Paper # 237: Clinical Outcome Scores Following Implantation of a Novel Meniscal Scaffold for the Treatment of Irreparable Partial Meniscus Tears and/or Partial Meniscal Tissue Loss, 2 Year Follow Up

Background: The retear rate after primary rotator cuff (RC) reconstruction is high and commonly leads to poorer clinical outcomes and shoulder function. In the case of primary failure, revision RC reconstruction (RCR) has become increasingly important to re-create RC integrity and improve outcomes. To date, clinical and structural outcomes after RCR have not been sufficiently investigated and described at midterm follow-up. Hypothesis/Purpose: The purpose was to evaluate the clinical and radiological outcomes after revision RCR. It was hypothesized that revision RCR significantly improves clinical outcomes and that the outcomes positively correlate with tendon integrity on magnetic resonance imaging (MRI). Study Design: Case series; Level of evidence, 4. Methods: Patients who underwent revision RCR between 2008 and 2014 were retrospectively evaluated with a minimum follow-up of 2 years. Outcomes were assessed by a clinical examination, a visual analog scale for pain (VAS), the Constant Score (CS), the American Shoulder and Elbow Surgeons (ASES) score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Tendon integrity was determined using 3-T MRI and graded according to the Sugaya classification. Results: Thirty-one of 40 patients (77.5%) were available for the final assessment at a mean follow-up of 50.3 ± 20.4 months. Clinical outcome scores significantly improved from preoperatively to postoperatively for the CS (39.7 ± 16.7 to 65.1 ± 19.7; P < .001), ASES (44.2 ± 17.7 to 75.2 ± 24.8; P < .001), and DASH (68.6 ± 15.1 to 21.5 ± 19.1; P < .001). The VAS score decreased from 6.1 ± 1.8 preoperatively to 1.3 ± 1.8 at final follow-up ( P < .001). MRI demonstrated a retear rate of 55.5%. No differences in CS, ASES, and DASH scores were detected between patients with an intact repair and failure. Abduction strength was not significantly different in patients with an intact repair and retears (55.5 N vs 44.0 N, respectively, P = .52). Conclusion: Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. The clinical outcome scores were comparable in patients with an intact repair and those with failed RC healing. Therefore, tendon integrity was not correlated with better clinical outcomes after revision RCR at final follow-up.

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Clinical Presentation and Outcomes Associated With Fabellectomy in the Setting of Fabella Syndrome

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120903722 ◽

2020 ◽

Vol 8 (2) ◽

pp. 232596712090372 ◽

Cited By ~ 1

Author(s):

Travis J. Dekker ◽

Matthew D. Crawford ◽

Nicholas N. DePhillipo ◽

Mitchell I. Kennedy ◽

W. Jeffrey Grantham ◽

...

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Case Reports ◽

Case Series ◽

High Rate ◽

Patient Satisfaction Score ◽

Presenting Symptoms ◽

Patient Reported ◽

Outcome Scores

Background: Clinical outcomes pertaining to isolated lateral fabellectomy in the setting of fabella syndrome are limited to small case reports at this time. Purpose: To assess the most common presenting symptoms, clinical outcomes, and satisfaction after fabella excision in the setting of fabella syndrome. Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients with a minimum of 21-month follow-up after isolated fabellectomy for fabella syndrome were reviewed retrospectively. Clinical outcome scores of the following domains were collected: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and Lysholm knee survey, along with a simple numeric patient satisfaction score (range, 1-10; 10 = “very satisfied”). Statistical analysis was performed using paired t tests for all clinical outcome data. Results: A total of 11 isolated fabella excisions were included in 10 patients with isolated lateral-sided knee pain in the setting of fabella syndrome (8 males, 2 females), with a mean age of 36.9 years (range, 23-58 years) and a mean follow-up of 2.4 years (range, 21-47 months). A total of 8 patients (80%) were able to return to full desired activities, including sports. Only 5 of 11 (45%) excisions had concomitant lateral femoral condyle cartilage pathology. There were significant improvements across multiple WOMAC domains, and the WOMAC total score improved from 28.5 ± 17.6 preoperatively to 11.6 ± 10.2 postoperatively ( P < .05). Lysholm scores significantly improved from 66.6 ± 23.1 preoperatively to 80.2 ± 13.9 postoperatively ( P = .044). Overall patient-reported satisfaction was 8.8 ± 1.6. Conclusion: Fabella excision in the setting of fabella syndrome demonstrated improvements in clinical outcome scores, high rate of returning to preinjury level of activities, and low risk of complications or need for additional surgical procedures.

