Pub Date : 2024-08-01DOI: 10.1016/j.arthro.2024.02.014
Evidence-based medicine is the commanding philosophy of patient care in the field of orthopaedic surgery, and analysis of clinical research is facilitated by instruments and scales developed for assessing methodologic quality and validity of conclusions. In contrast, little consideration has been given to developing metrics to assess the quality and validity of orthopaedic ex vivo and laboratory research. This is easier said than done because these studies may be heterogeneous and complex in design, and methodologic details may not be intuitive to (non-engineer) readers. The recently described Biomechanics Objective Basic Science Quality Assessment Tool (BOBQAT) represents a reliable means to assess cadaveric biomechanical studies. The BOBQAT emphasizes essential study elements including a clinically relevant, answerable purpose; detailed description of the specimens studied; thorough description of surgical technique; and careful consideration of loading conditions including clinically relevant cyclic loading. The BOBQAT provides a logical recipe for the design of future studies, a mechanism of quality assessment for systematic reviews, and a framework for readers to assess biomechanical research consistent with the ethos of evidence-based medicine.
{"title":"Editorial Commentary: Cadaveric Biomechanical Orthopaedic Research Is Essential and Requires Quality and Validity Metrics","authors":"","doi":"10.1016/j.arthro.2024.02.014","DOIUrl":"10.1016/j.arthro.2024.02.014","url":null,"abstract":"<div><p>Evidence-based medicine is the commanding philosophy of patient care in the field of orthopaedic surgery, and analysis of clinical research is facilitated by instruments and scales developed for assessing methodologic quality and validity of conclusions. In contrast, little consideration has been given to developing metrics to assess the quality and validity of orthopaedic ex vivo and laboratory research. This is easier said than done because these studies may be heterogeneous and complex in design, and methodologic details may not be intuitive to (non-engineer) readers. The recently described Biomechanics Objective Basic Science Quality Assessment Tool (BOBQAT) represents a reliable means to assess cadaveric biomechanical studies. The BOBQAT emphasizes essential study elements including a clinically relevant, answerable purpose; detailed description of the specimens studied; thorough description of surgical technique; and careful consideration of loading conditions including clinically relevant cyclic loading. The BOBQAT provides a logical recipe for the design of future studies, a mechanism of quality assessment for systematic reviews, and a framework for readers to assess biomechanical research consistent with the ethos of evidence-based medicine.</p></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139941215","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 : 2024-08-01DOI: 10.1016/j.arthro.2024.03.006
The rise of online platforms like YouTube for health information has prompted scrutiny over the quality of medical/surgical-related video content. Recent research on YouTube videos regarding anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon autograft shows low educational quality and reliability using established assessment tools. Physicians primarily published content, with longer videos, and physician-generated videos, generally correlating with higher quality. However, YouTube’s inadequacy as a reliable source for ACLR information underscores the need for alternative educational resources. Orthopaedic health care professionals must play a pivotal role in guiding patients toward credible sources and take aim at improving online content quality. Understanding patient preferences for online resources is essential for enhancing patient education, the patient-provider relationship, and decision-making in orthopaedic care.
