Pub Date : 2024-10-02DOI: 10.1016/j.arthro.2024.09.048
Mark Girard Siegel
Injectable treatments for arthritic knee pain continue to evolve. This is significant, considering that osteoarthritis is the most common orthopaedic pathology in adult patients. The Centers for Disease Control and Prevention report that 16.9% of all adults are affected, and by age 65 years, almost one-half of the population will experience pain related to cartilage degradation. Steroid injections show only short-term improvements. Both viscosupplementation using hyaluronates and platelet-rich plasma injection show inconsistent long-term results. Recently microfragmented adipose tissue injections in the office setting have been shown to provide symptomatic improvement at 6 and 12 months in patients with knee pain from degenerative joint disease. Additional studies are needed to confirm the reproducibility of this finding. Most of all, study of injections for knee arthritis must include a placebo control (saline injection) to truly demonstrate efficacy.
{"title":"Editorial Commentary: Microfragmented Adipose Tissue May Provide an Effective Injection Treatment Modality for Arthritic Knee Pain With 1-Year Improvement in Pain and Function.","authors":"Mark Girard Siegel","doi":"10.1016/j.arthro.2024.09.048","DOIUrl":"10.1016/j.arthro.2024.09.048","url":null,"abstract":"<p><p>Injectable treatments for arthritic knee pain continue to evolve. This is significant, considering that osteoarthritis is the most common orthopaedic pathology in adult patients. The Centers for Disease Control and Prevention report that 16.9% of all adults are affected, and by age 65 years, almost one-half of the population will experience pain related to cartilage degradation. Steroid injections show only short-term improvements. Both viscosupplementation using hyaluronates and platelet-rich plasma injection show inconsistent long-term results. Recently microfragmented adipose tissue injections in the office setting have been shown to provide symptomatic improvement at 6 and 12 months in patients with knee pain from degenerative joint disease. Additional studies are needed to confirm the reproducibility of this finding. Most of all, study of injections for knee arthritis must include a placebo control (saline injection) to truly demonstrate efficacy.</p>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":" ","pages":""},"PeriodicalIF":4.4,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376377","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.03.027
Diminished hip labral size and tissue quality may be a predictor of poor patient outcomes when a non-augmented primary labral repair is performed. Labral augmentation is an option for patients with hypoplastic or degenerative labral tissue. The optimal graft for augmentation has yet to be identified, and biomechanical research shows no difference in force to suction-seal disruption between dermal allograft and iliotibial band allograft when used to augment the labrum. However, time-zero biomechanical studies do not reflect the biological ability of the graft to heal to surrounding structures, revascularization of the graft, durability of the graft, hip capsular status, and response to functional demands of the patient.
{"title":"Editorial Commentary: Diminished Hip Hypoplastic Labrum Predicts Poor Patient Outcomes After Non-augmented Primary Repair","authors":"","doi":"10.1016/j.arthro.2024.03.027","DOIUrl":"10.1016/j.arthro.2024.03.027","url":null,"abstract":"<div><div>Diminished hip labral size and tissue quality may be a predictor of poor patient outcomes when a non-augmented primary labral repair is performed. Labral augmentation is an option for patients with hypoplastic or degenerative labral tissue. The optimal graft for augmentation has yet to be identified, and biomechanical research shows no difference in force to suction-seal disruption between dermal allograft and iliotibial band allograft when used to augment the labrum. However, time-zero biomechanical studies do not reflect the biological ability of the graft to heal to surrounding structures, revascularization of the graft, durability of the graft, hip capsular status, and response to functional demands of the patient.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2585-2587"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140307971","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.01.025
Purpose
To provide an updated assessment of hip arthroscopy use by using an institutional database that is specific to the treatment of femoroacetabular impingement syndrome (FAIS).
Methods
All patients undergoing hip arthroscopy for the treatment of FAIS were retrospectively identified between the years 2014 and 2022 via Current Procedural Terminology coding in a multi-institutional, single health system database. A longitudinal analysis was performed to identify trends in the use of arthroscopic techniques including capsular and labral treatment, osteoplasty, and traction set-up.
