bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of anxiety and depression on early pain and range of motion after rotator cuff repair - measured by HADS (Hospital Anxiety and Depression Scale) -
Authors: Park Joo Hyun , Jeong Hyeon Jang , Rhee Sung Min , Oh Joo Han
Published: July 2020

Objectives:

According to previous studies, the prevalence of anxiety and depression was approximately 25% in patients with rotator cuff tear, and psychological status may be an important predictor for clinical outcomes after rotator cuff repair. Considering continuous steady rehabilitation is essential for recovery of postoperative pain and range of motion (ROM), the anxiety or depression would affect this process. The aim of this study was to evaluate the effect of anxiety and depression measured by HADS (Hospital Anxiety and Depression Scale) on early pain and ROM after rotator cuff repair.

Methods:

Consecutive 156 patients who underwent arthroscopic rotator cuff repair were prospectively enrolled, and divided into two groups defined by HADS scores; Group I with normal psychological status (n = 105, anxiety ≤ 7 and depression ≤ 7), Group II with psychological distress (n = 51, anxiety ≥ 8 or depression ≥ 8). Same rehabilitation protocols were applied to all patients: 4 ˜ 6 weeks of brace according to tear size, and then ROM exercises. Clinical outcomes were measured with pain VAS and ROM at 3, 6 months and 1 year after surgery.

Results:

There were no significant differences in age, cuff tear size, preoperative external and internal rotation angle between two groups, but more female patients, higher preoperative pain VAS, and lower range of preoperative forward flexion in Group II (all p < 0.05). At 3 months after surgery, the average of pain VAS was 2.2 ± 1.3 in Group I, which was statistically lower than 3.5 ± 2.0 in Group II. The average forward flexion was 145.4° ± 23.4° in Group I, and 122.5° ± 30.3° in Group II. The average external rotation was 42.3° ± 16.1° in Group I, and 34.7° ± 17.6° in Group II. The mean level of internal rotation at back was T11.6 ± 2.8 in Group I, and L1.9 ± 2.4 in Group II (all p < 0.05). At 6 months after surgery, there was no significant difference in forward flexion (148.9° ± 23.2° in Group I compared with 144.9° ± 25.2° in Group II) and external rotation (59.5° ± 13.4° in Group I compared with 54.5° ± 17.5° in Group II). The mean level of internal rotation at back was T9.4 ± 1.8 in Group I, and T10.0 ± 1.5 in Group II (p < 0.05). The average of pain VAS was 0.8 ± 1.6 in Group I, which was statistically lower than 1.6 ± 2.0 in Group II (p < 0.05). However, there was no significant difference in ROM and pain VAS at 1 year after surgery.

Conclusion:

The recovery of pain and ROM was faster in patients with normal psychological status after arthroscopic rotator cuff repair. Therefore, psychologic intervention including medication should be collaborated to improve early clinical outcomes after rotator cuff repair through the encouragement of rehabilitation, as well as mitigation of anxiety and depression moods. [Figure: see text]
Variations in Glenohumeral Bony Morphology May Predict Recurrent Instability after Arthroscopic Bankart Repair
Authors: Sheean Andrew , Gasbarro Gregory , Como Christopher , Kohut Kevin , Wilmot Andrew , Borrero Camilo , Vyas Dharmesh , Lin Albert , Vaswani Ravi
Published: July 2020

Objectives:

Variations in bony anatomy may be associated with failure of stabilization surgery. The aim of this study was to develop a method to measure bony morphology on magnetic resonance imaging (MRI) to identify risk factors for failure after Bankart repair.

Methods:

This was a retrospective case-control study of 118 patients. Cases of postoperative dislocation were compared to matched controls. Demographic data was obtained by chart review and radiographic data from preoperative MRI. Volume was measured using a 3-D model. Radius of curvature of the humeral head and glenoid was measured on axial MRI images. Statistical analysis used student’s t-test for continuous variables and either Fisher’s exact or Chi-squared test for categorical variables; P value < 0.05 was significant. Interrater reliability between reviewers was calculated using interclass correlation coefficients (r).

Results:

Forty-six patients who had a postoperative dislocation met inclusion criteria and were matched to 72 controls. There was no difference between groups for demographic (age, sex, percentage of contact athletes) or radiographic (glenoid bone loss, off-track Hill-Sachs lesions) parameters. The average number of preoperative dislocations was higher in the case group (3.2 vs. 2.0, p=0.003). The humeral head (68.8 ml vs 62.8 ml, p=0.05) volume was greater in the case group, though this did not reach statistical significance. Glenoid volume (13.5 ml vs 12.8 ml, p=0.31) was similar between groups. The radius of curvature of the glenoid was larger, or shallower, in the case group compared to the control group (23.6 mm vs 22.6 mm, p=0.05), though the difference did not reach statistical significance. A greater percentage of patients with a glenoid radius of curvature > 24.5 mm experienced a postoperative dislocation compared to those who had a smaller radius of curvature (62.0% vs 29.8%, p < 0.01). In fact, patients who had glenoid radius of curvature > 24.5 mm were 5 times as likely to experience a postoperative dislocation compared to those who did not (odds ratio 5.04, 95% CI 2.13 – 11.94, p < 0.01) There was no significant difference between the number of preoperative dislocations between patients with larger or smaller glenoid radius of curvature (2.6 vs 2.3, p = 0.55). There was a strong interrater reliability for measurement of humeral head volume, glenoid volume, radius of curvature of glenoid and radius of curvature of humeral head (r = 0.94, 0.88, 0.89, 0.95).

