed. Two-year outcomes were obtained. All patients noted improvement in patient-reported outcome measures. Male patients had overall greater postoperative patient-reported outcomes measures at all time points for IKDC, Tegner, Lysholm, Marx, and Single Assessment Numeric Evaluation scores; however, the only significant time points were IKDC 6 months (<em>P</em> = .016), 1 year (<em>P</em> = .012) and Marx 1 year (<em>P</em> = .007) and 2 year (<em>P</em> = .016). Knee Injury and Osteoarthritis Outcome Score scores similarly showed greater postoperative scores at all time points and statistical significance at 3 months (<em>P</em> = .002), 6 months (<em>P</em> = .033), and 1 year (<em>P</em> = .031).</p></div><div><h3>Conclusions</h3><p>ACL reconstruction in individuals older than the age of 40 years using allograft results in good outcomes compared with preoperative status. Patient-reported outcomes were similar between male and female patients regarding most patient-reported outcome measures.</p></div><div><h3>Level of Evidence</h3><p>Level III, retrospective cohort study.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X2300233X/pdfft?md5=56b0e5cac896cbb0790f63033499dd24&pid=1-s2.0-S2666061X2300233X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139700054","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
Three-Dimensional Hinge Axis Orientation Contributes to Simultaneous Alignment Correction in All Three Anatomical Planes in Opening-Wedge High Tibial Osteotomy 三维铰链轴方向有助于在开楔式高胫骨截骨术中同时校正所有三个解剖平面的对齐情况
Q3 Medicine Pub Date : 2024-02-07 DOI: 10.1016/j.asmr.2024.100888
Quinten W.T. Veerman M.Sc. , Romy M. ten Heggeler M.Sc. , prof. Gabriëlle J.M. Tuijthof , Feike de Graaff Ph.D. , René Fluit Ph.D. , Roy A.G. Hoogeslag M.D., Ph.D.

Purpose

To investigate the simultaneous effect of 3-dimensional (3D) hinge axis (HA) orientation on alignment parameters in all 3 anatomical planes in high tibial osteotomy.

Methods

A computed tomography–based 3D model of a human tibia/fibula was used to establish a 3D tibial coordinate system based on the tibial mechanical axis. In here, an HA was positioned and an opening-wedge high tibial osteotomy with a rotation angle of 10° over the HA was simulated. HA rotation in the axial plane ranged from 0° to 90° and HA tilt relative to the axial plane ranged from –20° to +20°. The study quantified the simultaneous effect of HA orientation on change of alignment parameters in all anatomical reference planes.

Results

HA rotation within the tibial axial plane between orientations perpendicular to the coronal and sagittal planes primarily affected both coronal and sagittal plane alignment, with an inverse relationship between these planes (range: 0°-9.7°); the effect of HA rotation on the change in axial plane alignment was maximally 0.9°. In contrast, HA tilt relative to the tibial axial plane primarily affected axial alignment (maximum change: 6.9°); the effect on change in both coronal and sagittal plane alignment was maximally 0.6°.

Conclusions

HA rotation in the tibial axial plane primarily affects sagittal and coronal plane alignment, and HA tilt relative to the tibial axial plane primarily affects axial plane alignment.

Clinical Relevance

Integrating 3D HA orientation in malalignment planning and correction offers the potential to minimize unintended corrections in nontargeted planes in uniplanar correction osteotomies and to facilitate intentional multiplanar correction with a single osteotomy.

