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

{"title":"Podium Presentation Title: Lower Trapezius Tendon Transfer for Massive, Irreparable Rotator Cuff Tears","authors":"Jarret Woodmass M.D., F.R.C.S.C., Sheila McRae Ph.D., Hayden Cooke B.Sc., Anthony Karzon M.D., Peter Macdonald M.D., Michael Gottschalk M.D., Eric Wagner M.D.","doi":"10.1016/j.arthro.2024.11.034","DOIUrl":"10.1016/j.arthro.2024.11.034","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages e15-e16"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153283","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}

{"title":"Podium Presentation Title: Biceps “Smash” Augmentation for Rotator Cuff Repair: Histological Analysis of Tenocyte Viability","authors":"Joseph Brinkman M.D., Gregory P. Colbath M.D., Patrick J. Denard M.D., Jeremy J. Mercuri Ph.D., Justin Makovicka M.D., John M. Tokish M.D.","doi":"10.1016/j.arthro.2024.11.033","DOIUrl":"10.1016/j.arthro.2024.11.033","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Page e15"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143153476","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}

{"title":"Root Repair Has Superior Radiological and Clinical Outcomes Than Partial Meniscectomy and Nonoperative Treatment in the Management of Meniscus Root Tears: A Systematic Review","authors":"Dustin R. Lee M.D.,&nbsp;Yining Lu M.D.,&nbsp;Anna K. Reinholz B.S.,&nbsp;Sara E. Till M.S.,&nbsp;Abhinav Lamba B.S.,&nbsp;Daniel B.F. Saris M.D., Ph.D.,&nbsp;Christopher L. Camp M.D.,&nbsp;Aaron J. Krych M.D.","doi":"10.1016/j.arthro.2024.02.017","DOIUrl":"10.1016/j.arthro.2024.02.017","url":null,"abstract":"<div><h3>Purpose</h3><div>To compile and analyze structural and clinical outcomes after meniscus root tear treatment as currently described in the literature.</div></div><div><h3>Methods</h3><div>A review was conducted to identify studies published since 2011 on efficacy of repair, meniscectomy, and nonoperative management in the treatment of meniscus root tears. Patient cohorts were grouped into treatment categories, with medial and lateral root tears analyzed separately; data were collected on patient demographics, structural outcomes including joint space width, degree of medial meniscal extrusion, progression to total knee arthroplasty, and patient-reported outcome measures. Risk of bias was assessed using the MINORS (methodological index for non-randomized studies) criteria. Heterogeneity was measured using the I-statistic, and outcomes were summarized using forest plots without pooled means.</div></div><div><h3>Results</h3><div>The 56 included studies comprised a total of 3,191 patients. Mean age among the included studies ranged from 24.6 to 65.6 years, whereas mean follow-up ranged from 12 to 125.9 months. Heterogeneity analysis identified significant differences between studies. Change in joint space width ranged from –2.4 to –0.6 mm (i.e., decreased space) after meniscectomy (n = 186) and –0.9 to –0.1 mm after root repair (n = 209); change in medial meniscal extrusion ranged from –0.6 to 6.5 mm after root repair (n = 521) and 0.2 to 4.2 mm after meniscectomy (n = 66); and event rate for total knee arthroplasty ranged from 0.00 to 0.22 after root repair (n = 205), 0.35 to 0.60 after meniscectomy (n = 53), and 0.27 to 0.35 after nonoperative treatment (n = 93). Root repair produced the greatest numerical increase in International Knee Documentation Committee and Lysholm scores of the 3 treatment arms. In addition, root repair improvements in Knee Injury and Osteoarthritis Outcome Score Pain (range: 22-32), Sports and Recreational Activities (range: 23-36), Quality of Life (range: 22-42), and Symptoms subscales (range: 10-19), in studies with low risk of bias.</div></div><div><h3>Conclusions</h3><div>The literature reporting on the treatment of meniscus root tears is heterogenous and largely limited to Level III and IV studies. Current evidence suggests root repair may be the most effective treatment strategy in lessening joint space narrowing of the knee and producing improvements in patient-reported outcomes.</div></div><div><h3>Level of Evidence</h3><div>Level IV, systematic review of Level II-IV studies.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 390-417"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139944725","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}

