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

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.

Purpose: To identify factors that affect delayed gap healing after open-wedge high tibial osteotomy (OWHTO) and to determine whether large gap volume is a predictor of delayed gap healing.

Methods: This retrospective study analyzed biplane OWHTO performed between 2019 and 2023 for knee osteoarthritis or osteonecrosis. The minimum follow-up period was 1 year. Delayed gap healing was defined when the medial half of the osteotomy gap area had not reached the consolidation phase by 6 months after surgery based on anteroposterior knee radiographs. Gap volume was calculated from computed tomography images. Logistic regression was performed using body height, smoking, correction angle, hinge fracture, flange thickness, and gap volume. A gap volume cutoff value for delayed gap healing was determined with receiver operating characteristic curve analysis. Gap volume was predicted with multiple linear regression.

Results: There were 80 knees in 71 patients (36 men and 44 women). The mean gap volume was 7.6 cm³. Gap healing rates at 3, 6, 9, and 12 months after surgery were 26%, 65%, 89%, and 100%, respectively. There were 25 knees with delayed gap healing. Male sex was not a significant risk factor when adjusted for body height. Multivariate logistic regression revealed that only larger gap volume was a significant risk factor (odds ratio, 1.45; P = .006). The gap volume cutoff value was 7.6 cm³, with an area under the curve of 0.74. Tall body height and a large correction angle (both P < .001) were associated with a significantly larger gap volume (R² = 0.73).

Conclusions: Large gap volume is the most important risk factor for delayed gap healing after OWHTO. Gap volume can be predicted based on body height and correction angle. When OWHTO with substantial correction is planned for tall men, surgeons should be aware of possibly delayed gap healing.

Level of evidence: Level IV, retrospective case-control study.

Purpose: The purpose of this study is to develop machine learning models using the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) database to predict prolonged operative time (POT) for rotator cuff repair (RCR). Furthermore, this study aims to use the trained machine learning (ML) models, cross-referenced with traditional multivariate logistic regression (MLR), to determine the key perioperative variables that may predict POT for RCR.

Methods: Data were obtained from a large, national database (NSQIP) from 2021. Patients with unilateral RCR procedures were included. Demographic, preoperative, and operative variables were analyzed. A multivariable logistic regression (MLR) model and various other machine learning techniques, including random forest (RF) and artificial neural network (ANN), were compared using area under the curve (AUC), calibration, Brier score, and decision curve analysis. Feature importance was identified from the overall best-performing model.

Results: A total of 6,690 patients met inclusion criteria. The random forest (RF) ML model had the highest AUC upon internal validation (0.706) and the lowest Brier score (0.15), outperforming the other models. The RF model also demonstrated strong performance upon assessment of the calibration curves (Slope = 0.86, Intercept = 0.08) and decision curve analysis. The model identified concomitant procedure, specifically labral repair and biceps tenodesis, as the most important variable for determining POT, followed by age <30 years, Black or African American race, male sex, and general anesthesia.

Conclusions: Despite the advanced machine learning models used in this study, the NSQIP dataset was only able to fairly predict POT following RCR. The RF model identified concomitant procedures, specifically labral repair and biceps tenodesis, as the most important variables for determining POT. Additionally, demographic factors such as age <30 years, Black race, and general anesthesia were significant predictors. While male sex was identified as important in the RF model, the MLR model indicated that its predictive value is primarily in conjunction with specific procedures like biceps tenodesis and subacromial decompression.

Purpose: To explore differences in cam morphology defined by alpha angle (AA) and anterior femoral neck offset (AFNO) in the context of other anthropometric parameters in an osteologic collection to further elucidate whether each measurement tool is identifying the same underlying pathology.

Methods: Anthropometric measurements of 992 cadaveric hips from the Hamann-Todd Osteological Collection were analyzed. Femurs with cam morphology were identified by AA >55° or AFNO <7 mm. Anthropometric parameters stratified by cam morphology were assessed with Wilcoxon rank-sum and Pearson χ² tests. Multivariate logistic regressions were performed on significant variables in univariate analysis to examine the predictive ability of anthropometric variables to cam morphology.

Results: Cam morphology was identified in 242 hips via AA, 344 hips via AFNO, and 123 hips via both measures. Multivariate logarithmic regression analysis demonstrated that sex negatively predicted AA (females with less pathology, β = -0.14, P = .04), race negatively predicted AA (Blacks with less pathology, β = -0.21, P < .01), and proximal femoral osteoarthritis was positively associated with AA (β = 0.16, P = .02), while none of these were associated with AFNO. On the other hand, right-side specimens were associated with AA (β = 0.15, P = .02) and AFNO (β = 0.25, P < .01), whereas the combined version was unassociated with both measures.

Conclusions: In conclusion, cam morphology was identified in a modest percentage of osteologic specimens by both AA and AFNO in our study. Further, associations of multiple demographic, anthropometric, and anatomical parameters to AA and AFNO suggest they may identify different subsets of cam morphology.

Clinical relevance: Cam morphology identified by AA versus AFNO may represent 2 different pathologic entities. Future studies should assess differences between these measures in a clinical cohort and determine whether these 2 definitions of cam morphology identify different clinical populations.

Purpose: To investigate serial changes in postoperative alignment over 5 years after open-wedge high tibial osteotomy (OWHTO) and to identify risk factors associated with alterations in the postoperative weightbearing line (WBL) ratio.

Methods: Patients who underwent OWHTO during 2011-2017 were retrospectively reviewed. The inclusion criteria were (1) follow-up duration ≥5 years and (2) serial postoperative longstanding hip-to-ankle radiographs to evaluate alignment alterations. The WBL ratio was measured preoperatively and at 3 months, 6 months, 1 year, and 5 years postoperatively to evaluate serial changes. Alterations in the WBL ratio were analyzed using a linear mixed model, considering potential risk factors including International Cartilage Repair Society grades of each compartment and medial meniscus extrusion (≥3 mm). Clinical outcomes were assessed using the Knee Society objective and functional scores, and the correlations between clinical outcomes and alignment alteration were examined.

