bluuebunny/crossref_metadata_2025 huggingface dataset:
Indicators of Bacterial Colonization in Failed Anterior Cruciate Ligament Reconstructions
Authors: Flanigan David C. , Everhart Joshua Scott , DiBartola Alex
Published: July 2017

Objectives:

Anterior cruciate ligament (ACL) repair is one of the most common orthopedic procedures performed, with over 175,000 operations performed each year. While rare, graft failure can be a detrimental complication. A 2003 meta-analysis by Freedman et al. reported failure rates between 1.9% and 4.9%. There is a higher risk of ACL repair failure among younger patients and those that underwent allograft procedures (versus autograft). Despite extensive study of graft failure, the mechanism of graft failure remains poorly understood. However, traumatic loading, infection, and surgical error have all been suggested to play a roll. Colonization of ACL reconstruction graft with low virulence bacteria could cause graft tissue attenuation without overt clinical symptoms and predispose patients to ACL graft failure. Polymerase chain reaction (PCR) is a highly sensitive method for detecting bacteria present in very low concentrations and detecting species that cannot be reliably cultured clinically. We hypothesize that DNA form bacteria may be present in torn graft tissue at time of revision ACL reconstruction.

Methods:

A total of 31 revision ACL cases (mean age 28; sd 5.1) and 5 primary ACL reconstruction controls (all hamstring autograft; mean age 27; sd 4.6) from one academic medical center were included. All revisions were first time revisions and had no clinical signs of infection. Among revision cases, autograft was used in 22/31 (71%) and allograft in 9/31 (29%) at the time of index operation. Mean time to failure was 15.8 months (range 6 months-7 years). A sample from the graft material was obtained using new sterile instruments from the tribal tunnel and directly transported ot the lab. DNA extraction techniques were used to isolate and purify DNA from each sample. PCR and DNA sequencing analysis were used to determine the presence and quantity of DNA in each sample.

Results:

Bacterial DNA was detectable in graft tissue in the majority of revision ACL cases 27/31 (87.0%) and less commonly 1/5 (20%) in primary ACL autograft controls (p=0.002, Chi-square test). Median bacterial DNA concentration in torn grafts at time of revision ACL was low at 17.5 ng/ml (range 0-101) with no difference found between revision patients with allograft (median 18.6 ng/ml range 0-45) vs. autograft (median 17.1 ng/ml range 0-105) used at time of primary ACL reconstruction (p=0.56, Wilcoxon rank sum).

Conclusion:

Bacterial DNA was detectable in graft tissue in the majority of revision ACL cases 27/31 (87.0%) and less commonly 1/5 (20%) in primary ACL autograft controls (p=0.002, Chi-square test). Median bacterial DNA concentration in torn grafts at time of revision ACL was low at 17.5 ng/ml (range 0-101) with no difference found between revision patients with allograft (median 18.6 ng/ml range 0-45) vs. autograft (median 17.1 ng/ml range 0-105) used at time of primary ACL reconstruction (p=0.56, Wilcoxon rank sum).
Concomitant Lateral Meniscus Injury Aggravates Rotational Laxity of the Anterior Cruciate Ligament Injured Knees
Authors: Hoshino Yuichi , Miyaji Nobuaki , Nishizawa Yuichiro , Araki Daisuke , Matsushita Takehiko , Kuroda Ryosuke
Published: July 2017

Objectives:

Residual rotational laxity in the anterior cruciate ligament (ACL) reconstructed knees is a remaining problem after the ACL reconstruction. Improper detection and treatment of the secondary restraint for the knee rotational laxity after the ACL were considered as the major reason for the problem. Although anterolateral ligamentous structure of the knee has increasingly been focused on, meniscus injury is frequently accompanied with the ACL injury and assumed to have significant impact on the rotational laxity based on previous studies. The purpose of this study was to determine the effect of the meniscus tear on the rotational laxity in the ACL-deficient knees.

Methods:

Fifty-seven unilateral ACL-injured patients (26 males and 31 females, 24 ± 10 y.o.) were tested. The protocol of this study was approved by the IRB in Kobe University, and the informed consent was obtained from all the patients. The pivot-shift test was performed under general anesthesia during their ACL reconstruction. (Fig.1) Clinical grading according to the IKDC (none, glide, clunk, and gross) was determined, whereas the quantitative assessment of the pivot-shift was conducted using electromagnetic measurement system to provide the tibial acceleration (m/sec2). Meniscus injuries were finally confirmed under arthroscopy during the ACL reconstruction. The difference of clinical grading and tibial acceleration between the ACL-injured knees with and without additional meniscus tear was assessed, followed by subgroup analysis for each medial and lateral meniscus tear separately. Statistical significance was set at p-value of 0.05.

Results:

Concomitant meniscus tear was confirmed in 32 knees. Clinical grading was different between the ACL-injured knees with and without meniscus tear (p<0.05), while the quantitative evaluation did not find a statistical significance (meniscus-injured knees 1.6 ± 1.1 m/sec2 vs meniscus-intact knees 1.3 ± 0.8 m/sec2, p=0.09). Subgroup analysis demonstrated increased tibial acceleration in the ACL-deficient knees with lateral meniscus tear (1.8 ± 1.1 m/sec2, n=19) compared to the meniscus-intact knees (p<0.05), whereas the rotational laxity did not rise in the medial meniscus torn knees (1.4 ± 1.0 m/sec2, n=20, p=0.33).

