Pub Date : 2024-10-01DOI: 10.1016/j.arthro.2024.05.030
Purpose
To determine whether anthropometric measurements (height and weight), sex, age, and preinjury Tegner Activity Scale (TAS) were predictors of the quadrupled semitendinosus (ST) graft diameter in primary anterior cruciate ligament reconstruction.
Methods
A total of 4,519 patients who underwent primary anterior cruciate ligament reconstruction with a quadrupled ST autograft were included. Anthropometric measurements (height and weight), sex, age, and preinjury TAS were collected. Correlation coefficients and multiple linear regression analysis were used to determine the relationships among graft diameter and anthropometrics measurements (height and weight), sex, age, and preinjury TAS.
Results
The diameter of the quadrupled ST graft was correlated positively to height (r = 0.021, P < .001), age (r = 0.005, P < .001), and weight (r = 0.004, P = .001) and negatively to female sex (r = –0.297, P < .001). A regression equation was estimated to predict the ST graft diameter for men as 4.245 + 0.021 × height (cm) + 0.004 × age (years) + 0.005 × weight (kg) and for women as 3.969 + 0.021 × height (cm) + 0.004 × age (years) + 0.005 × weight (kg).
Conclusions
Height, age, and weight were positively correlated, whereas female sex was negatively correlated, to the diameter of the quadrupled ST graft. Knowledge of these factors can be used for the preoperative estimation of the graft diameter which can be helpful for appropriate graft choice.
{"title":"Patient’s Height and Sex Predict Graft Diameter: A Cohort Study of 4,519 Patients With Primary Anterior Cruciate Ligament Reconstruction Using Semitendinosus Autograft","authors":"","doi":"10.1016/j.arthro.2024.05.030","DOIUrl":"10.1016/j.arthro.2024.05.030","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine whether anthropometric measurements (height and weight), sex, age, and preinjury Tegner Activity Scale (TAS) were predictors of the quadrupled semitendinosus (ST) graft diameter in primary anterior cruciate ligament reconstruction.</div></div><div><h3>Methods</h3><div>A total of 4,519 patients who underwent primary anterior cruciate ligament reconstruction with a quadrupled ST autograft were included. Anthropometric measurements (height and weight), sex, age, and preinjury TAS were collected. Correlation coefficients and multiple linear regression analysis were used to determine the relationships among graft diameter and anthropometrics measurements (height and weight), sex, age, and preinjury TAS.</div></div><div><h3>Results</h3><div>The diameter of the quadrupled ST graft was correlated positively to height (<em>r</em> = 0.021, <em>P</em> < .001), age (<em>r</em> = 0.005, <em>P</em> < .001), and weight (<em>r</em> = 0.004, <em>P</em> = .001) and negatively to female sex (<em>r</em> = –0.297, <em>P</em> < .001). A regression equation was estimated to predict the ST graft diameter for men as 4.245 + 0.021 × height (cm) + 0.004 × age (years) + 0.005 × weight (kg) and for women as 3.969 + 0.021 × height (cm) + 0.004 × age (years) + 0.005 × weight (kg).</div></div><div><h3>Conclusions</h3><div>Height, age, and weight were positively correlated, whereas female sex was negatively correlated, to the diameter of the quadrupled ST graft. Knowledge of these factors can be used for the preoperative estimation of the graft diameter which can be helpful for appropriate graft choice.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective cohort study.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2588-2591"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141403422","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.02.031
Purpose
To prospectively compare pain intensity and patient-reported outcomes (PROs) after arthroscopic rotator cuff repair (ARCR) between patients who received ultrasound-guided suprascapular nerve block (SSNB) and axillary nerve block (ANB) as well as preincisional parecoxib and patients who received preincisional parecoxib only.
Methods
Sixty-one patients receiving ARCR between March 2020 and March 2021 were prospectively enrolled. They were randomly assigned to the peripheral nerve block group (group N, n = 30) or control group (group C, n = 31). Two patients in group C were excluded because of miscommunication. All patients were administered 40 mg of parecoxib intravenously prior to induction of anesthesia. SSNB and ANB were performed after general anesthesia in group N, whereas no nerve block was performed in group C. Pain intensity was compared before surgery, as well as immediately, 24 hours, and 2 weeks after surgery. PROs, including the Oxford Shoulder Score, University of California–Los Angeles shoulder score, and Single Assessment Numeric Evaluation score, were compared before and 6 months after surgery.
