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.

Purpose: To systematically review the literature for studies using video analysis to evaluate acute lower extremity injury mechanisms in soccer players.

Methods: The study was pre-registered on PROSPERO. PRISMA guidelines were followed. Three databases were searched for Level I-IV studies that quantified lower extremity injury mechanisms in soccer players using video analysis. Data recorded included study demographics, injury type, mechanisms, contact, phase of play, timing, and sagittal plane kinematics. Study methodological quality was analyzed using the Quality Appraisal for Sports Injury Video Analysis Studies (QA-SIVAS) Scale. Forest plots of proportions were generated for injuries occurring in the first versus second half, defensive versus offensive phase, and contact versus noncontact injury.

Results: Nineteen articles (mean QA-SIVAS score 14.3 + 1.9; all Level IV evidence, 1,652 videos, 17 professional male, 1 professional female, 1 both male/female) were included. Anterior cruciate ligament (ACL) tears (49% [42% - 55%]), muscle strains (hamstring: 71% [47% - 87%] ), and Achilles tears (80-83%) had a high percentage of noncontact (NC) injury mechanisms. Direct and indirect contact-predominant injuries include medial collateral ligament (MCL) sprains (14% NC) and foot/ankle sprains (6% [4% - 10%] NC). A majority of ACL injuries (68% [61% - 75%]) occurred while defending, and quadriceps strains (81-89%) occurred while attacking.

Conclusion: In soccer, video analysis demonstrates that a high proportion of acute ACL, Achilles, and muscle injuries occur through noncontact mechanisms, while MCL and foot/ankle injuries usually happen with direct contact. ACL injuries are more likely to be sustained when defending, specifically when pressing/tackling, and muscle injuries result from sprinting, kicking, and lunging. Most noncontact-predominant injuries occurred at a higher percentage in the first half, whereas contact-predominant injuries occurred at a higher percentage in the second half.

Level of evidence: Systematic review and meta-analysis of Level IV studies.

Purpose: To evaluate the clinical outcomes of intra-articular stromal vascular fraction (SVF) and adipose-derived mesenchymal stem cell (ASC) injections in patients with knee osteoarthritis through a meta-analysis of randomized clinical trials.

Methods: PubMed, Embase, the Cochrane Library, and Google Scholar were systematically searched to identify Level I studies that compared the clinical efficacy of SVF or ASC with that of other nonoperative treatments. Clinical scores measured 3, 6, and 12 months postinjection were standardized to pain and functional scales for meta-analysis based on minimal clinically important differences. Follow-up magnetic resonance imaging findings and safety-related data were also investigated.

Results: Nine studies involving 671 patients were included. SVF demonstrated superior pain and function score improvements compared to saline or hyaluronic acid (HA) at 3, 6, and 12 months postinjection. However, SVF was inferior to corticosteroid at 3 months, showed no difference at 6 months, and was comparable or slightly superior at 12 months. ASC consistently showed better pain and function score improvements compared to saline and conservative treatment at all time points, with no significant differences observed compared to HA. High heterogeneity was noted in SVF function score results, requiring cautious interpretation. No serious adverse events related to SVF or ASC were reported, although complications associated with liposuction were observed.

Conclusions: SVF showed consistent superiority in pain and function scores compared to HA and saline but not corticosteroids, except for the 3-month function score. ASC improved pain and function scores compared to saline and conservative treatment but was not superior to HA. While SVF and ASC significantly improved clinical scores, the potential complications from liposuction limit their ability to replace existing minimally invasive treatments for knee osteoarthritis.

Level of evidence: Level I, meta-analyses of randomized controlled trials.

Purpose: To evaluate the clinical outcomes of arthroscopically assisted lower trapezius tendon (aLTT) transfer using Achilles tendon allograft in patients with irreparable infraspinatus musculotendinous tears (IISMTTs).

Methods: We conducted a retrospective analysis of patients who underwent aLTT transfer for IISMTTs. The inclusion criteria were minimal glenohumeral arthritis (Hamada grade ≤ 1), isolated infraspinatus musculotendinous tear with poor muscle quality (Goutallier grade ≥ 3), and intact remaining rotator cuff muscles. The exclusion criteria included less than 5-year follow-up, loss to follow-up, or insufficient data. Clinical outcomes were assessed using the visual analog scale (VAS) pain score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), range of motion, tendon integrity, and arthritis progression.

Results: A total of 20 patients were included, with a mean follow-up period of 7.4 years. Significant improvements were observed in all clinical scores: VAS pain score, 7.9 ± 1.2 to 1.1 ± 0.7; Constant score, 33.7 ± 5.9 to 67.6 ± 16.3; ASES score, 38.0 ± 6.0 to 68.8 ± 16.2; and SSV, 20.2 ± 7.8 to 67.5 ± 18.1 (all with P < .001). Significant range-of-motion improvements were observed forward elevation (100° ± 13° to 139° ± 30°), abduction (77° ± 20° to 119° ± 13°), and external rotation (24° ± 9° to 56° ± 12°). Regarding the minimal clinically important difference (MCID), determined using the 0.5 standard deviation distribution-based method, all 20 patients (100%) achieved the MCID for the VAS pain score; 17 patients (85%), for the Constant score; 17 patients (85%), for the ASES score; and all 20 patients (100%), for the SSV. In all patients, glenohumeral joint integrity was maintained without the development of arthritis. No retears were observed.

Conclusions: The aLTT transfer effectively alleviated pain and improved shoulder function in patients with IISMTTs at mid-term follow-up. Significant improvements in pain and external rotation were observed without any progression of glenohumeral arthritis, and no retears were reported.

Level of evidence: Level IV, retrospective case series.