Arthroscopy-The Journal of Arthroscopic and Related Surgery最新文献

Purpose: To (1) review definitions and concepts necessary to interpret applications of deep learning (DL; a domain of artificial intelligence that leverages neural networks to make predictions on media inputs such as images) and (2) identify knowledge and translational gaps in the literature to provide insight into specific areas for improvement as adoption of this technology continues.

Methods: A comprehensive search of the literature was performed in December 2023 for articles regarding the use of DL in sports medicine. For each study, information regarding the joint of focus, specific anatomic structure/pathology to which DL was applied, imaging modality utilized, source of images used for model training and testing, data set size, model performance, and whether the DL model was externally validated was recorded. A numerical scale was used to rate each DL model's clinical impact, with 1 corresponding to proof-of-concept studies with little to no direct clinical impact and 5 corresponding to practice-changing clinical impact and ready for clinical deployment.

Results: Fifty-five studies were identified, all of which were published within the past 5 years, while 82% were published within the past 3 years. Of the DL models identified, 84% were developed for classification tasks, 9% for automated measurements, and 7% for segmentation. A total of 62% of studies utilized magnetic resonance imaging as the imaging modality, 25% radiographs, and 7% ultrasound, while 1 study each used computed tomography, arthroscopic images, or arthroscopic video. Sixty-five percent of studies focused on the detection of tears (anterior cruciate ligament [ACL], rotator cuff [RC], and meniscus). The diagnostic performance of ACL tears, as determined by the area under the receiver operator curve (AUROC), ranged from 0.81 to 0.99 for ACL tears (excellent to near perfect), 0.83 to 0.94 for RC tears (excellent), and from 0.75 to 0.96 for meniscus tears (acceptable to excellent). In addition, 3 studies focused on detection of cartilage lesions had AUROC ranging from 0.90 to 0.92 (excellent performance). However, only 4 (7%) studies externally validated their models, suggesting that they may not be generalizable or may not perform well when applied to populations other than that used to develop the model. Finally, the mean clinical impact score was 2 (range, 1-3) on scale of 1 to 5, corresponding to limited clinical applicability.

Conclusions: DL models in orthopaedic sports medicine show generally excellent performance (high internal validity) but require external validation to facilitate clinical deployment. In addition, current models have low clinical applicability and fail to advance the field due to a focus on routine tasks and a narrow conceptual framework.

Level of evidence: Level IV, scoping review of Level I to IV studies.

Purpose: To systematically review the literature to evaluate the clinical studies on bioinductive collagen implant (BCI) for the treatment of rotator cuff tears.

Methods: A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies reporting BCI for rotator cuff tears were included. Quantitive and qualitative data were evaluated.

Results: A total of 21 studies were included. In patients with full-thickness tears, 7 of the 8 studies with pre- to postoperative American Shoulder and Elbow Surgeons (ASES) scores demonstrated statistically significant improvements in mean pre- to postoperative ASES scores, with 75% to 100% of patients meeting the minimal clinically important difference. In those with partial-thickness tears, 7 of the 8 studies with pre- to postoperative ASES scores demonstrated statistically significant improvements in mean pre- to postoperative ASES scores, with 54.4% to 100% of patients meeting the minimal clinically important difference. For studies that quantified percent increases in tendon thickness, the reported increases ranged from 13% to 44% in full-thickness tears and 14% to 60% in partial-thickness tears. Six studies evaluated rotator cuff retears after BCI treatment in the full-thickness cohort, with rates reported ranging from 0% to 9%. Five studies evaluated rotator cuff retears after BCI treatment in the partial-thickness cohort, with rates reported ranging from 0% to 18%. Two of the included studies found that BCI was cost-effective due to the increased tendon healing, with cost savings of $5,338 to $13,061 per healed rotator cuff tendon.

Conclusions: The literature on rotator cuff tear augmentation with BCI has shown consistently reported good results. Additionally, there was evidence of low retear rates and consistently improved tendon thickness with BCI, with 2 randomized controlled trials showing improved tendon healing with BCI. However, there appears to be a higher rate of adhesive capsulitis reported.

Level of evidence: Level IV, systematic review of Level I, III, and IV studies.

Purpose: To determine whether the diameter of the quadrupled semitendinosus tendon (ST) graft in primary anterior cruciate ligament reconstruction (ACLR) is related to the risk of revision ACLR within 2 years of primary ACLR, postoperative knee laxity, and patient-reported knee outcome. Furthermore, to investigate whether smaller graft than estimated is related to revision ACLR.

Methods: Patients who underwent primary ACLR with a quadrupled ST autograft at our institution from January 2005 to December 2017 were identified. Data from the Swedish National Knee Ligament Registry were collected up to 2 years or until revision surgery was registered within 2 years after primary ACLR. Knee laxity was assessed preoperatively and at 6-month follow-up using the KT-1000 arthrometer (134 N anterior tibial load). The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 2 years postoperatively from Swedish National Knee Ligament Registry. On the basis of anthropometric measurements (body height and weight) and sex, the estimated quadrupled ST graft diameter was calculated.

Results: A total of 4,519 patients who underwent ACLR with a quadrupled ST autograft were included. The mean graft diameter was 8.3 ± 0.7 mm; 8.0 ± 0.6 mm for women and 8.6 ± 0.7 mm for men. The quadrupled ST graft diameter was not significantly correlated to revision ACLR. There was no significant difference in the ST graft diameter regarding postoperative knee laxity. The correlations between ST graft diameter and KOOS were weak, except for the "sport and recreation" subscale (P = .012).

