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

Purpose: To evaluate whether capsule repair after hip arthroscopy with interportal capsulotomy influences 2-year postoperative clinical outcomes.

Methods: A systematic review and meta-analysis of randomized controlled trials comparing outcomes of interportal capsulotomy with and without hip capsule repair in femoroacetabular impingement patients was conducted. The outcomes included modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport Specific Subscale, Numerical Rating Scale pain score, Copenhagen Hip and Groin Outcome Score, 12-item International Hip Outcome Tool, Veterans RAND 12-Item Health Survey, and revision rate. Studies with significant differences in preoperative scores between the repair and no repair groups were excluded from the meta-analysis.

Results: After the removal of duplicates, 966 studies remained. 56 studies met inclusion criteria. Three randomized controlled trials comprising 256 hips met criteria and were included finally after exclusion. Among these, 127 hips underwent capsule repair and 129 did not. The meta-analysis showed that the outcome measures including modified Harris Hip Score (mean difference = 0.98; 95 confidence interval [-2.77, 4.74]; I² = 0%; P = .61) and revision rate (mean difference = 0.98; 95% confidence interval [-2.77, 4.74]; I² = 0%; P = .61) did not significantly differ between the groups. One study reported the proportion of patients that met minimal clinically important difference and patient acceptable symptom state for modified Harris Hip Score. One study reported the proportion of patients met patient acceptable symptom state for Hip Outcome Score-Activities of Daily Living and 12-Item International Hip Outcome Tool.

Conclusions: When interportal capsulotomy was applied in hip arthroscopy, capsular repair did not show consistent superiority over nonrepair in femoroacetabular impingement patients at 2-year follow-up. No significant differences were observed in the modified Harris Hip Score and revision rates. Routine capsular closure cannot be universally recommended for interportal capsulotomy.

Level of evidence: Level II, systematic review and meta-analysis of Level I and II studies.

Hip arthroscopy femoroacetabular impingement syndrome continues to evolve, changing trends and constant pendulum swinging. While hip arthroscopy initially was performed with a capsulectomy, fastidious capsular management has became the norm over the last decade. Recently, the utility of routine capsular closure has again been called into question, with several studies finding minimal differences between repaired and unrepaired cohorts. Like most controversies in orthopaedics, the answer is likely nuanced, and a one-size-fits-all approach should be spurned in favor of patient-specific and capsulotomy technique-specific considerations. However, while capsule repair may not be required in every patient, the downside of closure is minimal and our understanding of the hip imperfect. Select patients that receive interporal capsulotomies may do well with an unrepaired capsule, but a high degree of caution should be used if considering this.

Purpose: To evaluate risk for revision anterior cruciate ligament reconstruction (ACLR) in patients undergoing primary ACLR using hamstring autograft (HS), bone-patellar tendon-bone autograft (BPTB), quadriceps tendon autograft (QT), or allograft with independent femoral tunnel drilling at a single institution over 10 years.

Methods: Patients undergoing primary ACLR from 2012 to 2023 were identified from a prospectively collected institutional registry. All patients underwent ACLR utilizing independent tunnel drilling without extra-articular stabilization. Revision ACLR was the primary outcome. Patient demographic factors, graft type and graft diameter (GD) were recorded. Survival analysis with multivariable cox proportional hazards regression was performed to assess predictors of failure, adjusting for age, sex, body mass index, and graft size.

Results: One thousand seven hundred thirty-one ACLR with minimum 2-year follow-up (mean 5.5 ± 3.3 years) were included: 1143 HS (mean GD 8.4 mm, patient age 29.3), 109 BPTB (mean GD 8.9 mm, patient age 23.0), 68 QT (mean GD 9.1 mm, patient age 18.0), and 411 allograft (mean GD 8.9 mm, patient age 41.8). Unadjusted revision ACLR rates and Kaplan-Meier survival analysis showed no significant differences between graft types-hamstring (3.3%), BPTB (1.8%), QT (5.9%), and allografts (3.6% failure), (P = .536). In multivariable Cox regression analysis, allograft use was associated with a significantly higher risk of revision compared to HS (HR 2.47, P = .027), while BPTB and QT were not significantly different compared to HS. Male sex (HR 2.68, P = .002), underweight BMI (HR 4.81, P = .025), and younger age (HR .95 per year increased age, P = .005) were independently associated with higher revision risk.

Conclusions: ACLR with HS over 8 mm in diameter utilizing independent femoral tunnel drilling and proper indications with respect to patient age may yield low failure risk. Younger patient age, male sex, underweight BMI, and use of allograft increased risk for revision ACLR.

Level of evidence: Level III, retrospective comparative case series.

Purpose: To evaluate magnetic resonance imaging (MRI) findings after nonoperatively treated anterior cruciate ligament (ACL) injuries and to assess objective knee stability using KT-1000/2000 arthrometer readings.

