Arthroscopy: The Journal of Arthroscopic & Related Surgery最新文献

Purpose

The purpose of our study was to provide an updated assessment of hip arthroscopy utilization using an institutional database that is specific to the treatment of femoroacetabular impingement syndrome (FAIS).

Methods

All patients undergoing hip arthroscopy for the treatment of FAIS were retrospectively identified between the years 2014 and 2022 via Current Procedural Terminology (CPT) coding in a multi-institutional, single health-system database. A longitudinal analysis was performed to identify trends in the utilization of arthroscopic techniques including capsular and labral treatment, osteoplasty, and traction set-up.

Results

During the study, a total of 789 arthroscopic hip procedures in 733 patients were analyzed (56 staged bilateral). Between 2016 and 2022, the number of hip arthroscopies performed each year increased by 1490% (R² =0.87, p=0.001). Capsular repair (R²=0.92, p<0.001), labral repair (R²=0.75, p=0.002), and femoroplasty (R²=0.70, p=0.004) were performed in an increasing proportion of cases over our study period while labral debridement (R²=-0.84, p<0.001) became less utilized. Postless traction systems were employed in 84% (663/789) of hip arthroscopies overall, were used in at least 70% of hip arthroscopies each year, and did not undergo any significant changes in utilization (R²=0.02, p=0.73).

Conclusion

Capsular repair, labral repair, and femoroplasty were increasingly performed for the arthroscopic treatment of FAIS while the use of labral debridement decreased significantly over our study period. Postless traction systems were utilized in the majority of cases each year.

Clinical Relevance

As comparative literature continues to define the safety and efficacy of hip arthroscopy, understanding how novel techniques or procedures are incorporated in clinical practice is important.

Purpose

To perform a systematic review of clinical studies to directly compare clinical outcomes of patients undergoing anterior cruciate ligament reconstruction (ACLR) with versus without suture tape (ST) augmentation.

Methods

A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify comparative studies directly comparing outcomes of ACLR with versus without ST augmentation with a minimum follow-up of 12 months. The search terms used were: anterior cruciate ligament suture tape. Patients were evaluated based on graft failure rates, return to sport (RTS), anteroposterior (AP) laxity, and patient-reported outcomes (PROs).

Results

Five studies (all level III) met inclusion criteria, including a total of 246 patients undergoing ACLR with ST augmentation (SA group) and 282 patients undergoing ACLR without augmentation (Control group). Patient age ranged from 14.9 to 29.7 years. The mean follow-up time ranged from 24.0 to 48.6 months. The average body mass index (BMI) ranged from 25.3 to 26.3 kg/m² and the overall percentage of males ranged from 43.4% to 69.0%. Overall, the graft failure rate ranged from 1.0% to 25.0% in the SA group and 8.0% to 20.0% in the Control group. Among the studies that reported RTS rates, the rate ranged from 69.2% to 88.9% in the SA group and 51.5% to 87.5% in the Control group. Among all PROs, 2 studies found a significant difference in the Tegner score favoring the SA group. Otherwise, no significant differences were found between groups in term of PROs. No significant differences in AP laxity were found between groups within any particular study. There was heterogeneity between studies regarding surgical techniques, post-operative rehabilitation protocols, and reported PROs.

Conclusion

There is insufficient evidence to suggest that patients undergoing ACLR with ST augmentation may experience favorable clinical outcomes compared to ACLR alone.

Purpose

To compare two-year clinical outcomes of primary hip arthroscopy with versus without capsular closure after interportal capsulotomy in patients with cam- or mixed- type femoroacetabular impingement (FAI).

Methods

Patients with cam- or mixed-type FAI undergoing primary hip arthroscopy with interportal capsulotomy were prospectively enrolled in this randomised controlled trial (RCT) and allocated into either capsular closure or no capsular closure groups. Patients were blinded to group allocation. Clinical outcomes were assessed preoperatively and at 2 years follow-up using the International Hip Outcome Tool (iHOT-12), modified Harris Hip Score (mHHS), and six subsections of the Copenhagen Hip and Groin Outcome Score (HAGOS). Complications and reoperations were noted.

Results

Eighty-four patients (100 hips) were enrolled, 49 hips in the capsular closure group and 51 in the no capsular closure group, with no significant differences in age (28.5±7.5 vs 30.4±8.4, p=0.261), BMI (23.5±3.0 vs 23.4±1.9, p=0.665), and sex distribution (F: 10.2% vs 13.7%, p=0.760). Four patients were lost to follow-up (2.0% vs 5.9%, p=0.618) and 6 had reoperations (6.1% vs 5.9%, p=1.000), which left 45 hips per group for clinical assessment. There were no significant differences between groups in the net change of iHOT-12 (28.3±19.6 vs 32.5±22.7, p=0.388), mHHS (7.6±13.1 vs 7.5±10.2, p=0.954), and subsections of HAGOS (p>0.05). Complication rates were also similar between groups (p>0.05).

