Pub Date : 2024-10-01DOI: 10.1016/j.asmr.2024.100957
Purpose
To compare the amount of time used to perform meniscal suturing on a standardized lesion using either a traditional or continuous arthroscopic suturing technique.
Methods
A preclinical study was carried out with 21 medical doctors who underwent training in the 2 modalities of meniscal repair by arthroscopy in an animal model laboratory. Participants performed both types of sutures with a previously standardized lesion. The execution time of the techniques was measured, and an experienced surgeon evaluated the stability of a meniscal tear after the repair. Data were analyzed using a t test for paired samples to calculate the difference between the execution times of the techniques.
Results
The time required to perform the continuous meniscal suture was shorter than that of the traditional suture. After statistical analysis, the time difference between the techniques was significant (mean difference 4:17 ± 5:30 minutes; 95% confidence interval, 1:46–6:46 minutes). Surgeons took less time than residents for the traditional suture (P = .036), but the times were similar for the continuous suture. This suggests that experience level has a greater effect on the time needed for the traditional suture than for the continuous suture.
Conclusions
The continuous suture technique was performed in a shorter time compared with the traditional suture technique in a porcine model.
Clinical Relevance
The results of this preclinical study suggest that the continuous vertical inside-out meniscal suture technique can enhance surgical procedures for longitudinal tears requiring ≥4 stitches, offering a faster and more intuitive learning curve compared with the traditional inside-out suture technique.
{"title":"Continuous Meniscal Repair Technique Allows for Shorter Operative Time and Learning Curve Compared With Traditional Vertical Mattress Technique in Controlled Arthroscopic Training in Porcine Model","authors":"","doi":"10.1016/j.asmr.2024.100957","DOIUrl":"10.1016/j.asmr.2024.100957","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the amount of time used to perform meniscal suturing on a standardized lesion using either a traditional or continuous arthroscopic suturing technique.</div></div><div><h3>Methods</h3><div>A preclinical study was carried out with 21 medical doctors who underwent training in the 2 modalities of meniscal repair by arthroscopy in an animal model laboratory. Participants performed both types of sutures with a previously standardized lesion. The execution time of the techniques was measured, and an experienced surgeon evaluated the stability of a meniscal tear after the repair. Data were analyzed using a <em>t</em> test for paired samples to calculate the difference between the execution times of the techniques.</div></div><div><h3>Results</h3><div>The time required to perform the continuous meniscal suture was shorter than that of the traditional suture. After statistical analysis, the time difference between the techniques was significant (mean difference 4:17 ± 5:30 minutes; 95% confidence interval, 1:46–6:46 minutes). Surgeons took less time than residents for the traditional suture (<em>P</em> = .036), but the times were similar for the continuous suture. This suggests that experience level has a greater effect on the time needed for the traditional suture than for the continuous suture.</div></div><div><h3>Conclusions</h3><div>The continuous suture technique was performed in a shorter time compared with the traditional suture technique in a porcine model.</div></div><div><h3>Clinical Relevance</h3><div>The results of this preclinical study suggest that the continuous vertical inside-out meniscal suture technique can enhance surgical procedures for longitudinal tears requiring ≥4 stitches, offering a faster and more intuitive learning curve compared with the traditional inside-out suture technique.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 5","pages":"Article 100957"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141393303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.asmr.2024.100978
Heather Myers P.T., D.P.T., A.T.C. , Kristina Wulff P.T., D.P.T., A.T.C. , Christopher Antonelli P.T., D.P.T., A.T.C. , Steven Bokshan M.D., M.B.B.S. , Stephanie Hendren M.L.I.S., A.H.I.P. , Brian C. Lau M.D.
Purpose
To report objective measures utilized to assess readiness to return to sport after shoulder instability procedures.
Methods
Our systematic review included studies if they assessed active individuals after a shoulder instability procedure with at least 1 patient-reported outcome or physical performance measure. We excluded studies of atraumatic instability, studies only reporting imaging, or studies of biomechanics. Risk of bias was assessed with the Methodological Items for Non-Randomized Studies tool, and studies were further scored with the Return to Sport Value Assessment.
Results
Thirty-seven articles selected for inclusion scored a median of 18.5 (comparative) and 10.0 (noncomparative) on the Methodological Items for Non-Randomized Studies and a mean of 2.5 on the Return to Sport Value Assessment. Twelve patient-reported outcomes were utilized across 19 studies to assess pain, function, and psychological readiness, with the Western Ontario Shoulder Index and the Shoulder Instability Return to Sport Index reported most frequently. Eighteen studies reported strength, most commonly internal and external rotation, and 18 studies reported range of motion. Physical performance tests, 6 discrete tests and 1 composite score, were less frequently reported (8 studies), with the Closed Kinetic Chain Upper Extremity Stability Test, Y-Balance Test of the Upper Quarter, and Unilateral Seated Shot-Put Test reported in more than 1 study. Deficits in patient-reported outcomes and limb symmetry persisted at the time of return to sport.
Conclusions
Most patients undergoing shoulder stabilization procedures regained fundamental strength and range of motion. However, some studies noted difficulties in achieving sufficient performance metrics for athletic activities 6 months postsurgery. Due to lack of standardized measures, recommendations for specific test components and benchmark data for clinical decision-making are not available.
Level of Evidence
Level IV, systematic review of Level III and IV studies.
