Background: Despite the widespread use of arthroscopic surgery for hip synovial chondromatosis, its postoperative outcomes remain uncertain. A head-to-head comparison between open arthrotomy and arthroscopic surgery is lacking.
Purpose: To compare the treatment outcomes of open arthrotomy, particularly with surgical dislocation, and arthroscopic surgery for hip synovial chondromatosis.
Study design: Cohort study; Level of evidence, 3.
Methods: All patients who were surgically treated for symptomatic synovial chondromatosis in a tertiary university referral hospital between April 1996 and February 2023 were investigated via 1:1 propensity score matching to compare open arthrotomy and arthroscopic surgery. The primary outcome was chondromatosis recurrence. Secondary outcomes were patient-reported outcome scores, reoperations, and complications.
Results: A total of 73 patients were enrolled, and after matching, 28 patients in each group were investigated. The mean age and mean follow-up period were 40.5 ± 13.7 years and 4.0 ± 3.1 years, respectively. Clinical and radiological recurrence rates did not differ between groups (clinical recurrence: 7.1% for open arthrotomy vs 25.0% for arthroscopic surgery [P = .143]; radiological recurrence: 14.3% for open arthrotomy vs 32.1% for arthroscopic surgery [P = .205]). However, all patient-reported outcomes at final follow-up were in favor of open arthrotomy compared with arthroscopic surgery (visual analog scale for pain: 1.6 for open arthrotomy vs 3.1 for arthroscopic surgery [P = .002]; quality of life scale: 80.4 for open arthrotomy vs 65.4 for arthroscopic surgery [P < .001]; and modified Harris Hip Score: 84.4 for open arthrotomy vs 75.9 for arthroscopic surgery [P = .001]). The symptom dissatisfaction rate at final follow-up was significantly higher with arthroscopic surgery than with open arthrotomy (35.7% vs 7.1%, respectively; P = .020). There was no difference in reoperation and complication rates between the 2 groups.
Conclusion: For treating primary synovial chondromatosis, particularly when it is distributed across both the central and peripheral zones, arthroscopic surgery should be chosen with caution, and open arthrotomy with surgical dislocation should be actively considered.
Background: Distal tibial allograft (DTA) reconstruction for glenoid bone loss (GBL) has gained popularity. While recent studies have demonstrated that glenoid concavity is an important factor in native glenohumeral stability, there remains a paucity of data regarding concavity restoration during reconstructive procedures for GBL and its biomechanical effect.
Purpose: To compare the restoration of anterior glenohumeral stability and glenoid concavity after DTA and classic Latarjet procedures.
Study design: Controlled laboratory study.
Methods: Nine human cadaveric specimens (mean age, 62.2 years; range, 52-69 years) underwent pretesting computed tomography (CT) to assess native glenoid concavity as determined by the glenoid depth and bony shoulder stability ratio (BSSR). GBL was created so the DTA and Latarjet graft could restore 100% of the native glenoid width. The rotator cuff tendons were loaded, and anterior stability testing was performed using a KUKA robot to apply a controlled anterior force with the shoulder in 90° of abduction and neutral external rotation. A motion capture system recorded humeral head translation. The following conditions were tested: intact, soft tissue Bankart lesion; bone loss model with DTA reconstruction; classic Latarjet procedure without conjoint tendon loaded; and classic Latarjet procedure with conjoint tendon loaded (sling effect). All specimens underwent posttesting CT to measure the BSSR of the DTA and Latarjet reconstructions. A repeated-measures analysis of variance was performed to compare the BSSR and anterior translations between the DTA and Latarjet reconstructions.
Results: DTA produced greater concavity than the Latarjet procedure (BSSR: 0.45 vs 0.35; P < .001). There was no difference in anterior translation between the DTA and Latarjet procedures with the sling effect (5.1 mm vs 4.7 mm; P > .999). However, maximum anterior translation was decreased after the DTA procedure when compared with the Latarjet technique without the sling effect (5.1 mm vs 10.3 mm; P = .045).
Conclusion: DTA produces a more concave reconstruction and decreased anterior translation compared with the flatter reconstruction produced by the classic Latarjet procedure without the sling effect. DTA and the classic Latarjet procedure with conjoint tendon loading, however, yielded equivalent reductions in anterior translation.
Clinical relevance: Distal tibial allograft reconstruction is a biomechanically equivalent alternative to the classic Latarjet due to the restoration of glenoid concavity in addition to glenoid width. Surgeons should consider the role of concavity when addressing glenohumeral instability with bone loss.
