Pub Date : 2025-12-01DOI: 10.1016/j.arthro.2025.08.010
George C. Balazs M.D. (Associate Editor)
Mounting evidence suggests that patient response to intra-articular injection may not predict clinical response to arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS), as once believed. However, the hip preservation community should not take this to mean that diagnostic injections lack value in establishing a diagnosis of FAIS and distinguishing it from extra-articular hip conditions. Like other diagnostic tools, intra-articular injection is not a stand-alone test intended to definitively determine proper treatment. All diagnostic tools, to include elements as basic as assessment of pain location and provocative examination maneuvers, have shown poor specificity in predicting response to arthroscopy for FAIS when evaluated in isolation. Intra-articular injections, as with all other tools of the orthopaedic surgeon, must be considered in light of the entire evaluation of the patient.
{"title":"Editorial Commentary: Response to Intra-articular Injection May Not Predict Response to Hip Arthroscopy, but Don’t Put Down That Needle Quite Yet","authors":"George C. Balazs M.D. (Associate Editor)","doi":"10.1016/j.arthro.2025.08.010","DOIUrl":"10.1016/j.arthro.2025.08.010","url":null,"abstract":"<div><div>Mounting evidence suggests that patient response to intra-articular injection may not predict clinical response to arthroscopy in the setting of femoroacetabular impingement syndrome (FAIS), as once believed. However, the hip preservation community should not take this to mean that diagnostic injections lack value in establishing a diagnosis of FAIS and distinguishing it from extra-articular hip conditions. Like other diagnostic tools, intra-articular injection is not a stand-alone test intended to definitively determine proper treatment. All diagnostic tools, to include elements as basic as assessment of pain location and provocative examination maneuvers, have shown poor specificity in predicting response to arthroscopy for FAIS when evaluated in isolation. Intra-articular injections, as with all other tools of the orthopaedic surgeon, must be considered in light of the entire evaluation of the patient.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 12","pages":"Pages 5149-5150"},"PeriodicalIF":5.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979715","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 : 2025-12-01DOI: 10.1016/j.arthro.2025.08.017
Robert U. Hartzler M.D., M.S.
Decision making in treating chronic irreparable rotator cuff tears is complex given the large and diverse number of treatment options for these conditions. Lack of knowledge about structural healing and clinical outcomes of reconstructive operations such as superior capsular reconstruction hinders rational decision making. Mid-term case series showing sustained clinical outcomes and graft survival for superior capsular reconstruction point to a future in which soft-tissue reconstructions can be offered with confidence in their effectiveness. However, higher-level comparative studies are warranted to determine the incremental benefit of complex soft-tissue reconstructions versus lower-resource-intensive operations.
{"title":"Editorial Commentary: High Reported Mid-term Healing of Folded Superior Capsular Reconstruction Xenografts Calls for Careful Analysis of Excluded Patients","authors":"Robert U. Hartzler M.D., M.S.","doi":"10.1016/j.arthro.2025.08.017","DOIUrl":"10.1016/j.arthro.2025.08.017","url":null,"abstract":"<div><div>Decision making in treating chronic irreparable rotator cuff tears is complex given the large and diverse number of treatment options for these conditions. Lack of knowledge about structural healing and clinical outcomes of reconstructive operations such as superior capsular reconstruction hinders rational decision making. Mid-term case series showing sustained clinical outcomes and graft survival for superior capsular reconstruction point to a future in which soft-tissue reconstructions can be offered with confidence in their effectiveness. However, higher-level comparative studies are warranted to determine the incremental benefit of complex soft-tissue reconstructions versus lower-resource-intensive operations.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 12","pages":"Pages 5036-5037"},"PeriodicalIF":5.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979736","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 : 2025-12-01DOI: 10.1016/j.arthro.2025.08.024
Taylor J. Freetly M.D., David E. Hartigan M.D. (Editorial Board)
Femoral retroversion is increasingly recognized as a contributor to hip pain, impingement, and inferior outcomes after hip preservation surgery. Although its natural history remains incompletely defined, biomechanical studies show that retroversion decreases impingement-free range of motion and alters labral contact. Clinical outcomes following hip arthroscopy in retroverted hips have been mixed. Recent comparative studies have reported that femoral derotational osteotomy, either alone or combined with hip arthroscopy, can outperform hip arthroscopy alone in terms of patient-reported outcomes in patients with <5° of femoral anteversion.