{"title":"Objective Measures for Assessing Readiness to Return to Sport After Shoulder Instability Procedures Are Not Standardized: A Systematic Review","authors":"Heather Myers P.T., D.P.T., A.T.C. , Kristina Wulff P.T., D.P.T., A.T.C. , Christopher Antonelli P.T., D.P.T., A.T.C. , Steven Bokshan M.D., M.B.B.S. , Stephanie Hendren M.L.I.S., A.H.I.P. , Brian C. Lau M.D.","doi":"10.1016/j.asmr.2024.100978","DOIUrl":"10.1016/j.asmr.2024.100978","url":null,"abstract":"<div><h3>Purpose</h3><div>To report objective measures utilized to assess readiness to return to sport after shoulder instability procedures.</div></div><div><h3>Methods</h3><div>Our systematic review included studies if they assessed active individuals after a shoulder instability procedure with at least 1 patient-reported outcome or physical performance measure. We excluded studies of atraumatic instability, studies only reporting imaging, or studies of biomechanics. Risk of bias was assessed with the Methodological Items for Non-Randomized Studies tool, and studies were further scored with the Return to Sport Value Assessment.</div></div><div><h3>Results</h3><div>Thirty-seven articles selected for inclusion scored a median of 18.5 (comparative) and 10.0 (noncomparative) on the Methodological Items for Non-Randomized Studies and a mean of 2.5 on the Return to Sport Value Assessment. Twelve patient-reported outcomes were utilized across 19 studies to assess pain, function, and psychological readiness, with the Western Ontario Shoulder Index and the Shoulder Instability Return to Sport Index reported most frequently. Eighteen studies reported strength, most commonly internal and external rotation, and 18 studies reported range of motion. Physical performance tests, 6 discrete tests and 1 composite score, were less frequently reported (8 studies), with the Closed Kinetic Chain Upper Extremity Stability Test, Y-Balance Test of the Upper Quarter, and Unilateral Seated Shot-Put Test reported in more than 1 study. Deficits in patient-reported outcomes and limb symmetry persisted at the time of return to sport.</div></div><div><h3>Conclusions</h3><div>Most patients undergoing shoulder stabilization procedures regained fundamental strength and range of motion. However, some studies noted difficulties in achieving sufficient performance metrics for athletic activities 6 months postsurgery. Due to lack of standardized measures, recommendations for specific test components and benchmark data for clinical decision-making are not available.</div></div><div><h3>Level of Evidence</h3><div>Level IV, systematic review of Level III and IV studies.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 5","pages":"Article 100978"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142529055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.asmr.2024.100955
S. Ali Ghasemi M.D. , Benjamin Murray D.O. , Adam Lencer D.O. , Emily Schueppert D.O. , James Raphael M.D. , Craig Morgan M.D. , Arthur Bartolozzi M.D.
Purpose
To evaluate the clinical outcome scores of an arthroscopic margin convergence technique without the use of suture anchors to repair different types of rotator cuff tears and to determine whether the type or extent of the tear has an effect on clinical outcome scores after this procedure.
Methods
Patients receiving arthroscopic margin convergence repair without suture anchors for rotator cuff tears from 2013 to 2018 were retrospectively analyzed. Arthroscopically determined partial- or full-thickness rotator cuff tears with a minimum follow-up period of 20 months were included. Outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) shoulder score; University of California, Los Angeles (UCLA) shoulder score; and visual analog scale (VAS) score. A 2-tailed distribution paired t test was used to determine statistical significance (P < .05) between preoperative scores and scores at final follow-up. Correlation tests and linear regression analysis were used to determine the correlation between various clinical variables and outcomes. A cohort-specific minimal clinically important difference analysis was performed for each outcome score, calculated as one-half of the standard deviation of the delta score.
Results
A total of 38 patients were included for analysis: 12 with partial-thickness tears and 26 with full-thickness tears. The mean postoperative follow-up period was 33.9 months (range, 22.2-94.5 months), with a minimum follow-up period of 22 months. The mean age of the patients was 62 ± 15.1 years. The minimal clinically important difference values for the ASES, UCLA, and VAS scores were 9.68, 2.92, and 1.13, respectively. There were significant improvements in the ASES (from 29.3 ± 18.3 preoperatively to 93.7 ± 8.3 postoperatively, P = .001), UCLA (from 14.3 ± 6.2 to 32.8 ± 2.6, P = .001), and VAS (from 7.37 ± 1.8 to 0.63 ± 1.02, P = .001) clinical outcome scores. However, patients with either Patte stage 3 retraction (P = .033 for ASES score and P = .020 for UCLA score) or U-shaped tears (P = .047 for ASES score and P = .050 for UCLA score) had significantly lower clinical outcome scores than patients with less severe retraction or differently shaped tears.
Conclusions
The arthroscopic margin convergence technique without the use of suture anchors may be a suitable option in patients with partial- or full-thickness rotator cuff tears.
