Arthroscopy-The Journal of Arthroscopic and Related Surgery最新文献

Purpose

To investigate the impact of hip adduction and abduction on the femoro-epiphyseal acetabular roof (FEAR) index using conventional anteroposterior pelvic radiographs of patients with borderline hip dysplasia (BHD).

Methods

Patients with BHD (lateral center edge angle [LCEA] with values of 18° ≤ LCEA <25°) and who were subject to periacetabular osteotoym were selected from a consecutive retrospective cohort from January 2009 to January 2016. The hip ad-/abduction (adduction handled as negative values) and the FEAR index (lateral opening angles handled as positive values) were measured in the initially standardized acquired pelvic radiographs. Thereafter, using surgical planning software, different degrees of hip adduction and abduction were simulated from 20° of adduction to 30° of abduction, and the FEAR index was measured at each position. Pearson correlation was used to identify a potential correlation between the hip ad-/abduction and the FEAR index.

Results

Eighty-nine hips were included. Initial radiographs showed unintentional mean ad-/abduction of –5.3° ± 3.1° (range, –14° to 2°). The mean FEAR index at the initial ad-/abduction angle was –3.6° ± 7.2° (range, –18.0° to 16.0°) and was significantly different from neutral position (0° of ad-/abduction) –9.2° ± 7.0° (range, –27.0° to 10.0°) (P < .001). The FEAR index was negatively correlated to the hip ad-/abduction angle (r = 1, P < .001), with lower values for the FEAR index with the hip in abduction.

Conclusions

Significant differences in FEAR index measurements were observed depending on hip ad-/abduction on pelvic radiographs. A linear change of the FEAR index of 5° per 5° of hip adduction or abduction could be demonstrated, with adduction resulting in increasing and abduction in decreasing values for the FEAR index.

Level of Evidence

Level III, diagnostic study.

Purpose

To compare adverse events, postoperative opioid-prescribing patterns, health care use, and secondary anterior cruciate ligament reconstruction (ACLR) surgery rates of patients undergoing primary ACLR with a preoperative antidepressant prescription (ADP) against a propensity-matched group with no preoperative antidepressant prescription (NADP) using the TriNetX Diamond Network.

Methods

Patients undergoing primary ACLR between ages 18 and 35 years of age were queried from the database using International Classification of Diseases, Tenth Revision/Current Procedural Terminology codes. Patients with an ADP were propensity matched in a 1:1 ratio to patients with NADP based on 11 patient characteristics. Postoperative rates of adverse events, emergency department (ED) visits, in-patient hospitalizations, outpatient services, physical therapy evaluations, postoperative opioid prescriptions, and secondary ACLR were compared at various time points.

Results

In total, 3,736 patients with an ADP with an average age of 21.4 ± 4.5 years undergoing primary ACLR were propensity matched to patients with NADP. A significantly greater percentage of patients with an ADP received opioid prescriptions at 2 weeks (ADP 21%, NADP 11.3%, odds ratio [OR] 2.08), 6 weeks (ADP 25.5%, NADP 13.9%, OR 2.13), 3 months (ADP 27.6%, NADP 15.6%, OR 2.07), 6 months (ADP 30.5%, NADP 17.2%, OR 2.1), and 1 year (ADP 35.3%, NADP 20.2%, OR 2.16) postoperatively (P <.0001 for each time point). Patients with ADP had greater rates of ED visits (ADP 9.7%, NADP 7.1%, P < .0001, OR 1.39) and outpatient appointments (ADP 28.3%, NADP 21.8%) P < .0001, OR 1.42) at 3 months’ postoperatively. Secondary surgery rates at 1 and 2 years were nonsignificant (P = .381 and P = .062, respectively).

Conclusions

Following ACLR, patients with ADP had a significant increase in postoperative opioid prescriptions at all time points and used more ED resources and outpatient services compared with patients with NADP at 3 months’ postoperatively. Thirty-day postoperative adverse events and both 1- and 2-year secondary ACL surgery rates demonstrated no significant differences between the groups.

Level of Evidence

Level III, retrospective comparative case series.

Purpose

To evaluate the radiographic and clinical outcomes when rerouting a pathologic biceps during arthroscopic rotator cuff repair by comparing it with concomitant subpectoral biceps tenodesis (SPBT).