{"title":"Editorial Commentary: Surgical Videos on YouTube Are Not Peer Reviewed and Have Low Educational Value","authors":"","doi":"10.1016/j.arthro.2024.03.006","DOIUrl":"10.1016/j.arthro.2024.03.006","url":null,"abstract":"<div><p>The rise of online platforms like YouTube for health information has prompted scrutiny over the quality of medical/surgical-related video content. Recent research on YouTube videos regarding anterior cruciate ligament reconstruction (ACLR) with quadriceps tendon autograft shows low educational quality and reliability using established assessment tools. Physicians primarily published content, with longer videos, and physician-generated videos, generally correlating with higher quality. However, YouTube’s inadequacy as a reliable source for ACLR information underscores the need for alternative educational resources. Orthopaedic health care professionals must play a pivotal role in guiding patients toward credible sources and take aim at improving online content quality. Understanding patient preferences for online resources is essential for enhancing patient education, the patient-provider relationship, and decision-making in orthopaedic care.</p></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140102918","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 : 2024-08-01DOI: 10.1016/j.arthro.2024.04.019
{"title":"Regarding “Rotator Cuff Tears Are Significantly More Frequent in Recurrent Shoulder Instability Patients With Initial Dislocation at Age 40 or Older”","authors":"","doi":"10.1016/j.arthro.2024.04.019","DOIUrl":"10.1016/j.arthro.2024.04.019","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873170","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 : 2024-08-01DOI: 10.1016/j.arthro.2024.05.001
Elbow arthroscopy is a useful tool that can be applied in a variety of surgical indications. However, performing the procedure safely demands a thorough understanding of the proximity of neurovascular structures around the elbow. Although nerve injuries in elbow arthroscopy are rare, complications can further be avoided by adhering to a set of principles designed to protect the surrounding neurovascular structures. Before making portals, the surgeon should palpate and mark the ulnar nerve to confirm its location in the groove. Next, the joint should be insufflated with fluid to distend the joint capsule and increase the distance between instruments and the anterior neurovascular structures. Anterior portals ideally should be made proximal to the medial and lateral epicondyles, thereby increasing distance from the median and radial nerve, respectively. Once in the joint, it is critical to stay oriented by maintaining instruments and the articular surfaces in the same view. Special caution should be exercised when in proximity to the capsule in the posteromedial gutter to protect the ulnar nerve. Similarly, the anterior inferior capsule should be approached with caution, as its violation puts branches of the radial nerve, specifically the posterior interosseous nerve, at risk. Elbow arthroscopy can be safely performed with proper knowledge and application of anatomy around the elbow when making portals and understanding at-risk areas beyond the capsule when working within the joint.
{"title":"Elbow Arthroscopy: Pearls to Avoid Nerve Injuries","authors":"","doi":"10.1016/j.arthro.2024.05.001","DOIUrl":"10.1016/j.arthro.2024.05.001","url":null,"abstract":"<div><p>Elbow arthroscopy is a useful tool that can be applied in a variety of surgical indications. However, performing the procedure safely demands a thorough understanding of the proximity of neurovascular structures around the elbow. Although nerve injuries in elbow arthroscopy are rare, complications can further be avoided by adhering to a set of principles designed to protect the surrounding neurovascular structures. Before making portals, the surgeon should palpate and mark the ulnar nerve to confirm its location in the groove. Next, the joint should be insufflated with fluid to distend the joint capsule and increase the distance between instruments and the anterior neurovascular structures. Anterior portals ideally should be made proximal to the medial and lateral epicondyles, thereby increasing distance from the median and radial nerve, respectively. Once in the joint, it is critical to stay oriented by maintaining instruments and the articular surfaces in the same view. Special caution should be exercised when in proximity to the capsule in the posteromedial gutter to protect the ulnar nerve. Similarly, the anterior inferior capsule should be approached with caution, as its violation puts branches of the radial nerve, specifically the posterior interosseous nerve, at risk. Elbow arthroscopy can be safely performed with proper knowledge and application of anatomy around the elbow when making portals and understanding at-risk areas beyond the capsule when working within the joint.</p></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141978496","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 : 2024-08-01DOI: 10.1016/j.arthro.2024.01.009
Purpose
To assess the outcomes of acute, combined, complete anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries in the literature.
Methods
A literature search using PubMed, Embase, Scopus, and Cochrane Reviews was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The inclusion criteria were studies reporting outcomes of complete ACL-MCL injuries at a minimum of 12 months’ follow-up. Data were presented as ranges.