{"title":"Arthroscopic Margin Convergence Repair Without Suture Anchors Improves Clinical Outcomes for Full- and Partial-Thickness Rotator Cuff Tears","authors":"S. Ali Ghasemi M.D. , Benjamin Murray D.O. , Adam Lencer D.O. , Emily Schueppert D.O. , James Raphael M.D. , Craig Morgan M.D. , Arthur Bartolozzi M.D.","doi":"10.1016/j.asmr.2024.100955","DOIUrl":"10.1016/j.asmr.2024.100955","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the clinical outcome scores of an arthroscopic margin convergence technique without the use of suture anchors to repair different types of rotator cuff tears and to determine whether the type or extent of the tear has an effect on clinical outcome scores after this procedure.</div></div><div><h3>Methods</h3><div>Patients receiving arthroscopic margin convergence repair without suture anchors for rotator cuff tears from 2013 to 2018 were retrospectively analyzed. Arthroscopically determined partial- or full-thickness rotator cuff tears with a minimum follow-up period of 20 months were included. Outcomes were assessed using the American Shoulder and Elbow Surgeons (ASES) shoulder score; University of California, Los Angeles (UCLA) shoulder score; and visual analog scale (VAS) score. A 2-tailed distribution paired <em>t</em> test was used to determine statistical significance (<em>P</em> < .05) between preoperative scores and scores at final follow-up. Correlation tests and linear regression analysis were used to determine the correlation between various clinical variables and outcomes. A cohort-specific minimal clinically important difference analysis was performed for each outcome score, calculated as one-half of the standard deviation of the delta score.</div></div><div><h3>Results</h3><div>A total of 38 patients were included for analysis: 12 with partial-thickness tears and 26 with full-thickness tears. The mean postoperative follow-up period was 33.9 months (range, 22.2-94.5 months), with a minimum follow-up period of 22 months. The mean age of the patients was 62 ± 15.1 years. The minimal clinically important difference values for the ASES, UCLA, and VAS scores were 9.68, 2.92, and 1.13, respectively. There were significant improvements in the ASES (from 29.3 ± 18.3 preoperatively to 93.7 ± 8.3 postoperatively, <em>P</em> = .001), UCLA (from 14.3 ± 6.2 to 32.8 ± 2.6, <em>P</em> = .001), and VAS (from 7.37 ± 1.8 to 0.63 ± 1.02, <em>P</em> = .001) clinical outcome scores. However, patients with either Patte stage 3 retraction (<em>P</em> = .033 for ASES score and <em>P</em> = .020 for UCLA score) or U-shaped tears (<em>P</em> = .047 for ASES score and <em>P</em> = .050 for UCLA score) had significantly lower clinical outcome scores than patients with less severe retraction or differently shaped tears.</div></div><div><h3>Conclusions</h3><div>The arthroscopic margin convergence technique without the use of suture anchors may be a suitable option in patients with partial- or full-thickness rotator cuff tears.</div></div><div><h3>Level of Evidence</h3><div>Level IV, therapeutic case series.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 5","pages":"Article 100955"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142529084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.asmr.2024.100960
Kendal Carter M.D. , Emily Rogers B.S. , Nicholas J. Peterman B.S. , Vincent Wang Ph.D. , John R. Tuttle M.D.
Purpose
To assess the biomechanical performance of 2 simplified loop-and-tack biceps tenodesis techniques, all-suture anchor and all-suture anchor with a button, compared with the interference screw technique in an ovine model.
Methods
Twenty-one biceps tenodesis procedures were executed on the humeri and flexor digitorum profundus tendons of skeletally mature, female sheep. Limbs were evenly randomized into 2 experimental groups (all-suture anchor with or without button) and 1 control group (interference screw). Cyclic loading followed by a load-to-failure test was conducted. The primary outcome metric was end-cycle stiffness, or stiffness measured at the end of cyclic loading, because it modeled the resistance of the construct to the lower-force activities of postoperative physical therapy. Secondary metrics included ultimate failure load (UFL), yield load, creep, and load-to-failure stiffness. End-cycle stiffness difference-of-means testing was conducted with a minimal clinically important difference threshold of –15 N/mm (–1.5 kg/mm). Groups were compared using analysis of variance for all recorded variables.
Results
Both the all-suture anchor techniques, without a button and with a button, were found to be noninferior in end-cycle stiffness to the interference screw technique (–5.2 N/mm [95% confidence interval, –13.6 to 3.3 N/mm] and –3.8 N/mm [95% confidence interval, –12.5 to –4.9 N/mm], respectively) with a minimal clinically important difference of –15 N/mm. The all-suture techniques showed significantly lower UFL, lower yield load, greater creep, and lower load-to-failure stiffness (P < .001, P < .001, P = .002, and P < .001, respectively). Tendon dimensions did not vary significantly across groups.
Conclusions
Under subfailure loading conditions, the all-suture anchor techniques with a button and without a button showed end-cycle stiffness noninferiority to an interference screw technique; however, these techniques were inferior in all secondary outcomes, including significantly lower UFL, lower yield load, greater creep, and lower load-to-failure stiffness.
Clinical Relevance
The all-suture anchor approaches with a button and without a button may retain the natural length-tension dynamics of the long head of the biceps tendon because fixation can occur before the release of the tendon origin. Additionally, they may offer a simpler and more cost-effective alternative to prevailing arthroscopic methods.
{"title":"All-Suture Anchor Techniques for Biceps Tenodesis Are Noninferior in End-Cycle Stiffness to an Interference Screw Technique; However, Secondary Outcomes, Such as Ultimate Failure Load, Yield Load, Creep, and Load-to-Failure Stiffness, Are Inferior in an Ovine Model","authors":"Kendal Carter M.D. , Emily Rogers B.S. , Nicholas J. Peterman B.S. , Vincent Wang Ph.D. , John R. Tuttle M.D.","doi":"10.1016/j.asmr.2024.100960","DOIUrl":"10.1016/j.asmr.2024.100960","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the biomechanical performance of 2 simplified loop-and-tack biceps tenodesis techniques, all-suture anchor and all-suture anchor with a button, compared with the interference screw technique in an ovine model.</div></div><div><h3>Methods</h3><div>Twenty-one biceps tenodesis procedures were executed on the humeri and flexor digitorum profundus tendons of skeletally mature, female sheep. Limbs were evenly randomized into 2 experimental groups (all-suture anchor with or without button) and 1 control group (interference screw). Cyclic loading followed by a load-to-failure test was conducted. The primary outcome metric was end-cycle stiffness, or stiffness measured at the end of cyclic loading, because it modeled the resistance of the construct to the lower-force activities of postoperative physical therapy. Secondary metrics included ultimate failure load (UFL), yield load, creep, and load-to-failure stiffness. End-cycle stiffness difference-of-means testing was conducted with a minimal clinically important difference threshold of –15 N/mm (–1.5 kg/mm). Groups were compared using analysis of variance for all recorded variables.</div></div><div><h3>Results</h3><div>Both the all-suture anchor techniques, without a button and with a button, were found to be noninferior in end-cycle stiffness to the interference screw technique (–5.2 N/mm [95% confidence interval, –13.6 to 3.3 N/mm] and –3.8 N/mm [95% confidence interval, –12.5 to –4.9 N/mm], respectively) with a minimal clinically important difference of –15 N/mm. The all-suture techniques showed significantly lower UFL, lower yield load, greater creep, and lower load-to-failure stiffness (<em>P</em> < .001, <em>P</em> < .001, <em>P</em> = .002, and <em>P</em> < .001, respectively). Tendon dimensions did not vary significantly across groups.</div></div><div><h3>Conclusions</h3><div>Under subfailure loading conditions, the all-suture anchor techniques with a button and without a button showed end-cycle stiffness noninferiority to an interference screw technique; however, these techniques were inferior in all secondary outcomes, including significantly lower UFL, lower yield load, greater creep, and lower load-to-failure stiffness.</div></div><div><h3>Clinical Relevance</h3><div>The all-suture anchor approaches with a button and without a button may retain the natural length-tension dynamics of the long head of the biceps tendon because fixation can occur before the release of the tendon origin. Additionally, they may offer a simpler and more cost-effective alternative to prevailing arthroscopic methods.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 5","pages":"Article 100960"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142529085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.asmr.2024.100971
Jeffrey J. Theismann M.D., Matthew J. Hartwell M.D., Samuel G. Moulton M.D., Stephanie E. Wong M.D., Alan L. Zhang M.D.
