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

Purpose: To investigate the underlying regeneration mechanisms of biological augmentation using pressed long head biceps tendon (LHBT) in a rat model.

Methods: Bilateral infraspinatus tendons were torn and repaired 1 week later in 32 Sprague-Dawley rats. In the biologic augmentation (BA) group, the LHBT was extracted, pressed, and augmented on the repair site. Histological evaluation was performed at 3 and 6 weeks to measure the thickness of the repaired tendon, number of chondrocytes and non-chondrocytes, percentage of aligned chondrocytes, areas of fibrocartilage and collagen fiber, and COL1/COL3 ratio. Genetic expression of collagen types 1 and 3 (COL1 and COL3, respectively); matrix metalloproteinases-1, 3, and 13; and transforming growth factor beta were measured at 3 and 6 weeks. Mechanical testing was performed at 3 and 6 weeks.

Results: Tendon thickness (3.72 mm vs 2.83 mm; P = .01), number of chondrocytes (73.8 vs 39.7; P = .01), fibrocartilage area (0.35 vs 0.22 mm²; P = .03), and collagen fiber area (0.20 vs 0.11 mm²; P = .03) at 6 weeks were significantly higher in the BA group than in the control group. COL1/COL3 ratio at 3 and 6 weeks was significantly higher in the BA group than in the control group (3 weeks, 1.01 vs 0.51; P = .01 and 6 weeks, 0.68 vs 0.27; P = .04). COL3 expression at 6 weeks was significantly lower in the BA group (P = .02). Matrix metalloproteinase-1 expression at 3 weeks was significantly higher in the BA group (P = .005). The ultimate load to failure at 6 weeks was significantly higher in the BA group (51.5 N vs 31.5 N; P = .03).

Conclusions: Biological augmentation using pressed autologous LHBT promoted tendon-to-bone healing and enhanced mechanical strength.

Clinical relevance: Augmentation with pressed LHBT may improve the biology and mechanical strength of rotator cuff repair.

Meniscal root tears are defined as a disruption or avulsion within 1 cm of the tibial root attachment. Posterior medial meniscus root tears (PMMRT) represent a distinct injury pattern, typically affecting sedentary, middle-aged patients through degenerative mechanisms. These injuries produce biomechanical consequences similar to total meniscectomy, including increased medial compartment peak contact pressures and decreased tibiofemoral contact area. The biomechanical and clinical consequences have led to PMMRT's being labeled as a "silent epidemic." By restoring hoop tension, PMMRT repair improves clinical symptoms and slows osteoarthritis progression. PMMRT repair can be accomplished with transtibial pull-out or suture anchor (SA) techniques. Transtibial pull-out remains the most common technique and has showed excellent healing rates, though concerns over laxity and meniscal extrusion remain. SA repairs obtain fixation directly beneath the root footprint and minimize suture length, potentially preventing initial displacement and suture elongation. SA repairs of PMMRT traditionally presented the technical challenge of inserting anchors through a posteromedial portal, though contemporary SA techniques frequently utilize anterior transosseous tibial tunnels for anchor deployment, which may increase familiarity and ease of use. Recent comparative biomechanical studies between transtibial pull-out and SA techniques show superior performance in displacement, load, stiffness, contact area, and extrusion with SA repairs. Suture cutout remains the most common complication for both procedures. While there is increasing biomechanical rationale for SA repair, further clinical and second-look data are required to determine the optimal technique.

Purpose: To analyze existing literature assessing the rate and types of complications associated with platelet-rich plasma (PRP) injections compared with alternative injectable therapies for the nonoperative treatment of rotator cuff pathology.

Methods: PubMed, Embase, Web of Science, and Cochrane databases were queried in accordance with the Preferred Reporting Items for Systematic Reviews protocol for randomized-controlled trials published prior to February 2025 that compared complications following PRP injection to a comparable injectable for rotator cuff pathology. Meta-analysis, reported in odds ratios (OR), was conducted for subgroups of comparison injection, leukocyte concentration, exogenous activator, and number of injections.