Results
Twenty-seven studies with 821 patients were included (mean age, 29 years; 61% male patients; mean follow-up period, 27 months). There were 4 randomized trials, 10 Level III studies, and 13 Level IV studies. Nine different strategies were noted, of which nonoperative MCL treatment with acute ACL reconstruction and acute MCL repair with acute ACL reconstruction were most commonly performed. Nonoperative MCL-ACL treatment and acute MCL repair with nonoperative ACL treatment led to low rates of valgus stability at 30° of flexion (27%-68% and 36%-77%, respectively) compared with acute ACL reconstruction with either nonoperative MCL treatment (80%-100%), acute MCL repair (65%-100%), or acute MCL reconstruction (81%-100%). Lysholm scores were not different between the strategies.
Conclusions
Outcomes in this systematic review suggest that ACL stabilization in the acute setting might result in the lowest rates of residual valgus laxity, whereas there is no clear difference between the different MCL treatments along with acute ACL reconstruction. Nonoperative MCL treatment with either nonoperative or delayed ACL reconstruction, as well as acute MCL repair with either nonoperative or delayed ACL reconstruction, leads to higher rates of valgus laxity.
Level of Evidence
Level IV, systematic review of Level I to IV studies.
{"title":"Early Anterior Cruciate Ligament Treatment Might Be Crucial for Acute Combined Anterior Cruciate Ligament and Medial Collateral Ligament Injuries: A Systematic Review of the Various Treatment Strategies","authors":"","doi":"10.1016/j.arthro.2024.01.009","DOIUrl":"10.1016/j.arthro.2024.01.009","url":null,"abstract":"<div><h3>Purpose</h3><p>To assess the outcomes of acute, combined, complete anterior cruciate ligament<span> (ACL) and medial collateral ligament (MCL) injuries in the literature.</span></p></div><div><h3>Methods</h3><p>A literature search using PubMed, Embase, Scopus, and Cochrane Reviews was performed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The inclusion criteria were studies reporting outcomes of complete ACL-MCL injuries at a minimum of 12 months’ follow-up. Data were presented as ranges.</p></div><div><h3>Results</h3><p>Twenty-seven studies with 821 patients were included (mean age, 29 years; 61% male patients; mean follow-up period, 27 months). There were 4 randomized trials, 10 Level III studies, and 13 Level IV studies. Nine different strategies were noted, of which nonoperative MCL treatment with acute ACL reconstruction<span> and acute MCL repair with acute ACL reconstruction were most commonly performed. Nonoperative MCL-ACL treatment and acute MCL repair with nonoperative ACL treatment led to low rates of valgus<span> stability at 30° of flexion (27%-68% and 36%-77%, respectively) compared with acute ACL reconstruction with either nonoperative MCL treatment (80%-100%), acute MCL repair (65%-100%), or acute MCL reconstruction<span> (81%-100%). Lysholm scores were not different between the strategies.</span></span></span></p></div><div><h3>Conclusions</h3><p>Outcomes in this systematic review suggest that ACL stabilization in the acute setting might result in the lowest rates of residual valgus laxity, whereas there is no clear difference between the different MCL treatments along with acute ACL reconstruction. Nonoperative MCL treatment with either nonoperative or delayed ACL reconstruction, as well as acute MCL repair with either nonoperative or delayed ACL reconstruction, leads to higher rates of valgus laxity.</p></div><div><h3>Level of Evidence</h3><p>Level IV, systematic review of Level I to IV studies.</p></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139498266","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 : 2024-08-01DOI: 10.1016/j.arthro.2024.02.002
Femoroacetabular impingement syndrome can cause pain and difficulty with sexual activity. Arthroscopic treatment of femoroacetabular impingement can improve a patient’s sexual health, as seen by improvement in patient-reported outcomes. This correlates with improved quality-of-life scores. Sexual function scores improve for both male and female patients after surgery, but improvement in female patients is greater, most likely because sexual positioning in female patients may involve more flexion, abduction, and rotation than male patients. Reviewing patient-reported outcomes can help provide context for the treating surgeon for discussion both preoperatively and postoperatively.