Results
During the study, 789 arthroscopic hip procedures in 733 patients were analyzed (56 staged bilateral). Between 2016 and 2022, the number of hip arthroscopies performed each year increased by 1,490% (R2 = 0.87, P = .001). Capsular repair (R2 = 0.92, P < .001), labral repair (R2 = 0.75, P = .002), and femoroplasty (R2 = 0.70, P = .004) were performed in an increasing proportion of cases over our study period whereas labral debridement (R2 = –0.84, P < .001) became less used. Postless traction systems were employed in 84% (663/789) of hip arthroscopies overall, were used in at least 70% of hip arthroscopies each year, and did not undergo any significant changes in use (R2 = 0.02, P = .73).
Conclusions
Capsular repair, labral repair, and femoroplasty were increasingly performed for the arthroscopic treatment of FAIS whereas the use of labral debridement decreased significantly over our study period. Postless traction systems were used in the majority of cases each year.
Clinical Relevance
As comparative literature continues to define the safety and efficacy of hip arthroscopy, understanding how novel techniques or procedures are incorporated in clinical practice is important.
{"title":"Capsular Repair, Labral Repair, and Femoroplasty With Postless Traction Are Increasingly Performed for the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome","authors":"","doi":"10.1016/j.arthro.2024.01.025","DOIUrl":"10.1016/j.arthro.2024.01.025","url":null,"abstract":"<div><h3>Purpose</h3><div>To provide an updated assessment of hip arthroscopy<span> use by using an institutional database that is specific to the treatment of femoroacetabular impingement syndrome (FAIS).</span></div></div><div><h3>Methods</h3><div><span>All patients undergoing hip arthroscopy for the treatment of FAIS were retrospectively identified between the years 2014 and 2022 via Current Procedural Terminology<span> coding in a multi-institutional, single health system database. A longitudinal analysis was performed to identify trends in the use of arthroscopic techniques including capsular and labral treatment, </span></span>osteoplasty, and traction set-up.</div></div><div><h3>Results</h3><div>During the study, 789 arthroscopic hip procedures in 733 patients were analyzed (56 staged bilateral). Between 2016 and 2022, the number of hip arthroscopies performed each year increased by 1,490% (R<sup>2</sup> = 0.87, <em>P</em> = .001). Capsular repair (R<sup>2</sup> = 0.92, <em>P</em> < .001), labral repair (R<sup>2</sup> = 0.75, <em>P</em> = .002), and femoroplasty (R<sup>2</sup> = 0.70, <em>P</em><span> = .004) were performed in an increasing proportion of cases over our study period whereas labral debridement (R</span><sup>2</sup> = –0.84, <em>P</em> < .001) became less used. Postless traction systems were employed in 84% (663/789) of hip arthroscopies overall, were used in at least 70% of hip arthroscopies each year, and did not undergo any significant changes in use (R<sup>2</sup> = 0.02, <em>P</em> = .73).</div></div><div><h3>Conclusions</h3><div>Capsular repair, labral repair, and femoroplasty were increasingly performed for the arthroscopic treatment of FAIS whereas the use of labral debridement decreased significantly over our study period. Postless traction systems were used in the majority of cases each year.</div></div><div><h3>Clinical Relevance</h3><div>As comparative literature continues to define the safety and efficacy of hip arthroscopy, understanding how novel techniques or procedures are incorporated in clinical practice is important.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2565-2571"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139664755","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.02.041
Knee lateral extra-articular tenodesis procedures (LEAPs) reduce graft rupture rates when performed at the time of anterior cruciate ligament (ACL) reconstruction. However, in the setting of revision ACL reconstruction, LEAPs are less studied and remain controversial. Many studies support combined procedures (ACL + LEAP), yet others do not. When the literature comprises small patient cohorts and short follow-up periods, conflicting results often arise. The controversy surrounding them may be unnecessarily generated by the publication of low-quality studies. Future studies should focus on adequate power; appropriate design and methodology, including matching or randomization to account for potential confounding factors; proper statistical analyses; and avoidance of spin bias.
