Arthroscopy-The Journal of Arthroscopic and Related Surgery最新文献_第5页

Patients With a History of Lumbar Fusion Have a Greater Risk of Revision Arthroscopy and Conversion to Total Hip Arthroplasty After Primary Hip Arthroscopy 有腰椎融合术病史的患者在初次髋关节镜手术后进行关节镜翻修和转为全髋关节置换术的风险较高。

IF 4.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.arthro.2024.08.026

Abhinaba Chatterjee M.D. , Kaisen Yao M.D. , Matthew H. Nasra M.D. , Thun Itthipanichpong M.D. , Gregory Galano M.D. , Anil S. Ranawat M.D.

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, to identify all patients who underwent hip arthroscopy for femoroacetabular impingement between 2010 and 2020. Patients with previous lumbar fusion were identified using Current Procedural Terminology and International Classification of Diseases, Ninth and Tenth Revision, coding definitions. Patients with and without previous 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: (1) no fusion, (2) 1-2 levels, or (3) ≥3 levels. Patients were followed for 2 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 and 2020, there were 23,277 patients who underwent primary hip arthroscopy in New York state. Of these, 348 (1.4%) had a previous lumbar fusion. After matching for age and comorbidities, the composite rate of revision hip arthroscopy or conversion to THA was greater in patients with previous lumbar fusion compared with patients without (16.5% vs 8.5%; P < .001). This risk increased with the number of levels fused (1-2 levels: 15.1%; adjusted odds ratio, 1.8; 95% confidence interval 1.3-2.6; vs ≥3 levels: 26.3%; adjusted odds ratio, 3.4; 95% confidence interval 1.7-7.0).

Conclusions

Patients with a history of lumbar fusion had significantly greater rates of revision hip arthroscopy and conversion to THA compared with patients without previous fusion. The risk of revision hip arthroscopy or conversion to THA was increased approximately 2-fold in patients with 1 to 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.

目的：分析有腰椎融合史的患者接受初次髋关节镜手术后进行髋关节镜翻修或转为全髋关节置换术（THA）的风险：我们利用全州规划与研究合作系统（Statewide Planning and Research Cooperative System）这一包括纽约州（NY）所有门诊和住院手术病例的行政数据库，确定了 2010-2020 年间因 FAI 接受髋关节镜手术的所有患者。使用 CPT 和 ICD 第 9/10 次修订版编码定义确定了既往接受过腰椎融合术的患者。根据年龄和合并症负担，将既往接受过腰椎融合术和未接受过腰椎融合术的患者按 1:5 的比例进行配对。融合的水平数定义如下：i) 无融合，ii) 1-2 水平，或 iii) ≥3 水平。对患者进行为期两年的随访，以评估髋关节镜翻修率或转为 THA 的比率。多变量逻辑回归模型用于测量融合水平数与髋关节镜翻修或转为THA之间的关系：2010-2020年间，纽约州共有23277名患者接受了初次髋关节镜手术。其中，348人（1.4%）曾接受过腰椎融合术。在对年龄和合并症进行匹配后，既往接受过腰椎融合术的患者与未接受过腰椎融合术的患者相比，髋关节镜翻修或转为 THA 的复合率更高（16.5% 对 8.5%；P < 0.001）。这一风险随融合的水平数增加而增加（1-2个水平：15.1%；aOR，1.8；95% CI，1.3-2.6；与≥3个水平相比：26.3%；aOR，3.4；95% CI，1.7-7.0）：结论：与无腰椎融合术史的患者相比，有腰椎融合术史的患者接受髋关节镜翻修手术和转为 THA 的比例明显更高。髋关节镜翻修或转为THA的风险在1-2级融合的患者中增加了约2倍，在3级或3级以上融合的患者中增加了3倍：III级，预后回顾性匹配比较病例系列。

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引用次数: 0

The Number of Patients Lost to Follow-Up May Exceed the Fragility Index of a Randomized Controlled Trial Without Reversing Statistical Significance: A Systematic Review and Statistical Model 失去随访的患者人数可能超过随机对照试验的脆性指数，但不会逆转统计意义：系统回顾与统计模型

IF 4.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.arthro.2024.05.006

Jacob F. Oeding M.S. , Aaron J. Krych M.D. , Christopher L. Camp M.D. , Nathan H. Varady M.D., M.B.A.