Conclusion:

Although the meniscus injury is the most common in addition to the ACL injury, the impact of the meniscus injury on the knee rotational laxity has not been fully examined. This study demonstrated the significant impact of the meniscus injury, especially lateral meniscus injury, on the rotational laxity in the ACL-deficient knees, which was successfully detected by using the quantitative measurement device. A careful inspection of the lateral meniscus tear should be required in the ACL-deficient knees with a substantial pivot-shift and, if there is any, it should be repaired as much as possible to avoid additional rotational laxity.
Clinical Outcomes of Patellofemoral Osteochondral Allograft Transplantation: A Prospective Analysis
Authors: Cotter Eric J. , Wischmeier Dillen , Frank Rachel M. , Yanke Adam B. , Farr Jack , Cole Brian J.
Published: July 2017

Objectives:

The use of osteochondral allograft transplantation (OAG) for chondral defects of the knee is increasing, particularly for defects involving the femoral condyles. The purpose of this study was to prospectively evaluate the clinical outcomes for patients undergoing patellofemoral OAG for symptomatic chondral lesions.

Methods:

Consecutive patients undergoing OAG for full-thickness patella and trochlear lesions between 2007 and 2014 by two senior surgeons were analyzed. Pre- and post-operative patient reported outcomes scores were collected, with a minimum 21-month follow-up. Patient demographics, preoperative clinical data including information on prior ipsilateral knee surgeries, and intraoperative details were analyzed for all patients. Complications, reoperations, and conversion to total knee or patellofemoral arthroplasty were recorded. Statistical analysis was conducted with student’s T-tests, with P<0.05 considered significant.

Results:

A total of 14 patients (10 females, 4 males) with an average age of 32.8±7.5 years (range, 20-48) were identified for inclusion with an average follow-up of 3.6±1.8 years (range, 1.8-7.8) (Table 1). The average body mass index was 27.5±6.9 kg/m2. Patients experienced an average 5.4±4.2 years of symptoms prior to OAG and 100% of patients had undergone previous ipsilateral knee surgery with an average 4.1±3.5 prior procedures before undergoing patellofemoral OAG. The average defect size on the patella was 855mm2 while that on the trochlea was 322mm2. At the time of OAG, 6 (43%) patients received trochlear grafts, 6 (43%) received patellar grafts, and 2 (14%) received bipolar grafts. Nine patients (64%) received a single allograft, 3 (21%) received 2 allografts to 2 separate lesions, and 2 (14%) received grafts to 4 separate lesions. At final follow-up, there were significant improvements in Lysholm, IKDC, KOOS, WOMAC, and SF-12 Physical outcomes scores; no significant improvements were found in the SF-12 Mental subscale (Figure 1). Two patients (both female, ages 27 and 41) were considered failures as they had converted to knee arthroplasty at an average 2.7 years following OAG. Both of these patients had received allografts to the patella with lesion sizes of 506mm2 and 1800mm2, respectively.

Conclusion:

Osteochondral allograft transplantation of the patellofemoral joint can be considered a viable restoration procedure for patients with symptomatic chondral lesions to the trochlea and patella. At an average follow-up of 3.6 years, the majority of patients will experience significant improvements in nearly all outcomes scores, with an arthroplasty conversion rate of 14%. Additional information on this difficult-to-treat patient population, including a better understanding of risk factors for failure, prognostic factors for success, and long-term outcomes, is needed. [Table: see text]
Nonoperative Management of Osteochondritis Dissecans: Progression to Osteoarthritis and Arthroplasty over a 35-Year Period in a Geographic Population
Authors: Krych Aaron John , Sanders Thomas L. , Pareek Ayoosh , Johnson Nick R. , Carey James L. , Maak Travis , Stuart Michael J.
Published: July 2017

Objectives:

Osteochondritis dissecans (OCD) is a disorder of subchondral bone that commonly affects the knee.The purpose of this study is to (1) evaluate the rate of arthritis and knee arthroplasty in a population-based cohort of patients with OCD lesions treated non-operatively and (2) evaluate factors that may predispose patients to knee osteoarthritis and arthroplasty.

Methods:

86 patients (mean age 21.4 years) with OCD lesions treated nonoperatively were identified between 1976 and 2014. Information related to the diagnosis, laterality of lesion, details of treatment, and progression to arthritis was obtained from the medical record. Factors predictive of arthritis and arthroplasty (age, gender, body mass index, and lesion location) were examined.

Results:

At a mean follow-up of 12.6 (±9.8) years from diagnosis, 13 patients (15%) were diagnosed with arthritis corresponding to a cumulative incidence of 5.0% at 5 years, 10.0% at 10 years, 20.0% at 25 years, and 30.0% at 35 years. The cumulative incidence of arthroplasty was 1.0% at 5 years, 3.0% at 10 years, 8.0% at 25 years, and 8.0% at 35 years. BMI greater than 25 kg/m2 (HR 15.4, 95% CI: 1.9, 124.5) and patellar OCD lesions (HR 15.0, 95% CI: 1.3, 345.3) were associated with arthritis.

Conclusion:

Arthritis following nonoperative treatment of OCD lesions is a challenging problem with an estimated 30% cumulative incidence at 35 years after diagnosis. In contrast, the long-term rate of arthroplasty is low. BMI greater than 25 kg/m2 and patellar OCD lesions are predisposing factors for arthritis. Older age at diagnosis was associated with a greater risk of arthritis and knee arthroplasty.
Meniscus Radial Repair with the Transtibial Two Tunnel Technique: A Non-Inferiority Study with Vertical Mensical Tears Repair Comparison
Authors: Chahla Jorge , Cinque Mark , Geeslin Andrew , Dornan Grant , LaPrade Robert F.
Published: July 2017

Objectives:

Radial meniscus tears disrupt the circumferential fibers and thereby compromise meniscal integrity. Historically, radial tears were often treated with meniscectomy due to an inunderstanding of the biomechanical consequences of these tears, limited information regarding the biomechanical performance of repairs, and the technical difficulty associated with repair. A paucity of studies on the outcomes of repair of radial meniscal tears are available. The purpose was to report early (minimum two-year follow-up) results of a two-tunnel transtibial repair of radial meniscus tears and compare these outcomes to the outcomes of patients who underwent repair of vertical meniscus tears. The hypothesis was that radial tear repair would be safe and efficacious and that there would be no difference between repair and repair of vertical meniscal tears.