Results
The numerical rating scale (NRS) score for resting pain was significantly lower in group N (4.9 ± 3.1 vs 7.6 ± 2.5, P < .001) immediately after surgery, but no difference was noted 24 hours after surgery. The resting pain NRS score 2 weeks after surgery was significantly lower in group N (1.4 ± 1.6 vs 2.7 ± 2.7, P = .03), but the scores for movement-evoked pain and night pain were similar. All PROs significantly improved 6 months after surgery in both groups, but there was no difference between the 2 groups.
Conclusions
The addition of preoperative ultrasound-guided SSNB and ANB to parecoxib offered better resting pain control immediately and 2 weeks after ARCR, but there was no benefit for PROs 6 months after surgery.
Level of Evidence
Level II, prospective randomized controlled trial.
{"title":"Addition of Preoperative Ultrasound-Guided Suprascapular Nerve Block and Axillary Nerve Block to Parecoxib Is More Effective in Early Postoperative Pain Control After Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Study","authors":"","doi":"10.1016/j.arthro.2024.02.031","DOIUrl":"10.1016/j.arthro.2024.02.031","url":null,"abstract":"<div><h3>Purpose</h3><div><span>To prospectively compare pain intensity and patient-reported outcomes (PROs) after arthroscopic rotator cuff repair (ARCR) between patients who received ultrasound-guided suprascapular nerve block (SSNB) and </span>axillary nerve<span> block (ANB) as well as preincisional parecoxib and patients who received preincisional parecoxib only.</span></div></div><div><h3>Methods</h3><div>Sixty-one patients receiving ARCR between March 2020 and March 2021 were prospectively enrolled. They were randomly assigned to the peripheral nerve block<span> group (group N, n = 30) or control group (group C, n = 31). Two patients in group C were excluded because of miscommunication. All patients were administered 40 mg of parecoxib intravenously prior to induction of anesthesia<span><span>. SSNB and ANB were performed after general anesthesia in group N, whereas no nerve block was performed in group C. Pain intensity was compared before surgery, as well as immediately, 24 hours, and 2 weeks after surgery. PROs, including the </span>Oxford Shoulder Score, University of California–Los Angeles shoulder score, and Single Assessment Numeric Evaluation score, were compared before and 6 months after surgery.</span></span></div></div><div><h3>Results</h3><div><span>The numerical rating scale (NRS) score for resting pain was significantly lower in group N (4.9 ± 3.1 vs 7.6 ± 2.5, </span><em>P</em> < .001) immediately after surgery, but no difference was noted 24 hours after surgery. The resting pain NRS score 2 weeks after surgery was significantly lower in group N (1.4 ± 1.6 vs 2.7 ± 2.7, <em>P</em> = .03), but the scores for movement-evoked pain and night pain were similar. All PROs significantly improved 6 months after surgery in both groups, but there was no difference between the 2 groups.</div></div><div><h3>Conclusions</h3><div>The addition of preoperative ultrasound-guided SSNB and ANB to parecoxib offered better resting pain control immediately and 2 weeks after ARCR, but there was no benefit for PROs 6 months after surgery.</div></div><div><h3>Level of Evidence</h3><div>Level II, prospective randomized controlled trial.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2532-2539"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051136","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.01.029
<div><h3>Purpose</h3><div>To investigate whether allograft<span><span> substitutes may be used to restore suctional seal properties with labral augmentation, the purpose of the current study was to evaluate the biomechanical properties<span> of the labral suction seal under several scenarios, including: (1) intact labrum, (2) rim preparation, (3) labral repair, (4) labral augmentation with iliotibial band (ITB), and (5) labral augmentation with a dermis </span></span>allograft.</span></div></div><div><h3>Methods</h3><div>Eleven hemi-pelvises were dissected to the level of the labrum and placed in a material testing system for biomechanical axial distraction. Each specimen was compressed to 250 newtons (N) and distracted at 10 mm/s while load, crosshead displacement, and time were continuously recorded. For each of the 5 labral states, 3 testing repetitions were performed. Peak force (N, newtons), displacement at peak force (mm, millimeter), and work (N-mm, newton, millimeter) were calculated and normalized to the intact state of each specimen.