目的研究三维(3D)铰链轴(HA)方向对高胫骨截骨术中所有 3 个解剖平面的对位参数的同时影响。方法使用基于计算机断层扫描的人体胫骨/腓骨三维模型,根据胫骨机械轴建立三维胫骨坐标系。在此模型中,对 HA 进行定位,并模拟在 HA 上旋转 10° 的开口楔形高胫骨截骨术。HA在轴向平面上的旋转角度从0°到90°不等,HA相对于轴向平面的倾斜角度从-20°到+20°不等。结果HA在胫骨轴向平面内垂直于冠状面和矢状面的方向之间的旋转主要影响冠状面和矢状面的对位,这两个平面之间呈反比关系(范围:0°-9.7°);HA旋转对轴向平面对位变化的影响最大为0.9°。结论HA在胫骨轴向平面的旋转主要影响矢状面和冠状面的对线,而HA相对于胫骨轴向平面的倾斜主要影响轴向平面的对线(最大变化:6.9°);对冠状面和矢状面对线变化的影响最大为0.6°。临床意义在错位规划和矫正中整合三维HA定位,可最大限度地减少单平面矫正截骨中非目标平面的意外矫正,并促进单次截骨的有意多平面矫正。
{"title":"Three-Dimensional Hinge Axis Orientation Contributes to Simultaneous Alignment Correction in All Three Anatomical Planes in Opening-Wedge High Tibial Osteotomy","authors":"Quinten W.T. Veerman M.Sc. ,&nbsp;Romy M. ten Heggeler M.Sc. ,&nbsp;prof. Gabriëlle J.M. Tuijthof ,&nbsp;Feike de Graaff Ph.D. ,&nbsp;René Fluit Ph.D. ,&nbsp;Roy A.G. Hoogeslag M.D., Ph.D.","doi":"10.1016/j.asmr.2024.100888","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100888","url":null,"abstract":"<div><h3>Purpose</h3><p>To investigate the simultaneous effect of 3-dimensional (3D) hinge axis (HA) orientation on alignment parameters in all 3 anatomical planes in high tibial osteotomy.</p></div><div><h3>Methods</h3><p>A computed tomography–based 3D model of a human tibia/fibula was used to establish a 3D tibial coordinate system based on the tibial mechanical axis. In here, an HA was positioned and an opening-wedge high tibial osteotomy with a rotation angle of 10° over the HA was simulated. HA rotation in the axial plane ranged from 0° to 90° and HA tilt relative to the axial plane ranged from –20° to +20°. The study quantified the simultaneous effect of HA orientation on change of alignment parameters in all anatomical reference planes.</p></div><div><h3>Results</h3><p>HA rotation within the tibial axial plane between orientations perpendicular to the coronal and sagittal planes primarily affected both coronal and sagittal plane alignment, with an inverse relationship between these planes (range: 0°-9.7°); the effect of HA rotation on the change in axial plane alignment was maximally 0.9°. In contrast, HA tilt relative to the tibial axial plane primarily affected axial alignment (maximum change: 6.9°); the effect on change in both coronal and sagittal plane alignment was maximally 0.6°.</p></div><div><h3>Conclusions</h3><p>HA rotation in the tibial axial plane primarily affects sagittal and coronal plane alignment, and HA tilt relative to the tibial axial plane primarily affects axial plane alignment.</p></div><div><h3>Clinical Relevance</h3><p>Integrating 3D HA orientation in malalignment planning and correction offers the potential to minimize unintended corrections in nontargeted planes in uniplanar correction osteotomies and to facilitate intentional multiplanar correction with a single osteotomy.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000063/pdfft?md5=b9d71471b4b302cded571ca7a9b890c2&pid=1-s2.0-S2666061X24000063-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139700053","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
The Perfect-Circle Technique Demonstrates Poor Inter-Rater Reliability in Measuring Posterior Glenoid Bone Loss on Magnetic Resonance Imaging 在磁共振成像中测量盂后骨质流失时,完美圆技术显示出较低的评分者间可靠性
Q3 Medicine Pub Date : 2024-02-05 DOI: 10.1016/j.asmr.2024.100889
Nata Parnes M.D. , Kyle J. Klahs D.O. , Alexis B. Sandler M.D. , Emily I. Wynkoop M.D. , Adam Goldman D.O. , Keith Fishbeck D.O. , Robert H. Rolf M.D. , John P. Scanaliato M.D.

Purpose

To evaluate the reliability of the “perfect-circle” methodology for measurement of glenoid bone loss with magnetic resonance imaging (MRI) in patients with posterior glenohumeral instability.

Methods

A prospective chart review was performed on patients who underwent isolated arthroscopic posterior labral repairs in our institution’s electronic medical records between January 1, 2021, and June 30, 2021. Inclusion criteria included isolated posterior shoulder instability with posterior labral repair and corroborated tears on MRI. A total of 9 raters, either sports or shoulder and elbow fellowship-trained orthopaedic surgeons, each evaluated the affected shoulder MRI scans twice, at over 2 weeks apart. Measurements followed the “perfect-circle” technique and included projected anterior-to-posterior (AP) glenoid diameter, amount of posterior bone loss, and percentage of posterior bone loss.