{"title":"Editorial Commentary: Femoral Version Is Not a Solo Act but Rather a Complex Interplay When Considered in Hip Preservation","authors":"Taylor J. Freetly M.D., David E. Hartigan M.D. (Editorial Board)","doi":"10.1016/j.arthro.2025.08.024","DOIUrl":"10.1016/j.arthro.2025.08.024","url":null,"abstract":"<div><div>Femoral retroversion is increasingly recognized as a contributor to hip pain, impingement, and inferior outcomes after hip preservation surgery. Although its natural history remains incompletely defined, biomechanical studies show that retroversion decreases impingement-free range of motion and alters labral contact. Clinical outcomes following hip arthroscopy in retroverted hips have been mixed. Recent comparative studies have reported that femoral derotational osteotomy, either alone or combined with hip arthroscopy, can outperform hip arthroscopy alone in terms of patient-reported outcomes in patients with <5° of femoral anteversion.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 12","pages":"Pages 5135-5136"},"PeriodicalIF":5.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145082556","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 : 2025-12-01DOI: 10.1016/j.arthro.2025.09.005
Aaron J. Krych M.D., Adam J. Tagliero M.D.
Meniscal root repair has advanced considerably, yet extrusion remains the pivotal determinant of outcomes, primarily with medial meniscus repairs. In our view, successful preservation of the meniscus—and ultimately the joint—hinges on minimizing extrusion through timely intervention, meticulous technique, and consideration of centralization strategies. If we fail to target extrusion, we fail to preserve meniscus function and ultimately protect the cartilage. Only by targeting extrusion as the key modifiable risk factor can we hope to achieve higher patient satisfaction and long-term cartilage preservation.
{"title":"Editorial Commentary: Targeting Meniscal Extrusion Is the Key to Saving the Meniscus and Preserving Articular Cartilage","authors":"Aaron J. Krych M.D., Adam J. Tagliero M.D.","doi":"10.1016/j.arthro.2025.09.005","DOIUrl":"10.1016/j.arthro.2025.09.005","url":null,"abstract":"<div><div>Meniscal root repair has advanced considerably, yet extrusion remains the pivotal determinant of outcomes, primarily with medial meniscus repairs. In our view, successful preservation of the meniscus—and ultimately the joint—hinges on minimizing extrusion through timely intervention, meticulous technique, and consideration of centralization strategies. If we fail to target extrusion, we fail to preserve meniscus function and ultimately protect the cartilage. Only by targeting extrusion as the key modifiable risk factor can we hope to achieve higher patient satisfaction and long-term cartilage preservation.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 12","pages":"Pages 5191-5192"},"PeriodicalIF":5.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145071243","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 : 2025-12-01DOI: 10.1016/j.arthro.2025.07.041
Andrew Bi M.D., Eric Y. Hu B.S., Jesus E. Cervantes B.S., Kyleen Jan M.D., Shane J. Nho M.D., M.S.
Purpose
To identify long-term patient-reported outcomes (PROs), achievement of clinically significant outcomes, and reoperation rates after primary hip arthroscopy for femoroacetabular impingement between patients requesting at least 1 postoperative opioid refill after hip arthroscopy and patients not requesting a refill.
Methods
Patients who underwent hip arthroscopy between January 2012 and October 2014 with minimum 10-year follow-up were included. Patients who had received at least 1 opioid refill were propensity matched 1:1 to patients who did not receive a refill, controlling for age, sex, and body mass index (BMI). Patients completed PROs including the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, and visual analog scale scores for pain and satisfaction. Clinically significant outcomes obtained at 10-year follow-up included the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). A Kaplan-Meier analysis was performed to evaluate survivorship between cohorts.