</div></div><div><h3>Results</h3><div><span>Eleven specimens were tested and 8 specimens (age: 58.6 ± 5.4 years, body mass index: 28.6 ± 6.8 kg/m</span><sup>2</sup><span>; 4 female patients; 5 right hips) were included in final analyses. Expressed as a percentage relative to the intact state, the average normalized peak force, displacement at peak force, and work for each labral state were as follows: intact (100.0% ± 0% for all), rim preparation (89.0% ± 9.2%, 93.3% ± 20.6%, 85.1% ± 9.0%), repair (61.3% ± 17.9%, 88.4% ± 36.9%, 58.1% ± 16.7%), ITB allograft (62.7% ± 24.9%, 83.9% ± 21.6%, 59.4% ± 22.4%), and dermis allograft (57.8% ± 27.2%, 88.2% ± 29.5%, 50.0% ± 20.1%). Regarding peak force, intact state was significantly greater compared with the labral repair, augmentation with ITB, and augmentation with the dermis allograft states (</span><em>P</em> < .001). No significant differences were demonstrated between displacement at peak force (<em>P</em> = .561). Regarding work, both intact state and rim preparation states were significantly greater than the repair, ITB augmentation, and dermis allograft augmentation states (<em>P</em> < .001). In all outcome measures, the dermis allograft augmentation performed with no statistical difference to the ITB augmentation state.</div></div><div><h3>Conclusions</h3><div>Labral repair and labral augmentation with either ITB allograft or the dermis allograft resulted in significantly lower peak force and work to equilibrium compared with the intact and rim prep states. There was no statistical difference between repair and augmentation states as well as no statistical difference between ITB allograft and dermal allograft at time zero.</div></div><div><h3>Clinical Relevance</h3><div>This study compares biomechanical properties of the suction seal of the hip comparing labral states including intact, rim preparation, repair, and augmentation, which can be used for su
{"title":"Labral Augmentation With Either Iliotibial Band Allograft or Dermis Allograft Perform Similarly Regarding Peak Force, Displacement, and Work to Labral Repair in Suction Seal Restoration: A Biomechanical Study","authors":"","doi":"10.1016/j.arthro.2024.01.029","DOIUrl":"10.1016/j.arthro.2024.01.029","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate whether allograft<span><span> substitutes may be used to restore suctional seal properties with labral augmentation, the purpose of the current study was to evaluate the biomechanical properties<span> of the labral suction seal under several scenarios, including: (1) intact labrum, (2) rim preparation, (3) labral repair, (4) labral augmentation with iliotibial band (ITB), and (5) labral augmentation with a dermis </span></span>allograft.</span></div></div><div><h3>Methods</h3><div>Eleven hemi-pelvises were dissected to the level of the labrum and placed in a material testing system for biomechanical axial distraction. Each specimen was compressed to 250 newtons (N) and distracted at 10 mm/s while load, crosshead displacement, and time were continuously recorded. For each of the 5 labral states, 3 testing repetitions were performed. Peak force (N, newtons), displacement at peak force (mm, millimeter), and work (N-mm, newton, millimeter) were calculated and normalized to the intact state of each specimen.</div></div><div><h3>Results</h3><div><span>Eleven specimens were tested and 8 specimens (age: 58.6 ± 5.4 years, body mass index: 28.6 ± 6.8 kg/m</span><sup>2</sup><span>; 4 female patients; 5 right hips) were included in final analyses. Expressed as a percentage relative to the intact state, the average normalized peak force, displacement at peak force, and work for each labral state were as follows: intact (100.0% ± 0% for all), rim preparation (89.0% ± 9.2%, 93.3% ± 20.6%, 85.1% ± 9.0%), repair (61.3% ± 17.9%, 88.4% ± 36.9%, 58.1% ± 16.7%), ITB allograft (62.7% ± 24.9%, 83.9% ± 21.6%, 59.4% ± 22.4%), and dermis allograft (57.8% ± 27.2%, 88.2% ± 29.5%, 50.0% ± 20.1%). Regarding peak force, intact state was significantly greater compared with the labral repair, augmentation with ITB, and augmentation with the dermis allograft states (</span><em>P</em> < .001). No significant differences were demonstrated between displacement at peak force (<em>P</em> = .561). Regarding work, both intact state and rim preparation states were significantly greater than the repair, ITB augmentation, and dermis allograft augmentation states (<em>P</em> < .001). In all outcome measures, the dermis allograft augmentation performed with no statistical difference to the ITB augmentation state.</div></div><div><h3>Conclusions</h3><div>Labral repair and labral augmentation with either ITB allograft or the dermis allograft resulted in significantly lower peak force and work to equilibrium compared with the intact and rim prep states. There was no statistical difference between repair and augmentation states as well as no statistical difference between ITB allograft and dermal allograft at time zero.</div></div><div><h3>Clinical Relevance</h3><div>This study compares biomechanical properties of the suction seal of the hip comparing labral states including intact, rim preparation, repair, and augmentation, which can be used for su","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2575-2584"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139687647","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.01.031
Purpose
To determine the most common indications for lateral extra-articular tenodesis (LET) augmentation of anterior cruciate ligament reconstruction (ACLR).
