Arthroscopy-The Journal of Arthroscopic and Related Surgery最新文献_第9页

All-Arthroscopic Inferior Glenohumeral Ligament Reconstruction With Gracilis Tendon Graft Can Successfully Restore Stability and Function in Predominantly Inferior and Multidirectional Instability Patients With Hyperlaxity 全关节镜下髌股肌腱重建下盂肱韧带（IGHL）可以成功地恢复下盂肱韧带的稳定性和功能。

IF 5.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-11-01 DOI: 10.1016/j.arthro.2025.04.052

Matthias A. Zumstein M.D. , Nicolas Galluser M.D. , Matthias Biner M.D. , Mustafa S. Rashid M.B., Ch.B., M.Sc., Ph.D. , Samy Bouaicha M.D. , Beat K. Moor M.D.

Purpose

To report the early clinical and radiographic outcomes of an arthroscopic technique to reconstruct the inferior glenohumeral ligament (IGHL) to stabilize the glenohumeral joint in patients with predominantly inferior and multidirectional instability and hyperlaxity.

Methods

Between October 2019 and March 2023, patients with unidirectional (inferior) or multidirectional instability with hyperlaxity, as assessed by a positive Gagey hyperabduction test with instability severity index score >3, IGHL lesions on cross-sectional imaging (magnetic resonance imaging or magnetic resonance angiography) or on arthroscopy, without glenoid bone loss, and with a minimum 12-month follow-up, were enrolled. All patients had symptomatic instability, a positive Gagey hyperabduction test (>105°) on clinical examination, and unsuccessful physical therapy. All patients underwent all-arthroscopic reconstruction of the IGHL using a gracilis tendon graft. Clinical outcomes (Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH]; Western Ontario Shoulder Instability [WOSI]; and Subjective Shoulder Value [SSV]) and radiographic evaluation were reported.

Results

Thirty-one shoulders in 30 patients (mean age, 27 ± 6.5 years) at a mean 2.4 years postoperatively (range, 1-8 years) were evaluated. The mean SSV (preoperative 50.0 to 89.6, P = .016), QuickDASH (preoperative 76.5 to 42.7, P = .008), and WOSI scores (preoperative 1,355.9 to 491.5, P = .016) improved significantly. Thirty of 31 patients (97%) met the minimal clinically important difference for SSV, 28 of 31 (90%) for QuickDASH, and 29 of 31 (94%) for WOSI score. There were no instability events noted postoperatively. There were no perioperative complications. One patient underwent reoperation at 15 months to release adhesions and long head of the biceps tenodesis. Six of 31 patients had grade 1 instability arthropathy at final follow-up. One patient had a static inferiorly subluxated humeral head at the final follow-up and an inferior clinical result.

Conclusions

At a minimum 12-month follow-up, an all-arthroscopic reconstruction of the IGHL with a gracilis tendon graft in hypermobile patients with predominantly inferior instability and without glenoid bone loss yielded promising clinical and radiographic results.

Level of Evidence

Level IV, retrospective case series.

目的：本研究的目的是报告关节镜下技术重建盂肱下韧带以稳定盂肱关节的早期临床和影像学结果，主要用于下关节和多向关节不稳伴高松弛的患者。方法：在2019年10月至2023年3月期间，纳入了单向（下）或多向不稳定伴高松弛的患者，通过ISIS评分为bbbb3的Gagey超外展试验阳性评估，横断面成像（MRI或MRA）或关节镜检查IGHL病变，无盂骨丢失，随访至少12个月。所有患者均有症状不稳定，临床检查Gagey超外展试验阳性（bbb1050），物理治疗失败。所有患者均采用股薄肌腱移植行全关节镜下IGHL重建。报告了临床结果（QuickDASH、WOSI和SSV）和影像学评价。结果：30例患者（平均年龄，27±6.5岁）的31个肩关节在术后平均2.4年（范围，1-8年）被评估。平均主观肩值（SSV）（术前50.0 ~ 89.6,p = 0.016）、QuickDASH（术前76.5 ~ 42.7,p = 0.008）和WOSI评分（术前1355.9 ~ 491.5,p = 0.016）均显著改善。SSV达到MCID的患者有30/31 (97%)，Quick DASH达到MCID的患者有28/31 (90%)，WOSI评分达到MCID的患者有29/31（94%）。术后未发现不稳定事件。无围手术期并发症。1例患者在15个月时再次手术以解除粘连和二头肌肌腱固定术。最后随访时，6/31例患者表现为1级不稳定性关节病。1例患者在最后随访时肱骨头静态下半脱位，临床结果较差。结论：在至少12个月的随访中，对以下关节不稳为主且无关节盂骨丢失的运动过度患者，采用股薄肌腱重建下盂肱韧带（IGHL）获得了良好的临床和影像学结果。证据水平：回顾性病例系列；4。

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引用次数: 0

Patients Report Improved Functional Outcomes After Puncture Capsulotomy Technique for Hip Arthroscopy at 5 Years 患者报告5年髋关节镜穿刺囊切开术后功能改善。

IF 5.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-11-01 DOI: 10.1016/j.arthro.2025.04.051

Rachel L. Poutre B.S. , Jeffrey S. Mun B.A. , Brandon J. Allen B.A. , Srish S. Chenna B.S.E. , Stephen M. Gillinov A.B. , Bilal S. Siddiq B.S. , Nathan J. Cherian M.D. , Christopher T. Eberlin M.D. , Scott D. Martin M.D.

Purpose

To (1) evaluate minimum 5-year functional outcomes, (2) assess secondary surgery rates, and (3) analyze postoperative complications after hip arthroscopy for labral tears due to femoroacetabular impingement using the puncture capsulotomy technique.