Results
Seventy-four patients who received opioid refills (age, 35.1 ± 11.7 years; 67.6% female sex; BMI, 26.3 ± 5.8) were successfully matched to 74 patients who did not receive a refill (age, 36.9 ± 11.1 years; 68.9% female sex; BMI, 26.1 ± 5.4). There were no significant differences in patient demographic characteristics. Refill group patients showed worse scores for preoperative Hip Outcome Score–Activities of Daily Living; preoperative, 1-year postoperative, and 5-year postoperative modified Harris Hip Score; and 1-year postoperative Hip Outcome Score–Sports Subscale. All other PROs at each time point were not significantly different. Maximum observable improvement did not differ between groups. Groups did not differ in 10-year MCID achievement (98.1 vs 94.0) or PASS achievement (75.9 vs 81.1). Time-dependent survivorship was similar between groups. Male and female opioid who received refills had similar 10-year outcomes and reoperation rates.
Conclusions
After primary hip arthroscopy, patients who require opioid refills have significantly worse PROs at short- and mid-term follow-up, with no differences in PROs, achievement of the MCID or PASS, and reoperation rates at long-term follow-up.
Level of Evidence
Level III, retrospective, comparative case-control series.
目的：本研究的目的是确定长期患者报告的结果（PROs），临床显著结果（CSOs）的实现，以及在髋关节镜检查后要求≥1次术后阿片类药物再填充的患者与不要求再填充的患者之间进行股骨髋臼撞击的原发性髋关节镜检查后再手术率。方法：纳入2012年1月至2014年10月期间接受髋关节镜检查的患者，随访至少10年。在控制年龄、性别和BMI的情况下，填充≥1次阿片类药物的患者与未填充阿片类药物的患者倾向匹配为1:1。患者完成的pro包括日常生活活动/运动亚量表髋关节结局评分（HOS-ADL/SS）、改良Harris髋关节评分（mHHS）和视觉模拟量表（VAS）疼痛/满意度。随访10年获得的cso包括最小临床重要差异（MCID）和患者可接受症状状态（PASS）。Kaplan Meier分析用于评估队列间的生存率。结果：74例阿片类药物再填充患者（年龄：35.1±11.7岁，67.6%女性，BMI: 26.3±5.8 kg/m2）与74例未再填充患者（年龄：36.9±11.1岁，68.9%女性，BMI: 26.1±5.4 kg/m2）成功匹配。患者人口统计数据无显著差异。补液组患者术前HOS-ADL较差；术前、1年和5年mHHS；及1年期居屋计划。其他各时间点未提及的PROs均无显著差异。最大可观察到的改善在两组之间没有差异。各组在10年MCID （98.1 vs 94.0）或PASS成绩（75.9 vs 81.1）方面没有差异。各组间的时间依赖生存率相似。男性和女性阿片类药物再填充者的10年预后和再手术率相似。结论：原发性髋关节镜术后，需要阿片类药物再填充的患者在短期和中期随访时的PROs明显较差，在长期随访时PROs、MCID或PASS的实现和再手术率无差异。证据级别：回顾性比较病例对照系列，III级。
{"title":"Patients Requiring Postoperative Opioid Prescription Refills Have Similar Long-Term Clinical Outcomes to Those Not Requiring Refills After Hip Arthroscopy for Femoroacetabular Impingement Syndrome","authors":"Andrew Bi M.D., Eric Y. Hu B.S., Jesus E. Cervantes B.S., Kyleen Jan M.D., Shane J. Nho M.D., M.S.","doi":"10.1016/j.arthro.2025.07.041","DOIUrl":"10.1016/j.arthro.2025.07.041","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify long-term patient-reported outcomes (PROs), achievement of clinically significant outcomes, and reoperation rates after primary hip arthroscopy for femoroacetabular impingement between patients requesting at least 1 postoperative opioid refill after hip arthroscopy and patients not requesting a refill.</div></div><div><h3>Methods</h3><div>Patients who underwent hip arthroscopy between January 2012 and October 2014 with minimum 10-year follow-up were included. Patients who had received at least 1 opioid refill were propensity matched 1:1 to patients who did not receive a refill, controlling for age, sex, and body mass index (BMI). Patients completed PROs including the Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports Subscale, modified Harris Hip Score, and visual analog scale scores for pain and satisfaction. Clinically significant outcomes obtained at 10-year follow-up included the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). A Kaplan-Meier analysis was performed to evaluate survivorship between cohorts.