<div><h3>Purpose</h3><div><span>To (1) analyze trends in the publishing of statistical fragility index (FI)–based systematic reviews<span> in the orthopaedic literature, including the prevalence of misleading or inaccurate statements related to the statistical fragility of </span></span>randomized controlled trials (RCTs) and patients lost to follow-up (LTF), and (2) determine whether RCTs with relatively “low” FIs are truly as sensitive to patients LTF as previously portrayed in the literature.</div></div><div><h3>Methods</h3><div><span>All FI-based studies published in the orthopaedic literature were identified using the Cochrane Database of Systematic Reviews<span>, Web of Science Core Collection, PubMed<span>, and MEDLINE databases. All articles involving application of the FI or reverse FI to study the statistical fragility of studies in orthopaedics were eligible for inclusion in the study. Study characteristics, median FIs and sample sizes, and misleading or inaccurate statements related to the FI and patients LTF were recorded. Misleading or inaccurate statements—defined as those basing conclusions of trial fragility on the false assumption that adding patients LTF back to a trial has the same statistical effect as existing patients in a trial experiencing the opposite outcome—were determined by 2 authors. A theoretical RCT with a sample size of 100, </span></span></span><em>P</em> = .006, and FI of 4 was used to evaluate the difference in effect on statistical significance between flipping outcome events of patients already included in the trial (FI) and adding patients LTF back to the trial to show the true sensitivity of RCTs to patients LTF.</div></div><div><h3>Results</h3><div>Of the 39 FI-based studies, 37 (95%) directly compared the FI with the number of patients LTF. Of these 37 studies, 22 (59%) included a statement regarding the FI and patients LTF that was determined to be inaccurate or misleading. In the theoretical RCT, a reversal of significance was not observed until 7 patients LTF (nearly twice the FI) were added to the trial in the distribution of maximal significance reversal.</div></div><div><h3>Conclusions</h3><div>The claim that any RCT in which the number of patients LTF exceeds the FI could potentially have its significance reversed simply by maintaining study follow-ups is commonly inaccurate and prevalent in orthopaedic studies applying the FI. Patients LTF and the FI are not equivalent. The minimum number of patients LTF required to flip the significance of a typical RCT was shown to be greater than the FI, suggesting that RCTs with relatively low FIs may not be as sensitive to patients LTF as previously portrayed in the literature; however, only a holistic approach that considers the context in which the trial was conducted, potential biases, and study results can determine the merits of any particular RCT.</div></div><div><h3>Clinical Relevance</h3><div>Surgeons may benefit from re-examining their interpretatio

目的：1）分析骨科文献中基于统计脆性指数（FI）的系统综述的发表趋势，包括与随机对照试验（RCT）的统计脆性和失访患者（LTF）相关的误导性或不准确陈述的普遍性；2）确定FI相对 "低 "的RCT是否真的像以前文献中描述的那样对失访患者敏感：使用 Cochrane 系统综述数据库、Web of Science Core Collection、PubMed 和 MEDLINE 数据库确定了骨科文献中发表的所有基于 FI 的研究。所有涉及应用FI或反向FI（RFI）研究骨科研究统计易损性的文章均符合纳入研究的条件。研究特点、中位数FI和样本量，以及与FI和患者LTF相关的误导性或不准确的陈述均被记录在案。误导性或不准确的陈述是指那些基于错误假设得出试验脆弱性结论的陈述，即在试验中增加LTF患者与试验中现有患者经历相反结果具有相同的统计效果，并由两位作者确定。一项样本量为 100、P 值为 0.006、FI 为 4 的理论 RCT 被用来评估已纳入试验（FI）的患者的结果事件翻转与将 LTF 患者重新纳入试验之间对统计学意义的影响差异，以证明 RCT 对 LTF 患者的真实敏感性：在 39 项基于 FI 的研究中，37 项（95%）直接将 FI 与失去随访的患者人数进行了比较。其中，22 项（59%）研究中关于 FI 和患者 LTF 的声明被认定为不准确或具有误导性。在理论上的 RCT 试验中，直到在最大显著性逆转分布中增加了 7 名 LTF 患者（几乎是 FI 的两倍），才观察到显著性逆转：如果任何 RCT 中的 LTF 患者人数超过 FI，那么只需保持研究随访，其显著性就有可能被逆转，这种说法通常是不准确的，而且在应用 FI 的骨科研究中非常普遍。患者LTF和FI并不等同。研究表明，典型 RCT 的显著性发生逆转所需的最低患者 LTF 数量大于 FI，这表明 FI 相对较低的 RCT 对患者 LTF 的敏感度可能并不像之前文献中描述的那样高；然而，只有综合考虑试验开展的背景、潜在偏倚和研究结果，才能确定任何特定 RCT 的优劣。

