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

Purpose: The purpose of this study was to compare the surgical outcomes of anterior cruciate ligament (ACL) reconstruction using hamstrings autograft (HA) plus lateral extra-articular tenodesis (LET), isolated all-soft-tissue quadriceps autograft (QA), and isolated HA.

Methods: A retrospective review was performed comparing high risk patients undergoing ACL reconstruction with isolated HA, isolated QA, or HA+LET from August 2013 to January 2023. High risk patients, as determined by high grade pivot shift or generalized ligament laxity, with at least 2 years of follow up were included. Lysholm and International Knee Documentation Committee (IKDC) scores were compared at 3, 6, 12, and 24 months postoperatively. Re-tear rate, postoperative pivot shift grade, return to sport, and complications were recorded.

Results: 159 patients (56 HA, 47 HA+LET, and 56 QA) were included. At 6 months postoperatively the HA IKDC score was significantly lower than the HA+LET and QA groups (p<0.0001). Similarly, the Lysholm score was significantly lower in the HA cohort at 6 months, 1 year, and 2 years postoperatively (p <0.0001-0.02). There was no difference in rate of achieving minimally important clinical difference between the cohorts for either of these outcome scores. The re-tear rate was significantly higher in the HA group (17.9%) compared to the HA+LET (4.3%) and QA (1.8%) cohorts (p=0.01). The rate of postoperative pivot shift of grade 2 or more was also higher in the isolated HA group (p=0.04).

Conclusion: The use of an all-soft-tissue QA or HA+LET for ACL reconstruction both resulted in a lower re-tear rate and postoperative pivot shift grade compared to an isolated HA graft in high-risk patients at two years postoperatively. There was no difference in the rate of achieving minimal clinically important difference between the cohorts. The QA and HA+LET reconstruction options may improve stability and decrease the failure rate compared to HA reconstruction alone.

Purpose: The purpose of this study is to compare postoperative healthcare utilization, prescriptions, and shoulder surgery between patients with an acute depressive episode (ADE) and those without an acute depressive episode (NADE) within 3 months before arthroscopic rotator cuff repair.

Methods: Diagnostic and procedural codes were used to identify patients in the TriNetX Research Network at least 18 years of age and underwent arthroscopic rotator cuff repair between January 2010 and November 2021. Patients with a previous rotator cuff repair or diagnosis of recurrent major depressive disorder were excluded. Patients were stratified into ADE and NADE cohorts and propensity matched. Outcomes were measured by healthcare utilization and medication prescribing up to 3 months and incidence of future shoulder surgery up to 2 years postoperatively.

Results: After propensity matching, the ADE cohort included 1,514 patients and were compared to 1,514 patients in the NADE cohort. Preoperative characteristics were similar including female sex (62.1 % and 63.0% respectively, P = 0.599). A greater percentage of the ADE cohort received inpatient services within 3 months (4.5% vs 3.0%, OR 1.54; CI 1.05-2.25, P = 0.027) following surgery. Patients with ADE were prescribed a greater percentage of antidepressants (32.8% vs 24.4%, OR 1.51, 95% CI 1.29-1.77, P < 0.0001), sedatives (25.2% vs 20.5%, OR 1.31, CI 1.11-1.55, P = 0.002), and opioid analgesics (63.4% vs 55.7%, OR 1.38 CI 1.19-1.59) P < 0.0001) within 3 months. Within 2 years, incidence of future surgery were similar for arthroscopy (7.9% vs 7.3%) and arthroplasty (2.2% vs 1.6%).

Conclusion: Acute depressive episodes prior to primary arthroscopic rotator cuff repair are associated with increased utilization of inpatient services and postoperative analgesic prescriptions. Incidence of future shoulder surgery for arthroscopy and arthroplasty was similar between patients with or without ADEs.

Purpose: To provide an aggregate review of literature on (1) outcomes related to the quality of intercourse (frequency, postoperative pain during intercourse, postoperative sexual dysfunction) after hip arthroscopy and (2) patient-reported outcomes regarding postoperative sexual function after hip arthroscopy.

Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Controlled Register of Trials (CENTRAL), and Scopus were queried in March 2024. Studies were included if they reported qualitative or quantitative outcomes of sexual function after hip arthroscopy. Articles reporting nerve-related complications without mention of sexual function were excluded. Statistical significance was defined as P < .05.

Results: Five studies reporting on 3,025 patients (1,899 [62.8%] women, 1,126 [37.2%] males) were included. The mean age ranged from 34 to 35.3 years, and mean follow-up periods ranged from 12 to 43 months. Two studies reported 98% and 95% of patients returning to sexual activity postoperatively. One study reported that the mean time for patients to resume sexual activity was 29.2 days, while another reported a median time of 6 weeks. One study reported significant improvements between mean preoperative and postoperative patient-reported outcomes in men using the International Erectile Function Score (20.3-21.9, P < .001) and women using the Female Sexual Function Scale (21.6-23.0, P < .001). Another study reported significant improvement in median patient scores for the Sexual Activity Question of the International Hip Outcome Tool-12 (35-70, P < .001). However, 3 studies reported residual pain related to intercourse after hip arthroscopy.

