Pub Date : 2024-10-01DOI: 10.1016/j.arthro.2024.07.009
There are multiple reasons for a clinician to consider serving as a manuscript reviewer, including improving their clinical knowledge and research skills, becoming a better writer, and making contributions to advancing scientific knowledge. Reviewers for the Arthroscopy family of journals can find essential tools on the journal websites, including a Journal Course for Writers and Reviewers: Checklists and Templates for Original Scientific Articles, Checklists and Templates for Systematic Reviews and Meta-Analyses, and a Research Pearls Collection. Arthroscopy reviewers provide journal editors with Confidential Comments, on which the editors heavily rely, summarizing study strengths and limitations as well as rationale supporting the reviewer’s recommendation as to whether the submission is recommended for publication. In addition, reviewers provide Comments to Authors suggesting opportunities to improve the research whether or not the article is recommended for publication; the goal is to provide helpful feedback. Key areas of reviewer focus are reproducible methods (like a cookbook), clinical (rather than statistical) significance, illustrative and well-labeled figures, and detailed figure legends. Most of all, reviewers must ensure that the conclusion of a study is based entirely on the study results and thus whether or not the study hypothesis is or is not supported by the results. Crucially, reviewers must ensure that authors resist the common temptation to state conclusions that go beyond or overreach the study results.
{"title":"Essentials of Scientific Manuscript Review","authors":"","doi":"10.1016/j.arthro.2024.07.009","DOIUrl":"10.1016/j.arthro.2024.07.009","url":null,"abstract":"<div><div>There are multiple reasons for a clinician to consider serving as a manuscript reviewer, including improving their clinical knowledge and research skills, becoming a better writer, and making contributions to advancing scientific knowledge. Reviewers for the <em>Arthroscopy</em> family of journals can find essential tools on the journal websites, including a Journal Course for Writers and Reviewers: Checklists and Templates for Original Scientific Articles, Checklists and Templates for Systematic Reviews and Meta-Analyses, and a Research Pearls Collection. <em>Arthroscopy</em> reviewers provide journal editors with Confidential Comments, on which the editors heavily rely, summarizing study strengths and limitations as well as rationale supporting the reviewer’s recommendation as to whether the submission is recommended for publication. In addition, reviewers provide Comments to Authors suggesting opportunities to improve the research whether or not the article is recommended for publication; the goal is to provide helpful feedback. Key areas of reviewer focus are reproducible methods (like a cookbook), clinical (rather than statistical) significance, illustrative and well-labeled figures, and detailed figure legends. Most of all, reviewers must ensure that the conclusion of a study is based entirely on the study results and thus whether or not the study hypothesis is or is not supported by the results. Crucially, reviewers must ensure that authors resist the common temptation to state conclusions that go beyond or overreach the study results.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513446","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}
Pub Date : 2024-10-01DOI: 10.1016/j.arthro.2024.06.036
Despite a push for a focus on clinical rather than “statistical” significance and an emphasis on reporting of outcome thresholds such as the patient acceptable symptomatic state (PASS) and substantial clinical benefit (SCB), the PASS and SCB are rarely reported and, when reported, are often reported incorrectly. Yet, patients require satisfaction (PASS) as a result of our treatments, and patients desire to improve substantially (SCB). Determining whether patients are satisfied and/or substantially improved is simple . . . just ask them. The questions are known as anchor questions. Obviously, different patients have different PASS and SCB thresholds, and reliance on previously published literature for values of these thresholds can result in error—thus, the anchor questions. And, each patient must be assessed individually. Outcome thresholds are not group-level metrics, and they must be reported as the percentage of individuals who achieve the clinically significant outcome. Certain patients, such as athletes, have high baseline function and may demand maximum outcome improvement. In contrast, the minimal clinically important difference is a less-than-ideal measure; patients do not desire “minimal” improvement. Journals must do a better job of publishing patient-reported outcome measures that matter most to patients: satisfaction and substantial benefit.