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引用次数: 0

Editorial Commentary: Biologics Injections for Partial-Thickness Rotator Cuff Tears Show Promise 生物制剂注射治疗部分厚度肩袖撕裂显示出前景。

IF 4.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.arthro.2024.05.012

Stephanie C. Petterson M.P.T., Ph.D. (Associate Editor)

Partial-thickness rotator cuff tears (PTRCTs) are difficult to treat. Conservative treatment typically includes physical therapy, nonsteroidal anti-inflammatory drugs, and injectables (e.g., corticosteroid injections, hyaluronic acid, platelet-rich plasma [PRP], stem cells). Recent studies have demonstrated that PRP alone or in combination with other injectables (e.g., PRP + hyaluronic acid) provides a positive short-term therapeutic benefit in patients with PTRCTs. Yet, effects tend to diminish after 1 year. Up to 42% of patients with PTRCTs treated conservatively exhibit tear progression necessitating surgical intervention, and some research shows that PRP may inhibit tendon regeneration. The efficacy and safety of PRP preparations and concentrations can vary, and the optimal biologic injectable and formulation is unknown. Yet, preoperative corticosteroid injections can increase risk of infection after shoulder arthroscopy; thus, continued investigation of biologic injection for rotator cuff tears is indicated.

部分厚度肩袖撕裂（PTRCT）很难治疗。保守治疗通常包括物理疗法、非类固醇抗炎药物和注射剂（如皮质类固醇注射剂、透明质酸、富血小板血浆、干细胞）。最近的研究表明，PRP 单独使用或与其他注射剂联合使用（如 PRP + HA）可为 PTRCTs 患者带来积极的短期治疗效果。然而，一年后效果会逐渐减弱。在接受保守治疗的 PTRCTs 患者中，高达 42% 的患者会出现撕裂进展，需要进行手术干预，而且一些研究表明 PRP 可能会抑制肌腱再生。PRP 制剂和浓度的疗效和安全性各不相同，最佳的生物注射剂和配方尚不清楚。然而，术前 CSI 可能会增加肩关节镜手术后感染的风险；因此，应继续研究肩袖撕裂的生物注射疗法。

引用次数: 0

Editorial Commentary: The Fragility Index Minimally Improves Interpretation of the Medical Literature: A Boat Made of Bricks in a Sea of Uncertainty 脆性指数可在最小程度上改进医学文献的解读：不确定性海洋中的砖块之舟

IF 4.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.arthro.2024.10.007

Mark P. Cote D.P.T., M.S.C.T.R. (Deputy Editor, Statistics) , Augustus D. Mazzocca M.S., M.D. , Jon P. Warner M.D.

The fragility index (FI) is statistical significance in a costume. Perhaps attractive and amusing, but behind the mask, it’s nothing more than spin, dichotomizing results as “statistically significant” versus “not”. In the medical literature, we must stop dichotomizing and start measuring the magnitude of effect and the uncertainty in this estimate. Statistical significance is thought stifling. Yet, it is the tool with which the medical research community has been provided. No wonder we dichotomize results; we’ve been encouraged to do so. The question is, “Will we recognize the folly in this exercise and move on to more critical questions of relevance and accuracy of published research?” The FI is heralded as a metric that provides insight beyond statistical significance. Rather than provide a measure of uncertainty, which is what fragility implies, it quantifies the number of patients needed to produce a P value that’s greater than .05. Unfortunately, although well intended, the FI is not a surrogate for robustness of clinical trial data, nor the underlying statistical analysis. In contrast, reporting and interpreting a confidence interval more effectively provides a sense of uncertainty. While far from perfect, the confidence interval provides a range of values that are compatible with the observed study data. This makes the uncertainty of the data transparent. Advancing our understanding of the data starts with stepping away from statistical significance.