</div></div><div><h3>Results</h3><div>Seventy-four patients who received opioid refills (age, 35.1 ± 11.7 years; 67.6% female sex; BMI, 26.3 ± 5.8) were successfully matched to 74 patients who did not receive a refill (age, 36.9 ± 11.1 years; 68.9% female sex; BMI, 26.1 ± 5.4). There were no significant differences in patient demographic characteristics. Refill group patients showed worse scores for preoperative Hip Outcome Score–Activities of Daily Living; preoperative, 1-year postoperative, and 5-year postoperative modified Harris Hip Score; and 1-year postoperative Hip Outcome Score–Sports Subscale. All other PROs at each time point were not significantly different. Maximum observable improvement did not differ between groups. Groups did not differ in 10-year MCID achievement (98.1 vs 94.0) or PASS achievement (75.9 vs 81.1). Time-dependent survivorship was similar between groups. Male and female opioid who received refills had similar 10-year outcomes and reoperation rates.</div></div><div><h3>Conclusions</h3><div>After primary hip arthroscopy, patients who require opioid refills have significantly worse PROs at short- and mid-term follow-up, with no differences in PROs, achievement of the MCID or PASS, and reoperation rates at long-term follow-up.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective, comparative case-control series.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 12","pages":"Pages 5108-5117"},"PeriodicalIF":5.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145056264","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 : 2025-12-01DOI: 10.1016/j.arthro.2025.08.020
Christopher Bernard M.D., Brooke Dickens M.D., Brian R. Waterman M.D. (Editorial Board)
The posterior tibial slope, used to define the angulation of the tibial plateau relative to the tibial shaft, is an important radiographic measurement that has gained significant interest recently. Increasing biomechanical and clinical literature has demonstrated the importance of evaluating posterior tibial slope because of its impact on knee kinematics. Although the risk of anterior cruciate ligament injury and graft rupture is multifactorial, studies have demonstrated that increased posterior tibial slope is likely a contributing factor. Numerous measurement techniques have been proposed for the evaluation of posterior tibial slope, but there remains a lack of consensus on how best to quantify sagittal alignment for the failed anterior cruciate ligament reconstruction. Consistent and precise assessment of the anatomic axis is paramount to guide clinical decision making, particularly when considering a deflexion, slope-reducing tibial osteotomy. Regardless of your technique, hear our humble plea: you don’t always have to obtain a full-length tibial radiograph when measuring posterior tibial slope, but you should definitely include at least 15 cm of proximal tibia on a lateral knee radiograph. The rest is up to you!