Results: There were 19 studies included with a total of 1043 patients, 510 of whom received PRP injections. Nine (47%) studies reported zero complications. Across the 10 remaining studies, there were 102 total complications, 48 (47%) of which occurred after PRP injections. There was no difference in overall complication rate between the PRP (9.41%) and comparison (10.13%) groups (P = .67), though PRP patients had significantly higher rates of frozen shoulder (P = .01). The most common complications included persistent pain, frozen shoulder, worsening of tear, and bursitis. Sub-analysis of 3 studies comparing PRP to saline injections found no difference in complications (OR = 1.62 [0.27-9.79], I² = 35.65%, P = .06) as did the 13 studies comparing PRP to corticosteroid (OR = 0.56 [0.27-1.16], I² = 8.79%, P = .12), even when sub-analyzed by leukocyte concentration (OR = 0.79 [0.38-1.65], I² = 0.00%, P = .53), exogenous activator use (OR = 0.79 [0.38-1.65], I² = 0.00%, P = .53), and injection number (OR = 0.56 [0.27-1.16], I² = 8.79%, P = .12).

Conclusions: Results of this review suggest that PRP injections are generally safe for treating rotator cuff pathologies with a similar overall complication incidence to comparator injectables with no reports of serious events across all studies. PRP injections were more often complicated by adhesive capsulitis. The pooled complication rates for the PRP group were similar to corticosteroid and saline injections.

Level of evidence: Level II, systematic review and meta-analysis of Level I and II randomized-controlled trials.

Purpose: To systematically review and meta-analyze cadaveric studies quantifying the medial patellofemoral ligament (MPFL) femoral attachment site using radiopaque markers on radiographs to evaluate the accuracy of Schöttle's point as a radiographic landmark for MPFL attachment.

Methods: A systematic review and meta-analysis was performed of the PubMed, EMBASE, and Scopus databases to identify cadaveric studies reporting the radiographic position of the MPFL femoral attachment. Included studies reported attachment location relative to the posterior cortical extension line in the anterior-posterior direction and to either the posterior point of Blumensaat's line or another radiographic landmark in the proximal-distal direction. The distance between Schöttle's point and other mean radiographic locations were calculated; distances greater than 3 mm, the radius of a femoral surgical tunnel, represented substantial variation.

Results: Nine studies of 94 cadaveric knees were included in the final analysis with a mean age of 62.45 ± 11.64 years. The average distance from the posterior cortical extension line to the MPFL insertion was 1.04 ± 10.09 mm anterior [95% CI: 0.40, 2.28, range: 4.80 mm posterior to 8.80 mm anterior] (n = 94). The average distance from Blumensaat's line was 2.07 ± 5.06 mm proximal [95% CI: 1.12, 2.00, range: 0.90 mm distal to 4.70 mm proximal] (n = 77). Three studies reported mean distance from the condylar transition line, averaging 2.88 ± 6.02 mm distal [95% CI: -5.04, -0.54, range: 0.50-5.70 mm distal] (n = 25).

Conclusions: There was substantial heterogeneity in the radiographic location of the MPFL attachment, which suggests that relying solely on Schöttle's point risks nonanatomic tunnel placement.

Clinical relevance: Although Schöttle's point is commonly used as a radiographic landmark during MPFL reconstruction, its variability suggests that the utilization of additional methods of assessment such as clinical palpation and graft isometry evaluation may enhance surgical precision and outcomes.

Purpose: To synthesize patient-reported outcome measures, failure rates, and mobility parameters for comparison of partial repair versus superior capsular reconstruction (SCR) in the treatment of irreparable posterosuperior rotator cuff tears.

Methods: EMBASE, OVID Medline, and Emcare were searched from database inception to November 2024 for studies on irreparable rotator cuff tears treated with partial repair (PR) or SCR. Eligible studies included adults (≥18 years) reporting recurrence or failure rates and patient-reported outcome measures. Risk of bias was assessed using the Risk of Bias 2.0 tool for randomized controlled trials and the Methodological Index for Non-Randomized Studies criteria for all other studies. Due to study heterogeneity, a descriptive synthesis was conducted. Individual study results were displayed using forest plots without pooled estimates.