脆性指数（FI）是统计学意义的一种伪装。也许它很吸引人，也很有趣，但在它的面具背后，不过是将结果二分为 "具有统计学意义 "和 "不具有统计学意义"。在医学文献中，我们必须停止二分法，开始衡量效果的大小以及这种估计的不确定性。统计显著性会扼杀思想。然而，这是医学研究界所掌握的工具。难怪我们会将结果二分法；我们一直被鼓励这样做。问题是，"我们是否会认识到这种做法的愚蠢，并转而思考已发表研究的相关性和准确性等更关键的问题？FI被誉为一种能提供超越统计意义的洞察力的指标。它不是对不确定性的测量（这正是脆性的含义），而是对产生大于 0.05 的 p 值所需的患者人数进行量化。遗憾的是，尽管初衷是好的，但脆性指数并不能代替临床试验数据的稳健性，也不能代替基本的统计分析。相比之下，报告和解释置信区间能更有效地提供一种不确定感。尽管可信区间远非完美，但它提供了一个与观察到的研究数据相符的数值范围。这使得数据的不确定性变得透明。要加深对数据的理解，首先要摆脱统计意义的束缚。

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引用次数: 0

Posterior Shoulder Instability, Part II—Glenoid Bone Grafting, Glenoid Osteotomy, and Rehabilitation/Return to Play—An International Expert Delphi Consensus Statement 肩关节后方失稳第二部分--蝶骨移植、蝶骨截骨和康复/重返赛场--国际专家德尔菲共识声明。

IF 4.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.arthro.2024.04.034

Eoghan T. Hurley M.D., Ph.D. , Zachary S. Aman M.D. , Tom R. Doyle M.B., M.Ch. , Jay M. Levin M.D., M.B.A. , Bogdan A. Matache MD, CM, FRCSC , Peter N. Chalmers MD , Brian R. Waterman MD , Brandon J. Erickson MD , Christopher S. Klifto M.D. , Oke A. Anakwenze M.D., M.B.A. , Jonathan F. Dickens M.D.

Purpose

To establish consensus statements on glenoid bone grafting, glenoid osteotomy, rehabilitation, return to play, and follow-up for posterior shoulder instability.

Methods

A consensus process on the treatment of posterior shoulder instability was conducted, with 71 shoulder/sports surgeons from 12 countries participating on the basis of their level of expertise in the field. Experts were assigned to 1 of 6 working groups defined by specific subtopics within posterior shoulder instability. Consensus was defined as achieving 80% to 89% agreement, whereas strong consensus was defined as 90% to 99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement.

Results

All of the statements relating to rehabilitation, return to play, and follow-up achieved consensus. There was unanimous consensus that the following criteria should be considered: restoration of strength, range of motion, proprioception, and sport-specific skills, with a lack of symptoms. There is no minimum time point required to return to play. Collision athletes and military athletes may take longer to return because of their greater risk for recurrent instability, and more caution should be exercised in clearing them to return to play, with elite athletes potentially having different considerations in returning to play. The relative indications for revision surgery are symptomatic apprehension, multiple recurrent instability episodes, further intra-articular pathologies, hardware failure, and pain.

Conclusions

The study group achieved strong or unanimous consensus on 59% of statements. Unanimous consensus was reached regarding the criteria for return to play, collision/elite athletes having different considerations in return to play, indications for revision surgery, and imaging only required as routine for those with glenoid bone grafting/osteotomies at subsequent follow-ups. There was no consensus on optimal fixation method for a glenoid bone block, the relative indications for glenoid osteotomy, whether fluoroscopy is required or if the labrum should be concomitantly repaired.

Level of Evidence

Level V, expert opinion.