Methods

This was a retrospective review of prospectively collected data from May 2014 to May 2019 that included patients aged 18 years or older who underwent hip arthroscopy via puncture capsulotomy for labral tears and concomitant femoroacetabular impingement and completed patient-reported outcome measure surveys for 5 years postoperatively.

Results

A total of 109 hips were included in this study (49.5% female sex; mean age ± standard deviation, 37.7 ± 14.1 years), with a mean follow-up time of 61.0 ± 1.58 months (range, 60-67 months) and mean body mass index of 25.5 ± 3.93. When compared with mean enrollment values, the mean modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living, Hip Outcome Score–Sports-Specific Subscale, and International Hip Outcome Tool-33 score were all significantly improved (P < .001) at 5-year follow-up (mHHS, 63.1 ± 14.6 preoperatively vs 88.9 ± 14.6 postoperatively; Hip Outcome Score–Activities of Daily Living, 71.1 ± 19.5 vs 92.8 ± 11.1; Hip Outcome Score–Sports-Specific Subscale, 41.8 ± 25.3 vs 81.7 ± 23.8; International Hip Outcome Tool-33 score, 41.9 ± 19.1 vs 84.4 ± 19.6). Furthermore, for the mHHS, 83.8%, 71.4%, and 52.1% of patients achieved the minimal clinically important difference, patient acceptable symptom state, and substantial clinical benefit, respectively. The rate of revision hip arthroscopy was 0%, and the rate of conversion to total hip arthroplasty was 7.83%.

Conclusions

At minimum 5-year follow-up, puncture capsulotomy results in significantly improved functional outcomes, as well as clinically meaningful outcomes. Overall, patients reported minimal rates of complications and conversion to total hip arthroplasty.

Level of Evidence

Level IV, retrospective case series.

目的：(1)评估至少5年的功能结局，(2)评估二次手术率，(3)分析采用穿刺囊切开术治疗股髋臼撞击并发唇裂的髋关节镜术后并发症。方法：回顾性分析2014年5月至2019年5月前瞻性收集的数据，包括≥18岁的患者，他们通过穿刺囊切开术接受髋关节镜检查，治疗唇唇撕裂和伴随的股髋臼撞击，并进行了5年的患者报告的结果测量（PROM）调查。结果：本研究共纳入109个髋部(49.5%为女性；平均年龄±SD: 37.7±14.1)，平均随访时间61.0±1.58个月（60-67个月），平均体重指数25.5±3.93 kg/m2。与平均入组值相比，平均改良Harris髋关节评分（mHHS）、髋关节结局评分-日常生活活动（HOS-ADL）、髋关节结局评分-运动特定子量表（HOS-SS）、国际髋关节结局工具-33 （iHOT-33）均有显著改善(结论：在至少5年的随访中，穿刺包膜切开术可显著改善功能和临床有意义的结果。总的来说，患者报告的并发症和转到全髋关节置换术的比例最小。

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引用次数: 0

Editorial Commentary: Transtibial Centralization Is Biomechanically Better Than Knotless Anchor Centralization When Repairing a Medial Meniscal Posterior Root Tear—But Only Just 编辑评论：在修复内侧半月板后根撕裂时，经胫骨中心化比无节锚定中心化在生物力学上更好-但只是刚刚好。

IF 5.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-11-01 DOI: 10.1016/j.arthro.2025.06.025

Chris Servant F.R.C.S. (Tr.&Orth.) (Associate Editor)

Medial meniscal posterior root tears are associated with medial meniscal extrusion, a decrease in tibiofemoral contact area, an increase in contact pressures, an acceleration of cartilage degeneration, and a high rate of progression to total knee arthroplasty. Although a medial meniscal posterior root repair may help slow the degenerative process, meniscal extrusion can persist after a repair. Strategies to reduce residual meniscal extrusion include ensuring that the repair is anatomical, using suture tape to minimize suture cut-out, performing an adequate capsular release, and restricting weight-bearing for 4 to 6 weeks postoperatively. The addition of a centralization suture also may help reduce meniscal extrusion by anchoring the meniscal body to the rim of the tibial plateau prior to root fixation. This can be achieved by inserting a further transtibial suture or suture anchors, with the transtibial tunnel or suture anchors located just central to the rim at the apex of the posteromedial aspect of the medial tibial plateau.

内侧半月板后根撕裂与内侧半月板挤压、胫股接触面积减少、接触压力增加、软骨退变加速和全膝关节置换术进展率高有关。虽然内侧半月板后根修复可能有助于减缓退行性进展，但半月板挤压可能在修复后持续存在。减少残余半月板挤压的策略包括确保修复是解剖性的，使用缝合带减少缝合切口，进行适当的囊膜释放，并在术后4至6周内限制负重。在根固定之前，通过将半月板体锚定在胫骨平台的边缘，增加集中缝线也有助于减少半月板挤压。这可以通过进一步插入经胫骨缝线或缝合锚来实现，经胫骨隧道或缝合锚位于胫骨内侧平台后内侧顶点的边缘中央。

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引用次数: 0

Rates of Return to Sport After Surgical Management of Multiligament Knee Injuries Are Higher Than Previously Described yet Highly Heterogeneous: A Systematic Review 膝关节多韧带损伤手术治疗后恢复运动的比率比先前描述的高，但高度异质性：一项系统综述。

IF 5.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-11-01 DOI: 10.1016/j.arthro.2025.06.006

Joshua Dworsky-Fried B.H.Sc. , Satyavenkata Kotipalli B.M.Sc. , Prushoth Vivekanantha M.D. , Meshal Alomari M.D. , Sachin Tapasvi M.B.B.S., M.S.(Orth), F.R.C.S. , Gilbert Moatshe M.D., Ph.D. , Ryan Martin M.D., F.R.C.S.C. , Darren de SA M.D., M.B.A., F.R.C.S.C.

