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Arthroscopy : the Journal of... Jun 2024Hip arthroscopy (HA) is preferred for surgical management of femoroacetabular impingement syndrome, while periacetabular osteotomy (PAO) is the gold standard for frank...
Hip arthroscopy (HA) is preferred for surgical management of femoroacetabular impingement syndrome, while periacetabular osteotomy (PAO) is the gold standard for frank developmental hip dysplasia in young adults. Borderline hip dysplasia (BHD) is a conundrum, with data supporting the use of either or both, not to mention that BHD is defined by varying lateral center-edge angle thresholds between 18°-25° or 20°-25° and features generalized ligamentous laxity and variations in acetabular and femoral version. That said, HA for BDH has been shown to have 10-year survivorship of 82%. In a revision situation after HA in patients with BHD, PAO seems a logical next step, but HA may be indicated under very narrow indications. From a technical standpoint, capsular preservation, labral function restoration, and avoiding acetabular rim over-resection are key points when performing HA in BHD. Most important, particularly in the revision setting, is to determine the root cause of failure. Primarily, instability-driven symptoms are an indication for PAO.
PubMed: 38936560
DOI: 10.1016/j.arthro.2024.06.026 -
Arthroscopy : the Journal of... Jun 2024To compare rates of revisions between patients with isolated ACL reconstruction to those who had concomitant MCL injuries managed either operatively or non-operatively...
PURPOSE
To compare rates of revisions between patients with isolated ACL reconstruction to those who had concomitant MCL injuries managed either operatively or non-operatively at time of index ACL reconstruction (ACLR).
METHODS
The PearlDiver-Mariner Database was queried for all patients who underwent ACLR between 2016-2020 using laterality-specific International Classification of Diseases, Tenth Revision (ICD-10) and Current Procedural Terminology (CPT) codes. Patients were included if they were ages 15 or higher and had a minimum of 2 years follow-up after index ACLR. Patients were then divided into cohorts by presence or absence of concomitant MCL injury. The cohort of concomitant MCL injuries was further subdivided into those with MCL injuries managed non-operatively, with MCL repair, or with MCL reconstruction at time of index ACLR. Multivariate regression was performed between cohorts to evaluate for factors associated with revision ACLR.
RESULTS
We identified 47,306 patients with isolated ACL injuries and 10,846 with concomitant MCL and ACL injuries. 93% of patients with concomitant MCL injuries had their MCL treated non-operatively; however, the annual proportion of patients being surgically managed for their MCL injury increased by 70% from 2016-2020. Concomitant MCL injury patients had higher odds of undergoing revision ACLR compared to patients with isolated ACL injuries (OR:1.50, 95%CI: 1.36-1.66, p<0.001). Amongst patients with concomitant MCL injuries, surgically managed patients had higher risk of revision ACLR compared to non-operatively managed MCL injuries (OR:1.39, 95%CI:1.01-1.86, p=0.034).
CONCLUSIONS
Despite an increase in operatively managed concomitant MCL injuries, the majority of concomitant MCL injuries are still managed non-operatively at time of ACLR. Patients with concomitant MCL injury, particularly those managed operatively, at the time of ACLR are at increased risk of requiring revision ACLR compared to those with isolated ACL injuries.
PubMed: 38936559
DOI: 10.1016/j.arthro.2024.06.016 -
Arthroscopy : the Journal of... Jun 2024Female and URMs (Under-Represented Minorities) continue to reflect the lack of diversity in the field of orthopedic surgery, the cause of which can best be described as...
Female and URMs (Under-Represented Minorities) continue to reflect the lack of diversity in the field of orthopedic surgery, the cause of which can best be described as multifactorial. That this predicament needs to be remedied is without controversy. How this can be achieved is the bigger question. A top-down approach has been relatively ineffective and a bolder, more foundational bottom-up approach, in which a "pipeline of talent" is nurtured, may be a solution.
PubMed: 38936558
DOI: 10.1016/j.arthro.2024.06.028 -
Arthroscopy : the Journal of... Jun 2024To assess the ability for ChatGPT-4, an automated Chatbot powered by artificial intelligence (AI), to answer common patient questions concerning the Latarjet procedure...
ChatGPT-4 Performs Clinical Information Retrieval Tasks Utilizing Consistently More Trustworthy Resources Than Does Google Search for Queries Concerning the Latarjet Procedure.
PURPOSE
To assess the ability for ChatGPT-4, an automated Chatbot powered by artificial intelligence (AI), to answer common patient questions concerning the Latarjet procedure for patients with anterior shoulder instability and compare this performance to Google Search Engine.
