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

Purpose: The purpose of this cohort study is to evaluate the clinical outcomes of non-operative versus operative treatment, consisting of combined Medial Patellofemoral Ligament and Medial Quadriceps Tendon Femoral Ligament (MPFL/MQTFL) reconstruction, for first-time patellar dislocation in the skeletally immature population through a standardized, rigorous approach.

Methods: This consecutive retrospective cohort is comprised of all skeletally immature patients that sustained a first-time patellofemoral dislocation. Patients were grouped into non-operative management (bracing and physical therapy) and operative management (MPFL/MQTFL reconstruction) cohorts. The primary outcome, failure, was defined as subsequent dislocation or subluxation. Additional outcomes included demographics, risk factors for patellofemoral instability, functional outcomes (Kujala and IKDC scores), return to sports, and complications. Minimum follow up was 2 years. A correlation analysis attempted to identify potential associations between failure and risk factors.

Results: 142 consecutive patients were included with 90 patients in the non-operative and 52 patients in the operative group. Failure rates differed by intervention; those receiving operative management had significantly lower failure rates than conservative management (15.4% versus 58.8%, p<.0001). Kujala and IKDC scores were significantly higher in the operative group, as compared to the non-operative group (91.5±7.8 versus 82.5±12.1, p<.0001 and 89.0±9.3 versus 78.4±12.9, p<.0001, respectively). Tegner activity level was also higher at the operative group (6.0±1.4 versus 4.0±1.4, p<.0001). Return to sport was significantly greater for those in the operative group (88.5% versus 66.2%, p<.001). Return to same level of activity was achieved in higher percentage of patients treated surgically (91.3% versus 69.6%, p=0.0075). Complication rates were more frequent in the operative group compared to the non-operative group (11.5% versus 1.1%, p<.001).

Conclusion: MPFL/MQTFL reconstruction in skeletally immature patients with first-time patellofemoral dislocation demonstrated lower failure rates and improved functional outcomes at a minimum 2-year follow-up, as compared to non-operative management.

Level of evidence: III.

Purpose: To evaluate rates of achieving meaningful outcomes and clinical failure at 2 years after undergoing microfracture augmented with allograft cartilage with autologous PRP, and to identify predictors of conversion to total hip arthroplasty.

Methods: Data from a prospective series of consecutive patients with Outerbridge grade IV chondromalacia of the acetabulum or femoral head who underwent hip microfracture augmented with allograft cartilage between January 2017 and June 2022 was analyzed. Patient-reported outcomes were collected preoperatively and at minimum 2 years postoperatively. The Hip Outcome Score- Activity of Daily Living (HOS-ADL), -Sports Subscale (HOS-SS), modified Hip Harris Score (mHHS), and Non-Arthritic Hip Score (NAHS) thresholds for achieving the minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), and substantial clinical benefit (SCB) at 2-year after surgery were calculated. Logistic regression analysis was performed to identify any association between non-modifiable variables and clinical failure.

Results: A total of 108 hips (80.6%) among 106 patients had 2-year follow up and were included in the final analysis. The combined mean age and BMI were 37.9+10.1 years and 26.8+4.7 respectively, with a mean follow-up time of 31.9+8.4 months (range 24-53 months). There was a statistically significant improvement in all functional score averages over the 2 years (p<0.05). A total of 84.7%, 75.5%, and 70.4% reached at least one threshold for achieving MCID, PASS, and SCB, respectively. There were 11(10.2%) patients that underwent conversion to THA (Total Hip Arthroplasty), with increased age, BMI, and preoperative pain duration increasing the likelihood of requiring THA (p<0.05 for all). Lastly, chondromalacia size or chondromalacia index (e.g., Outerbridge grade x surface area) was not associated with clinical failure or achieving meaningful outcomes (p>0.05 for all).

Conclusion: Patients undergoing microfracture with allograft cartilage and autologous PRP augmentation for acetabular or femoral head chondromalacia demonstrated statistically improved outcome scores and high rates of achieving meaningful outcomes at 2-year follow-up regardless of chondromalacia defect size. Conversion to THA was 10.2%, with increased age, BMI, and preoperative pain duration increasing the likelihood of requiring THA.