Conclusion

The present RCT compared primary hip arthroscopy with versus without capsular closure after interportal capsulotomy in a male-dominated, non-dysplastic, non-arthritic cohort with cam- or mixed- type FAI, and found no significant differences in patient-reported clinical outcomes, complication rates, or reoperation rates.

Level of Evidence

Level I, Randomised Controlled Trial

The hip capsule consists of the iliofemoral, ischiofemoral, and pubfemoral ligaments. The iliofemoral ligament is an important part of the anterior hip capsule that functions to stabilize the joint but is commonly incised in order to obtain access during hip arthroscopy, as described in techniques such as interportal, T, puncture, and periportal capsulotomy. For the most commonly utilized interportal capsulotomy, recent literature has advocated for closure of the capsule at the end of the surgery to avoid iatrogenic instability or microinstability. Systematic reviews and cohort studies have reported significantly better patient reported outcomes (PRO) after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) with capsule closure compared to without capsule closure. However, recent high-level evidence from a randomized controlled trial demonstrated that in a predominantly male cohort there was no difference in PRO improvements or complications between patients undergoing hip arthroscopy for FAIS through an interportal capsulotomy who were randomized to receive capsule closure versus no capsule closure. Of note, male patients have inherently tighter and more stable joints than female patients, and therefore are at lower risk for post-operative instability or microinstability from an interportal capsulotomy that does not properly heal. Also, if the capsule is not violated below the 3 o'clock position (for a right hip, or 9 o'clock for a left hip), there may be less risk to destabilizing the hip joint. A limited interportal capsulotomy in male patients could lead to healing in an unrepaired state.

Hip arthroscopy has become increasingly popular in the treatment of femoroacetabular impingement syndrome (FAI). Careful preoperative planning including evaluation of acetabular and femoral version, is necessary to optimize outcomes. Increased femoral anteversion has been associated with microinstability, and conversely, decreased femoral version may predispose to impingement. Computed tomography (CT) is considered the “gold standard” for femoral version measurements and preoperative planning. However, recent advancements in magnetic resonance imaging (MRI) technologies have demonstrated comparable measurements to CT imaging. In terms of advantages and disadvantages, CT requires radiation, albeit “low dose.” MRI has longer acquisition time, and movement of the patient may impact image quality and subsequent accuracy. MRI generally underestimates true version, probably as a result of patient positioning. 3D imaging could resolve this issue and may become the gold-standard for both CT and MRI.

Purpose

The purpose of the present study was to compare clinical outcomes and rates of secondary surgery, including revision hip arthroscopy and conversion to total hip arthroplasty (THA), following primary hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients ≥40 years of age at minimum 10-year follow-up compared to a propensity-matched control group of patients <40 years.

Methods

A retrospective cohort study was performed for patients who underwent primary hip arthroscopy for FAIS between January 2012 and February 2013.. Patients ≥40 years-old were propensity matched in a 1:1 ratio by sex and body mass index to patients <40 years-old. Patient reported outcomes including Hip Outcome Score for Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, modified Harris Hip (mHHS), international Hip Outcome Tool – 12 (iHOT-12), and Visual Analog Scale (VAS) for Pain and Satisfaction were collected. Rates of Minimal Clinically Important Difference (MCID) and Patient Acceptable Symptomatic State (PASS) achievement at 10-years were evaluated and compared between groups. Rates of secondary surgery including revision hip arthroscopy and conversion to THA were evaluated. Gross survivorship between cohorts was evaluated using a Kaplan-Meier curve.

Results

Fifty-three patients age ≥40 (age: 48.3 ± 5.8 years) were successfully matched to 53 patients age <40 (age: 28.9 ± 7.2, <0.001). There were no other preoperative group differences regarding patient demographics, characteristics, or radiographic findings. Both groups demonstrated significant improvement regarding all PROs at minimum 10-years (p<0.001 for all). No significant difference was noted between cohorts regarding any delta (preoperative to 10-years postoperative) scores (p>0.05 for all). High rates of MCID and PASS achievement were achieved in both cohorts, with no significant differences in any PRO measure (p>0.05 for all). No significant differences in rates of complications (age ≥40: 2.0%, age <40: 7.7%, p=0.363), rates of revision (age ≥40: 7.5%, age <40: 9.4%, p=0.999), or conversion to THA (age ≥40: 13.2%, age <40: 3.8%, p=0.161) were identified. On Kaplan-Meier analysis, no significant difference (p=0.321) was demonstrated in overall gross-survivorship between cohorts.

Conclusion

Patients with age ≥40 with FAIS undergoing primary hip arthroscopy demonstrated durable and comparable 10-year PRO and rates of MCID and PASS achievement compared to a propensity-matched cohort of age <40 counterparts.

Level of Evidence

Level III, retrospective comparative prognostic trial

Purpose

To determine the correlation and classification consistency of femoral version measurements between MR and CT using four commonly used measurement methods.