Methods: A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of Cochrane, Embase, Scopus, and Medline identified studies assessing ACL healing in nonoperative patients using MRI, arthrometer (KT-1000/2000), or arthroscopic evaluation. Inclusion criteria were: (1) studies that evaluated patients with ACL tears treated nonoperatively, (2) studies that used MRI to assess ACL healing, and (3) human studies published in English. Exclusion criteria were: (1) studies that did not use objective measures to assess ACL healing in nonoperative patients, (2) cadaveric studies, and (3) case reports and conference abstracts. Data extraction included demographics, treatment approaches, imaging findings, arthrometer and arthroscopic results, and patient-reported outcome measures.

Results: Seven studies with 351 patients (mean age: 30.1 years) met inclusion criteria. The studies had a mean follow-up time of 11.3 months (range: 6-30 months). MRI showed ACL fiber continuity in 85.6% (95% confidence interval: 84.5-86.6; standard deviation: 9.7; range: 70-100) of patients at follow-up. However, this did not correlate with clinical findings as arthrometer (KT-1000/2000) readings only revealed ACL stability in 54.7% (95% confidence interval: 53.4-55.9; standard deviation: 24.1; range: 2-85.7) of cases. Patient-reported outcomes showed a relatively good return of knee function, but 21.9% (standard deviation: 3.2; range: 14.3-25.8) of patients eventually underwent delayed anterior cruciate ligament repair. Additionally, 7.1% (standard deviation: 2.9; range: 5.9-14.3) of nonoperative patients experienced a reinjury.

Conclusions: Although MRI may show continuity of ACL fibers with nonoperative treatment protocols, KT-1000/2000 findings suggest that joint laxity persists.

Level of evidence: Level IV, systematic review of Level II to IV studies.

Purpose: To use publicly available injured list (IL) data to 1) describe Major League Baseball injury trends from 2010 to 2024; 2) analyze injury types and body regions affected to report the highest impact injuries; and 3) report the financial implications of time lost due to injury over this 15-year period.

Methods: IL data for every Major League Baseball player (pitchers and position players) from the 2010 to 2024 regular seasons were collected using publicly available sources, including player demographics, IL placements, body part injured, and length of each IL stay. Player salaries were compiled to determine the "financial loss" per injury.

Results: Across 15 seasons, 8078 players were placed on the IL, totaling 478,085 days. The mean IL placements/year was 634, and the annual number increased by an additional 27 injuries/year (P < .001). Mean total IL days/season was 31,872, and this increased year-over-year (P = .008). Shoulder injuries represented the most IL placements (n = 1555), followed by elbow (n = 1344) and upper leg (n = 769). Elbow injuries averaged the most days missed/IL placement (mean: 93, median: 74) and the greatest total days missed (129,610), followed by shoulder (95,189). Pitchers comprised 55% of IL placements and most commonly injured their shoulder or elbow. Infielders and outfielders accounted for 21% and 16% of IL placements, respectively. A total financial loss of $9,636,753,291 was accumulated over 15 seasons. Financial loss increased season-to-season (+$32,309,178/year, P = .002). Elbow injuries accounted for the highest financial loss at $1,932,048,168 ($1,379,049 lost/injury). In 2024, $2,220,432 was lost/elbow injury, $1,110,573/shoulder injury, $1,397,322/any injury, and $952,973,760 total for the season.

Conclusions: This study observed that the number of players, IL placements, days spent on the IL, and financial loss due to injury increased steadily each year. Pitchers were the most frequently injured players with shoulder and elbow injuries being most common. Over the 15-season study period, there was a total financial loss of nearly $9.7 billion due to salary paid to injured players, with elbow injuries contributing the highest loss at just under $2 billion.

Clinical relevance: Injury trends and financial data from Major League Baseball highlight the growing burden of shoulder and elbow injuries, particularly in pitchers. These findings underscore the need for orthopaedic surgeons to focus on prevention, early intervention, and optimized surgical management of high-impact injuries to reduce long-term morbidity and associated financial costs at the elite level.

Purpose: To evaluate the effects of tranexamic acid (TXA) on postoperative blood loss, operation time, pain control, and complications in arthroscopic rotator cuff repair and to investigate its impact on intraoperative visualization clarity, hemoglobin, and mean arterial pressure.

Methods: Randomized controlled trials up to February 2025 were comprehensively searched in databases such as PubMed, Embase, and the Cochrane Library. Literature was screened according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. The quality of included studies was assessed using the Cochrane Risk of Bias Tool. Meta-analysis of postoperative blood loss, operation time, Visual Analog Scale for pain, and complication rates was conducted using RevMan 5.4 software.