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Predictive accuracy of RSA migration thresholds for cemented total hip arthroplasty stem designs

Hip International ◽

10.1177/1120700018762179 ◽

2018 ◽

Vol 28 (4) ◽

pp. 363-368 ◽

Cited By ~ 3

Author(s):

Matthew G Teeter ◽

Richard W McCalden ◽

Xunhua Yuan ◽

Steven J MacDonald ◽

Douglas D Naudie

Keyword(s):

Clinical Outcome ◽

Predictive Accuracy ◽

Predictive Tool ◽

Total Hip ◽

Outcome Scores ◽

Long Term Follow Up ◽

Hip Stems ◽

Cemented Total Hip Arthroplasty

Introduction: Radiostereometric analysis (RSA) migration thresholds for cemented total hip stems have been established beyond which an unacceptably high risk of revision is likely to occur. These thresholds are subsidence >0.23 mm or >1.2 mm after 2 years. The purpose of this study was to retrospectively examine after long-term follow-up the predictive accuracy of the two thresholds. Methods: Data from two previous prospective RSA trials with 2 year follow-up for which minimum 10 year survivorship data was available were used. Thirty-six patients received a Spectron stem, 17 patients received an Exeter stem, and 17 patients received a CPCS stem. Subsidence after 2 years was compared to the migration thresholds, and long-term survivorship and clinical outcome scores were obtained. Results: At 2 years, the Spectron stem subsided 0.046 ± 0.160 mm, the Exeter stem subsided 1.218 ± 0.320 mm, and the CPCS stem subsided 0.681 ± 0.246 mm ( p < 0.0001). The Spectron stem passed both thresholds, the Exeter stem failed both thresholds, and the CPCS stem passed 1 and failed 1 threshold. At 10 years, survivorship exceeded 90% for all stems. Conclusion: All stems demonstrated strong 10 year survivorship and equivalent clinical outcome scores, but this success would not have been equally predicted across RSA migration thresholds. Although RSA is a useful predictive tool, care should be taken in applying migration thresholds only to those stem designs they are indicated for, with the threshold of 1.2 mm of subsidence at 2 years being most broadly applicable.

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Surgical Fixation of Chondral-Only Fragments of the Knee: A Case Series With a Mean 4-Year Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120961391 ◽

2021 ◽

Vol 9 (1) ◽

pp. 232596712096139

Author(s):

Andrew Gudeman ◽

Dillen Wischmeier ◽

Jack Farr

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Clinical Outcome ◽

Arthroscopic Surgery ◽

Case Series ◽

Resonance Imaging ◽

Outcome Scores ◽

Surgical Fixation ◽

The Mean

Background: Chondral-only fragments of the knee have traditionally been treated with excision, with or without cartilage restoration procedures. This is because of the historical assumption that cartilage has limited ability to heal to cancellous or subchondral bone. There is now a growing body of evidence supporting surgical fixation of these fragments. Hypothesis: We hypothesized that surgical fixation of chondral fragments would result in acceptable rates of healing with improvement in clinical outcome scores. Study Design: Case series; Level of evidence, 4. Methods: Data were collected on 15 surgically fixed chondral-only fragments in 14 patients. We retrospectively collected participant demographic information, lesion characteristics, primary mechanism (osteochondritis dissecans vs traumatic shear injury), fixation methods, reoperation information, second-look arthroscopic information, and clinical outcome scores. The mean clinical follow-up was 3.96 years, with a minimum of 1-year follow-up. All patients underwent follow-up magnetic resonance imaging at a mean of 2 years after the index procedure. Results: The mean age of our cohort was 17.7 years. We found an 80% survival rate for fixation of the fragments at a mean 4-year follow-up. There were statistically significant improvements in postoperative Knee injury and Osteoarthritis Outcome Score and Tegner scores compared with preoperative scores. Follow-up magnetic resonance imaging scans showed complete healing in 10 knees, partial healing in 2 knees, and loss of fixation in 3 knees. Second-look arthroscopic surgery of 3 knees for reasons other than fragment symptoms showed healing of the fragment, while arthroscopic surgery of 3 symptomatic knees showed loss of fixation. Conclusion: Surgical fixation of chondral-only lesions showed an 80% success rate with improvements in the KOOS and Tegner scores.

