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

When performing lateral extra-articular procedures (LEAPs) at the time of anterior cruciate ligament (ACL) reconstruction, it is essential to be aware of the possibility of tunnel collision and understand strategies to avoid it. The risk of tunnel collision is high, especially if an anteromedial portal ACL femoral tunnel is drilled. Tunnel collision can be avoided by using a single femoral tunnel for both procedures, outside-in femoral tunnel drilling to place the ACL tunnel a safe distance away from the LEAP, and cortical fixation techniques. Other strategies that have been explored have included anteromedial portal drilling in low degrees of flexion, anterior angulation of LEAP tunnels, and the use of an "anterior Lemaire" position. These alternative strategies are not preferred because they are associated with an increased risk of iatrogenic injuries to important posterolateral structures, penetration of trochlea articular cartilage, and overconstraint, respectively.

The InSpace subacromial balloon spacer (Stryker, USA) is indicated for the treatment of massive irreparable rotator cuff tears. The device is placed in the subacromial space with the aim of restoring shoulder function by limiting painful acromiohumeral contact and recentering the superiorly migrated humeral head. However, controversy exists because two randomized controlled trials have produced conflicting findings with regards to efficacy. These findings, along with narrow indications have led to low utilization of the balloon amongst European and Latin American Surgeons. The controversy generated by conflicting RCTs poses challenges in the interpretation of cost effectiveness especially when the role of the balloon amongst a plethora of other options including superior capsule reconstruction (either with long head of biceps or dermal allograft), graft augmentation, tendon transfer, biologic tuberoplasty, acromial resurfacing, and reverse shoulder arthroplasty is not well defined. However, it is my opinion that the balloon has particular value in older, low-demand patients, in whom severe co-morbidities make a shorter surgical duration and quicker recovery appealing.

Purpose: To better define the rate of return to work in patients undergoing Latarjet surgery for anterior shoulder instability.

Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Center Register of Controlled Trials, and Scopus were queried in October 2023 with the following keywords: ((latarjet) OR (anterior shoulder instability)) AND ((work) or (compensation)). Articles were included if they reported return to work in patients (including military members) undergoing Latarjet surgery for traumatic anterior shoulder instability with bone loss and were written in English. This study was registered in Prospero (ID blinded).

Results: Six studies reporting on 419 shoulders were included in the review. Five studies reported on patients in the general population, and 1 reported on military members. Mean age ± standard deviation of patients ranged from 23.1 ± 5.8 to 32.0 ± 12.3 years. Moreover, there were 286 primary Latarjet procedures, 131 revision Latarjet procedures, and 2 unspecified as primary or revision surgery. Mean glenoid bone loss ranged from 14.5% to 22.9%. Return-to-work rates ranged from 89.1% to 100%, with 2 studies reporting all patients were able to return to work. Among military members, 89.1% were able to return to duty. Mean time to return to work ranged from 8.69 to 34.8 weeks after surgery. Four studies also reported return to sport, which ranged from 60.9% to 100%. Mean time for returning to sport varied between 10.0 and 35.2 weeks after the Latarjet procedure.

Conclusions: Patients with anterior shoulder instability who undergo an arthroscopic or open Latarjet procedure can expect high rates of return to work and sport. All studies reported return-to-work rates over 89%, with 89.1% of military members able to return to duty.

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

Purpose: This study aims to systematically review the current evidence to compare the differences in outcomes of the suture button (SB) versus hook plate (HP) fixations for treating acute Rockwood type III acromioclavicular joint (ACJ) dislocation.

Methods: Two reviewers independently conducted a literature search based on the preferred reporting items from systematic reviews and meta-analyses guidelines. PubMed, EMBASE, Medline, and the Cochrane Library were systematically searched for studies comparing SB and HP in the treatment of acute Rockwood type III ACJ dislocation. Constant score, visual analogue scale (VAS), coracoclavicular distance, operation time, and occurrence of complications were assessed. Risk of bias was assessed using the Cochrane Collaboration's tools and the ROBINS-I tool.