{"title":"Editorial Commentary: Knee Lateral Extra-articular Tenodesis Procedures: Appropriate Study Design Is Essential for Reducing Conflicting Findings and Unnecessary Controversy in the Orthopaedic Literature","authors":"","doi":"10.1016/j.arthro.2024.02.041","DOIUrl":"10.1016/j.arthro.2024.02.041","url":null,"abstract":"<div><div>Knee lateral extra-articular tenodesis procedures (LEAPs) reduce graft rupture rates when performed at the time of anterior cruciate ligament (ACL) reconstruction. However, in the setting of revision ACL reconstruction, LEAPs are less studied and remain controversial. Many studies support combined procedures (ACL + LEAP), yet others do not. When the literature comprises small patient cohorts and short follow-up periods, conflicting results often arise. The controversy surrounding them may be unnecessarily generated by the publication of low-quality studies. Future studies should focus on adequate power; appropriate design and methodology, including matching or randomization to account for potential confounding factors; proper statistical analyses; and avoidance of spin bias.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2610-2613"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140137456","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.01.034
Purpose
To compare return-to-sport (RTS) rates, graft failure rates, and clinical outcomes in patients who underwent revision anterior cruciate ligament reconstruction (R-ACLR) with additional lateral extra-articular tenodesis (LET) versus isolated R-ACLR.
Methods
A retrospective review of the medical records of patients who underwent R-ACLR with or without a modified Lemaire LET procedure was performed. Seventy-four patients with at least 2 years of follow-up who had high-grade positive pivot-shift test findings were included. Concomitant procedures such as meniscectomy and meniscal repair were collected, along with any complications and/or graft failure. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee Subjective Knee Form score were collected. The ability to RTS was defined as fully, partially, or not returned.
Results
Of the patients, 39 underwent isolated R-ACLR (mean age ± standard deviation, 29.2 ± 12.2 years) whereas 35 underwent an additional LET procedure (mean age, 24.6 ± 7.4 years). The mean length of follow-up in the R-ACLR group was 56.6 ± 26.5 months compared with 44.3 ± 17.6 months in the R-ACLR–LET group (P = .02) (range, 24-120 months). Patient-reported outcome measures were higher in the R-ACLR–LET group, with the KOOS Activities of Daily Living (93.5 ± 2.0 vs 97.2 ± 1.6, P = .03) and KOOS Sport (63.0 ± 3.6 vs 74.3 ± 3.8, P = .05) subdomain scores reaching the level of statistical significance. No differences were found in the other KOOS subdomain scores or the International Knee Documentation Committee scores. Failure rates were not significantly different between the groups (12.8% for R-ACLR vs 11.4% for R-ACLR–LET, P = .99). There were 13 patients (72.2%) in the R-ACLR group and 14 patients (60.8%) in the R-ACLR–LET group who did not RTS.
Conclusions
R-ACLR with additional LET showed similar failure and RTS rates to isolated R-ACLR after failed ACLR. The R-ACLR–LET group showed better functional results with significantly higher KOOS subdomain scores for activities of daily living, as well as sports and recreation. However, this study was unable to recommend the modified Lemaire LET procedure to be routinely used in R-ACLR patients.
Level of Evidence
Level III, retrospective comparative therapeutic trial.