{"title":"Patient Acceptable Symptomatic State and Substantial Clinical Benefit Matter Most to Patients and Must Be Reported Correctly","authors":"","doi":"10.1016/j.arthro.2024.06.036","DOIUrl":"10.1016/j.arthro.2024.06.036","url":null,"abstract":"<div><div>Despite a push for a focus on clinical rather than “statistical” significance and an emphasis on reporting of outcome thresholds such as the patient acceptable symptomatic state (PASS) and substantial clinical benefit (SCB), the PASS and SCB are rarely reported and, when reported, are often reported incorrectly. Yet, patients require satisfaction (PASS) as a result of our treatments, and patients desire to improve substantially (SCB). Determining whether patients are satisfied and/or substantially improved is simple . . . just ask them. The questions are known as anchor questions. Obviously, different patients have different PASS and SCB thresholds, and reliance on previously published literature for values of these thresholds can result in error—thus, the anchor questions. And, each patient must be assessed individually. Outcome thresholds are not group-level metrics, and they must be reported as the percentage of individuals who achieve the clinically significant outcome. Certain patients, such as athletes, have high baseline function and may demand maximum outcome improvement. In contrast, the minimal clinically important difference is a less-than-ideal measure; patients do not desire “minimal” improvement. Journals must do a better job of publishing patient-reported outcome measures that matter most to patients: satisfaction and substantial benefit.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545603","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}
Pub Date : 2024-10-01DOI: 10.1016/j.arthro.2024.04.021
Is “killing the biceps” during rotator cuff repair a capital crime or a lawful act? One of the most passionately debated topics in shoulder surgery is what to do with the biceps during rotator cuff repair: save it, tenotomize it, or perform tenodesis. Results of repair are not very successful, and given that repair of massive rotator cuff tears shows a 40% to 57% failure rate, there is renewed interest in sparing the biceps tendon as a humeral head depressor—or so that it may be used as a local graft for revision rotator cuff repair. The literature regarding tenodesis versus biceps sparing during rotator cuff repair is controversial. There are so many confounding variables affecting rotator cuff repair outcomes (tear size, comorbidities, age, tissue quality, etc.) that we do not believe that anything less than a randomized, prospective study that matches groups is likely to provide a conclusive verdict.
{"title":"Editorial Commentary: Biceps Management During Rotator Cuff Tear: Confounding Variables Result in Unclear Indications","authors":"","doi":"10.1016/j.arthro.2024.04.021","DOIUrl":"10.1016/j.arthro.2024.04.021","url":null,"abstract":"<div><div>Is “killing the biceps” during rotator cuff repair a capital crime or a lawful act? One of the most passionately debated topics in shoulder surgery is what to do with the biceps during rotator cuff repair: save it, tenotomize it, or perform tenodesis. Results of repair are not very successful, and given that repair of massive rotator cuff tears shows a 40% to 57% failure rate, there is renewed interest in sparing the biceps tendon as a humeral head depressor—or so that it may be used as a local graft for revision rotator cuff repair. The literature regarding tenodesis versus biceps sparing during rotator cuff repair is controversial. There are so many confounding variables affecting rotator cuff repair outcomes (tear size, comorbidities, age, tissue quality, etc.) that we do not believe that anything less than a randomized, prospective study that matches groups is likely to provide a conclusive verdict.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872159","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}
Pub Date : 2024-10-01DOI: 10.1016/j.arthro.2024.01.032
Purpose
To assess serial changes of preoperative bone marrow lesion (BML) following medial open-wedge high tibial osteotomy (MOWHTO) up to 2 years and evaluate whether postoperative change of BML affected patient-reported outcome measures (PROMs) at 2 years’ follow-up. Factors related to the postoperative changes in BML also were evaluated.
Methods
The current study retrospectively assessed prospectively collected data of consecutive patients between December 2016 and March 2018 who underwent MOWHTO for symptomatic knee osteoarthritis with varus malalignment (≥5°) and a minimum 2-year follow-up. Serial magnetic resonance imaging scans at preoperative and postoperative 3, 6, 18, and 24 months were performed, and the extent of BML was evaluated consecutively using 2 validated methods. Clinically, preoperative and postoperative PROMs and their achievement of minimal clinically important difference values were evaluated. The associations of the extent of BMLs with PROMs at each follow-up period over time were analyzed using a linear mixed model. Furthermore, factors related to the postoperative changes of BML were assessed.
