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

Purpose: This study was performed to determine if at least one corticosteroid injection (CSI) within 8-weeks prior to Anterior Cruciate Ligament Reconstruction (ACL-R) increases the incidence of postoperative infection.

Methods: A large globally federated research database (TriNetX) containing over 200 million patient records was retrospectively queried for patients undergoing ACL-R between October 1st, 2010, and January 1st, 2024 using diagnosis and procedure codes. A cohort of patients receiving CSI up to 8-weeks prior to ACL-R were compared to a cohort of patients who did not receive a CSI prior to ACL-R. One-to-one Propensity score matching was performed based on preoperative characteristics and comorbid diagnoses. Outcomes examined were incidence of post-operative infection at 90 days and 180 days. Post-operative infection was defined as a formal infection diagnosis or need for a washout surgery. Comparisons were performed using Pearson Chi-squared tests.

Results: After matching, 2,439 patients were analyzed in each cohort with matched preoperative characteristics and comorbid diagnoses. Patients receiving a CSI in the 8 weeks prior to ACL-R had a 90-day infection rate of 1.2% (30/2,439) compared to a control group infection rate of 0.6% (14/2,439) represented as an odds ratio of 2.1 (95% CI 1.1-4.0, P=0.015). After 180 days the infection rates grew to 1.3% (33/2,439) for patients receiving CSI and 0.6% (15/2,439) for the control group with an odds ratio of 2.2 (95% CI 1.2-4.1, P=0.009).

Conclusions: Corticosteroid injections given within 8 weeks of ACL-Reconstruction approximately doubles the incidence of postoperative infection.

Level of evidence: III - Retrospective Cohort Study.

Purpose: To evaluate clinical outcomes of hip arthroscopy for patients with global acetabular overcoverage as defined by a lateral center-edge angle (LCEA) >40° with coxa profunda, acetabular protrusio, and/or a negative Tönnis angle.

Methods: A search following guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-analyses was performed in the PubMed, Embase, and Scopus databases in July 2024. Studies were included if they had a minimum two-year follow-up and reported on outcomes of hip arthroscopy for patients with global acetabular overcoverage which was defined as a LCEA >40° with coxa profunda, acetabular protrusio, and/or a negative Tönnis angle. The primary evaluated outcomes included patient-reported outcomes (PROs) and rates of revision and conversion to total hip arthroplasty (THA).

Results: Eight studies comprising 369 hips (58.5% female; age range, 31.2-42.4 years; follow-up range, 24.0-73.2 months) with global acetabular overcoverage treated with arthroscopy were included. For labral management, 0-30% of patients underwent debridement, 65-100% underwent repair, and 0-100% underwent reconstruction. Femoroplasty and acetabuloplasty were performed in 73.3-100% and 94.7-100% of patients, respectively. Six studies reporting both preoperative and postoperative PROs reported significant improvements in all PROs. Rates of revision and conversion to THA ranged from 1.5-27.3% and 1.8-13.6%, respectively. Of studies comparing outcomes between patients with global overcoverage versus normal coverage, there were no significant differences in any PROs (4/5 studies), revision rates (5/5 studies), and conversion to THA rates (3/5 studies).

Conclusions: Hip arthroscopy for global acetabular overcoverage can allow patients to achieve significant improvements in PROs along with low to moderate rates of revision and conversion to THA that are comparable to patients with normal acetabular coverage.

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

Predicting anterior cruciate ligament reconstruction (ACLR) failure remains a challenge, shaped by anatomical, biomechanical, surgical, and rehabilitation factors. The lateral femoral notch sign (LFNS), present in 6-52% of ACL injuries, is linked to lateral meniscal tears (40-67%), steeper posterior tibial slope (PTS, 2.7° higher), and cartilage degradation. However, despite its correlation with injury severity, LFNS has limited value in predicting ACL graft failure or postoperative instability. Recent studies reinforce that LFNS is a marker of past pivot trauma, not a predictor of future ACL failure. While deeper LFNS (>2mm) correlates with more severe initial injury, it does not influence long-term graft survival or knee stability. Research shows that LFNS resolves over time in pediatric patients, fails to correlate with residual tibial laxity or rotational instability, and is associated with non-progressive chondral lesions. In contrast, modifiable factors-such as achieving optimal tunnel positioning and effectively managing rotational instability-play a far more decisive role in determining ACL reconstruction success than static imaging markers like LFNS. Ultimately, LFNS is a historical remnant, not a clinical decision-making tool in ACL failure risk assessment. It reminds us that successful outcomes hinge on a comprehensive approach rather than isolated imaging findings. Such imaging signs show scars of battles lost but often don't predict the outcome of the war.

Visualization during hip arthroscopy can be challenging, particularly due to a bloody arthroscopic image. Tranaxemic acid is not effective in improving arthroscopic visualization, but techniques such as epinephrine-impregnated irrigation fluid; controlled hypotensive anesthesia; and safely establishing a second outflow portal and using radiofrequency to control capsular bleeding are effective.

Many artificial intelligence (AI) machine learning (ML) papers focused on clinical outcomes use registry data inadequate for predictive modeling. In contrast, diagnostic imaging is an area where available information (pixels, etc.) can result in a reliable, clinically relevant, and accurate model. The use of deep learning for image analysis can reduce interobserver variability, and highlight subtle and meaningful features. AI augments, rather than replaces, clinical expertise, allowing faster, more consistent, and potentially more accurate diagnostic information. This is especially relevant when imaging data is abundant, as continuous model training can further refine diagnostic precision. An effective 3-step approach includes: 1) an efficient "detector" to determine where to look; 2) computational ability to focus on key features of the image and "blur out" background noise ("attention module"); and 3) interpreted key features ("explainability"). Next, the larger process of developing and employing a predictive model needs to be externally validated, to determine the extent to which these results will generalize outside of a single institution. Outside this setting, i.e., external validity, needs to be determined.

