Assessment of the duration and effectiveness of intra-articular lidocaine injections for groin pain in patients with labral tears involving early osteoarthritis

Introduction: Intra-articular lidocaine injections have been used to confirm the hip pathology and may predict the efficacy of arthroscopic surgery. We have routinely performed the injections as a surgical indicator. The aim of this study was to assess the duration and effectiveness of these diagnostic intra-articular lidocaine injections on groin pain in patients with labral tears involving early osteoarthritis. Methods: A total of 113 patients were included in this study. All patients received one injection of 10 ml of 1% lidocaine into the hip joint under fluoroscopy. The duration and effectiveness of the injection were assessed 2 weeks after the injection and at a minimum of 1 year of follow-up. The effect of the injection was graded as 0: unchanged or worse; 1: an effect only on the day of injection; 2: the effect lasted a few days; 3: the effect lasted about a week; and 4: symptom remission. In addition, we recorded whether hip arthroscopic surgery was eventually performed. Results: The effect was rated as 0 in 19 patients (16.8%), as 1 in 30 patients (26.5%), as 2 in 38 patients (33.6%), as 3 in 13 patients (11.5%), and as 4 in 13 patients (11.5%). Seventy-two patients (63.7%) underwent hip arthroscopic surgery. No relationship with patients’ characteristics was found. Conclusion: In total, 83% of patients experienced some effect of the lidocaine injection. Furthermore, 11.5% of patients experienced complete remission of their symptoms.

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Outcomes of Hip Arthroscopic Surgery in Patients With Tönnis Grade 1 Osteoarthritis at a Minimum 5-Year Follow-up: A Matched-Pair Comparison With a Tönnis Grade 0 Control Group

The American Journal of Sports Medicine ◽

10.1177/0363546517706957 ◽

2017 ◽

Vol 45 (10) ◽

pp. 2294-2302 ◽

Cited By ~ 28

Author(s):

Benjamin G. Domb ◽

Edwin O. Chaharbakhshi ◽

Danil Rybalko ◽

Mary R. Close ◽

Jody Litrenta ◽

...

Keyword(s):

Arthroscopic Surgery ◽

Arthroscopic Treatment ◽

Matched Pair ◽

Harris Hip Score ◽

Control Group ◽

Pair Comparison ◽

Labral Tears ◽

Vas Scores ◽

Tönnis Grade

Background: Studies on midterm outcomes of the arthroscopic treatment of femoroacetabular impingement (FAI) and labral tears with mild osteoarthritis (OA) are limited. Purpose: To evaluate outcomes of the arthroscopic treatment of FAI and labral tears in patients with mild preoperative OA (Tönnis grade 1) at a minimum 5-year follow-up, and to perform a matched-pair comparison to a control group with Tönnis grade 0. Study Design: Cohort study; Level of evidence, 3. Methods: Data were prospectively collected on patients who underwent hip arthroscopic surgery between February 2008 and April 2011. Inclusion criteria were arthroscopic treatment for FAI and labral tears and having preoperative patient-reported outcome (PRO) scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score–Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) scores for pain. Exclusion criteria were workers’ compensation claims, preoperative Tönnis grade ≥2, and previous hip conditions (ipsilateral surgery, slipped capital femoral epiphysis, avascular necrosis, and dysplasia). Patients with minimum 5-year outcomes were eligible for matching on a 1:1 ratio (Tönnis grade 0 vs 1) based on age ±5 years, body mass index ±5 kg/m2, sex, labral treatment, and capsular treatment. Results: Of 356 eligible hips, 292 hips had minimum 5-year outcomes (82%). Eighty-five hips with Tönnis grade 1 were evaluated. At 5-year follow-up, patients with Tönnis grade 1 had significant improvements in all PRO and VAS scores ( P < .0001). The overall satisfaction score was 8.2. The survivorship rate with respect to conversion to total hip arthroplasty for the Tönnis grade 1 group was 69.4% at 5 years, while in the Tönnis grade 0 group, it was 88.4% ( P = .0002). Sixty-two hips with Tönnis grade 0 were matched to 62 hips with Tönnis grade 1. Both groups demonstrated improvements in all PRO and VAS scores from preoperatively to postoperatively ( P < .0001). No significant differences existed between preoperative or postoperative scores or survivorship between the groups. Conclusion: The arthroscopic treatment of FAI and labral tears in patients with Tönnis grade 1 had good results at 5-year follow-up. After controlling for other variables using a matched-pair comparison, patients with Tönnis grade 1 had similar, durable improvements to those with Tönnis grade 0. While strict surgical indications and appropriate expectations are recommended for patients with mild OA, Tönnis grade 1 alone should not be considered a contraindication to hip arthroscopic surgery.

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Correlation of anti-acetylcholine receptor antibody levels and long-term outcomes of juvenile myasthenia gravis in Taiwan: a case control study

10.21203/rs.2.512/v2 ◽

2019 ◽

Author(s):

cheng che chou ◽

I Chen Su ◽

I Jun Chou ◽

Jainn Jim LIN ◽

Shih Yun Lan ◽

...

