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

Purpose: To examine osteoarthritis (OA) development or progression and conversion to total knee arthroplasty (TKA) following medial meniscal posterior root rear (MMPRT) repair.

Methods: In adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, PubMed, Scopus, and Embase were searched from database inception to July 2024 using the terms "menisc* root" and "menisc* root repair." Studies reporting (1) MMPRT repair as an intervention, (2) patient sociodemographics, and (3) outcomes including either conversion to TKA or radiographic evidence of progression of OA with (4) full text available and (5) published in English were included. Case reports, systematic reviews and meta-analyses, studies published in non-peer-reviewed journals, in non-English language, and studies not reporting on subsequent surgeries or progression of OA were excluded. Studies were analyzed using forest plots, chi-square analysis or Fischer's exact test with alpha set to P < .005.

Results: Twenty-five studies met the inclusion criteria. All (100%) studies were of moderate quality evidence by Methodological Index for Non-Randomized Studies (MINORS) score. Sixteen (64%) studies had follow-up time between 2 and 5 years, while only one (4%) had follow-up beyond 10 years. Twenty (80%) studies populations were >60% female. Within the 18 (72%) studies reporting Kellgren-Lawrence (KL) grade OA, progression was 11.1% for BMI <25 kg/m², 13.6-71.8% for BMI's between 25 and 30 kg/m², and 29.9%-30.3% for BMI's between 30 and 35 kg/m². Conversion to TKA was reported in 12 (48%) studies, and conversion rates ranged from 0 to 21.6%. No TKAs occurred within the first 2 years postoperatively.

Conclusions: Following MMPRT repair, MMPRT repairs show progression of OA with higher rates with elevated BMI. Conversion to TKA occurred at low rates and increased gradually with follow-up time. More than 75% of patients had not converted to TKA after 10 years.

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

Purpose: To evaluate the accuracy of navigation-assisted arthroscopic osteochondroplasty by focusing on the total volume and location of residual deformities, specifically by assessing the total amount and areas of residual deformities and determining whether residual cam deformities result in simulated residual impingement in postoperative computed tomography (CT)-based computer simulations.

Methods: We analyzed pre- and postoperative CT data of patients with cam-type or combined-type femoroacetabular impingement who underwent navigation-assisted arthroscopic osteochondroplasty between November 2022 and May 2024. Preoperative planning included a virtual cam resection simulation to improve internal rotation by 10°. Three-dimensional models were created using Mimics and 3-matic software. Residual volume was calculated as a percentage of the planned resection volume, and residual thickness was quantified using a 3-mm threshold. Postoperative CT simulations at 0° adduction and 90° flexion were used to evaluate residual impingement.

Results: Of 26 patients (27 hips) who underwent CT-based navigation-assisted arthroscopic osteochondroplasty, 4 hips were excluded due to congenital hip disorders, missing planning data, or magnification inconsistencies, leaving 23 hips in 22 patients for analysis. The residual volume was 1149.3 (634.6-1427.2) mm³, accounting for 57.1 (37.4-67.6)% of the planned resection volume. Areas with a residual thickness >3 mm accounted for 5.4 (1.7-15.1%). Residual regions were predominantly in the distal lateral area (91.3%) and showed a high concordance with the residual impingement area (κ = 0.72). The planned resection volume was 2113.0 mm³ (1576.3-3164.5), and the actual resected volume was 1784.3 mm³ (1283.1-2473.9), showing a significant difference (P = .04).

Conclusions: Even with navigational assistance, insufficient cam resection and associated residual impingement may persist. The residual volume comprised 57.1% of the planned resection, with regions >3-mm thick accounting for 5.4%. The distal lateral region had substantial concordance with postoperative impingement areas.

Level of evidence: Level IV, retrospective therapeutic case series.

Arthroscopic rotator cuff repairs (ARCR) are fraught with low healing rates despite improvements in surgical techniques and constructs. Several studies have emerged showing significant improvements in failure to heal rates when incorporating bioinductive collagen implants (BCI) in the short term. Structural integrity following ARCR is paramount, as retear places exorbitant costs on the health care system and long-term studies have established that clinical outcomes are significantly worse in patients with structural retear. The up-front costs of biologic augmentation is cost-prohibitive in ambulatory surgery centers, where a large portion of ARCR occurs, despite the efficacy of improving rotator cuff repair tendon quality and integrity. This short-sighted, bundled reimbursement paradigm that omits BCI from Current Procedural Terminology coding must be revised considering the long-term cost effectiveness of reducing retear risk following ARCR. As BCI augmentation is established as a dominant strategy, strongly recommended by the American Academy of Orthopaedic Surgeons, to reduce retears and improve patient outcomes, it is critical that long-term clinical studies evaluating patient outcomes drive the indications for implementation of BCI in patients with high risk of repair failure.

Purpose: To further investigate predictors of recurrence after arthroscopic Bankart repair (ABR) and to assess postoperative function in patients with and without recurrence.

