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

Purpose: This randomized-controlled trial assessed the safety and effectiveness of intra-articular hyaluronic acid (IAHA) when administered at various time points following arthroscopic anterior cruciate ligament reconstruction (ACLR) surgery.

Methods: Ninety ACL tear patients undergoing arthroscopic ACLR were divided into three groups: Early HA group received HA on day 2 and saline at 2 months; Late HA group received saline on day 2 and HA at 2 months; Placebo group received saline at both times. Clinical (range of motion-ROM, knee circumference, Lysholm score, IKDC, VAS, EQ5D5L, Tegner scores) and blood parameters (blood ESR, and CRP) were assessed at baseline, monthly up to 6 months, and at 12 months. The synovial TNF-alpha level was measured at baseline, day 2, and 3 months.

Results: Early HA group showed significantly better ROM than Placebo (P=0.041) and Late HA groups (P=0.029) at one and two months' post-surgery. Pain was significantly lower in Early HA group at one month compared to Placebo (P=0.033). Early HA group achieved a faster median recovery to a Lysholm score of 83 (P=0.01) and had superior Lysholm scores at two months. EQ5D5L and IKDC scores were also significantly better at one and two months in Early HA group. There were no differences in blood ESR and CRP levels between the groups at any follow up. However, both HA groups had a significant decrease in TNF-alpha from baseline (P<0.05). No adverse events were reported. The Minimal Clinically Important Difference (MCID) for the VAS at one month was achieved by 93.3%, 60.7% and 65.5% participants respectively (p-value<0.01). However, no significant differences were observed between the groups in the percentages of patients achieving MCID for VAS at one year or for IKDC and Lysholm scores at one month, two months, and one year.

Conclusion: Early IAHA injection following ACLR effectively reduces pain and improves ROM during the early postoperative period, leading to enhanced functional outcomes and quality of life. However, these benefits were not sustained beyond 2 months and no clinical benefits were noted at 6- and 12-month follow-ups. The treatment was found to be safe and well-tolerated for postoperative use. Notably, there was no significant difference in the number of patients achieving MCID for functional scores, except for pain at one month.

Purpose: To evaluate postoperative outcomes of patients with seizure disorder undergoing stabilization surgery for the treatment of recurrent anterior shoulder instability.

Methods: Pubmed, Cochrane Center for Register of Controlled Trials (CENTRAL) and Scopus were searched in January 2024 for articles using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Articles were included if they evaluated postoperative functional, clinical, or recurrence/reoperation outcomes following surgical stabilization in patients with a history of seizures and recurrent anterior shoulder instability. For postoperative outcomes reported in three or more studies with mean and standard deviation, forest plots were generated, and I² was calculated.

Results: A total of eight studies were included: seven studies focused on the Latarjet or other bone block augmentation procedures and one study focused on a soft tissue-only stabilization procedure. There were a total of 157 Latarjet or bone block augmentation surgeries (143 patients: 124 M (86.7%), 19 F (13.3%)) and 29 soft tissue only stabilization surgeries (27 patients: 23 M (85.2%), 4F (14.8%)). Recurrent dislocation or subluxation rates ranged from 0% to 43%. Of the five studies that reported the cause of postoperative dislocation or instability, four identified seizures as the cause of all cases. In studies comparing Latarjet outcomes between patients with versus without seizure disorders, instability recurrence ranged from 1.8% to 9.5% in the non-seizure group and from 9% to 40% in the seizure group.

Conclusion: The recurrence of anterior shoulder instability after surgical stabilization in patients with seizure disorders was variable across studies ranging from 0% to 43%. Seizure was the most common reported cause for recurrent instability after surgery.

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

Purpose: To investigate associations between hormonal contraceptive use and females who had sustained an ACL injury requiring reconstruction.