Methods:

The primary study group included patients that underwent a two-tunnel transtibial pullout repair for a radial meniscus tear. The compare group included patients that underwent inside-out repair of vertical meniscus tears. Subjective questionnaires were administered pre-operatively and at a minimum of two years follow-up, including the Lysholm score, the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) score, the Short Form-12 (SF-12) physical component summary (PCS) and mental health component summary (MCS), the Tegner Activity scale and patient satisfaction. ANCOVA models were used to compare postop outcome scores between meniscus repair groups while accounting for baseline score. Adjusted mean effects relative to the radial repair group were reported with 95% confidence intervals.

Results:

Twenty-seven patients that underwent two tunnel transtibial pullout repairs for radial meniscal tears and 33 patients who underwent inside-out vertical meniscus tear inside-out repair group were available for follow-up at a minimum of two-years. No baseline outcome scale significantly differed between the groups. In the radial repair group, the mean ± SD preoperative SF-12 PCS, WOMAC and Lysholm were 36.7 ± 9.4, 36.6 ± 20.5, and 47.4±22.1, respectively. In the vertical repair group the mean ± SD preoperative SF-12 PCS, WOMAC and Lysholm were 37.4 ± 10.2, 40.4 ± 23.5, and 45.6 ±22, respectively. There were no significant group differences for any of the two-year postoperative outcomes scores. Relative to radial repair, the repaired vertical tear group exhibited an adjusted average of +0.4 (95% CI: -4.2, 5.00), +0.6 (-4.9, 6.0) and -5.1 (-13.6, 3.5) points on the SF-12 PCS, WOMAC and Lysholm scales, respectively.

Conclusion:

The Two tunnel transtibial pullout repairs for radial meniscal tear technique is a safe and efficacious procedure and produces similar clinical outcomes when compared to repairs of vertical tears.
Increased Glenoid Index is a Risk Factor for Pediatric Anterior Glenohumeral Dislocation: An MRI-Based Case-Control Study
Authors: Fabricant Peter D. , Yellin Joseph L. , Anari Jason Brett , Neuwirth Alexander , Ganley Theodore J. , Chauvin Nancy A. , Lawrence John Todd R.
Published: July 2017

Objectives:

In the adult population, anterior glenohumeral instability has been associated with a tall and narrow glenoid morphology, assessed using glenoid index (GI). This morphological association has not been assessed in children and adolescents. This study was designed to examine the association of GI with anterior glenohumeral dislocation in patients 19 years old and younger using a case-control study design.

Methods:

An institutional radiology database was queried over a 10-year period to identify patients 19 years old and younger who underwent glenohumeral MRI arthrography and were diagnosed with anterior shoulder dislocation (cases) and those without dislocation and normal shoulder arthrogram studies (controls). Those with bony Bankart lesions were excluded. Glenoid index (glenoid height-to-width ratio) was measured by an attending pediatric musculoskeletal radiologist and a fellowship-trained attending orthopedic surgeon. Comparative analysis between the two groups was performed using Student’s t-test for each variable, followed by receiver-operating-characteristic (ROC) analysis to determine discriminative ability when statistically significant.

Results:

Thirty-three males and 22 females (mean age: 15.4±2.1 years old) meeting inclusion and exclusion criteria were identified. Mean glenoid index in the dislocator group was significantly greater than the control group (1.55±0.14 vs. 1.38±0.08, P<0.001). ROC analysis revealed adequate discrimination of glenoid index in predicting glenohumeral dislocation (area under the curve [AUC] = 0.88). A glenoid index ≥1.45 was 83% sensitive and 79% specific for predicting dislocation in the study cohort.

Conclusion:

Patients with anterior glenohumeral dislocation were noted to have increased glenoid index (taller and narrower glenoid morphology) than controls. Glenoid index may help identify patients at risk for primary or recurrent anterior glenohumeral instability events, and can help guide treatment and anticipatory guidance.
Alterations in Glenohumeral Forces Following Rotator Cuff Injury and Repair
Authors: Golan Elan J. , Krochak Ryan , Garofolo Garret , Culbertson Maya Deza , Choueka Jack
Published: July 2017

Objectives:

Rotator cuff repair is associated with an unusually high incidence of osteoarthritic changes and cartilage damage in the glenohumeral joint. Such degeneration may be secondary to improper tensioning of muscular stabilizers during surgical intervention; however, existing studies have not specifically examined changes in joint congruity following rotator cuff repair. Therefore, the purpose of this study was to assess for changes in glenohumeral contact forces following the repair of rotator cuff injury.

Methods:

Transduction mapping was performed on the glenohumeral joint of ten fresh-frozen cadaveric shoulder specimens. A calibrated pressure-mapping sensor was introduced through the rotator interval and secured along the concavity of the glenoid labrum. Following a baseline force measurements, analysis of force intensity and total glenohumeral contact area was performed in each specimen for 6 simulated injury and treatment conditions: A) A 1 cm supraspinatus lesion; B) 2-suture repair of the 1 cm lesion; C) removal of the 2-suture repair; D) a 2 cm supraspinatus lesion; E) 3-suture repair of the 2 cm lesion and; F) removal of the 3-suture repair. All repairs were performed via bone tunnels in the standard method described. Data were recorded over 60s intervals at a rate of 4 frames per second and included raw force, area, and force per unit area. Values for lesion, repair, and post-repair conditions were expressed as a proportion of initial baseline measurements. Means and standard deviations were then calculated for each condition and compared via Student’s t-tests.