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Subscapularis Repair During Reverse Total Shoulder Arthroplasty Using a Stem-Based Double-Row Repair: Sonographic and Clinical Outcomes

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120906806 ◽

2020 ◽

Vol 8 (3) ◽

pp. 232596712090680

Author(s):

Brandon J. Erickson ◽

Yousef Shishani ◽

Meghan E. Bishop ◽

Midhat Patel ◽

Stacy Jones ◽

...

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Total Shoulder Arthroplasty ◽

Tendon Repair ◽

Suture Technique ◽

Subscapularis Tendon ◽

Double Row ◽

Outcome Scores ◽

Reverse Total Shoulder

Background: Treatment of the subscapularis in reverse total shoulder arthroplasty (RTSA) is a controversial topic, with conflicting evidence regarding outcomes after repair. Purpose/Hypothesis: The purpose of this study was to report clinical and sonographic outcomes of a through-implant double-row suture technique for subscapularis repair in RTSA and to compare clinical outcomes and range of motion (ROM) between patients with an intact subscapularis tendon repair versus those whose tendon repair was not intact. The authors hypothesized that the novel repair technique would find more than 80% of tendons intact on ultrasound, with significant improvement in clinical outcome scores and ROM. The authors also hypothesized that patients with an intact subscapularis tendon repair would have better clinical outcomes compared with those with a nonintact tendon repair. Study Design: Case series; Level of evidence, 4. Methods: The study included all patients who underwent RTSA by 1 of 2 surgeons between August 2016 and March 2017 with the through-implant double-row suture technique for subscapularis repair. Subscapularis tendon integrity was assessed postoperatively via ultrasound at minimum 1-year follow-up. American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and pain visual analog scale (VAS) scores were recorded at the final follow-up visit in addition to ROM measures. Results: A total of 48 patients (31 males, 17 females; mean age, 68.9 ± 7.4 years; mean follow-up, 13.8 ± 2.1 months) were included. On ultrasound, the subscapularis was intact in 83.3% of patients. Regarding preoperative versus postoperative outcome scores, the ASES score (mean ± SD) significantly improved from 38.3 ± 14.7 to 81.9 ± 13.6, the SANE score significantly improved from 29.8 ± 24.2 to 75.5 ± 21.0, and the VAS pain score significantly improved from 5.9 ± 2.1 to 1.2 ± 1.6 ( P < .001 for all). Forward flexion and external rotation significantly improved. No significant difference existed in clinical outcome scores or ROM between patients with intact versus torn subscapularis tendons based on ultrasound. Conclusion: Subscapularis repair using a stem-based double-row repair technique during RTSA demonstrated an overall healing rate of 83.3%, as evidenced by ultrasound examination at short-term follow-up. Integrity of subscapularis repair did not affect clinical outcome or ROM.

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Does capsular closure influence patient-reported outcomes in hip arthroscopy for femoroacetabular impingement and labral tear?

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnz025 ◽

2019 ◽

Vol 6 (3) ◽

pp. 199-206 ◽

Cited By ~ 4

Author(s):

Ran Atzmon ◽

Zachary T Sharfman ◽

Barak Haviv ◽

Michal Frankl ◽

Gilad Rotem ◽

...

Keyword(s):