Results: A total of 16 studies were included, consisting of two RCTs and 14 non-RCTs, with 471 patients in the SB group and 445 patients in the HP group. Among the included studies that reported patient-reported outcomes, four study indicated significantly higher Constant score in the SB group compared to the HP group, while the remaining five studies found no difference between the groups. Among the five included studies that reported VAS scores, two showed statistically significant differences favoring SB. Among 10 included studies reported operation time, three demonstrated shorter operation time for SB compared to HP, while two indicated longer operation time for SB surgery compared to HP. However, there was no statistically significant difference in the incidence rates of coracoclavicular distance and complications between the two groups.

Conclusions: The evidence suggests no clear clinical superiority of SB over HP in treating acute Rockwood type III ACJ dislocations. While some studies show SB may offer benefits like higher constant score and lower VAS scores, most outcomes reveal no significant differences.

Purpose: The aim of this study is to assess the statistical fragility of randomized controlled trials that assess the use of platelet rich plasma (PRP) for the treatment of knee osteoarthritis (OA) and report a continuous primary outcome measure with statistical significance.

Methods: A systematic electronic search of MEDLINE, EMBASE, and Cochrane database was performed on July 26, 2023. All randomized controlled trials addressing the use of PRP for the treatment of symptomatic knee osteoarthritis were included that reported statistically significant primary continuous outcomes. The continuous fragility index (CFI) and continuous fragility quotient (CFQ) was calculated using approximative method as previously described using the mean and standard deviation of the outcomes of interest.

Results: There was a total of 34 eligible outcomes for analysis. The overall median CFI across all included studies was 5.7 (IQR, 4.8 - 9.9). The overall median CFQ across all included studies was 0.131 (IQR, 0.055 - 0.243). Loss to follow-up was greater than the CFI in only 3 of 34 eligible outcomes (8.8%). The most analyzed outcome was the WOMAC total score (n=9) with a median CFI of 6.6 and median CFQ of 0.250. The outcome with the highest median CFI was the WOMAC stiffness subscale at 93. Spearman correlation analysis demonstrated a non-statistically significant trend towards decreasing CFI (-0.497) and a statistically significant decrease in CFQ (-0.681, p = 0.03) with increasing grades of osteoarthritis.

Conclusion: The was an overall median CFI of 5.7 and CFQ of 0.131 for RCTs that report statistically significant continuous outcomes for the use of PRP for symptomatic knee OA. Although there are no current guidelines regarding statistical fragility of continuous outcomes, these results can be considered fragile given statistical significance may be reversed with only a few changes in patient outcomes.

Level of evidence: 2; systematic review of Level I and II studies.

Purpose: The aims of this systematic review were to determine (1) which criteria are used to determine return to sport (RTS), (2) the number of patients that are unable to RTS following any superior labral pathophysiology treatment and (3) which reasons are reported for not returning.

Methods: A systematic review was performed across 5 databases, including studies that report rates for RTS following any treatment of superior labral pathophysiology. Study quality was assessed using the MINORS criteria. Definitions for nRTS were extracted as reported in the studies. The ranges of no return to sport (nRTS) and no return to pre-injury level (nRTPL) were summarized. Reasons for nRTS and nRTPL were categorized using a predefined coding scheme.

Results: Among 45 studies with level of evidence ranging from II to IV, 1857 patients were involved in sports, 78% (n=1453) of whom underwent superior labral reattachment, 21% (n=381) biceps tenodesis, and 9.4% (n=175) non-operative treatment. None of the studies provided criteria for RTS and two studies provided criteria for return to pre-injury level (RTPL). The ranges of nRTS and nRTPL varied following superior labral reattachment (0-60%, n=206; 0-89%, n=424, respectively), biceps tenodesis (0-25%, n=43; 3,8-48%, n =78) and nonoperative treatment (11-75%, n=62; 18-100%, n=78). Reasons for nRTS and nRTPL were related to physical sensations (pain, feeling of instability, discomfort, weakness, lack of motion), psychological factors (fear of reinjury, lack of confidence), personal factors (lifestyle change, social reasons) and injury at another site.

Conclusion: Criteria for determining successful RTS and RTPL following superior labral pathophysiology treatment were not reported by the majority of studies. The nRTS and nRTPL rates varied greatly within and between treatments. The reasons for this unsuccessful return were diverse and related to physical sensations, psychological factors, personal factors and injury unrelated to treatment.

Level of evidence: Level IV; Systematic Review.