METHODS
Using previously validated methods, a Google search was first performed using the query "Latarjet." Subsequently, the top ten frequently asked questions (FAQs) and associated sources were extracted. ChatGPT-4 was then prompted to provide the top ten FAQs and answers concerning the procedure. This process was repeated to identify additional FAQs requiring discrete-numeric answers to allow for a comparison between ChatGPT-4 and Google. Discrete, numeric answers were subsequently assessed for accuracy based on the clinical judgement of two fellowship-trained sports medicine surgeons blinded to search platform.
RESULTS
Mean (±standard deviation) accuracy to numeric-based answers were 2.9±0.9 for ChatGPT-4 versus 2.5±1.4 for Google (p=0.65). ChatGPT-4 derived information for answers only from academic sources, which was significantly different from Google Search Engine (p=0.003), which used only 30% academic sources and websites from individual surgeons (50%) and larger medical practices (20%). For general FAQs, 40% of FAQs were found to be identical when comparing ChatGPT-4 and Google Search Engine. In terms of sources used to answer these questions, ChatGPT-4 again used 100% academic resources, while Google Search Engine used 60% academic resources, 20% surgeon personal websites, and 20% medical practices (p=0.087).
CONCLUSION
ChatGPT-4 demonstrated the ability to provide accurate and reliable information about the Latarjet procedure in response to patient queries, using multiple academic sources in all cases. This was in contrast to Google Search Engine, which more frequently used single surgeon and large medical practice websites. Despite differences in the resources accessed to perform information retrieval tasks, the clinical relevance and accuracy of information provided did not significantly differ between ChatGPT-4 and Google Search Engine.
PubMed: 38936557
DOI: 10.1016/j.arthro.2024.05.025 -
The Journal of Hand Surgery Jun 2024Diagnosing the cause of ulnar-sided wrist pain can be difficult in the pediatric and adolescent age group. While frequently used, the diagnostic accuracy of magnetic...
PURPOSE
Diagnosing the cause of ulnar-sided wrist pain can be difficult in the pediatric and adolescent age group. While frequently used, the diagnostic accuracy of magnetic resonance image (MRI), as compared with intraoperative arthroscopic findings, is not well-described in this population. This study aimed to determine concordance rates between magnetic resonance and arthroscopic findings depending on the specific ulnar wrist pathology.
METHODS
A retrospective review was performed to identify pediatric and adolescent patients who underwent operative treatment of ulnar wrist pain between 2004 and 2021. Patients were included in the analysis if they were <18 years of age, complained of ulnar-sided wrist pain, underwent MRI of the affected wrist with an available report interpreted by a consultant radiologist, and had a diagnostic arthroscopy procedure within one year of imaging. Ulnar pathologies analyzed included triangular fibrocartilage (TFCC) tears, ulnotriquetral (UT) ligament tears, lunotriquetral ligament abnormalities, and ulnocarpal impaction.
RESULTS
A total of 40 patients with a mean age of 15-years-old (range 11 to 17) were included in the analysis. Twenty-four were female, and approximately half had their dominant extremity affected. Most had a history of antecedent trauma (n = 34, 85%), but only 15/40 (38%) had a history of fracture. The mean duration of symptoms prior to presentation was six months (standard deviation, 7). The most common etiologies were Palmer 1B TFCC tears (n = 27, 68%) followed by UT split tears (n = 11, 28%). MRI overall demonstrated high specificity (82% to 94%), but low sensitivity (14% to 71%) for ulnar-sided wrist conditions. Accuracy varied between 70% and 83% depending on the specific injury.
CONCLUSION
While MRI is a useful adjunct for determining the cause of ulnar wrist pathologies, findings are often discordant when compared with diagnostic arthroscopy. Surgeons should have a high degree of suspicion for TFCC-related pathology in the setting of positive provocative clinical examination despite negative MRI findings in young patients.
TYPE OF STUDY/LEVEL OF EVIDENCE
Diagnostic IIb.
PubMed: 38934985
DOI: 10.1016/j.jhsa.2024.04.015 -
Knee Surgery, Sports Traumatology,... Jun 2024To elucidate the features of bone cysts at attachment sites of medial meniscus posterior root tears (MMPRTs).
PURPOSE
To elucidate the features of bone cysts at attachment sites of medial meniscus posterior root tears (MMPRTs).
METHODS
Knees treated using arthroscopic surgery for MMPRT between 2015 and 2022 were retrospectively reviewed. Patients without a memory of onset (painful popping), prior knee surgeries, concomitant ligament or meniscus injuries or fractures were excluded. Duration from onset to magnetic resonance imaging (MRI) and type of tear were evaluated during arthroscopy. On radiography, meniscus signs (cleft/ghost/giraffe neck), bone cysts at the attachment site of the MMPRT and posterior shiny-corner lesions (PSCLs; bone marrow lesions on the meniscal-covered portion of the posterior tibial plateau) were evaluated. The sensitivity and specificity of the bone cysts were assessed by comparison with matched patients who underwent arthroscopic surgery for medial meniscus posterior horn tear. In addition, subgroups (cyst-positive/cyst-negative) among patients with MMPRT were created to assess the features of bone cysts.