Study design: Level 2, prospective cohort.

Purpose: The purpose of this scoping review was to identify how social media is used by sports medicine surgeons and how this is perceived by patients.

Methods: In accordance with PRISMA-ScR guidelines, PubMed, Embase, and Cochrane Library databases were searched in April 2024 for studies published after 2014. Studies were included if they met these criteria: evaluated sports medicine fellowship-trained orthopaedic surgeons, evaluated patient preferences regarding social media use among these surgeons, reported purpose of social media use, and were written in English. Studies that were not written in English, did not specifically evaluate sports medicine surgeons, or evaluated a singular procedure were excluded.

Results: The initial search identified 328 studies, 6 of which were included in this scoping review, each of which were cross-sectional studies. Four (67%) studies evaluated how sports medicine surgeons use social media and two (33%) evaluated patient experiences of consuming surgeons' social media content. Twitter was the most popular social media site among sports medicine orthopaedic surgeons with online social media presence scores in the top 10%. Academic sports medicine surgeons were more likely than non-academic surgeons to be active on social media. Increased Twitter use was correlated with increased research productivity and citation impact. Patients were interested in educational videos and live question-answer sessions from their sports medicine surgeons, irrespective of platform used.

Conclusions: Twitter and YouTube are popular platforms among sports medicine surgeons, particularly for professional networking and patient education. However, Instagram has emerged as the leading platform in terms of user engagement, making it an effective tool for fostering patient interaction and promoting clinical practice. These findings suggest that surgeons should prioritize Instagram alongside other platforms to effectively enhance their professional presence.

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

Purpose: To systematically review the reporting of clinically significant outcome measure (CSO) thresholds and methods for calculating thresholds following anterior cruciate ligament (ACL) reconstruction.

Methods: A systematic review of PubMed, Embase, and Web of Science databases was conducted to identify articles that met inclusion criteria from January 1, 2015, to July 7, 2024. Inclusion criteria included studies reporting CSO thresholds including minimal clinically important difference (MCID), substantial clinical benefit (SCB), or patient acceptable symptomatic state (PASS) for patients following ACL reconstruction with minimum 12-month follow-up. The MINORS criteria was used to assess study quality. Study demographics, patient-reported outcome measures (PROMs), CSO thresholds, and method of CSO calculation were collected.

Results: A total of 56 studies (n=52,292 patients) met the final inclusion criteria. Reported PROMs included International Knee Documentation Committee (IKDC) (n=35 studies), Knee Injury and Osteoarthritis Outcome score (KOOS) (n=33 studies), Tegner (n=20 studies) and Lysholm (n=19 studies) scores. The PASS was reported in 35 studies, MCID in 30, and SCB in 4. Among the studies that reported PASS, the most used threshold calculation was the ROC-Youden index (71.4%, n=25/35). In the studies reporting MCID, the most used threshold calculation was the 0.5 standard deviation (SD) of mean change method (36.7%, n=11/30). The most reported threshold calculation among the SCB studies was the ROC curve analysis (75%, n=3/4). In studies independently calculating CSOs, the most common methods were 0.5 standard deviations (SD) of mean change for MCID (50%, n=10/20), the ROC-Youden index for PASS (73.3%, n=11/15), and ROC curve analysis (75.0%, n=3/4) for SCB. Descriptions of anchor questions were reported in 22 studies (39.3%).

Conclusion: Substantial variability exists in the reporting and calculation of MCID, SCB, and PASS for various PROMs following ACL reconstruction.

Purpose: The purpose of this study was to examine the 12-month (12M), the 24-month (24M) and longest available time (LAT) rate of 1) second anterior cruciate ligament (ACL) rupture (graft rupture or contralateral ACL rupture), and 2) graft rupture alone, respectively, in patients with generalized joint hypermobility (GJH) following return to sport (RTS) after ACL reconstruction depending on graft choice, i.e., hamstring tendon (HT) autograft or bone-patellar tendon-bone (BPTB) autograft.