{"title":"Lateral Extra-articular Tenodesis Does Not Decrease Graft Failure in Revision Anterior Cruciate Ligament Reconstruction When Combined With Quadriceps or Patellar Tendon Grafts","authors":"","doi":"10.1016/j.arthro.2024.01.034","DOIUrl":"10.1016/j.arthro.2024.01.034","url":null,"abstract":"<div><h3>Purpose</h3><div><span>To compare return-to-sport (RTS) rates, graft failure<span> rates, and clinical outcomes in patients who underwent revision anterior cruciate ligament reconstruction (R-ACLR) with additional lateral extra-articular </span></span>tenodesis (LET) versus isolated R-ACLR.</div></div><div><h3>Methods</h3><div><span><span>A retrospective review of the medical records of patients who underwent R-ACLR with or without a modified Lemaire LET procedure was performed. Seventy-four patients with at least 2 years of follow-up who had high-grade positive pivot-shift test findings were included. Concomitant procedures such as </span>meniscectomy and </span>meniscal repair<span> were collected, along with any complications and/or graft failure. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee Subjective Knee Form score were collected. The ability to RTS was defined as fully, partially, or not returned.</span></div></div><div><h3>Results</h3><div>Of the patients, 39 underwent isolated R-ACLR (mean age ± standard deviation, 29.2 ± 12.2 years) whereas 35 underwent an additional LET procedure (mean age, 24.6 ± 7.4 years). The mean length of follow-up in the R-ACLR group was 56.6 ± 26.5 months compared with 44.3 ± 17.6 months in the R-ACLR–LET group (<em>P</em><span> = .02) (range, 24-120 months). Patient-reported outcome measures were higher in the R-ACLR–LET group, with the KOOS Activities of Daily Living (93.5 ± 2.0 vs 97.2 ± 1.6, </span><em>P</em> = .03) and KOOS Sport (63.0 ± 3.6 vs 74.3 ± 3.8, <em>P</em> = .05) subdomain scores reaching the level of statistical significance. No differences were found in the other KOOS subdomain scores or the International Knee Documentation Committee scores. Failure rates were not significantly different between the groups (12.8% for R-ACLR vs 11.4% for R-ACLR–LET, <em>P</em> = .99). There were 13 patients (72.2%) in the R-ACLR group and 14 patients (60.8%) in the R-ACLR–LET group who did not RTS.</div></div><div><h3>Conclusions</h3><div>R-ACLR with additional LET showed similar failure and RTS rates to isolated R-ACLR after failed ACLR. The R-ACLR–LET group showed better functional results with significantly higher KOOS subdomain scores for activities of daily living, as well as sports and recreation. However, this study was unable to recommend the modified Lemaire LET procedure to be routinely used in R-ACLR patients.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective comparative therapeutic trial.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2601-2609"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708613","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.02.035
Purpose
To compare outcomes of patients who underwent rotator cuff repair (RCR) with concomitant biceps tenodesis with those who underwent an isolated RCR.
Methods
Exclusion criteria included previous ipsilateral shoulder surgery, irreparable rotator cuff tears, rotator cuff arthropathy, calcific tendinitis, adhesive capsulitis requiring a capsular release, or advanced osteoarthritis of the glenohumeral joint. Patients were indicated for biceps tenodesis if they had any degree of tendon tearing, moderate-to-severe tenosynovitis, instability, or a significant degenerative SLAP tear. Primary outcome measures included American Shoulder and Elbow Surgeons score, Simple Shoulder Test, EuroQoL 5-Dimension 5-Level visual analog scale, EuroQoL 5-Dimension 5-Level, and a site-specific questionnaire, which focused on surgical expectations, satisfaction, and complications. Multivariate analysis of variance to analyze descriptive statistics and determine significant differences between the patient groups for subjective and objective outcome measures were performed.
Results
There were no significant differences for pain/visual analog scale (0.34 ± 0.09 vs 0.47 ± 0.09, P = .31), American Shoulder and Elbow Surgeons score (96.69 ± 0.87 vs 94.44 ± 0.91, P = .07), and Simple Shoulder Test (11.42 ± 0.17 vs 10.95 ± 0.18, P = .06) between the RCR with concomitant biceps tenodesis and isolated RCR at a minimum of 2 years’ postoperatively. This is despite the RCR with concomitant biceps tenodesis group having significantly larger rotator cuff tears (4.25 ± 0.30 cm2 vs 2.80 ± 0.32 cm2, P = .001) than the isolated RCR group.
Conclusions
This study revealed that concomitant biceps tenodesis does not compromise outcomes when compared with an isolated RCR at 2-year follow-up, despite this group having larger rotator cuff tears.