RESULTS
A total of 275 patients with MMPRT and 275 matched patients with posterior horn tears were evaluated. The sensitivity and specificity of bone cysts for MMPRT in this study were 22.2% and 98.6%, respectively. Among the 275 knees with MMPRT, compared with the cyst-negative group, the cyst-positive group had a longer duration from onset to MRI (12.9 ± 13.1 vs. 8.3 ± 10.9 weeks, respectively, p = 0.025) and reduced occurrence of PSCLs (18.0% vs. 42.0%, respectively, p = 0.031).
CONCLUSION
The occurrence of bone cysts at the attachment site was helpful for the accurate diagnosis of MMPRT and related to longer duration from onset to MRI and reduced PSCLs.
LEVEL OF EVIDENCE
Level III, cross-sectional study.
PubMed: 38932618
DOI: 10.1002/ksa.12338 -
Knee Surgery, Sports Traumatology,... Jun 2024The aim of the present study is to provide a comprehensive review on the surgical outcomes following arthroscopic treatments of partial-thickness rotator cuff tears...
PURPOSE
The aim of the present study is to provide a comprehensive review on the surgical outcomes following arthroscopic treatments of partial-thickness rotator cuff tears (PT-RCTs) and to compare the postoperative American Shoulder and Elbow Surgeons (ASES) score following in situ transtendon repair and tear completion, followed by repair.
METHODS
Medline, EMBASE, Scopus, CINAHL and CENTRAL bibliographic databases were searched. Papers including patients with PT-RCTs of any grade who underwent treatment using debridement, in situ transtendon repair, tear completion and repair or bioinductive collagen implants were reviewed. Primary PT-RCTs were the sole indication for surgery. Primary postoperative outcomes assessed included the ASES score, the Absolute Constant-Murley score, the Simple Shoulder Test, the Visual Analogue Scale, the University of California-Los Angeles Shoulder Scale, the Western Ontario Rotator Cuff Score, range of motion, complications and revisions. A meta-analysis of comparative studies compared the postoperative ASES score between patients treated with in situ transtendon repair versus tear completion repair.
RESULTS
Twenty-eight studies were included. The ASES score was reported by four comparative studies with contrasting results. The heterogeneity was high (I = 86%), and effect sizes ranged from -0.49 in favour of the tear completion and repair technique to an effect size of +1.07 favouring in situ transtendon repair. The overall effect size of 0.02 suggests an equivalence between the two techniques in terms of the ASES score. Two studies with a total sample size of 111 patients reported on debridement, and four studies with a total sample size of 155 patients reported on bioinductive collagen implants.
CONCLUSION
Debridement alone is suitable for Ellman grades I-II PT-RCTs. In situ transtendon and tear completion repair techniques yield similar postoperative outcomes. Bioinductive collagen implants hold promise but lack long-term efficacy data. High-quality comparative studies are needed to determine the best treatment for PT-RCTs.
LEVEL OF EVIDENCE
Level IV.
PubMed: 38932614
DOI: 10.1002/ksa.12326 -
Knee Surgery, Sports Traumatology,... Jun 2024This study aimed to investigate the development of patellofemoral joint (PFJ) cartilage lesions following anterior cruciate ligament reconstruction (ACLR) using...
PURPOSE
This study aimed to investigate the development of patellofemoral joint (PFJ) cartilage lesions following anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autograft through a systematic review.
METHODS
A comprehensive search was conducted in PubMed, Embase, Cochrane Library and Google Scholar databases to find articles published from database inception until 15 November 2023. The search terms were [('Anterior Cruciate Ligament' [mesh] OR 'anterior cruciate ligament' OR 'ACL') AND 'reconstruction' AND 'cartilage' AND ('second look arthroscopy' OR 'second-look arthroscopy' OR 'MRI' OR 'magnetic resonance imaging')]. Inclusion criteria were studies that reported on the occurrence of PFJ cartilage lesions following ACLR using HT autograft, as determined by second-look arthroscopy or follow-up magnetic resonance imaging (MRI).
RESULTS
Fifteen studies (1084 patients) met the inclusion criteria, with follow-up periods ranging from 1 to 5 years. In the results of second-look arthroscopy, cartilage grade deterioration was observed, ranging from MDs of 0.1 to 2.0 in the patella and from 0 to 1.0 in the trochlea. Follow-up MRI results reported the incidence of PFJ cartilage degeneration with rates ranging from 20% to 44%. Patient-reported outcome measures often showed no significant association with PFJ cartilage lesions. The studies included in this review reported various risk factors for cartilage lesion development.
