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PURPOSE: To evaluate functional outcomes and satisfaction in patients who underwent telerehabilitation (telerehab) compared with in-person rehabilitation after arthroscopic meniscectomy. METHODS: A randomized-controlled trial was conducted including patients scheduled to undergo arthroscopic meniscectomy for meniscal injury by 1 of 5 fellowship-trained sports medicine surgeons between September 2020 and October 2021. Patients were randomized to receive telerehab, defined as exercises and stretches provided by trained physical therapists over a synchronous face-to-face video visit or in-person rehabilitation for their postoperative course. International Knee Documentation Committee Subjective Knee Form (IKDC) score and satisfaction metrics were collected at baseline and 3 months postoperatively. RESULTS: Analysis was conducted on 60 patients with 3-month follow-up outcomes. There were no significant differences in IKDC scores between groups at baseline (P = .211) and 3 months’ postoperatively (P = .065). Patients were more likely to report being satisfied with their rehabilitation group 73% vs. 100% (P = .044) if there were in the in-person group. Satisfaction differed significantly between the 2 groups at the end of their rehabilitation course, and only 64% of those in the telerehab group would elect to undergo telerehab again for future indications. Furthermore, they believed that future rehabilitation would benefit from a hybrid model. CONCLUSIONS: Telerehab showed no difference versus traditional in-person rehabilitation in terms of functional outcomes up to 3 months after arthroscopic meniscectomy. However, patients were less satisfied with telerehab. LEVEL OF EVIDENCE: I, randomized controlled trial.

Peroneal nerve injuries are rare injuries and usually associated with multiligamentous knee injuries (MLKIs) involving one or both cruciate ligaments. The purpose of our study was to perform a multicenter retrospective cohort analysis to examine the rates of peroneal nerve injuries and to see whether a peroneal nerve injury was suggestive of a particular injury pattern.A retrospective chart review was conducted in patients who were diagnosed with MLKI at two level I trauma centers from January 2001 to March 2021. MLKIs were defined as complete injuries to two or more knee ligaments that required surgical reconstruction or repair. Peroneal nerve injury was clinically diagnosed in these patients by the attending orthopaedic surgeon. Radiographs, advanced imaging, and surgical characteristics were obtained through a chart review.Overall, 221 patients were included in this study. The mean age was 35.9 years, and 72.9% of the population was male. Overall, the incidence of clinical peroneal nerve injury was 19.5% (43 patients). One hundred percent of the patients with peroneal nerve injury had a posterolateral corner injury. Among patients with peroneal nerve injury, 95.3% had a complete anterior cruciate ligament (ACL) rupture as compared with 4.7% of the patients who presented with an intact ACL. There was 4.4 times of greater relative risk of peroneal nerve injury in the MLKI with ACL tear group compared with the MLKI without an ACL tear group. No statistical difference was observed in age, sex, or body mass index between patients experiencing peroneal nerve injuries and those who did not.The rate of ACL involvement in patients presenting with a traumatic peroneal nerve palsy is exceptionally high, whereas the chance of having a spared ACL is exceptionally low. More than 90% of the patients presenting with a nerve palsy will have sustained, at the least, an ACL and posterolateral corner injury.IV, Case Series.

The purpose of this study was to analyze patients that did not return to play (RTP) following arthroscopic Bankart repair (ABR) compared to those who did RTP, and analyze factors associated with not returning to play.A retrospective review of patients who underwent ABR, and subsequently did not RTP after a minimum of 24-month follow-up was performed. Additionally, these were pair matched in a 3:1 ratio for age, gender, sport and level of pre-operative play with a control group who RTP. Patients were evaluated for their psychological readiness to return to sport using the SIRSI score. Multivariate regression models were used to evaluate factors affecting RTP.The study included a total of 52 patients who were unable to RTP and 156 who returned to play. Ten patients (19.2 %) who did not RTP passed the SIRSI benchmark of 56 with a mean overall score of 39.8 ± 24.6, in those who returned 73.0 % passed the SIRSI benchmark of 56 with a mean overall score of 68.9 ± 22.0 (p 0.0001 for both). The most common primary reasons for not returning were 27 felt physically unable to return, whilst 21 felt it was a natural end to their career or their lifestyle had changed. Multi-logistic regression revealed that 4 of the 12 components of the SIRSI score (p 0.05 for all) and SSV (p = 0.0049), were the factors that were associated with RTP.Following ABR, those that do not return to play exhibit poor psychological readiness to return to play, with multi-linear regression revealing the SIRSI questions associated with fear of re-injury were associated with a lower rate of RTP. Additionally, functional limitations were found to be associated with a lower rate of RTP.Level III; Retrospective Comparative Cohort Study.

The purpose of this study was to evaluate the outcomes of patients 5 years postoperatively following arthroscopic SLAP repair, and to evaluate factors associated with satisfaction.A retrospective review of patients who underwent SLAP repair with a minimum of 5-year follow-up was performed. Recurrence, visual analog scale (VAS) score, Subjective Shoulder Value (SSV), American ShoulderElbow Surgeons (ASES) score, satisfaction, whether they would undergo the same surgery again, and the rate, level and timing of return to play (RTP) were evaluated. Multilinear regression models were used to evaluate factors affecting postoperative satisfaction.Overall, 122 patients who underwent SLAP repair were included, with a mean age of 33.4 years. 81% were males, and 58.2% were participating in sport preoperatively. The mean follow-up was 86.4 ± 14.4 months. At final follow up, the mean satisfaction was 87.7%, and the mean SSV was 82.9. Overall, the rate of RTP was 85.9%, with 64.8% returning at the same level at a mean of 10.5 ± 8 months. Ultimately, 13 (10.7%) patients had a further surgery, including 10 (8.2%) patients that had a biceps tenodesis. VAS during sport (P = .025), SSV (P.001), and time to RTP (P = .0056), were associated with higher satisfaction.There was a high rate of satisfaction at 5-year follow-up, with excellent patient-reported outcomes but with one-tenth of patients requiring revision surgeries. Additionally, while there was an overall high rate of RTP, there was only a modest rate of RTP at their preinjury level, and overhead athletes took longer to RTP.IV, case series.