Conclusion:

The results of this study demonstrate that a larger radius of curvature, indicative of a shallower glenoid, is associated with failure following primary arthroscopic Bankart. These findings suggest that the bony concavity of the glenoid may play a role in stability. [Figure: see text]
Arm abduction angle at ball release influences shoulder forces and torques during the windmill softball pitch
Authors: Scarborough Donna , Fallon Ryan , Berkson Eric , Linderman Luke Oh, Shannon
Published: July 2020

Objectives:

Shoulder pain and ligamentous injury is a common complaint among fast pitch softball pitchers. In addition to extreme shoulder joint motion during pitch delivery, sudden deceleration immediately after ball release places increased stress across the shoulder joint. Some pitchers release the ball with the throwing arm tucked close to the trunk, while others let the arm float outwards in a more abducted position. The position of the arm at ball release (BR) may be key to the mechanism of shoulder pain. Previous work demonstrated that during the change up pitch, softball pitchers with upper extremity pain demonstrated greater shoulder abduction at stride and less trunk lateral flexion at BR compared to athletes without pain (Oliver et al 2018). The purpose of this study was to test the hypothesis that placement of the arm closer to the trunk (shoulder adduction) at ball release will produce less shoulder stress during fastball windmill pitches.

Methods:

Twenty-six female fast pitch softball pitchers with a mean age of 18 +/- 6 y, including 16 high school, 7 collegiate, and 3 professional athletes, underwent 3D biomechanical pitch analyses using 20 Vicon high-speed motion capture cameras (240 hz). All pitchers threw the standard 13.11 m mound-to-plate distance at a strike zone target while a radar gun collected pitch speeds. The fastest, most accurate fastball pitches for each subject were selected for analyses (average of 5 pitches per subject). A total of 103 pitches were used to calculate: shoulder abduction angle and shoulder compression force during the BR phase (10 frames surrounding BR) and peak shoulder torques. Pearson correlations were performed to determine the relationship of shoulder frontal plane (adduction/abduction) angle during the ball release phase to these biomechanical measures.

Results:

The smallest abduction shoulder angle reached during the BR phase (avg: 14.06 +/- 6.71 degrees) demonstrated a significant positive correlation with shoulder compression force, p=0.008 and with peak flexion torque, p< 0.001 (Table 1). This shoulder abduction angle during the BR phase demonstrated negative correlations with peak shoulder adduction torque, p<0.001 and shoulder internal rotation torque, p< 0.001.

Conclusion:

These initial findings support the hypothesis that pitchers who release the ball with their arm close to their trunk demonstrate lower shoulder compression forces and shoulder flexion torques than those with a more abducted arm position. Future studies are needed to explore the interplay of pitching technique mechanics, shoulder joint stresses, and injury history to inform pitching instruction and injury prevention efforts. [Table: see text]
Treatment of Pectoralis Major Tendon Tears: A Systematic Review and Meta-Analysis of Operative and Nonoperative Treatment
Authors: Bodendorfer Blake , McCormick Brian , Wang David , Conroy Christine , Fryar Caroline , Kotler Joshua , Ferris William , Postma William , Chang Edward , Looney Austin
Published: July 2020

Objectives:

The incidence of pectoralis major tendon tears is rising, and repair is generally considered, but there is a paucity of comparative data to demonstrate the superiority of operative treatment. We sought to compare the outcomes of operative and nonoperative treatment of pectoralis major tendon tears. We hypothesized that repair would result in superior outcomes compared to nonoperative treatment.

Methods:

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of the literature was completed using MEDLINE, SPORTDiscus, CINAHL, Cochrane, Embase and Web of Science databases. English-language studies were included with a minimum of 6 months average follow-up and 5 cases per study. Methodological Index for Nonrandomized Studies was utilized to assess the quality of the existing literature. Meta-analysis of pooled mechanisms of injury and outcomes was completed. Pooled effect-sizes were calculated from random effects models. Continuous variables were assessed using mixed model analysis with the individual study designated as a random effect and the desired treatment for comparison as a fixed effect. Bivariate frequency data was transformed using the Freeman-Tukey log-linear transformation for variance stabilization and then assessed using a mixed model with a study-level random effect and subsequently back-transformed. Significance was set at P<.05.

Results:

Twenty-three articles with 664 injuries met the inclusion criteria for comparison (Figure 1). All patients were male with 63.2% of injuries occurring during weight training, with an average age of 31.48 years and follow-up of 37.02 months. Included studies had moderately high methodological quality. Operative treatment was significantly superior to nonoperative treatment with a relative improvement of functional outcome by 0.70 (P=.027), full isometric strength by 77.07% (P<.001), isokinetic strength by 28.86% (P<.001) compared to the uninjured arm, cosmesis satisfaction by 13.79% (P=.037), and resting deformity by 98.85% (P<.001) (Table 1). There was an overall complication rate of 14.21%, including a 3.08% rate of rerupture, for operative treatment.

