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

Purpose: To investigate the biomechanical efficacy of the reverse suture anchor (RSA) technique compared with the transtibial pull-out (TP) and suture anchor (SA) techniques using in vitro porcine knee models of PMMRTs.

Methods: 32 fresh frozen porcine tibiae with medial meniscus intact were randomly assigned to four groups (eight specimens each). A standardized posterior medial meniscus root tear (PMMRT) was established in 24 specimens. SA, TP, and RSA techniques were used to repair PMMRTs in 8 specimens respectively, while the native posterior medial meniscus roots (PMMRs) were left intact as a control in eight specimens. Pressure sensitivity, stress, cyclic load and failure load tests were performed. To evaluate differences in group variables, ANOVA was used to compare differences among ≥ three groups and Tukey's test was used to compare data between two groups. Significance level was set at P < .05.

Results: The SA and RSA groups had a wider contact area and higher pressure at the meniscus suture site and attachment area than the TP group (P < .001) while there was no significant difference in pressure sensitivity or stress between SA and RSA (P > .05). The SA, RSA and TP groups had significantly higher displacement during cyclic loading and significantly lower maximum load and stiffness during load-to-failure testing compared with the native PMMR (P < .05). The SA and RSA groups had significantly lower displacement after 100 (0.83 mm and 0.92 mm vs 1.77 mm, P < .01), 500 (1.64 mm and 1.52 mm vs 3.08 mm, P < .01), and 1000 cycles (2.22 mm and 1.91 mm vs 4.53 mm, P < .01) and significantly higher failure load compared with TP (114 N and 119 N vs 77 N, P < .01). No significant difference between SA, RSA and TP was observed for displacement at failure or stiffness (P > .05).

Conclusion: The RSA repair technique has similar biomechanical efficacy to the SA technique. It offers better biomechanical efficacy than the TP technique for PMMRT repair, making it a feasible and effective surgical procedure. The three repair techniques did not reach the strength of the native PMMR.

Clinical relevance: The RSA technique retrogradely implants anchors into the tibial bone tunnels to achieve a fixation effect comparable to that of traditional anchors, with shorter sutures in the bone tunnels and a more operable surgical procedure. The RSA technique not only provides satisfactory biomechanical properties for the repair of PMMRTs, but also greatly reduces the technical difficulty of surgery. However, repairing of PMMRTs still does not restore the strength of the repaired meniscal root to the native meniscus.

We have carefully reviewed the letter to the editor by Kushtrim Grezda and deemed it highly noteworthy. To address the issues stated in the letter to the editor, we agreed to prepare the authors' response.

Robot-assisted surgery (RAS) is a procedure in which a computerized system actively interacts with surgical instruments to perform specific tasks independent of the human surgeon. This is distinguished from computer-aided navigation (CAN) by the independence of the computer system. Navigation tells the surgeon what to do, whereas RAS does (some of) it. Both RAS and CAN are simply two sub-components of computer-assisted surgery (CAS). CAS is the application of digital technology to improve surgical precision through improved training/education, surgical planning, anatomic alteration, and/or implant placement. Everything from arthroscopic simulators (and eventually, virtual reality) used to train residents, to patient-specific implants (for knee osteotomies), to augmented reality headsets to guide minimally invasive procedures, to RAS and CAN, fall under the umbrella of CAS. The eventual adoption of robot-assisted surgery for orthopaedic sports medicine and arthroscopy procedures is inevitable and will dramatically improve the precision with which we perform surgery.

While there are many reported post operative rehab protocols following arthroscopic Bankart repair, significant variability exists within each protocol, leaving a lack of consensus or standardized evaluation of return to play. As such, criteria-based return to sport protocols have been established in an attempt to normalize the rehabilitation while reducing the recurrence rate following this procedure. This type of protocol has been published with promising results, but validation of the protocol has been difficult. Using the contralateral upper extremity as the "uninjured" extremity has resulted in healthy volunteers failing to pass the criteria based return to sport testing. Using the contralateral extremity, especially in the upper extremities, may not be the most accurate or appropriate control, however, and additional studies are needed in the search for an objective benchmark to return following arthroscopic Bankart repair.

Purpose: The purpose of this study was to compare the clinical outcomes and rates of recurrent instability of patients following arthroscopic Bankart repair with and without GLAD lesions in the setting of first-time anterior instability events.

