Arthroscopy: The Journal of Arthroscopic & Related Surgery最新文献

英文中文

Combined Single Anchor Fixation of Subscapularis and Biceps Pathology Leads to Improved Clinical Outcomes. 联合单锚固定肩胛下肌和肱二头肌病变可提高临床疗效。

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Pub Date : 2024-09-11 DOI: 10.1016/j.arthro.2024.09.009

William Ciccone

Upper-edge subscapularis tendon tears associated with biceps instability are a cause of anterior shoulder pain and disability. At shoulder arthroscopy, the incidence of subscapularis pathology was noted to be 27%, with 47% of these being combined lesions involving the medial reflection pulley. The anatomic location of the upper subscapularis and biceps allows for combined fixation techniques. Arthroscopic subscapularis tendon repair with biceps tenodesis with single-anchor fixation is a cheap and efficient way to address this pathology if biceps tissue quality is sufficient. Careful consideration of surgical technique should lead to improved patient outcomes.

肩胛下肌腱上缘撕裂与肱二头肌失稳相关联，是造成肩关节前部疼痛和残疾的原因之一。在肩关节镜检查中发现，肩胛下肌病变的发生率为 27%，其中 47% 是涉及内侧反射滑轮的合并病变。肩胛下肌上部和肱二头肌的解剖位置允许采用联合固定技术。如果肱二头肌组织质量足够好，关节镜下肩胛下肌腱修复术与肱二头肌腱鞘切除术加单锚固定是治疗这种病变的廉价而有效的方法。仔细考虑手术技巧应能改善患者的治疗效果。

引用次数: 0

Knee Posterolateral Corner Reconstruction Shows Low Failure and Complication Rates. 膝关节后外侧角重建失败率和并发症发生率较低

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Pub Date : 2024-09-11 DOI: 10.1016/j.arthro.2024.09.010

Warren W Nielsen,Andrew G Geeslin

High-grade knee posterolateral corner (PLC) injuries are potentially devastating, and often associated with high energy mechanisms. Failure of PLC injury diagnosis or treatment can lead to residual instability after combined cruciate ligament reconstruction due to increased risk of graft failure, and varus malalignment may lead to early osteoarthritis and meniscal injuries. PLC reconstruction has consistently shown superiority over PLC repair. Biomechanical studies have compared reconstruction techniques, specifically evaluating rotational and varus laxity. Some studies have demonstrated no difference between techniques whereas other studies have reported improved stability with techniques that include a separate tibial tunnel for reconstruction of the popliteus tendon and PFL. Yet many have suggested that there is less technical difficulty with techniques that do not use a tibial tunnel, and this may be an important consideration in certain settings. Recent reviews showing no differences in clinical outcomes when comparing techniques for PLC reconstruction are based on heterogeneous, low level of evidence, high-risk-of-bias literature. It is well-recognized that PLC injuries are heterogeneous, with approximately three quarters occurring in combination with anterior and/or posterior cruciate ligament tears. Further, laxity patterns vary for these injuries including high-grade posterior laxity and knee hyperextension as well as proximal tibial-fibular joint laxity, and these findings may necessitate use of an anatomic (separate tibial tunnel) PLC reconstruction technique. Reassuringly, both techniques show low complication and failure rates.comparison.

高级膝关节后外侧角（PLC）损伤具有潜在的破坏性，通常与高能量机制有关。PLC损伤的诊断或治疗失败可能导致联合十字韧带重建术后的残余不稳定性，因为移植失败的风险增加，而曲张错位可能导致早期骨关节炎和半月板损伤。PLC重建一直显示优于PLC修复。生物力学研究对重建技术进行了比较，特别是对旋转和屈曲松弛进行了评估。一些研究表明重建技术之间并无差异，而另一些研究则报告称，重建腘绳肌腱和腘绳肌腱的技术包括一个独立的胫骨隧道，可提高稳定性。然而，许多人认为不使用胫骨隧道的技术难度较低，这在某些情况下可能是一个重要的考虑因素。最近的一些综述显示，在比较 PLC 重建技术时，临床结果没有差异，这些综述是基于异质性、低证据水平、高偏倚风险的文献。众所周知，PLC 损伤具有异质性，约四分之三的损伤同时伴有前交叉韧带和/或后交叉韧带撕裂。此外，这些损伤的松弛模式也不尽相同，包括高度后方松弛、膝关节过伸以及胫腓关节近端松弛，这些发现可能需要使用解剖型（独立胫骨隧道）PLC 重建技术。令人欣慰的是，这两种技术的并发症和失败率都很低。

