Background: Superior labral tears are common shoulder injuries among athletes, and for athletes undergoing surgical intervention, one of the main priorities is to return to preinjury levels of activity in a timely manner. However, the literature surrounding return to play after superior labral repair presents inconsistent results, with limited studies evaluating the timing of return to play.
Purpose: To systematically review the rate and timing of return to play in athletes after arthroscopic superior labral repair.
Study design: Systematic review; Level of evidence, 4.
Methods: A systematic literature search was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the PubMed, EMBASE, and Cochrane Library databases. Eligible for inclusion were clinical studies reporting on return to play after arthroscopic superior labral repair. Subgroup analysis was conducted for overhead and collision athletes as well as for return to duty among military personnel. Meta-analysis was performed using Review Manager to compare superior labral repair to biceps tenodesis in the subset of studies comparing these treatments directly. A P value <.05 was considered to be statistically significant.
Results: This review identified 42 studies including 1759 unique cases meeting the inclusion criteria. The majority of patients were male (76.7%), with a mean age of 31.5 years (range, 15-75 years) and a mean follow-up of 50.4 months. The overall rate of return to sport was 77.5%, with 68.2% returning to the same level at a mean of 8.2 months. In overhead athletes, the overall rate of return to play was 69.9% and the rate of return to preinjury level was 55.5%. In collision and contact athletes, the overall rate of return to play was 77.2% and the rate of return to preinjury level was 70.2%. Among military personnel, the overall rate of return to duty was 83.4%, and 81.7% returned to preinjury level at a mean of 4.4 months. In the studies comparing return to play after superior labral repair and biceps tenodesis, a nonsignificant difference was found (risk ratio, 0.92; 95% CI, 0.85-1.00; I2 = 13%; P = .05).
Conclusion: Overall, nearly a quarter of athletes were unable to return to play after arthroscopic superior labral repair. However, a high rate of return to duty was found among the military population treated with arthroscopic superior labral repair.
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: 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.
Background: Although previous literature has established the association between femoroacetabular impingement and progressive hip osteoarthritis, there exists a paucity of studies investigating the effects of global acetabular overcoverage on chondral wear and long-term outcomes.
Purpose: To compare baseline joint space width (JSW), intraoperative findings, long-term total hip arthroplasty (THA)-free survivorship, patient-reported outcome measures (PROMs), pain levels, and patient satisfaction in patients who underwent hip arthroscopy with global overcoverage (GO) to a matched-control (MC) cohort.
Study design: Cohort study; Level of evidence, 3.
Methods: In this retrospective analysis, the authors queried patients who underwent hip arthroscopy for acetabular labral tears secondary to femoroacetabular impingement. Patients with complete PROMs at a minimum 8-year follow-up, the presence of coxa profunda as indicated by an acetabular wall projecting medial to the ilioischial line, and a lateral center-edge angle >40° were matched 1:1 by sex, age, body mass index, Tönnis grade, and labral treatment to a MC cohort of patients who had normal acetabular coverage. Baseline radiographic and intraoperative findings were compared between cohorts. Collected outcomes include the modified Harris Hip Score, Nonarthritic Hip Score, Lower Extremity Functional Scale score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Specific Subscale, 33-item International Hip Outcome Tool score, pain levels, patient satisfaction, and conversion to THA.
Results: In total, 38 patients with GO were 1:1 matched to a MC cohort. The GO cohort had significantly decreased baseline JSW at 50° (P = .002) and greater chondrolabral junction breakdown (P = .037). The GO and MC cohorts achieved similar outcomes for all 6 PROMs, rates of conversion to THA, pain levels, and patient satisfaction. Kaplan-Meier survival analysis demonstrated that the patients experienced a similar overall 18-year THA-free survival rate (GO: 71.1% vs MC: 84.2%; P = .101). To isolate the long-term effects of GO on hip arthroscopy outcomes, 6- to 18-year THA-free survivorship was examined, revealing that the GO cohort (-13.1%) experienced a significantly greater decrease compared with the MC cohort (-5.3%) (P = .008).
Conclusion: Patients with GO had significantly lower baseline ipsilateral JSW at 50° and greater intraoperative severity of chondrolabral junction breakdown. Furthermore, the GO cohort experienced a significantly greater decrease in long-term THA-free survivorship 6 to 18 years after hip arthroscopy.
Background: Trochlear dysplasia is a consistent risk factor for recurrent patellofemoral instability (PFI), but there is limited understanding of how the trochlea develops during growth. The aim of this study was to evaluate serial magnetic resonance imaging (MRI) studies performed in skeletally immature patients with and without PFI to characterize changes in trochlear anatomy over time.
Hypothesis: PFI leads to progressive worsening of trochlear dysplasia over time.
Study design: Cohort study; Level of evidence, 3.
Methods: A retrospective case-control study was conducted on pediatric patients (<18 years of age) with and without a diagnosis of PFI who had multiple ipsilateral MRI studies of the knee at least 6 months apart. Inclusion criteria were patients with open distal femoral physes at the initial MRI study and no intervening surgery between MRI studies. All patients with PFI were included, and 30 patients without PFI were identified for comparison. MRI scans were retrospectively reviewed to evaluate trochlear morphology using the Dejour and Oswestry-Bristol classifications and to measure the sulcus angle, trochlear depth index, medial condylar trochlear offset, and lateral trochlear inclination (LTI). Univariate and bivariate statistics were performed to evaluate differences in morphology between MRI studies and between groups.
Results: A total of 128 patients were identified (98 in the PFI group, 30 in the non-PFI group) with a mean age of 12.3 ± 2.4 years and mean time between MRI studies of 2.3 ± 1.5 years (range, 0.5-6.5 years). Among patients with PFI, rates of moderate to severe (Dejour grades B-D and Oswestry-Bristol classification flat or convex) trochlear dysplasia increased from the initial to most recent imaging study (67% vs 89%; P < .001), and statistically significantly more dysplastic LTI and sulcus angle were observed on follow-up (P < .05). Among the non-PFI group, the percentage of patients with normal trochlear morphology increased from 53% to 87% (P < .001), and less dysplastic measures of trochlear depth index, LTI, and sulcus angle were seen on follow-up imaging (P < .05). When comparing rates of change, trochlear metrics changed toward a more shallow and dysplastic direction in the PFI cohort and toward a deeper and less dysplastic direction in the non-PFI group.
Conclusion: Skeletally immature patients with untreated PFI have trochlear dysplasia that progressively worsens over time. Conversely, those without PFI have trochlear characteristics that appear to normalize with growth.
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