Methods
A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, Embase, Web of Science, and Cochrane Database of Systematic Reviews from 2000 to the present (June 2022). Studies that met the following criteria were included: patients of any age who underwent LET in addition to ACLR, studies reporting at least 1 indication for LET, and observational/randomized controlled trial study designs including prevalence of indications. Publications had to be reported in English and peer reviewed and to have originated in the United States or countries offering identical protocols and procedures.
Results
A total of 463 studies were identified from the initial search, 23 of which met inclusion criteria and were included in the review. Eight of the 23 studies (34.8%) used a modified Lemaire technique, seven (30.4%) used a MacIntosh modified by Arnold-Coker, and eight (34.8%) used other techniques to perform LET. A total of 2,125 patients (53% female, 47% male [3 studies did not report sex]) underwent ACLR augmented with LET. The indications along with prevalence were as follows: positive pivot shift test (grade ≥2) (19 of 23, 82.6%), revision ACLR (12 of 23, 52.2%), ligamentous laxity (11 of 23, 47.8%), general sports participation (11 of 23, 47.8%), age less than 25 years (8 of 23, 34.8%), high risk of graft failure (5 of 23, 21.7%), and positive Lachman test (4 of 23, 17.4%).
Conclusions
Pivot shift grade ≥2 was the most common reason orthopaedic surgeons chose to add LET to ACLR, with revision ACLR, patient age <25, and general sports participation following closely behind.
Level of Evidence
Level IV, systematic review of Level I-IV studies.
目的：本研究旨在确定 LET 增强 ACLR 的最常见适应症：采用系统综述和元分析首选报告项目 (PRISMA) 指南对文献进行了系统综述。我们检索了 2000 年至今的 PubMed、EMBASE、Web of Science 和 Cochrane。符合以下标准的研究均被纳入：除 ACLR 外还接受了 LET 的任何年龄段的患者、报告了至少一种 LET 适应症的研究、观察性/研究设计（包括适应症的流行程度）。文章必须以英语撰写，经过同行评审，且源自美国或提供相同方案和程序的国家：初步搜索共发现 463 项研究，其中 23 项符合纳入标准并被纳入审查范围。这 23 项研究中有 8 项（34.8%）使用了改良的 Lemaire 技术，7 项（30.4%）使用了经 Arnold-Coker 改良的 MacIntosh 技术，8 项（34.8%）使用了其他技术进行 LET。共有2125名患者（53%为女性，47%为男性，3项研究未报告性别）接受了前交叉韧带置换术，并使用了LET。适应症及发生率如下：枢轴移位试验阳性（≥2级）（19/23，82.6%）、翻修前交叉韧带置换术（12/23，52.2%）、韧带松弛（11/23，47.8%）、一般运动参与（11/23，47.8%）、年龄小于25岁（8/23，34.8%）、移植物失败风险高（5/23，21.7%）、Lachman试验阳性（4/23，17.4%）：枢轴移位≥2级是矫形外科医生选择在前交叉韧带置换术中添加LET的最常见原因，前交叉韧带置换术翻修、患者年龄、证据等级：I-IV级研究的系统回顾。
{"title":"Lateral Extra-articular Tenodesis Augmentation of Anterior Cruciate Ligament Reconstruction Is Most Commonly Indicated for Pivot Shift of Grade 2 or Greater and for Revision Anterior Cruciate Ligament Reconstruction","authors":"","doi":"10.1016/j.arthro.2024.01.031","DOIUrl":"10.1016/j.arthro.2024.01.031","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine the most common indications for lateral extra-articular tenodesis<span> (LET) augmentation of anterior cruciate ligament reconstruction (ACLR).</span></div></div><div><h3>Methods</h3><div>A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, Embase, Web of Science, and Cochrane Database of Systematic Reviews from 2000 to the present (June 2022). Studies that met the following criteria were included: patients of any age who underwent LET in addition to ACLR, studies reporting at least 1 indication for LET, and observational/randomized controlled trial study designs including prevalence of indications. Publications had to be reported in English and peer reviewed and to have originated in the United States or countries offering identical protocols and procedures.