{"title":"Micro-Fragmented Adipose Tissue Demonstrates Comparable Clinical Efficacy to Other Orthobiologic Injections in Treating Symptomatic Knee Osteoarthritis: A Systematic Review of Level I to IV Clinical Studies","authors":"Erik Hohmann M.D., Ph.D., F.R.C.S., F.R.C.S. (Tr & Orth), M.B.B.S. ,&nbsp;Natalie Keough Ph.D., M.Sc. ,&nbsp;Rachel M. Frank M.D. ,&nbsp;Scott Rodeo M.D.","doi":"10.1016/j.arthro.2024.03.002","DOIUrl":"10.1016/j.arthro.2024.03.002","url":null,"abstract":"<div><h3>Purpose</h3><div>To perform a systematic review<span> of clinical outcomes in patients who underwent treatment with micro-fragmented aspirated tissue for symptoms of knee osteoarthritis.</span></div></div><div><h3>Methods</h3><div>Medline, Embase, Scopus, and Google Scholar were screened for studies from 2000 to 2023. Risk of bias (ROB) was assessed using the Cochrane Collaboration’s tools and the Risk Of Bias In Non-randomised Studies-of Interventions tool. Study quality was assessed with the modified Coleman Methodology Score and Methodological Index for Non-Randomized Studies score. Heterogeneity was assessed using χ² and <em>I</em>² statistics.</div></div><div><h3>Results</h3><div><span><span><span>Twenty-one studies were included. One study had a high ROB, 1 had a critical ROB, 3 had serious ROB, and 16 had a moderate ROB. The mean Coleman score was 58, demonstrating fair study quality; the Methodological Index for Non-Randomized Studies score had a mean value of 13, indicating overall fair quality. Best evidence synthesis revealed moderate evidence. The visual analog scale score improved from 5.2 to 3.2 at 6 and 12 months. </span>Knee injury and Osteoarthritis Outcome Score<span> (KOOS) activities of daily living subscore improved from 58.8 to 70.2 at 6 months and 67.5 at 12 months. KOOS pain subscore improved from 54.3 to 70.2 at 6 months and 72.4 at 12 months. KOOS </span></span>quality of life subscore improved from 33.1 to 43.6 at 6 months and 42.9 at 12 months. KOOS sports subscore improved from 23.7 to 43.6 at 6 months and 57.4 at 12 months. KOOS symptoms subscore improved from 55.3 to 70.1 at 6 months and 67.9 at 12 months. The </span>Western Ontario and McMaster Universities Osteoarthritis Index score steadily increased from 61.8 at baseline to 78.4 at 12 months.</div></div><div><h3>Conclusions</h3><div>micro-fragmented aspirated tissue injection therapy for the treatment of symptomatic knee osteoarthritis is effective and improves pain and functional outcomes. Moderate study quality combined with a moderate risk of bias, moderate certainty of evidence, and moderate best synthesis evidence reduces external validity. Therefore, the results should be interpreted with a degree of caution.</div></div><div><h3>Level of Evidence</h3><div>Level IV, systematic review of Level I-IV studies.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 418-441.e14"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102917","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}

{"title":"Editorial Commentary: I Used to Be an Under-represented Minority","authors":"Richard K.N. Ryu M.D.","doi":"10.1016/j.arthro.2024.06.028","DOIUrl":"10.1016/j.arthro.2024.06.028","url":null,"abstract":"<div><div>Women and under-represented minorities continue to reflect the lack of diversity in the field of orthopaedic surgery, the cause of which can best be described as multifactorial. That this predicament needs to be remedied is without controversy. How this can be achieved is the bigger question. A top-down approach has been relatively ineffective, and a bolder, more foundational bottom-up approach, in which a “pipeline of talent” is nurtured, may be a solution.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 286-288"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141472918","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}

{"title":"Podium Presentation Title: Comparison of Clinical Outcomes and Return to Sport Rates Between Osteochondral Allograft Transplantation and Autologous Chondrocyte Implantation for Articular Cartilage Lesions in the Patellofemoral Joint","authors":"Jairo Triana B.S.,&nbsp;Andrew Hughes F.R.C.S.,&nbsp;Naina Rao B.S.,&nbsp;Zachary Li B.A.,&nbsp;Michael Moore B.A.,&nbsp;Sharif Garra M.D.,&nbsp;Eric Strauss M.D.,&nbsp;Kirk Campbell M.D.,&nbsp;Guillem Gonzalez-Lomas M.D.","doi":"10.1016/j.arthro.2024.11.021","DOIUrl":"10.1016/j.arthro.2024.11.021","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages e8-e9"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143129050","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}