Purpose

To provide an updated overview of return to sport (RTS) and return to work (RTW) after surgical management of multiligament knee injuries (MLKIs).

Methods

A search was conducted across the MEDLINE, Embase, and PubMed databases from inception to August 26, 2024. Studies published after 2018 that reported on rates of RTS or RTW after multiligament knee reconstruction were included. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed, and a quality assessment was performed using the Methodological Index for Non-randomized Studies (MINORS) criteria. Data on study characteristics, demographic characteristics, and surgical details were extracted. Rates of RTS or RTW at the same level or at any level of participation were recorded. Random-effects models were used to generate forest plots.

Results

Fifteen studies reported on RTS, with rates ranging from 41.2% to 100% when investigating RTS at any level. Thirteen studies reported rates of return to preinjury level, ranging from 5.9% to 100%. RTS rates at any level and preinjury level had higher ceilings than shown in a prior systematic review. Time taken to RTS ranged from 6.7 to 24.9 months. Twelve studies reported on RTW at any capacity, with rates ranging from 41% to 100%. Seven studies reported rates of RTW at preinjury capacity, ranging from 39.3% to 100%. For both RTS and RTW outcomes, high heterogeneities precluded pooled estimates. Time taken to RTW ranged from 2.4 to 24.8 months. Substantially lower RTW rates were associated with multi-trauma dislocations and sedentary occupations.

Conclusions

Rates of RTS at any level and preinjury level ranged from 41.2% to 100% and 5.9% to 100%, respectively, with corresponding heterogeneity values of 91% and 83%. These rates have higher ceilings than reported in a previous systematic review. Currently, there is insufficient evidence to recommend one surgical approach over another.

Level of Evidence

Level IV, systematic review of Level III and IV studies.

目的：提供多韧带膝关节损伤（MLKIs）手术治疗后恢复运动（RTS）和恢复工作（RTW）的最新概述。方法：检索MEDLINE， Embase和PubMed从成立到2024年8月26日。2018年以后发表的关于多韧带膝关节重建后RTS或RTW发生率的研究被纳入其中。遵循PRISMA指南，并使用未成年人标准进行质量评估。提取有关研究特征、人口统计学和手术细节的数据。记录相同或任何参与水平的RTS或RTW的比率。随机效应模型用于生成森林样地。结果：15项研究报告了RTS，在调查任何级别的RTS时，比率从41.2%到100%不等。13项研究报告了恢复到受伤前水平的比率，从5.9%到100%不等。任何水平和受伤前水平的RTS率都比之前的系统评价显示的要高。制作RTS所需时间从6.7个月到24.9个月不等。12项研究报告了任何容量的RTW，比率从41%到100%不等。七项研究报告了RTW对损伤前能力的影响，从39.3%到100%不等。对于RTS和RTW的结果，高异质性排除了汇总估计。复航所需时间为2.4至24.8个月。较低的RTW发生率与多重创伤脱位和久坐职业有关。结论：任意水平和损伤前水平RTS发生率分别为41.2% ~ 100%和5.9% ~ 100%，异质性值分别为91%和83%。这些比率的上限比以前系统评价报告的要高。目前，没有足够的证据推荐一种手术入路优于另一种。未来的研究应采用标准化的RTS标准、术后方案和结局指标，以更好地指导手术决策。

{"title":"Rates of Return to Sport After Surgical Management of Multiligament Knee Injuries Are Higher Than Previously Described yet Highly Heterogeneous: A Systematic Review","authors":"Joshua Dworsky-Fried B.H.Sc. , Satyavenkata Kotipalli B.M.Sc. , Prushoth Vivekanantha M.D. , Meshal Alomari M.D. , Sachin Tapasvi M.B.B.S., M.S.(Orth), F.R.C.S. , Gilbert Moatshe M.D., Ph.D. , Ryan Martin M.D., F.R.C.S.C. , Darren de SA M.D., M.B.A., F.R.C.S.C.","doi":"10.1016/j.arthro.2025.06.006","DOIUrl":"10.1016/j.arthro.2025.06.006","url":null,"abstract":"<div><h3>Purpose</h3><div>To provide an updated overview of return to sport (RTS) and return to work (RTW) after surgical management of multiligament knee injuries (MLKIs).</div></div><div><h3>Methods</h3><div>A search was conducted across the MEDLINE, Embase, and PubMed databases from inception to August 26, 2024. Studies published after 2018 that reported on rates of RTS or RTW after multiligament knee reconstruction were included. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed, and a quality assessment was performed using the Methodological Index for Non-randomized Studies (MINORS) criteria. Data on study characteristics, demographic characteristics, and surgical details were extracted. Rates of RTS or RTW at the same level or at any level of participation were recorded. Random-effects models were used to generate forest plots.</div></div><div><h3>Results</h3><div>Fifteen studies reported on RTS, with rates ranging from 41.2% to 100% when investigating RTS at any level. Thirteen studies reported rates of return to preinjury level, ranging from 5.9% to 100%. RTS rates at any level and preinjury level had higher ceilings than shown in a prior systematic review. Time taken to RTS ranged from 6.7 to 24.9 months. Twelve studies reported on RTW at any capacity, with rates ranging from 41% to 100%. Seven studies reported rates of RTW at preinjury capacity, ranging from 39.3% to 100%. For both RTS and RTW outcomes, high heterogeneities precluded pooled estimates. Time taken to RTW ranged from 2.4 to 24.8 months. Substantially lower RTW rates were associated with multi-trauma dislocations and sedentary occupations.</div></div><div><h3>Conclusions</h3><div>Rates of RTS at any level and preinjury level ranged from 41.2% to 100% and 5.9% to 100%, respectively, with corresponding heterogeneity values of 91% and 83%. These rates have higher ceilings than reported in a previous systematic review. Currently, there is insufficient evidence to recommend one surgical approach over another.</div></div><div><h3>Level of Evidence</h3><div>Level IV, systematic review of Level III and IV studies.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4911-4927.e13"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340723","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}