{"title":"Editorial Commentary: Sexual Function Improves After Hip Arthroscopy for Femoroacetabular Impingement","authors":"","doi":"10.1016/j.arthro.2024.02.002","DOIUrl":"10.1016/j.arthro.2024.02.002","url":null,"abstract":"<div><p>Femoroacetabular impingement syndrome can cause pain and difficulty with sexual activity. Arthroscopic treatment of femoroacetabular impingement can improve a patient’s sexual health, as seen by improvement in patient-reported outcomes. This correlates with improved quality-of-life scores. Sexual function scores improve for both male and female patients after surgery, but improvement in female patients is greater, most likely because sexual positioning in female patients may involve more flexion, abduction, and rotation than male patients. Reviewing patient-reported outcomes can help provide context for the treating surgeon for discussion both preoperatively and postoperatively.</p></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708617","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 : 2024-08-01DOI: 10.1016/j.arthro.2023.10.049
Purpose
To evaluate 10-year patient-reported outcome (PRO) scores following endoscopic surgery for gluteus medius partial and full-thickness tears with concomitant hip arthroscopy for labral tears and/or femoroacetabular impingement syndrome (FAIS).
Methods
Prospectively collected data on patients followed for a minimum of 10 years after endoscopic gluteus medius repair with concomitant hip arthroscopy performed by a single surgeon were retrospectively analyzed. Patients with preoperative and 10-year follow-up for the following PROs were included: modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS) score for pain.
Results
There were 13 patients eligible for inclusion, 11 (84.6%) of whom had 10-year follow up, with a mean of 127.6 months (range: 120.0-140.2 months). The group consisted of 10 females (90.9%) and one male (9.1%) with a mean age at surgery of 60.1 years (range: 46.2-74.8 years). PRO scores improved from preoperative to 10-year follow-up as follows: mHHS from 60.4 to 88.0 (P = .011); NAHS from 50.1 to 90.6 (P < .001); HOS-SS from 37.5 to 85.1 (P = .001); and VAS from 4.8 to 1.2 (P = .006). Mean patient satisfaction rating was 8.3. Patients achieved PASS and MCID for mHHS and HOS-SSS at a rate of 81.8%. There was no significant decline in PROs or satisfaction between 2, 5, and 10 years postoperatively. All patients underwent concomitant hip arthroscopy and labral treatment (debridement or repair). One patient, who had arthroscopic findings of acetabular and femoral outerbridge grade 4 lesions, subsequently underwent total hip arthroplasty; however, the GM was assessed during the THA, and it was verified that the repair was intact. There were no clinical failures, secondary operations, or complications.
Conclusions
Endoscopic repair of gluteus medius tears is a safe procedure with favorable and durable long-term outcomes at minimum 10-year follow-up.
{"title":"Favorable and Durable Outcomes at 10-Year Follow-Up After Endoscopic Gluteus Medius Repair With Concomitant Hip Arthroscopy","authors":"","doi":"10.1016/j.arthro.2023.10.049","DOIUrl":"10.1016/j.arthro.2023.10.049","url":null,"abstract":"<div><h3>Purpose</h3><p><span>To evaluate 10-year patient-reported outcome (PRO) scores following endoscopic surgery for gluteus medius partial and full-thickness tears with concomitant </span>hip arthroscopy<span> for labral tears and/or femoroacetabular impingement syndrome (FAIS).</span></p></div><div><h3>Methods</h3><p>Prospectively collected data on patients followed for a minimum of 10 years after endoscopic gluteus medius repair with concomitant hip arthroscopy performed by a single surgeon were retrospectively analyzed. Patients with preoperative and 10-year follow-up for the following PROs were included: modified Harris Hip Score<span> (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS) score for pain.