Conclusion:

Pectoralis major tendon repair resulted in significantly superior outcomes as compared to nonoperative treatment with an associated 14.21% complication rate. There was a statistically significant improvement in functional outcome, isokinetic strength, isometric strength, cosmesis, and resting deformity. [Figure: see text][Table: see text]
Preoperative opioid education has no effect on opioid use in patients undergoing arthroscopic rotator cuff repair: a prospective, randomized clinical trial
Authors: Klein David , Campbell Kirk , Jazrawi Laith , Bloom David , Baron Samuel
Published: July 2020

Objectives:

Opioid analgesics are frequently utilized among orthopaedic surgeons to mitigate postoperative pain. These drugs are well-known for their addictive potential and recent literature has suggested that preoperative patient-focused education on narcotic consumption may decrease post-operative opioid use. The purpose of this study was to determine whether preoperative opioid education reduces consumption following arthroscopic rotator cuff (ARTC) repair in the context of our current environment of limiting post-operative narcotic consumption.

Methods:

This is a single center randomized controlled trial. Opioid-naïve patients undergoing ARTC repair were randomized into one of two groups. Preoperatively, the control group received our institution’s standard of care for pain management education while the experimental group was shown a brief educational video on the proper use and dangers of opioids. All patients were discharged with 30 tabs of oxycodone-acetaminophen (5mg/325mg) prescribed as 1-2 tablets every 4-6 hours as needed for pain. They were contacted daily and asked to report opioid use, VAS pain, and satisfaction with overall pain management. A chart review was conducted at 3 months post-op to see if patients had been given narcotic refills after the initial postoperative period.

Results:

Our institution enrolled 106 patients, 87 of whom completed the study (41 control, 46 experimental). There were no statistically significant differences (p>0.05) with respect to patient demographics between groups (age at time of surgery, gender, ASA, or BMI). Additionally, there was no statistically significant difference with respect to Visual Analogue Scale (VAS) pain between groups preoperatively (p=0.85) or at 1-week follow up (p=0.29). Additionally, patients in each group were equally satisfied with their post-operative pain medication management (p=0.71). Patients in the education group did not utilize a statistically significant different number of narcotics than the control group throughout the first post-operative week (14.74 pills experimental vs. 13.71 pills control, p=0.68). At 3-month follow up, patients in the experimental group (n=9) were equally likely to have utilized at least one narcotic prescription refill as the control group (n=5) (odds ratio 1.65, p=0.56).

Conclusion:

The findings of this study suggest that preoperative video-based opioid education may have no effect on reducing the number of narcotic pills consumed following ARTC repair. As such, this form of intervention may not be of use with respect to mitigating the current opioid crisis.
Epidemiology of Acromioclavicular Joint Injuries in Professional Baseball
Authors: Ramkumar Prem , Frangiamore Salvatore , Jones Grant , Soloff Lonnie , Pollack Keshia , Curriero Frank , Schickendantz Mark , Frantz Travis
Published: July 2020

Objectives:

Shoulder injuries account for a large portion of all recorded injures in professional baseball. Much is known about other shoulder pathologies in the overhead athlete, but the incidence and impact of acromioclavicular (AC) joint injuries in this population is unknown. The purpose of this study was to examine the incidence, rates, and characteristics of AC joint injuries in professional baseball, and determine the impact on time missed.

Methods:

The Major League Baseball Health and Injury Tracking System (HITS) was used to compile records of all major and minor league player from 2011-2017 with documented AC joint injuries. These injuries were classified as acute (sprain or separation) or chronic (AC joint arthritis or distal clavicular osteolysis), and associated data included laterality, date of injury, player position, activity, mechanism of injury, length of return to play (RTP), and need for surgical intervention.

Results:

A total of 312 AC joint injuries (183 MiLB, 129 MLB; range 39-60 per year) were recorded (acute n=201, 64.4%; chronic n=111, 35.6%). A total of 81% of acute injuries resulted in time missed with an average RTP of 22.8 days whereas 59% of chronic injuries resulted in days missed with an average RTP of 32.2 days (p<0.001). Acute injuries occurred most commonly in outfielders (42.7%), followed by infielders (27.3%). Chronic injuries were seen in higher proportions among pitchers and catchers (45.5-56.4% chronic injuries). Acute AC injuries occurred most often while playing defense (n=100; 49.8%) in the infield or outfield (n=138; 68.7%), with 63.2% the result of a contact injury. Chronic AC joint injuries were most commonly with throwing or pitching (n=48; 43.2%) and non-contact injuries (n=79; 71.2%).

Conclusion:

Acute AC joint injuries are contact injuries occurring most commonly among infielders and outfielders that result in more than 3 weeks missed before return to play whereas chronic AC joint injuries occur more commonly in pitchers and catchers from repetitive overhead activity. Knowledge of these data can better guide expectation management in this elite population to better elucidate the prevalence of two common injury patterns in the acromioclavicular joint.
Ultrasound-guided Percutaneous Tenotomy Shows Sustained Clinical and Sonographic Outcomes for Recalcitrant Lateral Elbow Tendinopathy at 7.5 Years
Authors: Koh Joyce , Png Meng Ai , Howe Tet Sen , Lee Brian , Morrey Bernard , Mohan Benjamin Ang FRCS Chandra
Published: July 2020

Objectives:

In our previously published study, 20 patients who underwent ultrasound-guided percutaneous tenotomy for recalcitrant lateral elbow tendinopathy were followed up clinically and sonographically for 3 years, demonstrating sustained pain relief and functional improvement, with sonographic evidence of tissue healing. We aim to explore the long-term clinical and sonographic results of ultrasound-guided percutaneous tenotomy.

Methods:

The same cohort of patients were recalled at 7-8 years and assessed for visual analog scale (VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) scores, need for secondary intervention, and overall satisfaction. They were also reassessed with ultrasound imaging to evaluate tendon hypervascularity, tendon thickness, and the progress or recurrence of the hypoechoic scar tissue.