引用次数: 0

Commercial Products Using Generative Artificial Intelligence Include Ambient Scribes, Automated Documentation and Scheduling, Revenue Cycle Management, Patient Engagement and Education, and Prior Authorization Platforms 使用生成式人工智能的商业产品包括环境抄写器、自动文档和调度、收入周期管理、患者参与和教育以及事先授权平台。

IF 5.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-11-01 DOI: 10.1016/j.arthro.2025.05.021

Kyle N. Kunze M.D. , Jennifer Bepple M.D., M.M.Ci. , Asheesh Bedi M.D. , Prem N. Ramkumar M.D., M.B.A. , Christian A. Pean M.D., M.S.

The integration of artificial intelligence into clinical practice is rapidly transforming health care workflows. At the forefront are large language models (LLMs), embedded within commercial and enterprise platforms to optimize documentation, streamline administration, and personalize patient engagement. The evolution of LLMs in health care has been driven by rapid advancements in natural language processing and deep learning. Emerging commercial products include ambient scribes, automated documentation and scheduling, revenue cycle management, patient engagement and education assistants, and prior authorization platforms. Ambient scribes remain the leading commercial generative artificial intelligence product, with approximately 90 platforms in existence to date. Emerging applications may improve provider efficiency and payer-provider alignment by automating the prior authorization process to reduce the manual labor burden placed on clinicians and staff. Current limitations include (1) lack of regulatory oversight, (2) existing biases, (3) inconsistent interoperability with electronic health records, and (4) lack of physician and stakeholder buy-in due to lack of confidence in LLM outputs. Looking forward requires discussion of ethical, clinical, and operational considerations.

人工智能（AI）与临床实践的集成正在迅速改变医疗保健工作流程。最前沿的是大型语言模型（llm），嵌入到商业和企业平台中，以优化文档、简化管理和个性化患者参与。自然语言处理（NLP）和深度学习的快速发展推动了医疗保健领域法学硕士的发展。新兴的商业产品包括Ambient Scribes、自动文档和调度、收入周期管理、患者参与和教育助理以及事先授权平台。Ambient Scribes仍然是领先的商业生成人工智能产品，迄今为止已有大约90个平台。新兴应用程序可以通过自动化事先授权流程来减少临床医生和工作人员的体力劳动负担，从而提高提供者效率和付款人-提供者一致性。目前的限制包括(1)缺乏监管；(2)现有的偏见；(3)与电子病历的互操作性不一致；(4)由于对法学硕士产出缺乏信心，医生和利益相关者缺乏支持。展望未来需要讨论伦理、临床和操作方面的考虑。

{"title":"Commercial Products Using Generative Artificial Intelligence Include Ambient Scribes, Automated Documentation and Scheduling, Revenue Cycle Management, Patient Engagement and Education, and Prior Authorization Platforms","authors":"Kyle N. Kunze M.D. , Jennifer Bepple M.D., M.M.Ci. , Asheesh Bedi M.D. , Prem N. Ramkumar M.D., M.B.A. , Christian A. Pean M.D., M.S.","doi":"10.1016/j.arthro.2025.05.021","DOIUrl":"10.1016/j.arthro.2025.05.021","url":null,"abstract":"<div><div>The integration of artificial intelligence into clinical practice is rapidly transforming health care<span> workflows. At the forefront are large language models (LLMs), embedded within commercial and enterprise platforms to optimize documentation, streamline administration, and personalize patient engagement. The evolution of LLMs in health care has been driven by rapid advancements in natural language processing and deep learning. Emerging commercial products include ambient scribes, automated documentation and scheduling, revenue cycle management, patient engagement and education assistants, and prior authorization platforms. Ambient scribes remain the leading commercial generative artificial intelligence product, with approximately 90 platforms in existence to date. Emerging applications may improve provider efficiency and payer-provider alignment by automating the prior authorization process to reduce the manual labor burden placed on clinicians and staff. Current limitations include (1) lack of regulatory oversight, (2) existing biases, (3) inconsistent interoperability with electronic health records, and (4) lack of physician and stakeholder buy-in due to lack of confidence in LLM outputs. Looking forward requires discussion of ethical, clinical, and operational considerations.</span></div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"41 11","pages":"Pages 4950-4955"},"PeriodicalIF":5.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144152908","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}

引用次数: 0

Significant Heterogeneity in Existing Literature Limits Both Indication and Outcome Comparability Between Studies Involving Periacetabular Osteotomy for Acetabular Dysplasia With or Without Arthroscopy Despite Improvement for Both: A Systematic Review 一项系统综述：现有文献的显著异质性限制了髋臼周围截骨术治疗髋臼发育不良的研究的适应症和结果的可比性，尽管两者均有改善。

IF 5.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-11-01 DOI: 10.1016/j.arthro.2025.06.030

Benjamin D. Kuhns M.D., M.S. , Nils Becker M.D. , Dharma Patel B.A. , Paras P. Shah B.A. , Benjamin G. Domb M.D.