</span></p></div><div><h3>Results</h3><p>There were 13 patients eligible for inclusion, 11 (84.6%) of whom had 10-year follow up, with a mean of 127.6 months (range: 120.0-140.2 months). The group consisted of 10 females (90.9%) and one male (9.1%) with a mean age at surgery of 60.1 years (range: 46.2-74.8 years). PRO scores improved from preoperative to 10-year follow-up as follows: mHHS from 60.4 to 88.0 (<em>P</em> = .011); NAHS from 50.1 to 90.6 (<em>P</em> < .001); HOS-SS from 37.5 to 85.1 (<em>P</em> = .001); and VAS from 4.8 to 1.2 (<em>P</em><span><span> = .006). Mean patient satisfaction rating was 8.3. Patients achieved PASS and MCID for mHHS and HOS-SSS at a rate of 81.8%. There was no significant decline in PROs or satisfaction between 2, 5, and 10 years postoperatively. All patients underwent concomitant hip arthroscopy and labral treatment (debridement or repair). One patient, who had arthroscopic findings of acetabular and femoral outerbridge grade 4 lesions, subsequently underwent </span>total hip arthroplasty; however, the GM was assessed during the THA, and it was verified that the repair was intact. There were no clinical failures, secondary operations, or complications.</span></p></div><div><h3>Conclusions</h3><p>Endoscopic repair of gluteus medius tears is a safe procedure with favorable and durable long-term outcomes at minimum 10-year follow-up.</p></div><div><h3>Level of Evidence</h3><p>Level IV, therapeutic case series.</p></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134650499","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 : 2024-08-01DOI: 10.1016/j.arthro.2024.01.003
Purpose
To develop a quality appraisal tool for the assessment of cadaveric biomechanical laboratory and other basic science biomechanical studies.
Methods
For item identification and development, a systematic review of the literature was performed. The content validity index (CVI) was used either to include or exclude items. The content validity ratio (CVR) was used to determine content validity. Weighting was performed by each panel member; the final weight was either up- or downgraded to the closest of 5% or 10%. Face validity was scored on a Likert scale ranked from 1 to 7. Test-retest reliability was determined using the Fleiss kappa coefficient. Internal consistency was assessed with Cronbach’s alpha. Concurrent criterion validity was assessed against the Quality Appraisal for Cadaveric Studies scale.
Results
The final Biomechanics Objective Basic science Quality Assessment Tool (BOBQAT) score included 15 items and was shown to be valid, reliable, and consistent. Five items had a CVI of 1.0; 10 items had a CVI of 0.875. For weighting, 5 items received a weight of 10%, and 10 items a weight of 5%. CVR was 1.0 for 6 items and 0.75 for 9 items. For face validity, all items achieved a score above 5. For test-retest reliability, almost-perfect test-retest reliability was observed for 10 items, substantial agreement for 4 items, and moderate agreement for 1 item. For internal consistency, Cronbach’s alpha was calculated to be 0.71. For concurrent criterion validity, Pearson’s product-moment correlation was 0.56 (95% confidence interval [CI] = 0.38-0.70, P = .0001).
Conclusions
Cadaveric biomechanical and laboratory research can be quantitatively scored for quality based on the inclusion of a clear and answerable purpose, demographics, specimen condition, appropriate bone density, reproducible technique, appropriate outcome measures, appropriate loading conditions, appropriate load magnitude, cyclic loading, sample size calculation, proper statistical analysis, results consistent with methods, limitations considered, conclusions based on results, and disclosure of funding and potential conflicts.
Clinical Relevance
Study quality assessments are important to evaluate internal and external validity and reliability and to identify methodological flaws and misleading conclusions. The BOBQAT score will help not only in the critical appraisal of cadaveric biomechanical studies but also in guiding the designs of such research endeavors.
