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

Purpose: To characterize the risk of revision hip arthroscopy or conversion to total hip arthroplasty (THA) among patients with a history of lumbar fusion undergoing primary hip arthroscopy.

Methods: We used the Statewide Planning and Research Cooperative System, an administrative database including all ambulatory and inpatient surgery encounters in New York (NY), to identify all patients who underwent hip arthroscopy for FAI between 2010-2020. Patients with prior lumbar fusion were identified using CPT and ICD 9th/10th Revision coding definitions. Patients with and without prior fusion were matched in a 1:5 ratio according to age and comorbidity burden. The number of levels fused was defined in the following fashion: i) no fusion, ii) 1-2 levels, or iii) ≥3 levels. Patients were followed for two years to evaluate the rate of revision hip arthroscopy or conversion to THA. Multivariable logistic regression models were used to measure the association between number of levels fused and revision hip arthroscopy or conversion to THA.

Results: Between 2010-2020, there were 23,277 patients that underwent primary hip arthroscopy in NY state. Of these, 348 (1.4%) had a prior lumbar fusion. After matching for age and comorbidities, the composite rate of revision hip arthroscopy or conversion to THA was higher in patients with prior lumbar fusion compared to patients without (16.5% vs. 8.5%; P < 0.001). This risk increased with the number of levels fused (1-2 levels: 15.1%; aOR, 1.8; 95% CI, 1.3-2.6; vs. ≥3 levels: 26.3%; aOR, 3.4; 95% CI, 1.7-7.0).

Conclusion: Patients with a history of lumbar fusion had significantly higher rates of revision hip arthroscopy and conversion to THA compared to patients without prior fusion. The risk of revision hip arthroscopy or conversion to THA was increased approximately 2-fold in patients with 1-2 levels fused and 3-fold in patients with 3 or more levels fused.

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

Repair of rotator cuff tear is challenging because poor biologic factors can negatively impact tendon healing and risk complications. Sometimes, instead of attempting complex procedures with a guarded prognosis to reconstruct or replace rotator cuff like tissue, less is more. Minimally invasive, arthroscopic subacromial balloon spacer (SBS) for massive rotator cuff tears, demonstrates excellent long-term outcomes. Radiographically, SBS outcomes may be concerning, but clinically, patients do well. If pain is the primary complaint and function is maintained, the balloon spacer is an excellent option with a fast recovery. However, if function is deficient, or if the patient prioritizes strength recovery as their primary desired outcome, then more invasive procedures are often indicated.

Purpose: The purpose of this study was to investigate the relationship between magnetic resonance imaging (MRI) signal intensities and mitochondrial function in patients undergoing arthroscopic rotator cuff repair, assessed through histological and genetic profiling of tendon tissue.

Methods: This study, conducted between April 2022 and January 2023, included 20 patients undergoing rotator cuff repair for atraumatic/degenerative tears. Rotator cuff tendon edge samples were obtained during arthroscopic rotator cuff repair. Patients were classified based on signal intensity from preoperative T2-weighted fat suppressed MRI. Specifically, they were categorized as having either high or low signal intensity at the rotator cuff tendon edge, with the deltoid muscle serving as a reference. Comparative analyses specifically compared the histological features and genetic profiles of the tendon tissue at the rotator cuff tendon edge. Histological evaluation of harvested tendon specimens during arthroscopic rotator cuff repair employed the modified Bonar score. Real-time polymerase chain reaction was used to assess expression of various mitochondrial and apoptosis-related genes. The mitochondrial morphology of the rotator cuff torn site was examined using electron microscopy.

Results: The higher signal intensity group showed significantly higher modified Bonar scores (p=0.0068), decreased mitochondrial gene expression, increased TUNEL-positive cells (p=0.032), lower SOD activity (p=0.011), reduced ATP5A (p=0.031), and increased cleaved caspase-9 activity (p=0.026) when compared to the lower signal intensity group. Electron microscopy revealed fewer mitochondrial cristae in the higher signal intensity group.