Background: Hip arthroscopy is a procedure commonly performed to correct various hip pathologies such as femoroacetabular impingement and labral tears. These hip pathologies commonly affect young, otherwise healthy patients. The recovery after hip arthroscopy can prevent patients from returning to work and impair performance levels, having significant economic repercussions. To date, there has been no cumulative analysis of the existing literature on return to work after hip arthroscopy. Purpose: The purpose of this study was to perform a systematic review of the existing literature regarding return to work after hip arthroscopy and analysis of factors associated with the ability to return to work and time to return to work. Study Design: Systematic review and meta-analysis; Level of evidence, 4. Methods: A literature search of the MEDLINE, EMBASE, and Cochrane Library databases was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies assessing functional outcomes and return to work, including return to military duty, after hip arthroscopy were included. Patients’ ability to return to work, as well as time to return, was compared between selected studies. Where available, workers’ compensation status as well as type of work was compared. All statistical analysis was performed using SPSS, Version 22. P < .05 was considered statistically significant. Results: Twelve studies with 1124 patients were included. Patients were followed for an average of 17.6 months. Using weighted means, the average rate of return to work was 71.35%, while full return to previous work duties was achieved at a rate of 50.89%. Modification to work duties was required at a rate of 15.48%. On average, the time to return to work was 115 days (range, 17-219 days). Rate of return by patients with workers’ compensation status was found to be 85.15% at an average of 132 days (range, 37-211 days). Rate of return to work in workers performing professions reported as strenuous vs light (ie, mostly sedentary) jobs showed a statistically higher return to work in light professions (risk ratio, 0.53; 95% CI, 0.41-0.69). Conclusion: After hip arthroscopy, there is a high rate of return to work at an average of 115 days after surgery. However, full return to work was achieved by only half of patients upon final follow–up.

IMPORTANCE There have been several recent systematic reviews of quadriceps tendon autografts (QT) which have not shown any significant difference in outcomes between QT and hamstring tendon autograft (HS) for ACL reconstruction (ACLR). However, several recent comparative studies have been published comparing QT to HS for ACLR. AIM The purpose of this study is to perform a systematic review and meta-analysis of the studies comparing QT to HS for ACLR. EVIDENCE REVIEW Two independent reviewers performed the literature search based on the PRISMA guidelines, with a senior author arbitrating discrepancies. Cohort studies comparing QT with HS were included. FINDINGS There were 15 studies comparing 611 patients with QT to 543 patients with HS, with a mean of 27.4 months follow-up. QT resulted in a significantly lower rate of graft re-rupture (2.5% vs 8.7%, p=0.01), and donor site morbidity (17.6% vs 26.2%, p=0.02). There was a significant difference in favor of QT for the positive pivot shift test (Grade I/II: 15.8% vs 23.0%, p=0.02), but not in the rate of positive Lachman test (Grade I/II: 18.3% vs 26.7%, p=0.16). Additionally, there was no difference in the side to side difference in knee stability (1.8mm vs 2.0mm, p=0.48). Functionally, both grafts had similar functional outcomes in terms of the IKDC score (88.0 vs 87.9, p=0.69), and Lysholm score (89.3 vs 87.6, p=0.15). CONCLUSIONS AND RELEVANCE: Our study showed that QT has a lower re-rupture rate than HS in ACLR, with lower donor site morbidity. QT appeared to be slightly better for residual pivot shift, but there was no difference in patient-reported outcomes. LEVEL OF EVIDENCE III.

Studies have shown a high prevalence of femoroacetabular impingement (FAI) among elite athletes yet there is a paucity of data on FAI in Nordic skiers. The purpose of this study was to determine the prevalence of radiographic FAI in professional Nordic Combined Skiers and Ski jumpers compared to controls and assess functional outcomes including hip range of motion (ROM) and pain in patients with radiographic evidence of FAI compared to those without it.A cohort of elite Nordic Skiers underwent medical history, physical examination, and pelvic radiographs at their visit with a fellowship-trained sports medicine physician. On pelvis radiographs, Alpha angle55 degrees was deemed cam-positive, and positive crossover signs, Tönnis0, or LCEA40 were deemed pincer positive. Further stratification was performed by sex, ski event type, hip pain, presence of cam lesions, and presence of pincer lesions. Spearman correlation matrix was performed to measure the association between radiographic measurements and ROM.Nineteen Nordic skiers and nineteen age, sex, and BMI matched controls were included in the study. There were no significant differences in age, sex, BMI, and hip pain between groups. While Nordic skiers demonstrated decreased ROM bilaterally on external rotation compared to controls, skiers had larger ROM bilaterally on extension, abduction, adduction compared to controls. Skiers were significantly more likely to have bilateral crossover sign and alpha angles55 compared to controls. Subgroup analysis showed that Cam positive patients had higher flexion and adduction ROM and pincer positive patients had significantly higher flexion and abduction ROM compared to patients without cam and pincer lesions respectively. Patients with hip pain had significantly lower right hip abduction ROM compared to patients without hip pain. No significant correlations were seen between radiographic measurements and ROM.Similar to other elite 'hip heavy' sport athletes, Nordic skiers gave a notably higher prevalence of radiographic cam and pincer type morphology and significantly higher ROM compared to nonathletic controls. Clinicians evaluating Nordic skiers should be aware of these baseline findings with respect to a possible elevated long-term risk of symptomatic FAI in these athletes as well as other conditions related to radiographic FAI.