Conclusions: The reviewed literature showed that hip arthroscopy is associated with high rates of resumption of sexual activity within 4 to 6 weeks postoperatively, with significant improvement in sexual activity-related patient-reported outcomes. However, patients may expect some residual pain related to sexual function after surgery.

Study design: Level IV, systematic review of Level III and Level IV studies.

Purpose: To evaluate sex-based disparities in outcomes following surgery for anterior shoulder instability and to assess the quality of the current literature on this topic.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a June 2023 database search (PubMed, Web of Science, Embase, Cinahl) identified Level I to III clinical studies on anterior shoulder instability (January 2003 to May 2023). Eligible studies included male and female outcomes after anterior shoulder stabilization. Systematic reviews, case reports, and case series were excluded. A meta-analysis examined sex-specific results: recurrence, reoperation, return to sport, American Shoulder and Elbow Surgeons (ASES) score, and Western Ontario Shoulder Instability (WOSI) index.

Results: The initial search identified 7,028 studies, with 14 meeting inclusion criteria, totaling 1,262 patients (73.9% male, 26.1% female). Of the studies, 53% were excluded due to failure to disaggregate by sex. The meta-analysis found comparable outcomes by sex for recurrence (odds ratio [OR] = 1.05; 95% confidence interval [CI], 0.74-1.50; P = .77), reoperation rate (OR = 0.84; 95% CI, 0.69-1.02; P = .08), or return to sport (OR = 1.09; 95% CI, 0.54-2.22; P = .81) after arthroscopic Bankart, open Bankart, and open Latarjet procedures. Mean ASES scores were 91.08 ± 13.59 standard error of the mean (SEM) for males and 89.85 ± 16.73 SEM for females, while WOSI scores were 81.32 ± 19.23 SEM and 87.26 ± 14.09 SEM, respectively. Comparable outcomes were found in ASES (mean difference = -1.20; 95% CI, -4.28 to 1.88; P = .45) or WOSI scores (mean difference = 4.94; 95% CI, -0.31 to 10.00; P = .06).

Conclusions: Recurrence, return to sport, and reoperation rates were similar between males and females after arthroscopic Bankart, open Bankart, and open Latarjet procedures. Comparable outcomes were found in postoperative ASES and WOSI scores between sexes. Most relevant studies were excluded due to lack of disaggregation by sex, limiting the certainty of the conclusion and suggesting an opportunity to improve future research.

Level of evidence: Level III, systematic review of Level I and III studies.

As surgeons, we strive to recognize and correct any mistakes that may occur before completing an operation, and importantly, do our best to avoid irreversible mistakes. Over-resection of the femoral cam lesion in patients having hip arthroscopy for femoroacetabular impingement syndrome has been considered irreversible. While cam under-resection is a technical complication of femoroacetabular impingement surgery to be avoided, avoiding this at the expense of over-resection of the proximal femur is of great concern. Despite the quest to avoid leaving the operating room before the ideal surgical plan has been executed and errors corrected, we must anticipate a certain rate of both over- and under-resection of the cam deformity in the post-surgical patient population. The solution for under-resection is straightforward; additional resection. The same cannot be said for over-resection. Over-resection can result in femoral neck fracture or loss of the hip suction seal. A potential solution is placing a soft tissue allograft in the over-resection defect ("remplissage" of the femoral resection lesion). This may address the suction seal for too proximal resection. In contrast, for too deep a resection in the femoral neck, when fracture is a risk, internal fixation and/or bone grafting may be considered.

Purpose: To compare arthroscopic Bankart repair versus the open Latarjet procedure at a minimum of a 10-year follow-up evaluating recurrence and arthropathy development rates.

Methods: A systematic review was performed in concordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were included if they reported on the arthroscopic Bankart repair or open Latarjet procedure with a minimum 10-year follow-up. Recurrent instability, revisions, and instability arthropathy were evaluated.

Results: Overall, 40 studies met our criteria and were included, with 2,019 shoulders undergoing arthroscopic Bankart repair and 1,069 undergoing the open Latarjet procedure. The rate of recurrent instability was 0.0% to 22.6% (redislocations: 0.0%-9.6%) in those undergoing an open Latarjet procedure and 13.3% to 82.2% (redislocations: 9.6%-25.7%) among those undergoing arthroscopic Bankart repair. The rate of total revisions was 0.0% to 17.9% in those undergoing an open Latarjet procedure and 4.8% to 42.9% among those undergoing arthroscopic Bankart repair. The rate of overall arthritis was 10.3% to 71.4% in those undergoing an open Latarjet procedure and 16.7% to 89.3% among those undergoing arthroscopic Bankart repair.

Conclusions: There was a lower recurrent instability rate and revision rate in the open Latarjet group compared to the arthroscopic Bankart group at long-term follow-up. The rates of moderate to severe arthritis were comparable between the 2 procedures.