Purpose
To assess the quality and presence of spin bias in the abstracts of systematic reviews and meta-analyses that evaluated the outcomes of using hip arthroscopy for the treatment of hip pathology in the setting of borderline hip dysplasia.
Methods
PubMed and Embase were searched using the terms “borderline hip dysplasia” and “systematic review” or “meta-analysis.” Forty-one initial studies were identified, and 12 met the inclusion criteria. Study characteristics were then collected, and each study was evaluated for the 15 most common types of bias and study quality using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) rating system. Inclusion criteria included a systematic review with or without meta-analysis, published in a peer-reviewed journal, accessible in English, with outcomes after hip arthroscopy for borderline hip dysplasia.
Results
The 12 reviewed studies were published between 2016 and 2023, and 10 of the studies represented Level IV evidence (2 studies were Level III evidence). At least 1 form of spin was identified in 83% (10/12) of the included studies. Regarding the specific categories of spin type, misleading interpretation was identified in 58% (7/12) of the studies, misleading reporting in 67% (8/12) of the studies, and inappropriate extrapolation in 50% (6/12) of the studies. On the basis of the AMSTAR 2 assessment, 92% (11/12) were categorized as either low quality or critically low quality, with 1 study being categorized as moderate.
Conclusions
Spin bias is frequently encountered in the abstracts for systematic reviews and meta-analyses that evaluate outcomes after hip arthroscopy for the treatment of hip pathology in the setting of borderline hip dysplasia.
Level of Evidence
Level IV, systematic review of Level III and IV studies.
{"title":"Spin Bias Is Common in the Abstracts and Main Body of Systematic Reviews and Meta-analyses of Hip Arthroscopy in the Setting of Borderline Hip Dysplasia","authors":"Jeffrey J. Theismann M.D., Matthew J. Hartwell M.D., Samuel G. Moulton M.D., Stephanie E. Wong M.D., Alan L. Zhang M.D.","doi":"10.1016/j.asmr.2024.100971","DOIUrl":"10.1016/j.asmr.2024.100971","url":null,"abstract":"<div><h3>Purpose</h3><div>To assess the quality and presence of spin bias in the abstracts of systematic reviews and meta-analyses that evaluated the outcomes of using hip arthroscopy for the treatment of hip pathology in the setting of borderline hip dysplasia.</div></div><div><h3>Methods</h3><div>PubMed and Embase were searched using the terms “borderline hip dysplasia” and “systematic review” or “meta-analysis.” Forty-one initial studies were identified, and 12 met the inclusion criteria. Study characteristics were then collected, and each study was evaluated for the 15 most common types of bias and study quality using A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2) rating system. Inclusion criteria included a systematic review with or without meta-analysis, published in a peer-reviewed journal, accessible in English, with outcomes after hip arthroscopy for borderline hip dysplasia.</div></div><div><h3>Results</h3><div>The 12 reviewed studies were published between 2016 and 2023, and 10 of the studies represented Level IV evidence (2 studies were Level III evidence). At least 1 form of spin was identified in 83% (10/12) of the included studies. Regarding the specific categories of spin type, misleading interpretation was identified in 58% (7/12) of the studies, misleading reporting in 67% (8/12) of the studies, and inappropriate extrapolation in 50% (6/12) of the studies. On the basis of the AMSTAR 2 assessment, 92% (11/12) were categorized as either low quality or critically low quality, with 1 study being categorized as moderate.</div></div><div><h3>Conclusions</h3><div>Spin bias is frequently encountered in the abstracts for systematic reviews and meta-analyses that evaluate outcomes after hip arthroscopy for the treatment of hip pathology in the setting of borderline hip dysplasia.</div></div><div><h3>Level of Evidence</h3><div>Level IV, systematic review of Level III and IV studies.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 5","pages":"Article 100971"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141716320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.asmr.2024.100962
Christopher D. Bernard M.D., Eva Bowles M.D., Marcus Trotter M.D., Levi Aldag M.D., Erik Henkelman M.D., Rachel Long B.S., Paul Schroeppel M.D., Scott Mullen M.D., Jacob White M.L.S., Armin Tarakemeh B.A., Bryan Vopat M.D.