{"title":"Cadaveric Biomechanical Laboratory Research Can Be Quantitatively Scored for Quality With the Biomechanics Objective Basic Science Quality Assessment Tool: The BOBQAT Score","authors":"","doi":"10.1016/j.arthro.2024.01.003","DOIUrl":"10.1016/j.arthro.2024.01.003","url":null,"abstract":"<div><h3>Purpose</h3><p>To develop a quality appraisal tool for the assessment of cadaveric biomechanical laboratory and other basic science biomechanical studies.</p></div><div><h3>Methods</h3><p><span>For item identification and development, a systematic review<span> of the literature was performed. The content validity<span> index (CVI) was used either to include or exclude items. The content validity ratio (CVR) was used to determine content validity. Weighting was performed by each panel member; the final weight was either up- or downgraded to the closest of 5% or 10%. Face validity<span><span> was scored on a Likert scale ranked from 1 to 7. Test-retest reliability was determined using the Fleiss </span>kappa coefficient. </span></span></span></span>Internal consistency<span> was assessed with Cronbach’s alpha. Concurrent criterion validity was assessed against the Quality Appraisal for Cadaveric Studies scale.</span></p></div><div><h3>Results</h3><p>The final Biomechanics Objective Basic science Quality Assessment Tool (BOBQAT) score included 15 items and was shown to be valid, reliable, and consistent. Five items had a CVI of 1.0; 10 items had a CVI of 0.875. For weighting, 5 items received a weight of 10%, and 10 items a weight of 5%. CVR was 1.0 for 6 items and 0.75 for 9 items. For face validity, all items achieved a score above 5. For test-retest reliability, almost-perfect test-retest reliability was observed for 10 items, substantial agreement for 4 items, and moderate agreement for 1 item. For internal consistency, Cronbach’s alpha was calculated to be 0.71. For concurrent criterion validity, Pearson’s product-moment correlation was 0.56 (95% confidence interval [CI] = 0.38-0.70, <em>P</em> = .0001).</p></div><div><h3>Conclusions</h3><p>Cadaveric biomechanical and laboratory research can be quantitatively scored for quality based on the inclusion of a clear and answerable purpose, demographics, specimen condition, appropriate bone density, reproducible technique, appropriate outcome measures, appropriate loading conditions, appropriate load magnitude, cyclic loading, sample size calculation, proper statistical analysis, results consistent with methods, limitations considered, conclusions based on results, and disclosure of funding and potential conflicts.</p></div><div><h3>Clinical Relevance</h3><p>Study quality assessments are important to evaluate internal and external validity and reliability and to identify methodological flaws and misleading conclusions. The BOBQAT score will help not only in the critical appraisal of cadaveric biomechanical studies but also in guiding the designs of such research endeavors.</p></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139378860","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 : 2024-08-01DOI: 10.1016/j.arthro.2024.01.013
Gluteus medius and minimus tendon pathology is a common cause of lateral hip pain. In patients who are dissatisfied with their hip condition following nonsurgical treatment, gluteal repair has demonstrated excellent short-, mid-, and, now recently, long-term subjective patient-reported and objective clinician-measured outcomes. In patients with peritrochanteric hip pain, the proportion of their overall hip pain may be influenced by the hip joint due to conditions like femoroacetabular impingement syndrome, acetabular dysplasia, labral tears, and arthritis. Thus, surgical decision-making must include consideration of also addressing the joint at the same time as the gluteal repair. This is sometimes challenging due to the high frequency of observing labral injuries and cam/pincer/dysplasia morphology in patients without symptoms due to the “radiographic abnormalities.” Labral pathology is also more prevalent in older patients, who happen to also be those individuals with symptomatic gluteal tendon pain. Both open and endoscopic approaches to the gluteal tendons have advantages and disadvantages without significant outcomes differences in the short- or mid-term. Long-term clinical follow-up of patients treated with endoscopic gluteal repair with or without concomitant hip arthroscopy should be included in large national and international prospective registries using validated, reliable, and responsive patient-reported outcome scores, with clinical importance assessed using the minimal clinically important difference, patient acceptable symptom state, substantial clinical benefit, and maximal outcome improvement.