Background: Failed anterior cruciate ligament reconstruction (ACLR) leads to reduced quality of life and sometimes the need for repeat surgery. The reason for failure can be multifactorial and difficult to determine. Reports on failure leading to revision are few with limited generalizability. Also, no studies have investigated the reasons for early (<2 years) versus late (≥2 years) revision.
Purpose: To describe patients undergoing revision surgery, the surgeon's reported cause of failure, and the risk of undergoing early versus late revision surgery.
Study design: Cohort study; Level of evidence, 3.
Methods: Primary ACLR cases without concomitant ligament injuries or surgery, registered in the Norwegian Knee Ligament Register from 2004 throughout 2023, were eligible. Descriptive analyses were conducted on intraoperative findings and procedures, time from injury to surgery, activity at the time of injury, revision surgery, surgeon-reported cause of revision, and reporting method. The Kaplan-Meier method was used to calculate revision rates. A multivariable Cox regression model, adjusted for confounders, was used to calculate the hazard ratio of early and late revision surgery.
Results: A total of 30,035 primary ACLR cases were analyzed, of which 1599 resulted in revision surgery. The overall revision rate was 7.1% at 15 years. Female patients were younger at the time of both primary and revision surgery (23.8 and 22.5 years, respectively) compared with male patients (28.2 and 22.2 years, respectively). Age at the time of primary surgery was significantly lower for patients who underwent revision (20.4 years) compared with those who did not undergo revision (26.5 years). Male sex, lower age, hamstring tendon graft, and no cartilage injury at the time of primary reconstruction were all associated with a higher risk of early revision. Lower age, hamstring tendon graft, and no meniscal injury were associated with a higher risk of late revision. New trauma (38.1%) was found to be the most common cause of failure leading to revision.
Conclusion: In the current study, representing one of the largest cohorts to date investigating failed primary ACLR leading to revision, the overall 15-year revision rate was estimated as 7.1%. Patients receiving hamstring tendon grafts were at a particular risk for early revision during the first 2 years after primary reconstruction. New trauma was the most common reported cause of failure leading to revision ACLR.
Background: Patellofemoral instability is a common problem, and medial patellofemoral ligament (MPFL) reconstruction is a standard treatment approach for recurrent instability. The accurate restoration of anatomy in MPFL reconstruction is essential. While coronal-plane anatomy of the MPFL patellar insertion has been previously reported, sagittal-plane anatomy has not been widely studied.
Purpose: To evaluate the sagittal patellar insertion of the MPFL in pediatric specimens to guide future anatomic reconstruction.
Study design: Descriptive laboratory study.
Methods: A total of 11 pediatric cadaveric knee specimens were dissected. The patella and sagittal MPFL insertion were evaluated. The maximal anterior-posterior patellar width, distance from the posterior patella to the posterior MPFL insertion, distance from the medial patellar articular cartilage edge to the MPFL insertion, maximal MPFL thickness, and distance from the anterior MPFL insertion to the anterior patella were measured. The proportion of patellar coverage by the sagittal MPFL insertion footprint was calculated.
Results: The pediatric knee specimens had a mean age of 9.3 ± 1.4 years (range, 6-11 years). The mean maximal transverse patellar width was 19.0 ± 2.7 mm (range, 13.7-22.7 mm). The mean posterior patella-to-posterior MPFL distance was 10.5 ± 1.6 mm (range, 7.7-12.6 mm). The mean patellar articular cartilage edge-to-MPFL distance was 2.3 ± 0.6 mm (range, 1.5-3.5 mm). The mean maximal MPFL thickness was 4.0 ± 0.9 mm (range, 2.6-5.5 mm). The mean anterior MPFL-to-anterior patella distance was 4.4 ± 1.1 mm (range, 2.6-5.8 mm). The sagittal MPFL insertion footprint spanned a mean of 21.0% (range, 16.1%-29.7%) of the medial patella.
Conclusion: This study, utilizing skeletally immature cadaveric specimens, demonstrated that the sagittal MPFL insertion consistently resided in the anterior third of the patella, averaging 21% of the total sagittal patellar width. Additionally, the distance from the MPFL insertion to the medial patellar articular cartilage edge showed minimal variation, representing a consistent intraoperative landmark for MPFL graft placement.