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引用次数: 0

Long-term, clinical outcome of arthroscopic rotator cuff repair may be improved with concomitant acromioplasty in patients with a Type III acromion. 对于 III 型肩峰的患者，同时进行肩峰成形术可改善关节镜下肩袖修复术的长期临床疗效。

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Pub Date : 2024-09-10 DOI: 10.1016/j.arthro.2024.09.007

Andrew Arjun Sayampanathan,Andrew Tan Hwee Chye

In theory, extrinsic anterolateral acromial impingement of the rotator cuff can contribute to cuff tearing. Thus, acromioplasty may be performed concomitantly with arthroscopic rotator cuff repair (ARCR). A review of recent randomized controlled trials confirms that patient long-term outcomes after ARCR is superior when acromioplasty is performed, when compared to no concomitant acromioplasty, while complication and retear rates are similar. This is in contrast to previous reviews identifying no significant clinical differences in post-operative functional outcomes, patient reported outcomes, or reoperation rates in the short- to medium-term. In sum, emerging evidence suggests that we start to observe differences in outcomes in the longer-term in favor of acromioplasty. From our point of view, both patient and surgical factors determine outcome. There is growing evidence that ARCRs with acromioplasties may contribute to superior functional outcomes and reduced reoperation rates in the long-term post-operation. However, post-operative outcomes of such procedures remain dependent on both patient and surgical factors. Patient factors include acromial morphology, comorbidities, and tear pattern, size, and repairability. Type III acromial morphology is a risk factor for poor outcome absent acromioplasty. Surgical factors include repair technique and surgeon experience.

理论上讲，肩袖前外侧撞击可导致肩袖撕裂。因此，肩峰成形术可与关节镜下肩袖修复术（ARCR）同时进行。对近期随机对照试验的回顾证实，与不同时进行肩峰成形术相比，同时进行肩峰成形术的患者在肩袖修复术后的长期疗效更好，而并发症和再撕裂率则相似。这与之前的综述形成鲜明对比，综述发现，在中短期内，术后功能预后、患者报告预后或再手术率方面没有明显的临床差异。总之，新出现的证据表明，我们开始观察到肩峰成形术在长期疗效上的差异。在我们看来，患者和手术因素共同决定了手术效果。越来越多的证据表明，肩峰成形术（ARCR）可能有助于获得更好的功能性治疗效果，并降低术后长期的再手术率。然而，此类手术的术后效果仍取决于患者和手术因素。患者因素包括肩峰形态、合并症、撕裂模式、大小和可修复性。III 型肩峰形态是肩峰成形术效果不佳的风险因素。手术因素包括修复技术和外科医生的经验。

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引用次数: 0

Injectable therapeutic peptides-an adjunct to regenerative medicine and sports performance? 注射治疗肽--再生医学和运动表现的辅助手段？

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Pub Date : 2024-09-10 DOI: 10.1016/j.arthro.2024.09.005

Mikalyn T DeFoor,Travis J Dekker

High level athletes and bodybuilders are constantly seeking novel therapies to enhance recovery and expedite return from injury-injectable peptides are a new and trending therapy that may be the wave of the future of in the realm of regenerative medicine research in treating joint injuries and osteoarthritis. Very early in vivo research of the pharmacokinetics suggests the possibility of Body Protection Compound 157 (BPC-157) appears to be at the forefront of therapeutic peptides with early demonstration of these experimental peptides optimizing endurance training, metabolism, recovery and tissue repair. While uUnregulated, yetand readily available for purchase over the internet, there is scarce orthopaedic literature investigating the clinical use and outcomes of these therapeutic peptides in tendon, muscle and cartilage injury. However, this has not slowed the recent exponential growth of the multi-billion-dollar industry in development of therapeutic peptides. As orthopaedic surgeons and team physicians, we should stay up-to-date with the latest pharmacokinetic, safety, ethical, and legal profilesregulations regarding synthetic peptide supplementation for injury recovery and sports performance optimization from our elite athletes to our fitness fanatics as these patients will continue to seek the latest and greatest in treatment options and will be approaching us with questions on their results, risks and benefits..