Clinical Outcome ◽

Femoroacetabular Impingement ◽

Hip Arthroscopy ◽

Demographic Data ◽

Labral Tear ◽

Harris Hip Score ◽

Patient Reported ◽

Outcome Scores ◽

The Mean

Abstract Capsulotomy is necessary to facilitate instrument manoeuvrability within the joint capsule in many arthroscopic hip surgical procedures. In cases where a clear indication for capsular closure does not exist, surgeon’s preference and experience often determines capsular management. The purpose of this study was to assess the influence of capsular closure on clinical outcome scores and satisfaction in patients who underwent hip arthroscopy surgery for femoroacetabular impingement (FAI) and labral tear. Data were prospectively collected and retrospectively analysed for hip arthroscopy surgeries with a minimum 2 years follow-up. Patients with developmental dysplasia of the hip, previous back or hip surgeries, and degenerative changes to this hip and secondary gains were excluded. Demographic data, intraoperative findings and patient-reported outcome scores were recorded, including the Modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). A total of 29 and 35 patients were included in the non-closure and closure groups, respectively. The mean follow-up time was over 3 years for both groups. The mean pre-operative and post-operative HOS scores and MHHS scores did not significantly differ between groups (pre-operative HOS: 65.6 and 66.3, P = 0.898; post-operative HOS: 85.4 and 87.2, P = 0.718; pre-operative MHHS: 63.2 and 58.4, P = 0.223; post-operative MHHS: 85.7 and 88.7, P = 0.510). Overall patient satisfaction did not differ significantly between groups (non-closure 86.3%, closure group 88.6%; P = 0.672). Capsular closure did not significantly influence satisfaction or clinical outcome scores in patients who underwent arthroscopic hip surgery for FAI or labral tear.

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Comparison of Structural Subscapularis Integrity After Latarjet Procedure Versus Iliac Crest Bone Graft Transfer

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120958007 ◽

2020 ◽

Vol 8 (10) ◽

pp. 232596712095800

Author(s):

Paul Siegert ◽

Fabian Plachel ◽

Doruk Akgün ◽

Alexander D.J. Baur ◽

Eva Schulz ◽

...

Keyword(s):

Clinical Outcome ◽

Bone Graft ◽

Iliac Crest ◽

Group Versus ◽

Iliac Crest Bone Graft ◽

Latarjet Procedure ◽

Rotation Capacity ◽

Outcome Scores ◽

Tendon Thickness

Background: Although clinical outcome scores are comparable after coracoid transfer procedure (Latarjet) and iliac crest bone graft transfer (ICBGT) for anterior shoulder instability with glenoid bone loss, a significant decrease in internal rotation capacity has been reported for the Latarjet procedure. Hypothesis: The subscapularis (SSC) musculotendinous integrity will be less compromised by ICBGT than by the Latarjet procedure. Study Design: Cohort study; Level of evidence, 3. Methods: We retrospectively analyzed pre- and postoperative computed tomography (CT) scans at short-term follow-up of 52 patients (26 Latarjet, 26 ICBGT) previously assessed in a prospective randomized controlled trial. Measurements included the preoperative glenoid defect area and graft area protruding the glenoid rim at follow-up and tendon thickness assessed through SSC and infraspinatus (ISP) ratios. Fatty muscle infiltration was graded according to Goutallier, quantified with muscle attenuation in Hounsfield units, and additionally calculated as percentages. We measured 3 angles to describe rerouting of the SSC musculotendinous unit around the bone grafts. Results: SSC fatty muscle infiltration was 2.0% ± 2.2% in the Latarjet group versus 2.4% ± 2.2% in ICBGT ( P = .546) preoperatively and showed significantly higher values in the Latarjet group at follow-up (5.3% ± 4.5% vs 2.3% ± 1.7%; P = .001). In total, 4 patients (15.4%) in the Latarjet group showed a progression from grade 0 to grade 1 at follow-up, whereas no changes in the ICBGT group were noted. The measured rerouting angle of the SSC muscle was significantly increased in the Latarjet group (11.8° ± 2.1°) compared with ICBGT (7.5° ± 1.3°; P < .001) at follow-up, with a significant positive correlation between this angle and fatty muscle infiltration ( R = 0.447; P = .008). Ratios of SSC/ISP tendon thickness were 1.03 ± 0.3 in the Latarjet group versus 0.97 ± 0.3 ( P = .383) in ICBGT preoperatively and showed significantly lower ratios in the Latarjet group (0.7 ± 0.3 vs 1.0 ± 0.2; P < .001) at follow-up. Conclusion: Although clinical outcome scores after anterior shoulder stabilization with a Latarjet procedure and ICBGT are comparable, this study shows that the described decline in internal rotation capacity after Latarjet procedure has a radiographic structural correlate in terms of marked thinning and rerouting of the SSC tendon as well as slight fatty degeneration of the muscle.