Methods: Data were extracted from a rehabilitation registry that comprised patients who had undergone ACL reconstruction between 2014-2022. Patients with GJH between 16-50 years of age who had ≥24 months follow-up time following RTS after ACL reconstruction with HT autograft (GJH-HT) or BPTB autograft (GJH-BPTB) were included. Cox proportional hazard regression model was used to examine the rate of 1) a second ACL rupture (graft rupture or contralateral ACL rupture), and 2) graft rupture alone, at 12M, 24M and at the LAT after RTS.

Results: Eighty-two patients (GJH-HT n=54 and GJH-BPTB n=28) of which 72.0% were females, with an average age of 22.7±7.4 years were included. The proportion of second ACL ruptures was greater in GJH-HT compared to GJH-BPTB at 12M (11/54, 20.4% versus 0/28, 0%, p=0.013), at 24M (13/54, 24.1% versus 1/28, 3.6%, p=0.028) and at LAT after RTS (16/54, 29.6% versus 2/28, 7.1%, p=0.024). The rate of second ACL rupture was greater in GJH-HT compared to GJH-BPTB (hazard ratio=4.98, p=0.032) at LAT after RTS. The proportion of patients with graft rupture was greater in GJH-HT compared to the GJH-BPTB at 12M (8/54, 14.8% versus 0/28, 0%, p=0.046), at 24M (10/54, 18.5% versus 0/28, 0%, p=0.013)and at LAT after RTS (12/54, 22.2% versus 0/28, 0%, p=0.006).

Conclusion: Over 4 times greater rate of second ACL rupture after RTS was reported for patients with GJH and who had ACL reconstruction performed with HT compared with BPTB autograft. Patients with GJH who were treated with BPTB autograft for ACL reconstruction did not experience graft rupture after RTS.

Level of evidence: Level III, Retrospective study.

Purpose: The purpose of this systematic review is to compare the outcomes of open surgery versus arthroscopic surgery in the treatment of lateral epicondylitis, focusing on pain relief, functional recovery, complication rates, and patient satisfaction, in order to provide evidence-based recommendations for clinical practice and identify areas for future research.

Methods: The systematic review process was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search was conducted across PubMed, Embase, Cochrane Library, Google Scholar, and Web of Science. Studies comparing open and arthroscopic surgery for lateral epicondylitis were included. The methodological quality of the included studies was assessed using the Cochrane Risk of Bias tool for randomized controlled trials and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for non-randomized studies. Outcomes assessed included recurrence pain, persistent pain, infection rates, reoperation rates, nerve-related complications, hematoma, patient satisfaction, visual analog scale, disabilities of the arm, shoulder, and hand score, operation time, and return to work time. Both randomized controlled trials (RCTs) and non-RCTs were included.

Results: 14 studies, comprising 6 RCTs and 8 cohort studies with a total of 20153 participants, were included. Both surgical techniques yielded comparable outcomes in terms of recurrence pain (arthroscopic: 0% to 13.3%; open: 2.9% to 13.2%), persistent pain (arthroscopic: 0% to 13.3%; open: 0% to 11.9%), patient dissatisfaction (arthroscopic: 4.9% to 13.3%; open: 3.8% to 16.7%), infection rates (arthroscopic: 0% to 13.3%; open: 0% to 6.7%), reoperation rates (arthroscopic: 2.4% to 7.1%; open: 2.9% to 5.3%), nerve-related complications (arthroscopic: 0% to 6.7%; open: 0% to 7.7%), and hematoma (arthroscopic: 0% to 5%; open: 0% to 6.7%). The surgical time for arthroscopy (34 to 36 min) was generally longer than that for the open group (22.5 to 34.7 min). No significant differences in functional outcomes were observed in the majority of studies.

Conclusions: Both arthroscopic and open surgeries provide similar clinical outcomes for lateral epicondylitis, with no significant differences in functional results. Despite longer operative times, arthroscopic surgery is expected to become the preferred approach due to its minimally invasive nature.

Purpose: To evaluate the efficacy of assistant arthroscopy in the surgical treatment of distal radius fractures (DRFs) by the functional and radiological outcomes between the arthroscopic and control groups.