Results:

For baseline measurements, the mean intact glenohumeral force was 38.55 ± 24.79 N and the mean contact area was 313 ± 84.09 mm2. In comparison to baseline values, 3-suture repair yielded a significant increase in both total glenohumeral force (mean proportion: 2.16 ± 3.26; p=0.046) as well as proportion of force per unit area (1.73 ± 1.86 N/mm2; p=0.024). Both the 2 cm lesion and the 2-suture repair removal yielded significant decreases in contact area when compared to baseline, with the former exhibiting a proportion of 0.76 ± 0.19 (p=0.040) and the latter yielding a proportion of 0.60 ± 0.29 (p=0.004). No other conditions exhibited significant changes from baseline measurements.

Conclusion:

Rotator cuff injury leads to alterations in glenohumeral forces, with significant increases in articular contact-pressures following repair of larger supraspinatus lesions. These findings offer a possible explanation for the high rate of degenerative changes demonstrated following rotator cuff repair. Further study is warranted to determine how current treatment methods might be improved to result in glenohumeral contact pressures resembling those experienced prior to injury.
Epidemiology of Ulnar Collateral Ligament Reconstruction in Major and Minor League Baseball Pitchers: Comprehensive Report on 1,313 Cases
Authors: Camp Christopher L. , Conte Stan , D’Angelo John , Fealy Stephen
Published: July 2017

Objectives:

Although much as been done to better understand and characterize the epidemic of UCL reconstruction in pitchers, a comprehensive review of all UCL reconstructions performed in professional baseball pitchers is surprisingly lacking. Accordingly, the purpose of this work was to provide an epidemiologic report on every UCL reconstruction ever performed in professional baseball with a special focus on outcomes (return to play rates and time) and overall survivorship.

Methods:

Three resources (including the Major League Baseball [MLB] injury tracking system) were combined and cross-referenced to identify all professional baseball players who had ever undergone primary UCL reconstruction (1974 to 2015). Variables analyzed included the date of injury, date of surgery, time out of play, geographical region, and revision status. Trends over time were analyzed collectively and based on level of play at the time of surgery. A minimum of 2 years of follow up was required to determine return to play status. Revision free Kaplan-Meier survivor analysis was performed.

Results:

A total of 1,313 UCL reconstructions were identified. The annual rate of primary and revision UCL reconstructions rose significantly for all levels of play from 1974 to 2015 and from (p<0.001). The overall mean time to return to play (RTP) was 436 days (range 98 to 1,643). The rate of RTP to any level was 93.9% for MLB pitchers vs. 76.3% for MiLB pitchers (p<0.001), and MLB pitchers RTP at the MLB level in 73.1% of cases. The time to RTP was longer (by 54 days) for revisions (p=0.025) compared to primaries, and MLB pitchers RTP from primary surgery 95.6% of the time but only 81.8% for revision surgery (p=0.008). The revision rate was 10.7%, and the percentage of players free of revision and still playing professional baseball was 92% at 2 years, 53% at 5 years, and 17% at 10 years. Survivorship was improved for players undergoing UCL reconstruction before age 25 opposed to after 25.

Conclusion:

This study represents the most robust epidemiologic report of UCL reconstruction in baseball to date, and a number of novel findings are reported. A number of key differences in MLB and MiLB, as well as primary and revision surgeries, were identified. Although the revision rate (10.7%) is higher than prior reports, 75% of players who had surgery before age of 25 are revision free and still playing professional baseball four years post operative.
The Anterior-posterior Distance Between the Tibial Tuberosity and Trochlear Groove
Authors: Tanaka Miho Jean , D’Amore Taylor , Elias John J. , Thawait Gaurav , Demehri Shadpour , Cosgarea Andrew J.
Published: July 2017

Objectives:

Tibial tuberosity osteotomy is often performed to correct excessive lateralization of the tuberosity in patients with patellar instability. An anteriorizing component has been recommended in the setting of chondral pathology, yet the ideal anterior-posterior relationship of the tibial tuberosity to the trochlear groove is unknown.

Methods:

Patients with symptomatic patellar instability underwent static CT imaging, and were compared to age- and gender-matched controls. All knees were imaged in full extension. Tibial-tuberosity-trochlear-groove (TTTG) distance was measured to quantify lateralization of the tuberosity, as well as the anterior-posterior distance between these two points (APTTTG distance). Lateral trochlear inclination (LTI), sulcus angle (SA) and trochlear depth (TD) were measured as indicators of trochlear dysplasia. Measurements were compared between the symptomatic and control groups using paired t-tests. Correlations between APTTTG with LTI, SA and TD were assessed using linear regression analyses.

Results:

22 knees in 18 patients with symptomatic patellar instability were included in the study group, with 22 control knees. TTTG and APTTTG distances were 19.9 mm and 8.3 mm in the symptomatic group, versus 16.8 mm and -0.5 mm in the control group, with a difference of 3.1 mm (p=0.002) and 8.8 mm (p<0.0001) respectively. The symptomatic group displayed greater trochlear dysplasia with lower LTI (13.0° vs 21.9°, p<0.0001), higher SA (152.7° vs 137.7°, p<0.0001) and lower TD (1.3mm vs 6.0mm, p<0.0001). There was strong correlation between APTTTG and TD (r=0.62, R2=0.39, p<0.0001).