Methods: De-identified data were obtained from female patients 15 to 35 years of age between 2011 to 2024 from the Colorado Health Data Compass database for this study. The study was separated by females who sustained an ACL injury, treated by arthroscopic ACL reconstruction, and females without a history of ACL injury. Among these groups, non-contraceptive users, total hormonal systemic contraceptive (including oral contraceptive pills (OCPs), implant, ring, injection, and patch) users, OCP users (including formulations norethindrone (NE) only, drospirenone (DS) + ethinyl estradiol (EE), (NE + EE), norgestimate (NG + EE)) users were included in the analysis.

Results: The 2,120,628 females in the systemic hormonal contraceptive use group had a lower ACL injury incidence (0.079%; CI: 0.075 to 0.083) compared to the incidence of the 12,766,138 females in the no contraceptive use group (0.12%; CI: 0.118 to 0.121). The 745,062 females in the OCP use group also had a lower ACL injury incidence (0.088%; CI: 0.081 to 0.095), suggesting an association between contraceptive use and ACL injuries. When stratified by five-year age intervals, the 15 to 19-year-old age group saw no difference between ACL injury incidence in the OCP use group (0.101%, CI: 0.081, 0.125) and no contraceptive group (0.118%, CI: 0.114, 0.122) while all other age groups had a lower ACL injury incidence in the OCP use group. All age groups in the systemic hormonal contraceptive use group had a lower ACL injury incidence compared to the no contraceptive use. Additionally, different contraceptive formulations showed similar injury incidence, with a lower proportion of ACL injuries in NE only (0.03%) users compared to NG+EE (0.093%), NE+EE (0.099%), and DS+EE users (0.096%).

Conclusion: Systemic hormonal contraceptive use is associated with a lower incidence of ACL injury requiring ACL reconstruction compared to no contraceptive use in females ages 15 to 35, with a stronger association with progestin-only OCPs. Females ages 15 to 19 showed no difference in the association with ACL injury incidence between OCP use and no contraceptive use.

Purpose: To compare rates of postoperative complications, health care utilization, opioid prescribing patterns, and secondary knee surgery in patients with versus without a pre-existing anxiety or depressive disorder (ADD) undergoing isolated primary arthroscopic partial meniscectomy (APM).

Methods: The TriNetX database was queried from inception to compare patients older than 18 years who underwent isolated primary APM with versus without a pre-existing ADD. Patients were matched in a 1:1 ratio based on demographic factors and comorbidities, including diabetes and hypertension. The following outcomes were collected: (1) postoperative complications and health care utilization within 90 days, (2) proportion of patients prescribed an opioid within 1 year, and (3) subsequent knee surgery within 2 years, specifically ipsilateral or contralateral meniscus surgery or total knee arthroplasty. Two subgroup analyses were conducted. Opioid-naive patients with and without an ADD were compared based on the proportion of patients prescribed an opioid within 1 year of APM. Rates of revision meniscus surgery on the ipsilateral knee were also compared within 2 years of APM.

Results: Within 90 days, patients with a pre-existing ADD (n = 26,507), compared to those without (n = 26,507), had higher rates of health care utilization, including readmission (P < .001), and medical complications, like cerebrovascular accident (P = .002). A greater proportion of patients with an ADD were prescribed opioids at all chosen time points within 1 year of APM. Similarly, a greater proportion of opioid-naive patients with an ADD were prescribed opioids within 6 months (P < .001) and 1 year (P < .001). Patients with an ADD also had higher rates of total knee arthroplasty (P = .001) and ipsilateral revision meniscus surgery (left knee: P = .020; right knee: P = .019) within 2 years.

Conclusions: Patients with an anxiety or depressive disorder have higher rates of health care utilization, medical complications, opioid prescriptions, and subsequent knee surgery after isolated primary arthroscopic partial meniscectomy.

Level of evidence: Level III, retrospective cohort study.

Purpose: To examine the effects of timing of anterior cruciate ligament (ACL) reconstruction on the odds to recover muscle (quadriceps and hamstring) strength, return to preinjury physical activity level, and achieve rehabilitation goals at 12 months follow-up.