Purpose
To perform a systematic review about the varying definitions of “failure” of hip arthroscopy (HA) in the current literature and to provide a recommendation for the standardization of defining failure of HA.
Methods
A systematic search of electronic databases was conducted to identity Level I-IV clinical studies on HA failure published between January 2016 and July 2021 according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Inclusion criteria consisted of studies of patients who underwent an arthroscopic hip procedure and included a definition of failure. Studies with patients who underwent open hip procedures and non–full-text articles were excluded.
Results
Of 1,290 titles, 85 (6.6%) met inclusion criteria and were analyzed in this review. The most common definition of HA failure used was the need for any subsequent ipsilateral hip surgery (80/85, 94.1%). Among studies that noted reoperation as a cause for failure, conversion to total hip arthroplasty was most frequently cited (66/85, 77.6%) followed by any other reoperation on the ipsilateral hip, including repeat HA, hip resurfacing, and hip periacetabular osteotomy (65/85, 76.5%). Multiple studies used subjective patient-reported outcomes, with use of the modified Harris Hip Score being the most common (17/85, 20%).
Conclusions
There are numerous definitions of the term “failure” of HA used by authors in the peer-reviewed literature. A standardized definition of HA failure should be multifactorial. It may include any unplanned subsequent procedures; patient-reported outcomes with emphasis on minimal clinically important difference, substantial clinical benefit, and/or patient acceptable symptom state values; and the inability to return to normal function or sports.
Level of Evidence
Level IV, systematic review of Level III and IV studies.
{"title":"The Definition of Failure in Hip Arthroscopy May Include Factors Outside of Reoperation: A Systematic Review","authors":"Christopher D. Bernard M.D., Eva Bowles M.D., Marcus Trotter M.D., Levi Aldag M.D., Erik Henkelman M.D., Rachel Long B.S., Paul Schroeppel M.D., Scott Mullen M.D., Jacob White M.L.S., Armin Tarakemeh B.A., Bryan Vopat M.D.","doi":"10.1016/j.asmr.2024.100962","DOIUrl":"10.1016/j.asmr.2024.100962","url":null,"abstract":"<div><h3>Purpose</h3><div>To perform a systematic review about the varying definitions of “failure” of hip arthroscopy (HA) in the current literature and to provide a recommendation for the standardization of defining failure of HA.</div></div><div><h3>Methods</h3><div>A systematic search of electronic databases was conducted to identity Level I-IV clinical studies on HA failure published between January 2016 and July 2021 according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Inclusion criteria consisted of studies of patients who underwent an arthroscopic hip procedure and included a definition of failure. Studies with patients who underwent open hip procedures and non–full-text articles were excluded.</div></div><div><h3>Results</h3><div>Of 1,290 titles, 85 (6.6%) met inclusion criteria and were analyzed in this review. The most common definition of HA failure used was the need for any subsequent ipsilateral hip surgery (80/85, 94.1%). Among studies that noted reoperation as a cause for failure, conversion to total hip arthroplasty was most frequently cited (66/85, 77.6%) followed by any other reoperation on the ipsilateral hip, including repeat HA, hip resurfacing, and hip periacetabular osteotomy (65/85, 76.5%). Multiple studies used subjective patient-reported outcomes, with use of the modified Harris Hip Score being the most common (17/85, 20%).</div></div><div><h3>Conclusions</h3><div>There are numerous definitions of the term “failure” of HA used by authors in the peer-reviewed literature. A standardized definition of HA failure should be multifactorial. It may include any unplanned subsequent procedures; patient-reported outcomes with emphasis on minimal clinically important difference, substantial clinical benefit, and/or patient acceptable symptom state values; and the inability to return to normal function or sports.</div></div><div><h3>Level of Evidence</h3><div>Level IV, systematic review of Level III and IV studies.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 5","pages":"Article 100962"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.asmr.2024.100970
Bruno Capurro M.D., Ph.D. , Reagan S. Chapman M.D., M.S. , Daniel J. Kaplan M.D. , Omair Kazi M.S. , Alexander B. Alvero M.D. , Tai C. Holland M.D. , Morgan Rice M.D. , Shane J. Nho M.D., M.S.
Purpose
To identify structures at risk during proximal adductor longus repair and to report observed distances between these structures and the adductor longus (AL) footprint.
Methods
Eight hemipelves from fresh cadaver whole-body specimens were dissected using a previously established surgical approach. The tendinous attachment of the AL was scored into the underlying bone and the footprint size was measured in millimeters. A guidewire was placed at the footprint center along the longitudinal axis of the resected AL muscle. Utilizing a digital caliper, the proximity of key anatomic structures was measured as the radial distance from the guidewire and distance distal to the footprint along the guidewire axis.
Results
The AL footprint was on average 16.95 ± 3.02 mm wide by 9.36 ± 1.66 mm high. The ilioinguinal nerve was 27.10 ± 7.25 mm distal to the AL footprint and 31.75 ± 7.51 mm medial, with a resulting mean surface area of 158.12 ± 39.90 (110.9-230.2). mm2 The genital branch of the genitofemoral nerve was found 7.79 ± 4.05 mm proximal and 15.37 ± 4.54 mm medial. The round ligament (n = 6) was 14.00 ± 2.75 mm and the spermatic cord (n = 2) was 13.57 ± 3.02 mm directly superficial to the AL footprint. The obturator nerve was 63.98 ± 4.57 mm distal as it crossed the adductor brevis muscle laterally. The location of the external pudendal artery was variable but was found to have a mean distance of 37.01 ± 17.97 mm distal and immediately deep to the AL.
Conclusions
When repairing AL tendon injuries, the genitofemoral nerve is the structure anatomically nearest the footprint of the tendon, and this structure is most at risk for iatrogenic injury.