{"title":"Editorial Commentary: Long-Term Follow-Up After Endoscopic Gluteal Repair Plus Hip Arthroscopy Shows Durable Results Using Validated Patient-Reported Outcome Scores That Largely Exceed the Minimal Clinically Important Difference and Patient Acceptable Symptom State","authors":"","doi":"10.1016/j.arthro.2024.01.013","DOIUrl":"10.1016/j.arthro.2024.01.013","url":null,"abstract":"<div><p>Gluteus medius and minimus tendon pathology is a common cause of lateral hip pain. In patients who are dissatisfied with their hip condition following nonsurgical treatment, gluteal repair has demonstrated excellent short-, mid-, and, now recently, long-term subjective patient-reported and objective clinician-measured outcomes. In patients with peritrochanteric hip pain, the proportion of their overall hip pain may be influenced by the hip joint due to conditions like femoroacetabular impingement syndrome, acetabular dysplasia, labral tears, and arthritis. Thus, surgical decision-making must include consideration of also addressing the joint at the same time as the gluteal repair. This is sometimes challenging due to the high frequency of observing labral injuries and cam/pincer/dysplasia morphology in patients without symptoms due to the “radiographic abnormalities.” Labral pathology is also more prevalent in older patients, who happen to also be those individuals with symptomatic gluteal tendon pain. Both open and endoscopic approaches to the gluteal tendons have advantages and disadvantages without significant outcomes differences in the short- or mid-term. Long-term clinical follow-up of patients treated with endoscopic gluteal repair with or without concomitant hip arthroscopy should be included in large national and international prospective registries using validated, reliable, and responsive patient-reported outcome scores, with clinical importance assessed using the minimal clinically important difference, patient acceptable symptom state, substantial clinical benefit, and maximal outcome improvement.</p></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139557033","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 : 2024-08-01DOI: 10.1016/j.arthro.2024.03.010
The biceps rerouting (BR) augmentation technique has emerged as a useful option for the repair of rotator cuff tears when the torn tendon does not cover the footprint or can only be reduced under excessive tension. BR offers several advantages over traditional methods. It is an all-inside joint procedure, eliminating the need for skin incisions other than those for the arthroscopic portal, thus reducing operative time and infection risk. It does not lead to donor-site morbidity, unlike superior capsular reconstruction. In addition, the rerouted long head of the biceps tendon serves as a depressor of the humeral head and an internal splint, protecting cuff healing. Finally, it provides a biceps tenodesis such that biceps-related symptoms are prevented postoperatively. Clinical studies have shown the efficacy of the BR technique, particularly in achieving low rates of retear. Although the BR technique is a nonanatomic reconstruction, its biomechanical impact effectively restores joint function to a state similar to the original. Considering these findings, the BR technique represents a significant advancement in managing large to massive rotator cuff tears, given its straightforward application and ability to re-establish joint biomechanics.
{"title":"Editorial Commentary: Biceps Rerouting Augmentation Technique Restores Biomechanics, Improves Healing, and Has Many Advantages for Repair of Large and Massive Rotator Cuff Tears","authors":"","doi":"10.1016/j.arthro.2024.03.010","DOIUrl":"10.1016/j.arthro.2024.03.010","url":null,"abstract":"<div><p>The biceps rerouting (BR) augmentation technique has emerged as a useful option for the repair of rotator cuff tears when the torn tendon does not cover the footprint or can only be reduced under excessive tension. BR offers several advantages over traditional methods. It is an all-inside joint procedure, eliminating the need for skin incisions other than those for the arthroscopic portal, thus reducing operative time and infection risk. It does not lead to donor-site morbidity, unlike superior capsular reconstruction. In addition, the rerouted long head of the biceps tendon serves as a depressor of the humeral head and an internal splint, protecting cuff healing. Finally, it provides a biceps tenodesis such that biceps-related symptoms are prevented postoperatively. Clinical studies have shown the efficacy of the BR technique, particularly in achieving low rates of retear. Although the BR technique is a nonanatomic reconstruction, its biomechanical impact effectively restores joint function to a state similar to the original. Considering these findings, the BR technique represents a significant advancement in managing large to massive rotator cuff tears, given its straightforward application and ability to re-establish joint biomechanics.</p></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":null,"pages":null},"PeriodicalIF":4.4,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137454","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}