Methods: Data were extracted from a local rehabilitation registry in Sweden in November 2023. Patients ≥16 years old who underwent primary ACL reconstruction with hamstring tendon autografts, who underwent isokinetic muscle strength assessment, and responded to patient-reported outcomes 12-months after surgery were included. A multivariable logistic regression analysis was used to analyze the association between timing of ACL reconstruction and the recovery of muscle strength, return to preinjury physical activity level, and achievement of rehabilitation goals. The results of the logistic regression analysis were expressed as odds ratios (OR) for every 1-unit increase in the predictor variable (months between ACL injury and reconstruction).

Results: In total, 715 patients were included, of which 53.4% (n=383) were women. The mean age at ACL reconstruction was 28.3±10.5 years, and the median time between ACL injury to reconstruction was 4.9 months (IQR 2.9;9.4). Delayed ACL reconstruction significantly decreased the odds of returning to preinjury physical activity level at 12-months in patients with a Tegner score of 6-10 (OR 0.97 [95% CI 0.94;0.99], p=0.009) and regardless of age. Shorter median time in months from ACL injury to reconstruction was observed for patients who returned to preinjury physical activity level, especially in younger patients (16-30 years old) (3.9 [IQR 2.5;6.5] versus 4.7 [IQR 2.9;9.1], p=0.007) and in patients who participated in pivoting activities (Tegner scale 6-10) preinjury (3.4 [IQR 2.3-6.2] versus 5.0 [IQR 2.9-9.7], p<0.001).

Conclusion: Delayed ACL reconstruction reduces the odds of returning to preinjury physical activity level in patients active in pivoting activities preinjury (Tegner 6-10), and in patients regardless of age 12 months after surgery.

Level of evidence: III. Retrospective study.

Purpose: To compare the changes in labral size after primary hip arthroscopy between patients requiring revision surgery and those did not.

Methods: Data collected between August 2016 and September 2021 were retrospectively reviewed. Patients diagnosed with femoroacetabular impingement syndrome and undergoing primary and revision hip arthroscopy at our institute were included in the revision group. Exclusion criteria were Tönnis grade >1, concomitant hip conditions, and incomplete magnetic resonance imaging (MRI) data. Patients who did not undergo revision surgery or conversion to total hip arthroplasty at minimum 2-year follow-up were matched in a 1:2 ratio and included in the control group. The labral size (width and height at 11:30, 1:30, and 3:00) on MRI (noncontrast, 3.0 T) before and after 12 months of primary surgery was compared.

Results: Twenty-one patients were included in the revision group, and 42 patients were matched in the control group. In the revision group, significant reduction in labral width and height at 11:30 and 1:30, and labral width at 3:00 was observed at 12 months after primary hip arthroscopy (all with P < .05), whereas the control group did not show significant difference of changes in labral size (all with P > .05). Smaller postoperative labral width at 1:30 and 3:00 was observed in the revision group compared with the control group (all with P < .05). The revision group presented with greater reduction of labral width at all 3 positions and labral height at 1:30 compared with the control group (all with P < .05).

Conclusions: Patients requiring revision surgery after primary hip arthroscopy for femoroacetabular impingement syndrome presented with smaller postoperative labral size (less than 1 mm difference) and greater reduction of labral size (at or less than 1mm difference) on MRI 12 months after primary surgery compared with those patients that did not require later revision surgery.

Level of evidence: Level III, retrospective case control.

Hamstring pathology is both a common, and commonly missed, source of pain. Acute traumatic tears can be missed or underappreciated, and hamstring tendinopathy and partial-thickness tears are often atraumatic with insidious onset. Partial-thickness hamstring tears or tendinopathy can be underappreciated on magnetic resonance imaging or missed in conjunction with concomitant pathology. Ultrasound-guided diagnostic injections are invaluable tools when sorting through concomitant pathologic processes. If noninvasive treatment options are unsuccessful, injections and surgery are options. Corticosteroid injections have limited utility; platelet-rich plasma injections have shown promise. When surgical treatment is warranted, both endoscopic and open techniques allow for improvement. Although technically demanding, endoscopic hamstring repair allows minimally invasive access to the entirety of the ischial tuberosity, magnified viewing of the tendon structure, and the ability to visualize both the sciatic nerve as well as the posterior femoral cutaneous nerve. These latter 2 structures are most at risk. Maintaining orientation with fluoroscopy enhances arthroscopic understanding of the deep gluteal space, with the posterior aspect of the ischium acting as a safe zone from which careful surgical dissection can begin.