Purpose

To report preoperative and intraoperative variables as well as patient-reported outcome measures (PROMs) of patients receiving either isolated periacetabular osteotomy (PAO) or combined hip arthroscopy with PAO (PAOHS) for the surgical management of acetabular dysplasia.

Methods

A review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted to identify studies published between January 2014 and March 2025 that reported PROMs for combined arthroscopic hip surgery with PAO (PAOHS) or isolated PAO. Patient demographics, radiographic variables, surgical data, as well as postoperative PROMs and complications were recorded. Forest plots were used to identify heterogeneity using the I² statistic.

Results

In total, 29 studies (13 PAOHS; 18 PAO) with 3,809 patients were included in the review. Rates of intra-articular pathology for the PAOHS studies ranged from 68% to 100%. Level of evidence ranged from I-IV. The most common PROMs used by both the PAO and PAOHS studies were the modified Harris Hip Score (53% vs 70%) and the International Hip Outcome Tool-12 (26% vs 40%), whereas other outcome scores were used more infrequently between the 2 groups. Postoperative PROM improvement was significant for all studies with significant heterogeneity for the modified Harris Hip Score (I² = 0.95) and International Hip Outcome Tool-12 (I² = 0.97). Five studies in the PAOHS group reported clinically relevant outcomes including the minimum clinically important difference (MCID) and patient acceptable symptomatic state (PASS), with MCID rates ranging 75.9-93.3% and PASS rates ranging from 56.4% to 91%. No studies in the isolated PAO group reported on the MCID or PASS.

Conclusions

Although there was sustained PROM improvement for both the PAO and PAOHS, there was significant heterogeneity and little comparability between the 2 groups of studies, limiting potential conclusions regarding the efficacy of intra-articular intervention despite high levels of intra-articular pathology identified in the PAOHS studies.

Level of Evidence

Level IV, systematic review of Level I to IV studies.

目的：本系统综述的目的是报告接受孤立髋臼周围截骨术（PAO）或联合髋关节镜与PAO （PAOHS）手术治疗髋臼发育不良患者的术前和术中变量以及患者报告的结果测量（PROMs）。方法：根据系统评价和荟萃分析的首选报告项目（PRISMA）对文献进行回顾，以确定2014年1月至2025年3月期间发表的报道PAO联合关节镜髋关节手术（PAOHS）或孤立PAO的PROMs的研究。记录患者人口统计学、影像学变量、手术数据以及术后PROMs和并发症。森林样地采用I2统计量鉴定异质性。结果：29项研究(10例PAOHS；19例PAO)共3,809例患者纳入本综述。PAOHS研究的关节内病理发生率为68%-100%。证据等级从1 - 4级不等。PAO和PAOHS研究中最常用的PROMs是改良Harris髋关节评分（mHHS: 53%对70%）和国际髋关节结局工具-12 (iHOT-12；26%对40%)，而其他结果评分在两组之间的使用频率更低。所有研究的术后胎膜早破改善均显著，mHHS （I2=0.95）和iHOT-12 （I2=0.97）存在显著异质性。PAOHS组的5项研究报告了临床相关结果，包括最小临床重要差异（MCID）和患者可接受症状状态（PASS），其中MCID率为75.9-93.3%，PASS率为56.4%-91%。在孤立的PAO组中没有关于MCID或PASS的研究报道。结论：虽然PAO和PAOHS都有持续的PROM改善，但两组研究之间存在显著的异质性和可比性，限制了关于关节内干预疗效的潜在结论，尽管PAOHS研究中发现了高水平的关节内病理。证据水平：对1级至4级研究进行系统评价。

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引用次数: 0

Intravenous Tranexamic Acid Is Marginally Inferior to Epinephrine Irrigation for Visual Clarity During Arthroscopic Rotator Cuff Repair: A Double-Blind, Randomized Controlled Trial 在关节镜下肩袖修复术中，静脉注射氨甲环酸的视力清晰度略低于肾上腺素冲洗：一项双盲、随机对照试验。

IF 5.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-11-01 DOI: 10.1016/j.arthro.2025.05.034

Son Quang Tran M.D. , Thun Itthipanichpong M.D. , Danaithep Limskul M.D. , Napatpong Thamrongskulsiri M.D. , Thanathep Tanpowpong M.D.

Purpose

To compare the effects of intravenous tranexamic acid (TXA) versus epinephrine (EPN)–diluted irrigation on visual clarity, surgical outcomes, and safety during arthroscopic rotator cuff repair.

Methods

This study randomized 82 patients (aged 64.9 ± 9.6 years) diagnosed with rotator cuff tears, allocated 1:1 into the TXA and EPN groups. The TXA group received a preoperative intravenous infusion of TXA (15 mg/kg) over 15 minutes with normal saline irrigation, while the EPN group received irrigation with 0.33 mg/L EPN in normal saline without intravenous TXA. Both patients and surgeons were blinded to the interventions. Visual clarity was assessed by surgeons using a numeric rating scale (0-10). Secondary outcomes included operative time, irrigation fluid volume, pump pressure, perioperative hemodynamic parameters, postoperative pain and swelling, and adverse events.

Results

The EPN group showed higher visual clarity scores than the TXA group, with a mean difference of 1.41 (95% confidence interval [CI], 0.55-2.28; P = .002) on a 0 to 10 scale. In contrast, the TXA group exhibited a significantly higher proportion of cases requiring increased pump pressure during surgery compared to the EPN group, with an absolute difference of 34.1% and an odds ratio of 4.4 (95% CI, 1.5-12.7; P = .002). The average pump pressure was also higher in the TXA group than in the EPN group (mean difference, 3.2 mm Hg, 95% CI, 1.36-5.04; P = .001). No serious adverse events were observed.