{"title":"Editorial Commentary: Measuring Posterior Tibial Slope: You Don’t Always Have to Obtain a Full-Length Tibial Radiograph, but You Should Definitely Include at Least 15 cm of Proximal Tibia on a Lateral Knee Radiograph","authors":"Christopher Bernard M.D., Brooke Dickens M.D., Brian R. Waterman M.D. (Editorial Board)","doi":"10.1016/j.arthro.2025.08.020","DOIUrl":"10.1016/j.arthro.2025.08.020","url":null,"abstract":"<div><div>The posterior tibial slope, used to define the angulation of the tibial plateau relative to the tibial shaft, is an important radiographic measurement that has gained significant interest recently. Increasing biomechanical and clinical literature has demonstrated the importance of evaluating posterior tibial slope because of its impact on knee kinematics. Although the risk of anterior cruciate ligament injury and graft rupture is multifactorial, studies have demonstrated that increased posterior tibial slope is likely a contributing factor. Numerous measurement techniques have been proposed for the evaluation of posterior tibial slope, but there remains a lack of consensus on how best to quantify sagittal alignment for the failed anterior cruciate ligament reconstruction. Consistent and precise assessment of the anatomic axis is paramount to guide clinical decision making, particularly when considering a deflexion, slope-reducing tibial osteotomy. Regardless of your technique, hear our humble plea: you don’t always have to obtain a full-length tibial radiograph when measuring posterior tibial slope, but you should definitely include at least 15 cm of proximal tibia on a lateral knee radiograph. The rest is up to you!</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 12","pages":"Pages 5214-5216"},"PeriodicalIF":5.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006912","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 : 2025-11-01DOI: 10.1016/j.arthro.2025.06.026
Jordi Vega M.D. (Editorial Board)
Arthroscopic all-inside ligament repair is a minimally invasive procedure for the treatment of patients with chronic ankle instability. Excellent results have been obtained through this arthroscopic procedure. However, remnant tissue quality can be a limitation to ligament repair. During the procedure, it is necessary to decide whether the injured ligament is repairable. When ligament resorption occurs, ligamentoplasty is indicated. In the case of good or excellent remnant ligament quality, ligament repair is the technique of choice. However, when ligament quality is poor, the surgeon must decide whether to proceed with repair. Although a poor-quality ligament can be repaired with good results, the use of augmentation techniques to protect the ligament repair should be considered when remnant ligament quality is poor.
{"title":"Editorial Commentary: Arthroscopic All-Inside Ligament Repair Is an Essential Technique and the Emerging Gold-Standard Treatment for Ankle Instability","authors":"Jordi Vega M.D. (Editorial Board)","doi":"10.1016/j.arthro.2025.06.026","DOIUrl":"10.1016/j.arthro.2025.06.026","url":null,"abstract":"<div><div>Arthroscopic all-inside ligament repair is a minimally invasive procedure for the treatment of patients with chronic ankle instability. Excellent results have been obtained through this arthroscopic procedure. However, remnant tissue quality can be a limitation to ligament repair. During the procedure, it is necessary to decide whether the injured ligament is repairable. When ligament resorption occurs, ligamentoplasty is indicated. In the case of good or excellent remnant ligament quality, ligament repair is the technique of choice. However, when ligament quality is poor, the surgeon must decide whether to proceed with repair. Although a poor-quality ligament can be repaired with good results, the use of augmentation techniques to protect the ligament repair should be considered when remnant ligament quality is poor.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4750-4751"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144531236","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 : 2025-11-01DOI: 10.1016/j.arthro.2025.06.035
Mark G. Siegel M.D. (Editorial Board)
Using a double-blinded randomized technique, a matched cohort of shoulder arthroscopic surgeries was compared and evaluated for visual clarity of the surgical field. Epinephrine in a 0.9% saline irrigation solution was marginally superior to an intravenous infusion of tranexamic acid. It is unknown whether 0.9% saline is inferior to a solution of Ringer’s lactate irrigation when evaluating loss of clarity as a result of intraoperative bleeding during arthroscopy.
{"title":"Editorial Commentary: Epinephrine Solution in Arthroscopic Irrigation Fluid Is Marginally Superior to Intravenous Tranexamic Acid, but Should We Focus Instead on Using Ringer’s Lactate Instead of Normal Saline for Arthroscopic Clarity?","authors":"Mark G. Siegel M.D. (Editorial Board)","doi":"10.1016/j.arthro.2025.06.035","DOIUrl":"10.1016/j.arthro.2025.06.035","url":null,"abstract":"<div><div>Using a double-blinded randomized technique, a matched cohort of shoulder arthroscopic surgeries was compared and evaluated for visual clarity of the surgical field. Epinephrine in a 0.9% saline irrigation solution was marginally superior to an intravenous infusion of tranexamic acid. It is unknown whether 0.9% saline is inferior to a solution of Ringer’s lactate irrigation when evaluating loss of clarity as a result of intraoperative bleeding during arthroscopy.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4469-4471"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144568147","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 : 2025-11-01DOI: 10.1016/j.arthro.2025.04.048
Jared P. Sachs M.S., Alexander C. Weissman M.S., Kyle R. Wagner M.D., Kaitlyn M. Joyce M.D., Trice Pickens B.A., Andrew S. Bi M.D., Brian J. Cole M.D., M.B.A.