高水平运动员和健美运动员一直在寻求新的疗法，以促进恢复和加快伤后康复--注射肽是一种新的趋势性疗法，可能成为再生医学研究领域治疗关节损伤和骨关节炎的未来趋势。早期的体内药代动力学研究表明，人体保护化合物 157（BPC-157）似乎走在了治疗肽的最前沿，这些实验性肽可优化耐力训练、新陈代谢、恢复和组织修复。虽然这些治疗肽不受管制，而且可以在互联网上随时购买，但很少有骨科文献研究这些治疗肽在肌腱、肌肉和软骨损伤中的临床应用和效果。然而，这并没有减缓最近数十亿美元的治疗肽开发产业的指数级增长。作为骨科外科医生和队医，我们应该随时了解有关合成肽补充剂用于损伤恢复和运动表现优化的最新药代动力学、安全性、道德和法律规定，从我们的精英运动员到我们的健身狂热者，因为这些患者将继续寻求最新和最好的治疗方案，并会带着有关其效果、风险和益处的问题来找我们。

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引用次数: 0

Suture tape augmentation improves posterior stability after isolated posterior cruciate ligament reconstruction using hamstring tendon autograft with single-bundle transtibial technique 使用腘绳肌腱自体移植物和单束经胫技术进行孤立后交叉韧带重建后，缝合带增量改善了后部稳定性

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Pub Date : 2023-12-22 DOI: 10.1016/j.arthro.2023.12.007

Hangzhou Zhang, Jian Wang, Yuzhong Gao, Peng Zheng, Lianhai Gong

Purpose

The purpose of this study was to assess whether posterior cruciate ligament reconstruction (PCLR) suture tape augmentation can yield more stability after isolated PCLR.

Methods

A prospective database was retrospectively reviewed to identified patients that underwent primary isolated PCLR (control study) or isolated PCLR with suture tape augmentation (study group) from January 2016 to September 2020. the subjective International Knee Documentation Committee Subjective (IKDC) Knee, Lysholm and Tegner scores, posterior draw tests, as well as posterior stress radiographs and return to sports activity rates. The minimal clinically important difference (MCID) was used to evaluate the clinically relevance (subjective IKDC, Lysholm and Tegner scores).

Results

59 were included in this analysis (28 patients in control group, 31 patients in study group). The average length of follow-up was similar between the study and control groups (48.6 vs 47.9months; p=0.800). Knee function, in terms of subjective IKDC (study vs. control: 85.1±6.4 vs. 79.8±6.4; P=0.002), Lysholm (study vs. control: 86.3±7.4 vs. 80.8±7.4; P=0.005) and Tegner (study vs. control: 7.0±1.4 vs. 5.6±1. 7; P=0.006) scores, was significantly improved in the study group. However, the differences between control group and study group were less than the MCID in the subjective IKDC score and Lysholm score. 21.4% (6/28) and 48.4% of patients (15/31) in the control and study groups, respectively, returned to the preinjury sports activity levels (P=0.031). At last follow-up, the mean side-to-side differences in posterior laxity was significantly improved in the study group compared with the control patients (study vs. control: 1.52±0.70 mm vs. 3.17±2.01 mm; p<0.01).

Conclusions

Primary isolated PCLR with suture tape augmentation provides better posterior stability than PCLR without suture tape augmentation at a minimum 2 years follow-up. No differences observed between the groups in the percentage of patients who met or exceeded the MCID in subjective IKDC and Lysholm score.

