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

Purpose: To report and evaluate the time of return to work and sports of patients who underwent an anatomic arthroscopic reconstruction using allograft for chronic lateral ankle instability (CLAI) through 2 portals, and to analyze the functional results as well as the postoperative complications of the reconstruction surgery.

Methods: We retrospectively reviewed patients who underwent allograft arthroscopic reconstruction of anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) in the period from January 2018 to January 2022. The inclusion criteria encompassed patients with CLAI who (1) are more than 18 years old, (2) underwent arthroscopic ATFL & CF ligament reconstruction using allograft and (3) have been followed up for at least 2 years. The operation was performed with two arthroscopic portals, a percutaneous incision for CFL reconstruction and 2 knotless anchors. Time of return to work and sports was recorded. In addition, Karlsson Ankle Functional Score (KAFS), Tegner Activity Scale (TAS), visual analogue pain scale (VAS), visual analogue scale for patient satisfaction (VASPS) were evaluated preoperatively and postoperatively, and all complications were documented at a minimum follow up of two years.

Results: In total, 44 patients (mean age, 35.6±9.7 years) were included, and the average follow-up duration was 29.6±3.7 months (range, 24-42 months). The mean time of return to work was 3.29 ± 0.93 months, while the mean time of return to sports was 6.45 ± 1.55 months. KAFS increased from 53.91 ± 9.31 to 91.14 ± 6.03 (p<0.001), mean TAS increased from 2.22 ±1.05 to 7.34 ±1.51 (p<0.001), VAS decreased from 3.95 ± 1.71 to 0.43± 0.66 (p<0.001) and VASPS increased from 1.11 ±1.43 to 9.59 ± 0.76 (p<0.001). All patients (100%) achieved the minimal clinically important difference in KAFS, VAS, TAS and VASPS. Subgroup analysis indicated no statistically significant differences in functional outcomes regarding the presence/absence of Associated Intra-articular Lesions (AILs) and Body Mass Index (BMI) (greater or less than 25 kg/m²). Minor complications were observed in only 4 patients (9.1%).

Conclusion: CLAI patients who underwent arthroscopic allograft reconstruction of ATFL and CFL through two portals and an additional incision successfully returned to their pre-injury occupations within 5 months. They also returned to their pre-injury level of sports without restrictions, adaptations, or protective measures within 9 months. They demonstrated excellent clinical outcomes as all patients (100%) achieved the MCID in KAFS, VAS, TAS and VASPS at minimum of 24 months' follow-up. However, 9.1% of patients had minor neurological complications.

Level of evidence iv: A retrospective therapeutic case series.

Purpose: To analyze the difference of the sagittal tibial tubercle trochlear-groove (sTTTG) on magnetic resonance imaging (MRI) and computed tomography (CT) and to assess the influence of the knee flexion angle (KFA) and tibiofemoral (TF) rotation on the sTTTG.

Methods: All patients who underwent patellar-stabilizing surgery for patellar instability between January 2019 and July 2023 at a single institution were included in the current study. Patients were included when a preoperative MRI of the assessed knee and standardized CT imaging in full knee extension of the lower extremity was available. Two independent reviewers assessed KFA, TF rotation, and sTTTG distance on MRI and CT scans. The sTTTG distance was measured between both the osseous (MRI and CT) and chondral nadir of the trochlea (MRI only) and the bony apex of the tibial tubercle. A positive value indicated a posteriorly located tibial tubercle in relation to the trochlea. Differences between MRI and CT measurements as well as the influence of KFA and TF rotation on sTTTG were assessed.

Results: In the included knees (n = 77), the osseous sTTTG on MRI (4.8 mm, 95% confidence interval [CI] 3.7-5.8 mm) was significantly lower than both the chondral sTTTG on MRI (8.3 mm, 95% CI 7.2-9.3 mm) and the sTTTG on CT (6.6 mm, 95% CI 5.4-7.7 mm) (both P < .001). TF rotation was significantly correlated with sTTTG both on MRI and CT (r = 0.468; P < .001 and r = 0.634; P < .001). KFA was not correlated with sTTTG either on MRI or CT (nonsignificant). Neither the difference of TF rotation nor KFA between both modalities was associated with the difference seen in sTTTG between MRI (osseous) and CT (nonsignificant).

Conclusions: The sTTTG shows smaller values when measured on MRI compared with CT, but its clinical significance is yet to be determined. Although TF rotation is correlated with the sTTTG on MRI and CT, KFA does not influence the sTTTG in patients with patellar instability within the limits of range of motion during image acquisition.

Level of evidence: Level IV, retrospective case comparative study.

Purpose: To compare the clinical outcomes and tendon healing between bone marrow stimulation (BMS) and decortication as footprint preparation techniques for arthroscopic rotator cuff repair (ARCR) in shoulder active patients.

Methods: This double-blinded randomized clinical trial recruited 120 patients aged older than 45 years, at active levels, and diagnosed with chronic unilateral rotator cuff tears. Participants were 1:1 randomized to undergo ARCR using the double-row suture-bridge technique with BMS (BMS group) or with decortication (DEC group) for footprint preparation. The primary outcome was the American Shoulder and Elbow Surgeons score (range, 0-100, with greater scores indicating better shoulder function and fewer symptoms) at 24 months. Secondary outcomes included patient-reported outcomes, physical examinations, and rotator cuff integrity (evaluated on magnetic resonance imaging using a 5-graded system).