Results

Ten consecutive patients between the ages of 17 and 46 years with diagnosed posterior glenohumeral instability were selected. The average age was 28 ± 10 years, and 60% of patients were male. The patient’s dominant arm was affected in 40%, and 50% of cases involved the right shoulder. The average glenoid diameter was 29.62 ± 3.69 mm, and the average measured bone loss was 2.8 ± 1.74 mm. The average percent posterior glenoid bone loss was 9.41 ± 5.78%. The inter-rater reliability was poor for the AP diameter and for the posterior glenoid bone loss with intraclass correlation coefficients at 0.30 (0.12-0.62) and 0.22 (0.07-0.54) respectively. The intrarater reliability was poor for AP diameter and moderate for posterior glenoid bone loss, with intraclass correlation coefficients at 0.41 (0.22-0.57) and 0.50 (0.33-0.64), respectively.

Conclusions

Using the “perfect-circle” technique for evaluating posterior glenohumeral bone loss has poor-to-moderate inter- and intrarater reliability from MRI.

Level of Evidence

Level IV, prospective diagnostic study.

目的 评估通过磁共振成像(MRI)测量盂骨损失的 "完美圆 "方法在盂后不稳患者中的可靠性。方法 对本机构电子病历中 2021 年 1 月 1 日至 2021 年 6 月 30 日期间接受孤立关节镜后唇裂修复术的患者进行前瞻性病历审查。纳入标准包括孤立性肩关节后方不稳定、后唇修复以及核磁共振成像证实的撕裂。共有 9 名评分员,他们都是受过运动或肩肘研究培训的骨科外科医生,每人评估受影响肩部的 MRI 扫描两次,每次间隔 2 周以上。测量采用 "完美圆 "技术,包括盂体前后(AP)投影直径、后方骨质流失量和后方骨质流失百分比。平均年龄为(28 ± 10)岁,60%的患者为男性。40%的患者的优势臂受到影响,50%的病例涉及右肩。平均盂顶直径为(29.62 ± 3.69)毫米,平均骨质流失量为(2.8 ± 1.74)毫米。盂后骨丢失的平均百分比为 9.41 ± 5.78%。AP直径和盂后骨质流失的评分者间可靠性较差,类内相关系数分别为0.30(0.12-0.62)和0.22(0.07-0.54)。结论使用 "完美圆 "技术评估盂肱骨后部骨质流失在MRI上的研究者之间和研究者内部的可靠性较差至中等。
{"title":"The Perfect-Circle Technique Demonstrates Poor Inter-Rater Reliability in Measuring Posterior Glenoid Bone Loss on Magnetic Resonance Imaging","authors":"Nata Parnes M.D. ,&nbsp;Kyle J. Klahs D.O. ,&nbsp;Alexis B. Sandler M.D. ,&nbsp;Emily I. Wynkoop M.D. ,&nbsp;Adam Goldman D.O. ,&nbsp;Keith Fishbeck D.O. ,&nbsp;Robert H. Rolf M.D. ,&nbsp;John P. Scanaliato M.D.","doi":"10.1016/j.asmr.2024.100889","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100889","url":null,"abstract":"<div><h3>Purpose</h3><p>To evaluate the reliability of the “perfect-circle” methodology for measurement of glenoid bone loss with magnetic resonance imaging (MRI) in patients with posterior glenohumeral instability.</p></div><div><h3>Methods</h3><p>A prospective chart review was performed on patients who underwent isolated arthroscopic posterior labral repairs in our institution’s electronic medical records between January 1, 2021, and June 30, 2021. Inclusion criteria included isolated posterior shoulder instability with posterior labral repair and corroborated tears on MRI. A total of 9 raters, either sports or shoulder and elbow fellowship-trained orthopaedic surgeons, each evaluated the affected shoulder MRI scans twice, at over 2 weeks apart. Measurements followed the “perfect-circle” technique and included projected anterior-to-posterior (AP) glenoid diameter, amount of posterior bone loss, and percentage of posterior bone loss.</p></div><div><h3>Results</h3><p>Ten consecutive patients between the ages of 17 and 46 years with diagnosed posterior glenohumeral instability were selected. The average age was 28 ± 10 years, and 60% of patients were male. The patient’s dominant arm was affected in 40%, and 50% of cases involved the right shoulder. The average glenoid diameter was 29.62 ± 3.69 mm, and the average measured bone loss was 2.8 ± 1.74 mm. The average percent posterior glenoid bone loss was 9.41 ± 5.78%. The inter-rater reliability was poor for the AP diameter and for the posterior glenoid bone loss with intraclass correlation coefficients at 0.30 (0.12-0.62) and 0.22 (0.07-0.54) respectively. The intrarater reliability was poor for AP diameter and moderate for posterior glenoid bone loss, with intraclass correlation coefficients at 0.41 (0.22-0.57) and 0.50 (0.33-0.64), respectively.</p></div><div><h3>Conclusions</h3><p>Using the “perfect-circle” technique for evaluating posterior glenohumeral bone loss has poor-to-moderate inter- and intrarater reliability from MRI.</p></div><div><h3>Level of Evidence</h3><p>Level IV, prospective diagnostic study.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000075/pdfft?md5=f4e2a94a2cdafb6ea0a19218c74a25a1&pid=1-s2.0-S2666061X24000075-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139694723","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
Adding Lateral Retinacular Release to Medial Patellofemoral Ligament Reconstruction Fails to Demonstrate Clinical Benefit Compared With Isolated Medial Patellofemoral Ligament Reconstruction 与单独的髌股内侧韧带重建术相比,在髌股内侧韧带重建术中加入外侧韧带松解术未能显示出临床疗效
Q3 Medicine Pub Date : 2024-02-05 DOI: 10.1016/j.asmr.2024.100890
Timothy L. Waters B.A. , Evan M. Miller M.D. , Edward C. Beck M.D., M.P.H. , Danielle E. Rider M.D. , Brian R. Waterman M.D.