Methods

A retrospective study was performed on femoroacetabular impingement (FAI) patients who received preoperative CT and MR imaging assessment of the surgical hip and ipsilateral distal femur. Femoral version was measured using the Murphy method, the oblique method, the Reikerås method and the Lee method. Intra- and inter-rater agreements were calculated. Linear regression and Bland-Altman analysis were performed for measurements using different imaging modalities and measurement methods. Femoral version measurements within the lower quartile, the middle 2 quartiles and the upper quartile were classified into different groups based on their percentile within the sample population. Classification consistency rates between modalities and methods were calculated and compared.

Results

Fifty-three patients (39.4 ± 9.1 years; 32 female) were included for analysis. Intra- and inter-rater reliability were high for all modalities and methods (intra-rater ICC range, 0.963-0.993; inter-rater ICC range, 0.871-0.960). MR- and CT-based femoral version measurements showed strong correlations for all methods, with the Lee method demonstrating the strongest association (r = 0.904), while the oblique method exhibited the lowest correlation (r = 0.684) (all P < .001). MR-based measurements were smaller than CT-based measurements with mean differences ranging from 4.5° to 10.3°. Classification consistency between MR and CT ranged from 51% to 74%, whereas the consistency between different measurement methods ranged from 68% to 85%.

Conclusions

While strong correlations were observed between MR- and CT-based femoral version measurements, MR-based measurements were significantly smaller than their CT counterparts. Classification consistency between the modalities was moderate to high. Measurements between different methods showed strong correlations with high consistency rates.

Level of Evidence

Level III, retrospective case series.

Purpose

The purpose of this study was to assess whether posterior cruciate ligament reconstruction (PCLR) suture tape augmentation can yield more stability after isolated PCLR.

Methods

A prospective database was retrospectively reviewed to identified patients that underwent primary isolated PCLR (control study) or isolated PCLR with suture tape augmentation (study group) from January 2016 to September 2020. the subjective International Knee Documentation Committee Subjective (IKDC) Knee, Lysholm and Tegner scores, posterior draw tests, as well as posterior stress radiographs and return to sports activity rates. The minimal clinically important difference (MCID) was used to evaluate the clinically relevance (subjective IKDC, Lysholm and Tegner scores).

Results

59 were included in this analysis (28 patients in control group, 31 patients in study group). The average length of follow-up was similar between the study and control groups (48.6 vs 47.9months; p=0.800). Knee function, in terms of subjective IKDC (study vs. control: 85.1±6.4 vs. 79.8±6.4; P=0.002), Lysholm (study vs. control: 86.3±7.4 vs. 80.8±7.4; P=0.005) and Tegner (study vs. control: 7.0±1.4 vs. 5.6±1. 7; P=0.006) scores, was significantly improved in the study group. However, the differences between control group and study group were less than the MCID in the subjective IKDC score and Lysholm score. 21.4% (6/28) and 48.4% of patients (15/31) in the control and study groups, respectively, returned to the preinjury sports activity levels (P=0.031). At last follow-up, the mean side-to-side differences in posterior laxity was significantly improved in the study group compared with the control patients (study vs. control: 1.52±0.70 mm vs. 3.17±2.01 mm; p<0.01).

Conclusions

Primary isolated PCLR with suture tape augmentation provides better posterior stability than PCLR without suture tape augmentation at a minimum 2 years follow-up. No differences observed between the groups in the percentage of patients who met or exceeded the MCID in subjective IKDC and Lysholm score.

Purpose

To compare adverse events, medical resource utilization, prescribing patterns and revision surgery rates of patients with opioid related disorders (ORD) undergoing primary hip arthroscopy against a propensity matched group with no opioid related disorders (NORD).

Methods

The TriNetX database was queried between January 2015 and December 2020 using ICD-10 and CPT codes to identify patients undergoing primary hip arthroscopy between ages 18 and 70. The ORD cohort was propensity matched in a 1:1 ratio to NORD patients based on age, sex, alcohol related disorders, heart disease, hypertension, metabolic disorders, anxiety disorders, major depressive disorder, diabetes mellitus, and anti-depressant prescriptions. Postoperative rates of adverse events and medical resources were compared within 90 days of procedure, prescriptions were compared within 1 year, and revision surgery were compared within 2 years.

Results

A total of 809 ORD patients were propensity matched in a 1:1 ratio to NORD patients. Postoperative adverse events were similar between groups (P = .693). Rates of revision arthroscopy were also similar for both ORD (9.3%) and NORD (8.0%) cohorts (OR: 1.17 [95% CI 0.83-1.66]; P = .377). ORD patients received care from the emergency department, inpatient admission, outpatient visit, and physical therapy evaluations at higher rates. The ORD cohort received a greater amount of new opioid (OR: 2.66 [95% CI 2.17-3.26]; P < .0001) and antidepressant prescriptions (OR: 1.58 [95%CI 1.26 -1.97]; P < .0001) compared to NORD patients within 1 year of surgery.

Conclusion

ORD patients demonstrated similar rates of adverse events and revision surgery when compared to a propensity matched group of NORD patients undergoing primary hip arthroscopy. However, ORD patients experienced increased rates of ED visits, hospitalizations and were prescribed higher rates of opioid and antidepressant prescriptions.

Level of Evidence

Level III, Cohort Study