Conclusion:

Our findings demonstrate that the trochlear groove is almost 9mm more anterior to the tibial tuberosity in patients with symptomatic instability, and this distance correlates with measurements of trochlear dysplasia. While further studies are needed to determine the relationship between APTTTG distance and patellar instability, these findings suggest that the anterior-posterior relationship between the trochlea and tuberosity may be a factor to consider when planning for tibial tuberosity osteotomy in patients with trochlear dysplasia.
Trochleoplasty is a Viable Option for Patellar Instability in Patients with Severe Trochlear Dysplasia: Early Outcomes Analysis of the U.S. Experience
Authors: Diduch David R. , Burrus Matthew Tyrrell , Cancienne Jourdan M. , Kurkis Gregory M. , Carstensen S. Evan , Griffin Justin W. , Werner Brian C.
Published: July 2017

Objectives:

Patellar instability caused by severe trochlear dysplasia is best treated by sulcus-deepening trochleoplasty. There have been no studies examining outcomes after this procedure in the United States. The purpose of this study was to evaluate the early outcome data of patients undergoing sulcus-deepening trochleoplasty for high-grade trochlear dysplasia at our institution.

Methods:

A total of 43 patients (49 knees) with severe trochlear dysplasia were prospectively enrolled and underwent sulcus-deepening trochleoplasty. 23 out of 49 (46.9%) knees had prior surgery related to patellar instability, and six knees had more than one such surgery. Concomitant procedures during the trochleoplasty included medial patellofemoral ligament reconstruction (100%), lateral release (49.0%), tibial tubercle osteotomy (36.7%), and some type of cartilage procedure (49.0%). Physical examination, radiographic analysis, and clinical follow up were obtained for all patients. Patients also completed pre and postoperative Kujala and IKDC scores, in addition to reporting on return to sport and any instances of recurrent instability.

Results:

79.6% of patients were female with an average age of 20.1 +/- 6.3 years. Follow up ranged from 6 weeks to 49 moths (mean 10.6 +/- 10.5 months). There were no episodes of recurrent instability. All patients reported clinically significant improvements compared with baseline preoperative outcome scores. Patellar tracking was normal in all cases with no patellar apprehension at final follow up. The mean preoperative IKDC score was 49.6, which improved to 78.3 (p < 0.001), and the mean preoperative Kujala score was 54.5 which improved to 82.8 (p < 0.001). Patients reported high satisfaction rates (mean 9.3 +/- 1.8 out of 10), and 81.5% patients were able to return to sport. 9 knees (18.4%) developed arthrofibrosis and required manipulation under anesthesia, 7 of which underwent simultaneous arthroscopic lysis of adhesions. At the latest follow-up, average knee range of motion was 126.6 +/- 13.7 degrees. Radiographic analysis of the sulcus angle demonstrated a significant decrease from 144.2 degrees preoperatively to 133.0 postoperatively (p < 0.001).

Conclusion:

When indicated in the setting of severe trochlear dysplasia, sulcus-deepening trochleoplasty can provide a reliable and successful surgical solution to recurrent patellar instability. Early follow up demonstrates improved radiographic parameters coupled with excellent clinical outcomes and no recurrent instability.
Open Subpectoral Biceps Tenodesis for Isolated Biceps Reflection Pulley Lesions: Minimum 2-year Outcomes in a Young Patient Population
Authors: Vap Alexander R. , Katthagen Jan Christoph , Pogorzelski Jonas , Tahal Dimitri S. , Horan Marilee P. , Fritz Erik M. , Millett Peter J.
Published: July 2017

Objectives:

Biceps Reflection Pulley (BRP) lesion is a common generator of anterior shoulder pain and cause of biceps tendon instability. The purposes of this study were (1) to investigate if patients younger than 50 years had improved functional outcomes following open subpectoral biceps tenodesis (BT) for treatment of an isolated BRP lesion with a minimum follow-up of 2-years, and (2) to determine whether a correlation exists between patient age and outcomes scores. It was hypothesized that subpectoral BT would result in reduced pain, improved functional outcomes, and a high return-to-activity rate and that there would be no association between patient age and outcomes scores.

Methods:

This was an IRB-approved study with retrospective review of prospectively-collected data. All patients who had arthroscopically confirmed isolated BRP lesion treated with open subpectoral biceps tenodesis were at least 2 years out from surgery were included in the study. Patients with additional surgery on the index shoulder were excluded from the study. ASES (pain and function), QuickDASH, and SF-12 scores were collected pre- and postoperatively. Postoperative satisfaction (10-point scale) was also collected. The pre- and postoperative scores of each patient were compared with a Wilcoxon-test, and association between patient age and outcomes scores were investigated with a Spearman correlation test. Further, patient return-to-activity was evaluated by questionnaire. Failure was defined as revision surgery of the biceps tenodesis.

Results:

14 shoulders in 14 patients (6 male, 8 female) with a mean age of 37 ± 8.9 years met the inclusion criteria. Minimum 2-year outcomes data were available for 13 (93%) shoulders. The mean follow-up time was 3.6 ± 1.3 years. There were significant improvements postoperatively for all outcome scores (p<0.05, see table 1) and no patients underwent revision surgery of the biceps tenodesis. There was no correlation between age and outcomes scores (p>0.05). Overall, median patient satisfaction was 9 out of 10 (range 3-10). Of 14 patients who answered the “return-to-activity” questions, 5 patients () reported return to activity with no modification; 9 patients reported return to activity with modifications. The 5 patients who returned to activity with no modification had significantly less time from initial injury/onset of symptoms until surgery in comparison to the 9 patients who modified their activity (p <0.05, see table 1).