Conclusion: Our results suggest correlations between high MRI signal intensities and the presence of degeneration, mitochondrial dysfunction, and increased apoptosis in rotator cuff tissues. This underscores the utility of MRI signal intensity as an indicator of tissue condition.

Clinical relevance: Building on the established premise that elevated preoperative MRI signal intensities may indicate higher rates of postoperative rotator cuff re-tears, the current study substantiates these findings from a mitochondrial function perspective.

Purpose: To identify independent factors responsible for the poor outcomes after a graft tear after arthroscopic superior capsular reconstruction (ASCR).

Methods: Patients who underwent ASCR for massive rotator cuff tears between January 2013 and July 2021were reviewed. Based on the achievement of the minimal clinically important differences for clinical outcome measures at the final follow up, patients were divided into the good outcome (GO) and poor outcome (PO) groups. The minimal clinically important differences were calculated as the values equal to one-half of the standard deviation of the changes in outcome scores between the preoperative baseline and the latest follow-up. Pre- and final follow-up variables included demographics, American Shoulder and Elbow Surgeons (ASES) score, Constant score, visual analog scale (VAS) score, range of motion, Preoperative and postoperative 1-year radiological variables were analyzed using MRIs, including anteroposterior (AP) and mediolateral (ML) tear sizes, subscapularis tear, acromiohumeral distance (AHD), and degree of fatty degeneration. Logistic regression analysis was performed to identify the significant predictors of poor outcomes.

Results: A total of 33 patients who underwent ASCR presented with graft tears, which were confirmed by postoperative 1-year magnetic resonance imaging (MRI), and had a minimum follow-up duration of 2 years after surgery were enrolled. The GO group demonstrated significantly greater improvements in functional outcomes compared with the PO group (ASES: 83.5 ± 11.8 vs. 64.0 ± 20.4, P = 0.004; Constant: 67.6 ± 5.7 vs. 57.1 ± 9.8, P <0.001; and VAS: 0.9 ± 1.2 vs. 2.4 ± 2.0, P = 0.026). The postoperative 1-year AHD showed significant improvement in the GO group (3.1 ± 1.2 vs. 6.1 ± 1.4, P <0.001) but no change in the PO group (3.4 ± 1.3 vs. 4.2 ± 0.9, P = 0.074) postoperatively. Multivariate logistic regression analysis indicated that a decreased postoperative 1-year AHD (OR, 0.145; P = 0.019) was associated with a poor outcome after a graft tear.

Conclusion: A narrow postoperative 1-year AHD was identified as the most importantindependent risk factor indicating poor clinical outcomes after a graft tear post-ASCR, which was related to a larger tear and loss of integrity between the grafts and infraspinatus at 1 year postoperatively.

Level of evidence: Level IV.

Purpose: The present study aimed to characterize the incidence of anterior cruciate ligament (ACL) tears, ACL reconstruction (ACLR), and ACL non-operative management from 2010-2020, stratifying by age, biological sex, and Charlson Comorbidity Index (CCI) score.

Methods: A retrospective cohort analysis was performed using the PearlDiver national insurance claims database. Cohorts of patients with ACL tears, ACLR, and non-operative management were identified using ICD-9/10, and CPT codes between 2010-2020. All patients with ACL tears were included. Patients were stratified by age, sex, and CCI. Compound Annual Growth Rate (CAGR) analysis, T tests, and Cohen's d tests were performed to analyze trends and demographic variables.

Results: Of 931,186 ACL tears during the study period, 196,589 were managed with ACLR and 734,597 were managed non-operatively. The cumulative incidence of ACL tears was 75.19 tears per 100,000 person-years. There was a modest decrease in the incidence of ACL tears, ACLR, and non-operative management from 2010-2020, with CAGRs of -3.43%, -3.55%, and -5.35%, respectively. The relative utilization of ACLR compared to non-operative management increased from 2010-2020 (CAGR 2.15%). Patients aged 10-19 accounted for the majority of ACL tears (22.31%) and ACLRs (30.97%). A slight majority of ACL tears (51.2%, p<0.001), ACLR (50.7%, p<0.001), and ACL tears with non-operative management (51.6%, p<0.001) occurred in female patients. The mean CCI of patients who underwent ACLR (mean=0.32; SD=0.77) was significantly lower than that of the general ACL tear cohort (mean=0.54; SD=1.19; p=0.005), and the non-operative management cohort (mean=0.64; SD 1.32; p=0.0004).