Results
Of 26 patients, 21 (80.8%) had preoperative BML at medial femoral and tibial condyles. The postoperative decrease in BML was noted in 17 (81.0%) and 18 (85.7%) at medial femoral and tibial condyles. The BML decreased at postoperative 3 months and, thereafter, the extent of BML gradually reduced until postoperative 24 months. The proportion of patients achieved minimal clinically important difference was 84.6% for total Western Ontario and McMaster Universities Osteoarthritis Index scores and 80.8%, 76.9%, and 84.6% for KOOS symptom, pain, and activity of daily living subscales. Postoperative decrease in BML was significantly associated with better PROMs over postoperative 24 months. Furthermore, normo-correction (2°-5° valgus) was a significant factor for decreased BML following MOWHTO.
Conclusions
Preoperative BML gradually decreased with time following MOWHTO, and the postoperative decrease in BML related with better PROMs over postoperative 24 months. Moreover, postoperative valgus alignment was a significant factor relating the postoperative decrease of BML.
{"title":"Postoperative Decrease in Bone Marrow Lesion Associated With Better Clinical Outcomes Following Medial Open-Wedge High Tibial Osteotomy","authors":"","doi":"10.1016/j.arthro.2024.01.032","DOIUrl":"10.1016/j.arthro.2024.01.032","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess serial changes of preoperative bone marrow lesion (BML) following medial open-wedge high tibial osteotomy (MOWHTO) up to 2 years and evaluate whether postoperative change of BML affected patient-reported outcome measures (PROMs) at 2 years’ follow-up. Factors related to the postoperative changes in BML also were evaluated.</div></div><div><h3>Methods</h3><div><span>The current study retrospectively assessed prospectively collected data of consecutive patients between December 2016 and March 2018 who underwent MOWHTO for symptomatic knee osteoarthritis with varus malalignment (≥5°) and a minimum 2-year follow-up. Serial magnetic resonance imaging scans at preoperative and postoperative 3, 6, 18, and 24 months were performed, and the extent of BML was evaluated consecutively using 2 validated methods. Clinically, preoperative and postoperative PROMs and their achievement of </span>minimal clinically important difference values were evaluated. The associations of the extent of BMLs with PROMs at each follow-up period over time were analyzed using a linear mixed model. Furthermore, factors related to the postoperative changes of BML were assessed.</div></div><div><h3>Results</h3><div><span>Of 26 patients, 21 (80.8%) had preoperative BML at medial femoral and tibial condyles. The postoperative decrease in BML was noted in 17 (81.0%) and 18 (85.7%) at medial femoral and tibial condyles. The BML decreased at postoperative 3 months and, thereafter, the extent of BML gradually reduced until postoperative 24 months. The proportion of patients achieved minimal clinically important difference was 84.6% for total </span>Western Ontario and McMaster Universities Osteoarthritis Index<span> scores and 80.8%, 76.9%, and 84.6% for KOOS<span> symptom, pain, and activity of daily living subscales. Postoperative decrease in BML was significantly associated with better PROMs over postoperative 24 months. Furthermore, normo-correction (2°-5° valgus) was a significant factor for decreased BML following MOWHTO.</span></span></div></div><div><h3>Conclusions</h3><div>Preoperative BML gradually decreased with time following MOWHTO, and the postoperative decrease in BML related with better PROMs over postoperative 24 months. Moreover, postoperative valgus alignment was a significant factor relating the postoperative decrease of BML.</div></div><div><h3>Level of Evidence</h3><div>Level IV, retrospective case series.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708616","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}
Pub Date : 2024-10-01DOI: 10.1016/j.arthro.2024.02.032
Purpose
To analyze the results of the subscapular sling procedure developed for anterior shoulder instability in patients with less than 10% anterior glenoid bone loss.
Methods
Patients were treated surgically with the arthroscopic subscapular sling procedure. A semitendinosus graft was used to reconstruct the anterior labrum and to establish a sling suspension around the upper part of the subscapularis tendon. The patients were followed up with radiographs (at 12 and 24 months). Magnetic resonance imaging (MRI) of the shoulder region and clinical examinations were performed at 3, 12, and 24 months. Recurrent dislocation was the primary endpoint. The Western Ontario Shoulder Instability Index (WOSI) and MRI results were secondary outcome measures. An independent physiotherapist assessed residual instability and range of motion.