{"title":"Concomitant Biceps Tenodesis Does Not Compromise Arthroscopic Rotator Cuff Repair Outcomes","authors":"","doi":"10.1016/j.arthro.2024.02.035","DOIUrl":"10.1016/j.arthro.2024.02.035","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare outcomes of patients who underwent rotator cuff<span> repair (RCR) with concomitant biceps tenodesis with those who underwent an isolated RCR.</span></div></div><div><h3>Methods</h3><div><span><span>Exclusion criteria included previous ipsilateral shoulder surgery, irreparable rotator cuff tears, rotator cuff </span>arthropathy, calcific </span>tendinitis<span><span><span>, adhesive capsulitis requiring a </span>capsular release, or advanced </span>osteoarthritis<span><span> of the glenohumeral joint. Patients were indicated for biceps tenodesis if they had any degree of tendon tearing, moderate-to-severe </span>tenosynovitis<span><span>, instability, or a significant degenerative SLAP tear. Primary outcome measures included American Shoulder and Elbow Surgeons score<span>, Simple Shoulder Test, EuroQoL 5-Dimension 5-Level visual analog scale, EuroQoL 5-Dimension 5-Level, and a site-specific questionnaire, which focused on surgical expectations, satisfaction, and complications. </span></span>Multivariate analysis of variance to analyze descriptive statistics and determine significant differences between the patient groups for subjective and objective outcome measures were performed.</span></span></span></div></div><div><h3>Results</h3><div>There were no significant differences for pain/visual analog scale (0.34 ± 0.09 vs 0.47 ± 0.09, <em>P</em> = .31), American Shoulder and Elbow Surgeons score (96.69 ± 0.87 vs 94.44 ± 0.91, <em>P</em> = .07), and Simple Shoulder Test (11.42 ± 0.17 vs 10.95 ± 0.18, <em>P</em> = .06) between the RCR with concomitant biceps tenodesis and isolated RCR at a minimum of 2 years’ postoperatively. This is despite the RCR with concomitant biceps tenodesis group having significantly larger rotator cuff tears (4.25 ± 0.30 cm<sup>2</sup> vs 2.80 ± 0.32 cm<sup>2</sup>, <em>P</em> = .001) than the isolated RCR group.</div></div><div><h3>Conclusions</h3><div>This study revealed that concomitant biceps tenodesis does not compromise outcomes when compared with an isolated RCR at 2-year follow-up, despite this group having larger rotator cuff tears.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective case study.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2556-2562.e1"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121471","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.07.009
Jefferson Brand M.D. , Michael Rossi M.D., M.S. , Andrew Geeslin M.D. , James Lubowitz M.D.
There are multiple reasons for a clinician to consider serving as a manuscript reviewer, including improving their clinical knowledge and research skills, becoming a better writer, and making contributions to advancing scientific knowledge. Reviewers for the Arthroscopy family of journals can find essential tools on the journal websites, including a Journal Course for Writers and Reviewers: Checklists and Templates for Original Scientific Articles, Checklists and Templates for Systematic Reviews and Meta-Analyses, and a Research Pearls Collection. Arthroscopy reviewers provide journal editors with Confidential Comments, on which the editors heavily rely, summarizing study strengths and limitations as well as rationale supporting the reviewer’s recommendation as to whether the submission is recommended for publication. In addition, reviewers provide Comments to Authors suggesting opportunities to improve the research whether or not the article is recommended for publication; the goal is to provide helpful feedback. Key areas of reviewer focus are reproducible methods (like a cookbook), clinical (rather than statistical) significance, illustrative and well-labeled figures, and detailed figure legends. Most of all, reviewers must ensure that the conclusion of a study is based entirely on the study results and thus whether or not the study hypothesis is or is not supported by the results. Crucially, reviewers must ensure that authors resist the common temptation to state conclusions that go beyond or overreach the study results.
{"title":"Essentials of Scientific Manuscript Review","authors":"Jefferson Brand M.D. , Michael Rossi M.D., M.S. , Andrew Geeslin M.D. , James Lubowitz M.D.","doi":"10.1016/j.arthro.2024.07.009","DOIUrl":"10.1016/j.arthro.2024.07.009","url":null,"abstract":"<div><div>There are multiple reasons for a clinician to consider serving as a manuscript reviewer, including improving their clinical knowledge and research skills, becoming a better writer, and making contributions to advancing scientific knowledge. Reviewers for the <em>Arthroscopy</em> family of journals can find essential tools on the journal websites, including a Journal Course for Writers and Reviewers: Checklists and Templates for Original Scientific Articles, Checklists and Templates for Systematic Reviews and Meta-Analyses, and a Research Pearls Collection. <em>Arthroscopy</em> reviewers provide journal editors with Confidential Comments, on which the editors heavily rely, summarizing study strengths and limitations as well as rationale supporting the reviewer’s recommendation as to whether the submission is recommended for publication. In addition, reviewers provide Comments to Authors suggesting opportunities to improve the research whether or not the article is recommended for publication; the goal is to provide helpful feedback. Key areas of reviewer focus are reproducible methods (like a cookbook), clinical (rather than statistical) significance, illustrative and well-labeled figures, and detailed figure legends. Most of all, reviewers must ensure that the conclusion of a study is based entirely on the study results and thus whether or not the study hypothesis is or is not supported by the results. Crucially, reviewers must ensure that authors resist the common temptation to state conclusions that go beyond or overreach the study results.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2529-2531"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513446","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.06.036