The ideal rotator cuff repair construct has low tension, maximizes footprint coverage, is biomechanically strong, and optimizes tendon-to-bone healing. However, these principles are not always feasible, especially with larger tear patterns and poor tendon quality, factors which are also associated with higher retear rates. There is a constant effort with often opposing priorities to achieve a tension free rotator cuff repair while also achieving maximal footprint coverage. This is not always possible and there is little data to guide surgeons on which factor - tension free repair or footprint coverage - should be prioritized. Recent studies have reported that achieving a tension free repair with incomplete medial to lateral footprint coverage leads to similar functional and radiographic outcomes as compared to complete footprint coverage using a trans-osseous equivalent repair with bone marrow stimulation.

Routine capsular closure following hip arthroscopy remains controversial. The hip capsule is important for hip stability, but this can sometimes heal after a small periportal or intraportal capsulotomy without closure. While reliable healing of intraportal capsulotomies can be achieved with capsular closure, multiple systematic reviews show improved outcomes and less revision surgery after capsular closure. In my practice, I do an interportal capsulotomy in all patients, and I close or plicate the capsule.

Purpose: The purpose of this systematic review was to evaluate the effect of pelvic tilt on hip joint contact forces and range of motion in patients with femoroacetabular impingement (FAI) and acetabular dysplasia.

Methods: A literature review querying the U.S. National Library of Medicine (PubMed/MEDLINE), EMBASE, SCOPUS, and Cochrane Databases using the key words ("Femoroacetabular Impingement" OR "Hip Dysplasia") AND ((((("Pelvic Tilt") OR (Joint Contact) OR (Kinetics) OR ("Pelvic Incidence") OR (Lumbar Lordosis)))). 14 studies were included in the review with methodological quality evaluated through the Methodological Index for Non-Randomized Studies (MINORS) and Risk of Bias in Non-Randomized Studies - of Interventions (ROBINS-I) criteria.

Results: There were 474 total patients (577 hips) in the 14 studies reviewed. Two studies focused on hip joint contact forces and femoral head coverage in acetabular dysplasia. These found posterior pelvic tilt was associated with decreased hip joint contact area (Range: 490-581mm² vs. 919-1094mm²) , increased joint contact pressure (Range: 3.9-7.3mPa vs. 1.8-3,5mPa), and decreased femoral head coverage (Range: 30.2-43.4% vs. 38.9-50.3%) in dysplastic subjects compared to control populations. 12 studies evaluated range of hip motion in FAI populations undergoing different functional maneuvers. Posterior pelvic tilt in FAI patients was found to increase hip range of motion to impingement on supine testing and biomechanical modeling (Internal rotation in flexion range: -6.5°-15.5° with anterior tilt, 12.9-31.4 with posterior tilt). With dynamic maneuvers FAI patients had decreased pelvic mobility (Range: 7.2°-14.7° vs. 12.7°-24.2°) and decreased posterior pelvic tilt (Range: 3.4°-15.9° vs. 9.8°-21.1°) compared to patients without FAI.

Conclusions: Hip joint stress is increased with posterior pelvic tilt in dysplastic patients, while increasing posterior pelvic tilt increases hip range of motion to impingement in patients with FAI. During weightbearing exercises, the ability for FAI patients to posteriorly tilt the pelvis is restricted compared to a control population.

Clinical relevance: Spinopelvic kinematics and alignment affect composite hip motion and play a critical role in bipedal locomotion. The influence of spinopelvic parameters on treatment outcomes for acetabular dysplasia and FAI is controversial and currently limited by an imperfect understanding of the hip-spine relationship as it related to non-arthritic hip disease. The present systematic review provides a summary of the results of biomechanical studies investigating pelvic tilt in this population.

Purpose: To investigate whether 2 months postoperative intra-articular corticosteroid injection after arthroscopic rotator cuff repair (ARCR) in rotator cuff tear (RCT) patients with stiffness would improve the functional scores and range of motion (ROM) of the operated shoulder without capsular release during ARCR.

Methods: From March 2020 to September 2021, a total of 73 patients who had RCT with stiffness and were scheduled for ARCR were enrolled prospectively and randomly allocated into 2 groups. The patients who underwent ARCR with capsular release were allocated to group 1 (n = 37). The patients who underwent ARCR without capsular release and were injected with 1mL triamcinolone acetate (40mg/1cc) into the glenohumeral joint 2 months after surgery were allocated to group 2 (n = 36). Functional scores and shoulder ROM were evaluated before surgery; 3, 6, and 12 months after surgery; and at the last follow-up. Magnetic resonance imaging was performed at 12 months postoperatively.

Results: The mean follow-up period was 26.5 months. The functional and VAS pain scores in both groups were significantly improved at the last follow-up (P < .001). The 3-month postoperative VAS pain score of group 2 was significantly lower than that of group 1 (group 1; 3.4 ± 1.5, group 2; 2.1 ± 1.0, P <.001). VAS pain scores at 6 months or 12 months or at the last follow-up and functional scores and ROM at 3, 6, or 12 months or at the last follow-up were not significantly different between the 2 groups (P > .05). The retear rate of repaired rotator cuff during follow-up was not significantly different between the 2 groups (P = 0.71).

Conclusion: Corticosteroid injection in the glenohumeral joint performed 2 months after ARCR in RCT patients with stiffness is as effective as capsular release during ARCR for improving clinical outcome of the operated shoulder.

Level of evidence: Level I, prospective randomized clinical trial.