Pub Date : 2025-11-01DOI: 10.1016/j.arthro.2025.07.038
Matthew Salzler M.D. (Associate Editor), Adnan Saithna M.D. (Associate Editor), Mark P. Cote P.A., D.P.T., M.S.C.T.R. (Deputy Editor, Statistics), Elizabeth Matzkin M.D. (Deputy Editor), Michael J. Rossi M.D., M.S. (Editor-in-Chief)
The interconnectedness of the modern world should make following patients and accessing their records much easier than in the past. For those of us old enough to remember, this once involved boxes full of papers, charts, microfiche records, images printed on radiographic films, and connecting with our patients via mailed letters. With modern electronic medical records and numerous means of electronic communication, this should be much easier. However, the demands on our patients’ time are higher than ever before, mitigating some of these technological benefits. While all studies would benefit from 100% follow-up, real-world concerns lead to the inevitable loss of patients in research studies. Researchers should strive to lower and mitigate these losses and, when possible, explore potential bias introduced with attrition. Losses to follow-up risk lowering the validity of the research via the introduction of selection and attrition bias. Proper accounting for and reporting of patients throughout the inclusion, exclusion, and analysis of a study allows the reader to assess the amount of risk introduced by patient loss and its potential effect on the study outcomes and conclusion. Finally, when loss to follow-up occurs, it should be explicitly reported, accounted for by using appropriate statistical analyses (such as Kaplan-Meier), and its impact discussed in the interpretation of the results.
{"title":"Lost but Not Forgotten: How to Manage Follow-Up Loss in Clinical Research","authors":"Matthew Salzler M.D. (Associate Editor), Adnan Saithna M.D. (Associate Editor), Mark P. Cote P.A., D.P.T., M.S.C.T.R. (Deputy Editor, Statistics), Elizabeth Matzkin M.D. (Deputy Editor), Michael J. Rossi M.D., M.S. (Editor-in-Chief)","doi":"10.1016/j.arthro.2025.07.038","DOIUrl":"10.1016/j.arthro.2025.07.038","url":null,"abstract":"<div><div>The interconnectedness of the modern world should make following patients and accessing their records much easier than in the past. For those of us old enough to remember, this once involved boxes full of papers, charts, microfiche records, images printed on radiographic films, and connecting with our patients via mailed letters. With modern electronic medical records and numerous means of electronic communication, this should be much easier. However, the demands on our patients’ time are higher than ever before, mitigating some of these technological benefits. While all studies would benefit from 100% follow-up, real-world concerns lead to the inevitable loss of patients in research studies. Researchers should strive to lower and mitigate these losses and, when possible, explore potential bias introduced with attrition. Losses to follow-up risk lowering the validity of the research via the introduction of selection and attrition bias. Proper accounting for and reporting of patients throughout the inclusion, exclusion, and analysis of a study allows the reader to assess the amount of risk introduced by patient loss and its potential effect on the study outcomes and conclusion. Finally, when loss to follow-up occurs, it should be explicitly reported, accounted for by using appropriate statistical analyses (such as Kaplan-Meier), and its impact discussed in the interpretation of the results.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4381-4388"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144823202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arthro.2025.07.018
Maximilian M. Mueller M.D. , Gregory S. DiFelice M.D.
The long-standing belief that the anterior cruciate ligament (ACL) cannot be successfully repaired to achieve subsequent healing is increasingly being challenged by emerging clinical and imaging evidence. Recent studies have demonstrated favorable short- to midterm outcomes after selective, arthroscopic ACL primary repair, particularly in the setting of proximal tears with good or excellent tissue quality. Magnetic resonance imaging follow-up indicates progressive ligamentous maturation and remodeling during the first 2 years postoperatively, supporting the notion of sufficient biological healing potential with preservation of tissue integrity in selected cases. Clinically, patients undergoing primary repair have demonstrated excellent patient-reported outcomes, as well as preservation of anterior knee stability with comparable results achieved after ACL reconstruction in certain populations. Moreover, primary repair offers several reported potential advantages because it preserves the native ACL, avoids autograft harvesting and tunnel drilling, and maintains proprioceptive function, all while reestablishing biomechanical stability. By bridging the gap between nonoperative treatment and reconstruction techniques, ACL primary repair should be part of an individualized, injury-specific, patient-centered treatment strategy.