Results:

We successfully scored 19 subjects and performed ultrasound on 16 subjects, with a follow up of 90 (median±standard deviation: 90±2.7; range: 86-94) months. Among them, one patient had subsequently undergone surgical fixation for an ipsilateral radial head fracture 6 years after ultrasound-guided percutaneous tenotomy, and was thus excluded from the study. There were no adverse outcomes and satisfaction remained at 100% (6 satisfied, 12 very satisfied). No patient developed a recurrence of lateral elbow tendinopathy, and therefore no secondary intervention was required. The improvement from baseline and early term scores was sustained as seen in figure 1. There was no significant change in VAS score (median±SD: 0±1.0; range: 0-4) at 7.5 years, compared to 3 years (0±0.9; 0-3) (p=1.000) or DASH-Compulsory score (0±4.51; 0-13.3) at 7.5 years compared to 3 years (0±0.644; 0-2) (p=0.627) or DASH-Work score (0±6.61; 0-25) at 7.5 years compared to 3 years (0±0; 0)(p=1.000), although there were isolated cases of increased DASH scores due to rotator cuff issues, as described by the patients, which were consistent with degeneration. DASH-Sports/performing arts had too few responses for analysis. At current, hypervascularity remained resolved in 13/16 (81%) subjects, 16/16 (100%) subjects had reduced tendon swelling, and 15/16 (94%) had sustained resolution or reduction of the hypoechoic lesion (Figure 2).

Conclusion:

At long term follow up, ultrasound-guided percutaneous tenotomy, previously shown to enhance recovery of lateral elbow tendinopathy, demonstrates good sustainability of pain relief and functional recovery that was previously achieved, accompanied with sonographic evidence of tissue healing at 7.5 years. [Figure: see text][Figure: see text]
Comparison of Contact Pressures Between Partial and Complete Femoral Osteoplasty Treatment in Hips with CAM Impingement
Authors: Suppauksorn Sunikom , Beck Edward , Cancienne Jourdan , Shewman Elizabeth , Chahla Jorge , Krivicich Laura , Nho Shane , Rasio Jonathan
Published: July 2020

Objectives:

To determine hip biomechanical properties in three conditions including 1) native cam deformity 2) cam deformity with incomplete resection and 3) cam deformity with complete resection.

Methods:

A cadaveric study was performed using 8 frozen hemi-pelvises with cam-type deformity (alpha angle >55 degrees) with an intact labrum. Intraarticular pressure maps were produced for each specimen under the following conditions: 1) native cam deformity, 2) cam deformity with incomplete resection and 3) cam deformity with complete resection. A 5.5-mm burr was used to resect the lateral portion of the cam deformity. The specimen was placed in a custom-designed jig in the MTS electromechanical test system to create pressure and area map measurements. In each condition, contact pressure, contact area, and peak force within a region-of-interest (ROI) were obtained. Repeated measurements were performed three times in each condition and the average value of each parameter was used for statistical analysis. Repeated measures ANOVA was used to compare biomechanical parameters between three conditions.

Results:

Contact pressures averages of hips with complete resection of cam lesions were significantly lower when compared to averages of hips with incomplete femoral cam lesion and intact cam deformity (2.48+0.56 kg/cm3 vs 2.32+0.50 kg/cm3 vs 2.02+0.54 kg/cm3, respectively; p-value<0.01). Percentage reduction of contact pressure in the complete and incomplete resection groups compared to the native CAM deformity groups were 18.49% and 1.58%, respectively. There was no statistically significant difference in contact pressures between the incomplete resection and unoperated group. Contact area and peak force showed no statistically significant differences across three conditions.

Conclusion:

There are lower intraarticular hip contract pressures in complete resection of the cam lesions when compared to an incomplete resection and intact hip without resection. These observations underscore the importance of ensuring complete resection of femoral cam lesions in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. [Table: see text]
Proximal Over-Resection During Femoral Osteochondroplasty Negatively Affects the Distractive Stability of the Hip Joint
Authors: Lim Daniel , Nelson Trevor , Eberlein Samuel , Banffy Michael , Metzger Melodie , Lazaro Lionel
Published: July 2020

Objectives:

Hip microinstability is an increasingly recognized source of hip pain and disability. Femoral osteochondroplasty is usually performed with direct visualization through the arthroscope, assisted with repeated fluoroscopic view for orientation and feedback. However, a two-dimensional representation of a three dimensional structure can be misleading compromising the precision of the planned osteochondroplasty. Sometimes the resection can extend proximally into the Femoral Head (FH) diminishing the surface area of the articular cartilage available to be in contact with the labrum, in order to create the suction effect (suction seal) that maintains the stability of the femoral head in the acetabulum. The purpose of the study is to evaluate the role of proximal over-resection of femoral osteochondroplasty in the rotational and distractive stability of the hip joint. We hypothesis that proximal over resection will result in decrease stability, specially at higher degrees of flexion and internal rotation where the contact between labrum and articular cartilage will be lost, and breaking the suction seal.

Methods:

Six hemi-pelvises were repeatedly tested in the following five conditions: (a) intact, (b) T-capsulotomy, (c) Osteochondroplasty to the level of the physeal scar, followed by a (d) 5mm and (e) 10mm proximal extension of the resection. The pelvis was secured to a metal plate and the distal portion of the femur was potted and attached to a multi-axial hip jig. (Fig.1) Specimens were axially distracted with a load from 0-150N followed by 5Nm of internal and external torque at 0 o, 15 o, 30 o, 60 o, 90o of flexion while the resultant displacement/rotation was recorded using a 3D motion tracking system. Repeated measures ANOVA was used with statistical significance set at p<0.05.