Despite a push for a focus on clinical rather than “statistical” significance and an emphasis on reporting of outcome thresholds such as the patient acceptable symptomatic state (PASS) and substantial clinical benefit (SCB), the PASS and SCB are rarely reported and, when reported, are often reported incorrectly. Yet, patients require satisfaction (PASS) as a result of our treatments, and patients desire to improve substantially (SCB). Determining whether patients are satisfied and/or substantially improved is simple . . . just ask them. The questions are known as anchor questions. Obviously, different patients have different PASS and SCB thresholds, and reliance on previously published literature for values of these thresholds can result in error—thus, the anchor questions. And, each patient must be assessed individually. Outcome thresholds are not group-level metrics, and they must be reported as the percentage of individuals who achieve the clinically significant outcome. Certain patients, such as athletes, have high baseline function and may demand maximum outcome improvement. In contrast, the minimal clinically important difference is a less-than-ideal measure; patients do not desire “minimal” improvement. Journals must do a better job of publishing patient-reported outcome measures that matter most to patients: satisfaction and substantial benefit.
{"title":"Patient Acceptable Symptomatic State and Substantial Clinical Benefit Matter Most to Patients and Must Be Reported Correctly","authors":"","doi":"10.1016/j.arthro.2024.06.036","DOIUrl":"10.1016/j.arthro.2024.06.036","url":null,"abstract":"<div><div>Despite a push for a focus on clinical rather than “statistical” significance and an emphasis on reporting of outcome thresholds such as the patient acceptable symptomatic state (PASS) and substantial clinical benefit (SCB), the PASS and SCB are rarely reported and, when reported, are often reported incorrectly. Yet, patients require satisfaction (PASS) as a result of our treatments, and patients desire to improve substantially (SCB). Determining whether patients are satisfied and/or substantially improved is simple . . . just ask them. The questions are known as anchor questions. Obviously, different patients have different PASS and SCB thresholds, and reliance on previously published literature for values of these thresholds can result in error—thus, the anchor questions. And, each patient must be assessed individually. Outcome thresholds are not group-level metrics, and they must be reported as the percentage of individuals who achieve the clinically significant outcome. Certain patients, such as athletes, have high baseline function and may demand maximum outcome improvement. In contrast, the minimal clinically important difference is a less-than-ideal measure; patients do not desire “minimal” improvement. Journals must do a better job of publishing patient-reported outcome measures that matter most to patients: satisfaction and substantial benefit.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2523-2524"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141545603","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.01.032
Purpose
To assess serial changes of preoperative bone marrow lesion (BML) following medial open-wedge high tibial osteotomy (MOWHTO) up to 2 years and evaluate whether postoperative change of BML affected patient-reported outcome measures (PROMs) at 2 years’ follow-up. Factors related to the postoperative changes in BML also were evaluated.
Methods
The current study retrospectively assessed prospectively collected data of consecutive patients between December 2016 and March 2018 who underwent MOWHTO for symptomatic knee osteoarthritis with varus malalignment (≥5°) and a minimum 2-year follow-up. Serial magnetic resonance imaging scans at preoperative and postoperative 3, 6, 18, and 24 months were performed, and the extent of BML was evaluated consecutively using 2 validated methods. Clinically, preoperative and postoperative PROMs and their achievement of minimal clinically important difference values were evaluated. The associations of the extent of BMLs with PROMs at each follow-up period over time were analyzed using a linear mixed model. Furthermore, factors related to the postoperative changes of BML were assessed.
Results
Of 26 patients, 21 (80.8%) had preoperative BML at medial femoral and tibial condyles. The postoperative decrease in BML was noted in 17 (81.0%) and 18 (85.7%) at medial femoral and tibial condyles. The BML decreased at postoperative 3 months and, thereafter, the extent of BML gradually reduced until postoperative 24 months. The proportion of patients achieved minimal clinically important difference was 84.6% for total Western Ontario and McMaster Universities Osteoarthritis Index scores and 80.8%, 76.9%, and 84.6% for KOOS symptom, pain, and activity of daily living subscales. Postoperative decrease in BML was significantly associated with better PROMs over postoperative 24 months. Furthermore, normo-correction (2°-5° valgus) was a significant factor for decreased BML following MOWHTO.