The purpose of this article is to evaluate the application of artificial intelligence (AI) from the perspective of the orthopaedic industry with respect to the specific opportunities offered by AI. It is clear that AI has the potential to impact the entire continuum of musculoskeletal and orthopaedic care. The following areas may experience improvements from integrating AI into surgical applications: surgical trainees can learn more easily at lower costs in extended reality simulations; physicians can receive support in decision-making and case planning; efficiencies can be driven with improved case management and hospital episodes; performing surgery, which until recently was the only element industry engaged with, can benefit from intraoperative AI-derived inputs; and postoperative care can be tailored to the individual patient and their circumstances. AI delivers the potential for industry to offer valuable augments to patient experience and enhanced surgical insights along the digital episode of care. However, the true value is in considering not just how AI can be applied in each silo but also across the patient's entire continuum of care. This opportunity was first opened with the advent of robotics. The data derived from the robotic systems have added something akin to a black box flight recorder to the operation, which now offers 2 critical outcomes for industry. First, together we can now start to stitch preoperative elements like demographics, morphological phenotyping, and pathology that can be integrated with intraoperative elements to produce surgical plans and on-the-fly anatomic data like ligament tension. Second, postoperative elements such as recovery protocols and outcomes can be considered through the lens of the intraoperative experience. In forming this bridge, AI can accelerate the development of a truly integrated digital ecosystem, facilitating a shift from providing implants to providing patient experience pathways. LEVEL OF EVIDENCE: Level V, expert opinion.

Sports-related injuries are costly to treat and have many associated intangible effects. Musculoskeletal health care professionals in rehabilitation strive to keep athletes at their peak performance with a principal focus on injury prevention. "Prevention is better than a cure" remains relevant to all athletes and nonathletes alike. In this special issue of Arthroscopy, Sports Medicine, and Rehabilitation, "Injury Prevention and Rehabilitation," which can be found at https://www.arthroscopysportsmedicineandrehabilitation.org/injury-prevention-and-rehabilitation, we bring a multifaceted approach and diverse perspectives in helping athletes and active individuals remain injury free with prevention and training strategies while optimizing performance and providing key rehabilitation strategies for common sports-related injuries.

Recurrent anterior shoulder instability with subcritical bone loss is a challenging clinical scenario. Many treatment options have been described, including arthroscopic Bankart repair, arthroscopic Bankart repair plus remplissage, open Bankart repair, and the Latarjet procedure. Arthroscopic Bankart repair alone has higher rates of failure in high-risk patient populations, especially at long-term follow-up. These high-risk populations include patients with significant glenoid bone loss (>20%), bipolar bone loss (including subcritical bone loss and off-track or "near-track" [8-10 mm] Hill-Sachs lesions), and demographic risk factors including young age, hyperlaxity, contact sports participation, and number of prior dislocations. Treatment algorithms favor arthroscopic Bankart repair plus remplissage or the Latarjet procedure for high-risk patients, but they go from "A" (arthroscopy) to "C" (coracoid transfer) and forget about "B" (open Bankart repair). Open Bankart repair has decreased in use by 65% across the United States since 2008, whereas the popularity of the Latarjet procedure has risen by 250% over the same time frame. With its reported success at long-term follow-up (1.6%-17.5% failure rates at 17-21 years), open Bankart repair must be reconsidered for properly indicated patients. Ongoing large-scale multicenter trials such as the Open Versus Arthroscopic Surgery for Shoulder Instability (OASIS) trial are looking at arthroscopic Bankart repair with or without remplissage versus open Bankart repair versus the Latarjet procedure in the setting of 10% to 20% anterior glenoid bone loss. We highly recommend open Bankart repair in contact athletes with an acute bony Bankart fracture and thoughtfully consider open Bankart repair in contact athletes with approximately 10% glenoid bone loss.