Conclusion:

At minimum 2-year follow-up, patients with symptomatic isolated BRP lesions can expect excellent clinical outcomes, high satisfaction, and a high return-to-activity rate with little postoperative pain if treated with an open subpectoral BT close to the time of their initial injury/onset of symptoms. No differences in outcomes were observed upon patient age. [Table: see text]
Open Sub-pectoral Biceps Tenodesis: A Biomechanics Comparison Of Interference Screw And Various Fixation Techniques
Authors: Diaz Miguel , Shi Brendan , Belkoff Stephen , Srikumaran Umasuthan
Published: July 2017

Objectives:

The purpose of this study was to biomechanically compare six techniques for biceps tenodesis to evaluate the potential difference of anchor size, type and configuration (single- versus double-loaded). The six techniques were interference screws (IS), endobutton (EB), double-loaded 2.9mm PEEK anchor (DL-2.9), double-loaded 1.9mm all-suture anchor (DL-1.9), single-loaded 1.7mm all-suture anchor (SL-1.7), and soft tissue tenodesis (ST) (Smith and Nephew, Memphis, TN, USA).

Methods:

42 fresh-frozen cadaver shoulders (mean age, 72 years [range 54 to 89 years; SD, 9.8 years]; 71% male specimens) were dissected leaving the proximal humerus, proximal biceps tendon, and pectorals major insertion. Specimens were randomized 1 to 6 groups and a sub-pectoral biceps tenodesis was performed. The specimens underwent load to failure axial traction on a materials testing machine.

Results:

The mean failure loads with the 95%Cl are as follows: IS (78.6N, 58.1-99.1 N), ST (100.3 N, 77.7-122.9 N), DL-1.9 (120.6 N, 101.3-139.8 N), EB (136.7 N, 104.5-168.9 N), DL-2.9 (141.0 N, 111.3-170.7 N), and SL-1.7 (142.0 N, 107.9-176.1 N). Failure occurred at the tendon in almost all specimens, however 5 specimens sustained anchor failure during mechanical loading (IS, n=2; DL-2.9, n=1; DL-1.9, n=1; SL-1.7, n=1).

Conclusion:

The load to failure testing of the interference screw group demonstrated statistically significant lower results than the endobutton and anchor techniques. The endobutton and anchor techniques were not significantly different. The endobutton, double-loaded 2.9mm PEEK anchor, and single-loaded 1.7mm all-suture anchor attained the largest ultimate failure loads at approximately 140 N. These results may be taken into consideration when the orthopedic surgeon selects the appropriate fixation technique.
Hip Arthroscopy Survivorship: A Population-based Study
Authors: Heidari K Soraya , Heckmann Nathanael , Pannell William C. , Hill J Ryan , McKnight Braden Michael , Vangsness C. Thomas , Hatch George F. Rick
Published: July 2017

Objectives:

Recently, hip arthroscopy has been increasingly utilized to address pathology such as femoracetabular impingement and symptomatic labral tears. However, its role in advanced age and degenerative changes has not been clearly defined. The aim of this study was to examine survivorship following hip arthroscopy and identify risk factors for failure.

Methods:

Data from the California Office of Statewide Health Planning and Development, a mandatory statewide discharge database, was utilized to identify patients who underwent hip arthroscopy from 2000 to 2014. Exclusions included lower extremity trauma, infection, congenital deformities, malignancy, and concurrent arthroplasty. Demographic information was assessed and failure defined as conversion to total hip arthroplasty (THA). Statistically significant differences between patients requiring THA and those who did not were identified by univariate analysis. Multivariate analysis was performed to account for identified differences, and a Kaplan-Meier curve constructed to estimate 5 and 10-year survivorship.

Results:

After exclusions, 10,061 patients were identified with an average follow-up of 2.7 years. Five and 10-year survivorship were 90.9% and 77.9%, respectively. Patients converted to THA were older (53.1 years versus 40.1 years, p<0.001) and had more comorbidities (27.5% versus 20.1% having at least one comorbidity, p<0.001). THA patients had a higher prevalence of osteoarthritis (41.5% versus 13.24%, p<0.001) and osteochondral defects (44.0% versus 38.9%, p=0.001). On multivariate analysis, each 1-year increase in age presented a 7% increase in failure risk (OR 1.07, p<0.001). Obese patients were more likely to fail (OR 2.19, p=0.049), as were patients with osteoarthritis and osteochondral defects (OR 2.98, p<0.001 and OR 1.13, p=0.081). Patients whose surgery included removal of loose bodies or debridement were also at increased risk of failure (OR 1.58, p<0.001 and OR 1.62, p=0.001).

Conclusion:

Older age, obesity, and diagnoses of osteoarthritis or osteochondral defects at the time of surgery are risk factors for conversion to arthroplasty following hip arthroscopy. [Table: see text][Figure: see text]
Hip Arthroscopy with Labral Preservation and Capsular Plication in Patients with Borderline Hip Dysplasia: Minimum 5-year Patient Reported Outcomes
Authors: Ashberg Lyall , Chaharbakhshi Edwin , Perets Itay , Close Mary , Walsh John P. , Domb Benjamin G.
Published: July 2017

Objectives:

Arthroscopic management of hip pathology in patients with hip dysplasia has been controversial, and historically demonstrated mixed results. Studies on patients with borderline dysplasia, emphasizing the importance of the labrum and capsule as secondary stabilizers, have shown favorable outcomes. We predicted that patients with borderline dysplasia, who are undergoing hip arthroscopy for intrarticular pathology and who have commensurate labral preservation and capsular plication, will have favorable outcomes at mid-term follow up.