Results
Fifteen patients were included with a dislocation rate of 0% after 24 months follow-up. There was a significant clinical improvement of the WOSI score from 57% (904) at baseline to 88% (241) at 24 months (P < .001). The proportion of patients with an improvement in the WOSI Total score larger than the estimated minimal clinically important difference was 100% both at 12 and 24 months. MRI showed an intact sling in all patients. External rotation was not significantly reduced (52° at baseline vs 47° at 24 months, P = .211). Flexion and abduction were significantly improved from 152° to 174° (P = .001) and 141° to 170° (P < .001) after 24 months. The surgical procedures were completed without any intraoperative complications.
Conclusions
The subscapular sling procedure resulted in low recurrent shoulder instability and improved patient-reported outcome measures at 24 months of follow-up.
Level of Evidence
Level IV, case series.
目的：本研究的目的是分析肩胛下吊带术的效果，该手术是针对肩关节前侧不稳定而开发的，适用于盂前骨质缺损少于10%的患者。目的是探讨该手术能否成功预防肩关节复发性脱位：患者采用关节镜下肩胛下吊带术进行手术治疗。使用半腱肌移植物重建前唇，并在肩胛下肌腱上部建立吊带悬吊。对患者进行了 X 光随访（12 个月和 24 个月）。3个月、12个月和24个月时进行肩部磁共振成像（MRI）和临床检查。复发性脱位是主要终点。西安大略省肩关节不稳定指数（WOSI）和核磁共振成像结果是次要结果测量指标。一位独立理疗师对残余不稳定性和ROM进行了评估：随访24个月后，15名患者脱位率为0%。WOSI评分有了明显的临床改善，从基线时的57%（904人）提高到24个月时的88%（241人）（p < 0.001）。12个月和24个月时，WOSI总分改善幅度大于最小临床意义差异（MCID）估计值的患者比例均为100%。磁共振成像显示，所有患者的吊带都完好无损。外旋没有明显减少（基线为52°，24个月时为47°，P = 0.211）。屈伸和外展则有明显改善，分别从152°增至174°（P=0.001）和141°增至170°（P=0.001）：肩胛下吊带术后复发的肩关节不稳定性较低，24个月随访时患者报告的结果也有所改善。
{"title":"The Arthroscopic Subscapular Sling Procedure Results in Low Recurrent Anterior Shoulder Instability at 24 Months of Follow-Up","authors":"","doi":"10.1016/j.arthro.2024.02.032","DOIUrl":"10.1016/j.arthro.2024.02.032","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze the results of the subscapular sling procedure developed for anterior shoulder instability in patients with less than 10% anterior glenoid bone loss.</div></div><div><h3>Methods</h3><div>Patients were treated surgically with the arthroscopic subscapular sling procedure. A semitendinosus graft was used to reconstruct the anterior labrum and to establish a sling suspension around the upper part of the subscapularis tendon. The patients were followed up with radiographs (at 12 and 24 months). Magnetic resonance imaging (MRI) of the shoulder region and clinical examinations were performed at 3, 12, and 24 months. Recurrent dislocation was the primary endpoint. The Western Ontario Shoulder Instability Index (WOSI) and MRI results were secondary outcome measures. An independent physiotherapist assessed residual instability and range of motion.</div></div><div><h3>Results</h3><div>Fifteen patients were included with a dislocation rate of 0% after 24 months follow-up. There was a significant clinical improvement of the WOSI score from 57% (904) at baseline to 88% (241) at 24 months (<em>P</em> < .001). The proportion of patients with an improvement in the WOSI Total score larger than the estimated minimal clinically important difference was 100% both at 12 and 24 months. MRI showed an intact sling in all patients. External rotation was not significantly reduced (52° at baseline vs 47° at 24 months, <em>P</em> = .211). Flexion and abduction were significantly improved from 152° to 174° (<em>P</em> = .001) and 141° to 170° (<em>P</em> < .001) after 24 months. The surgical procedures were completed without any intraoperative complications.</div></div><div><h3>Conclusions</h3><div>The subscapular sling procedure resulted in low recurrent shoulder instability and improved patient-reported outcome measures at 24 months of follow-up.</div></div><div><h3>Level of Evidence</h3><div>Level IV, case series.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.arthro.2024.04.017
Anterior shoulder instability is common. Cases of mild glenoid bone loss are typically addressed with conventional arthroscopic Bankart repair procedures, whereas more critical glenoid bone loss often necessitates more invasive, bone-blocking procedures. Recently, for cases that fall between the need for arthroscopic repair and open procedures, surgeons have developed methods for using soft tissue grafts to create a “sling” effect and augment glenoid labral repair. The subscapular sling procedure aims to restore stability by introducing a semitendinosus autograft into the glenohumeral joint to reconstruct the torn labrum; the graft is wrapped around the subscapularis to create a suspensory sling. Limitations include harvest site morbidity; increased surgical time; subscapularis split, which can compromise the tendon integrity, resulting in loss of internal rotation; and a persistently positive apprehension test. Finally, the technique is complex, and similar alternatives with fewer limitations may include a dynamic anterior stabilization technique using the long head of the biceps tendon, which creates a stabilizing sling effect without graft harvest from the leg and has positive reported outcomes.