Methods: We searched the PubMed, Embase, Web of Science, and Cochrane Library databases for studies that compared the clinical outcomes of patients who underwent surgery with or without adjuvant arthroscopy. After screening the studies, we identified six randomized controlled trials. We analyzed radiological outcomes, range of motion, functional scores, grip strength, operative time, and complication rates. The standardized mean difference (SMD) was used to analyze differences in outcomes between the two groups. Statistical significance was set at p < 0.05.

Results: Six studies involving 455 patients were included. The findings of this analysis indicate that the utilization of arthroscopic assistance did not yield superior radiological outcomes and functional outcomes, except in radial deviation (SMD = 0.96; 95% CI = 0.36, 1.55; I² = 69%) and ulnar deviation (SMD = 0.69; 95% CI = 0.38, 1.00; I² = 16%). In addition, the arthroscopic group exhibited longer operation time (SMD = 0.65; 95% CI = 0.1, 1.2; I² = 81%) compared to the control group. There were no significant differences in the grip strength or complication rates between the two groups.

Conclusion: The findings of this analysis indicate that arthroscopy-assisted surgery for DRF does not yield significantly enhanced outcomes in terms of radiological outcomes, functional scores, grip strength, and complications, even though range of motion (radial deviation and ulnar deviation) were superior in the arthroscopically assisted cases. Given the extended operational time associated with adjuvant arthroscopy, the efficacy of assistant arthroscopy in the surgical management of distal radius fractures with joint involvement is not justified.

Level of evidence: Level II, meta-analysis of Level I and Level II studies.

Efforts to optimize patients' medical conditions are worthwhile to improve the outcomes of rotator cuff repair (RCR). Investigators in both basic science studies and lower level of evidence clinical studies have identified dyslipidemia and statin medication dosing as factors that may affect RCR outcomes. However, a recent, retrospective review of a single surgeon's experience indicates that these factors may not significantly affect structural outcomes of RCR. Such discrepancies should compel more robust, prospective efforts to better inform substantive changes in clinical practice.

Recurrent patellar instability is a common problem, and especially pronounced in young and active adults. Surgical treatment is preferred over nonoperative treatment for recurrent instability, as this reduces redislocations or subluxations and potential cartilage damage, and is associated with increased quality of life. There are several risk factors for patellar instability, which include demographic risk factors (age, gender), soft-tissue imbalances (weak core stability, dynamic valgus, patellar tilt), and underlying anatomic abnormalities (patella alta, increased tibial tubercle trochlear grove distance [TT-TG], coronal malalignment, rotational malalignment, trochlea dysplasia). These risk factors should be routinely assessed in all patients with patellofemoral symptoms using history, physical examination (tracking, J-sign, Q-angle, rotation), and with imaging (standard and long-leg radiographs, magnetic resonance imaging, computed tomography). The cornerstone of surgical management of patellar instability consists of medial patellofemoral ligament reconstruction (MPFLR), and if needed an additional medializing or distalizing tibial tubercle osteotomy (TTO) and/or lateral retinaculum release or lengthening. In rare cases, additional osteotomies (distal femoral osteotomy, trochleoplasty, rotational osteotomy) are required. Distal femoral osteotomy carries significant risk of complications and could be indicated, rarely, in the setting of patellar instability and severe valgus alignment, and is often considered in revision situations.

There has been a growing concern over the impact of mental health on patient outcomes in the field of orthopedic surgery. However, it is uniquely difficult to investigate the impact of depression on surgical outcomes for several reasons: 1) Patients who do not formally seek help for mental health issues often go undiagnosed. 2) Prospectively administered depression screening forms provide limited data. 3) Pain and limitation of function may be the cause - not effect - of mental health pathology. Recent literature for patients undergoing arthroscopic rotator cuff repair suggests an association between depression and increased utilization of healthcare resources. There is also evidence that patients with a recent acute depressive episode shortly before surgery are more likely to require more opioids, sedatives, and anti-depressants after surgery. Consideration of surgical patients' mental health status can result in timely intervention to improve outcomes.