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

In terms of rotator cuff repair, there is a goal for complete repair and healing, as rotator cuff integrity correlates with clinical and functional results. Retear has been shown to have a significant influence on progression toward osteoarthritis, and patients with an intact supraspinatus show superior abduction and flexion strength. However, in cases where complete repair may not be possible and/or cost limitations may prohibit augmentation, partial repair can provide a respectable outcome. Furthermore, regardless of healing status, partial repair may provide satisfactory relief for patients to still achieve the minimally clinically important difference threshold based on patient-reported outcomes. As introduced by Burkhart, repairing the tear margin and the transverse force couple (subscapularis and/or infraspinatus tears, if present) establishes a "suspension bridge" mechanism for force transmission, effectively creating a "functional cuff tear" by minimizing the defect size and allowing for a balanced shoulder joint with a stable fulcrum. A deltoid retraining program following a partial rotator cuff repair can restore range of motion and strength to the shoulder as alternative muscle activation (latissimus dorsi and teres major) in unison with the deltoid can compensate for the partial tear to limit superior migration of the humeral head and generate a stable glenohumeral fulcrum in cases of large to massive rotator cuff tears. Ultimately, as the rates of shoulder arthroplasty increase in patients under 50 years of age, in terms of societal burden, surgeons should consider joint-sparing techniques such as partial repair.

The combination of hip arthroscopy and periacetabular osteotomy (PAO) has been proven safe and effective for addressing symptoms in patients with developmental dysplasia of the hip. As not every patient with dysplasia will require a hip arthroscopy to obtain desired clinical improvement in the setting of PAO, a challenge is identifying which patients require adjacent procedures (either via arthroscopic or open) to fully treat their hip pathology. Even though labral repair is the most reported arthroscopic procedure in cases of hip dysplasia, I would suggest that labral treatment is the least likely helpful component of hip arthroscopy in these cases. Not all patients with hip dysplasia will have restoration of their suction seal after arthroscopic repair or debridement of the labrum. On the basis of numerous studies demonstrating the effectiveness of PAO for hip dysplasia, labral pathology has unknown importance for either mechanical stability or for the long-term survivorship of the dysplastic hip and thus must be examined instead as a significant pain generator. Reorientation of the labrum out of the zone of injury, and/or desensitization of the labrum during labral stabilization, may alleviate pain generated from labral pathology in the setting of PAO for dysplasia. I find hip arthroscopy to be most helpful as a tool to assess articular cartilage and address femoroacetabular impingement in the most common forms of subspine or true femoral cam morphology, when present. One may argue that the best evaluation of femoroacetabular impingement only exists after PAO correction is achieved. In cases in which I am concerned about iatrogenic impingement from reorientation, particularly in the subspine area, I have intentionally delayed capsule closure to be able to assess and address residual impingement after PAO. Despite the fact that combining hip arthroscopy and PAO in a single stage is safe, we should approach hip arthroscopy and capsulotomy with trepidation, as capsular adhesions, iatrogenic articular cartilage damage, and disruption of capsular integrity are all risks best avoided if capsule violation is not necessary. Clearer definitions for labral pathology and indications for repair or debridement are required.

Purpose: To identify the patient acceptable symptom state (PASS) and substantial clinical benefit (SCB) thresholds for hip arthroscopy and provide guidance on how to choose among the thresholds.

Methods: A systematic review of literature was conducted in PubMed and MEDLINE databases in August 2024 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies with Level I to IV evidence that defined SCB or PASS thresholds for patient-reported outcomes for hip arthroscopy in the setting of intra-articular pathology were included. Case reports, review, technique, and non-English articles were excluded. Title, authors, publication date, study design, patient demographics, timepoint of interest, threshold values, anchor information, and calculation method were recorded.

Results: In total, 35 studies met the inclusion criteria, with 102 PASS thresholds and 82 SCB thresholds being defined across 13 patient-reported outcomes. Hip Outcome Score-Sport-Specific Subscale was the most commonly defined PASS threshold with 22 designations at the 12-, 24-, 60-, and 120-month periods ranging from 63.9-75, 64.3-82.3, 75.2-86.8, and 60.2-61.1, respectively. The International Hip Outcome Tool was the most commonly defined threshold for SCB, with 18 thresholds designations at the 12-, 24-, and 60-month periods ranged from 72.6-86.0, 66.7-86.0, and 86.1-87.5.

Conclusions: Clinically relevant thresholds exhibit significant variability depending on the characteristics of the specific cohort. This study identified several key factors contributing to the heterogeneity in PASS and SCB values, including (1) the anchor questions used, particularly for SCB, (2) the criteria defining responders versus non-responders, (3) the follow-up time at the time point of interest, (4) sample size, and (5) the demographics of the patient population. When determining which threshold to use, surgeons should prioritize those that align closely with the follow-up timepoint of interest for the specific procedure for more accurate comparisons.