Methods:

Data was prospectively collected for patients < age 40, who underwent hip arthroscopy for intra-articular pathology. Inclusion criteria included lateral center-edge angle (LCEA) between 18° and 25°, concurrent capsular plication and labral preservation, and minimum five-year follow-up. Exclusion criteria were severe dysplasia (LCEA ≤ 18°), Tönnis grade ≥ 2, preexisting childhood hip conditions, or prior hip surgery. Patient-reported outcome scores (PROs) including modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-sport specific subscale (HOS-SSS) and Visual Analogue Score for pain (VAS) were collected preoperatively, at 3 months, and annually thereafter. Complications and revisions were recorded.

Results:

Twenty-five hips (24 patients) met inclusion criteria. Twenty-one hips (19 patients, 84%) were available for follow-up. Mean age was 22.9 years. Mean preoperative LCEA and Tönnis angle were 21.7° and 6.9°, respectively. Mean follow-up was 68.8 months. Mean mHHS increased from 70.3 to 85.9 (p < 0.0001), NAHS from 68.3 to 87.3 (p < 0.0001) and HOS-SSS from 52.1 to 70.8 (p = 0.0002). VAS improved from 5.6 to 1.8 (p < 0.0001). Four hips (19%) required secondary arthroscopic procedures, all of which resulted in improved PROs at latest follow-up. No patient required conversion to arthroplasty.

Conclusion:

Using strict patient selection, hip arthroscopy with labral preservation and capsular plication can provide a safe, durable means of managing intra-articular pathology in the setting of borderline acetabular dysplasia. For this select group, this procedure may offer a viable alternative to open surgery (PAO).
Clinical Outcomes and Return to Sport in Competitive Athletes Undergoing Iliopsoas Fractional Lengthening as a Part of Hip Arthroscopy - Minimum Two-Year Follow-Up
Authors: Perets Itay , Hartigan David Edward , Walsh John P. , Chaharbakhshi Edwin , Close Mary R. , Domb Benjamin G.
Published: July 2017

Objectives:

The iliopsoas is a hip flexor and stabilizer that may be associated with internal snapping. Although flexion and stability are important in competitive athletes, painful internal snapping may be debilitating and may necessitate arthroscopic iliopsoas fractional lengthening (IFL). The purpose of this study was to report minimum two-year results for athletes’ patient-reported outcomes (PROs), returning to sports, and competitive abilities after IFL during hip arthroscopy. We hypothesized that IFL for internal snapping in athletes is a safe procedure and will demonstrate favorable outcomes, with a majority of athletes returning to sports with the same or higher competitive abilities.

Methods:

Data were prospectively collected and retrospectively reviewed for 1,682 patients undergoing hip arthroscopy between February 2008 and October 2013. Inclusion criteria were as follows: high school, collegiate, or professional athlete, who underwent arthroscopic IFL, and agreed to preoperative modified Harris Hip Score (mHHS), Non-Arthritic Athletic Hip Score (NAHS), Hip Outcome Score - Sports Specific Subscale (HOS-SSS), and Visual Analog Scale (VAS). All patients failed to improve with at least three months of conservative treatment, including physical therapy, anti-inflammatories, and rest. Exclusion criteria were as follows: patients under 16 years old, Tönnis grade > 1, previous hip conditions such as Legg-Calve-Perthes disease, hip fractures, slipped capital femoral epiphysis, avascular necrosis of the femoral head, hip dysplasia, and previous surgical intervention for either hip.

Results:

Fifty athletes were eligible for inclusion, 44 (88%) of which had minimum two-year follow-up. All PRO scores demonstrated significant improvements at latest follow-up (p < 0.0001). Mean improvements were as follows: mHHS (65.1 to 83.7), NAHS (60.7 to 86.2), HOS-SSS (41.5 to 75.4), VAS (5.8 to 2.0). Mean satisfaction was 8.1. Painful snapping was resolved in 41 patients (93%). Six patients (14%) had non-painful snapping at latest follow-up. Of the 44 athletes, 6 (14%) did not return to sport due to their hip symptomatology, 29 (65.9%) returned to sports, and 24 (54.5%) maintained or improved their competitive abilities. Nine patients (20.5%) did not return to sports for reasons unrelated to their hip (e.g., loss of interest, aging, etc.). The only complications were two (4.6%) superficial wound infections that resolved with topical treatment. There were no complaints of weakness in hip flexion.

Conclusion:

In competitive athletes, IFL during hip arthroscopy is safe and demonstrates favorable improvements in PROs and VAS, high satisfaction, and high rate of symptom resolution at a minimum of two years postoperatively. The majority of patients were able to return to sports and maintain or improve their competitive levels.
Arthroscopic Treatment of Acetabular Condral Defects Using BST-CarGel
Authors: Wong Ivan , Rhee Chanseok (Chris) , Amar Eyal , Glazebrook Mark , Coady Catherine M.
Published: July 2017

Objectives:

The purpose of this study is to retrospectively analyze prospectively collected data to evaluate the shortterm outcome of patients treated arthroscopically with BSTCarGel for acetabular chondral defect.

Methods:

Between November 2014 and December 2015, 22 patients (23 hips) underwent hip arthroscopy for correction of femoroacetabular impingement, labral repair and treatment of acetabular chondral defect. Patient evaluations included general assessment with iHOT33 questionnaire at the time of preoperative consultation, and the postoperative followup at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 year marks. Additionally, preoperative and postoperative plain radiographs and MRarthrogram scans were analyzed for evaluation.

Results:

22 patients (23 hips) have been evaluated with a mean age of 33.34 years at the time of the index operation. There were 16 males (17 hips, mean age of 32.00) and 6 female (6 hips, mean age of 37.15). The average followup was 1 year, with a minimum followup of 6 months. The preoperative iHOT33 score was 47.1, the 6 months postoperative score was 54.8, and the 12 month postoperative score was 63.7 (p < 0.05) MRIArthrograms demonstrated a decrease in the size of the chondral defects. No significant adverse outcomes have been reported.