{"title":"Author Reply to \"Regarding ‘YouTube Is an Inconsistent Source of Information on Orthobiologics: Implications for Content Quality, Reliability, Comprehensiveness, and Patient Decision Making’”","authors":"Jared P. Sachs M.S., Alexander C. Weissman M.S., Kyle R. Wagner M.D., Kaitlyn M. Joyce M.D., Trice Pickens B.A., Andrew S. Bi M.D., Brian J. Cole M.D., M.B.A.","doi":"10.1016/j.arthro.2025.04.048","DOIUrl":"10.1016/j.arthro.2025.04.048","url":null,"abstract":"","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Page 4392"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049494","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 : 2025-11-01DOI: 10.1016/j.arthro.2025.05.024
Adam B. Yanke M.D., Ph.D. , Navya Dandu M.D. , Blake M. Bodendorfer M.D. , Nicholas A. Trasolini M.D. , Mario Hevesi M.D., Ph.D. , Tristan J. Elias B.A. , Erik Haneberg B.S. , Reem Y. Darwish B.S. , Athan Zavras M.D. , Brian Forsythe M.D. , Brian J. Cole M.D., M.B.A.
Purpose
To perform a prospective, double-blind, randomized controlled trial to assess differences in integration and patient-reported outcomes metrics (PROMs) of osteochondral allograft transplantation with and without bone marrow aspirate concentrate (BMAC) augmentation.
Methods
Patients (n = 36) undergoing osteochondral allograft transplantation of the knee were consented and enrolled in this prospective study. They were randomized to either iliac crest BMAC or sham incision groups and blinded to their allocation. Computerized tomography (CT) scans of the knee were obtained at 6 months postoperatively after the index transplantation and graded by the semiquantitative assessment CT osteochondral allograft system. PROMs, including the International Knee Documentation Committee and Knee injury and Osteoarthritis Outcome Score–Joint Replacement, were obtained at 6 months, 1 year, and 2 years postoperatively.
Results
On 6-month postoperative CT scans, patients receiving BMAC-treated grafts were more likely to have small cystic changes (P = .01), with an associated trend toward reduction in large cyst formation (P = .06), but equal osseous integration, graft signal density, and presence of discernible clefts and intra-articular fragments. The BMAC group was less likely to undergo subsequent surgery for graft debridement or revision (5.3% vs 35.3%; P = .02). There were no significant differences in PROMs between the 2 groups preoperatively or postoperatively at 6 months, 1 year, or 2 years. Patients receiving BMAC trended toward a higher rate of achievement of Knee Documentation Committee and Knee injury and Osteoarthritis Outcome Score–Joint Replacement minimal clinically important difference (88% vs 55%; P = .076).
Conclusions
Patients receiving BMAC-treated grafts were more likely to have small cystic changes and were less likely to undergo subsequent surgery for persistent or new symptoms after the index procedure. No difference in postoperative PROMs was shown at the 6-month, 1-year, and 2-year follow-ups between the 2 groups.
Level of Evidence
Level I, prospective, randomized controlled trial.