Results:

Proximal extension of the resection by 5mm and 10mm increased axial instability (decreased force required for hip distraction) at every angle of flexion tested, with the greatest increase observed at higher angles of flexion (60 deg and 90 deg), p<0.05. T-capsulotomy alone increased both internal and external rotation at all angles of flexion, p<0.05. (Fig. 2) Subsequent resection and extension of the resection did not significantly increase rotational instability compared to the capsulotomy state.

Conclusion:

Extending the osteochondroplasty proximally into the femoral head compromised the distractive stability of the hip joint. It is important to be precise when performing femoral osteochondroplasty to minimize proximal extension that can lead to iatrogenic instability of the hip joint and poor postoperative outcomes. [Figure: see text][Figure: see text]
Borderline Dysplasia with Acetabular Retroversion: Key Findings from a Large Hip Arthroscopy Study Group
Authors: Kivlan Benjamin , Nho Shane , Wolff Andrew , Salvo John , Christoforetti John , Ellis Thomas , Carreira Dominic , Matsuda Dean
Published: July 2020

Objectives:

The radiographic crossover sign (COS) is an indicator of acetabular retroversion, classically representing anterosuperior overcoverage often treated with acetabuloplasty which could exacerbate acetabular hypovolemia in dysplasia. No prior study has investigated the prevalence of acetabular retroversion in patients with dysplasia undergoing hip arthroscopy, acetabuloplasty rates, and outcomes in this setting. Study objectives are to report the prevalence of acetabular retroversion in dysplasia, the influence of the COS on arthroscopic acetabuloplasty rates, and relative outcomes compared with control groups.

Methods:

A retrospective cohort study was performed from a prospectively collected multi-center database. Patients undergoing isolated hip arthroscopic surgery were assigned to dysplasia (lateral center-edge angle (LCEA) ≤ 25°) or one of two control groups: normal(LCEA 26-38°), or pincer femoroacetabular impingement (FAI)(LCEA ≥ 39°). The prevalence of COS and acetabuloplasty rates between and within study and control groups were compared (Chi square analysis). Minimum 2 year outcomes utilizing iHOT-12 were compared (analysis of variance).

Results:

Of 401 study patients, 64 (16%) comprised the dysplasia group, 273 (68%) normal group, and 64 (16%) pincer group. Mean LCEAs were 22.3°, 31.5°, and 42.4°, respectively (p<0.001). COS prevalence was similar between groups at 31%, 26%, and 33%, respectively (p=0.873). Acetabuloplasty rates were dependent on the amount of acetabular coverage with lowered rate in the dysplasia group(40%) and increasing rates in the normal(52%) and the pincer(90%) groups (p=0.013). Post-operative iHOT-12 scores improved in all groups (68, 74, and 77, respectively, p=0.222). Patients with a COS plus rendered acetabuloplasty reported similar scores that improved to 77, 74, and 79, respectively,(p=0.949). Patients with dysplasia with COS averaged 73.1(SD 23.3) iHOT-12 score compared to 67.1(SD: 28.7) for the patients with dysplasia without COS (p=0.466). Within the dysplasia with COS subgroup, there was no significant difference in iHOT-12 scores between the group with acetabuloplasty (77.0;SD:17.1) and without acetabuloplasty (70.4;SD:27.4,p=0.580).

Conclusion:

Acetabular retroversion occurs with similar prevalence in borderline dysplasia compared with non-dysplastic hips undergoing hip arthroscopy but with lower acetabuloplasty rates not influenced by the COS. Arthroscopic outcomes of dysplasia with retroversion are similarly successful and comparable with those of dysplasia and non-dysplastic hips. Although infrequently performed, acetabuloplasty did not compromise outcomes in dysplasia with retroversion.
Prolonged Postoperative Opioid Use after Arthroscopic Femoroacetabular Impingement Syndrome Surgery: Predictors and Outcomes at Minimum Two Year Follow-up
Authors: Beck Edward , Nwachukwu Benedict , Drager Justin , Jan Kyleen , Nho Shane , Rasio Jonathan
Published: July 2020

Objectives:

To identify preoperative predictors for patients requiring at least one postoperative opioid refill after undergoing hip arthroscopy for femoroacetabular impingement and 2) to determine 2-year reported outcomes in those requiring opioid refills.

Methods:

Data from consecutive patients undergoing hip arthroscopy for FAIS from January 2012 to December 2016 was analyzed. Baseline demographics were recorded, including preoperative opioid use, as well as pre- and 2-year postoperative functional scores specifically the Hip Outcome Score-Activity of Daily Living (HOS-ADL), HOS-Sports Subscale (HOS-SS), modified hip Harris score (mHHS), international hip outcome tool (iHOT-12), and visual analog score (VAS) for pain and satisfaction were recorded. A correlation analysis was used to identify preoperative demographic and clinical variables associated with requiring postoperative opioid refill. Variables with a statistically significant association (p<0.05) were included in a final logistic regression model.