{"title":"Editorial Commentary: Arthroscopic Subscapular Sling Procedure for Anterior Glenohumeral Instability Has Limitations: Dynamic Anterior Stabilization Using Long Head of the Biceps Tendon May Represent a More Favorable Alternative","authors":"","doi":"10.1016/j.arthro.2024.04.017","DOIUrl":"10.1016/j.arthro.2024.04.017","url":null,"abstract":"<div><div>Anterior shoulder instability is common. Cases of mild glenoid bone loss are typically addressed with conventional arthroscopic Bankart repair procedures, whereas more critical glenoid bone loss often necessitates more invasive, bone-blocking procedures. Recently, for cases that fall between the need for arthroscopic repair and open procedures, surgeons have developed methods for using soft tissue grafts to create a “sling” effect and augment glenoid labral repair. The subscapular sling procedure aims to restore stability by introducing a semitendinosus autograft into the glenohumeral joint to reconstruct the torn labrum; the graft is wrapped around the subscapularis to create a suspensory sling. Limitations include harvest site morbidity; increased surgical time; subscapularis split, which can compromise the tendon integrity, resulting in loss of internal rotation; and a persistently positive apprehension test. Finally, the technique is complex, and similar alternatives with fewer limitations may include a dynamic anterior stabilization technique using the long head of the biceps tendon, which creates a stabilizing sling effect without graft harvest from the leg and has positive reported outcomes.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140859207","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}
Pub Date : 2024-10-01DOI: 10.1016/j.arthro.2024.07.011
{"title":"Author Reply to “Regarding ‘MRI Accurately Predicts Quadrupled Semitendinosus Autograft Size Using Posterior Hamstring Harvest for ACL Reconstruction’”","authors":"","doi":"10.1016/j.arthro.2024.07.011","DOIUrl":"10.1016/j.arthro.2024.07.011","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141768050","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}
Pub Date : 2024-10-01DOI: 10.1016/j.arthro.2024.05.030
Purpose
To determine whether anthropometric measurements (height and weight), sex, age, and preinjury Tegner Activity Scale (TAS) were predictors of the quadrupled semitendinosus (ST) graft diameter in primary anterior cruciate ligament reconstruction.
Methods
A total of 4,519 patients who underwent primary anterior cruciate ligament reconstruction with a quadrupled ST autograft were included. Anthropometric measurements (height and weight), sex, age, and preinjury TAS were collected. Correlation coefficients and multiple linear regression analysis were used to determine the relationships among graft diameter and anthropometrics measurements (height and weight), sex, age, and preinjury TAS.
Results
The diameter of the quadrupled ST graft was correlated positively to height (r = 0.021, P < .001), age (r = 0.005, P < .001), and weight (r = 0.004, P = .001) and negatively to female sex (r = –0.297, P < .001). A regression equation was estimated to predict the ST graft diameter for men as 4.245 + 0.021 × height (cm) + 0.004 × age (years) + 0.005 × weight (kg) and for women as 3.969 + 0.021 × height (cm) + 0.004 × age (years) + 0.005 × weight (kg).