本研究的目的是评估后交叉韧带重建（PCLR）缝合带增量术是否能在孤立PCLR术后获得更高的稳定性。方法回顾性审查了前瞻性数据库，确定了2016年1月至2020年9月期间接受原发性孤立PCLR术（对照组）或缝合带增量术的孤立PCLR术（研究组）的患者。研究组患者接受了国际膝关节文献委员会主观（IKDC）膝关节、Lysholm 和 Tegner 评分、后方牵引测试、后方应力X光片和运动恢复率。采用最小临床意义差异（MCID）来评估临床相关性（IKDC、Lysholm 和 Tegner 主观评分）。结果59例患者被纳入分析（对照组28例，研究组31例）。研究组和对照组的平均随访时间相似（48.6 个月 vs 47.9 个月；P=0.800）。从主观 IKDC（研究组 vs. 对照组：85.1±6.4 vs. 79.8±6.4；P=0.002）、Lysholm（研究组 vs. 对照组：86.3±7.4 vs. 80.8±7.4；P=0.005）和 Tegner（研究组 vs. 对照组：7.0±1.4 vs. 5.6±1.7；P=0.006）评分来看，研究组的膝关节功能明显改善。然而，在主观 IKDC 评分和 Lysholm 评分方面，对照组和研究组之间的差异小于 MCID。对照组和研究组分别有 21.4% （6/28）和 48.4% （15/31）的患者恢复到了受伤前的运动活动水平（P=0.031）。在最后一次随访中，与对照组患者相比，研究组患者后方松弛的平均侧向差异明显改善（研究组与对照组：1.52±0.70 mm vs. 3.17±2.01 mm；P<0.01）。在主观IKDC和Lysholm评分达到或超过MCID的患者比例方面，观察到两组之间没有差异。

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引用次数: 0

Prior Diagnosis of Opioid Related Disorder is Associated with Higher Medical Resource Utilization Following Primary Hip Arthroscopy: A National Database Study 原发性髋关节镜手术后，阿片类药物相关疾病的诊断与较高的医疗资源利用率有关：一项国家数据库研究

Arthroscopy: The Journal of Arthroscopic & Related Surgery

Pub Date : 2023-12-22 DOI: 10.1016/j.arthro.2023.12.008

Peter F. Monahan, Serkan Surucu, Natalie K. Pahapill, Andrew E. Jimenez, Kenneth F. Taylor

Purpose

To compare adverse events, medical resource utilization, prescribing patterns and revision surgery rates of patients with opioid related disorders (ORD) undergoing primary hip arthroscopy against a propensity matched group with no opioid related disorders (NORD).

Methods

The TriNetX database was queried between January 2015 and December 2020 using ICD-10 and CPT codes to identify patients undergoing primary hip arthroscopy between ages 18 and 70. The ORD cohort was propensity matched in a 1:1 ratio to NORD patients based on age, sex, alcohol related disorders, heart disease, hypertension, metabolic disorders, anxiety disorders, major depressive disorder, diabetes mellitus, and anti-depressant prescriptions. Postoperative rates of adverse events and medical resources were compared within 90 days of procedure, prescriptions were compared within 1 year, and revision surgery were compared within 2 years.

Results

A total of 809 ORD patients were propensity matched in a 1:1 ratio to NORD patients. Postoperative adverse events were similar between groups (P = .693). Rates of revision arthroscopy were also similar for both ORD (9.3%) and NORD (8.0%) cohorts (OR: 1.17 [95% CI 0.83-1.66]; P = .377). ORD patients received care from the emergency department, inpatient admission, outpatient visit, and physical therapy evaluations at higher rates. The ORD cohort received a greater amount of new opioid (OR: 2.66 [95% CI 2.17-3.26]; P < .0001) and antidepressant prescriptions (OR: 1.58 [95%CI 1.26 -1.97]; P < .0001) compared to NORD patients within 1 year of surgery.

Conclusion

ORD patients demonstrated similar rates of adverse events and revision surgery when compared to a propensity matched group of NORD patients undergoing primary hip arthroscopy. However, ORD patients experienced increased rates of ED visits, hospitalizations and were prescribed higher rates of opioid and antidepressant prescriptions.