Results: A total of 9 randomized controlled trials (691 patients) were included. The results showed that compared with the control group, the TXA group significantly reduced surgical blood loss (mean difference = -6.40 mL, 95% confidence interval (CI): -12.44 to -0.36, P = .04, I² = 62%), shortened operation time (mean difference = -8.60 min, 95% CI: -12.83 to -4.37, P < .00001, I² = 59%), and decreased Visual Analog Scale pain scores at 24 hours postoperatively (mean difference = -0.65, 95% CI: -0.97 to -0.34, P < .0001, I² = 41%), but the minimal clinically important difference was not reached. There was no statistically significant difference at both 24 and 48 hours. TXA lowered the overall complication rate (odds ratio = 0.23, 95% CI: 0.08 to 0.69, P = .009, I² = 0). However, TXA did not have a significant effect on intraoperative visualization clarity, postoperative hemoglobin levels, or mean arterial pressure.

Conclusions: TXA reduces postoperative bleeding, shortens operation time, alleviates early pain (within 24 hours), where no significant differences were observed at 48 or 72 hours postoperatively, and lowers the incidence of complications in arthroscopic rotator cuff repair, with a favorable safety profile.

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

Purpose: To investigate whether primary anterior cruciate ligament reconstruction (ACLR) in the setting of adult irreducible tibial eminence fracture could achieve comparable clinical outcomes to suture fixation (SF) in reducible cases.

Methods: Patients who were diagnosed with displaced tibial eminence fracture and underwent either ACLR or SF were retrospectively analyzed. The treatment modalities were determined intra-operatively based on the intra-operative evaluation of the osseous and ligamentous status, according to which native ACL preservation by SF was applied in reducible cases and ACLR for irreducible cases. The primary outcome was patient-reported outcome measures at a minimum 2-year follow-up. Secondary outcomes include ipsilateral reinjury at the ACL-injured limb, contralateral injury, range of motion loss, arthrofibrosis, return to sport, and patient satisfaction at the most recent follow-up. Patient-acceptable symptomatic state was determined by the anchor question: "Taking into account your daily activities and functional performance, do you find your current condition satisfactory?".

Results: A total of 31 patients in the ACLR group and 43 patients in the SF group were included. Patients' characteristics were comparable between groups, except for time from injury to surgery (ACLR vs SF: mean [range], 11.8 [0.1, 84.0] months vs 1.2 [0.0, 12.0] months, P < .001) and lateral meniscal injury (ACLR vs SF: 45.2% vs 16.3%, P = .023). The mean follow-up was 77 months. Univariate comparison revealed no significant intergroup difference for the primary and secondary outcomes (all P > .05). Multivariable linear regressions revealed no significant association between treatment modalities and clinical outcomes in terms of the Tegner, Lysholm, and International Knee Documentation Committee scores (all P > .05). Subgroup analyses based on fracture types and sex also suggested similar results. Multivariable logistic regressions revealed no difference in ipsilateral reinjury, contralateral injury, range of motion loss, arthrofibrosis, return to sport, and patient satisfaction between groups (all P > .05). A total of 63 (85.1%) participants reported achieving patient-acceptable symptomatic state, with no significant difference between the ACLR and SF groups (26/31 vs 37/43, P > .999).

Conclusions: Primary ACLR using hamstring autograft in the setting of adult irreducible tibial eminence fracture achieved clinical outcomes comparable to SF in reducible cases. The percentage of patients reported achieving patient-acceptable symptomatic state was similar between the 2 groups.

Level of evidence: Level III, retrospective comparative case series.

Purpose: To evaluate the minimum 5-year clinical outcomes and return-to-sport (RTS) rates of patients with generalized ligamentous laxity (GLL) who underwent hip arthroscopy with a secondary comparison to a benchmark control group with no GLL.

Methods: We retrospectively analyzed all patients with GLL (Beighton score ≥ 4) who underwent primary hip arthroscopy between November 2009 and January 2019. We included patients who reported preoperative sport participation and had preoperative and minimum 5-year follow-up for at least one patient-reported outcome (PRO) measure: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool-12 (iHOT-12), or Visual Analog Scale (VAS) for pain. Revision hip arthroscopy or conversion to arthroplasty was accounted for. Patients with GLL were matched to patients with a Beighton score of <3. Rates of meeting the minimal clinically important difference (MCID), RTS, and having secondary surgery were analyzed.

Results: Two hundred thirty-two hips were included, with 116 hips in the GLL group (age: 27.3 years, BMI: 23.7 kg/m²) (78.7% follow-up) and 116 in the control group (age: 28.4 years, BMI: 23.6 kg/m²). Patients in the GLL group showed significant improvement in all evaluated PROs (mHHS: 66.1-86.7, NAHS: 67.6-87.0, iHOT-12: 40.1-78.2, HOS-SSS: 45.0-79.7, VAS: 4.9-2.1; P < .01). MCID was met at similarly high rates for both groups (P > .05). Patients with GLL reported a RTS rate of 83% at any time point postoperative, and 74.6% of those that returned were able to continue playing at the 5-year mark. No differences in postoperative PRO scores, RTS, continuation-of-sport participation, and survivorship were found between groups.