Conclusions

Intravenous TXA was marginally less effective than EPN irrigation in bleeding control during arthroscopic rotator cuff repair and showed less improvement in visual clarity, with no severe adverse events observed.

Level of Evidence

Level I, randomized controlled trial.

目的：比较静脉注射氨甲环酸（TXA）与肾上腺素（EPN）稀释冲洗在关节镜下肩袖修复术中视觉清晰度、手术效果和安全性的影响。方法：本研究将82例肩袖撕裂患者（64.9±9.6岁）随机分为TXA组和EPN组。TXA组术前15分钟静脉输注TXA (15 mg/kg)，并灌注生理盐水；EPN组术前0.33 mg/L EPN灌注生理盐水，不灌注TXA。患者和外科医生都对干预措施不知情。视觉清晰度由外科医生使用数值评定量表（0-10）评估。次要结局包括手术时间、冲洗液量、泵压、围手术期血流动力学参数、术后疼痛和肿胀以及不良事件。结果：EPN组视觉清晰度评分高于TXA组，在0-10评分范围内，平均差值（MD）为1.4 （95% CI: 0.55 - 2.28, p = 0.002）。相比之下，与EPN组相比，TXA组在手术中需要增加泵压的病例比例明显更高，绝对差异为34.1%，优势比为4.4 （95% CI: 1.5 - 12.7, p = 0.02）。TXA组的平均泵压也高于EPN组（MD: 3.2 mmHg, 95% CI: 1.36 ~ 5.04, p = 0.001）。未观察到严重不良事件。结论：在关节镜下肩袖修复术中，静脉注射TXA在控制出血方面的效果略低于EPN冲洗，并且在视觉清晰度方面的改善较少，未观察到严重的不良事件。证据等级：一级，随机对照试验。

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引用次数: 0

Transtibial Centralization Better Restores Meniscal Extrusion and Contact Mechanics Compared With Knotless Anchor Centralization for Medial Meniscal Posterior Root Tears: An In Vitro Biomechanical Study Using a Porcine Model 与无节锚定中心相比，经胫骨中心更好地恢复半月板挤压和接触力学，用于内侧半月板后根撕裂：一项使用猪模型的体外生物力学研究。

IF 5.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-11-01 DOI: 10.1016/j.arthro.2025.04.041

Khalis Boksh M.B.Ch.B., B.Sc., M.Sc., M.R.C.S. , Daniel M. Espino B.Sc., Ph.D., C.Eng. , Arijit Ghosh M.B.B.S., M.A., M.Sc., F.R.C.S.(Tr&Orth) , Randeep Aujla M.B.Ch.B., Ch.M., M.F.S.E.M., F.R.C.S.(Tr&Orth) , Tarek Boutefnouchet M.B.Ch.B., M.Sc., F.R.C.S.(Tr&Orth) , Duncan E.T. Shepherd B.Eng., Ph.D., C.Eng.

Purpose

To investigate the tibiofemoral contact mechanics and extent of medial meniscal extrusion (MME) between an isolated anatomic transtibial pull-through root repair (ATPR) and an ATPR combined with either transtibial or knotless anchor centralization in a porcine medial meniscal posterior root tear (MMPRT) model.

Methods

Porcine knee joints (N = 12) were used to test 5 meniscal conditions: (1) intact, (2) MMPRT, (3) ATPR, (4) ATPR with transtibial centralization (TTC), and (5) ATPR with 2 knotless anchor–based centralization (2AC). Contact area and peak contact pressure on the medial meniscus, as well as extrusion, were evaluated at 30°, 45°, 60°, and 90° of knee flexion under a 200-N compressive force.

Results

MME was significantly less after ATPR-TTC than after ATPR or ATPR-2AC at 60° (2.68 mm vs 4.39 mm vs 4.09 mm, P < .001) and 90° (2.99 mm vs 4.75 mm vs 4.36 mm, P < .001). Contact area was significantly greater with ATPR-TTC than with ATPR-2AC at 60° (693.31 mm² vs 603.13 mm², P = .011) and ATPR at 60° (693.31 mm² vs 601.01 mm², P = .008) and 90° (619.68 mm² vs 563.97 mm², P = .037). ATPR-TTC significantly reduced peak contact pressure compared with ATPR at 45° (4.97 MPa vs 5.60 MPa, P = .015) and 60° (5.20 MPa vs 5.99 MPa, P = .026), with similar values to those of ATPR-2AC across all angles.

Conclusions

In a cadaveric porcine model evaluating time-zero biomechanics, an anatomic transtibial pull-through repair with TTC using 2 suture tapes reduced extrusion and improved contact mechanics when compared with an isolated repair or a repair combined with centralization using 2 knotless anchors.

Clinical Relevance

When there are concerns of MME after a MMPRT repair, the addition of a TTC suture may provide better biomechanical properties than an isolated repair or a repair combined with centralization using 2 knotless anchors.