Methods: This was a retrospective comparative case series of consecutive patients with GLAD lesions in the setting of first-time anterior instability events who underwent arthroscopic Bankart repair. Patients with GLAD lesions (cases) were matched in a 1:3 ratio for sex, age, BMI, and sport to those without GLAD lesions (controls). Primary outcomes included postoperative ROM (forward elevation and external rotation) and PROs: Subjective Shoulder Value (SSV), Visual Analog Scale (VAS), and Western Ontario Shoulder Instability Index (WOSI). Recurrent instability following primary arthroscopic stabilization was also collected. STATA was used for data analysis. Statistical significance was set at P ≤ 0.05.

Results: A total of 56 patients undergoing arthroscopic anterior stabilization between 2012-2020 were included for analysis, of which 14 patients had GLAD lesions while the remaining 42 were controls. Average follow-up time from surgery in controls was 8.2 years (3.1 - 11.7) while the average follow-up in GLAD patients was 7.6 years (3.8 - 11.8). There were no differences in postoperative forward flexion or external rotation, and no difference in SSV, VAS, or WOSI scores. The rate of recurrent instability was found to be the same in both the control and GLAD groups (7% vs. 7% respectively, p=0.16).

Conclusion: Patients with GLAD lesions in the setting of first-time anterior instability had comparable PROs, forward flexion, and external rotation postoperatively to controls. In addition, the presence of a GLAD lesion did not influence the rate of recurrent instability.

Level of evidence: Level IV Retrospective Comparative Case Series.

Women taking hormonal birth control have a statistically decreased risk of requiring an anterior cruciate ligament injury leading to surgery. The protective effect of hormonal birth control is evident irrespective of whether by device, oral medication, or systemic administration. Additionally, the benefits are seen with diverse products. Due to the complexity and interactions of hormones on physiology, the mechanism of this protection is unclear, yet it has been shown that hormonal fluctuations affect postural stability, cognitive performance, and brain function including risk aversion. Finally, this effect is not seen in women between 15-19 years of age, although data collection may be poor on this age group for this topic.

The anterior cruciate ligament (ACL) and medial and lateral menisci are essential contributors of both anteroposterior (AP) and rotational knee stability. Multiple studies have shown both ACL-deficient knees lead to increased risk of meniscal injury, as well as multiple types of meniscal tears or deficiency leading to increased risk of ACL tear or ACL reconstruction (ACLR) failures. All amenable meniscal tears, such as red-red peripheral tears, radial tears, root tears, lateral meniscal oblique radial tears (LMORTs), and ramp lesions should be attempted to be repaired at time of ACLR. In addition, other contributors to rotational stability, such as collateral, posterolateral/posteromedial corner, anterolateral injuries, and excessive posterior tibial slope (PTS) should be identified and addressed. Rotational stability should be part of every ACL surgeon's algorithm; in my practice, my preference for patients that will place high rotational stress on their knee is for bone-patellar tendon-bone autograft ACLR, aggressively repairing aforementioned meniscal pathology, and adding anterolateral extraarticular reconstructions when recurvatum/ligamentous laxity, increased PTS, high risk patients (e.g., young females in pivoting sports), or high-grade pivot shift is present.

Purpose: To compare the clinical outcomes between patients who received arthroscopic anatomic glenoid reconstruction (AAGR) using distal tibia allograft with button fixation versus screw fixation.

Methods: A retrospective chart review was conducted for all patients who underwent AAGR with button or screw fixation between 2012 and 2021. Patients were matched at a 1:1 ratio based on sex, type of surgery, and time since surgery. All patients who were included had a minimum clinical follow-up of two years. Study outcomes compared Western Ontario Shoulder Instability (WOSI) Index scores, recurrence of instability, incidence of revision surgeries, and CT readings.

Results: 44 patients were included with 22 patients in each group. The pre-operative glenoid bone loss was 22.57 ± 8.06% in the screw group and 22.92 ± 8.84% in the button group (p = 0.898). Both groups demonstrated a significant improvement in WOSI from pre-operative to latest follow-up, however patients in the screw group demonstrated significantly better WOSI scores at both two-year (p = 0.003) and latest follow-up (p = 0.019) compared to the button group. Recurrent dislocation was observed in 9 patients (40.9%), all of whom underwent button fixation (p < 0.001). Two patients in the screw group experienced hardware complications (p = 0.488). Individuals who underwent button fixation were significantly more likely to undergo a revision surgery for recurrent instability (p = 0.011). Individuals in the button group demonstrated a significantly smaller mean graft AP diameter postoperatively (p < 0.001).

Conclusion: AAGR with both screw fixation results in significantly improved WOSI scores at minimum two-year follow-up. Button fixation has a significantly higher incidence of re-dislocation. Radiographic findings suggest that on average, button fixation results in higher grade bone resorption and subsequently smaller post-operative glenoid AP width than screw fixation.

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