Results: Twenty-eight studies comprising 1199 patients were included. In SCR studies, final American Shoulder and Elbow Surgeons scores often exceeded 80, and Visual Analogue Score pain scores improved by 4 to 5 points. In PR studies, postoperative American Shoulder and Elbow Surgeons scores generally ranged from 77.0 to 86.0, and Visual Analogue Score pain scores typically decreased to below 2.0. Failure rates ranged from 5.0% to 38.9% for SCR and 3.3% to 84.8% for PR. Gains in forward elevation ranged from 24.6° to 73.0° in SCR studies and from 9.5° to 51.7° in PR studies, with considerable variability reported across both groups. External rotation improved in both groups, though results were inconsistent. All SCR studies reporting Constant-Murley Scores exceeded 70.0, while only 1 PR study reached this threshold. Complications were more frequently reported in SCR studies, including persistent pain and stiffness.

Conclusions: SCR and PR both showed improvements in pain, functional scores, and range of motion for patients with irreparable posterosuperior rotator cuff tears. Outcomes varied considerably across studies, reflecting heterogeneity in patient selection, surgical technique, and reporting practices.

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

Purposes: To compare minimum 2-year patient-reported outcomes measures (PROMs) between adolescents undergoing primary and revision hip arthroscopy.

Methods: Data were prospectively collected and retrospectively reviewed for adolescents who underwent revision hip arthroscopy from November 2008 and November 2021. Patients with baseline and minimum 2-year PROMs were included. Exclusion criteria were patients over 19 years old or dysplastic. A propensity-matched comparison was performed to a primary control group in a 1:2 ratio based on age at surgery, sex, body mass index, and acetabular Outerbridge grade. PROMs, clinical benefit achievement rates, and secondary surgeries were reported and compared.

Results: Thirty-five adolescents (37 revisions hips) were included and propensity-matched. Significant improvement was noted for modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score Sport-Specific Subscale, International Hip Outcome Tool, patient satisfaction, and visual analog scale for pain in both groups (P < .01). The revision group had significantly lower postoperative values for all the PROMs (P < .01); however, improvement (delta value) was similar. Revision hips underwent secondary arthroscopy at higher rates when compared with primary hips (21.6% vs 5.4%; P < .05) and were 4.83 times as likely to receive an additional rerevision surgery.

Conclusions: Adolescents undergoing revision arthroscopy showed significant improvement in all PROMs (modified Harris Hip Score, Non-Arthritic Hip Score, Hip Outcome Score Sport-Specific Subscale, International Hip Outcome Tool, and visual analog scale for pain) at a minimum 2-year follow-up. When compared with a propensity-matched primary control group, revision hips had lower preoperative and postoperative values, but similar improvement magnitude for all PROMs, but met clinically meaningful thresholds at lower rates, and were 4.83 times more likely to require a subsequent hip arthroscopy.

Level of evidence: Level III, retrospective comparative study.

Revision hip arthroscopy in adolescents has become increasingly common as more young athletes undergo primary surgery for femoroacetabular impingement and labral pathology. In my experience, revision procedures can provide meaningful pain relief and functional gains, but the hip rarely behaves like a "primary" hip once again. Clinical data consistently show lower absolute outcome scores, lower clinical benefit rates, and a higher risk of rerevision after adolescent revision compared with primary arthroscopy. For me, the central message is simple: the first operation matters profoundly. Precise correction of bony morphology, preservation of the native cartilage, anatomic reconstruction of the labrum, and meticulous capsular management are essential if we hope to preserve the adolescent hip and protect future options.

The addition of lateral extra-articular procedures in conjunction with anterior cruciate ligament injuries in selected patients appears to reduce the risk of graft failure and persistent rotational instability. In skeletally immature patients, the close proximity between the growth plate, the anterior cruciate ligament tunnel, and the extra-articular tenodesis attachment site provides an important reminder that the promise of lateral extra-articular procedures is not without risk. As lateral extra-articular procedures becomes more popular, proper surgical technique is equally critical to proper reporting and monitoring of potential complications and outcomes.

Over the past 2 decades, platelet-rich plasma injections have emerged as a widely utilized treatment of lateral epicondylitis, supported by a substantial body of high-level evidence showing durable clinical benefit. As adoption has expanded, scrutiny has appropriately shifted toward safety and complication profiles. Recent systematic review data confirm what many clinicians already observe in practice: platelet-rich plasma injections are safe, with complication rates comparable to corticosteroid and saline injections. Transient postinjection pain is the most commonly reported adverse event, but it is self-limited and resolves without consequence. This discomfort should be understood as an expected physiological response rather than a true complication. Clear patient counseling is essential but concerns regarding safety should not deter the use of platelet-rich plasma in appropriately selected patients.