{"title":"Editorial Commentary: Preservation of the Ruptured Anterior Cruciate Ligament—Evidence of Ligamentous Maturation After Primary Repair","authors":"Maximilian M. Mueller M.D. , Gregory S. DiFelice M.D.","doi":"10.1016/j.arthro.2025.07.018","DOIUrl":"10.1016/j.arthro.2025.07.018","url":null,"abstract":"<div><div>The long-standing belief that the anterior cruciate ligament (ACL) cannot be successfully repaired to achieve subsequent healing is increasingly being challenged by emerging clinical and imaging evidence. Recent studies have demonstrated favorable short- to midterm outcomes after selective, arthroscopic ACL primary repair, particularly in the setting of proximal tears with good or excellent tissue quality. Magnetic resonance imaging follow-up indicates progressive ligamentous maturation and remodeling during the first 2 years postoperatively, supporting the notion of sufficient biological healing potential with preservation of tissue integrity in selected cases. Clinically, patients undergoing primary repair have demonstrated excellent patient-reported outcomes, as well as preservation of anterior knee stability with comparable results achieved after ACL reconstruction in certain populations. Moreover, primary repair offers several reported potential advantages because it preserves the native ACL, avoids autograft harvesting and tunnel drilling, and maintains proprioceptive function, all while reestablishing biomechanical stability. By bridging the gap between nonoperative treatment and reconstruction techniques, ACL primary repair should be part of an individualized, injury-specific, patient-centered treatment strategy.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4708-4712"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arthro.2025.07.011
Philip J. Rosinsky M.D. (Associate Editor)
Recent evidence continues to support the clinical advantages of adding remplissage to most Bankart repairs, even in many cases with on-track Hill–Sachs lesions. The study by Schriener et al. strengthens the argument for broader use, while also promoting reflection on the need for judicious, patient-specific, decision-making. The presence of other risk factors, such as lesion orientation, activity level, and capsular quality all influence outcomes, and the long-term implications of remplissage remain incompletely understood. As Voltaire reminded us, “the perfect is the enemy of the good”—and in shoulder stabilization, more is not always better.
{"title":"Editorial Commentary: Not Every Hill-Sachs Needs Filling: Most Do, But Selective, Cost-Conscious Remplissage Is Still Warranted","authors":"Philip J. Rosinsky M.D. (Associate Editor)","doi":"10.1016/j.arthro.2025.07.011","DOIUrl":"10.1016/j.arthro.2025.07.011","url":null,"abstract":"<div><div>Recent evidence continues to support the clinical advantages of adding remplissage to most Bankart repairs, even in many cases with on-track Hill–Sachs lesions. The study by Schriener et al. strengthens the argument for broader use, while also promoting reflection on the need for judicious, patient-specific, decision-making. The presence of other risk factors, such as lesion orientation, activity level, and capsular quality all influence outcomes, and the long-term implications of remplissage remain incompletely understood. As Voltaire reminded us, “the perfect is the enemy of the good”—and in shoulder stabilization, more is not always better.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4491-4492"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arthro.2025.05.036
Francesco Pegreffi M.D., Ph.D., Maria Tiziana Di Leo M.D., Ph.D., Giuseppe Gianluca Costa M.D., Ph.D., Marco Sapienza M.D., Ph.D., Gianluca Testa M.D., Ph.D., Vito Pavone M.D., Ph.D., Vincenzo Cristian Francavilla M.D., Ph.D., Raoul Saggini M.D., Ph.D., Arcangelo Russo M.D., Ph.D.