Clinical Relevance
This study investigates the structures at risk during AL repair and seeks to define their location relative to the footprint. These findings will assist surgeons in identifying the crucial anatomic structures at risk to safely perform an anatomic repair of the tendon and avoid iatrogenic complications.
{"title":"The Genitofemoral Nerve Is the Structure Closest to the Tendon Footprint and Is Most at Risk for Iatrogenic Injury During Proximal Adductor Longus Repair: A Cadaveric Anatomy Study","authors":"Bruno Capurro M.D., Ph.D. , Reagan S. Chapman M.D., M.S. , Daniel J. Kaplan M.D. , Omair Kazi M.S. , Alexander B. Alvero M.D. , Tai C. Holland M.D. , Morgan Rice M.D. , Shane J. Nho M.D., M.S.","doi":"10.1016/j.asmr.2024.100970","DOIUrl":"10.1016/j.asmr.2024.100970","url":null,"abstract":"<div><h3>Purpose</h3><div>To identify structures at risk during proximal adductor longus repair and to report observed distances between these structures and the adductor longus (AL) footprint.</div></div><div><h3>Methods</h3><div>Eight hemipelves from fresh cadaver whole-body specimens were dissected using a previously established surgical approach. The tendinous attachment of the AL was scored into the underlying bone and the footprint size was measured in millimeters. A guidewire was placed at the footprint center along the longitudinal axis of the resected AL muscle. Utilizing a digital caliper, the proximity of key anatomic structures was measured as the radial distance from the guidewire and distance distal to the footprint along the guidewire axis.</div></div><div><h3>Results</h3><div>The AL footprint was on average 16.95 ± 3.02 mm wide by 9.36 ± 1.66 mm high. The ilioinguinal nerve was 27.10 ± 7.25 mm distal to the AL footprint and 31.75 ± 7.51 mm medial, with a resulting mean surface area of 158.12 ± 39.90 (110.9-230.2). mm<sup>2</sup> The genital branch of the genitofemoral nerve was found 7.79 ± 4.05 mm proximal and 15.37 ± 4.54 mm medial. The round ligament (n = 6) was 14.00 ± 2.75 mm and the spermatic cord (n = 2) was 13.57 ± 3.02 mm directly superficial to the AL footprint. The obturator nerve was 63.98 ± 4.57 mm distal as it crossed the adductor brevis muscle laterally. The location of the external pudendal artery was variable but was found to have a mean distance of 37.01 ± 17.97 mm distal and immediately deep to the AL.</div></div><div><h3>Conclusions</h3><div>When repairing AL tendon injuries, the genitofemoral nerve is the structure anatomically nearest the footprint of the tendon, and this structure is most at risk for iatrogenic injury.</div></div><div><h3>Clinical Relevance</h3><div>This study investigates the structures at risk during AL repair and seeks to define their location relative to the footprint. These findings will assist surgeons in identifying the crucial anatomic structures at risk to safely perform an anatomic repair of the tendon and avoid iatrogenic complications.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 5","pages":"Article 100970"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141709420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.asmr.2024.100968
Miguel A. Diaz M.S. , Eric A. Branch M.D. , Jacob G. Dunn D.O. , Anthony Brothers M.D. , Steve E. Jordan M.D.
Purpose
To compare the biomechanical properties of quadriceps tendon (QT) graft stitch methods using 3 different suture systems for anterior cruciate ligament reconstruction.
Methods
A total of 48 QTs were harvested from cadaveric knee specimens (age: 73 ± 7 years; range, 66-86 years). Samples were randomly divided into 3 groups where different suture needle systems were used to create 2 stitch methods: whipstitch (WS) and locking stitch (LS). Surgeons performed each technique to 5 stitches, each 0.5 cm apart. Stitching time was recorded. Samples were preconditioned and then underwent cyclic loading, followed by load to failure. Stiffness (N/mm), ultimate failure load (N), peak-to-peak displacement (mm), elongation (mm), and failure displacement (mm) were recorded.
Results
WS and LS were equivalent across stiffness, ultimate load, and peak-to-peak displacement within groups 2 and 3. In group 1, the LS was stiffer than the WS, but the WS achieved a higher ultimate load. For all groups, the LS achieved lower elongation and failure displacement than the WS, with significant differences in groups 1 and 2. Within each stitching method, equivalence was determined for total elongation and ultimate failure load for all 3 suture system groups. For WS samples, group 1 all failed from suture breakage, and both groups 2 and 3 had instances of failure from suture pull-through. All LS samples failed from suture breakage.
Conclusions
Both LS and WS provide adequate mechanical properties in each of the 3 suture systems. Differences in performance do exist; however, each method shows equivalent total elongation and ultimate failure load for all 3 suture systems. LS may be preferred over WS due to lower mean elongation and failure displacement.
Clinical Relevance
There is an increased use of QT grafts in for anterior cruciate ligament reconstruction. However, there have been a limited number of studies comparing various stitching methods and optimizing techniques for QT graft fixation. This study may provide important information to surgeons about which suture techniques have better biomechanical profiles.