Conclusion:

Arthroscopic treatment of chondral acetabular defect with BSTCarGel demonstrates encouraging signs of cartilage healing as shown on MRarthrograms, without significant adverse outcomes. Longer followup is required to determine if this improvement is maintained.
Association of Hip Strength with the Hip Sports Test: A Functional Test to Measure Athlete’s Ability to Return to Sport Activity after Hip Arthroscopy
Authors: Bolia Ioanna , Briggs Karen K. , Locks Renato , Utsunomiya Hajime , Philippon Marc J.
Published: July 2017

Objectives:

Excellent clinical outcomes and high rates of return to pre-operative level of activity has been reported in athletes that underwent hip arthroscopy. However, physicians often struggle to decide whether or not in an athlete is able to return to full activity. The Hip sports test (HST), like the already established knee test, may be a useful assessment tool towards this direction. The purpose of our study was evaluate the the correlation of the hip muscle strength values with the HST performance of athlete (measured on the same day) during the post-operative rehabilitation period. Muscle strength could serve as a complimentary, to sports test, tool in order to evaluate the return to sport ability of the athletes.

Methods:

The HST score as well as the muscle strength measurement were obtained on the same day in 115 athletes. Hip muscle strength was assessed using the MicroFET Dynometer pre-operatively and post-operatively. Measurements were made in hip flexion, extension, abduction, adduction, internal rotation, external rotation, gluteus medius and hamstrings. During the HST assessment patients were assessed in single leg squats (single knee bents), lateral agility, diagonal agility exercises as well as in forward single leg lunges in order to obtain their score. The score of 18 or more is considered a passing score for this test. Pre-operatively, 62 tests were performed whereas 53 tests were performed post-operatively. Our data were normally distributed- however, correlation was done non-parametrically using Spearman’s rank correlation coefficient (Spearman’s rho) due to the limited scale of HST.

Results:

The pre-operative strength change compared to the uninjured hip was -4.8% for flexion, -2.2% for extension, 2.4% for abduction, 0.3% for adduction, -2.1% for internal rotation, -1.7% for external rotation, -1.5% for gluteus medius and 1.3% for hamstring. The pre-operative median HST score was 12.5 (range: 0-20). Post-operative hip strength measurements and the distribution of HTS scores are summarized in the table.The Total HST score performance was correlated with hip muscle strength in extension (rho=0.344; p=0.001) and external Rotation (rho=0.260; p=0.006).

Conclusion:

The HST score performance is correlated with the hip muscle strength of hip extension and hip external rotation. [Table: see text]
Comparison of Early Lower Extremity Functional Recovery in Pediatric Patients Following Anterior Cruciate Ligament Reconstruction Using Hamstring Versus IT Band Autograft
Authors: Sugimoto Dai , Heyworth Benton E. , Collines Sara , Kocher Mininder S. , Micheli Lyle J.
Published: July 2017

Objectives:

The influence of graft type and gender in anterior cruciate ligament reconstruction (ACLR) has not been adequately studied in pediatric patients. The purpose of this study was to compare parameters of early lower extremity functional recovery among three cohorts of pediatric patients under 15 years-old: pediatric males who underwent ACLR with hamstring grafts (PM w/HS), pediatric females with hamstring grafts (PF w/HS), and pediatric males with IT band graft (PM w/ITB).

Methods:

A prospective cohort study design was used. At 6-month post-operative visits following ACLR, thigh circumference, knee ROM (extension and flexion), strength (quadriceps, hamstrings, hip abductors, and hip extensors), Y-balance (anterior, posterolateral, and posteromedial reach), and functional hop tests (single, triple, cross-over, and 6 meter timed hops) were assessed in all ACL-R under 15 years-old. Limb symmetry index was used to compare deficits between involved and uninvolved limb between the three graft groups (PM w/HS, PF w/HS, and PM w/ITB). There was an inadequate number of pediatric females who underwent ITB ACL-R for analysis. Analysis of variance (ANOVA) with post-hoc correction was employed.

Results:

A total of 87 pediatric ACLR patients (PM w/HS: N=20, Age:14.3±1.1; PF w/HS: N=33, Age:13.9±0.7; PM w/ITB: N=34, Age:13.2±1.3) were examined. There was no statistically significant difference in ROM and Y-balance tests performance between the cohorts. Of the various additional comparisons analyzed, only the following findings were statistically significant: (a) PM w/HS demonstrated greater thigh circumference deficits (-3.7% relative to healthy limb) than PM w/ITB (-1.5% relative to healthy limb, p=0.024); (b) PM w/HS group showed greater hamstring strength deficits (-34.1% relative to healthy limb) than PM w/ITB (-7.1% relative to healthy limb, p=0.001). The hamstring strength deficits of PF w/HS (-13.3% relative to healthy limb) were not statistically different from either of the male cohorts. (c) PM w/HS cohort showed greater deficits in the triple hop test (-40.1% relative to healthy limb) compared to PM w/ITB (-17.9% relative to healthy limb, p=0.019) and PF w/HS (-10.2% relative to healthy limb, p=0.001).

Conclusion:

While there is a slight age differences exist, PM w/HS patients demonstrated significant thigh circumference, hamstring strength, and functional hop test deficits compared to PM w/ITB at approximately 6 months following ACLR. Autograft type may influence strength and functional recovery following ACLR in pediatric patients. Approximately at 6 months post-operatively, PM w/ITB showed superior recovery in thigh circumference, hamstring strength, and triple hop tests, compared to PM w/HS. Additional research correlating timing and nature of functional recovery with graft retear and athletic performance are warranted.