{"title":"Kellgren-Lawrence Versus Outerbridge Classifications: Shedding Light on the Weak Correlation to Reaffirm the Value of Knee Clinical Examination","authors":"Francesco Pegreffi M.D., Ph.D., Maria Tiziana Di Leo M.D., Ph.D., Giuseppe Gianluca Costa M.D., Ph.D., Marco Sapienza M.D., Ph.D., Gianluca Testa M.D., Ph.D., Vito Pavone M.D., Ph.D., Vincenzo Cristian Francavilla M.D., Ph.D., Raoul Saggini M.D., Ph.D., Arcangelo Russo M.D., Ph.D.","doi":"10.1016/j.arthro.2025.05.036","DOIUrl":"10.1016/j.arthro.2025.05.036","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4389-4390"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arthro.2025.06.004
Nathan H. Varady M.D., M.B.A. , Jacob F. Oeding Ph.D. , Paul M. Inclan M.D. , Anil S. Ranawat M.D. , Sabrina M. Strickland M.D. , Andrew D. Pearle M.D. , Scott A. Rodeo M.D. , Riley J. Williams III M.D.
Purpose
To evaluate the cost-effectiveness of anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET) augmentation in athletes with primary anterior cruciate ligament ruptures compared with ACLR alone.
Methods
A Markov chain Monte Carlo model evaluated the outcomes and costs of 1,000 athletes undergoing ACLR with LET (ACLR-LET, iliotibial band) compared with ACLR alone. Costs, utility values, graft failure rates, and transition probabilities were derived from existing literature. Targeted meta-analysis of failure rates and patient-reported outcomes from randomized controlled trials comparing ACLR versus ACLR-LET was performed. Model outcomes included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio. Given varying definitions of “high risk,” sensitivity analyses assessed the cost-effectiveness of ACLR-LET across a range of theoretical failure rates.
Results
Meta-analysis of 1,072 patients (530 ACLR-LET and 542 ACLR patients) showed a graft failure rate of 5.1% (95% confidence interval [CI], 2.9%-8.8%) for ACLR-LET compared with 11.2% (95% CI, 7.0%-17.6%) for ACLR alone (relative risk, 0.39; 95% CI, 0.27-0.57; P < .001). Across a 5-year horizon, the mean total cost of ACLR alone was $68,605 ± $9,472 compared with $56,217 ± $7,349 for ACLR-LET. ACLR-LET yielded 1.88 ± 0.30 QALYs compared with 1.54 ± 0.30 QALYs for ACLR alone, and ACLR-LET was the preferred treatment in 98.1% of patients in the microsimulation model. In sensitivity analyses, ACLR-LET remained more cost-effective assuming an ACLR-LET failure rate up to 11.3% or an ACLR-alone failure rate down to 4.8%.
Conclusions
LET augmentation is cost-effective in athletes undergoing primary ACLR. The results of this Monte Carlo microsimulation suggest that ACLR-LET yields both superior outcomes and lower overall costs compared with ACLR alone. By use of sensitivity analysis, we found that only small improvements in graft failure rates were required for LET augmentation to be the favored treatment, suggesting that LET may be a cost-effective treatment option even when used beyond the athletes at highest-risk of graft rupture.
{"title":"Adding a Lateral Extra-articular Tenodesis Is Cost-Effective in Primary Anterior Cruciate Ligament Reconstruction: A Markov Analysis","authors":"Nathan H. Varady M.D., M.B.A. , Jacob F. Oeding Ph.D. , Paul M. Inclan M.D. , Anil S. Ranawat M.D. , Sabrina M. Strickland M.D. , Andrew D. Pearle M.D. , Scott A. Rodeo M.D. , Riley J. Williams III M.D.","doi":"10.1016/j.arthro.2025.06.004","DOIUrl":"10.1016/j.arthro.2025.06.004","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the cost-effectiveness of anterior cruciate ligament reconstruction (ACLR) with lateral extra-articular tenodesis (LET) augmentation in athletes with primary anterior cruciate ligament ruptures compared with ACLR alone.</div></div><div><h3>Methods</h3><div>A Markov chain Monte Carlo model evaluated the outcomes and costs of 1,000 athletes undergoing ACLR with LET (ACLR-LET, iliotibial band) compared with ACLR alone. Costs, utility values, graft failure rates, and transition probabilities were derived from existing literature. Targeted meta-analysis of failure rates and patient-reported outcomes from randomized controlled trials comparing ACLR versus ACLR-LET was performed. Model outcomes included costs, quality-adjusted life-years (QALYs), and the incremental cost-effectiveness ratio. Given varying definitions of “high risk,” sensitivity analyses assessed the cost-effectiveness of ACLR-LET across a range of theoretical failure rates.</div></div><div><h3>Results</h3><div>Meta-analysis of 1,072 patients (530 ACLR-LET and 542 ACLR patients) showed a graft failure rate of 5.1% (95% confidence interval [CI], 2.9%-8.8%) for ACLR-LET compared with 11.2% (95% CI, 7.0%-17.6%) for ACLR alone (relative risk, 0.39; 95% CI, 0.27-0.57; <em>P</em> < .001). Across a 5-year horizon, the mean total cost of ACLR alone was $68,605 ± $9,472 compared with $56,217 ± $7,349 for ACLR-LET. ACLR-LET yielded 1.88 ± 0.30 QALYs compared with 1.54 ± 0.30 QALYs for ACLR alone, and ACLR-LET was the preferred treatment in 98.1% of patients in the microsimulation model. In sensitivity analyses, ACLR-LET remained more cost-effective assuming an ACLR-LET failure rate up to 11.3% or an ACLR-alone failure rate down to 4.8%.