Femoroacetabular impingement (FAI) can cause pain, dysfunction, and early arthritic progression in young patients. The purpose of this study was to systematically review the evidence in literature to determine patient-reported outcomes and failure rates as defined by the need for revision surgery, following hip arthroscopy for pediatric patients with FAI. The literature search was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Clinical studies evaluating the outcomes following primary hip arthroscopy for pediatric patients with FAI were included. Clinical outcomes evaluated included revisions, complications, functional outcome scores (modified Hip Harris Score [mHHS], Non-Arthritis Hip Score, and Visual Analogue Score), and return to play. Statistical analysis was performed using GraphPad Prism version 7. This study is a level IV systematic review. Overall, 20 clinical studies with 1,136 patients (1,223 hips) were included in this review, with an average age of 16.3 years. Overall, 8.6% patients experienced revision surgery. The mHHS was the most widely used metric, present in 17 of the 20 studies. The mHHS was reported as excellent (> 90) in six of these studies and good (80–89) in 11. The weighted mean of the post-operative mHHS found across reporting studies was 84.3, from a baseline score of 58.1. The overall return to play rate was 91%. This study reports excellent post-hip arthroscopy clinical outcomes for FAI and labral tears in the pediatric population. However, revision rates for this surgical procedure are higher than previously documented.

The purpose of this study is to systematically review the evidence regarding return to sport evaluation following ACL reconstruction and evaluate the relationship between testing and secondary ACL injury.A systematic review of the literature with PubMed, Ovid MEDLINE, Cochrane Reviews, was performed on June, 2020 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they compared outcomes following passing and failing RTP testing subsequent to ACLR. Clinical outcomes were compared, with all statistical analysis performed using Review Manager Version 5.3. Correlation was calculated with Spearman testing.Overall, 8 studies with 1224 patients were included in the analysis. Overall, 34.3% (420/1224) patients passed the RTP testing. Those who passed the RTP testing had a statistically significant 47% lower rate of ACL graft re-rupture compared to those who did not pass the RTP testing (p = 0.03). However, there was a slightly higher, albeit not statistically significant, rate of contralateral ACL rupture in those who passed the RTP testing compared to those who did not (p = 0.42). There was a strong positive correlation between a high rate of patients passing the ACL RTP testing in studies and ACL graft rupture rate in those who failed (0.80).Passing RTP testing following ACLR results in a lower rate of ACL graft rupture, but not contralateral ACL injury. Further evaluation and standardization of RTP testing is necessary in order to increase reliability in identifying patients at risk for re-injury after ACLR.Level of Evidence III.

Purpose: The purpose of this study is to evaluate the patient-reported outcomes of open Latarjet (OL) compared to arthroscopic Latarjet (AL) for anterior shoulder instability. Methods: A retrospective review of patients who underwent either OL or AL for anterior shoulder instability between 2011 and 2019 was performed. Recurrent instability, visual analog scale (VAS) score, Shoulder Instability-Return to Sport after Injury (SIRSI), Subjective Shoulder Value (SSV), Western Ontario Shoulder Instability (WOSI) score, patient satisfaction, willingness to undergo surgery again, and return to work/sport (RTW/RTS) were evaluated. A P value of < .05 was considered to be statistically significant. Results: Our study included 102 patients in total; 72 patients treated with OL, and 30 treated with AL. There were no demographic differences between the two groups (P > .05 for all). At final follow up (mean of 51.3 months), there was no difference between those that underwent OL or AL in the reported WOSI, VAS, VAS during sports, SSV, and SIRSI scores, nor in patient satisfaction, or whether they would undergo surgery again (P > .05). Overall, there was no significant difference in the total rate of RTP (65% vs 60.9%; P = .74), or timing of RTP (8.1 months vs 7 months; P = .35). Additionally, there was no significant difference in the total rate of RTW (93.5% vs 95.5%; P = .75). Overall, 3 patients in the OL group and 2 patients in the AL group had recurrent instability events (6.9% vs 6.7%; P = .96), with no significant difference in the rate of recurrent dislocation (4.2% vs 3.3%; P = .84). Conclusion: In patients with anterior shoulder instability, both the OL and AL are reliable treatment options, with a low rate of recurrent instability, and similar patient-reported outcomes.

PURPOSE The purpose of this study was to evaluate the outcomes of athletes 5-years post-operatively following arthroscopic Bankart repair, and to evaluate factors associated with satisfaction and shoulder function, as defined by subjective shoulder value. METHODS A retrospective review of athletes who underwent arthroscopic Bankart repair, with a minimum of 5-year follow-up was performed. Recurrence, Visual Analogue Scale (VAS) score, Subjective Shoulder Value (SSV), satisfaction, and whether they would undergo the same surgery again, and rate, level and timing of return to play, and Shoulder Instability-Return to Sport after Injury (SIRSI) score were evaluated. Multi-linear regression models were used to evaluate factors affecting postoperative Satisfaction, and SSV level. RESULTS Overall, 144 athletes who underwent arthroscopic Bankart repair were included, with a mean age of 26.9 years (SD: 8.1), 132 (91.7%) were males, and mean follow-up of 75.7 months. At final follow up, 82.6% were satisfied/very satisfied, and the mean SSV was 85.8 (SD: 14.4). Overall, the rate of return to play was 80.5%, with 63.9% returning at the same level at a mean of 6.2 months (SD: 2.7). Overall, there was 18 (12.5%) had recurrent instability, and a further procedure was performed in 15 (10.4%) patients. Linear regression revealed that the SIRSI score (p