{"title":"Hyaluronate Acid Plus Platelet-Rich Plasma Is Superior to Steroids for Pain Relief Less Than 6 Months Using Injection Therapy of Partial Rotator Cuff Tears: A Systematic Review and Network Meta-analysis","authors":"Viktor Weninger M.D. ,&nbsp;Gergely Agócs Ph.D. ,&nbsp;Norbert Kovács M.D. ,&nbsp;Szilárd Váncsa M.D. ,&nbsp;Luca Hergár M.D. ,&nbsp;Chan Ju Baek ,&nbsp;Péter Hegyi M.D., DSc. ,&nbsp;Gergely Holnapy Ph.D. ,&nbsp;Gábor Skaliczki M.D., Ph.D.","doi":"10.1016/j.arthro.2024.03.035","DOIUrl":"10.1016/j.arthro.2024.03.035","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the efficacy of steroid injections to other injectable therapies in partial-thickness rotator cuff (RC) tears.</div></div><div><h3>Methods</h3><div>A systematic literature search was performed until October 25, 2021, in 3 databases (Cochrane Central Register of Controlled Trials, Embase, MEDLINE). Eligible studies compared the efficacy of steroid, hyaluronic acid (HA), platelet-rich plasma (PRP), the combination of HA and PRP (HA + PRP), and adipose-derived regenerative cells in RC tears. The primary outcomes were the visual analog scale (VAS), Constant-Murley Shoulder Outcome Score (CMS) and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form. Using paired and network meta-analysis, we calculated pooled mean differences (MDs) with 95% confidence intervals (CIs).</div></div><div><h3>Results</h3><div>We included a total of 7 articles in the quantitative synthesis. In shorter periods, the HA + PRP combination was superior to the other substances we investigated (HA + PRP: VAS [0-4 weeks]: MD: −0.99 [95% CI, −1.62 to −0.36]; CMS [0-3 months]: 20.56 [95% CI, 16.18 to 24.94]. This combination was followed by the use of HA or PRP alone, depending on the duration of follow-up and the outcome being studied. In our study, short-term results suggest that saline is superior to steroids for partial tears, but this trend is reversed at 6-month follow-up.</div></div><div><h3>Conclusions</h3><div>The HA and PRP combination is currently the most effective in partial RC tear treatment in the short term. After 6 months, there is no meaningful difference, so the benefits of the combination are short term.</div></div><div><h3>Level of Evidence</h3><div>Level II, systematic review and meta-analysis of Level I and II studies.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 304-315"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140868275","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}

{"title":"Posterior Shoulder Instability, Part I—Diagnosis, Nonoperative Management, and Labral Repair for Posterior Shoulder Instability—An International Expert Delphi Consensus Statement","authors":"Eoghan T. Hurley M.D., Ph.D. ,&nbsp;Zachary S. Aman M.D. ,&nbsp;Tom R. Doyle M.B., M.Ch. ,&nbsp;Jay M. Levin M.D., M.B.A. ,&nbsp;Laith M. Jazrawi M.D. ,&nbsp;Grant E. Garrigues M.D. ,&nbsp;Surena Namdari M.D. ,&nbsp;Jason E. Hsu M.D. ,&nbsp;Christopher S. Klifto M.D. ,&nbsp;Oke Anakwenze M.D., M.B.A. ,&nbsp;Jonathan F. Dickens M.D.","doi":"10.1016/j.arthro.2024.04.035","DOIUrl":"10.1016/j.arthro.2024.04.035","url":null,"abstract":"<div><h3>Purpose</h3><div>To establish consensus statements on the diagnosis, nonoperative management, and labral repair for posterior shoulder instability.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>Unanimous agreement was reached on the indications for nonoperative management and labral repair, which include whether patients had primary or recurrent instability, with symptoms/functional limitations, and whether there was other underlying pathology, or patient’s preference to avoid or delay surgery. In addition, there was unanimous agreement that recurrence rates can be diminished by attention to detail, appropriate indication and assessment of risk factors, recognition of abnormalities in glenohumeral morphology, careful capsulolabral debridement and reattachment, small anchors with inferior placement and multiple fixation points that create a bumper with the labrum, treatment of concomitant pathologies, and a well-defined rehabilitation protocol with strict postoperative immobilization.</div></div><div><h3>Conclusions</h3><div>The study group achieved strong or unanimous consensus on 63% of statements related to the diagnosis, nonoperative treatment, and labrum repair for posterior shoulder instability. The statements that achieved unanimous consensus were the relative indications for nonoperative management, and the relative indications for labral repair, as well as the steps to minimize complications for labral repair. There was no consensus on whether an arthrogram is needed when performing advanced imaging, the role of corticosteroids/orthobiologics in nonoperative management, whether a posteroinferior portal is required.</div></div><div><h3>Level of Evidence</h3><div>Level V, expert opinion.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 166-180.e11"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140912731","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}