目的：在猪内侧半月板后根撕裂（MMPRT）模型中，研究分离解剖性经胫根修复（ATPR）和ATPR联合经胫根或无节锚定中心之间的胫股接触力学和内侧半月板挤压（MME）的程度。方法：采用猪膝关节（n = 12）进行以下手术之一：(1)完整；(2) MMPRT;(3) ATPR;(4) ATPR和transstibial centralization (TTC)；(5) ATPR和双节锚扶正（2AC）。在200 N的压力下，评估膝关节弯曲30°、45°、60°和90°时内侧半月板的接触面积（CA）和峰值接触压力（PCP）。结果：ATPR + TTC后MME （mm）在60°（2.68 vs. 4.39 vs. 4.09, p < 0.001）和90°（2.99 vs. 4.75 vs. 4.36, p < 0.001）显著低于ATPR或ATPR + 2AC后。ATPR + TTC组CA （mm2）明显大于ATPR + 2AC组（60°）（693.31 vs. 603.13, p=0.011）， ATPR组（60°）（693.31 vs. 601.01, p=0.008）和ATPR组（619.68 vs. 563.97, p=0.037）。与45°ATPR （4.97 vs. 5.60, p=0.015）和60°ATPR （5.20 vs. 5.99, p=0.026）相比，ATPR + TTC显著降低PCP (MPa)，与ATPR + 2AC在所有角度的值相似。结论：在零时间生物力学条件下的尸体猪模型中，与孤立修复或无节锚钉集中修复联合修复相比，使用两根缝合带的解剖性经胫骨牵引修复与经胫骨集中修复减少了挤压，改善了接触力学。临床相关性：当MMPRT修复后存在MME的担忧时，添加经胫骨中心化缝合线可能比单独修复或使用两个无节锚钉中心化修复联合提供更好的生物力学性能。

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引用次数: 0

IF 5.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-11-01 DOI: 10.1016/j.arthro.2025.04.034

David Filan Ph.D. , Karen Mullins Ph.D. , Patrick Carton M.D., F.R.C.S.(Orth.) F.F.S.E.M.

<div><h3>Purpose</h3><div>To (1) compare 5-year survivorship (avoiding repeat hip arthroscopy (HA)/total hip replacement conversion) between those undergoing routine capsular repair compared with where no repair was performed; (2) compare patient-reported outcome measures (PROMs) and achievability of metrics of clinically important improvement between these groups; and (3) evaluate the moderating influence of age and sex on outcomes.</div></div><div><h3>Methods</h3><div>Review of prospectively collected data from an institutional hip preservation registry, of cases undergoing hip arthroscopy (HA) for femoroacetabular impingement between January 2011 and September 2018, with minimum 5-year follow-up, was undertaken. Cases undergoing routine interportal capsular repair (CR) were matched in a 1:1 ratio (age ± 2 years, sex, Tönnis grade) to hips with no capsular repair (NR). Exclusion criteria were dysplasia, Tönnis grade >1, age >50 years, and concomitant hip pathologies. Group survival was evaluated using Kaplan-Meier analysis and for levels of sex and age. Where revision surgery (repeat HA/total hip replacement) was avoided, PROMs (modified Harris Hip Score, University of California and Los Angeles Activity Scale [UCLA], Short Form 36 [SF-36]) were assessed at minimum 5 years, and proportion of cases achieving minimal clinically important difference (MCID) and substantial clinical benefit (SCB) determined.</div></div><div><h3>Results</h3><div>In total, 285 CR cases were matched with 285 NR cases. The average age was 27.0 ± 5.9 years, and most patients (90%) were male. The overall total hip replacement rate was 0.7% (0.4% NR; 0.9% CR, <em>P</em> = .619) and was not significantly different between groups when adjusting for sex (χ<sup>2</sup> = 0.474, <em>P</em> = .491), or age (χ<sup>2</sup> = 0.463, <em>P</em> = .496). The overall repeat HA rate was 12.0% (12.9% NR; 11.1% CR, <em>P</em> = .538), which was not significantly different between groups when adjusting for sex (χ<sup>2</sup> = 0.479, <em>P</em> = .489), or age (χ<sup>2</sup> = 0.448, <em>P</em> = .503). Significant improvement in all PROMs was noted for both the NR and CR groups (<em>P</em> < .001 for all). At 5 years postoperatively, SF-36 was marginally greater for the NR group (<em>P</em> = .006, r = 0.169). No significant difference between groups at 5 years postoperatively were found: modified Harris Hip Score (<em>P</em> = .476), UCLA (<em>P</em> = .188). A greater proportion of CR cases achieved MCID in UCLA (69.4% vs 56.5%, <em>P</em> = .032, Φ = 0.131). MCID achievement rates were similar between groups for all other PROMs (<em>P</em> > .05). A greater proportion of patients in the NR group achieved SCB in SF-36 (54.0% vs 41.9%, <em>P</em> = .049, Φ = 0.127). SCB achievement rates were similar between groups for all other PROMs (<em>P</em> > .05).</div></div><div><h3>Conclusions</h3><div>Routine repair of an interportal capsulotomy makes no difference to survivorsh