Purpose The purpose of this study was to systematically review the evidence in the literature to ascertain whether acetabular labral repair (ALR) or debridement (ALD) resulted in superior patient outcomes. Methods The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Peer-reviewed studies comparing ALR and ALD published in English with full text available were included. Patients undergoing both open and arthroscopic surgery in randomized controlled trials, prospective cohort studies, retrospective cohort studies, and case-control studies were included. Studies were quantified for methodological quality using the MINORS criteria. Clinical outcomes were compared, with qualitative analysis, and quantitative analyses were performed using GraphPad Prism version 7. A P value

Femoroacetabular impingement (FAI) appears common in ice hockey, but there is a lack of data examining pincer-type impingement in women's ice hockey athletes. The objective of this study was to assess the prevalence of pincer-type impingement in National Women's Hockey League (NWHL) athletes. Our hypothesis was that there would be an increased prevalence of pincer impingement in these athletes.Data were gathered for a team of NWHL players, and age, gender, and body mass index (BMI) matched controls were also retrospectively collected. All subjects were above 18 years of age. Control patients were excluded if they had undergone prior hip surgery, were greater than age 30, or had BMI greater than 35. Radiographs of both groups were assessed for lateral center edge angle (LCEA), Tönnis angle, and crossover sign. Tönnis angle0 or LCEA40 degrees was considered pincer morphology. An alpha angle55 degrees was considered cam morphology.Thirty-seven NWHL players and 37 female controls were included. Overall 32% of the players had a pincer lesion in either hip based on LCEA, 8% had a Tönnis angle0, and 22% had a crossover sign in either hip compared to 9%, 19%, and 13% for the controls, respectively. None of these findings were significantly different between the groups (p 0.05). An alpha angle ≥55 degrees in either hip was found in 84% of players, but lateral Dunn images for alpha angle measurements were not available for the control group.Pincer-type morphology and crossover signs were present in a larger portion of NWHL players than has been reported in the general population, but these findings were not statistically different than in the control group. Cam-type morphology was even more prevalent in these athletes and may be related to age at menarche due impingement at the physis prior to closure.

Prior studies have examined the role of hip and knee positioning, specifically hip extension and knee flexion, to reduce the risk of sciatic nerve palsy during the Bernese periacetabular osteotomy. They have qualitatively noted that the sciatic nerve moves farther from the connection between the ischial and posterior column osteotomies in hip extension than flexion but has not precisely measured this change in position. This cadaveric study aimed to quantitatively evaluate how hip positioning affects the location of the sciatic nerve relative to the connection between the ischial and posterior column osteotomies. We dissected four cadaveric specimens (three females and one male) with a mean age of 83.0 ± 7.8. An anterior Smith–Peterson approach was performed to allow the cuts for the periacetabular osteotomy (PAO). A posterolateral approach was taken to identify the sciatic nerve and its emergence from the pelvis. Measurements were performed on the width of the posterior column and, in both hip flexion and extension, the distance from the emergence of the sciatic nerve from the pelvis to the connection point between the ischial and posterior column osteotomies. Each measurement was performed independently by two observers. All data are reported as a mean ± standard deviation (range). The width of the posterior column was 4.84 ± 0.48 cm (range: 4.20–5.35 cm). The distances from the sciatic nerve's emergence to the osteotomy connection point in extension and flexion were 4.73 ± 0.79 and 2.93 ± 0.85 cm, respectively. The distance from the sciatic nerve's emergence to the osteotomy connection point was significantly greater in hip extension than hip flexion (p = 0.021). When the hip is flexed, the distance from the sciatic nerve to the posterior column osteotomy connection point is significantly less than when it is in extension. This anatomic finding is essential for surgical safety, as it provides further evidence on the importance of positioning for reducing the risk of sciatic nerve injury during a PAO.

Purpose The purpose of this study is to evaluate the short-term complication rate following the open and arthroscopic Latarjet procedures and to meta-analyze the studies comparing the 2 approaches. Methods PubMed was searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to find clinical and biomechanical studies comparing complication rates in open and arthroscopic Latarjet procedures. A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the PRISMA guidelines. Clinical studies reporting on the complications following the open or arthroscopic Latarjet were included. Meta-analysis was performed for comparative studies using Review Manager, version 5.3. A P value of Results Overall, 89 studies (Level of Evidence [LOE] I: 2, LOE II: 2, LOE III: 24, LOE IV: 61) met inclusion criteria, with 7175 shoulders. Following the open Latarjet procedure, the overall complication rate was 6.1%, with a 1.9% occurrence of graft-related complications, 1.1% hardware, 1.1% wound, 0.9% nerve, and 1.2% other complications. Following the arthroscopic Latarjet procedure, the overall complication rate was 6.8%, with a 3.2% occurrence of graft-related complications, 1.9% hardware, 0.5% wound, 0.7% nerve, and 0.5% other complications. Complications were reported in 7 studies comparing 379 patients treated with the open Latarjet and 531 treated with the arthroscopic Latarjet, with no statistically significant difference between the two (P = .81). Conclusion Our study established that the overall complication rate following the Latarjet procedure was 6%-7%, with the most common complication being graft-related. Furthermore, based on the current evidence, there is no significant difference in the complication rate between the open and arthroscopic Latarjet procedures.

The role of the iliopsoas as an obstructing and re-dislocating factor in developmentally dislocated hips is unclear. The purpose of this article is to determine the change in the iliopsoas' tension during flexion and extension when performing an open reduction. We evaluated 34 hips undergoing an anterior open reduction for a developmental dislocation. At the time of surgery, we identified the iliopsoas, and before sectioning it as part of the open reduction, we measured the tension while cycling the reduced hip through flexion and extension. We performed statistical analysis using Pearson and Spearman correlation tests. We created an initial tension artificially at 20 N with the hip held in 90º of flexion, which then doubled to a mean of 42 N when placed in extension. We found a significant increase in tension when the hip went below 20º of flexion. We also found the correlation between the angle of the hip and the force of tension to be statistically significant (P = 0.003). This study provides quantitative support that the tension of the iliopsoas tendon increases significantly in extension when performing an open reduction of a developmentally dislocated hip.