Results:

A total of 775 patients with postoperative opioid use and 2-year follow-up were included in the analysis. 141 (18.2%) patients required at least one preoperative opioid prescription refill in addition to the routine opioid total prescription postoperatively to every patient after hip arthroscopy. Patients requiring opioid refills had significantly lower HOS-ADL (79.9+20.3 vs 88.7+14.9), HOS-SS (64.6+29.5 vs 78.2+23.7), mHHS (74.2+21.1 vs 83.6+15.9), iHOT-12(63.6+27.9 vs 74.9+24.8), and VAS satisfaction (73.4+30.3 vs 82.2+24.9) averages, as well as higher pain (26.8+23.4 vs 17.9+21.8) when compared to patients without additional opioid refills with p<0.001 for all outcomes. Logistic regression analysis demonstrated that preoperative predictors of requiring additional postoperative opioids included patients with a history of opioid use prior to surgery (OR: 4.04; 95%CI: 1.99-8.19) and larger preoperative alpha angles (OR:1.04; 95%CI: 1.01-1.07). Sub-analysis by past versus current opioid use at the time of surgery demonstrated that current use was a predictive of requiring additional postoperative opioids (OR:3.12; 95%CI: 1.06-9.21; p=0.039), while past opioid use for was not.

Conclusion:

Patients requiring at least one postoperative opioid refill after undergoing hip arthroscopy for FAIS have lower 2-year functional scores when compared to patients not requiring refills. Additionally, active pre-operative opioid use at the time of surgery, as well as larger preoperative alpha angles are predictors of requiring additional opioids for pain management.
Is there a gender gap in outcomes after hip arthroscopy for femoroacetabular impingement? Assessment of clinically meaningful improvements in a prospective cohort
Authors: Flores Sergio , Chambers Caitlin , Borak Kristina , Zhang Alan
Published: July 2020

Objectives:

Although patients have been found to have significant improvements after hip arthroscopy for femoroacetabular impingement (FAI), prior studies suggest women have worse outcomes compared to men. These previous studies lack comparisons of patient reported outcome (PRO) scores based on gender with respect to clinical significance measurements, including the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS). Therefore, the purpose of this study is to evaluate outcomes following hip arthroscopy for FAI based on patient gender by prospectively assessing changes in PRO scores, MCID, and PASS.

Methods:

Women and men undergoing hip arthroscopy for FAI were prospectively enrolled and preoperative radiographic and intra-operative findings were collected. The cohort was stratified based on self-identified patient gender so the term gender as well as the terms women and men were used to describe the patients as opposed to sex and the terms female and male. Patients completed the following PRO surveys before surgery and 2-years postoperatively: modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), and the 12-Item Short Form Health survey (SF-12). Mean scores and the percentage of patients reaching MCID and PASS were analyzed. An a priori power calculation was performed which determined 42 hips in each group were needed to adequately power the study to 95%.

Results:

A total of 131 hips, from 72 women and 59 men were included. The mean ± SD age for women and men was 34.2 ± 9.5 vs 35.8 ± 10.3 years, respectively; P= .347 and body mass index (BMI) of 24.9 ± 4.4 vs 25.5 ± 3.3 kg/m2, respectively; P= .379. Women had smaller preoperative alpha angles (59.1 vs 63.7, respectively; P< 0.001) and lower acetabular cartilage injury grade (6.9% vs 22.0% with grade 4 injury, respectively; P= 0.013). Both women and men achieved equivalent significant improvements in PRO scores after surgery (PRO scores increased 18.4 to 45.1 points for mHHS and HOOS). Women and men reached PASS for mHHS at similar rates (76.4% and 77.2%, respectively; P=0.915). MCID was also achieved at similar rates between women and men for all scores (ranged 61.4% to 88.9%) except HOOS-ADL in which a higher percentage of women reached MCID compared to men (79.2% vs 62.7%, respectively; P= .037). Additional stratification by age group using the median cohort age of 34 showed no significant differences in PRO improvement based on age group for each gender.

Conclusions:

Women can achieve clinically meaningful improvements in patient reported outcomes scores after hip arthroscopy for FAI. Compared to men, women demonstrated equivalent high rates of achieving MCID and PASS at 2 years following surgery. [Table: see text]
Effect of Sex and Age on Achieving Meaningful Clinical Outcomes at 5-years after Hip Arthroscopy for Femoroacetabular Impingement: A Comparative Match-Group Analysis
Authors: Beck Edward , Drager Justin , Nwachukwu Benedict , Jan Kyleen , Nho Shane , Rasio Jonathan
Published: July 2020

Objectives:

Non-modifiable factors including age and sex have been shown to effect outcomes following hip arthroscopy in patients with femoroacetabular impingement syndrome (FAIS) at short-term follow-up. However, their effect on achieving long-term meaningful outcomes has not been evaluated. As such, the purpose of this study is to compare clinical outcomes, including achieving meaningful clinical important difference (MCID) and the patient acceptable symptomatic state (PASS) at 5-years, by age and sex.

Methods:

150 patients undergoing hip arthroscopy for femoroacetabular impingement by a single fellowship trained surgeon were prospectively analyzed, with 25 patients in each of the following groups: female patients younger than 30 years of age, female patients 30 to 45 years of age, female patients older than 45 years of age, male patients younger than 30 years of age, male patients 30 to 45 years of age, and male patients older than 45 years of age. Pre and postoperative functional scores were collected including the Hip Outcome Score Activities of Daily Living Subscale (HOS-ADL), Hip Outcome Score Sport-Specific Subscale (HOS-Sport), the modified Harris hip score (mHHS), and visual analog scale (VAS) satisfaction and pain at 5-year follow-up. MCID and PASS was calculated for each functional measure and compared by gender and age category.