Results: A total of 78 knees were investigated. During the study period, the overall WBL ratio decreased by 5.5% ± 7.2%, signifying varus shifting, from 58.6% ± 11.5% at 3 months postsurgery to 51.5% ± 12.7% at 5 years postsurgery. Based on univariate regression analyses, International Cartilage Repair Society grades of the medial compartment and medial meniscus extrusion were included in a linear mixed model regarding alignment alteration. The model identified medial meniscus extrusion as a significant risk factor after adjusting for time (P < .001). Medial meniscus extrusion also had a significant interaction with time (P < .001), indicating greater alignment alteration in cases of medial meniscus extrusion. The extrusion was noted in 68 of 78 knees.

Conclusions: In the midterm following OWHTO, the overall alignment had a tendency toward varus shifting. A linear mixed model found that preoperative medial meniscus extrusion on magnetic resonance imaging is associated with the tendency.

Level of evidence: Level III, retrospective cohort study.

Purpose: The purpose of this study was to analyze whether unique SCR with key-hole technique using Achilles allograft can improve pseudoparalysis in patients with irreparable rotator cuff tears and additionally to identify preoperative factors that influence clinical outcomes.

Methods: Between January 2018 and October 2021, patient data from SCR with our institution's unique key-hole technique using Achilles were retrospectively collected (minimum 2-years follow up). The patients were categorized into pseudoparalysis group (P group) and no pseudoparalysis group (NP group). Active range of motion (ROM) of shoulder, clinical scores (constant and pain visual analog scale scores) and muscle strength was assessed preoperatively and at 2-years postoperatively. And the correlation between preoperative and postoperative clinical data was analyzed through simple linear regression in the P group.

Results: 69 patients who underwent SCR with key-hole technique using Achilles, were included in the study. Group P and NP had 24 and 45 cases, respectively. Preoperative ROM (FE, ER), constant score and muscle strength (FE, ER) were significantly lower in P group than NP group. At 2-year follow-up the active ROM (FE, p<0.001, ER, p<0.001), constant score, VAS, muscle strength (FE, p<0.001, ER, p<0.001) were improved in the P group. In P group, pseudoparalysis recovered in 21 out of 24 patients (87.5%) at 2-year after surgery. The minimum clinically important difference of patient reported outcomes (Constant Score / VAS) were 8.15/1.05 for the P group and 9.47/0.92 for the NP group. Among the 3 cases of recovery failed, 2 cases were due to graft failure, and 1 case had delayed recovery. Prolonged preoperative pseudoparalysis and weaker preoperative external rotation strength were associated with worse clinical outcomes.

Conclusions: Superior capsular reconstruction with mini open key-hole technique using Achilles allograft demonstrates favorable outcomes for patients with preoperative pseudoparalysis. However, for SCR with the pseudoparalyis patients the careful attention is needed because the longer pseudoparalysis duration and the weaker external rotation strength could have the tendency of worse postoperative outcomes.

Purpose: To compare the postoperative side-to-side laxity and short-term clinical outcomes of patients who received primary anterior cruciate ligament (ACL) repair with suture tape augmentation, acute anterior cruciate ligament reconstruction (ACLR) with suture tape augmentation performed within 8 weeks of injury (ACLR_acute), or ACLR beyond 8 weeks of injury.

Methods: After institutional review board approval was obtained, 100 patients were enrolled in this prospective trial: 34 primary ACL repair with suture tape augmentation, 33 ACLRs performed within 8 weeks of injury (ACLR_acute), and 33 ACLRs. Patients were allocated to ACL repair if a proximal avulsion was present with good tissue quality (Sherman type 1), confirmed by intraoperative diagnostic arthroscopy. Preoperative side-to-side anteroposterior knee laxity was assessed with KT-1000 arthrometer, and patient-reported outcomes (PROs) including the visual analog scale, Marx activity scale, Veterans RAND 12-item health survey (VR-12 physical & mental), Single Assessment Numeric Evaluation, Knee Injury and Osteoarthritis Outcome Score survey subscales, and range of motion were collected. These objective and subjective measures were repeated at regular intervals postoperatively through 2 years. Minimal clinically important difference calculations were performed assessing postoperative PRO changes at 2 years compared with preoperative.

Results: The average time from injury to surgery was 5.03 ± 1.2 weeks for the ACL repair group, 5.09 ± 0.74 weeks for the ACLR_acute, and 43.22 ± 33.5 weeks for the ACLR group. Postoperatively, the KT-1000 side-to-side laxity difference for 30 lbs was determined to be 0.1 ± 0.37 (95% confidence interval [CI] -0.7 to 0.8) for ACL repair versus ACLR (P < .0001), -0.8 ± 0.35 (95% CI -1.5 to -0.1) for ACLR_acute versus ACLR (P < .0001), and 0.8 ± 0.40 (95% CI 0.0-1.6) for ACL repair versus ACLR_acute (P < .0001). The data reveal ACL repair and ACLR_acute are noninferior to ACLR at 2-year follow-up. The postoperative difference from baseline for all PROs demonstrated improvement for all PROs. Magnetic resonance imaging at 1 year revealed tissue healing for the 3 ACL injury treatment groups.

Conclusions: Patients who underwent ACL repair of proximal tears with suture tape augmentation or ACL reconstruction within 8 weeks from injury resulted in noninferior side-to-side knee laxity, comparable PROs, and similar range of motion at 2-year follow-up compared with ACLR.

Level of evidence: Level II, prospective comparative study.