</div></div><div><h3>Results</h3><div>A total of 463 studies were identified from the initial search, 23 of which met inclusion criteria and were included in the review. Eight of the 23 studies (34.8%) used a modified Lemaire technique, seven (30.4%) used a MacIntosh modified by Arnold-Coker, and eight (34.8%) used other techniques to perform LET. A total of 2,125 patients (53% female, 47% male [3 studies did not report sex]) underwent ACLR augmented with LET. The indications along with prevalence were as follows: positive pivot shift test (grade ≥2) (19 of 23, 82.6%), revision ACLR (12 of 23, 52.2%), ligamentous laxity (11 of 23, 47.8%), general sports participation (11 of 23, 47.8%), age less than 25 years (8 of 23, 34.8%), high risk of graft failure (5 of 23, 21.7%), and positive Lachman test (4 of 23, 17.4%).</div></div><div><h3>Conclusions</h3><div>Pivot shift grade ≥2 was the most common reason orthopaedic surgeons chose to add LET to ACLR, with revision ACLR, patient age <25, and general sports participation following closely behind.</div></div><div><h3>Level of Evidence</h3><div>Level IV, systematic review of Level I-IV studies.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2624-2632"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708659","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.02.029
Trends in hip arthroscopy show that labral repair and preservation, capsular repair and preservation, and treatment of femoroacetabular impingement during hip arthroscopy are associated with superior short-term and mid- to longer-term outcomes. Hip arthroscopy, and in particular arthroscopic femoroacetabular impingement correction, is in its infancy compared with many other orthopaedic procedures. As we assimilate knowledge, data, and evidence-based research, it is critical to evaluate surgical trends and how they affect our management of these patients and pathologies. However, it is important to recognize that there is great variability with regards to surgical volume and awareness of impending evidence-based research for relatively newer procedures such as hip arthroscopy. This can lead to delays for incorporating newer evidence-based techniques. The gap is closing, but the time required to close this disparity in management trends between higher-volume/academic surgeons and the orthopaedic community as a whole could be shorter. Whether this delay for adapting evidence-based trends is consistent across the spectrum of orthopaedic surgery or specific to smaller subspecialty areas such as hip arthroscopy is unclear. Regardless, it is essential that those who are performing the larger volume of cases and research must raise our voices, turn up our loudspeakers, and publish, present, and use social media platforms to spread the word of the latest evidence-based trends quickly! It is equally critical for the greater orthopaedic community to listen for the benefit of patients. If all parties collaborate, we can get up to speed in a timelier manner and achieve the best-possible outcomes together.
髋关节镜手术的发展趋势表明，在髋关节镜手术中进行唇缘修复和保留、关节囊修复和保留以及股骨髋臼撞击症（FAI）治疗可获得较好的短期和中长期疗效。与许多其他骨科手术相比，髋关节镜手术，尤其是关节镜股骨髋臼撞击症（FAI）矫正术尚处于起步阶段。在我们吸收知识、数据和循证研究的过程中，评估手术趋势以及它们如何影响我们对这些患者和病理的管理至关重要。然而，我们必须认识到，对于髋关节镜等相对较新的手术，在手术量和对即将开展的循证研究的认识方面存在很大差异。这可能导致较新循证技术的应用出现延误。差距正在缩小，但缩小高手术量/学术外科医生与整个骨科界在管理趋势上的差距所需的时间可能更短。目前还不清楚，在适应循证趋势方面的这种延迟是在整个骨科手术领域都存在，还是针对髋关节镜等较小的亚专科领域。无论如何，从事大量病例和研究的人员必须大声疾呼，打开扩音器，发表、展示并利用社交媒体平台迅速传播最新的循证趋势！同样重要的是，广大骨科社区要倾听患者的利益诉求。如果各方通力合作，我们就能更及时地掌握最新进展，共同取得最佳成果。与其他骨科疾病和手术相比，非关节炎性髋关节疾病和髋关节镜手术仍处于相对初级阶段。在过去的 20 年中，开刀和关节镜髋关节保护外科医生的循证研究成果越来越多。我们最初只专注于在关节镜下进入关节，如果能看到股骨头、髋臼或髋臼唇，我们就会非常兴奋。虽然我们的重点早期转移到了唇囊撕裂的处理和关节囊的处理上，但随着人们对髋关节FAI以及髋关节发育不良概念的进一步理解和传播，髋关节镜手术的格局发生了显著变化。运动医学外科医生开始学习髋关节病理解剖学知识，并开发出创新技术，通过关节镜方法更全面地治疗这些疾病。由于这些创新，开放式髋关节保留/重建外科医生也意识到了在关节镜下处理 FAI 的潜力，而无需对大部分患者进行开放式矫正手术。2000 年代后期及以后，有关髋关节镜的研究开始迅速增加，显示出关节镜治疗这些髋关节疾病的巨大前景。研究评估了髋臼唇修复、髋臼囊修复、FAI 和极轻度发育不良的治疗效果，我们根据这些证据进一步完善了髋关节疾病的适应症和最佳治疗方法（1,2,3,4,5,6,7,8,9,10）。作为一名住院医师，我只做过两例髋关节镜手术，没有任何专业知识或培训来帮助我在实践中实施这些手术。然而，随着年轻外科医生在住院医师和研究员培训期间接触到更多的髋关节镜手术，将其纳入临床实践的外科医生数量有了显著增长。20 多年前，我刚从研究班毕业，在没有任何成功路线图的情况下就开始了髋关节镜手术，相比之下，现在的外科医生必须熟悉有关患者选择和手术技术的越来越多的证据。髋关节镜手术管理中的这些循证变化应反映在过去10-20年的手术趋势中。