Purpose The purpose of this study was to survey the members of North American and European shoulder surgery and sports medicine societies to evaluate their criteria for deciding when an athlete can safely return to play (RTP) following shoulder stabilization surgery. Methods A survey was sent to the members of the American Shoulder and Elbow Surgeons (ASES), American Orthopaedic Society for Sports Medicine (AOSSM), European Society for Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), and European Society for Surgery of the Shoulder and the Elbow (SECEC). Surgeons were asked which criteria they used to determine when an athlete can return to play following the arthroscopic Bankart repair and Latarjet procedures, with additional questions on how time from surgery and participation in collision sports affect return. Results Overall, 317 surgeons responded to the survey. Following arthroscopic Bankart repair, the most common criteria used were time (98.7%), strength (74.8%), and range of motion (70%). The most commonly reported time point was 4 months (43.8%), and the majority used an additional time period, most commonly 2 months (38.2%), before allowing a collision athlete to return to play (75.4%). Interestingly, the addition of a remplissage procedure did not affect decision making regarding RTP in most cases (92.1%). Following the Latarjet procedure, the most common criteria used were time (98.4%), strength (67.5%), and range of motion (65.9%). Less than half reported using imaging to assess for radiographic union before allowing patients to return to play (47%), and the most common modality was plain radiography (80%). The most common time point was 4 months (33.1%), and the majority reported waiting an additional period of time, most commonly by 2 months (25.9%), before allowing a collision athlete to return to play (59.6%). Conclusion Despite the absence of evidence-based guidelines on when athletes can safely return to play following shoulder stabilization surgery, there exists minimal variability in recommendations between North American and European shoulder surgeons. Further research is required to better define criteria for RTP after the arthroscopic Bankart repair and Latarjet procedures.

Extensor mechanism ruptures (EMR) of the knee are rare but debilitating injuries that always require surgery to restore knee function. The purpose of this study was to systematically review the literature to ascertain the rate of return to play following patellar or quadriceps tendon ruptures. A systematic literature search was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the EMBASE, MEDLINE, and Cochrane Library databases. Inclusion criteria consisted of clinical studies reporting on return to play after patellar or quadriceps tendon repair. Statistical analysis was performed with the use of SPSS. Our review found 48 studies including 1135 cases meeting our inclusion criteria. There were 33 studies including 757 patellar tendon (PT) repairs, and 18 studies including 378 quadriceps tendon (QT) repairs. The overall rate of return to play for PT repairs was 88.9%, with 80.8% returning to the same level of play. The overall rate of return to play for QT repairs was 89.8%, with 70.0% returning to the same level of play. Among professional athletes, the overall rate of return to play after PT repair and QT repair was 76.9% and 70.9%, respectively. Following PT repair, 95.8% were able to return to work, and following QT repair, 95.9% were able to return to work. The overall rate of return to play was high following both PT and QT repairs. Moreover, a high percentage of those patients were able to return to their pre-operative level of sport with a low risk for re-rupture. Level IV.

This case presentation described a technique for repairing an acute quadriceps tendon rupture with suture anchors. The patient was a 51-year-old man who sustained an acute quadriceps tendon rupture after a fall. We used a midline incision over the quadriceps tendon and muscle. The tendon was found to be completely avulsed from the superior border of the patella. Three suture anchors were used to re-approximate the quadriceps tendon to the patella and additional sutures were used to repair the medial and lateral patellar retinacula. The patient had excellent range of motion at his 6-week follow-up appointment after the procedure.

As platelet-rich plasma injection for knee osteoarthritis (OA) has increased in popularity, it has become more important to assess its effectiveness and satisfaction with its use in the context of its high cost. The purpose of this study was to determine satisfaction, commercial appeal, and effectiveness of platelet-rich plasma (PRP) for the treatment of knee OA. A retrospective review of patients who underwent PRP injection in the knee from 2016 to 2019 was performed. Various patient-reported outcomes were collected, including: satisfaction with the PRP injection (out of 100), whether the patient would want to undergo PRP injection again, whether they would recommend the injection and whether they felt that the injection was worth the cost was collected. VAS pain scores were collected and measured out of 100. Demographics and radiographical information were obtained via chart review. Statistical analyses were conducted including descriptive statistics and binary logistic and linear regressions. Overall, 114 patients were included. The mean pre-injectionpain score was 70.4, and the mean pain level decreased after injection to 36.8. Patients rated their satisfaction on average as neutral along the aforementioned continuous scale (49.2), , 50.9% stated that they would get the PRP injection again, 60.5% would recommend to a friend, and 50.9% felt the injection was worth the cost. Younger age and improved post-injection pain correlated with increasing likelihood of desiring further PRP injection. Patients on average rated satisfaction slightly below average, indicating net neutrality in terms of satisfaction with their injection. Furthermore, only half of the patients indicated that it was worth the cost and that they would receive it again. Younger age and post-injection pain relief increased desire for further injection, but pain-relief did not correlate with patients saying that the injection was worth the cost.

A 17-year-old adolescent boy presented with continued knee pain, swelling, and mechanical symptoms after anterior cruciate ligament (ACL) reconstruction with partial meniscectomy. The patient eventually underwent ACL revision surgery that was without complications. Postoperatively, the well leg grew firm with associated neurological deficits, and physical examination confirmed compartment syndrome of the lower leg compartments that resolved with emergency fasciotomy. The patient proceeded on normal postoperative course.Compartment syndrome of the well leg is a rare complication in the field of sports medicine, owing to the relatively healthy and young demographic, but providers should nonetheless be vigilant to prevent disastrous sequalae.