Conclusions
Preoperative BML gradually decreased with time following MOWHTO, and the postoperative decrease in BML related with better PROMs over postoperative 24 months. Moreover, postoperative valgus alignment was a significant factor relating the postoperative decrease of BML.
{"title":"Postoperative Decrease in Bone Marrow Lesion Associated With Better Clinical Outcomes Following Medial Open-Wedge High Tibial Osteotomy","authors":"","doi":"10.1016/j.arthro.2024.01.032","DOIUrl":"10.1016/j.arthro.2024.01.032","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess serial changes of preoperative bone marrow lesion (BML) following medial open-wedge high tibial osteotomy (MOWHTO) up to 2 years and evaluate whether postoperative change of BML affected patient-reported outcome measures (PROMs) at 2 years’ follow-up. Factors related to the postoperative changes in BML also were evaluated.</div></div><div><h3>Methods</h3><div><span>The current study retrospectively assessed prospectively collected data of consecutive patients between December 2016 and March 2018 who underwent MOWHTO for symptomatic knee osteoarthritis with varus malalignment (≥5°) and a minimum 2-year follow-up. Serial magnetic resonance imaging scans at preoperative and postoperative 3, 6, 18, and 24 months were performed, and the extent of BML was evaluated consecutively using 2 validated methods. Clinically, preoperative and postoperative PROMs and their achievement of </span>minimal clinically important difference values were evaluated. The associations of the extent of BMLs with PROMs at each follow-up period over time were analyzed using a linear mixed model. Furthermore, factors related to the postoperative changes of BML were assessed.</div></div><div><h3>Results</h3><div><span>Of 26 patients, 21 (80.8%) had preoperative BML at medial femoral and tibial condyles. The postoperative decrease in BML was noted in 17 (81.0%) and 18 (85.7%) at medial femoral and tibial condyles. The BML decreased at postoperative 3 months and, thereafter, the extent of BML gradually reduced until postoperative 24 months. The proportion of patients achieved minimal clinically important difference was 84.6% for total </span>Western Ontario and McMaster Universities Osteoarthritis Index<span> scores and 80.8%, 76.9%, and 84.6% for KOOS<span> symptom, pain, and activity of daily living subscales. Postoperative decrease in BML was significantly associated with better PROMs over postoperative 24 months. Furthermore, normo-correction (2°-5° valgus) was a significant factor for decreased BML following MOWHTO.</span></span></div></div><div><h3>Conclusions</h3><div>Preoperative BML gradually decreased with time following MOWHTO, and the postoperative decrease in BML related with better PROMs over postoperative 24 months. Moreover, postoperative valgus alignment was a significant factor relating the postoperative decrease of BML.</div></div><div><h3>Level of Evidence</h3><div>Level IV, retrospective case series.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2592-2600.e1"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708616","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 : 2024-10-01DOI: 10.1016/j.arthro.2024.02.032
Purpose
To analyze the results of the subscapular sling procedure developed for anterior shoulder instability in patients with less than 10% anterior glenoid bone loss.
Methods
Patients were treated surgically with the arthroscopic subscapular sling procedure. A semitendinosus graft was used to reconstruct the anterior labrum and to establish a sling suspension around the upper part of the subscapularis tendon. The patients were followed up with radiographs (at 12 and 24 months). Magnetic resonance imaging (MRI) of the shoulder region and clinical examinations were performed at 3, 12, and 24 months. Recurrent dislocation was the primary endpoint. The Western Ontario Shoulder Instability Index (WOSI) and MRI results were secondary outcome measures. An independent physiotherapist assessed residual instability and range of motion.