Results:

At 5-year follow-up, all groups demonstrated statistically significant improvement in the functional outcome score averages and pain (p<0.001 for all). Both within gender and within age category analysis of postoperative functional scores did not demonstrate any statistically significant differences (p>0.05).Analysis of achieving MCID and PASS demonstrated that females had a higher rate of reaching the HOS-SS and mHHS threshold for achieving MCID as compared to their male counterparts (48.3% vs 58%%; p=0.008 and 54% vs 75.4%; p=0.012, respectively). Furthermore, patients <30 years old had higher rates of reaching the HOS-ADL and mHHS for achieving PASS than the two older age groups (p>0.05 for both).

Conclusions:

Non-modifiable factors, including age and sex, influence the rate of achieving meaningful clinical outcomes at 5-year follow up. Female patients are more likely to reach the HOS-SS and mHHS threshold for achieving MCID, while those <30 years of age are more likely to reach the HOS-ADL and mHHS threshold for achieving PASS as compared to older patients.
Clinical Outcomes after Arthroscopic Repair of Gluteus Medius with a Two-year Minimum Follow-up
Authors: Bloom David , Kirby David , Youm Thomas , Fried Jordan
Published: July 2020

Objectives:

Hip arthroscopy has replaced the need for many open surgeries including repairs of gluteus medius tendon tear. There are only a few studies that have analyzed patient reported outcomes at 2 years for arthroscopic gluteus medius tendon repair. The purpose of the current study is to evaluate clinical outcomes in patients who underwent arthroscopic gluteus medius repair with at least 2 year follow-up.

Methods:

This was a single-center, retrospective IRB approved study. Between August 2010 and August 2016, patients who underwent hip arthroscopy with gluteus medius repair by a single surgeon were evaluated at baseline and two year follow-up via Modified Harris Hip Score (MHHS) and Non-arthritic Hip Score (NAHS). Inclusion criteria included all patients who received arthroscopic repair of the full or partial thickness tears of the gluteus medius tendon and had a minimum follow up of at least two years. Paired t-test was used for statistical comparison between baseline and follow-up for each respective outcome score and group.

Results:

20 hips were evaluated, met the inclusion criteria and separated based on partial (group one) or full thickness tear (group two). The study population comprised of 15 (79%) females and 4 (21%) males. Group one presented with a mean age of 54.8 ± 11.3 years and an average BMI of 25.1 ± 4.0. Group two presented with a mean age of 46 ± 11.4 and an average BMI of 25.5 ± 4.0. Patients in group one reported an average preoperative MHHS and NAHS of 33.6 ± 11.3 and 40.4 ± 14.9, respectively. At 2 year follow-up, an average MHHS and NAHS of 72.9 ± 22.9 and 77.2 ± 19.7 was reported, respectively. Patients in group two reported an average preoperative MHHS and NAHS of 43.8 ± 14.7 and 46.4 ± 8.3, respectively. At 2 year follow-up, an average MHHS and NAHS of 80.1 ± 8.5 and 79.5 ± 10.1, respectively. There was significant clinical improvement at the 2 year follow-up, relating to both outcome measures in each subject group (p<0.0004).

Conclusions:

After a minimum of two years for follow-up, arthroscopic repair of gluteus medius tears proves to be an effective approach and treatment. In the future, studies looking at longer follow-up time would help determine if the current approach maintains long-term clinical improvement.
Alpha-2-Macroglobulin Not Significantly Better Than Regular PRP For Knee Arthritis Symptoms
Authors: Klein David , Bloom David , Campbell Kirk , Gonzalez-Lomas Guillem , Alaia Michael , Strauss Eric , Jazrawi Laith , Thompson Kamali
Published: July 2020

Objectives:

Osteoarthritis, a degenerative and debilitating joint disease, is one of the most prevalent diseases in the United States. Despite the significant burden osteoarthritis can place on an individual and society, nonoperative treatment options are still very limited. Little clinical data exists on the use of injectable macromolecules for the treatment of osteoarthritis of the knee. Alpha-2-macroglobulin (A2M), a naturally occurring macromolecule, inhibits the many endogenous and exogenous proteinases presenting in the pathogenesis of osteoarthritis. To date, no studies exist evaluating the effectiveness of A2M with other intra-articular injectables. The purpose of this study is to compare the clinical effectiveness of intra-articular injection of A2M against both platelet-rich plasma (PRP) and corticosteroids.

Methods:

This prospective randomized control trial was conducted at a single medical center. Seventy-five patients with symptomatic knee osteoarthritis with Kellgren-Lawrence grade 2 or 3 were randomized into one of three cohorts receiving intra-articular injection. One group was given PRP, one group was given A2M, and one group was given corticosteroids. All groups had blood drawn to simulate A2M preparation. Patient reported outcomes were collected prior to injection, 6 weeks and 12 weeks following injection. Several measures were used for clinical assessment including the visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm, and Tegner scores.

Results:

Seventy-five patients with a mean age of 61.08 (± 8.48) were enrolled between June 2018 and February 2019. At six weeks, the A2M group had the greatest decrease in VAS (-1.60) and WOMAC (-10.9), however, the differences were not statistically significant. Between the injection and the twelve week visit, the A2M group had a statistically significant difference in WOMAC score compared with PRP (-18.43 vs -5.70, p <0.02). Overall, both corticosteroid (-1.57) and A2M (-1.70) had a similar improvement in VAS when compared with PRP (-0.61). These differences were also not statistically significant.