Methods

This retrospective, historical cohort study was conducted with patients who underwent an arthroscopic repair of a full-thickness rotator cuff tear, with intraoperative confirmation of biceps pathology including partial tears, subluxation, pulley lesions, or type II SLAP lesions. Until May 2018, such patients were treated with concomitant subpectoral tenodesis (group SPBT). Afterward, biceps rerouting (BR) was done regardless of biceps pathology (group BR) without biceps or SLAP repair. Radiographic parameters, including fatty degeneration, acromiohumeral distance, Sugaya classification, and retears, were evaluated using preoperative and 1-year postoperative magnetic resonance imaging results. Clinical evaluation with a minimum 2-year follow-up included pain visual analog scale, American Shoulder and Elbow Surgeons, Simple Shoulder Test, and Constant–Murley scores. Whether individual patients exceeded these scores' minimal clinically important difference also was determined.

Results

A total of 64 patients (group SPBT = 32; group BR = 32) were included in the final analysis. The duration of clinical follow-up was 36.2 ± 9.3 months in group SPBT and 29.4 ± 6.9 months in the BR group (P = .002). Compared with group SPBT, group BR demonstrated a significantly lower retear rate (SPBT vs BR: 34.4% vs 12.5%, P = .039). In the BR group, 8 of 32 (25%) patients demonstrated a postoperative LHBT tear. The 4 cuff retears in group BR only took place within these patients. Other postoperative radiographic and clinical outcomes were comparable between the groups. Within each group, significant postoperative improvements were demonstrated (P < .05 for all clinical scores).

Conclusions

Even in the presence of a pathologic LHBT and/or a type II SLAP lesion, augmenting the rotator cuff repair with BR significantly reduced retear rates while achieving clinical scores comparable with SPBT in a minimum 2-year follow-up.

Level of Evidence

Level III, retrospective comparative study.

All-inside anterior cruciate ligament (ACL) reconstruction is the most minimally invasive ACL reconstruction technique available. Systematic review and meta-analysis show equally excellent outcomes for all-inside ACL reconstruction as compared with full tibial tunnel ACL reconstruction. Advantages of the all-inside technique may include improved tibial side fixation, improved stability, less tunnel widening, improved cosmesis, and less postoperative pain. Interference screw fixation using a full tibial tunnel technique can be complicated by inferior proximal tibial bone density. All-inside ACL reconstruction preserves the integrity of the tibial cortex and lends itself to cortical suspension fixation. Given modern adjustable suspensory cortical fixation and excellent clinical outcomes, surgeons should consider all-inside ACL reconstruction as a primary ACL reconstruction technique.

Purpose

To investigate changes in sexual function and activity after arthroscopic hip surgery for femoroacetabular impingement using the United Kingdom Non-Arthroplasty Hip Registry dataset. Subanalyses were performed between males and females, and patients over 40 and under 40 years old.

Methods

Patients who had arthroscopic hip surgery between January 1, 2012, and October 31, 2020, were aged over 16, and completed the relevant patient-reported outcome measures were included. Question 9 of the International Hip Outcome Tool-12 (sexual activity question [SAQ]) refers to problems with sexual activity, and responses to this were compared before surgery and at 6 and 12 months after surgery. Subanalyses were also performed, including SAQ scores by patients’ sex or age. SAQ scores were correlated with Euroqol-5 dimension-5 level self-reporting tool (EQ-5D-5L) scores using Spearman’s rank coefficient.

Results

SAQ was answered by 2,547 patients before and at 6 months after surgery (62.3% female, median age = 36.2, interquartile range [IQR] = 29-44 years) and by 2,314 at 12 months (61.9% female, median age = 36.2, IQR = 29-44 years). Scores for sexual activity increased from 35.0 before surgery to 70.0 at 6 months (P < .001) and were maintained at 12 months (P < .001). Female patients demonstrated a significantly greater improvement in their scores for sexual function from before surgery (median = 30.0, IQR = 14-50) to 6 months (median = 60, IQR = 28-86, P < .001) and 12 months (median = 62.0, IQR = 29-90, P < .001), compared to male patients (preoperative median = 50.0, IQR 25-84; 6-month median = 80, IQR = 45-97; 12-month median = 80, IQR = 41-98). The effect of age on improvements in sexual function did not demonstrate a significant difference. A significant positive correlation was found between improvements in sexual function and quality of life, as measured by the EQ-5D-5L, at 6 and 12 months (P < .001).