{"title":"Whipstitch and Locking Stitch Show Equivalent Elongation and Load to Failure Across 3 Suture Systems in a Biomechanical Model of Quadriceps Tendon Grafts for Anterior Cruciate Ligament Reconstruction","authors":"Miguel A. Diaz M.S. , Eric A. Branch M.D. , Jacob G. Dunn D.O. , Anthony Brothers M.D. , Steve E. Jordan M.D.","doi":"10.1016/j.asmr.2024.100968","DOIUrl":"10.1016/j.asmr.2024.100968","url":null,"abstract":"<div><h3>Purpose</h3><div>To compare the biomechanical properties of quadriceps tendon (QT) graft stitch methods using 3 different suture systems for anterior cruciate ligament reconstruction.</div></div><div><h3>Methods</h3><div>A total of 48 QTs were harvested from cadaveric knee specimens (age: 73 ± 7 years; range, 66-86 years). Samples were randomly divided into 3 groups where different suture needle systems were used to create 2 stitch methods: whipstitch (WS) and locking stitch (LS). Surgeons performed each technique to 5 stitches, each 0.5 cm apart. Stitching time was recorded. Samples were preconditioned and then underwent cyclic loading, followed by load to failure. Stiffness (N/mm), ultimate failure load (N), peak-to-peak displacement (mm), elongation (mm), and failure displacement (mm) were recorded.</div></div><div><h3>Results</h3><div>WS and LS were equivalent across stiffness, ultimate load, and peak-to-peak displacement within groups 2 and 3. In group 1, the LS was stiffer than the WS, but the WS achieved a higher ultimate load. For all groups, the LS achieved lower elongation and failure displacement than the WS, with significant differences in groups 1 and 2. Within each stitching method, equivalence was determined for total elongation and ultimate failure load for all 3 suture system groups. For WS samples, group 1 all failed from suture breakage, and both groups 2 and 3 had instances of failure from suture pull-through. All LS samples failed from suture breakage.</div></div><div><h3>Conclusions</h3><div>Both LS and WS provide adequate mechanical properties in each of the 3 suture systems. Differences in performance do exist; however, each method shows equivalent total elongation and ultimate failure load for all 3 suture systems. LS may be preferred over WS due to lower mean elongation and failure displacement.</div></div><div><h3>Clinical Relevance</h3><div>There is an increased use of QT grafts in for anterior cruciate ligament reconstruction. However, there have been a limited number of studies comparing various stitching methods and optimizing techniques for QT graft fixation. This study may provide important information to surgeons about which suture techniques have better biomechanical profiles.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 5","pages":"Article 100968"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.asmr.2024.100972
Matthew Quinn M.D. , Alex Albright M.D. , Victoria Kent B.S. , Patrick Morrissey M.D. , Luca Katz B.S. , Michael Kutschke M.D. , Nicholas Lemme M.D. , Ramin R. Tabaddor M.D.
Purpose
To evaluate the efficacy of the senior author’s hybrid “mini-open” technique for abductor tendon repair at 2-year follow-up.
Methods
After institutional review board approval, we performed a retrospective review of prospectively collected data for all patients undergoing isolated mini-open gluteus medius tendon repairs from January 2018 to January 2022. Inclusion criteria included ongoing abductor pain refractory to nonoperative management, magnetic resonance imaging demonstrating gluteus medius/minimus tear, completion of preoperative patient-reported outcome measures (PROMs) including Modified Harris Hip Score (mHHS), Hip Outcome Score for Activities of Daily Living (HOS-ADL), Hip Outcome Score for Sports-Related Activities (HOS-SS), and visual analog scale (VAS) for pain and minimum 2-year follow-up. PROMs were assessed at preoperative, 6-month, 1-year, and 2-year postoperative intervals. Paired-sample t tests were used to compare the change in each outcome measure. The minimal clinically important difference (MCID) was calculated, and complications were recorded.
Results
Sixty-one patients (59 female, 96.7%) with an average age of 61.4 ± 1.3 years were included. The mean follow-up was 25.9 ± 1.13 months. mHHS improved from a mean of 47.2 preoperatively to 68.9 at 2 years (P < 0.001), HOS-ADL from 54 to 78.9 (P < 0.001), HOS-SS from 37 to 66.5 (P = 0.015), and VAS from 13.3 to 7.4 (P = 0.001). The MCIDs for mHHS, HOS-ADL, HOS-SS, and VAS were 11.1 (60% achievement), 6.1 (78.6% achievement), 9.7 (80.3% achievement), and 14.5 (75.4% achievement), respectively. Two patients experienced retears (3.2%), with no other complications reported.
Conclusions
The mini-open technique for abductor tendon repair provides sustained improvement in both pain and function-related PROMs at 2-year follow-up with comparable complication rates to endoscopic and open techniques in 1 surgeon’s practice.
{"title":"Mini-Open Technique for Gluteus Medius Tendon Repairs Is Associated With Low Complication Rates and Sustained Improvement in Patient Reported Outcomes at 2-Year Follow-Up","authors":"Matthew Quinn M.D. , Alex Albright M.D. , Victoria Kent B.S. , Patrick Morrissey M.D. , Luca Katz B.S. , Michael Kutschke M.D. , Nicholas Lemme M.D. , Ramin R. Tabaddor M.D.","doi":"10.1016/j.asmr.2024.100972","DOIUrl":"10.1016/j.asmr.2024.100972","url":null,"abstract":"<div><h3>Purpose</h3><div>To evaluate the efficacy of the senior author’s hybrid “mini-open” technique for abductor tendon repair at 2-year follow-up.</div></div><div><h3>Methods</h3><div>After institutional review board approval, we performed a retrospective review of prospectively collected data for all patients undergoing isolated mini-open gluteus medius tendon repairs from January 2018 to January 2022. Inclusion criteria included ongoing abductor pain refractory to nonoperative management, magnetic resonance imaging demonstrating gluteus medius/minimus tear, completion of preoperative patient-reported outcome measures (PROMs) including Modified Harris Hip Score (mHHS), Hip Outcome Score for Activities of Daily Living (HOS-ADL), Hip Outcome Score for Sports-Related Activities (HOS-SS), and visual analog scale (VAS) for pain and minimum 2-year follow-up. PROMs were assessed at preoperative, 6-month, 1-year, and 2-year postoperative intervals. Paired-sample <em>t</em> tests were used to compare the change in each outcome measure. The minimal clinically important difference (MCID) was calculated, and complications were recorded.</div></div><div><h3>Results</h3><div>Sixty-one patients (59 female, 96.7%) with an average age of 61.4 ± 1.3 years were included. The mean follow-up was 25.9 ± 1.13 months. mHHS improved from a mean of 47.2 preoperatively to 68.9 at 2 years (<em>P</em> < 0.001), HOS-ADL from 54 to 78.9 (<em>P</em> < 0.001), HOS-SS from 37 to 66.5 (<em>P</em> = 0.015), and VAS from 13.3 to 7.4 (<em>P</em> = 0.001). The MCIDs for mHHS, HOS-ADL, HOS-SS, and VAS were 11.1 (60% achievement), 6.1 (78.6% achievement), 9.7 (80.3% achievement), and 14.5 (75.4% achievement), respectively. Two patients experienced retears (3.2%), with no other complications reported.</div></div><div><h3>Conclusions</h3><div>The mini-open technique for abductor tendon repair provides sustained improvement in both pain and function-related PROMs at 2-year follow-up with comparable complication rates to endoscopic and open techniques in 1 surgeon’s practice.</div></div><div><h3>Level of Evidence</h3><div>Level IV, therapeutic retrospective case series.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 5","pages":"Article 100972"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141696568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-01DOI: 10.1016/j.asmr.2024.100965
Hussein Elkousy M.D. , Davin K. Fertitta B.S. , Laith Elkousy , Maudood Rana , Allyson N. Pfeil B.S. , Corey F. Hryc Ph.D.