Methods: A retrospective review was conducted on patients aged 14 to 50 years who underwent ABR for anteroinferior glenohumeral instability between 2009 and 2021. All patients had a minimum follow-up of 3 years. Clinical and radiological data were extracted and analyzed. Cox regression models identified independent predictors of recurrence, and receiver operating characteristic curves evaluated the predictive performance of individual and combined indicators. Patient-reported outcomes, including the American Shoulder and Elbow Surgeons score, Rowe score, and Single Assessment Numerical Evaluation score, were assessed.

Results: A total of 264 patients (241 males) with a mean age of 25.6 ± 7.1 years and a mean follow-up 93.7 ± 36.7 months were included. Recurrent instability occurred in 38 patients (14.4%). Multivariate Cox regression analysis identified the Instability Severity Index Score and the Hill-Sachs interval-to-glenoid track ratio as independent predictors of recurrence. The integration of these 2 indicators into a binary logistic regression model yielded a composite score that significantly improved predictive performance (area under the curve = 0.81 vs Instability Severity Index Score = 0.76, Hill-Sachs interval-to-glenoid = 0.77; all P < .05). At the final follow-up, all patients achieved the minimal clinically significant difference, and patients without recurrence exhibited superior patient-reported outcomes (all P < .05) compared to those with recurrent instability.

Conclusions: The Instability Severity Index Score and the Hill-Sachs interval-to-glenoid track ratio composite score showed good predictive performance for recurrence after ABR. It stratified patients into distinct treatment categories: (1) ABR for low-risk patients (score < 3.4), (2) alternative stabilization procedures for high-risk patients (score > 5.5), and (3) individualized clinical evaluation and shared decision-making for intermediate-risk patients (score 3.4-5.5). Additionally, shoulder function in patients undergoing revision surgery due to recurrence was worse than in those without recurrence.

Level of evidence: Level III, retrospective prognostic case series.

Purpose: To assess the precision of patient-specific instrumentation (PSI) in medial open wedge high tibial osteotomy (MOWHTO) based on medial proximal tibial angle (MPTA) and evaluate cartilage regeneration and clinical outcomes.

Methods: From August 2018 to December 2022, patients undergoing PSI-guided MPTA-based MOWHTO were included, with a minimum follow-up period of 2 years. Exclusion criteria included MOWHTO without PSI, surgical planning not based on MPTA, bilateral knee surgery, procedure changes during surgery, and loss of follow-up. Accuracy was classified into 3 categories: high, acceptable, and low accuracy based on the correction error (≤1°, 1°-2°, and >2°, respectively). Paired-sample t-tests compared preoperative and postoperative alignment and clinical scores, while rank sum and Fisher's exact tests assessed arthroscopic findings.

Results: Radiological and clinical assessments were conducted on 39 patients. Cartilage regeneration was assessed by arthroscopy in 30 knees during implant removal. The error between preoperative planning and postoperative MPTA was at 0.1° ± 1.7° (95% CI: -0.5 to 0.6). The number of knees having the high, acceptable, and low accuracy was 21 (54%), 9 (23%), and 9 (23%) (p-value = .03) respectively. No significant changes were observed in posterior tibial slope. The KOOS showed a significant improvement after surgery compared to the preoperative score, from 47 ± 18 to 74 ± 14 with 100% patients exceeding the threshold for minimal clinically important difference. The mean weight-bearing line percentage significantly improved 19.5% ± 10.1% to 59.0% ± 7.3%, and the mean MPTA was corrected from 84.7° ± 1.8° preoperatively to 92.6° ± 2.1° postoperatively. A second-look arthroscopy revealed significant cartilage regeneration on the medial femoral condyle surfaces.

Conclusions: The use of PSI in MPTA-based MOWHTO resulted in highly and acceptably accurate correction in the majority of cases, preservation of the PTS, and improved clinical outcomes in all patients. Furthermore, MOWHTO promotes cartilage regeneration at MFC following a 2-year follow-up.

Level of evidence: Level IV, retrospective study.

Purpose: To assess the prevalence and associated variables of spin bias in the abstracts of systematic reviews and meta-analyses of knee osteoarthritis (KOA) treatment with intra-articular platelet-rich plasma (PRP).

Methods: PubMed and Embase were queried for peer-reviewed systematic reviews with or without meta-analysis reporting on intra-articular PRP treatment of KOA. Two authors independently analyzed the abstracts for the 15 most common types of spin by comparing details within the abstract to the full manuscript. Methodological quality was appraised using A Measurement Tool to Assess Systematic Reviews, Version 2 scoring. Descriptive statistics were used for spin and A Measurement Tool to Assess Systematic Reviews, Version 2 scores. Logistic regression and categorical association tests (Fisher's and chi-square) assessed the effect of study characteristics on the presence of spin.

Results: One or more forms of spin were found in 92% (45/49) of evaluated abstracts. The most common form of spin identified was type 11, "conclusion focuses selectively on statistically significant efficacy outcome," which was identified in 63% (31/49) of studies. A Measurement Tool to Assess Systematic Reviews, Version 2 ratings were high for 10% (5/49) of studies, moderate in 8% (4/49), low in 27% (13/49), and critically low in 55% (27/49). Decreasing level of evidence was associated with inappropriate extrapolation spin (odds ratio = 2.528, 95% confidence interval 1.037-6.161, P = .041).