目的：本研究旨在就肩关节后路不稳的盂骨移植、盂骨截骨、康复、重返赛场和随访等问题达成共识：根据来自 12 个国家的 71 名肩关节/运动外科医生在该领域的专业水平，就肩关节后方不稳定的治疗方法达成了共识。专家们被分配到 6 个工作组中的一个，这 6 个工作组是根据肩关节后方不稳定的特定子课题定义的。共识的定义是达成 80-89% 的一致意见，强烈共识的定义是达成 90-99% 的一致意见，而一致共识则是对某项建议声明达成 100% 的一致意见：结果：所有与康复、重返赛场和随访相关的声明都达成了共识。一致同意应考虑以下标准：恢复力量、活动范围、本体感觉和运动特定技能，且无症状。恢复比赛没有最低时间要求。碰撞运动员和军事运动员可能需要更长的时间才能重返赛场，因为他们复发不稳的风险较高，在批准他们重返赛场时应更加谨慎，精英运动员在重返赛场时可能有不同的考虑因素。翻修手术的相对适应症是症状性忧虑、多次复发不稳定、进一步的关节内病变、硬件故障和疼痛：研究小组就 59% 的声明达成了强烈或一致的共识。在重返赛场的标准、碰撞/精英运动员在重返赛场时的不同考虑、翻修手术的适应症、盂骨移植/正中切口者在后续随访时只需常规进行影像学检查等方面达成了一致共识。对于盂骨块的最佳固定方法、盂骨截骨术的相对适应症、是否需要透视或是否应同时修复盂唇等问题尚未达成共识：专家意见。

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引用次数: 0

Editorial Commentary: Microfragmented Adipose Tissue May Provide an Effective Injection Treatment Modality for Arthritic Knee Pain With 1-Year Improvement in Pain and Function 微碎屑脂肪组织可为膝关节炎疼痛提供一种有效的注射治疗方式，并在一年内改善疼痛和功能。

IF 4.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.arthro.2024.09.048

Mark Girard Siegel M.D. (Editorial Board)

Injectable treatments for arthritic knee pain continue to evolve. This is significant, considering that osteoarthritis is the most common orthopaedic pathology in adult patients. The Centers for Disease Control and Prevention report that 16.9% of all adults are affected, and by age 65 years, almost one-half of the population will experience pain related to cartilage degradation. Steroid injections show only short-term improvements. Both viscosupplementation using hyaluronates and platelet-rich plasma injection show inconsistent long-term results. Recently microfragmented adipose tissue injections in the office setting have been shown to provide symptomatic improvement at 6 and 12 months in patients with knee pain from degenerative joint disease. Additional studies are needed to confirm the reproducibility of this finding. Most of all, study of injections for knee arthritis must include a placebo control (saline injection) to truly demonstrate efficacy.

膝关节炎疼痛的注射疗法在不断发展。考虑到骨关节炎是成年患者最常见的骨科病症，这一点意义重大。据美国疾病控制和预防中心报告，16.9% 的成年人都会受到骨关节炎的影响，到 65 岁时，几乎一半的人都会经历与软骨退化有关的疼痛。类固醇注射只能在短期内改善症状。使用透明质酸盐进行粘度补充和注射富血小板血浆都显示出不一致的长期效果。最近的研究表明，在诊室注射微碎屑脂肪组织可在 6 个月和 12 个月后改善退行性关节病引起的膝关节疼痛患者的症状。还需要更多的研究来证实这一发现的可重复性。最重要的是，膝关节炎注射研究必须包括安慰剂对照（生理盐水注射），才能真正证明疗效。

引用次数: 0

Injectable Therapeutic Peptides—An Adjunct to Regenerative Medicine and Sports Performance? 注射治疗肽--再生医学和运动表现的辅助手段？

IF 4.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-02-01 DOI: 10.1016/j.arthro.2024.09.005

Mikalyn T. DeFoor M.D., Travis J. Dekker M.D.

High-level athletes and bodybuilders are constantly seeking novel therapies to enhance recovery and expedite return from injury—injectable peptides are a new and trending therapy that may be the wave of the future in the realm of regenerative medicine research in treating joint injuries and osteoarthritis. Very early in vivo research on pharmacokinetics indicates the possibility that body protection compound 157 (BPC-157) is at the forefront of therapeutic peptides, with early demonstrations of this experimental peptide optimizing endurance training, metabolism, recovery, and tissue repair. Although unregulated and yet readily available for purchase over the internet, there is scarce orthopaedic literature investigating the clinical use and outcomes of such therapeutic peptides in tendon, muscle, and cartilage injury. However, this has not slowed the recent exponential growth of the multi-billion-dollar industry in the development of therapeutic peptides. As orthopaedic surgeons and team physicians, we should stay up to date with the latest pharmacokinetic, safety, ethical, and legal profiles and regulations regarding synthetic peptide supplementation for injury recovery and sports performance optimization in our patients, from elite athletes to fitness fanatics, because they will continue to seek the latest and greatest in treatment options and will be approaching us with questions on their results, risks, and benefits.