Purpose

To compare functional outcomes and failure rates between medial patellofemoral ligament (MPFL) reconstructions with and without lateral retinacular release (LRR) at minimum 1-year follow up.

Methods

A retrospective review identified consecutive patients from 2013 to 2019 at a single center who met all of the following inclusion criteria: at least 1 confirmed patellar dislocation, patellar tilt (evidenced by tight retinaculum on operative examination or patellar tilt on radiographs), underwent either MPFL reconstruction alone or combined with LRR, had available preoperative documentation and imaging, and were at least 1 year out of surgery. Patients were excluded if they had previous surgery to the ipsilateral limb or had any concomitant procedure performed. Demographics and preoperative imaging were evaluated. Failure rates and functional outcome scores were obtained including Kujala, Patient-Reported Outcomes Measurement Information System, International Knee Documentation Committee, Single Assessment Numeric Evaluation, and Knee injury and Osteoarthritis Outcome Scores. Clinical failure was defined as revision MPFL reconstruction on the affected knee or at least 1 instance of postoperative patellar dislocation.

Results

A total of 18 patients underwent isolated MPFL reconstruction (mean follow-up = 29.3 ± 8.3 months, range = 15.1-42.8 months), and 31 underwent MPFL reconstruction combined with LRR (mean follow up = 36.0 ± 11.3 months, range = 14.0-51.9 months). At final follow-up, there were no statistical differences between the isolated MPFL and MPFL combined with LRR cohorts for any of the functional outcome scores (P > .05 for all). At the time of final follow-up, no patients who underwent isolated MPFL and 19.3% (n = 6) or patients undergoing MPFL combined with LRR experienced clinical failure (P = .073), as defined by subsequent patellar dislocation or revision MPFL reconstruction. Of these, 2 patients underwent revision MPFL reconstructions with distal tubercle transfer for borderline abnormal TT:TG (i.e., >15 mm).

Conclusions

MPFL reconstruction surgery combined with LRR failed to demonstrate significantly different functional outcome scores and failure rates compared with isolated MPFL reconstruction at minimum 1-year follow up. In addition, there were no differences in rates of achieving MCID between both groups

Level of Evidence

Level III, retrospective cohort study.