Conclusion: The overall decrease in ACL tears, ACLR, and non-operative management found in this study is a reversal from trends reported in the literature from previous decades.

Level of evidence: 4 (Retrospective Case Series).

Purpose: To perform a systematic review to evaluate the effect of industry affiliation on the outcomes of randomized controlled trials (RCTs) for platelet-rich plasma (PRP) injections in rotator cuff tears.

Methods: PubMed, SPORTdiscus, and Scopus databases were searched from 2010 to the present for terms "rotator cuff" and "platelet-rich plasma." Inclusion criteria were RCTs comparing PRP to controls for treatment of rotator cuff tears and exclusion criteria were systematic reviews, meta-analyses, case reports, cohort studies, basic science studies, other level 3 and below studies, and studies not in English. Degree of industry affiliation was categorized into three groups: direct, indirect, and not affiliated. Direct affiliation required the study or its authors to receive financial support from the company manufacturing the devices used in the study to prepare or administer PRP. Indirect affiliation required financial association with a different company that produces or administers PRP than the one used in the study. Studies were classified as favorable if study outcomes achieved significance (p < 0.05) of PRP over the control, or analogous if there was no statistical significance between PRP and control. Data was analyzed using chi-squared and fisher's exact tests.

Results: Of the 47 studies selected for analysis, 8 (17.0%) had no direct industry affiliation, 9 (19.1%) indirect affiliation and 30 (63.8%) no industry affiliation. 22 (46.8%) studies reported favorable results with PRP compared to the control and 25 (53.2%) showed analogous results between PRP and control. Degree of industry affiliation was significantly associated with increased likelihood of reporting favorable study outcomes (p = 0.041). Directly affiliated studies had a significantly increased likelihood of reporting favorable results (p = 0.024) compared to indirectly affiliated.

Conclusions: Studies that used PRP produced by companies that directly fund the study or were financially affiliated with the authors were significantly more likely to report favorable results.

Level of evidence: Systematic review of Level I and II studies.

Purpose: The purpose of this study was to determine if there are patient-reported outcome differences in bone-patellar-tendon-bone (BTB), quadriceps tendon (QT), and hamstring (HS) grafts of comparable size.

Methods: We performed a retrospective analysis of global registry data to include all patients that had an ACL reconstruction with BTB, QT, or HS autograft of at least 9mm diameter between 2010 and 2021 with complete 1- and 2-year outcome scores. We compared 1- and 2-year postoperative outcome scores (VAS, KOOS pain, MARS, VR-12) between BTB, QT and HS of the same size graft.

Results: 2318 subjects were included in the analysis and all graft types showed improved PROMs at 1- and 2-years postoperatively when compared to baseline. The KOOS pain score for the BTB group was significantly better than the HS (between-group difference = 2.71, p<0.01) and QT (between-group difference = 2.51, p<0.01) groups at 1-year, and the BTB group was better than HS (between-group difference = 1.88, p<0.01) at 2-years. However, the differences were small and not clinically meaningful. When comparing graft type there were no differences in the percentage of patients who reached MCID, or clinical scores VAS, MARS at 2-years follow-up.

Conclusion: There is no clinically meaningful difference in KOOS-pain, VR-12, VAS, and MARS at 1- and 2-years postoperatively in patients having anterior cruciate ligament reconstruction with BTB, HS or QT if graft size is at least 9mm in diameter.

Level of evidence: III (Retrospective Comparative Study).