目的：本研究的目的是进行一项前瞻性、随机对照双盲试验，以评估有和没有骨髓浓缩物（BMAC）增强的同种异体骨软骨移植在整合和患者报告的结果指标（PROMs）方面的差异。方法：接受同种异体膝关节骨软骨移植的患者（n=36）被同意并纳入这项前瞻性研究。他们被随机分为髂嵴BMAC组或假切口组，并对其分配进行盲法观察。膝关节计算机断层扫描（CT）于指数移植术后6个月进行，并通过半定量评估CT骨软骨同种异体移植（ACTOCA）系统进行分级。在术后6个月、1年和2年获得PROMs，包括国际膝关节文献委员会（IKDC）和膝关节损伤和骨关节炎结局评分-关节置换术（oos JR）。结果：在术后6个月的CT扫描中，接受bmac处理的移植物的患者更有可能表现出小的囊性改变（p=0.01），并有减少大囊肿形成的趋势（p=0.06），但骨整合、移植物信号密度和可识别的裂隙和关节内碎片的存在相同。BMAC组接受移植物清创或翻修手术的可能性较低（5.3%对35.3%）（p=0.02）。两组患者术前、术后6个月、1年、2年的PROMs均无显著差异。接受BMAC治疗的患者有更高的kos JR mcd成活率(88% vs 55%；p = 0.076)。结论：接受bmac处理的移植物的患者更有可能出现小的囊性改变，并且在指数手术后持续或新的症状不太可能接受后续手术。两组术后6个月、1年和2年的PROMs均无差异。证据等级：一级，前瞻性，随机对照试验。
{"title":"Bone Marrow Aspirate Concentrate May Decrease Reoperation in Osteochondral Allograft Transplantation: A Prospective, Randomized, Double-Blind Investigation","authors":"Adam B. Yanke M.D., Ph.D. , Navya Dandu M.D. , Blake M. Bodendorfer M.D. , Nicholas A. Trasolini M.D. , Mario Hevesi M.D., Ph.D. , Tristan J. Elias B.A. , Erik Haneberg B.S. , Reem Y. Darwish B.S. , Athan Zavras M.D. , Brian Forsythe M.D. , Brian J. Cole M.D., M.B.A.","doi":"10.1016/j.arthro.2025.05.024","DOIUrl":"10.1016/j.arthro.2025.05.024","url":null,"abstract":"<div><h3>Purpose</h3><div>To perform a prospective, double-blind, randomized controlled trial<span> to assess differences in integration and patient-reported outcomes metrics (PROMs) of osteochondral allograft transplantation with and without bone marrow aspirate concentrate (BMAC) augmentation.</span></div></div><div><h3>Methods</h3><div><span>Patients (n = 36) undergoing osteochondral allograft transplantation of the knee were consented and enrolled in this prospective study. They were randomized to either </span>iliac crest<span> BMAC or sham incision groups and blinded to their allocation. Computerized tomography (CT) scans of the knee were obtained at 6 months postoperatively after the index transplantation and graded by the semiquantitative assessment CT osteochondral allograft system. PROMs, including the International Knee Documentation Committee and Knee injury and Osteoarthritis Outcome Score–Joint Replacement, were obtained at 6 months, 1 year, and 2 years postoperatively.</span></div></div><div><h3>Results</h3><div>On 6-month postoperative CT scans, patients receiving BMAC-treated grafts were more likely to have small cystic changes (<em>P</em> = .01), with an associated trend toward reduction in large cyst formation (<em>P</em><span><span> = .06), but equal osseous integration, graft signal density, and presence of discernible clefts and intra-articular fragments. The BMAC group was less likely to undergo subsequent surgery for graft </span>debridement or revision (5.3% vs 35.3%; </span><em>P</em><span> = .02). There were no significant differences in PROMs between the 2 groups preoperatively or postoperatively at 6 months, 1 year, or 2 years. Patients receiving BMAC trended toward a higher rate of achievement of Knee Documentation Committee and Knee injury and Osteoarthritis Outcome Score–Joint Replacement minimal clinically important difference (88% vs 55%; </span><em>P</em> = .076).</div></div><div><h3>Conclusions</h3><div>Patients receiving BMAC-treated grafts were more likely to have small cystic changes and were less likely to undergo subsequent surgery for persistent or new symptoms after the index procedure. No difference in postoperative PROMs was shown at the 6-month, 1-year, and 2-year follow-ups between the 2 groups.</div></div><div><h3>Level of Evidence</h3><div>Level I, prospective, randomized controlled trial.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4664-4673.e1"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250997","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}
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