</div></div><div><h3>Conclusions</h3><div>LET augmentation is cost-effective in athletes undergoing primary ACLR. The results of this Monte Carlo microsimulation suggest that ACLR-LET yields both superior outcomes and lower overall costs compared with ACLR alone. By use of sensitivity analysis, we found that only small improvements in graft failure rates were required for LET augmentation to be the favored treatment, suggesting that LET may be a cost-effective treatment option even when used beyond the athletes at highest-risk of graft rupture.</div></div><div><h3>Level of Evidence</h3><div>Level II, economic and decision analysis.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4772-4785.e3"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arthro.2025.06.019
Patrick J. Tansey M.D. (Editorial Board), Robert W. Lindeman M.D. (Editorial Board)
Partial-thickness rotator cuff tears disrupt the most structurally sound layers of collagen as tear thickness approaches 50% on either the articular or bursal side. Recent studies of cuff insertional dimensions suggest that a tear of just 3 mm may begin to compromise the most supportive zones. Partial-thickness tears can be effectively treated with debridement or a variety of reparative techniques. However, creating a more biomechanically favorable environment is not sufficient in all cases, given that up to 22% of patients who undergo repair experience tear progression and reoperation. Bioinductive bovine collagen patches represent a relatively recent approach to biologically augmenting cuff repairs. Collagen patches appear to increase mean tendon thickness at short-term follow-up, and complication profiles appear comparable to those of non-augmented tears, although surgeon vigilance for early postoperative stiffness is advised. Patients who undergo patch augmentation may show earlier functional outcome improvement with debridement versus take-down and repair. Ultimately, comparative studies with non-augmented control groups are necessary to better understand the contribution of patch augmentation to improved clinical outcomes. Equally important, consistent reporting and clear definitions of rotator cuff tear progression will be essential to determining whether biologic reinforcement can truly prevent long-term repeat injury.
{"title":"Editorial Commentary: Collagen Patch Augmentation of Partial-Thickness Rotator Cuff Tears Appears to Increase Tendon Thickness With Few Complications, but Indications and Efficacy Remain Unclear","authors":"Patrick J. Tansey M.D. (Editorial Board), Robert W. Lindeman M.D. (Editorial Board)","doi":"10.1016/j.arthro.2025.06.019","DOIUrl":"10.1016/j.arthro.2025.06.019","url":null,"abstract":"<div><div>Partial-thickness rotator cuff tears disrupt the most structurally sound layers of collagen as tear thickness approaches 50% on either the articular or bursal side. Recent studies of cuff insertional dimensions suggest that a tear of just 3 mm may begin to compromise the most supportive zones. Partial-thickness tears can be effectively treated with debridement or a variety of reparative techniques. However, creating a more biomechanically favorable environment is not sufficient in all cases, given that up to 22% of patients who undergo repair experience tear progression and reoperation. Bioinductive bovine collagen patches represent a relatively recent approach to biologically augmenting cuff repairs. Collagen patches appear to increase mean tendon thickness at short-term follow-up, and complication profiles appear comparable to those of non-augmented tears, although surgeon vigilance for early postoperative stiffness is advised. Patients who undergo patch augmentation may show earlier functional outcome improvement with debridement versus take-down and repair. Ultimately, comparative studies with non-augmented control groups are necessary to better understand the contribution of patch augmentation to improved clinical outcomes. Equally important, consistent reporting and clear definitions of rotator cuff tear progression will be essential to determining whether biologic reinforcement can truly prevent long-term repeat injury.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4836-4838"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144512796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To compare the postoperative trajectory of posterior tibial slope (p-TS) after distal (DTO) versus proximal (PTO) biplanar open-wedge high tibial osteotomy performed with an identical, early weightbearing protocol.