Conclusions
Height, age, and weight were positively correlated, whereas female sex was negatively correlated, to the diameter of the quadrupled ST graft. Knowledge of these factors can be used for the preoperative estimation of the graft diameter which can be helpful for appropriate graft choice.
{"title":"Patient’s Height and Sex Predict Graft Diameter: A Cohort Study of 4,519 Patients With Primary Anterior Cruciate Ligament Reconstruction Using Semitendinosus Autograft","authors":"","doi":"10.1016/j.arthro.2024.05.030","DOIUrl":"10.1016/j.arthro.2024.05.030","url":null,"abstract":"<div><h3>Purpose</h3><div>To determine whether anthropometric measurements (height and weight), sex, age, and preinjury Tegner Activity Scale (TAS) were predictors of the quadrupled semitendinosus (ST) graft diameter in primary anterior cruciate ligament reconstruction.</div></div><div><h3>Methods</h3><div>A total of 4,519 patients who underwent primary anterior cruciate ligament reconstruction with a quadrupled ST autograft were included. Anthropometric measurements (height and weight), sex, age, and preinjury TAS were collected. Correlation coefficients and multiple linear regression analysis were used to determine the relationships among graft diameter and anthropometrics measurements (height and weight), sex, age, and preinjury TAS.</div></div><div><h3>Results</h3><div>The diameter of the quadrupled ST graft was correlated positively to height (<em>r</em> = 0.021, <em>P</em> < .001), age (<em>r</em> = 0.005, <em>P</em> < .001), and weight (<em>r</em> = 0.004, <em>P</em> = .001) and negatively to female sex (<em>r</em> = –0.297, <em>P</em> < .001). A regression equation was estimated to predict the ST graft diameter for men as 4.245 + 0.021 × height (cm) + 0.004 × age (years) + 0.005 × weight (kg) and for women as 3.969 + 0.021 × height (cm) + 0.004 × age (years) + 0.005 × weight (kg).</div></div><div><h3>Conclusions</h3><div>Height, age, and weight were positively correlated, whereas female sex was negatively correlated, to the diameter of the quadrupled ST graft. Knowledge of these factors can be used for the preoperative estimation of the graft diameter which can be helpful for appropriate graft choice.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective cohort study.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141403422","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}
Pub Date : 2024-10-01DOI: 10.1016/j.arthro.2024.01.030
Purpose
To systematically investigate the influence of preoperative depression diagnosis and symptom severity on outcomes after anterior cruciate ligament reconstruction (ACLR).
Methods
A literature search was performed using the PubMed, Scopus, and Embase databases according to the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies evaluating the impact of depression on clinical outcomes after ACLR were included. Clinical outcomes, changes in depression, and complications were aggregated.
Results
Nine studies comprising 308,531 patients (mean age, 28.1 years; age range, 14-50 years) were included. The depression incidence ranged from 3.8% to 42%. Seven studies showed postoperative improvement in depression scores, with 5 reporting statistical significance. Assessment of depression exhibited substantial variability, with Patient-Reported Outcomes Measurement Information System (PROMIS) scores being the most common method. Patients with depression, despite showing greater improvements in scores, experienced significantly higher PROMIS Pain Interference scores preoperatively (range, 59.1-65.7 vs 56.8-59.2) and postoperatively (range, 46.3-52.3 vs 46.3-47.4) than patients without depression. They also showed significantly lower preoperative (range, 33-38.1 vs 39.7-41.5) and postoperative (range, 51.6-56.7 vs 56.7-57.6) PROMIS Physical Function scores, regardless of greater score improvement. Patients affected by depression had significantly higher rates of minimal clinically important difference achievement for the PROMIS Physical Function score (71%-100% vs 80%) and similar rates for the PROMIS Pain Interference score (71%-81% vs 68%) compared with patients without depression in 3 studies. Depression was associated with reduced adherence to rehabilitation protocols and increased postoperative complications, including infection, graft failure, arthrofibrosis, and readmission.
Conclusions
ACLR yields favorable outcomes for patients with and without preoperative depression. Individuals with preoperative depression may report inferior outcomes in terms of pain and functionality; nevertheless, despite these challenges, they exhibit significant improvements across all outcome measures after surgery, including reductions in depression levels.
Level of Evidence
Level IV, systematic review of Level II to IV studies.