Conclusions: Hip arthroscopy in patients with GLL yields favorable outcomes and survivorship at 5-year minimum follow-up comparable to patients without GLL. A high percentage of athletes with GLL were able to RTS and continue playing 5 years after hip arthroscopy.

Level of evidence: Level IV, retrospective comparative case series.

Purpose: To critically evaluate the impact of tranexamic acid (TXA) on hip arthroscopy outcomes, including its effects on bleeding, functional recovery, postoperative pain, complications, intraoperative visualization, and surgical efficiency.

Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Searches were conducted across PubMed, Embase, and Cochrane through March 2025. Inclusion criteria encompassed randomized controlled trials and prospective or retrospective comparative studies evaluating intravenous TXA during hip arthroscopy. Studies were excluded if they lacked original clinical data, involved non-arthroscopic procedures or did not report TXA use. Primary outcomes included blood loss, visual field clarity, operative time, postoperative pain, complications, and functional scores.

Results: Six studies comprising 1034 patients (TXA, 584; control, 450) were analyzed. TXA significantly reduced perioperative bleeding, with postoperative hemoglobin and hematocrit declines consistently smaller in TXA patients compared with controls (P < .01). Intraoperative blood loss was also lower with TXA (0.18 L vs 0.24 L, P = .020). TXA did not consistently improve intraoperative visualization (Likert scores 2.51 to 2.85 vs 2.64 to 2.67, P = .13 to 0.16) or operative time (P > .3). One trial reported lower VAS pain scores at postoperative day 14 (2.3 ± 1.1 vs 3.1 ± 0.7, P < .05), though no long-term functional benefits were observed. A large cohort reported fewer complications with TXA (2.0% vs 6.8%, P < .01), largely driven by reduced lateral femoral cutaneous nerve neuritis (1.8% vs 4.6%, P = 0.02). Given the absence of a plausible mechanism and no difference when neuritis was excluded, this association is likely incidental. No significant differences were observed in thromboembolic events (0.2% vs 0.5%, P = .51), infections (P = .27), or revision rates (P = .68).

Conclusions: TXA use in hip arthroscopy significantly reduces perioperative bleeding without increasing the risk of major complications. It may offer modest short-term pain relief and early functional improvements, but no consistent long-term functional benefits have been showed. TXA does not reliably enhance intraoperative visualization or reduce operative time. The optimal dosing strategy remains uncertain, though continuous infusion may provide superior hemostatic efficacy compared to single bolus administration.

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

Purpose: To determine if preoperative femoral or tibial bone marrow edema (BME) is indicative of higher rates of re-tear and conversion to total knee arthroplasty (TKA) after posterior medial meniscal root tear repair, and, secondarily, whether preoperative BME impacted patient-reported outcome measures and rates of infection and arthrofibrosis.

Methods: Patients that underwent posterior medial meniscal root tear repair between 2013 and 2021 with a 2-year minimum follow-up were retrospectively analyzed. Primary outcome measures included re-tears and TKA conversion. Secondary outcomes included International Knee Documentation Committee (IKDC) score and Lysholm score, infection, and arthrofibrosis. Cohort-specific minimally clinically important difference and Patient Acceptable Symptomatic Scale rates were calculated. Two-tailed t-tests, Wilcoxon rank-sum tests, and Fisher's exact tests were used where appropriate.

Results: The study population consisted of 97 knees (74 without BME [NBME], 23 with BME) with average follow-up of 38.9 months (24-68). Preoperatively, the NBME group had higher IKDC scores (P = .008). Postoperatively, the NBME group had higher IKDC scores at 6 months, 1 year, and 2 years (84.5 [6.0] vs 68.5 [11.0]) (P = .041, <.001, <.001). IKDC minimally clinically important difference rates were not significantly different between groups at all follow-ups. Patient Acceptable Symptomatic Scale rates were higher for the NBME group at 1-year and final follow-up (100.0% vs 60.9%) (P < .001 for both). Lysholm scores were higher for the NBME group at 1-year and final follow-up (84.0 [5.6] vs 74.6 [12.8]) (P = .019 and .008, respectively). Re-tear occurred in 17.4% of the BME group and 0% of the NBME group (P = .003). TKA conversion rates were 21.7% in the BME group and 2.7% in the NBME group (P = .008). There was no difference in arthrofibrosis or infection rates.

Conclusions: Preoperative BME in patients undergoing posterior medial meniscal root tear repair is associated with higher rates of recurrent meniscal root tearing and conversion to TKA in addition to lower subjective IKDC and Lysholm scores compared to patients without preoperative BME.

Level of evidence: Level III, retrospective prognostic case control series.