Methods
All consecutive open-wedge high tibial osteotomies performed from May 2015 to December 2020 were reviewed. Eligible knees had complete lateral radiographs (preoperative, 1 week, 1 month, 3 months, 6 months, 12 months) and a ≥24-month follow-up. p-TS and Caton-Deschamps index were measured. International Cartilage Repair Society cartilage grade at routine plate removal was recorded.
Results
Thirty consecutive DTOs and 30 consecutive PTOs were retrospectively compared. The mean p-TS in the DTO group initially decreased after osteotomy but subsequently increased compared to the PTO group (P = .016). From 1 week to 12 months postoperatively, 9 of 30 knees (30%) that underwent DTO had a >2° increase in p-TS, compared with 2 of 30 knees (7%) that underwent PTO (P = .045). Of the 9 DTO knees with a >2° p-TS increase, 4 exhibited widening of the descending gap (the descending cut in the tibial tuberosity) and nonunion in the retrotubercle. The p-TS correction loss primarily occurred between 1 and 3 months postoperatively (P < .001). Arthroscopic assessment revealed patellofemoral cartilage deterioration in 8 of 28 knees (29%) in the PTO group, compared to only 1 of 28 knees (4%) in the DTO group (P = .024). A greater change in the Caton-Deschamps index was associated with patellofemoral cartilage deterioration at 12 months (P = .021).
Conclusions
The p-TS changes during the postoperative course occurred more frequently in DTO compared to PTO. In DTO, p-TS increased for up to 12 months postoperatively, with the most substantial changes occurring between 1 and 3 months. While DTO has the advantage of preserving the patellofemoral joint, the increase in p-TS may require careful attention, as it could adversely impact bone union in the retrotubercle.
{"title":"Distal High Tibial Osteotomy Allows Improved Patellofemoral Joint Preservation but Results in Increased Posterior Tibial Slope Compared to Proximal High Tibial Osteotomy","authors":"Yukio Akasaki M.D., Ph.D., Yu Soejima M.D., Satoshi Hamai M.D., Ph.D., Shinya Kawahara M.D., Ph.D., Taishi Sato M.D., Ph.D., Yasuharu Nakashima M.D., Ph.D.","doi":"10.1016/j.arthro.2025.05.017","DOIUrl":"10.1016/j.arthro.2025.05.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the postoperative trajectory of posterior tibial slope (p-TS) after distal (DTO) versus proximal (PTO) biplanar open-wedge high tibial osteotomy performed with an identical, early weightbearing protocol.</div></div><div><h3>Methods</h3><div>All consecutive open-wedge high tibial osteotomies performed from May 2015 to December 2020 were reviewed. Eligible knees had complete lateral radiographs (preoperative, 1 week, 1 month, 3 months, 6 months, 12 months) and a ≥24-month follow-up. p-TS and Caton-Deschamps index were measured. International Cartilage Repair Society cartilage grade at routine plate removal was recorded.</div></div><div><h3>Results</h3><div>Thirty consecutive DTOs and 30 consecutive PTOs were retrospectively compared. The mean p-TS in the DTO group initially decreased after osteotomy but subsequently increased compared to the PTO group (<em>P</em> = .016). From 1 week to 12 months postoperatively, 9 of 30 knees (30%) that underwent DTO had a >2° increase in p-TS, compared with 2 of 30 knees (7%) that underwent PTO (<em>P</em> = .045). Of the 9 DTO knees with a >2° p-TS increase, 4 exhibited widening of the descending gap (the descending cut in the tibial tuberosity) and nonunion in the retrotubercle. The p-TS correction loss primarily occurred between 1 and 3 months postoperatively (<em>P</em> < .001). Arthroscopic assessment revealed patellofemoral cartilage deterioration in 8 of 28 knees (29%) in the PTO group, compared to only 1 of 28 knees (4%) in the DTO group (<em>P</em> = .024). A greater change in the Caton-Deschamps index was associated with patellofemoral cartilage deterioration at 12 months (<em>P</em> = .021).</div></div><div><h3>Conclusions</h3><div>The p-TS changes during the postoperative course occurred more frequently in DTO compared to PTO. In DTO, p-TS increased for up to 12 months postoperatively, with the most substantial changes occurring between 1 and 3 months. While DTO has the advantage of preserving the patellofemoral joint, the increase in p-TS may require careful attention, as it could adversely impact bone union in the retrotubercle.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective comparative case series.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4641-4651"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arthro.2025.06.032
Xinlong Ma M.D. , Zhihu Zhao M.D. , Haohao Bai M.D. , Songqing Ye M.D. , Bin Zhao M.D. , Wei Luo M.D.