Background: Exertional compartment syndrome (ECS) is an underdiagnosed cause of lower extremity pain among athletes. The condition can be managed operatively by fasciotomy to relieve excess compartment pressure. However, symptom recurrence rates after fasciotomy are considerable, ranging from 3% to 17%. Hypothesis: Leg paresthesia and its distribution during ECS episodes would be a significant predictor of outcomes after fasciotomy. Study Design: Retrospective cohort study. Level of Evidence: Level 4. Methods: We conducted a retrospective chart review of patients who underwent fasciotomy for ECS at our center from 2010 to 2020 (institutional review board no. 21-00107). We measured postoperative outcomes including pain frequency and severity, Tegner activity level, and return to sport. Significant predictors of outcomes were identified using multivariable linear and logistic regression. P values Results: A total of 78 legs (from 42 male and 36 female participants) were included in the study with average follow-up of 52 months (range, 3-126 months); 33 participants (42.3%) presented with paresthesia. Paresthesia was an independent predictor of worse outcomes, including more severe pain at rest ( P = 0.05) and with daily activity ( P = 0.04), reduced postoperative improvement in Tegner scores ( P = 0.04), and lower odds of return to sport ( P = 0.05). Those with paresthesia symptoms in the tibial nerve distribution had worse outcomes than those without paresthesia in terms of preoperative-to-present improvement in pain frequency ( P < 0.01), pain severity at rest ( P < 0.01) and with daily activity ( P = 0.04), and return to sport ( P = 0.04). Conclusion: ECS patients who present with paresthesia have worse pain and activity outcomes after first-time fasciotomy, but prognosis is worst among those with tibial nerve paresthesia. Clinical Relevance: Paresthesia among ECS patients is broadly predictive of more severe recurrent leg pain, reduced activity level, and decreased odds of return to sport after fasciotomy.

Background: The American Academy of Orthopaedic Surgeons (AAOS) clinical practice guidelines (CPGs) note “strong” evidence that early and delayed mobilization protocols after small to medium arthroscopic rotator cuff repairs achieve similar rotator cuff healing rates. Purpose: We utilized the reverse fragility index (RFI) to assess the fragility of randomized controlled trials (RCTs) reporting no statistically significant difference in tendon re-tear rates after rotator cuff repair in those undergoing early versus delayed rehabilitation. Methods: Randomized controlled trials used in the most recent AAOS CPGs on the timing of postoperative mobilization after arthroscopic rotator cuff repairs were analyzed. Only RCTs with a reported P value ≥ .05 were included. The RFI at a threshold of P < .05 was calculated for each study. The reverse fragility quotient (RFQ) was calculated by dividing the RFI by the study sample size. Results: In 6 clinical trials with a total of 542 patients, the number of tendon re-tear events was 48. The median RFI at the P < .05 threshold was 4 (range: 3.25–4.75), and the median RFQ was .05 (range: 0.03–0.08). The median loss to follow-up was 6 patients. Of the 6 studies investigated, 3 reported a loss to follow-up greater than their respective RFI. Conclusion: The equivalence in rotator cuff repair healing rates associated with early and delayed mobilization protocols rests on fragile studies, as their statistical non-significance can be reversed by changing the outcome status of only a handful of patients. Consideration should be given to the routine reporting of RFI in clinical practice guidelines including RCTs with statistically non-significant results.

Prior studies of hamstring tendon tears have reported varied findings on whether increased delay from injury to surgery is associated with worse outcomes. The purpose of this study was to determine whether increased time from injury to surgical repair is associated with worse clinical outcomes in patients with proximal hamstring ruptures.Patients who underwent surgical repair of a proximal hamstring rupture from 2010 to 2019 were followed for a minimum of 24 months from surgery. A cutoff of 6 weeks from injury to the time of surgery was used to distinguish between acute and chronic ruptures. All patients completed patient-reported outcome measures (PROs) at the final follow-up. Multiple factors were analyzed for their effects on PROs including time to surgery, amount of tendon retraction, and demographics such as sex and age.Complete data sets were obtained for 38 patients at a mean follow-up of 4.9 years. All data is reported as a mean ± standard deviation. Patients who underwent acute repair of proximal hamstring ruptures had significantly greater Perth Hamstring Assessment Tool (PHAT) scores than those who underwent chronic repair (76.9 ± 18.8 vs 60.6 ± 18.2, p = 0.01). Increased time to surgery was significantly correlated with worse PHAT scores (ρ = - 0.47, p = 0.003). There was no difference in PROs based on the amount of tendon retraction, number of tendons torn, sex, smoking status, or BMI.This study found that acute repair performed within 6 weeks of injury appears to yield improved PROs compared to chronic repair. These data highlight the importance of timely and accurate diagnosis of proximal hamstring ruptures and early operative intervention for surgical candidates.

Background: The minimal clinically important difference (MCID) is a term synonymous with orthopaedic clinical research over the past decade. The term represents the smallest change in a patient-reported outcome measure that is of genuine clinical value to patients. It has been derived in a myriad of ways in existing orthopaedic literature. Purpose: To describe the various modalities for deriving the MCID. Study Design: Narrative review; Level of evidence, 4. Methods: The definitions of common MCID determinations were first identified. These were then evaluated by their clinical and statistical merits and limitations. Results: There are 3 primary ways for determining the MCID: anchor-based analysis, distribution-based analysis, and sensitivity- and specificity-based analysis. Each has unique strengths and weaknesses with respect to its ability to evaluate the patient’s clinical status change from baseline to posttreatment. Anchor-based analyses are inherently tied to clinical status yet lack standardization. Distribution-based analyses are the opposite, with strong foundations in statistics, yet they fail to adequately address the clinical status change. Sensitivity and specificity analyses offer a compromise of the other methodologies but still rely on a somewhat arbitrarily defined global transition question. Conclusion: This current concepts review demonstrates the need for (1) better standardization in the establishment of MCIDs for orthopaedic patient-reported outcome measures and (2) better study design—namely, until a universally accepted MCID derivation exists, studies attempting to derive the MCID should utilize the anchor-based within-cohort design based on Food and Drug Administration recommendations. Ideally, large studies reporting the MCID as an outcome will also derive the value for their populations. It is important to consider that there may be reasonable replacements for current derivations of the MCID. As such, future research should consider an alternative threshold score with a more universal method of derivation.