Conclusions: Spin bias is highly prevalent in the abstracts of systematic reviews and meta-analyses of intra-articular PRP to treat KOA. Findings should be interpreted in the context of the subjective scoring system used to assess spin. A lower level in the hierarchy of evidence was associated with the presence of inappropriate extrapolation spin. Identified spin tended to favor the use of PRP in treating KOA.

Clinical relevance: In the present study, abstract conclusions were found to have a high prevalence of spin. Identifying and understanding spin aids in the critical appraisal of research with implications for clinical decision making in the usage of PRP.

Purpose: To validate the performance of a pretrained large language model (LLM) in predicting orthopaedic surgeon recommendations for management of newly referred patients, using free-text previsit questionnaire responses as input.

Methods: This retrospective cross-sectional study included new patients visiting an orthopaedic sports medicine clinic between 2020 and 2023. Using zero-shot prompting, the LLM analyzed previsit questionnaire responses (e.g., "When did you start to have pain?") to predict whether patients required advanced imaging and/or surgical intervention. The LLM was blinded to all other clinical information, including surgeon notes, physical exams, or referral data. Model predictions were evaluated with accuracy, sensitivity, and specificity in comparison to actual surgeon-generated plans. For a subset of patients who had undergone advanced imaging, the LLM was augmented with free-text radiology reports and asked to provide updated surgical recommendations.

Results: In the combined cohort of 1141 patients, the LLM predicted surgeon recommendation for advanced imaging with 70% accuracy, 83% sensitivity, and 64% specificity using previsit questionnaire responses alone. Imaging predictions were accurate for common diagnoses, including anterior cruciate ligament (ACL, 94%), meniscus (85%), and rotator cuff (80%) injuries but poor for knee (54%) and shoulder arthritis (66%). When augmented with imaging reports, the LLM predicted recommendations for surgery with 81% accuracy, 88% sensitivity, and 72% specificity. Surgical predictions were highly accurate for ACL (93%), meniscus (78%), rotator cuff (83%), and shoulder instability related pathologies (78%).

Conclusions: Using previsit questionnaire data from new orthopaedic patients with knee and shoulder complaints, the pretrained LLM showed 70% accuracy for imaging recommendations, and the augmented surgical-decision LLM showed 81% accuracy for surgical recommendations.

Level of evidence: Level III, retrospective diagnostic case-control study.

Purpose: To analyze the incidence of shoulder dislocations in a nationwide sample from 2014 to 2024 among various demographic factors and determine rates of surgical intervention within 1 year of dislocation.

Methods: Utilizing the deidentified data within the United States Collaborative Network in TriNetX platform, the incidence of shoulder dislocations from 2014 to 2024 was determined for patients aged 18 and older who presented to either emergency departments or ambulatory settings. The demographic information of age, sex, and race was collected to further stratify the incidence rates (IRs) for comparative analysis, and treatment approaches were determined by current procedural terminology coding.

Results: From 2014 to 2024, there were 48,646 instances of adult shoulder dislocations recorded in the United States TriNetX database. The overall IR was 8.26 per 100,000 person-years. Males showed a significantly greater IR (11.10 per 100,000 person-years) than females (6.10 per 100,000 person-years). IR by age showed a bimodal distribution with the highest rates occurring in the 18 to 24 and 75 to 84 age groups. While only 5.40% of patients were treated with surgery within 1 year, more than 70% of those surgically treated underwent arthroscopic stabilization.

Conclusions: Shoulder dislocations in adults in the United States showed a bimodal age distribution from 2014 to 2024, occurring most commonly in young adults and elderly individuals susceptible to falls at particularly high risk. Overall, males are at a higher risk than females. While rates of arthroscopic treatment remained relatively consistent, they comprised more than 70% of surgical procedures.

Clinical relevance: This study identifies current at-risk populations, potential risk factors, and changes in orthopedic care regarding adult shoulder dislocations over the past decade.

Platelet-rich plasma (PRP) continues to generate both excitement and skepticism within orthopaedics and sports medicine. As a biologic derived from autologous blood, PRP offers an appealing, minimally invasive option for treating musculoskeletal pathology through the delivery of concentrated growth factors and cytokines. Evidence across orthopaedic subspecialties remains mixed, however, with studies showing variable efficacy and inconsistent methodologies. Recent data on PRP use for extra-articular hip pathology, particularly greater trochanteric pain syndrome, hamstring injuries, and piriformis syndrome show encouraging improvements in pain and function, including faster return to sport and favorable patient-reported outcomes. Yet, significant heterogeneity in study design, PRP preparation, and control interventions limits generalizability and hinders clear clinical guidance. These inconsistencies mirror similar challenges in PRP research for a variety of other orthopaedic pathologies, underscoring the need for standardized preparation protocols and consistent reporting frameworks. Despite these limitations, a signal of efficacy persists within the data, suggesting PRP may indeed provide meaningful benefit for select extra-articular hip conditions. As surgical alternatives for these pathologies often carry substantial morbidity, continued refinement of PRP formulations and methodology represents a promising step toward establishing biologics as reliable, evidence-based tools in orthopaedic care.