Purpose
To evaluate clinical outcomes and accuracy of patient-specific cutting guides (PSCGs) in double-level knee osteotomy (DLO) patients over a minimum 24-month follow-up.
Methods
This single-center retrospective case series included consecutive patients who underwent DLO using PSCGs from December 2016 to May 2022. Inclusion criteria comprised symptomatic knee osteoarthritis with varus/valgus malalignment, planned double-level correction, and a minimum 24-month follow-up. Primary outcomes were functional improvement (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] scores) and complications; secondary outcomes included alignment accuracy (hip-knee-ankle, medial proximal tibial angle, lateral distal femoral angle, joint line obliquity, joint line convergence angle) and patient satisfaction. The WOMAC scores and achievements of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were compared between patients with and without postoperative effusion-synovitis. Statistical analysis used the Mann-Whitney U test for alignment accuracy and paired t tests for functional outcomes.
Results
Among 31 patients (35 knees), there was a mean 36.2-month follow-up (range, 24-91 months). Patients’ average age was 59.3 ± 5.14 years with a body mass index of 22.1 ± 1.8. Hip-knee-ankle improved from 163.9° to 181.1°, medial proximal tibial angle from 83.9° to 91.5°, lateral distal femoral angle from 94.7° to 85.7°, and joint line convergence angle from 5.6° to 2.4° (all preoperative to postoperative P < .05). Postoperative values showed no significant difference versus planned values (all P > .05). Preoperative joint line obliquity (4.71° ± 2.12°) significantly improved to 2.31° ± 2.02° postoperatively (P = .019), with no significant difference from the target (2.10° ± 1.53°, P = .526). WOMAC total scores decreased from 41.6 to 22.4 (P < .001), with 100% achieving the MCID. PASS rates varied: WOMAC pain (85.3%), stiffness (67.6%), physical function (94.1%), and total (79.4%). Complications included 2 femoral and 1 tibial hinge fractures, plus 6 venous thromboses (all resolved with rivaroxaban). Patient satisfaction was high (26/31 highly satisfied).
Conclusions
DLO with PSCGs achieved consistent alignment with preoperative plans, preserved physiological joint line orientation, and sustained functional improvements over 36.2 months. All patients met the MCID for WOMAC total scores, with 94.1% attaining PASS in physical function and 85.3% in pain subdomains at a minimum 24-month follow-up.