Conclusions:

Our study demonstrates Alpha 2 Macroglobulin shows similar effectiveness to corticosteroids in the treatment of knee osteoarthritis. Both A2M and corticosteroids appear to show marginally better effectiveness than PRP injection, however the differences are small and did not reach statistical significance in most outcome measures.
How should we define clinically significant improvement on Patient-Reported Outcomes Measurement Information System (PROMIS) for patients undergoing Knee Meniscal Surgery?
Authors: Lu Yining , Nwachukwu Benedict , Beletsky Alexander , Patel Bhavik , Yanke Adam , Verma Nikhil , Cole Brian , Bush-Joseph Charles , Bach Bernard , Forsythe Kelechi Okoroha Brian
Published: July 2020

Objectives:

The Patient-Reported Outcomes Measurement Information System (PROMIS) attempts to optimize patient reported outcome (PRO) instruments by utilizing item response theory (IRT) and computer adaptive testing (CAT). Relatively little is known about clinically significant outcome (CSO) improvements on the PROMIS Physical Function (PF) CAT. The objective of this study is to define the minimal clinically important difference (MCID), substantial clinical benefit (SCB) and patient-acceptable symptom state (PASS) of the PROMIS PF CAT in arthroscopic meniscal surgery.

Methods:

The PROMIS PF CAT, Short Form-12 Health Survey (SF-12 physical health [PCS] and mental health [MCS]), Veterans Rand-12 Health Survey (VR-12 physical health [PH] and mental health [MH]), and the Marx Activities Ratings Scale were administered pre- and post- operatively to patients undergoing arthroscopic meniscal surgery. Six months postoperatively, patients graded their knee function based on a domain-specific anchor question. Answers to the anchor questions were dichotomized to indicate achievement of SCB and MCID. A satisfaction anchor question was used to indicate achievement of PASS. Receiver operating characteristic (ROC) analysis determined the relevant psychometric values. Cutoff analysis was performed to find preoperative PRO scores predicting CSO achievement.

Results:

Sixty patients (N = 27, 45% female) were included, with mean age of 45.0 ± 14.0 years and average follow up of 24.0 + 1.2 weeks. The most common indication for knee arthroscopy was partial meniscectomy (N = 53; 88.3%) followed by meniscal repair (N = 7; 11.7%). MCID on PROMIS PF was calculated to be 2.08 (AUC: 0.75, 95% CI: 0.57 - 0.94). Net score improvement equivalent to achievement of SCB was found to be 7.41 (AUC: 0.77, 95% CI: 0.55 – 0.99). PASS was found to be 45.47 (AUC: 0.89, 95% CI: 0.79-0.99). Preoperative score below 37.6 on the PROMIS PF CAT predicted achievement of MCID (AUC: 0.76, 95% CI: 0.64-0.88), while scores above 41.7 predicted achievement of PASS (AUC: 0.76, 95% CI: 0.63-0.89). Absence of pre-existing arthritis and higher baseline functional status were also found to be statistically significant predictors of achieving CSOs.

Conclusion:

Our study defined MCID, SCB, and PASS, for the PROMIS PF CAT. We found that a pre-operative score below 37.6 was predictive for achieving a meaningful clinical change with surgery, while a pre-operative score above 41.7 was predictive of achievement of an acceptable post-operative health state. [Table: see text][Table: see text][Table: see text][Figure: see text]
Establishing the Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient Acceptable Symptomatic State following Primary Medial Patellofemoral Ligament Reconstruction
Authors: Huddleston Hailey , Naveen Neal , Southworth Taylor , Nwachukwu Benedict , Cole Brian , Yanke Adam , Walsh Justin
Published: July 2020

Objectives:

Medial patellofemoral ligament (MPFL) reconstruction is an effective surgical procedure for patients with recurrent lateral dislocations. Outcome measurements can identify the success of a surgical procedure but are shifting away from absolute values or deltas of patient-reported outcomes (PROs) towards the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS), representing the smallest clinical improvement that patients perceive as important, the threshold at which patients notice a considerable improvement, and patient satisfaction with their outcome, respectively. To our knowledge no prior study has defined these thresholds in MPFL reconstruction patients.

Methods:

An institutional database was reviewed for patients who underwent primary MPFL reconstruction between August 2015 to February 2018 with a minimum 6-month follow-up. IKDC, Kujala and KOOS were administered to all patients pre-operatively and at 6-months and 1-year post-operatively. An anchor-based approach with a receiver-operator curve/area under the curve analysis using the Youden index was performed to calculate the MCID, SCB and PASS. The predictive power was determined to be acceptable with AUC≥70% and excellent with AUC≥80%.

Results:

From 2015 to 2018, 93 of 162 patients (mean age 23.7±10.1 years; 25 males, 68 females) completed for 6-month follow-up. At 6-months follow-up, SCB and PASS were defined with acceptable predictive power for all scores listed, while MCID achieved this for KOOS pain and sports subscores only (Table 1). At 1-year follow-up, SCB and PASS were each defined with acceptable predictive power for all scores listed, while MCID achieved this mark for KOOS pain and quality of life subscores as well as both Kujala scales.

Conclusion:

This study establishes MCID, SCB and PASS for IKDC, Kujala, and KOOS subscores at 6-months and 1-year postoperatively with excellent predictive power for 19/23 PROMs investigated at 1-year. These findings represent important benchmarks in patients undergoing primary MPFL reconstruction.