Purpose
To investigate the effects of arthroscopy surgery on ankylosis and synovitis after total knee arthroplasty (TKA), with patient satisfaction as the main outcome measure.
Methods
A single surgeon’s database was queried for all knee arthroscopy procedures done from 2002 to 2024 using the International Classification of Diseases, Ninth and Tenth Revision, codes for ankylosis or synovitis and Current Procedural Terminology codes 29884 and 29876. Patients were excluded if they did not have a previous TKA, had a TKA but arthroscopy was done for multiple or other indications, were <2 months from TKA, lacked medical records, or were worker’s compensation cases. Patients were separated into either the ankylosis group or the synovitis group. A patient satisfaction survey was collected at first and last follow-up and asked individuals to rate their condition as “better,” “unchanged,” or “worse” after arthroscopy. A total of 199 subjects were included: 48 in the ankylosis group and 151 in the synovitis group.
Results
The mean initial follow-up time was 5.2 and 7.2 months for the ankylosis and synovitis groups, respectively. The mean final follow-up time was 3.7 and 4.8 years, respectively. For initial follow-up, the ankylosis group reported 31% better, 56% unchanged, and 13% worse, whereas the synovitis group reported 69% better, 29% unchanged, and 2% worse (P < .001). For final follow-up, the ankylosis group reported 44% better, 41% unchanged, and 15% worse, whereas the synovitis group reported 78% better, 10% unchanged, and 12% worse (P < .001).
Conclusions
After TKA, arthroscopic surgery can reduce symptoms and improve satisfaction for patients with ankylosis or synovitis. Patient satisfaction is improved in a greater percentage of patients with synovitis compared with ankylosis.
{"title":"Arthroscopic Debridement After Total Knee Arthroplasty Is More Effective for Synovitis Than for Ankylosis","authors":"Hussein Elkousy M.D. , Davin K. Fertitta B.S. , Laith Elkousy , Maudood Rana , Allyson N. Pfeil B.S. , Corey F. Hryc Ph.D.","doi":"10.1016/j.asmr.2024.100965","DOIUrl":"10.1016/j.asmr.2024.100965","url":null,"abstract":"<div><h3>Purpose</h3><div>To investigate the effects of arthroscopy surgery on ankylosis and synovitis after total knee arthroplasty (TKA), with patient satisfaction as the main outcome measure.</div></div><div><h3>Methods</h3><div>A single surgeon’s database was queried for all knee arthroscopy procedures done from 2002 to 2024 using the <em>International Classification of Diseases</em>, <em>Ninth</em> and <em>Tenth Revision</em>, codes for ankylosis or synovitis and Current Procedural Terminology codes 29884 and 29876. Patients were excluded if they did not have a previous TKA, had a TKA but arthroscopy was done for multiple or other indications, were <2 months from TKA, lacked medical records, or were worker’s compensation cases. Patients were separated into either the ankylosis group or the synovitis group. A patient satisfaction survey was collected at first and last follow-up and asked individuals to rate their condition as “better,” “unchanged,” or “worse” after arthroscopy. A total of 199 subjects were included: 48 in the ankylosis group and 151 in the synovitis group.</div></div><div><h3>Results</h3><div>The mean initial follow-up time was 5.2 and 7.2 months for the ankylosis and synovitis groups, respectively. The mean final follow-up time was 3.7 and 4.8 years, respectively. For initial follow-up, the ankylosis group reported 31% better, 56% unchanged, and 13% worse, whereas the synovitis group reported 69% better, 29% unchanged, and 2% worse (<em>P</em> < .001). For final follow-up, the ankylosis group reported 44% better, 41% unchanged, and 15% worse, whereas the synovitis group reported 78% better, 10% unchanged, and 12% worse (<em>P</em> < .001).</div></div><div><h3>Conclusions</h3><div>After TKA, arthroscopic surgery can reduce symptoms and improve satisfaction for patients with ankylosis or synovitis. Patient satisfaction is improved in a greater percentage of patients with synovitis compared with ankylosis.</div></div><div><h3>Level of Evidence</h3><div>Level III, retrospective, comparative study.</div></div>","PeriodicalId":34631,"journal":{"name":"Arthroscopy Sports Medicine and Rehabilitation","volume":"6 5","pages":"Article 100965"},"PeriodicalIF":0.0,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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