高水平运动员和健美运动员一直在寻求新的疗法，以促进恢复和加快伤后康复--注射肽是一种新的趋势性疗法，可能成为再生医学研究领域治疗关节损伤和骨关节炎的未来趋势。早期的体内药代动力学研究表明，人体保护化合物 157（BPC-157）似乎走在了治疗肽的最前沿，这些实验性肽可优化耐力训练、新陈代谢、恢复和组织修复。虽然这些治疗肽不受管制，而且可以在互联网上随时购买，但很少有骨科文献研究这些治疗肽在肌腱、肌肉和软骨损伤中的临床应用和效果。然而，这并没有减缓最近数十亿美元的治疗肽开发产业的指数级增长。作为骨科外科医生和队医，我们应该随时了解有关合成肽补充剂用于损伤恢复和运动表现优化的最新药代动力学、安全性、道德和法律规定，从我们的精英运动员到我们的健身狂热者，因为这些患者将继续寻求最新和最好的治疗方案，并会带着有关其效果、风险和益处的问题来找我们。

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引用次数: 0

Current Definitions of Return to Play After Medial Ulnar Collateral Ligament Injuries and Surgery in Professional Baseball Players Prohibit Cross-Study Comparison: A Systematic Review.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-01-30 DOI: 10.1016/j.arthro.2025.01.030

Timothy R Buchanan, Andrew H A Kaiser, Keegan M Hones, Sravya Kamarajugadda, Brandon Portnoff, Victoria E Bindi, Jonathan O Wright, Ryan P Roach, Kevin W Farmer, Xinning Li, Joseph J King, Kevin A Hao

Purpose: The current review assesses the definitions of return to play (RTP) and return to same level of play (RTSP) utilized in literature describing UCL injuries in professional baseball players.

Methods: A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases were queried to identify all articles that included UCL injuries between January 2002 and October 2022. Studies of only Major League Baseball (MLB) and Minor League Baseball (MiLB) players were included and summarized descriptively.

Results: We included 29 articles (24 reporting RTP, 23 reporting RTSP). Minimum level of play was not included in 46% of RTP definitions and 26% of RTSP definitions; when defined, return to MLB level only was most common in RTP definitions (25%) and return to either MLB or MiLB level was most common in RTSP definitions (39%). Time to return was frequently not included (96% of RTP and RTSP definitions); when defined, return within 2 full seasons after injury was the sole definition used. Duration of play after return was frequently not included (50% and 61%, respectively); when defined, a one game minimum was most utilized (42% and 17%, respectively). No study used performance measures (e.g., strikeouts, earned run average [ERA], etc.) to define RTP or RTSP.

Conclusions: Definitions of RTP and RTSP in the UCL injury literature for professional baseball players of all positions are vague, heterogenous, and prohibit cross-study comparison.

Clinical relevance: The present study investigates the definitions for RTP and RTSP used across professional baseball UCL injury literature in hopes of identifying common threads to promote future cross-study comparison.