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Wrist Arthrodesis with Excision of the Proximal Carpal Bones Using the AO/ASIF Wrist Fusion Plate and Local Bone Graft

Journal of Hand Surgery (European Volume) ◽

10.1054/jhsb.2000.0488 ◽

2001 ◽

Vol 26 (3) ◽

pp. 247-251 ◽

Cited By ~ 23

Author(s):

B. J. HARTIGAN ◽

D. J. NAGLE ◽

M. J. FOLEY

Keyword(s):

Clinical Outcome ◽

Bone Graft ◽

Carpal Bones ◽

Secondary Surgery ◽

Wrist Arthrodesis ◽

Local Bone ◽

Outcome Scores ◽

Wrist Fusion ◽

The Mean

We present our series of 17 patients who underwent wrist arthrodesis with excision of the proximal row carpal bones using the AO wrist fusion plate and local bone graft obtained from the excised proximal carpal row. All patients were evaluated using a questionnaire to assess pain, function, ability to perform an occupation and satisfaction with the procedure. The mean follow-up was 17 months, at which time all the fusions had united. Clinical outcome scores showed that 14 and 15 of the 17 patients achieved good or excellent results with regard to their current condition and clinical improvement, respectively. Four patients required secondary surgery, two for fractures and two for instability of the distal radio-ulnar joint unrelated to the wrist fusion.

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Two-Tunnel Transtibial Repair of Radial Meniscus Tears Produces Comparable Results to Inside-Out Repair of Vertical Meniscus Tears

The American Journal of Sports Medicine ◽

10.1177/0363546517704425 ◽

2017 ◽

Vol 45 (10) ◽

pp. 2253-2259 ◽

Cited By ~ 14

Author(s):

Mark E. Cinque ◽

Andrew G. Geeslin ◽

Jorge Chahla ◽

Grant J. Dornan ◽

Robert F. LaPrade

Keyword(s):

Postoperative Outcome ◽

Analysis Of Covariance ◽

Meniscus Tear ◽

Significant Group ◽

Meniscus Tears ◽

Outcome Scores ◽

Pullout Repair ◽

Inside Out ◽

Repair Group

Background: Radial meniscus tears disrupt the circumferential fibers and thereby compromise meniscus integrity. Historically, radial tears were often treated with meniscectomy because of an incomplete understanding of the biomechanical consequences of these tears, limited information regarding the biomechanical performance of repair, and the technical difficulty associated with repair. There is a paucity of studies on the outcomes of the repair of radial meniscus tears. Purpose/Hypothesis: The purpose was to determine the outcomes of 2-tunnel transtibial repair of radial meniscus tears and compare these results to the outcomes of patients who underwent the repair of vertical meniscus tears with a minimum of 2-year follow-up. The hypothesis was that radial and vertical meniscus tear repair outcomes were comparable. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent 2-tunnel transtibial pullout repair for a radial meniscus tear were included in this study and compared with patients who underwent inside-out repair for a vertical meniscus tear. Subjective questionnaires were administered preoperatively and at a minimum of 2-year follow-up, including the Lysholm score, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Short Form–12 (SF-12) physical component summary (PCS), the Tegner activity scale, and patient satisfaction. Analysis of covariance was used to compare postoperative outcome scores between the meniscus repair groups while accounting for baseline scores. Adjusted mean effects relative to the radial repair group were reported with 95% CIs. Results: Twenty-seven patients who underwent 2-tunnel transtibial pullout repair for radial meniscus tears and 33 patients who underwent inside-out repair for vertical meniscus tears were available for follow-up at a mean of 3.5 years (range, 2.0-5.4 years). No preoperative outcome score significantly differed between the groups. There were no significant group differences for any of the 2-year postoperative outcome scores. Relative to the vertical repair group, the radial repair group exhibited an adjusted mean of −0.2 (95% CI, −5.4 to 4.9), −0.6 (95% CI, −6.6 to 5.5), and 5.1 (95% CI, −3.9 to 14.0) points on the SF-12 PCS, WOMAC, and Lysholm scores, respectively. Conclusion: The 2-tunnel transtibial pullout technique for the repair of radial meniscus tears produces similar clinical outcomes when compared with the repair of vertical meniscus tears at a mean 3.5 years’ follow-up.

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