Conclusions: The quadrupled ST graft diameter was not significantly related to the need for early revision ACLR, nor was it related to postoperative knee laxity or patient-reported outcome except for the KOOS "sport and recreation" subscale. Smaller ST graft than estimated was not a risk factor for revision ACLR.

Level of evidence: Level III, retrospective cohort study.

The study of human donors allows us unique perspective of the pathomechanics of ischiofemoral impingement syndrome. Use of cadaveric modeling and fluoroscopic evaluation reveals that hip external rotation reduces the ischiofemoral space. Thus ischiofemoral impingement is likely to occur with hip motion into external rotation and extension in combination with femoral and acetabular anteversion according to cadaveric study. The combination of cadaveric study and diagnostic imaging helps us to understand the intricate relationship between anatomical structure and human movement causing ischiofemoral impingement syndrome. The advancement of our knowledge is aided the gracious donar of human donors to study their bodies, specifically in response to human movement.

Purpose: To describe the currently available literature reporting clinical outcomes for bioactive and bioinductive implants in sports medicine.

Methods: In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search of 4 databases was completed to identify eligible studies. Inclusion criteria were studies using bioactive or bioinductive implants in human clinical studies for sports medicine procedures. Data were extracted and reported in narrative form, along with study characteristics.

Results: In total, 145 studies were included involving 6,043 patients. The majority of included studies were level IV evidence (65.5%), and only 36 included a control group (24.8%). Bioactive materials are defined as any materials that stimulate an advantageous response from the body upon implantation, whereas bioinductive materials provide a favorable environment for a biological response initiated by the host. Bioactivity can speed healing and improve clinical outcome by improving vascularization, osteointegration, osteoinduction, tendon healing, and soft-tissue regeneration or inducing immunosuppression or preventing infection. The most common implants reported were for knee (67.6%, primarily cartilage [most commonly osteochondral defects], anterior cruciate ligament, and meniscus), shoulder (16.6%, primarily rotator cuff), or ankle (11.7%, primarily Achilles repair). The most common type of implant was synthetic (44.1%), followed by autograft (30.3%), xenograft (16.6%), and allograft (9.0%). In total, 69% of implants were standalone treatments and 31% were augmentation.

Conclusions: The existing bioactive and bioinductive implant literature in sports medicine is largely composed of small, low-level-of-evidence studies lacking a control group.

Clinical relevance: Before bioactive implants can be adapted as a new standard of care, larger, comparative clinical outcome studies with long-term follow-up are essential.

Compared with total hip arthroplasty, hip arthroscopy is a relatively new procedure, and as such, hip-spine syndrome in young adults is an emerging topic of research. In the past decade, our understanding of spinopelvic alignment has improved the stability and survivorship of hip replacements in patients with prior lumbar fusions. Obviously, the hip affects the spine and the spine affects the hip. In terms of hip arthroscopy, just as older patients and patients with cartilage damage have inferior outcomes, patients with spine pathology are at risk for postoperative worsening spinal symptoms, including sciatica. In addition, back and radicular pain may limit postoperative hip rehabilitation. Yet other patients show resolution of back symptoms after hip arthroscopy. Today, surgeons indicating hip arthroscopy must first investigate patient sagittal balance, which includes pelvis tilt, pelvic incidence, and sacral slope. When properly indicated, hip-spine pain patients show greater percentage improvement with no increased failure risk compared with patients with isolated FAIS. Exceptions include patients with concomitant lumbar stenosis or lumbar fusion. Rate of revision hip arthroscopy and conversion to total hip replacement is 2-fold compared with controls if patients had prior 1-2 level fusion and 3-fold if 3 or more levels are fused. Our understanding of hip-spine patients with regard to arthroscopy outcomes continues to develop. In addition to a comprehensive spine exam, the patient's spine surgical history and current spine symptoms must be investigated to predict the efficacy of hip arthroscopy. If patients have both hip and spine symptoms, a diagnostic hip injection to determine the prime pain generator is essential. If the hip is the source of pain, patients should be counseled that back symptoms will likely improve after hip arthroscopy but not in all cases. EOS imaging to measure sagittal balance may allow the surgeon to predict if impingement measurements on hip radiographs may be underestimated in the setting of a stiff spine. If the patient has multiple risk factors for poor outcomes such as advancing age, articular cartilage damage, borderline dysplasia, or hypermobility, on top of a history of multilevel lumbar fusion or spinal deformity, hip arthroscopy may not be ideal, and hip arthroplasty should be considered. Clearly, the spine may not be ignored in patients with femoroacetabular impingement.

In recent decades, artificial intelligence (AI) has infiltrated a variety of domains, including media, education, and medicine. There exists no glossary, lexicon, or reference for the uninitiated medical professional to explore the new terminology. As AI-driven technologies and applications become more available for clinical use in healthcare settings, an understanding of basic components, models, and tasks related to AI is crucial for clinical and academic appraisal. Here, we present a glossary of AI definitions that healthcare professionals can utilize to augment personal understanding of AI during this fourth industrial revolution. LEVEL OF EVIDENCE: Level V, expert opinion.