{"title":"Patient-Specific Cutting Guides Provide Consistent Planned Correction and Preserved Joint Line Obliquity for Double-Level Knee Osteotomy","authors":"Xinlong Ma M.D. , Zhihu Zhao M.D. , Haohao Bai M.D. , Songqing Ye M.D. , Bin Zhao M.D. , Wei Luo M.D.","doi":"10.1016/j.arthro.2025.06.032","DOIUrl":"10.1016/j.arthro.2025.06.032","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate clinical outcomes and accuracy of patient-specific cutting guides (PSCGs) in double-level knee osteotomy (DLO) patients over a minimum 24-month follow-up.</div></div><div><h3>Methods</h3><div>This single-center retrospective case series included consecutive patients who underwent DLO using PSCGs from December 2016 to May 2022. Inclusion criteria comprised symptomatic knee osteoarthritis with varus/valgus malalignment, planned double-level correction, and a minimum 24-month follow-up. Primary outcomes were functional improvement (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] scores) and complications; secondary outcomes included alignment accuracy (hip-knee-ankle, medial proximal tibial angle, lateral distal femoral angle, joint line obliquity, joint line convergence angle) and patient satisfaction. The WOMAC scores and achievements of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were compared between patients with and without postoperative effusion-synovitis. Statistical analysis used the Mann-Whitney <em>U</em> test for alignment accuracy and paired <em>t</em> tests for functional outcomes.</div></div><div><h3>Results</h3><div>Among 31 patients (35 knees), there was a mean 36.2-month follow-up (range, 24-91 months). Patients’ average age was 59.3 ± 5.14 years with a body mass index of 22.1 ± 1.8. Hip-knee-ankle improved from 163.9° to 181.1°, medial proximal tibial angle from 83.9° to 91.5°, lateral distal femoral angle from 94.7° to 85.7°, and joint line convergence angle from 5.6° to 2.4° (all preoperative to postoperative <em>P</em> < .05). Postoperative values showed no significant difference versus planned values (all <em>P</em> > .05). Preoperative joint line obliquity (4.71° ± 2.12°) significantly improved to 2.31° ± 2.02° postoperatively (<em>P</em> = .019), with no significant difference from the target (2.10° ± 1.53°, <em>P</em> = .526). WOMAC total scores decreased from 41.6 to 22.4 (<em>P</em> < .001), with 100% achieving the MCID. PASS rates varied: WOMAC pain (85.3%), stiffness (67.6%), physical function (94.1%), and total (79.4%). Complications included 2 femoral and 1 tibial hinge fractures, plus 6 venous thromboses (all resolved with rivaroxaban). Patient satisfaction was high (26/31 highly satisfied).</div></div><div><h3>Conclusions</h3><div>DLO with PSCGs achieved consistent alignment with preoperative plans, preserved physiological joint line orientation, and sustained functional improvements over 36.2 months. All patients met the MCID for WOMAC total scores, with 94.1% attaining PASS in physical function and 85.3% in pain subdomains at a minimum 24-month follow-up.</div></div><div><h3>Level of Evidence</h3><div>Level IV, retrospective case series.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4713-4723"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arthro.2025.07.033
Samuel R. Huntley M.D., M.P.H. , Alan D. Villegas Meza B.A. , Michael J. Nocek B.A. , Marc J. Philippon M.D.
Routine capsular closure during hip arthroscopy remains a cornerstone of my surgical approach. In my experience, restoring the capsule enhances joint stability, maintains the suction seal, and reduces long-term risk of microinstability, particularly in active or high-risk patients. Although some advocate for selective repair, I believe the downsides of routine closure are minimal and the benefits long-lasting. Until long-term evidence proves otherwise, restoring capsular integrity is essential to joint preservation.
{"title":"Editorial Commentary: Hip Arthroscopy and the Capsule: Why Repair Remains Central to My Approach","authors":"Samuel R. Huntley M.D., M.P.H. , Alan D. Villegas Meza B.A. , Michael J. Nocek B.A. , Marc J. Philippon M.D.","doi":"10.1016/j.arthro.2025.07.033","DOIUrl":"10.1016/j.arthro.2025.07.033","url":null,"abstract":"<div><div>Routine capsular closure during hip arthroscopy remains a cornerstone of my surgical approach. In my experience, restoring the capsule enhances joint stability, maintains the suction seal, and reduces long-term risk of microinstability, particularly in active or high-risk patients. Although some advocate for selective repair, I believe the downsides of routine closure are minimal and the benefits long-lasting. Until long-term evidence proves otherwise, restoring capsular integrity is essential to joint preservation.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4542-4543"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144786015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-01DOI: 10.1016/j.arthro.2025.06.023
Roger Quesada-Jimenez M.D. , Elizabeth G. Walsh B.S. , Ady H. Kahana-Rojkind M.D. , Andrew R. Schab B.S. , Tyler R. McCarroll M.D. , Benjamin G. Domb M.D.