{"title":"Microfragmented Adipose Tissue Injection Reduced Pain Compared With a Saline Control Among Patients With Symptomatic Osteoarthritis of the Knee During 1-Year Follow-Up: A Randomized Controlled Trial","authors":"Dustin L. Richter M.D. ,&nbsp;Joshua L. Harrison M.D. ,&nbsp;Lauren Faber M.D. ,&nbsp;Samuel Schrader M.D. ,&nbsp;Yiliang Zhu Ph.D. ,&nbsp;Carina Pierce ,&nbsp;Leorrie Watson ,&nbsp;Anil K. Shetty M.D. ,&nbsp;Robert C. Schenck Jr. M.D.","doi":"10.1016/j.arthro.2024.08.037","DOIUrl":"10.1016/j.arthro.2024.08.037","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the effectiveness of microfragmented adipose tissue (MFAT) for pain relief and improved joint functionality in osteoarthritis (OA) of the knee in a randomized controlled clinical trial with 1-year follow-up.</div></div><div><h3>Methods</h3><div>Seventy-five patients were stratified by baseline pain level and randomized to 1 of 3 treatment groups: MFAT, corticosteroid (CS), or saline control (C) injection. Patients 18 years of age or older, diagnosed with symptomatic OA of the knee, with radiographic evidence of OA of the knee and a visual analog pain scale score of 3 of 10 or greater were included. Patients were excluded if they had any previous intra-articular knee injection, current knee ligamentous instability, or an allergy to lidocaine/corticosteroid. The visual analog pain scale, Western Ontario and McMaster Universities Osteoarthritis Index, and the Knee Injury and Osteoarthritis Outcome score (KOOS) were recorded preprocedure and at 2 weeks, 6 weeks, 3 and 6 months, and 1-year follow-up.</div></div><div><h3>Results</h3><div>MFAT demonstrated consistent and statistically significant improvements across all primary outcome measures for joint pain and functionality compared with C. For MFAT, there was a significant improvement over baseline at each follow-up, with median (95% confidence interval) KOOS Pain score changes of 18.1 (11.1-26.4) at week 2 to 27.8 (19.4-37.5) at 1 year. For CS, the median KOOS pain score reached a maximum of 22.2 (15.3-30.6) at week 2, only to level off to 13.9 (–2.8 to 29.2), a level not statistically different from baseline, at 1 year. The median changes for C hovered around 6 to 11 points, with statistically significant improvements over baseline indicating a placebo effect. Similar trends were seen for the Western Ontario and McMaster Universities Osteoarthritis Index Pain score and VAS Pain score.</div></div><div><h3>Conclusions</h3><div>In this study, MFAT demonstrated a clinically significant improvement in primary outcome scores compared with the C group, whereas the CS group only showed statistically significant improvement compared with the C group at 2 and 6 weeks. This finding indicates that MFAT may be a viable alternative treatment for patients with OA of the knee who fall into the orthopaedic treatment gap.</div></div><div><h3>Level of Evidence</h3><div>Level II, partially blinded, randomized controlled clinical trial.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 248-260"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146955","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}

{"title":"Editorial Commentary: Off-the-Shelf Large Language Models Are of Insufficient Quality to Provide Medical Treatment Recommendations, While Customization of Large Language Models Results in Quality Recommendations","authors":"Prem N. Ramkumar M.D., M.B.A. (Associate Editor),&nbsp;Andrew F. Masotto B.S.,&nbsp;Joshua J. Woo B.A.","doi":"10.1016/j.arthro.2024.09.047","DOIUrl":"10.1016/j.arthro.2024.09.047","url":null,"abstract":"<div><div>The content accuracy of off-the-shelf large language models (LLMs) mirrors the content accuracy of the unregulated Internet from which these generative artificial intelligence models are supplied. With error rates approximating 30% in terms of treatment recommendations for the management of common musculoskeletal conditions, seeking expert opinion remains paramount. However, custom LLMs represent an excellent opportunity to infuse niche, bespoke expertise from the many specialties and subspecialties within medicine. Methods of customizing these generative models broadly fall under the categories of prompt engineering; “retrieval-augmented generation” prioritizing retrieval of relevant information from a specific domain of data; “fine-tuning” of a basic pretrained model into one that is refined for health care–related vernacular and acronyms; and “agentic augmentation” including software that breaks down complex tasks into smaller ones, recruiting multiple LLMs (with or without retrieval-augmented generation), optimizing the output, internally deciding whether the response is appropriate or sufficient, and even passing on an unmet outcome to a human for supervision (“phone a friend”). Custom LLMs offer physicians and their associated organizations the rare opportunity to regain control of our profession by re-establishing authority in our increasingly digital landscape.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 2","pages":"Pages 276-278"},"PeriodicalIF":4.4,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378570","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}