CONCLUSION
Cartilage lesions in the PFJ, detected using second-look arthroscopy or follow-up MRI, frequently develop shortly after ACLR using HT autograft. At this stage, patients might not show specific symptoms; however, those with risk factors require careful observation and evaluation by clinicians during follow-up.
LEVEL OF EVIDENCE
Level IV.
PubMed: 38932612
DOI: 10.1002/ksa.12339 -
Journal of Personalized Medicine May 2024In ACL reconstruction, it is desirable to assess preoperatively whether a sufficient graft diameter can be achieved with the planned tendon graft. The present study...
BACKGROUND
In ACL reconstruction, it is desirable to assess preoperatively whether a sufficient graft diameter can be achieved with the planned tendon graft. The present study investigated the effect of the location of the cross-sectional area (CSA) measurement of the hamstring tendons in preoperative MRI on the correlation of the CSA with the intraoperative graft diameter. In addition, we analyzed whether the measurement results of examiners with different skill levels were comparable.
METHODS
A total of 32 subjects undergoing a single bundle ACL reconstruction using an autologous ipsilateral quadrupled hamstring graft (STGT) were included. The CSA of the semitendinosus and gracilis tendon was determined in preoperative MRI on six defined levels by three examiners. The intraclass correlation coefficient between the measurements of these observers was determined. The correlation between the sum of the CSA of both tendons (CSA STGT) and the graft diameter was investigated.
RESULTS
The interrater reliability was excellent on most of the investigated levels. A significant correlation between CSA STGT and the graft diameter was seen on all levels. The strongest correlation was found on the level 10 mm above the joint line.
CONCLUSIONS
The measurement of the CSA STGT in the preoperative MRI 10 mm above the joint line enabled a good assessment of the achievable graft diameter in ACL reconstruction, independent of the examiners' training level.
PubMed: 38929803
DOI: 10.3390/jpm14060582 -
Medicina (Kaunas, Lithuania) Jun 2024: Lateral ankle injuries are commonly encountered injuries, and the open modified Broström operation (OMBO) is the primary treatment option. Recently, an arthroscopic... (Comparative Study)
Comparative Study
: Lateral ankle injuries are commonly encountered injuries, and the open modified Broström operation (OMBO) is the primary treatment option. Recently, an arthroscopic modification of the Broström operation (AMBO) was developed; many studies have shown that there are no significant differences in clinical and radiological outcomes between the two surgical methods. However, no studies have been conducted comparing the two surgical methods in terms of return to play (RTP) time. This study assesses the time to RTP and the functional clinical outcomes. : Sixty patients were enrolled from January 2012 to July 2014. They were segregated into two cohorts: the AMBO group comprised 30 patients, while the OMBO group comprised another 30 patients. Each participant underwent standardized treatment and rehabilitation regimens and RTP time was measured using seven questions that explored the times to return of painless walking, running, jumping, squatting, climbing stairs, and rising up on the heels and toes. We compared the time intervals from the onset of instability to the date of surgery. Clinical outcomes were evaluated before the surgery, 6 weeks after surgery, and 6 months after surgery. The assessments included the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the pain visual analog scale (VAS) score, subjective satisfaction with rehabilitation, and activity level. : In terms of RTP, AMBO was associated with a shorter interval to walking without pain (7.07 ± 2.96 weeks) relative to OMBO (11.03 ± 8.58 weeks). No disparities were observed in the time to return to play (RTP) between OMBO and AMBO. While there were no discrepancies in the 6-month postoperative AOFAS or VAS scores, the 6-week postoperative VAS score was notably lower in the AMBO group compared to the OMBO group. AMBO provided a faster RTP in terms of two of the seven questions in a group exhibiting high-level physical activity. The rate of subjective satisfaction with rehabilitation was higher for AMBO than for OMBO. : Aside from walking, the duration to return to play and the clinical outcomes were similar between AMBO and OMBO treatments for lateral ankle instability. AMBO is a good treatment option and should be carefully considered for athletes with lateral ankle instability. AMBO demonstrated positive outcomes in a group with higher activity levels compared to others, particularly in terms of time to RTP, subjective satisfaction, and postoperative pain.
Topics: Humans; Male; Female; Adult; Joint Instability; Arthroscopy; Return to Sport; Treatment Outcome; Ankle Injuries; Time Factors; Ankle Joint; Young Adult; Recovery of Function
PubMed: 38929538
DOI: 10.3390/medicina60060921