ObjectiveTo investigate the feasibility and effectiveness of a novel remnant-preserving anterior cruciate ligament (ACL) reconstruction with bidirectional barbed suture.MethodsBetween February 2014 and January 2016, 96 patients (96 knees) with ACL injury who met the inclusion criteria were recruited and randomly divided into 2 groups (n=48). All patients underwent ACL reconstruction with autologous tendon. The tibial remnant was fixed with PDS-Ⅱ suture (control group) and bidirectional barbed suture (trial group). There was no significant difference in age, gender, injury side, the interval from injury to operation, and preoperative knee stability (KT-1000 test), International Knee Documentation Committee (IKDC) score, and Lysholm score (P>0.05). The knee stability (KT-1000 test), IKDC score, Lysholm score, proprioception, and Cyclops lesion after operation were recorded.ResultsAll incisions healed by first intention in both groups. Forty-four patients in control group were followed up 26-47 months (mean, 36.6 months), and 45 patients in trial group were followed up 26-48 months (mean, 35.6 months). At last follow-up, the IKDC score, Lysholm score, and KT-1000 test were significantly improved when compared with preoperative ones in both groups (P<0.05); but no significant difference was found between 2 groups (P>0.05). There was no significant difference in proprioception between 2 groups at 1 and 2 years after operation, and between 1 year after operation and 2 years after operation (P>0.05) in the same group. The incidences of Cyclops lesion at 6 months, 1 year and 2 years after operation were 0, 4.44% (2/45), and 4.44% (2/45) in trial group, and 13.6% (6/44), 13.6% (6/44), 20.5% (9/44) in control group, showing significant differences between 2 groups at 6 months and at 2 years after operation (P=0.012; P=0.022) and no significant difference at 1 year after operation (P=0.157).ConclusionThe remnant-preserving ACL reconstruction with bidirectional barbed suture can decrease the incidence of Cyclops lesions. However, this technique can not improve the effectiveness in terms of the clinical function and stability compared with the traditional technique.
Objective To identify and screen sensitive predictors associated with subscapularis (SSC) tendon tear and develop a web-based dynamic nomogram to assist clinicians in early identification and intervention of SSC tendon tear. Methods Between July 2016 and December 2021, 528 consecutive cases of patients who underwent shoulder arthroscopic surgery with completely MRI and clinical data were retrospectively analyzed. Patients admitted between July 2016 and July 2019 were included in the training cohort, and patients admitted between August 2019 and December 2021 were included in the validation cohort. According to the diagnosis of arthroscopy, the patients were divided into SSC tear group and non-SSC tear group. Univariate analysis, least absolute shrinkage and selection operator (LASSO) method, and 10-fold cross-validation method were used to screen for reliable predictors highly associated with SSC tendon tear in a training set cohort, and R language was used to build a nomogram model for internal and external validation. The prediction performance of the nomogram was evaluated by concordance index (C-index) and calibration curve with 1 000 Bootstrap. Receiver operating curves were drawn to evaluate the diagnostic performance (sensitivity, specificity, predictive value, likelihood ratio) of the predictive model and MRI (based on direct signs), respectively. Decision curve analysis (DCA) was used to evaluate the clinical implications of predictive models and MRI. Results The nomogram model showed good discrimination in predicting the risk of SSC tendon tear in patients [C-index=0.878; 95%CI (0.839, 0.918)], and the calibration curve showed that the predicted results were basically consistent with the actual results. The research identified 6 predictors highly associated with SSC tendon tears, including coracohumeral distance (oblique sagittal) reduction, effusion sign (Y-plane), subcoracoid effusion sign, biceps long head tendon displacement (dislocation/subluxation), multiple posterosuperior rotator cuff tears (≥2, supra/infraspinatus), and MRI suspected SSC tear (based on direct sign). Compared with MRI diagnosis based on direct signs of SSC tendon tear, the predictive model had superior sensitivity (80.2% vs. 57.0%), positive predictive value (53.9% vs. 53.3%), negative predictive value (92.7% vs. 86.3%), positive likelihood ratio (3.75 vs. 3.66), and negative likelihood ratio (0.25 vs. 0.51). DCA suggested that the predictive model could produce higher clinical benefit when the risk threshold probability was between 3% and 93%. ConclusionThe nomogram model can reliably predict the risk of SSC tendon tear and can be used as an important tool for auxiliary diagnosis.