Conclusions

Hip arthroscopy for symptomatic femoroacetabular impingement produces an improvement in sexual function and activity. Scores for sexual function improved regardless of patient age or sex; however, female patients experienced a greater improvement in sexual function than males.

Level of Evidence

Level III, Retrospective cohort study.

Purpose

To systematically review clinical and functional outcomes of endoscopic repairs of hip abductor tendon tears.

Methods

A search following guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed in the PubMed, Embase, and Cochrane databases using variations of the terms “endoscopy,” “gluteus medius,” “hip abductor,” “outcome,” “success,” and “failure.” Data for patient demographics, tear severity and location, patient-reported outcomes (PROs), clinical benefit, and rates of retears and revision surgery were collected and tabulated. Forest plots depicting preoperative versus postoperative PROs were generated. Quality assessment was performed using the modified Coleman Methodology Score.

Results

In total, 13 studies, 3 Level III and 10 Level IV, were included in this review, with a total of 272 patients whose ages ranged from 46.0 to 66.9 years and follow-up times from 16.4 to 46.7 months. Most tears were isolated to the gluteus medius, with the number of partial- versus full-thickness tears being similar. Trendelenburg gait, reported by 4 studies, persisted in 0% to 13.6% of patients after repair. Of 9 studies reporting both preoperative and postoperative PROs at latest follow-up, 8 reported significant improvements in all PROs (P < .05). In 5 studies, rates of achieving minimal clinically important difference and patient-acceptable symptomatic state ranged from 50.0% to 93.3% and 40.7% to 75.0%, respectively. Surgical complication rates were 0% in 11 studies and 4.3% and 18.2% in 2 studies. Retear rates were 0% in 10 studies and ranged from 6.7% to 33.3% in 3 studies. Rates of revision due to retear, reported by 12 studies, were 0% in 8 studies and ranged from 2.2% to 13.0% in 4studies.

Conclusions

Endoscopic repairs of both partial- and full-thickness hip abductor tendon tears have good-to-excellent PROs and low complication, retear, and revision rates. However, rates of minimal clinically important difference and patient-acceptable symptomatic state achievement rates are highly variable and less than favorable.

Level of Evidence

Level IV, systematic review of Level III and IV studies.

Purpose

To assess whether early postoperative stiffness predicts long-term stiffness and its relationship with repair integrity in patients who undergo arthroscopic rotator cuff repair (ARCR).

Methods

This was a single-center retrospective study; 427 patients undergoing primary ARCR by a board-certified orthopaedic surgeon over 4 years were considered. Patients with at least 1 year of follow-up were categorized into stiff and non-stiff groups based on their range of motion (ROM) at 3 months’ postoperatively. Stiffness was defined as passive forward flexion <120°, external rotation <30°, or internal rotation below L3. We evaluated clinical outcomes using demographics, ROM, Constant Shoulder (CS) score, University of California, Los Angeles (UCLA) score, and visual analog scale (VAS) for pain preoperatively and at 3, 6, and 12 months’ postoperatively. Stiffness, retear rates, and tendon integrity were assessed via magnetic resonance imaging at 12 months.

Results

Of 155 patients meeting the inclusion criteria, 68 (43.9%) were stiff, and 87 (56.1%) were non-stiff. The stiff group had significantly lower preoperative CS and UCLA scores (P = .013/.014) and greater VAS score (P = .034). At 3 months, this group showed lower ROM and functional scores (P < .001), persisting at 6 and 12 months (except internal rotation) (P < .001). Their 12-month VAS score was greater (P = .024). Postoperative stiffness occurred in 10.3% of the stiff group and 2.3% of the non-stiff group (P = .035). The 12-month retear rate was 5.9% in the stiff group and 17.2% in the non-stiff group (P = .032). Minimal clinically important difference analysis indicated ROM changes but limited functional score changes in the 2 groups.

Conclusions

This study showed that early postoperative shoulder stiffness correlates with lower preoperative functional scores and greater pain levels. Shoulder stiffness at 3 months’ post-ARCR predicts 12-month shoulder stiffness but indicates better tendon integrity. While early stiffness is linked to lower functional scores and more pain, its long-term clinical impact seems limited.

Level of Evidence

Level III, retrospective comparison study.