目的比较至少随访 1 年的髌股内侧韧带 (MPFL) 重建术与外侧韧带松解术 (LRR) 的功能结果和失败率。方法回顾性研究确定了2013年至2019年期间在一个中心接受治疗的连续患者,这些患者符合以下所有纳入标准:至少有1例确诊髌骨脱位、髌骨倾斜(手术检查时韧带紧绷或X光片显示髌骨倾斜)、单独接受MPFL重建或结合LRR、有术前文件和影像学资料、手术至少1年。同侧肢体曾接受过手术或同时接受过任何手术的患者均不在研究范围内。对人口统计学和术前影像学进行了评估。获得的失败率和功能结果评分包括Kujala、患者报告结果测量信息系统、国际膝关节文献委员会、单一评估数字评价以及膝关节损伤和骨关节炎结果评分。结果 共有18名患者接受了孤立的MPFL重建(平均随访时间=29.3 ± 8.3个月,范围=15.1-42.8个月),31名患者接受了MPFL重建联合LRR(平均随访时间=36.0 ± 11.3个月,范围=14.0-51.9个月)。在最终随访中,孤立的 MPFL 和 MPFL 合并 LRR 两组患者的任何功能结果评分均无统计学差异(P 均为 0.05)。在最终随访时,没有接受孤立MPFL的患者和19.3%(n = 6)或接受MPFL联合LRR的患者出现临床失败(P = .073),临床失败的定义是随后的髌骨脱位或翻修MPFL重建。结论MPFL重建手术联合LRR与单独的MPFL重建手术相比,在至少1年的随访中未能显示出明显不同的功能结果评分和失败率。证据级别III级,回顾性队列研究。
{"title":"Adding Lateral Retinacular Release to Medial Patellofemoral Ligament Reconstruction Fails to Demonstrate Clinical Benefit Compared With Isolated Medial Patellofemoral Ligament Reconstruction","authors":"Timothy L. Waters B.A. ,&nbsp;Evan M. Miller M.D. ,&nbsp;Edward C. Beck M.D., M.P.H. ,&nbsp;Danielle E. Rider M.D. ,&nbsp;Brian R. Waterman M.D.","doi":"10.1016/j.asmr.2024.100890","DOIUrl":"https://doi.org/10.1016/j.asmr.2024.100890","url":null,"abstract":"<div><h3>Purpose</h3><p>To compare functional outcomes and failure rates between medial patellofemoral ligament (MPFL) reconstructions with and without lateral retinacular release (LRR) at minimum 1-year follow up.</p></div><div><h3>Methods</h3><p>A retrospective review identified consecutive patients from 2013 to 2019 at a single center who met all of the following inclusion criteria: at least 1 confirmed patellar dislocation, patellar tilt (evidenced by tight retinaculum on operative examination or patellar tilt on radiographs), underwent either MPFL reconstruction alone or combined with LRR, had available preoperative documentation and imaging, and were at least 1 year out of surgery. Patients were excluded if they had previous surgery to the ipsilateral limb or had any concomitant procedure performed. Demographics and preoperative imaging were evaluated. Failure rates and functional outcome scores were obtained including Kujala, Patient-Reported Outcomes Measurement Information System, International Knee Documentation Committee, Single Assessment Numeric Evaluation, and Knee injury and Osteoarthritis Outcome Scores. Clinical failure was defined as revision MPFL reconstruction on the affected knee or at least 1 instance of postoperative patellar dislocation.</p></div><div><h3>Results</h3><p>A total of 18 patients underwent isolated MPFL reconstruction (mean follow-up = 29.3 ± 8.3 months, range = 15.1-42.8 months), and 31 underwent MPFL reconstruction combined with LRR (mean follow up = 36.0 ± 11.3 months, range = 14.0-51.9 months). At final follow-up, there were no statistical differences between the isolated MPFL and MPFL combined with LRR cohorts for any of the functional outcome scores (<em>P</em> &gt; .05 for all). At the time of final follow-up, no patients who underwent isolated MPFL and 19.3% (n = 6) or patients undergoing MPFL combined with LRR experienced clinical failure (<em>P</em> = .073), as defined by subsequent patellar dislocation or revision MPFL reconstruction. Of these, 2 patients underwent revision MPFL reconstructions with distal tubercle transfer for borderline abnormal TT:TG (i.e., &gt;15 mm).</p></div><div><h3>Conclusions</h3><p>MPFL reconstruction surgery combined with LRR failed to demonstrate significantly different functional outcome scores and failure rates compared with isolated MPFL reconstruction at minimum 1-year follow up. In addition, there were no differences in rates of achieving MCID between both groups</p></div><div><h3>Level of Evidence</h3><p>Level III, retrospective cohort study.</p></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2666061X24000087/pdfft?md5=11fed4883d2c06f0a8da019bdf5b43bb&pid=1-s2.0-S2666061X24000087-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139694724","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
The Perfect Circle Technique Shows Poor Inter-rater Reliability in Measuring Anterior Glenoid Bone Loss on Magnetic Resonance Imaging 完美圆技术在磁共振成像上测量盂前骨质流失时的交互可靠性较差
Q3 Medicine Pub Date : 2024-02-03 DOI: 10.1016/j.asmr.2024.100905
Nata Parnes M.D. , Clare K. Green B.S. , Emily I. Wynkoop M.D. , Adam Goldman D.O. , Keith Fishbeck D.O. , Kyle J. Klahs D.O. , Robert H. Rolf M.D. , John P. Scanaliato M.D.