{"title":"Current Definitions of Return to Play After Medial Ulnar Collateral Ligament Injuries and Surgery in Professional Baseball Players Prohibit Cross-Study Comparison: A Systematic Review.","authors":"Timothy R Buchanan, Andrew H A Kaiser, Keegan M Hones, Sravya Kamarajugadda, Brandon Portnoff, Victoria E Bindi, Jonathan O Wright, Ryan P Roach, Kevin W Farmer, Xinning Li, Joseph J King, Kevin A Hao","doi":"10.1016/j.arthro.2025.01.030","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.01.030","url":null,"abstract":"<p><strong>Purpose: </strong>The current review assesses the definitions of return to play (RTP) and return to same level of play (RTSP) utilized in literature describing UCL injuries in professional baseball players.</p><p><strong>Methods: </strong>A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases were queried to identify all articles that included UCL injuries between January 2002 and October 2022. Studies of only Major League Baseball (MLB) and Minor League Baseball (MiLB) players were included and summarized descriptively.</p><p><strong>Results: </strong>We included 29 articles (24 reporting RTP, 23 reporting RTSP). Minimum level of play was not included in 46% of RTP definitions and 26% of RTSP definitions; when defined, return to MLB level only was most common in RTP definitions (25%) and return to either MLB or MiLB level was most common in RTSP definitions (39%). Time to return was frequently not included (96% of RTP and RTSP definitions); when defined, return within 2 full seasons after injury was the sole definition used. Duration of play after return was frequently not included (50% and 61%, respectively); when defined, a one game minimum was most utilized (42% and 17%, respectively). No study used performance measures (e.g., strikeouts, earned run average [ERA], etc.) to define RTP or RTSP.</p><p><strong>Conclusions: </strong>Definitions of RTP and RTSP in the UCL injury literature for professional baseball players of all positions are vague, heterogenous, and prohibit cross-study comparison.</p><p><strong>Clinical relevance: </strong>The present study investigates the definitions for RTP and RTSP used across professional baseball UCL injury literature in hopes of identifying common threads to promote future cross-study comparison.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Lateral Femoral Notch Sign Presence, Location, and Depth Are Not Associated with Primary Anterior Cruciate Ligament Reconstruction Failure: A Retrospective Case-Control Study.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-01-30 DOI: 10.1016/j.arthro.2025.01.029

Anna M Ifarraguerri, Michael S Collins, Ainsley K Bloomer, Kennedy K Gachigi, David Trofa, Patrick Siparsky, Dana P Piasecki, James E Fleischli, Bryan M Saltzman

Purpose: The purpose of this study is to assess the relationship between the presence, depth, and location of the lateral femoral notch sign (LFNS) on preoperative MRI and the risk of ACL reconstruction (ACLR) graft failure, as well as secondary return to sport (RTS) endpoints.

Methods: Patients with primary ACLR failure between 2012 and 2021 with a minimum of a 2-year follow-up were identified and matched to patients without primary ACLR failure by sex, age, and BMI. Patients with incomplete medical records or concomitant lateral extra-articular tenodesis or anterolateral ligament reconstruction were excluded. The LFNS presence, depth and location were recorded from patients' preoperative MRI. Intraoperative data, concomitant injuries, ACLR failure, and return to sport (RTS) were collected.

Results: Of the 253 included patients, 158(62.5%) were male, the mean age was 22 ± 9.1 years old, and the mean body mass index (BMI) was 25.7 ± 5.7 kg/m2. 87(34.4%) had a LFNS on preoperative MRI. There was no difference in the prevalence of the LFNS between patients with primary ACLR failure (42(32.1%)) and without primary ACLR failure (45(36.9%)) (OR 1.24, 95% CI 0.74 to 2.08; P=0.42). Among patients with the LFNS, there was no difference in mean depth between those with and without primary ACLR failure, or when stratifying depth by 1.0-1.5mm, 1.5-2.0mm, and >2.0mm. The mean location of the LFNS from Blumensaat line did not differ between patients with or without primary ACLR failure, and RTS rate, level, and time were comparable between patients with and without the LFNS.

Conclusion: There was no significant difference in the presence, depth or location of LFNS in patients with and without primary ACLR failure. Presence of the LFNS is not associated with additional risk of primary ACLR failure, and clinical outcomes were comparable in patients with and without the LFNS.

Level of evidence: Retrospective case-control study; IV.

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引用次数: 0

Patients Undergoing Hip Arthroscopy with Periportal and Puncture Capsulotomy Demonstrate Favorable Outcomes at Short-Term Follow-Up: A Systematic Review.

IF 4.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-01-30 DOI: 10.1016/j.arthro.2025.01.027

Trevan Klug, James D Fox, Raquel Rosa, Nicholas Pettinelli, Scott Fong, Soheil Sabzevari, Michael S Lee, Jay Moran, Nancy Park, Ronak J Mahatme, Stephen M Gillinov, Andrew E Jimenez

Purpose: To evaluate whether patients undergoing primary hip arthroscopy with periportal or puncture capsulotomy demonstrate improved PROs at minimum 2-year follow-up when compared to pre-operative PROs.