Background During the COVID impacted 2020-2021 season of the English soccer league, there was an appreciable number of injuries experienced by players. These injuries however, have not been quantified against previous seasons to highlight the altered season as a causative factor. Methods A review of an online database was conducted to search for injuries to football players in the Premier League across three seasons; 2018-2019, 2019-2020, and 2020-2021, to compare for difference in injury rates across the years and assess for higher rates in this current season, where athletes have had less play time due to COVID-19. Injury number and injury characteristics were abstracted from the online database Transfermarkt, with the provided information allowing for the sorting of the data into muscular and ligamentous injuries and skeletal injuries. Results Overall 226, 260, and 289 muscular and ligamentous injuries were observed across the 2018/2019, 2019/2020, and 2020/2021 seasons, respectively. There were 495 minutes on average played leading up to first injury in the 2020/2021 season, compared with 521 minutes in the 2019/2020 season and 536 minutes in the 2018/2019. There was an average of games played to injury of 5.6 games in the 2020/2021 year, with 6.0 in the 2019/2020 year and 6.1 in the 2018/2019 year. Additionally, there was a significantly shorter time in between games was noted during the COVID-affected season with a mean time of 6.8 days in-between games played during the 2020-2021 season as compared to the previous years of 9.12 and 7.12 days. Conclusion Our study found that there were more injuries and a decreased time to first injury observed during the COVID-impacted 2020-2021 season than the two preceding seasons, perhaps demonstrating a link between fixture congestion and athlete injuries as evidenced by the significantly shorter time between games. It is therefore prudent to retain fixture spacing for athlete recovery even against the backdrop of an overall shortened season.

To determine whether increased joint hypermobility, quantified by the Beighton score, is associated with a greater incidence of iliopsoas tendinitis (IPT) in postoperative hip arthroscopy patients treated for femoroacetabular impingement (FAI).We conducted a retrospective chart review of patients who underwent hip arthroscopy for labral repair and FAI from 2016 to 2020 for whom at least 12 months of follow-up data were available. The Beighton score was measured by a blinded, independent reviewer. IPT was clinically diagnosed by a sports medicine fellowship-trained orthopaedic surgeon through physical examination. Patients with a diagnosis of IPT were matched at a 1:1 ratio to controls based on age, sex, and body mass index. Demographic characteristics, radiographs and advanced imaging, surgical characteristics, and corticosteroid injection therapy data were obtained via chart review. Statistical analysis was conducted using Mann-Whitney testing and binary logistic regression.Forty patients in whom postoperative IPT developed were identified and matched to 40 control patients in whom postoperative tendinitis did not develop. Increased joint hypermobility, quantified by the Beighton score, was associated with an increased risk of IPT. For each 1-point increase in the Beighton score, there was a 1.69 (95% confidence interval, 1.25-2.29; P.001) increased odds of IPT development postoperatively. A high (≥4) versus low (4) Beighton score was associated with an increased likelihood of tendinitis (odds ratio, 9.82; 95% confidence interval, 2.79-34.58; P.001). However, there was no association between greater Beighton scores and patients' likelihood of receiving a corticosteroid injection (P = .173).Increased joint hypermobility, quantified by the Beighton score, is associated with an increased risk of IPT developing in the hip arthroscopy postoperative period in patients treated for FAI and labral pathology.Level III, retrospective cohort study.

Purpose The purpose of the current study is to perform a systematic review of the literature and evaluate maximum medical improvement and minimal clinically important difference (MCID) of different injectables in the treatment of symptomatic knee osteoarthritis. Methods A systematic review was performed to evaluate maximum medical improvement and MCID in patients undergoing injections of different modalities for knee osteoarthritis. Demographic factors of the patients being reviewed were analyzed, with patient-reported outcomes as reported by visual analog scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) being used to evaluate the clinical trajectory of patients receiving intra-articular injections. Results Overall, 79 (level of evidence I: 79) studies met inclusion criteria, with 8761 patients. Corticosteroid (CS) injections, middle molecular weight hyaluronic acid (MMW-HA), and leukocyte-rich platelet rich plasma (LR-PRP) injections reached their maximum pain control at 4 to 6 weeks after injection, as measured by VAS. The lowest VAS scores were reached for low molecular weight hyaluronic acid (LMW-HA), high molecular weight hyaluronic acid (HMW-HA), and leukocyte-poor platelet rich plasma (LP-PRP) by 3 months after injection. Similarly, the WOMAC scores were lowest at 4 to 6 weeks after CS and MMW-HA injections, and at 3 months after HMW-HA and LP-PRP injections. LR-PRP demonstrated the most prolonged pain relief relative to the other injection types, with the lowest VAS score of all groups measured at final follow-up. LP-PRP showed the lowest WOMAC scores at final follow-up, one year post-injection. Conclusion PRP injections provide continued pain relief at up to 1 year after injection. Corticosteroids and hyaluronic acid have good efficacy and are suitable for many patients but lack this longevity. Level of Evidence Level I, a systematic review of Level I studies.