Level of evidence: Level IV, systematic review of Level I-IV studies.

The pathophysiology of rotator cuff disease is complex, involving intrinsic and extrinsic factors that contribute to mechanical alterations, inflammation, apoptosis, and neovascularization. These changes result in structural and cellular disruptions, including inflammatory cell infiltration and collagen disorganization. Macrophages recently have gained attention as critical mediators of tissue repair and regeneration. M1 macrophages traditionally have been associated with proinflammatory cytokines involved in the acute inflammatory process after injury, whereas M2 macrophages are thought to play a role in resolution of inflammation and tissue healing. Therefore, achieving a balance between M1 and M2 macrophage phenotypes may be crucial in influencing tendon healing outcomes. Strategies have ranged from mediating circulating macrophage recruitment with CCR2 inhibition to promoting M2 macrophage polarization, increasing secretion of transforming growth factor-β1 from M2 macrophages, and subsequently enhancing chondrogenesis of mesenchymal progenitor cells to improve tendon-to-bone healing. Modulating macrophage activity to favor the M2 phenotype also has been hypothesized to not only enhance healing but also to reduce adhesion formation, making it an attractive potential therapeutic strategy for tendon injuries. However, inflammation is complex and multifactorial, and identifying the optimal targets to modulate and at what time points in the healing process can be difficult. In addition, although preclinical models of tendon disorders can be helpful in identifying promising cellular and molecular targets, recapitulating the human disease process, which often consists of chronic, degenerative tendinopathies, remains challenging. Many studies use young, healthy small animal models with acute injuries, which do not fully recreate the chronic degenerative conditions commonly seen in human rotator cuff injuries. In addition, recent studies have used aged mice (∼18 to 20 months), which, although expensive, are likely closer in biological age relative to human patients and thus more representative of the changes in microstructure and composition seen in degenerative rotator cuff pathology.

Losartan and other modulators of the renin-angiotensin system have been used for their antifibrotic effects by nonsurgeons for decades when suppression of maladaptive scar deposition is helpful, such as heart failure and chronic kidney disease. Only recently have orthopaedic surgeons begun to explore whether these medications might reduce or prevent postoperative joint stiffness. The relationship between orthopaedic surgeons and fibrosis is more complicated. When immune cell recruitment, fibroblast activation, collagen deposition, and extracellular matrix remodeling occurs in a fashion we like, we call it "healing." When it occurs in a fashion we dislike, we call it "fibrosis." There is growing interest in chemoprophylaxis against postoperative fibrosis after shoulder surgery, arthroplasty, and hip arthroscopy. Limited studies examining the issue to date have produced conflicting results. Mining large databases for answers is unlikely to produce clinically meaningful results, and specific trials will be necessary to answer the question. Future research should not ignore the fact that medications other than losartan function in similar ways-and may also have antifibrotic effects.

The long head of the biceps tendon is a common source of anterior shoulder pain, frequently addressed during rotator cuff repairs. Surgical management typically involves either tenotomy or tenodesis, each offering distinct advantages and disadvantages. Tenotomy, a straightforward procedure with a short rehabilitation period, is well suited for low-demand patients but carries a higher risk of Popeye deformity and cramping pain. In contrast, tenodesis, which reattaches the long head of the biceps tendon, minimizes these risks and is preferred for younger, active patients. Randomized controlled trials have shown equivalent functional outcomes for both techniques, with tenotomy associated with a higher risk of cosmetic deformity. The choice of a specific technique often reflects patient age, activity demands, and cosmetic concerns. Surgeons are more likely to select tenodesis for younger, male patients. Thus, nonrandomized studies introduce confounding variables and selection bias that can obscure clear recommendations based on the literature.

The Latarjet procedure is a successful treatment for anterior shoulder instability, with fewer than 5% of patients having redislocations-revision surgery and prior surgery having been shown to be significant risk factors for recurrence. Approximately 90% of athletes return to play after the Latarjet procedure, comparable to arthroscopic Bankart repair. Patients may be physically unable to return to play, which may be due to persistent pain, apprehension, or weakness. Pain may be common after the Latarjet procedure and may be attributable to issues with hardware or graft placement, and it may be best evaluated with computed tomography scans. If screw fixation is not parallel to the joint and too posterior, then it may irritate the suprascapular nerve. Weakness due to nerve injury occurs in fewer than 1% of patients. Graft issues may be difficult to manage if due to nonunion, malunion, malpositioning, or graft fracture. All of these may also contribute to apprehension, as could incomplete rehabilitation or psychological reasons. Psychological reasons for not returning to play are the greatest contributor to athletes being unable to return to play after the Latarjet procedure and may be an area where improvements could be made in early screening and intervention. Improvements in the rehabilitation process could address psychological issues, and perhaps patients with kinesiophobia should be rehabilitated differently from those with concerns over their ability to perform for other reasons, such as retirement from sport. Finally, it is important to report why athletes are not returning to sport.