Methods: A systematic review was performed and registered in PROSPERO under ID: CRD42023466053. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus were searched in October of 2024 using the following string: (capsul* OR puncture OR periportal) and (hip OR femoroacetabular impingement) AND (arthroscop*). Articles were included if they reported pre-operative and minimum 2-year follow-up PROs in patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement (FAI) and/or labral tears with periportal or puncture capsulotomy and were written in English.

Results: Six studies were included, with five studies reporting outcomes on periportal capsulotomy 313 hips) and one study on puncture capsulotomy (163 hips). Three studies were level IV evidence and three were level III. Study periods ranged from 2013-2020. Average improvement in the modified Harris Hip Score (mHHS) ranged from 21.1-32.56 (I2=97%). Average improvement in the Visual Analog Scale for pain (VAS Pain) ranged from -2.5- (-5.3) (I2=94%). Minimal Clinically Important Difference (MCID) was achieved by 65.0-100% of patients for Hip Outcome Score - Activities of Daily Living (HOS-ADL), 71.8-88% for HOS-Sport, and 62.5-78% for VAS Pain. Three studies reported rates of secondary total hip arthroplasty (THA), ranging from 0%-1.7%.

Conclusion: Patients undergoing hip arthroscopy with periportal capsulotomy showed improvements in multiple PROs at a minimum of 2-year follow-up. Periportal capsulotomy appears to be an effective capsulotomy technique in patients undergoing hip arthroscopy for the treatment of FAI and/or labral tears. Preliminary evidence shows puncture capsulotomy may be an effective way to access the capsule during hip arthroscopy, but conclusions are limited given the lack of studies available.

Level of evidence: IV, Systematic Review of Level III and IV studies.

{"title":"Patients Undergoing Hip Arthroscopy with Periportal and Puncture Capsulotomy Demonstrate Favorable Outcomes at Short-Term Follow-Up: A Systematic Review.","authors":"Trevan Klug, James D Fox, Raquel Rosa, Nicholas Pettinelli, Scott Fong, Soheil Sabzevari, Michael S Lee, Jay Moran, Nancy Park, Ronak J Mahatme, Stephen M Gillinov, Andrew E Jimenez","doi":"10.1016/j.arthro.2025.01.027","DOIUrl":"https://doi.org/10.1016/j.arthro.2025.01.027","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate whether patients undergoing primary hip arthroscopy with periportal or puncture capsulotomy demonstrate improved PROs at minimum 2-year follow-up when compared to pre-operative PROs.</p><p><strong>Methods: </strong>A systematic review was performed and registered in PROSPERO under ID: CRD42023466053. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus were searched in October of 2024 using the following string: (capsul* OR puncture OR periportal) and (hip OR femoroacetabular impingement) AND (arthroscop*). Articles were included if they reported pre-operative and minimum 2-year follow-up PROs in patients who underwent hip arthroscopy for the treatment of femoroacetabular impingement (FAI) and/or labral tears with periportal or puncture capsulotomy and were written in English.</p><p><strong>Results: </strong>Six studies were included, with five studies reporting outcomes on periportal capsulotomy 313 hips) and one study on puncture capsulotomy (163 hips). Three studies were level IV evidence and three were level III. Study periods ranged from 2013-2020. Average improvement in the modified Harris Hip Score (mHHS) ranged from 21.1-32.56 (I2=97%). Average improvement in the Visual Analog Scale for pain (VAS Pain) ranged from -2.5- (-5.3) (I2=94%). Minimal Clinically Important Difference (MCID) was achieved by 65.0-100% of patients for Hip Outcome Score - Activities of Daily Living (HOS-ADL), 71.8-88% for HOS-Sport, and 62.5-78% for VAS Pain. Three studies reported rates of secondary total hip arthroplasty (THA), ranging from 0%-1.7%.</p><p><strong>Conclusion: </strong>Patients undergoing hip arthroscopy with periportal capsulotomy showed improvements in multiple PROs at a minimum of 2-year follow-up. Periportal capsulotomy appears to be an effective capsulotomy technique in patients undergoing hip arthroscopy for the treatment of FAI and/or labral tears. Preliminary evidence shows puncture capsulotomy may be an effective way to access the capsule during hip arthroscopy, but conclusions are limited given the lack of studies available.</p><p><strong>Level of evidence: </strong>IV, Systematic Review of Level III and IV studies.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143076388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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