Results
Fifteen patients were included with a dislocation rate of 0% after 24 months follow-up. There was a significant clinical improvement of the WOSI score from 57% (904) at baseline to 88% (241) at 24 months (P < .001). The proportion of patients with an improvement in the WOSI Total score larger than the estimated minimal clinically important difference was 100% both at 12 and 24 months. MRI showed an intact sling in all patients. External rotation was not significantly reduced (52° at baseline vs 47° at 24 months, P = .211). Flexion and abduction were significantly improved from 152° to 174° (P = .001) and 141° to 170° (P < .001) after 24 months. The surgical procedures were completed without any intraoperative complications.
Conclusions
The subscapular sling procedure resulted in low recurrent shoulder instability and improved patient-reported outcome measures at 24 months of follow-up.
Level of Evidence
Level IV, case series.
目的：本研究的目的是分析肩胛下吊带术的效果，该手术是针对肩关节前侧不稳定而开发的，适用于盂前骨质缺损少于10%的患者。目的是探讨该手术能否成功预防肩关节复发性脱位：患者采用关节镜下肩胛下吊带术进行手术治疗。使用半腱肌移植物重建前唇，并在肩胛下肌腱上部建立吊带悬吊。对患者进行了 X 光随访（12 个月和 24 个月）。3个月、12个月和24个月时进行肩部磁共振成像（MRI）和临床检查。复发性脱位是主要终点。西安大略省肩关节不稳定指数（WOSI）和核磁共振成像结果是次要结果测量指标。一位独立理疗师对残余不稳定性和ROM进行了评估：随访24个月后，15名患者脱位率为0%。WOSI评分有了明显的临床改善，从基线时的57%（904人）提高到24个月时的88%（241人）（p < 0.001）。12个月和24个月时，WOSI总分改善幅度大于最小临床意义差异（MCID）估计值的患者比例均为100%。磁共振成像显示，所有患者的吊带都完好无损。外旋没有明显减少（基线为52°，24个月时为47°，P = 0.211）。屈伸和外展则有明显改善，分别从152°增至174°（P=0.001）和141°增至170°（P=0.001）：肩胛下吊带术后复发的肩关节不稳定性较低，24个月随访时患者报告的结果也有所改善。
{"title":"The Arthroscopic Subscapular Sling Procedure Results in Low Recurrent Anterior Shoulder Instability at 24 Months of Follow-Up","authors":"","doi":"10.1016/j.arthro.2024.02.032","DOIUrl":"10.1016/j.arthro.2024.02.032","url":null,"abstract":"<div><h3>Purpose</h3><div>To analyze the results of the subscapular sling procedure developed for anterior shoulder instability in patients with less than 10% anterior glenoid bone loss.</div></div><div><h3>Methods</h3><div>Patients were treated surgically with the arthroscopic subscapular sling procedure. A semitendinosus graft was used to reconstruct the anterior labrum and to establish a sling suspension around the upper part of the subscapularis tendon. The patients were followed up with radiographs (at 12 and 24 months). Magnetic resonance imaging (MRI) of the shoulder region and clinical examinations were performed at 3, 12, and 24 months. Recurrent dislocation was the primary endpoint. The Western Ontario Shoulder Instability Index (WOSI) and MRI results were secondary outcome measures. An independent physiotherapist assessed residual instability and range of motion.</div></div><div><h3>Results</h3><div>Fifteen patients were included with a dislocation rate of 0% after 24 months follow-up. There was a significant clinical improvement of the WOSI score from 57% (904) at baseline to 88% (241) at 24 months (<em>P</em> < .001). The proportion of patients with an improvement in the WOSI Total score larger than the estimated minimal clinically important difference was 100% both at 12 and 24 months. MRI showed an intact sling in all patients. External rotation was not significantly reduced (52° at baseline vs 47° at 24 months, <em>P</em> = .211). Flexion and abduction were significantly improved from 152° to 174° (<em>P</em> = .001) and 141° to 170° (<em>P</em> < .001) after 24 months. The surgical procedures were completed without any intraoperative complications.</div></div><div><h3>Conclusions</h3><div>The subscapular sling procedure resulted in low recurrent shoulder instability and improved patient-reported outcome measures at 24 months of follow-up.</div></div><div><h3>Level of Evidence</h3><div>Level IV, case series.</div></div>","PeriodicalId":55459,"journal":{"name":"Arthroscopy-The Journal of Arthroscopic and Related Surgery","volume":"40 10","pages":"Pages 2543-2552.e1"},"PeriodicalIF":4.4,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140061414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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