Clinical relevance: This research characterized MPFL insertion anatomy on the medial patella in the sagittal plane. This knowledge provides a clear target area for anatomic graft placement during MPFL reconstruction.
Background: Untreated chronic subscapularis (SSC) tears pose a challenging problem to treat owing to the resultant tendon retraction, atrophy, fatty infiltration, and changes in humeral head position, which complicate surgical options. Anterior latissimus dorsi (LD) transfer has shown effective results in treating these tears without glenohumeral arthritis.
Purpose/hypothesis: This study introduces and evaluates fully arthroscopic and arthroscopically assisted anterior LD transfer techniques for reconstructing irreparable SSC tears. The authors hypothesize that both methods will yield promising and comparable clinical outcomes.
Study design: Cohort study; Level of evidence, 3.
Methods: This retrospective study reviewed patients who underwent anterior LD tendon transfer between February 2014 and April 2022. Indications for surgery included persistent shoulder pain and functional limitations unresponsive to nonoperative treatment, irreparable SSC tears (Lafosse grade ≥4), significant fatty infiltration (Goutallier grade ≥3), and minimal glenohumeral arthritis (Hamada stage <3). Patients were excluded if they had <2 years of follow-up or if data were lost. For comparison, the study divided patients into 2 groups based on the surgical methods: fully arthroscopic LD tendon transfer and arthroscopically assisted LD tendon transfer. Clinical assessments included pain levels (visual analog scale), Constant score, Subjective Shoulder Value score, and range of motion. Radiologic measurement and complications were assessed.
Results: The study included 34 patients (mean ± SD age, 62.4 ± 7.5 years; follow-up, 35.4 ± 15.9 months). Significant improvements were observed in all patient-reported outcomes (pre- to posttest visual analog scale, 7.5 ± 1.2 to 1.2 ± 1.6; Constant score, 28.3 ± 6.0 to 68.8 ± 15.8; Subjective Shoulder Value, 23.2 ± 8.7 to 65.3 ± 22.0; all P < .001), range of motion in all directions, and internal rotation strength. Fully arthroscopic (n = 18) and arthroscopically assisted (n = 16) LD tendon transfers produced comparable clinical outcomes. Complications included 3 retears, 3 infections, and 5 cases of arthritis progression.
Conclusion: Fully arthroscopic and arthroscopically assisted anterior LD transfers significantly reduce pain, enhance range of motion, and strengthen internal rotation in patients with irreparable SSC tears, with no significant differences in complications. These techniques offer comparable clinical outcomes, providing different options for surgeons.
Background: Brain activity during knee movements is altered throughout the sensorimotor network after anterior cruciate ligament reconstruction (ACLR). Patients at 2 to 5 years after surgery appear to require greater neural activity to perform basic knee movement patterns, but it is unclear if brain activity differences within sensorimotor regions are present early after surgery. It is also unknown whether uninvolved knee movements elicit similar or unique activity compared with involved knee movements.
Purpose: To examine brain activity in sensorimotor regions during involved and uninvolved knee movements in patients at 6 weeks after ACLR compared with control participants.
Study design: Cohort study; Level of evidence, 2.
Methods: A total of 15 patients who underwent ACLR (mean age, 21.9 ± 4.3 years [range, 17-29 years]; 8 female) and 15 control participants performed 30-second blocks of repeated knee flexion and extension, followed by 30 seconds of rest, during functional magnetic resonance imaging. Regions of interest included the right and left primary motor cortex (M1), right and left primary somatosensory cortex (S1), supplementary motor area (SMA), precuneus, and lingual gyrus. Activity from task-relevant voxels (move > rest) was extracted, and generalized estimating equations evaluated the main effect of group and group-by-limb interaction. Effect sizes were calculated using the Cohen d.
Results: Reduced brain activity during knee flexion and extension was observed in the ACLR group in the ipsilateral M1 and S1, contralateral S1, SMA, and precuneus during movements of the involved and uninvolved knees. There were no group-by-limb interaction effects, indicating no significant differences between the involved knee and uninvolved knee in the ACLR group. Medium to large effect sizes were identified for between-group differences in all regions.
Conclusion: At 6 weeks after ACLR, patients exhibited bilateral reductions in brain activity during knee movements in multiple sensorimotor regions. These identified regions are associated with motor planning, motor execution, somatosensory function, and sensorimotor integration. These data indicate that ACLR affected sensorimotor brain activity in both limbs during the early postoperative phase of rehabilitation.
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