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

Purpose: To identify sex-based differences in pathology, outcomes, and complications after hip arthroscopy for femoroacetabular impingement (FAI), and to compare patient-reported outcomes (PRO) scores between male and female patients.

Methods: The PubMed and MEDLINE databases were searched in September 2024, according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Included studies had data stratified by sex, minimum 2-year PRO scores for hip arthroscopy in the setting of FAI and labral pathology, and a 2014 or later publication date. Patient demographic information, preoperative radiographic measurements, and surgical procedure information was also recorded. PROs were recorded when discussed. Information on the minimum clinically important difference, patient acceptable symptomatic state, and substantial clinical benefit was recorded when available.

Results: In total, 21 studies were included in the systematic review. The systematic review found that there are sex-based differences in preoperative characteristics, such as male patients having a significantly greater incidence of acetabular injury, larger alpha angle, complex labral tearing, and greater grade LT villar classification, leading to differences in surgical indication, and female patients being indicated for capsular repair or plication at a greater frequency. There was a significant heterogeneity between male and female patients for preoperative modified Harris Hip Score (mHHS) (male: 55.7-83; female: 49-64.45; I² = 0.78), Non-Arthritic Hip Score (NAHS) (male: 62.54-78.1; female: 47.2-66; I² = 0.77), Hip Outcome Score-Sport-Specific Subscale (HOS-SSS) (male: 46.72-52.3; female: 22.8-45.7; I² = 0.96), as well as postoperative HOS-SSS (male: 72.2-91; female: 62.6-82.4; I² = 0.66). Despite these differences, both male and female patients experienced similar magnitudes of improvement for mHHS (male: 13-20.14; female: 20.6-30.2; I² = 0.00), NAHS (male: 18-19.93; female: 18.75-33.5; I² = 0.00), and HOS-SSS (male: 27.7-31.4; female: 26.75-39.8; I² = 0.42), as well as postoperative scores for mHHS (male: 82.445-96; female: 79.2-89.6; I² = 0.00) and NAHS (male: 82.445-94.5; female: 81.2-89.2; I² = 0.00). No differences were consistently identified in regard to survival rates and complications.

Conclusions: Male and female patients present with different preoperative characteristics that affect surgical treatment. With proper surgical indication, both male and female patients achieve significant postoperative improvement after hip arthroscopy and demonstrate comparable survival rates.

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

Purpose: To evaluate ≥2-year patient outcomes after primary all-soft tissue quadriceps tendon autograft (ASTQ) anterior cruciate ligament reconstruction (ACLR) with suture tape augmentation (STA) in skeletally mature high school and collegiate athletes.

Methods: All high school and collegiate athletes who underwent primary ASTQ ACLR with STA with a minimum of 2-year follow-up were analyzed retrospectively. Patients were administered validated patient-reported outcome measures (PROMs) pre- and postoperatively. The minimal clinically important difference was calculated for each PROM based on this study population and applied to the individual patient. Return to sport, subsequent surgical intervention including contralateral ACLR, and KT-1000 arthrometer measurements for knee laxity were collected. Complications were assessed by physical examination, radiologic studies, or obtained via telephone.

Results: In total, 60 patients were included in the final data analysis, with a mean age of 16.8 years (95% confidence interval 13-23) and mean final follow-up of 37.1 months (95% confidence interval 33.1-41.1). Twelve patients (20%) required subsequent surgery on the ipsilateral knee, which included 7 patients having a subsequent meniscal procedure and 3 patients who underwent arthrolysis. None sustained a graft failure, and 6 patients sustained a contralateral ACL injury necessitating surgery. All PROMs improved at the final follow-up (P < .001). In addition, KT-1000 arthrometer measurements significantly improved postoperatively at 1-year clinical follow-up (P < .001). Most patients obtained the minimal clinically important difference thresholds for each PROM at the final follow-up. There were 48 patients (80%) who participated in pivoting sports. The return-to-sport rate at same level was 54 patients (90%), with 6 patients (10%) not returning to the same level because of graduation.

Conclusions: ASTQ ACLR with STA in a young athletic patient population may result in a low graft failure rate while maintaining satisfactory patient outcomes at short-term follow-up, including a return to sport at the same level of 90%.

Level of evidence: Level IV, retrospective case series.

Purpose: To evaluate patient-reported outcomes (PROs) and survivorship at mid-term follow-up after hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) in patients with and without preoperative lower back pain (LBP).