Purpose: This study aims to compare posterior tibial slope (PTS) measurements of the medial tibial plateau (MTP) and lateral tibial plateau (LTP) on magnetic resonance imaging (MRI) versus computed tomography (CT) to determine the agreement of measurement between imaging modalities.

Methods: Patients aged 15-65 years with concurrent MRI and CT imaging were initially included. Knees with significant arthrosis (Kellgren-Lawrence grade >2), proximal tibia fracture, or artifact obscuring visualization were excluded. Two independent raters measured PTS of the MTP and LTP on paired MRI and CT. Interrater and intrarater reliability were assessed using the intraclass correlation coefficient (ICC). Intermethod agreement was assessed using ICC and Bland-Altman analyses. An acceptable Bland-Altman limit of agreement (LOA) was set at ±2°, requiring 95% of measurement differences between imaging modalities to fall between ±2° for an acceptable level of agreement.

Results: 46 knees in 45 patients met final inclusion criteria. Interrater reliability was good for MRI (ICC 0.78-0.83) and moderate-to-good for CT (ICC 0.64-0.80) studies. Intrarater reliability was moderate-to-excellent (ICC 0.64-0.94). Intermethod agreement between MRI and CT was poor at the MTP (ICC 0.34-0.42) and moderate at the LTP (ICC 0.59-0.70). Bland-Altman analysis demonstrated high variability of PTS measurements between MRI and CT: 0.16° (95% LOA -6.10-6.41°) for MTP for Rater 1; 0.22° (95% LOA -5.01-5.45°) for LTP for Rater 1; -0.95° (95% LOA -7.22-5.33°) for MTP for Rater 2; -0.99° (95% LOA -6.48-4.85°) for LTP for Rater 2, with only 47.83 to 60.87% of measurement differences falling within the predetermined acceptable LOA of ±2°.

Conclusion: Although the interrater and intrarater reliability was moderate-to-excellent, the degree of agreement between PTS measurements on MRI and CT was highly variable at both medial and lateral plateaus. Although some variability may have been due to the study's limitations, PTS measurements at individual plateaus may not be interchangeable between MRI and CT.

Level of evidence: Level III, retrospective cohort study.

Purpose: To determine the long-term outcomes of hip arthroscopy (HA) for femoroacetabular impingement (FAI) in the presence of concomitant lateral rim dysplasia compared to a matched control group.

Methods: Patients undergoing HA between January 2009 and October 2013 with minimum 10-year follow up were reviewed. Inclusion criteria consisted of hip arthroscopy patients for FAI with evidence of lateral rim dysplasia (LCEA of <25^o). Patients with lateral rim dysplasia, were matched to patients with a LCEA >30^o, based on sex, Tonnis grade and age. Outcomes included survival (avoidance of total hip replacement {THR}), repeat-HA and patient-reported outcomes. Survivorship was assessed using a Kaplan-Meier curve and Log ranks test, while revision rates between groups were assessed using Chi Squared analysis. Between and within group analysis for PROs were conducted using Mann Whitney U and Wilcoxon signed ranks respectively. The proportion of cases achieving the patient acceptable symptom state (PASS) was compared between groups using Chi squared analysis.

Results: Forty-six dysplasia and 90 control cases were reported on. There was no statistical difference between groups for baseline metrics apart from the LCEA (p<0.001), Sharp angle (p<0.001) and Tonnis angle (p<0.001). By 10 years, 9% of dysplasia cases and 4% of control cases converted to THR. There was no statistical difference between groups for survival or revision rates. Both groups reported improvements in PROs and there was no difference between PRO scores at either timepoint. Excluding those undergoing THR, 84% and 83% of dysplasia and control cases respectively achieved PASS.

Conclusion: Hip arthroscopy for symptomatic femoroacetabular impingement (FAI) is a successful treatment in cases where dysplasia is present. Low complication rates, comparable outcomes to those without lateral rim dysplasia, and a high survivorship rate of 91% at minimum 10-year follow up are observed. Increasing Tonnis angle preoperatively may increase the risk of THR conversion.

Level of evidence: IV Retrospective Cohort Study.