Results: Of the 120 participants (age, 58.7 ± 8.1 years; 83 females [69.2%]) enrolled and randomized between May 2017 and November 2021, 109 (90.8%) were analyzed with the completion of follow-up visits. The American Shoulder and Elbow Surgeons scores at 24 months were not statistically significantly different between the BMS and DEC groups (89.2 ± 12.2 vs 87.8 ± 13.9; adjusted difference, 1.7; 95% confidence interval -3.3 to 6.7; P = .498). The BMS group showed superior rotator cuff integrity (incomplete healing, 33.9% vs 54.7%; P = .029) and abduction muscle strength (8.7 ± 3.2 vs 7.4 ± 3.3 kg; P = .031) at 24 months as compared with the DEC group; the superiority was more significant in the subgroup of participants with higher shoulder activity levels. The rates of adverse events were comparable between groups.

Conclusions: Among shoulder active patients undergoing ARCR, BMS did not result in superior patient-reported outcomes at 24 months postoperatively compared with decortication. Nevertheless, BMS resulted in greater rates of tendon healing and clinically significant improvement in abduction strength and thus can be recommended in patients requiring high levels of manual labor or sports activities.

Level of evidence: Level I, randomized clinical trial.

Purpose: To compare the diagnostic value of magnetic resonance arthrography (MRA) in different shoulder lesions using arthroscopy as gold standard.

Methods: We performed a comprehensive search in Cochrane, Scopus, PubMed, and Web of Science databases for articles that reported the diagnostic value of MRA in diagnosing labral tears, rotator cuff tears (RCTs), Hill-Sachs, and Bankart injuries. We used arthroscopic surgery as a reference standard for comparison. The quality of the studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. We pooled the collected data and used Stata/MP17 to generate summary statistics.

Results: We identified a total of 53 articles compromising 5,487 patients. The sensitivity and specificity for Hill-Sachs lesions were 0.94 (95% confidence interval [CI] 0.80-0.99) and 0.89 (95% CI 0.77-0.95), Bankart lesions were 0.94 (95% CI 0.89-0.97) and 0.99 (95% CI 0.90-1.00), anterior labral tears were 0.91 (95% CI 0.82-0.96) and 0.96 (95% CI 0.90-0.99), posterior labral tears were 0.74 (95% CI 0.58-0.86) and 0.98 (95% CI 0.86-1.00), superior labral tears were 0.77 (95% CI 0.62-0.88) and 0.83 (95% CI 0.54-0.95), SLAP lesions were 0.86 (95% CI 0.80-0.90) and 0.91 (95% CI 0.83-0.96), partial-thickness RCTs were 0.67 (95% CI 0.45-0.83) and 0.92 (95% CI 0.78-0.97), whereas full-thickness RCTs were 0.97 (95% CI 0.91-0.99) and 0.99 (95% CI 0.93-1).

Conclusions: In conclusion, MRA is a sensitive and specific imaging method for identifying anterior labrum lesions, full-thickness RCTs, Bankart, SLAP, and Hill-Sachs lesions, with lower accuracy in partial-thickness RCTs, both posterior and superior labrum.

Level of evidence: Level III, meta-analysis of prospective and retrospective cohort and case-control studies.

Purpose: To evaluate whether healthy volunteers can pass a previously published criteria-based return to sport (CBRTS) protocol after Bankart repair.

Methods: This was a prospective evaluation of asymptomatic volunteers conducted in March 2024. This study included 26 volunteers with no history of upper-extremity injury or surgery. Volunteers were assessed according to a published CBRTS protocol: (1) isometric testing of external rotation (ER) and internal rotation (IR) in the supine and prone position assessed by hand-held dynamometry; (2) isokinetic strength testing of ER and IR assessed by isokinetic dynamometry; (3) endurance testing of side lying ER, prone ER, and prone Y test; and (4) functional testing via closed kinetic chain upper extremity (CKCUE) stability test and unilateral shot put test. A limb symmetry index (LSI) and proportion of volunteers who passed each test were calculated. A passing LSI value was defined as LSI within 10% of the contralateral side, except for the shot put test, for which a passing value was defined as 80% ≤ LSI ≤ 110%. A passing score for the CKCUE stability test was ≥21.

Results: No individual participant passed all the tests; instead, an individual on average passed 47% of the CBRTS protocol. On average, the proportion of participants who passed isometric testing was 60.6% (range 46.2-69.2). For isokinetic testing, the proportion of participants passing was 41.4% (range 30.8-57.7). For endurance testing, the proportion of participants passing was 23.1% (range 19.2-30.8). Lastly, 50% of participants passed the CKCUE stability test, whereas 96.2% passed the unilateral shot put test. A nondominant arm deficit was apparent in 4 of the 12 bilateral arm tests.

Conclusions: This study shows that a high percentage of healthy individuals are unable to pass many of the post-Bankart repair CBRTS protocol tests. Specifically, no participant passed all the tests and individuals only passed 47% of the tests on average.

Level of evidence: Level III, prospective single-cohort study.