{"title":"Editorial Commentary: Trends in Hip Arthroscopy Require Rapid Dissemination From Higher-Volume and Academic Surgeons to the Greater Orthopaedic Community","authors":"","doi":"10.1016/j.arthro.2024.02.029","DOIUrl":"10.1016/j.arthro.2024.02.029","url":null,"abstract":"<div><div>Trends in hip arthroscopy show that labral repair and preservation, capsular repair and preservation, and treatment of femoroacetabular impingement during hip arthroscopy are associated with superior short-term and mid- to longer-term outcomes. Hip arthroscopy, and in particular arthroscopic femoroacetabular impingement correction, is in its infancy compared with many other orthopaedic procedures. As we assimilate knowledge, data, and evidence-based research, it is critical to evaluate surgical trends and how they affect our management of these patients and pathologies. However, it is important to recognize that there is great variability with regards to surgical volume and awareness of impending evidence-based research for relatively newer procedures such as hip arthroscopy. This can lead to delays for incorporating newer evidence-based techniques. The gap is closing, but the time required to close this disparity in management trends between higher-volume/academic surgeons and the orthopaedic community as a whole could be shorter. Whether this delay for adapting evidence-based trends is consistent across the spectrum of orthopaedic surgery or specific to smaller subspecialty areas such as hip arthroscopy is unclear. Regardless, it is essential that those who are performing the larger volume of cases and research must raise our voices, turn up our loudspeakers, and publish, present, and use social media platforms to spread the word of the latest evidence-based trends quickly! It is equally critical for the greater orthopaedic community to listen for the benefit of patients. If all parties collaborate, we can get up to speed in a timelier manner and achieve the best-possible outcomes together.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2572-2574"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051139","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.06.010
Multimodal analgesia in arthroscopic rotator cuff surgery is commonly used for pain control and to reduce opioid consumption in the early postoperative time and the days following. Indeed, the combination of local anesthetic peripheral nerve blocks and systemic or oral analgesics ensures a better outcome than the isolated use of nonsteroidal anti-inflammatory drugs. In particular, intrascalene block has significant advantages in more complex procedures involving the anterior aspect of the shoulder. However, intrascalene block should be discouraged under conditions of respiratory comorbidity such as severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. In such cases, a multimodal approach based on periarticular infiltration analgesia combined with pharmacologic therapies can ensure excellent pain control with limited use of opioids in the immediate postoperative period. When selecting the best therapeutic combination, it is essential to consider factors that can determine the best balance between safety and effectiveness, such as the complexity of the surgical procedure, preoperative pain, and any comorbidities that could contraindicate the use of certain medications or that could be negatively affected by potential complications or side effects of the analgesic therapy.