Level of Evidence

Level III, Cohort Study

目的比较接受初级髋关节镜检查的阿片相关疾病（ORD）患者与无阿片相关疾病（NORD）倾向匹配组的不良事件、医疗资源利用率、处方模式和翻修手术率。方法在 2015 年 1 月至 2020 年 12 月期间，使用 ICD-10 和 CPT 编码查询 TriNetX 数据库，以识别年龄在 18 岁至 70 岁之间接受初级髋关节镜检查的患者。根据年龄、性别、酒精相关疾病、心脏病、高血压、代谢性疾病、焦虑症、重度抑郁症、糖尿病和抗抑郁药处方，按 1:1 的比例将 ORD 队列与 NORD 患者进行倾向匹配。比较了术后90天内的不良事件发生率和医疗资源，比较了1年内的处方，并比较了2年内的翻修手术。两组患者术后不良反应相似（P = .693）。ORD 组（9.3%）和 NORD 组（8.0%）的关节镜翻修率也相似（OR：1.17 [95% CI 0.83-1.66]；P = .377）。ORD患者接受急诊科治疗、住院治疗、门诊治疗和理疗评估的比例较高。与接受初级髋关节镜手术的 NORD 患者相比，ORD 患者在术后 1 年内接受了更多的新阿片类药物处方（OR：2.66 [95%CI 2.17-3.26]；P <；.0001）和抗抑郁药物处方（OR：1.58 [95%CI 1.26-1.97]；P <；.0001）。然而，ORD 患者的急诊室就诊率和住院率均有所上升，阿片类药物和抗抑郁药物的处方率也更高。

{"title":"Prior Diagnosis of Opioid Related Disorder is Associated with Higher Medical Resource Utilization Following Primary Hip Arthroscopy: A National Database Study","authors":"Peter F. Monahan, Serkan Surucu, Natalie K. Pahapill, Andrew E. Jimenez, Kenneth F. Taylor","doi":"10.1016/j.arthro.2023.12.008","DOIUrl":"https://doi.org/10.1016/j.arthro.2023.12.008","url":null,"abstract":"<h3>Purpose</h3><p>To compare adverse events, medical resource utilization, prescribing patterns and revision surgery rates of patients with opioid related disorders (ORD) undergoing primary hip arthroscopy against a propensity matched group with no opioid related disorders (NORD).</p><h3>Methods</h3><p>The TriNetX database was queried between January 2015 and December 2020 using ICD-10 and CPT codes to identify patients undergoing primary hip arthroscopy between ages 18 and 70. The ORD cohort was propensity matched in a 1:1 ratio to NORD patients based on age, sex, alcohol related disorders, heart disease, hypertension, metabolic disorders, anxiety disorders, major depressive disorder, diabetes mellitus, and anti-depressant prescriptions. Postoperative rates of adverse events and medical resources were compared within 90 days of procedure, prescriptions were compared within 1 year, and revision surgery were compared within 2 years.</p><h3>Results</h3><p>A total of 809 ORD patients were propensity matched in a 1:1 ratio to NORD patients. Postoperative adverse events were similar between groups (P = .693). Rates of revision arthroscopy were also similar for both ORD (9.3%) and NORD (8.0%) cohorts (OR: 1.17 [95% CI 0.83-1.66]; P = .377). ORD patients received care from the emergency department, inpatient admission, outpatient visit, and physical therapy evaluations at higher rates. The ORD cohort received a greater amount of new opioid (OR: 2.66 [95% CI 2.17-3.26]; P < .0001) and antidepressant prescriptions (OR: 1.58 [95%CI 1.26 -1.97]; P < .0001) compared to NORD patients within 1 year of surgery.</p><h3>Conclusion</h3><p>ORD patients demonstrated similar rates of adverse events and revision surgery when compared to a propensity matched group of NORD patients undergoing primary hip arthroscopy. However, ORD patients experienced increased rates of ED visits, hospitalizations and were prescribed higher rates of opioid and antidepressant prescriptions.</p><h3>Level of Evidence</h3><p>Level III, Cohort Study</p>","PeriodicalId":501029,"journal":{"name":"Arthroscopy: The Journal of Arthroscopic & Related Surgery","volume":"310 5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139030158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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Arthroscopy: The Journal of Arthroscopic & Related Surgery

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