Methods: Patients with self-endorsed preoperative LBP who underwent HA for FAIS with mid-term follow-up were identified and propensity matched 1:1 to patients without back pain by age, sex, and body mass index (BMI). PROs collected preoperatively and at postoperative years 1, 2, and 5 included Hip Outcome Score-Activities of Daily Living (HOS-ADL) and Hip Outcome Score-Sports Subscale (HOS-SS), 12-item International Hip Outcome Tool (iHOT-12), modified Harris Hip Score (mHHS), and Visual Analog Scale (VAS) for Pain. Achievement of minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were compared. Survivorship was compared with Kaplan-Meier analysis.

Results: In total, 119 patients with LBP were matched to 119 patients without LBP. Group demographic factors were as follows: age (37.4 ± 11.9 vs 37.6 ± 12.6 years, P = .880), sex (64.4% vs 67.7% female, P = .796), and BMI (25.3 ± 5.1 vs 25.3 ± 5.4, P = .930). Average follow-up duration was 6.0 ± 1.9 years. LBP patients showed similar preoperative PROs, yet lower 1-year scores for all PROs (P ≤ .044). At final follow-up, similar PROs were shown between groups (P ≥ .196). LBP and non-LBP patients had similar MCID achievement for HOS-ADL (59.3% vs 63.1%, P = .640), HOS-SS (73.9% vs 70.8%, P = .710), mHHS (66.7% vs 73.4%, P = .544), iHOT-12 (85.1% vs 79.4%, P = .500), and VAS Pain (75.6% vs 69.9%, P = .490). Groups also had similar PASS achievement for HOS-ADL (63.5% vs 61.3%, P = .777), HOS-SS (57.0% vs 62.5%, P = .461), mHHS (81.9% vs 79.1%, P = .692), iHOT-12 (54.6% vs 61.2%, P = .570), and VAS Pain (51.0% vs 55.4%, P = .570). Additionally, achievement of MCID ≥ 1 PRO (P ≥ .490) and PASS ≥ 1 PRO (P ≥ .370) was similar across groups. Conversion to total hip arthroplasty occurred in 3.4% of hips with LBP and 0.8% of hips without LBP (P = .370). Back pain patients demonstrated inferior time-dependent survivorship compared with patients without back pain on Kaplan-Meier survival analysis (P = .023).

Conclusions: Patients undergoing primary hip arthroscopy for FAIS with LBP achieve comparable PROs and clinically significant outcomes to patients without back pain at mid-term, despite lower 1-year PRO scores. LBP patients show inferior reoperation-free time-dependent survivorship compared with those without LBP.

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

Purpose: To investigate the accuracy of Chat Generative Pre-Trained Transformer (ChatGPT)'s responses to frequently asked questions prior to rotator cuff repair surgery.

Methods: The 10 most common frequently asked questions related to rotator cuff repair were compiled from 4 institution websites. Questions were then input into ChatGPT-3.5 in 1 session. The provided ChatGPT-3.5 responses were analyzed by 2 orthopaedic surgeons for reliability, quality, and readability using the Journal of the American Medical Association Benchmark criteria, the DISCERN score, and the Flesch-Kincaid Grade Level.

Results: The Journal of the American Medical Association Benchmark criteria score was 0, indicating the absence of reliable source material citations. The mean Flesch-Kincaid Grade Level was 13.4 (range, 11.2-15.0). The mean DISCERN score was 43.4 (range, 36-51), indicating that the quality of the responses overall was considered fair. All responses cited making final decision-making to be made with the treating physician.

Conclusions: ChatGPT-3.5 provided substandard patient-related information in alignment with recommendations from the treating surgeon regarding common questions around rotator cuff repair surgery. Additionally, the responses lacked reliable source material citations, and the readability of the responses was relatively advanced with a complex language style.

Clinical relevance: The findings of this study suggest that ChatGPT-3.5 may not effectively supplement patient-related information in the context of recommendations provided by the treating surgeon prior to rotator cuff repair surgery.

The management of anterior cruciate ligament (ACL) injuries continually evolves, with new interest in all-soft tissue quadriceps tendon autograft, as well as new interest in suture tape augmentation of the graft, particularly in high-risk patients with young age; female sex; lower-limb alignment, tibial, or femoral abnormalities; hyperlaxity; concomitant meniscal and/or additional ligamentous injuries; or participation in high-risk sports. Load-sharing suture tape enhances the biomechanical stability of the reconstructed ACL, especially during the initial ingrowth and ligamentization phase, and biomechanical evidence highlights a reduced risk of graft elongation and failure under the loads encountered during daily physical activities and sport. Optimal tape tensioning could be achieved in knee hyperextension, when the ACL is at maximal length, to avoid overconstraint. The published 2-year outcomes of this technique are excellent. Current comparative studies, however, have not shown superiority. Additional controlled studies and studies with longer-term follow-up are needed, as well as comparison to extra-articular tenodesis augmentation.