Purpose

To evaluate the reliability of the perfect circle methodology for measurement of glenoid bone loss in patients with anterior glenohumeral instability.

Methods

We performed a chart review of retrospectively collected patients who underwent isolated arthroscopic anterior labral repair between January 1 and June 30, 2021, using our institution’s electronic medical records. The inclusion criteria included isolated anterior shoulder instability with anterior labral repair and corroborated tears on magnetic resonance imaging. A total of 9 raters, either sports or shoulder and elbow fellowship-trained orthopaedic surgeons, each evaluated the affected shoulder magnetic resonance imaging scans twice, with a minimum of 2 weeks between measurements. Measurements followed the “perfect circle” technique and included projected anterior-to-posterior glenoid diameter, amount of posterior bone loss, and percentage of posterior bone loss. Intrarater reliability and inter-rater reliability were then determined by calculating intraclass correlation coefficients (ICCs).

Results

Ten consecutive patients meeting the selection criteria were chosen for inclusion in this analysis. Average estimated bone loss for the cohort was 2.45 mm, and the mean estimated glenoid diameter of the involved shoulder was 28.82 mm. The average percentage of bone loss measured 8.54%. The ICC for interobserver reliability was 0.55 for the perfect circle diameter and 0.17 for the anterior bone loss measurement (poorly to moderately reliable). The ICC for intraobserver reliability was 0.69 for the perfect circle diameter and 0.71 for anterior bone loss (moderately reliable).

Conclusions

The perfect circle technique for estimating anterior glenoid bone loss on magnetic resonance imaging was found to have moderate intrarater reliability; however, reliability between observers was found to be moderate to poor.

Level of Evidence

Level IV, diagnostic case series.

方法 我们利用本机构的电子病历,对 2021 年 1 月 1 日至 6 月 30 日期间接受孤立性关节镜前唇修补术的患者进行了病历回顾。纳入标准包括孤立性肩关节前侧不稳定、前唇修补术和磁共振成像证实的撕裂。共有 9 名评分员,他们都是受过运动或肩肘研究培训的骨科外科医生,每人评估受影响肩部的磁共振成像扫描两次,两次测量之间至少间隔 2 周。测量采用 "完美圆 "技术,包括髋臼前后直径、后部骨质流失量和后部骨质流失百分比。然后通过计算类内相关系数(ICC)来确定研究者内部的可靠性和研究者之间的可靠性。该组患者的平均估计骨质流失量为 2.45 毫米,受累肩关节的平均估计盂直径为 28.82 毫米。骨质流失的平均百分比为 8.54%。完美圆直径的观察者间可靠性ICC为0.55,前方骨质流失测量的观察者间可靠性ICC为0.17(可靠性差到中等)。结论在磁共振成像中估算盂前骨质缺损的完美圆技术具有中等程度的内部可靠性;但是,观察者之间的可靠性为中等至较差。
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引用次数: 0
期刊
Arthroscopy Sports Medicine and Rehabilitation
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