目的 系统研究术前抑郁症诊断和症状严重程度对前交叉韧带重建术后疗效的影响。方法 根据 2020 年系统综述和元分析首选报告项目指南，使用 PubMed、Scopus 和 EMBASE 数据库进行文献检索。纳入了评估抑郁对前交叉韧带重建后临床结果影响的研究。结果共纳入九项研究，包括 308531 名患者（平均年龄 28.1 岁；年龄范围 14-50 岁）。抑郁症发生率为 3.8%-42%。与非抑郁症患者相比，抑郁症患者术前（范围为 59.1-65.7 vs 56.8-59.2）和术后（范围为 46.3-52.3 vs 46.3-47.4）的 PROMIS 疼痛干扰（PROMIS-PI）评分显著较高，尽管评分有较大改善。他们的术前（范围：33-38.1 vs 39.7-41.5）和术后（范围：51.6-56.7 vs 56.7-57.6）PROMIS-PF（PROMIS-Physical Function）评分也明显低于非抑郁症患者，无论评分改善程度如何。在三项研究中，与非抑郁症患者相比，抑郁症患者的PROMIS-PF（71%-100% vs 80%）最小临床重要差异（MCID）达标率明显更高，PROMIS-PI（71%-81% vs 68%）达标率相似。抑郁与康复方案的依从性降低和术后并发症（包括感染、移植物失败、关节纤维化和再入院）增加有关。术前患有抑郁症的患者可能会在疼痛和功能方面表现较差；然而，尽管存在这些挑战，他们在术后的所有结果指标上都有显著改善，包括抑郁水平的降低。
{"title":"Preoperative Depression Negatively Impacts Pain and Functionality Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review","authors":"","doi":"10.1016/j.arthro.2024.01.030","DOIUrl":"10.1016/j.arthro.2024.01.030","url":null,"abstract":"<div><h3>Purpose</h3><div>To systematically investigate the influence of preoperative depression diagnosis and symptom severity on outcomes after anterior cruciate ligament reconstruction (ACLR).</div></div><div><h3>Methods</h3><div><span>A literature search was performed using the PubMed, Scopus<span>, and Embase databases according to the 2020 PRISMA (Preferred Reporting Items for </span></span>Systematic Reviews and Meta-analyses) guidelines. Studies evaluating the impact of depression on clinical outcomes after ACLR were included. Clinical outcomes, changes in depression, and complications were aggregated.</div></div><div><h3>Results</h3><div><span>Nine studies comprising 308,531 patients (mean age, 28.1 years; age range, 14-50 years) were included. The depression incidence ranged from 3.8% to 42%. Seven studies showed postoperative improvement in depression scores, with 5 reporting statistical significance. Assessment of depression exhibited substantial variability, with Patient-Reported Outcomes Measurement Information System (PROMIS) scores being the most common method. Patients with depression, despite showing greater improvements in scores, experienced significantly higher PROMIS Pain Interference scores preoperatively (range, 59.1-65.7 vs 56.8-59.2) and postoperatively (range, 46.3-52.3 vs 46.3-47.4) than patients without depression. They also showed significantly lower preoperative (range, 33-38.1 vs 39.7-41.5) and postoperative (range, 51.6-56.7 vs 56.7-57.6) PROMIS Physical Function scores, regardless of greater score improvement. Patients affected by depression had significantly higher rates of minimal clinically important difference achievement for the PROMIS Physical Function score (71%-100% vs 80%) and similar rates for the PROMIS Pain Interference score (71%-81% vs 68%) compared with patients without depression in 3 studies. Depression was associated with reduced adherence to rehabilitation protocols and increased </span>postoperative complications<span><span>, including infection, graft failure<span>, arthrofibrosis, and </span></span>readmission.</span></div></div><div><h3>Conclusions</h3><div>ACLR yields favorable outcomes for patients with and without preoperative depression. Individuals with preoperative depression may report inferior outcomes in terms of pain and functionality; nevertheless, despite these challenges, they exhibit significant improvements across all outcome measures after surgery, including reductions in depression levels.</div></div><div><h3>Level of Evidence</h3><div>Level IV, systematic review of Level II to IV studies.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139690334","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}
Pub Date : 2024-10-01DOI: 10.1016/j.arthro.2024.02.031
Purpose
To prospectively compare pain intensity and patient-reported outcomes (PROs) after arthroscopic rotator cuff repair (ARCR) between patients who received ultrasound-guided suprascapular nerve block (SSNB) and axillary nerve block (ANB) as well as preincisional parecoxib and patients who received preincisional parecoxib only.