The purpose of this study was to evaluate the outcomes of athletes 5-years post-operatively following arthroscopic Bankart repair, and to evaluate factors associated with satisfaction and shoulder function, as defined by subjective shoulder value.A retrospective review of athletes who underwent arthroscopic Bankart repair, with a minimum of 5-year follow-up was performed. Recurrence, Visual Analogue Scale (VAS) score, Subjective Shoulder Value (SSV), satisfaction, and whether they would undergo the same surgery again, and rate, level and timing of return to play, and Shoulder Instability-Return to Sport after Injury (SIRSI) score were evaluated. Multi-linear regression models were used to evaluate factors affecting postoperative Satisfaction, and SSV level.Overall, 144 athletes who underwent arthroscopic Bankart repair were included, with a mean age of 26.9 years (SD: 8.1), 132 (91.7%) were males, and mean follow-up of 75.7 months. At final follow up, 82.6% were satisfied/very satisfied, and the mean SSV was 85.8 (SD: 14.4). Overall, the rate of return to play was 80.5%, with 63.9% returning at the same level at a mean of 6.2 months (SD: 2.7). Overall, there was 18 (12.5%) had recurrent instability, and a further procedure was performed in 15 (10.4%) patients. Linear regression revealed that the SIRSI score (p 0.0001), SSV (p 0.0001), VAS (p 0.0031), no sleep trouble (p = 0.0129) was associated with satisfaction. Logistic regression revealed whether a patient required revision surgery (p = 0.0029), or had re-dislocation (p = 0.0031) was also associated with satisfaction. Linear regression revealed that the SIRSI score (p 0.0001), VAS score (p 0.0001), and no sleep trouble (p 0.0001), were associated with SSV score.There was a high rate of satisfaction at 5-year follow-up, with excellent patient-reported outcomes and a high rate of return to play among athletes. However, there was a moderate rate of recurrent instability and further revision surgery. This study identified that the SIRSI score, VAS score, no sleep trouble and ability to return to play at the same level were associated with both satisfaction and SSV score.III.

Background The purpose of this study is to systematically review the literature and evaluate patient-reported outcomes and complication/revision rates of bone block augmentation in the treatment of posterior shoulder instability (PSI). Methods PubMed was searched according to PRIMSA guidelines to find clinical studies evaluating patient-reported outcomes, revision, and complication rates in posterior bone block for PSI. A literature search of MEDLINE, EMBASE, and the Cochrane Library was performed based on the PRISMA guidelines. Clinical studies reporting on the complications following posterior bone block were included. Results Overall, 11 studies (level of evidence [LOE] III: 2, LOE IV: 9) met inclusion criteria, with 225 shoulders. Recurrent instability after the posterior bone block was found to be 9.8%. The overall complication rate was 13.8%, with 0.89% having graft complications, 11.1% having hardware complications, 0.4% having wound complications, 0.4% having nerve complications, and 0.89% having other complications. Residual pain was found in 11.6% of shoulders operated on. Patient-reported outcomes were evaluated most commonly by Rowe (81.4%), Constant (84.6%), and Walch-Duplay scores (81.6%). Conclusion There is a moderate rate of recurrence following posterior bone block for PSI. However, the patient-reported outcomes are high despite there being commonly reported persistent shoulder pain postoperatively.

Extensor mechanism ruptures (EMR) of the knee are rare but debilitating injuries that always require surgery to restore knee function. The purpose of this study was to systematically review the literature to ascertain the rate of return to play following patellar or quadriceps tendon ruptures.A systematic literature search was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the EMBASE, MEDLINE, and Cochrane Library databases. Inclusion criteria consisted of clinical studies reporting on return to play after patellar or quadriceps tendon repair. Statistical analysis was performed with the use of SPSS.Our review found 48 studies including 1135 cases meeting our inclusion criteria. There were 33 studies including 757 patellar tendon (PT) repairs, and 18 studies including 378 quadriceps tendon (QT) repairs. The overall rate of return to play for PT repairs was 88.9%, with 80.8% returning to the same level of play. The overall rate of return to play for QT repairs was 89.8%, with 70.0% returning to the same level of play. Among professional athletes, the overall rate of return to play after PT repair and QT repair was 76.9% and 70.9%, respectively. Following PT repair, 95.8% were able to return to work, and following QT repair, 95.9% were able to return to work.The overall rate of return to play was high following both PT and QT repairs. Moreover, a high percentage of those patients were able to return to their pre-operative level of sport with a low risk for re-rupture.Level IV.

Background: The Latarjet procedure is indicated in patients with risk factors for postoperative recurrence, including collision and competitive athletes. However, the factors that prevent athletes from being able return to play (RTP) after the open Latarjet procedure are still unclear and have not been fully elucidated in the literature. Purpose: To evaluate patient-reported outcomes and psychological and psychosocial factors associated with athletes who did not RTP after the open Latarjet procedure compared with patients who did RTP. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a retrospective review of athletes who underwent the open Latarjet procedure and subsequently did not RTP after a minimum of 12 months. These patients were pair matched in a 2:1 ratio for age, sex, sport, and level of preoperative play with a control group who returned to play. Patients were evaluated for their psychological readiness to return to sport using the Shoulder Instability–Return to Sport after Injury (SIRSI); other measures included the visual analog scale (VAS) for pain and Subjective Shoulder Value (SSV). Multivariate regression models were used to evaluate factors affecting RTP. Results: Included were 35 patients in the no-RTP group and 70 patients in the RTP group. In the no-RTP group, 7 patients (20%) passed the SIRSI benchmark of 56, with a mean overall score of 41.5 ± 21.9; in the RTP group, 57 patients (81.4%) passed the SIRSI benchmark, with a mean overall score of 74.5 ± 19.8 ( P < .0001 for both). Patients in the RTP group had better SSV (88.0 vs 75.7; P Conclusion: Patients who did not RTP after open Latarjet exhibited poor psychological readiness to RTP and worse pain VAS and SSV scores compared with patients who did RTP.