{"title":"Editorial Commentary: Multimodal Analgesia for Rotator Cuff Repair Should Be Individualized Based on Surgical Location and Complexity and Patient Comorbidity","authors":"","doi":"10.1016/j.arthro.2024.06.010","DOIUrl":"10.1016/j.arthro.2024.06.010","url":null,"abstract":"<div><div>Multimodal analgesia in arthroscopic rotator cuff surgery is commonly used for pain control and to reduce opioid consumption in the early postoperative time and the days following. Indeed, the combination of local anesthetic peripheral nerve blocks and systemic or oral analgesics ensures a better outcome than the isolated use of nonsteroidal anti-inflammatory drugs. In particular, intrascalene block has significant advantages in more complex procedures involving the anterior aspect of the shoulder. However, intrascalene block should be discouraged under conditions of respiratory comorbidity such as severe chronic obstructive pulmonary disease, obstructive sleep apnea, and morbid obesity. In such cases, a multimodal approach based on periarticular infiltration analgesia combined with pharmacologic therapies can ensure excellent pain control with limited use of opioids in the immediate postoperative period. When selecting the best therapeutic combination, it is essential to consider factors that can determine the best balance between safety and effectiveness, such as the complexity of the surgical procedure, preoperative pain, and any comorbidities that could contraindicate the use of certain medications or that could be negatively affected by potential complications or side effects of the analgesic therapy.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2540-2542"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428327","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.06.034
{"title":"Author Reply to “Classification Applicability to Special Injuries Such as Oblique Radial Tears, Ramp Lesions, and Posterior-Medial Tibial Rim Fractures”","authors":"","doi":"10.1016/j.arthro.2024.06.034","DOIUrl":"10.1016/j.arthro.2024.06.034","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2526-2527"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478007","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.06.033
{"title":"Classification Applicability to Special Injuries Such as Oblique Radial Tears, Ramp Lesions, and Posterior-Medial Tibial Rim Fractures","authors":"","doi":"10.1016/j.arthro.2024.06.033","DOIUrl":"10.1016/j.arthro.2024.06.033","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Page 2525"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141494388","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 : 2024-09-28DOI: 10.1016/j.arthro.2024.09.045
Robert Z Tashjian
Limited data have been previously published on the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) after the treatment of shoulder instability. The MCID and PASS are useful in understanding how well one treatment performs against another and whether the differences in outcomes between treatments are clinically important to patients, supporting either treatment, performing power calculations for clinical studies and trials, and making an assessment as to whether a patient's final clinical state after treatment is reasonable. Anchor-based and distribution methods of MCID calculation have been performed for a variety of patient-reported outcome measures after the treatment of shoulder instability. In general, there is a high degree of variability in the MCID and PASS metrics reported in a relatively limited number of studies. Because of the importance of these metrics in interpreting clinical data, an emphasis should be placed on improved research to further define these metrics, along with others including substantial clinical benefit and maximal outcome improvement, for a variety of different shoulder instability pathologies as well as treatments. Nevertheless, the initial set of MCID and PASS metrics published provides a solid foundation for interpreting patient-reported outcome measures in the treatment of shoulder instability.
{"title":"Editorial Commentary: Shoulder Minimal Clinically Important Difference and Patient Acceptable Symptomatic State Metrics Provide a Foundation for Interpreting Patient-Reported Outcomes.","authors":"Robert Z Tashjian","doi":"10.1016/j.arthro.2024.09.045","DOIUrl":"10.1016/j.arthro.2024.09.045","url":null,"abstract":"<p><p>Limited data have been previously published on the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) after the treatment of shoulder instability. The MCID and PASS are useful in understanding how well one treatment performs against another and whether the differences in outcomes between treatments are clinically important to patients, supporting either treatment, performing power calculations for clinical studies and trials, and making an assessment as to whether a patient's final clinical state after treatment is reasonable. Anchor-based and distribution methods of MCID calculation have been performed for a variety of patient-reported outcome measures after the treatment of shoulder instability. In general, there is a high degree of variability in the MCID and PASS metrics reported in a relatively limited number of studies. Because of the importance of these metrics in interpreting clinical data, an emphasis should be placed on improved research to further define these metrics, along with others including substantial clinical benefit and maximal outcome improvement, for a variety of different shoulder instability pathologies as well as treatments. Nevertheless, the initial set of MCID and PASS metrics published provides a solid foundation for interpreting patient-reported outcome measures in the treatment of shoulder instability.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333009","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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