Methods
Sixty-one patients receiving ARCR between March 2020 and March 2021 were prospectively enrolled. They were randomly assigned to the peripheral nerve block group (group N, n = 30) or control group (group C, n = 31). Two patients in group C were excluded because of miscommunication. All patients were administered 40 mg of parecoxib intravenously prior to induction of anesthesia. SSNB and ANB were performed after general anesthesia in group N, whereas no nerve block was performed in group C. Pain intensity was compared before surgery, as well as immediately, 24 hours, and 2 weeks after surgery. PROs, including the Oxford Shoulder Score, University of California–Los Angeles shoulder score, and Single Assessment Numeric Evaluation score, were compared before and 6 months after surgery.
Results
The numerical rating scale (NRS) score for resting pain was significantly lower in group N (4.9 ± 3.1 vs 7.6 ± 2.5, P < .001) immediately after surgery, but no difference was noted 24 hours after surgery. The resting pain NRS score 2 weeks after surgery was significantly lower in group N (1.4 ± 1.6 vs 2.7 ± 2.7, P = .03), but the scores for movement-evoked pain and night pain were similar. All PROs significantly improved 6 months after surgery in both groups, but there was no difference between the 2 groups.
Conclusions
The addition of preoperative ultrasound-guided SSNB and ANB to parecoxib offered better resting pain control immediately and 2 weeks after ARCR, but there was no benefit for PROs 6 months after surgery.
Level of Evidence
Level II, prospective randomized controlled trial.
{"title":"Addition of Preoperative Ultrasound-Guided Suprascapular Nerve Block and Axillary Nerve Block to Parecoxib Is More Effective in Early Postoperative Pain Control After Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Study","authors":"","doi":"10.1016/j.arthro.2024.02.031","DOIUrl":"10.1016/j.arthro.2024.02.031","url":null,"abstract":"<div><h3>Purpose</h3><div><span>To prospectively compare pain intensity and patient-reported outcomes (PROs) after arthroscopic rotator cuff repair (ARCR) between patients who received ultrasound-guided suprascapular nerve block (SSNB) and </span>axillary nerve<span> block (ANB) as well as preincisional parecoxib and patients who received preincisional parecoxib only.</span></div></div><div><h3>Methods</h3><div>Sixty-one patients receiving ARCR between March 2020 and March 2021 were prospectively enrolled. They were randomly assigned to the peripheral nerve block<span> group (group N, n = 30) or control group (group C, n = 31). Two patients in group C were excluded because of miscommunication. All patients were administered 40 mg of parecoxib intravenously prior to induction of anesthesia<span><span>. SSNB and ANB were performed after general anesthesia in group N, whereas no nerve block was performed in group C. Pain intensity was compared before surgery, as well as immediately, 24 hours, and 2 weeks after surgery. PROs, including the </span>Oxford Shoulder Score, University of California–Los Angeles shoulder score, and Single Assessment Numeric Evaluation score, were compared before and 6 months after surgery.</span></span></div></div><div><h3>Results</h3><div><span>The numerical rating scale (NRS) score for resting pain was significantly lower in group N (4.9 ± 3.1 vs 7.6 ± 2.5, </span><em>P</em> < .001) immediately after surgery, but no difference was noted 24 hours after surgery. The resting pain NRS score 2 weeks after surgery was significantly lower in group N (1.4 ± 1.6 vs 2.7 ± 2.7, <em>P</em> = .03), but the scores for movement-evoked pain and night pain were similar. All PROs significantly improved 6 months after surgery in both groups, but there was no difference between the 2 groups.</div></div><div><h3>Conclusions</h3><div>The addition of preoperative ultrasound-guided SSNB and ANB to parecoxib offered better resting pain control immediately and 2 weeks after ARCR, but there was no benefit for PROs 6 months after surgery.</div></div><div><h3>Level of Evidence</h3><div>Level II, prospective randomized controlled trial.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051136","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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