Purpose
To evaluate the outcomes of endoscopic sciatic neurolysis and piriformis release as treatment for piriformis syndrome with a minimum 2-year follow-up, as well as present a comprehensive approach to enhance diagnostic accuracy.
Methods
Prospectively collected data were retrospectively analyzed for all patients who underwent endoscopic piriformis release and sciatic neurolysis as a treatment for piriformis syndrome between 2010 and 2021. A diagnostic algorithm was employed for surgical indications throughout this time period. Included patients had completed preoperative and a minimum of 2-year postoperative questionnaires for the following patient-reported outcome measures: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain and patient satisfaction. The minimal clinically important difference was calculated for the mentioned patient-reported outcome and included in the analysis.
Results
A total of 18 patients with a mean follow-up time of 93.1 ± 38.2 months were included in the study. All patients experienced symptom relief postoperatively. Significant improvement was seen at latest follow-up compared to preoperative baseline for mHHS (P < .001), NAHS (P < .001), HOS-SSS (P = .019), and VAS (P < .001), as well as a high mean patient satisfaction of 8.3 ± 1.7. Furthermore, a high percentage of patients reached the calculated minimal clinically important difference for mHHS (83.3%), NAHS (77.8%), HOS-SSS (61.1%), and VAS (94.4%).
Conclusions
Endoscopic release of the piriformis tendon and sciatic neurolysis have shown favorable outcomes, high patient satisfaction rates, and a high percentage of patients reaching clinically important thresholds, with a low rate of complications at a minimum 2-year follow-up.
{"title":"Comprehensive Management of Piriformis Syndrome With Endoscopic Release and Sciatic Neurolysis Provides Favorable Outcomes and Low Complication Rate","authors":"Roger Quesada-Jimenez M.D. , Elizabeth G. Walsh B.S. , Ady H. Kahana-Rojkind M.D. , Andrew R. Schab B.S. , Tyler R. McCarroll M.D. , Benjamin G. Domb M.D.","doi":"10.1016/j.arthro.2025.06.023","DOIUrl":"10.1016/j.arthro.2025.06.023","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the outcomes of endoscopic sciatic neurolysis and piriformis release as treatment for piriformis syndrome with a minimum 2-year follow-up, as well as present a comprehensive approach to enhance diagnostic accuracy.</div></div><div><h3>Methods</h3><div>Prospectively collected data were retrospectively analyzed for all patients who underwent endoscopic piriformis release and sciatic neurolysis as a treatment for piriformis syndrome between 2010 and 2021. A diagnostic algorithm was employed for surgical indications throughout this time period. Included patients had completed preoperative and a minimum of 2-year postoperative questionnaires for the following patient-reported outcome measures: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score–Sports Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain and patient satisfaction. The minimal clinically important difference was calculated for the mentioned patient-reported outcome and included in the analysis.</div></div><div><h3>Results</h3><div>A total of 18 patients with a mean follow-up time of 93.1 ± 38.2 months were included in the study. All patients experienced symptom relief postoperatively. Significant improvement was seen at latest follow-up compared to preoperative baseline for mHHS (<em>P</em> < .001), NAHS (<em>P</em> < .001), HOS-SSS (<em>P</em> = .019), and VAS (<em>P</em> < .001), as well as a high mean patient satisfaction of 8.3 ± 1.7. Furthermore, a high percentage of patients reached the calculated minimal clinically important difference for mHHS (83.3%), NAHS (77.8%), HOS-SSS (61.1%), and VAS (94.4%).</div></div><div><h3>Conclusions</h3><div>Endoscopic release of the piriformis tendon and sciatic neurolysis have shown favorable outcomes, high patient satisfaction rates, and a high percentage of patients reaching clinically important thresholds, with a low rate of complications at a minimum 2-year follow-up.</div></div><div><h3>Level of Evidence</h3><div>Level IV, retrospective case series.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4596-4603"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531237","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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