目的：(1)比较常规包膜修复组与未行包膜修复组的5年生存率(避免重复髋关节镜（HA)/全髋关节置换术（THR）转换）；(2)比较两组之间的PROMs和临床重要改善指标的可达性；(3)评估年龄和性别对结局的调节作用方法：回顾2011年1月至2018年9月期间接受髋关节镜检查（HA）治疗股髋臼撞击的机构髋关节保存登记的前瞻性收集数据，并进行至少5年的随访。接受常规门囊间修补术（CR）的病例与未接受门囊修补术（NR）的患者按1:1的比例（年龄±2岁，性别，Tonnis分级）配对。排除标准为发育不良、托尼氏淋巴结肿大1、年龄1 ~ 50岁、伴有髋关节病变。使用Kaplan-Meier分析以及性别和年龄水平来评估组生存率。在避免翻修手术（重复HA/THA）的情况下，至少在5年内评估患者报告的结果（PROMs）（mHHS， UCLA, SF36），并确定达到最小临床重要差异（MCID）和实质性临床获益（SCB）的病例比例。结果：285例CR与285例NR配对。大多数（90%）男性患者的平均年龄为27.0±5.9岁。总THR率为0.7% (0.4% NR；0.9% CR, p=0.619)，在调整性别（χ2=0.474, p=0.491）和年龄（χ2=0.463, p=0.496）后，组间差异无统计学意义。总重复HA率为12.0% (12.9% NR；11.1% CR, p=0.538)，在调整性别（χ2=0.479, p=0.489）和年龄（χ2=0.448, p=0.503）后，组间差异无统计学意义。NR组和CR组的所有PROMs均有显著改善（p0.05）。SF36中NR患者达到SCB的比例较高（54.0% vs 41.9%, p=0.049， Φ=0.127）。各组间SCB完成率差异无统计学意义（p < 0.05）。结论：与不修复相比，门静脉间囊切开术的常规修复对HA后至少5年的生存率没有影响，PROMs有边际差异，MCID和SCB阈值达到临床显著改善。包膜处理（修复/非修复）的影响可能对特定患者群体更为明显，而不是对所有病例进行常规修复。证据级别：III，回顾性匹配比较病例系列。

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引用次数: 0

The Open Latarjet Is More Cost-Effective Than Arthroscopic Bankart Repair for First-Time Shoulder Dislocations in Male Patients With <10% Glenoid Bone Loss 对于首次肩关节脱位且关节盂骨丢失< 10%的男性患者，开放式Latarjet比关节镜下Bankart修复更具成本效益。

IF 5.4 1区医学 Q1 ORTHOPEDICS

Arthroscopy-The Journal of Arthroscopic and Related Surgery

Pub Date : 2025-11-01 DOI: 10.1016/j.arthro.2025.04.053

Eoghan T. Hurley M.B., M.Ch., Ph.D. , Alex M. Meyer M.D. , Samuel G. Lorentz M.D. , Jacob F. Oeding M.S. , Mark A. Glover M.D. , Ignacio Pasqualini M.D. , Luciano A. Rossi M.D. , Hannan Mullett F.R.C.S. (Tr & Orth), Ph.D. , Jonathan F. Dickens M.D.

Purpose

To perform a Markov model–based cost-effectiveness analysis comparing arthroscopic Bankart repair (ABR) to open Latarjet for first-time shoulder dislocations.

Methods

A Markov chain Monte Carlo probabilistic model was developed to evaluate the outcomes and costs of 1,000 simulated patients undergoing ABR versus open Latarjet. A 20-year-old man presenting with a first-time shoulder dislocation with <10% glenoid bone loss serves as the base case for our model. Health utility values, transition probabilities, and costs were derived from the literature. Outcome measures included costs, quality-adjusted life years (QALYs), and the incremental cost-effectiveness ratio. Ten-year costs for each patient in the microsimulation model were averaged by initial treatment strategy to capture the costs of any subsequent treatments patients underwent. Cycle length was defined as 1 year, with all costs and utilities discounted at 3% annually.

Results

Over the 10-year time horizon, mean total costs resulting from ABR and open Latarjet were $35,463 ± $6,377 and $32,593 ± $5,742, respectively. On average, ABR was associated with 6.8 ± 0.5 QALYs, while open Latarjet was associated with 7.9 ± 0.5 QALYs. Overall, open Latarjet was determined as the preferred cost-effective strategy in 99.9% of patients included in the microsimulation model, with ABR predicted to be preferred in 0.1% of patients. Deterministic sensitivity analysis found that the recurrence risk associated with ABR would need to be less than 4.3% for ABR to be more cost-effective than the Latarjet procedure.

Conclusions

The open Latarjet was shown to be the dominant, cost-effective treatment strategy for first-time shoulder dislocations based on the Monte Carlo microsimulation and probabilistic sensitivity analysis. Historical data reporting higher risks of redislocation following ABR created increased downstream costs in the model that exceeded those of open Latarjet.

Level of Evidence

Level III, economic and decision analysis.

目的：本研究的目的是进行基于Markov模型的成本-效果分析，比较关节镜下Bankart修复（ABR）和开放Latarjet治疗首次肩关节脱位的成本-效果。方法：建立马尔可夫链蒙特卡罗概率模型，评估1000例模拟患者接受ABR与开放Latarjet的结果和成本。一例20岁男性首次出现肩关节脱位，肩关节盂骨丢失< 10%作为我们模型的基础病例。健康效用值、转移概率和成本来源于文献。结果测量包括成本、质量调整生命年（QALYs）和增量成本-效果比。在微观模拟模型中，每位患者的十年成本按初始治疗策略平均，以获取患者接受的任何后续治疗的成本。周期长度定义为一年，所有成本和公用事业每年按3%折现。结果：在10年的时间范围内，ABR和开放式Latarjet的平均总成本分别为35,463±6,377美元和32,593±5,742美元。ABR平均与6.8±0.5 QALYs相关，而open Latarjet平均与7.9±0.5 QALYs相关。总体而言，在微观模拟模型中，99.9%的患者认为开放Latarjet是首选的成本效益策略，而ABR预计在0.1%的患者中是首选。确定性敏感性分析发现，ABR相关的复发风险需要低于4.3%，才能使ABR比Latarjet更具成本效益。结论：基于蒙特卡罗微模拟和概率敏感性分析，开放式Latarjet被证明是首次肩关节脱位的主要、经济有效的治疗策略。历史数据显示，ABR后再脱位的风险更高，导致该模型的下游成本增加，超过了开放式Latarjet。证据等级：三级，经济和决策分析。

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