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Johns WL, Martinazzi BJ, Miltenberg B, Nam HH, Hammoud S. ChatGPT Provides Unsatisfactory Responses to Frequently Asked Questions Regarding Anterior Cruciate Ligament Reconstruction. Arthroscopy 2024; 40:2067-2079.e1. [PMID: 38311261 DOI: 10.1016/j.arthro.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/01/2024] [Accepted: 01/08/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE To determine whether the free online artificial intelligence platform ChatGPT could accurately, adequately, and appropriately answer questions regarding anterior cruciate ligament (ACL) reconstruction surgery. METHODS A list of 10 questions about ACL surgery was created based on a review of frequently asked questions that appeared on websites of various orthopaedic institutions. Each question was separately entered into ChatGPT (version 3.5), and responses were recorded, scored, and graded independently by 3 authors. The reading level of the ChatGPT response was calculated using the WordCalc software package, and readability was assessed using the Flesch-Kincaid grade level, Simple Measure of Gobbledygook index, Coleman-Liau index, Gunning fog index, and automated readability index. RESULTS Of the 10 frequently asked questions entered into ChatGPT, 6 were deemed as unsatisfactory and requiring substantial clarification; 1, as adequate and requiring moderate clarification; 1, as adequate and requiring minor clarification; and 2, as satisfactory and requiring minimal clarification. The mean DISCERN score was 41 (inter-rater reliability, 0.721), indicating the responses to the questions were average. According to the readability assessments, a full understanding of the ChatGPT responses required 13.4 years of education, which corresponds to the reading level of a college sophomore. CONCLUSIONS Most of the ChatGPT-generated responses were outdated and failed to provide an adequate foundation for patients' understanding regarding their injury and treatment options. The reading level required to understand the responses was too advanced for some patients, leading to potential misunderstanding and misinterpretation of information. ChatGPT lacks the ability to differentiate and prioritize information that is presented to patients. CLINICAL RELEVANCE Recognizing the shortcomings in artificial intelligence platforms may equip surgeons to better set expectations and provide support for patients considering and preparing for ACL reconstruction.
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Affiliation(s)
- William L Johns
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Brandon J Martinazzi
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A..
| | - Benjamin Miltenberg
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
| | - Hannah H Nam
- Penn State College of Medicine, Hershey, Pennsylvania, U.S.A
| | - Sommer Hammoud
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A
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Yaari L, Singer J, Goldberg D, Yassin M, Agar G, Lindner D, Beer Y, Haviv B. Eighteen-year outcome of anterior cruciate ligament reconstruction with patellar tendon or hamstring autograft. Arch Orthop Trauma Surg 2024; 144:2189-2195. [PMID: 38630253 DOI: 10.1007/s00402-024-05317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 04/04/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To evaluate patient reported outcomes and radiographic arthritic changes of transtibial anterior cruciate ligament reconstruction (ACLR) with either bone-patellar tendon-bone (BPTB) or hamstrings (HS) auto-grafts at a minimum of 15-year follow-up. METHODS Ninety-four patients (51 of the HS group, 43 of BPTB group) who were operated between the years 2000 to 2005 in two tertiary referral hospitals were contacted and invited to a retrospective evaluation. The interview included subjective outcomes using the Lysholm knee scoring questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Tegner activity level scale, Visual Analogue Scale (VAS) for pain and patients' satisfaction scale. Knee examination included measurements of motion and stability. Knee radiographs were evaluated for osteoarthritic changes according to the Kellgren-Lawrence (KL) score. RESULTS The average evaluation time from surgery was 18.6 years. Subjectively, there was no significant difference between groups except for a better post-operative level of activity and satisfaction in the HS group. Objectively, there was no significant difference between groups in knee stability and range of motion. Most patients had grade KL ≤ 1 radiographic osteoarthritits changes and there was no significant difference between groups. Recurrent complete tear of the reconstructed graft occurred in 3 patients of each group. In both groups 84% had no further surgery while the indications for further surgery were mostly a meniscal tear or tibial hardware removal. CONCLUSIONS Very long-term outcomes and clinical stability of transtibial HS or BPTB graft ACL reconstruction are good with low rate of graft failure and radiographic osteoarthritis.
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Affiliation(s)
- Lee Yaari
- Arthroscopy and Sports Injuries Unit, Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Jonathan Singer
- Arthroscopy and Sports Injuries Unit, Orthopedic Division, Assaf Harofeh-Shamir Medical Center, Tzrifin, Israel
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Dan Goldberg
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Mustafa Yassin
- Arthroscopy and Sports Injuries Unit, Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Gabriel Agar
- Arthroscopy and Sports Injuries Unit, Orthopedic Division, Assaf Harofeh-Shamir Medical Center, Tzrifin, Israel
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Dror Lindner
- Arthroscopy and Sports Injuries Unit, Orthopedic Division, Assaf Harofeh-Shamir Medical Center, Tzrifin, Israel
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Yiftah Beer
- Arthroscopy and Sports Injuries Unit, Orthopedic Division, Assaf Harofeh-Shamir Medical Center, Tzrifin, Israel
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel
| | - Barak Haviv
- Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, 7 Keren Kayemet St, Petach-Tikva, 49372, Israel.
- Arthroscopy and Sports Injuries Unit, Orthopedic Department, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel.
- Orthopedic Department, Faculty of Medical & Health Sciences, Tel-Aviv University, Tel Aviv, Israel.
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Hellberg C, Kostogiannis I, Stylianides A, Neuman P. Outcomes >30 Years After Initial Nonoperative Treatment of Anterior Cruciate Ligament Injuries. Am J Sports Med 2024; 52:320-329. [PMID: 38193189 PMCID: PMC10838478 DOI: 10.1177/03635465231214423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 09/22/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND It is unclear how anterior cruciate ligament (ACL) reconstruction (ACLR) affects the development of osteoarthritis (OA). This uncertainty is partly caused by the lack of long-term studies on ACL injuries treated primarily without reconstruction and the underreporting of symptomatic OA. PURPOSE To determine (1) the knee function, symptoms, and activity level, as well as the presence of radiographic and symptomatic OA; (2) how these clinical outcomes have changed over time; and (3) the frequency of subsequent knee surgeries after the index ACL injury in a cohort of patients with ACL injuries treated primarily without reconstruction. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 100 patients underwent initial nonoperative treatment >30 years ago (mean, 33.2 ± 1.4 years). Of these, 81 patients (mean age, 59 ± 8 years) completed the Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Scoring Scale, and Tegner Activity Scale. Seventy-three patients underwent radiography to evaluate tibiofemoral and patellofemoral OA in the ACL-injured knee. Patients only underwent late ACLR if they experienced insufficient knee stability. RESULTS At 33 years after the ACL injury, the KOOS Activities of Daily Living subscore was better than population-based reference values, but scores were similar for the remaining KOOS subscales. Furthermore, 65% of patients had a good or excellent Lysholm score (≥84 points). The Tegner score decreased 4 points from before the injury to 33-year follow-up (P < .001). Most patients (75%) had evidence of radiographic tibiofemoral and/or patellofemoral OA, but only 38% were classified as having symptomatic OA (defined as radiographic OA in combination with a symptomatic knee according to cutoffs on the KOOS). Approximately 50% underwent meniscal surgery, and 29% subsequently underwent ACLR for recurrent instability. There were 2 patients who underwent total knee replacement. CONCLUSION Despite a high prevalence of radiographic OA, patients achieved acceptable subjective knee function and had a relatively low prevalence of symptomatic OA at >30 years after an ACL injury when an initial nonoperative treatment strategy was employed.
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Affiliation(s)
- Clara Hellberg
- Clinical Epidemiology Unit, Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ioannis Kostogiannis
- Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Alexandros Stylianides
- Musculoskeletal Radiology Section, Skåne University Hospital, Lund University, Lund, Sweden
| | - Paul Neuman
- Department of Orthopaedics, Clinical Sciences Malmö, Lund University, Malmö, Sweden
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Puzzitiello RN, Sylvia SM, Perrone GS, Bragg JT, Richmond JC, Salzler MJ. Preoperative factors associated with failure to reach the patient acceptable symptom state after anterior cruciate ligament reconstruction in patients aged 40 and older. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07334-x. [PMID: 36811656 DOI: 10.1007/s00167-023-07334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/30/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To perform a predictive analysis to identify preoperative patient factors associated with failure to achieve a newly defined patient acceptable symptom state (PASS) for the International Knee Documentation Committee (IKDC) Score after anterior cruciate ligament reconstruction (ACLR) in patients aged ≥ 40 years with a minimum of 2-year follow-up. METHODS This was a secondary analysis of a retrospective review of all patients aged 40 years or older receiving a primary allograft ACLR at a single institution between the years of 2005 and 2016, with 2-year minimum follow-up. Using an updated PASS threshold of 66.7 for the International Knee Documentation Committee (IKDC) score previously established for this patient cohort, a univariate and multivariate analysis was performed to identify preoperative patient characteristics predictive of failure to achieve PASS. RESULTS A total of 197 patients with a mean follow-up of 6.2 ± 2.1 years (range 2.7 - 11.2) were included in the analysis (48.5 ± 5.6 years, 51.8% female, Body Mass Index (BMI) 25.9 ± 4.4). PASS was achieved by 162 patients (82.2%). Patients who failed to achieve PASS more often had lateral compartment cartilage defects (P = 0.001) and lateral meniscus tears (P = 0.004), higher BMIs (P = 0.004), and Workers' Compensation status (P = 0.043) on univariable analysis. Factors predictive of failure to achieve PASS on multivariable analysis included BMI and lateral compartment cartilage defect (OR 1.12 [1.03-1.23], P = 0.013; OR 5.1 [1.87-13.9], P = 0.001). CONCLUSION Among patients ≥ 40 years who receive a primary allograft ACLR, patients who fail to achieve PASS more often had lateral compartment cartilage defects and higher BMIs. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Richard N Puzzitiello
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St. # 306, Boston, MA, 02111, USA
| | - Stephen M Sylvia
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St. # 306, Boston, MA, 02111, USA
| | - Gabriel S Perrone
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St. # 306, Boston, MA, 02111, USA
| | - Jack T Bragg
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St. # 306, Boston, MA, 02111, USA
| | | | - Matthew J Salzler
- Department of Orthopaedic Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St. # 306, Boston, MA, 02111, USA.
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