Keyword(s):

Complete Remission ◽

Myasthenia Gravis ◽

Acetylcholine Receptor ◽

Autoimmune Thyroid Diseases ◽

Autoimmune Thyroid ◽

Symptom Remission ◽

Receptor Antibodies ◽

Juvenile Myasthenia Gravis ◽

Anti Acetylcholine

Abstract Background Myasthenia gravis is the most common disease affecting the neuromuscular junction. The most common etiology among patients with juvenile myasthenia gravis is the production of antibodies against the acetylcholine receptor. However, the clinical outcome in relation to serum levels of anti-acetylcholine receptor antibodies in juvenile myasthenia gravis has rarely been discussed. We aimed to analyze the correlation between the presence of anti-acetylcholine receptor antibodies and outcome in juvenile myasthenia gravis. Methods Patients diagnosed with juvenile myasthenia gravis younger than of 20 years of age were retrospectively recruited from January 1995 to February 2017 in a tertiary referral medical center. According to the Myasthenia Gravis Foundation of America outcome scale, the primary outcome was complete symptom remission and cessation of medications for at least 1 year measured 2 years after diagnosis. Secondary outcome was complete symptom remission at the last outpatient clinic. Results A total of 54 patients were followed up for over 2 years. Nine patients (9/54, 16.7%) achieved complete remission without medication use at two years after diagnosis. Thirteen (24.1%) patients achieved complete remission during longer follow-up periods. Those with negative anti-acetylcholine receptor antibodies were more likely to achieve complete remission at 2 years (6/15 [40%] vs. 3/39 [7.7%], 95% Confidence interval [CI] 1.670 to 38.323) and at the last outpatient clinic follow-up (8/15 [53.3%] vs. 5/39 [12.8%], 95% CI 2.367 to 20.704). Thirteen patients with comorbid autoimmune thyroid diseases were older than those without disease (11.8 ± 5.8 years old vs. 8.0 ± 6.3 years old, 95% CI 0.018 to 7.33). Moreover, patients negative for anti-acetylcholine receptor antibodies were less likely comorbid with autoimmune thyroid disease (1/35 [2.9%] vs. 12/71 [16.9%], 95% CI 0.018 to 1.161). Conclusions Juvenile myasthenia gravis patients without anti-acetylcholine antibodies exhibited significantly increased complete remission rates and a reduced likelihood of comorbid autoimmune thyroid diseases compared with those with anti-acetylcholine receptor antibodies among Chinese.

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Return to Play After Hip Arthroscopy Among Tennis Players: Outcomes with Minimum Five-Year Follow-up

10.21203/rs.2.14819/v2 ◽

2019 ◽

Author(s):

David R. Maldonado ◽

Mitchell J. Yelton ◽

Philip J. Rosinsky ◽

Jacob Shapira ◽

Mitchell Meghpara ◽

...

Keyword(s):

Hip Arthroscopy ◽

Arthroscopic Surgery ◽

Return To Sport ◽

Return To Play ◽

Harris Hip Score ◽

Tennis Players ◽

Labral Tears ◽

Patient Reported ◽

Modified Harris Hip Score

Abstract Background: Playing tennis is associated with various movements that can lead to labral injuries and may require arthroscopic surgery. While hip arthroscopies have demonstrated good outcomes in athletes, there is limited literature reporting Patient Reported Outcomes (PROs) and return to play in competitive or recreational tennis players after hip arthroscopic surgery. Therefore, the purpose of the present study was to (1) report minimum five-year PROs and return to sport in tennis players who underwent hip arthroscopic surgery and (2) compare outcomes between recreational and competitive tennis players. Methods: Data for patients who underwent hip arthroscopy surgery in the setting of femoroacetabular impingement (FAI) and labral tears between March 2009 and January 2014 and who played tennis at any level within one-year of surgery were retrospectively reviewed. Patients with preoperative and minimum five-year postoperative scores for the following PROs were included: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with preoperative Tönnis osteoarthritis Grade >1, Workers’ Compensation claims, age > 60 years old, or previous ipsilateral hip surgeries or conditions were excluded. Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) for mHHS and HOS-SSS were calculated. Results: Of 28 patients, 31 hips met all inclusion and exclusion criteria of which 28 (90.3%) had minimum 5-year follow-up (mean: 72.8 ± 13.9 months). There were 3 professional, 3 collegiate, 2 high school, 2 organized amateur, and 18 recreational level tennis players. All PROs significantly improved at latest follow-up: mHHS from 67.0 to 86.7 (P < 0.001), NAHS from 65.9 to 87.2 (P < 0.001), HOS-SSS from 50.0 to 77.9 (P = 0.009), and VAS from 5.4 to 1.8 (P < 0.001). There was a 75.0% return to sport rate. Additionally, 66.7% of patients achieved MCID and 83.3% achieved PASS for mHHS, and 63.6% achieved MCID and 58.3% achieved PASS for HOS-SSS. Conclusion: Regardless of the level of participation, tennis players who underwent hip arthroscopic surgery reported statistically significant PRO improvements. A favorable rate of return to sport was also achieved.

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Prospective Analysis of Arthroscopic Hip Anatomic Labral Repair Utilizing Knotless Suture Anchor Technology: The Controlled-Tension Anatomic Technique at Minimum 2-Year Follow-up

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120935079 ◽

2020 ◽

Vol 8 (7) ◽

pp. 232596712093507

Author(s):

David R. Maldonado ◽

Sarah L. Chen ◽

Jeffery W. Chen ◽

Jacob Shapira ◽

Philip J. Rosinksy ◽

...

Keyword(s):

Arthroscopic Surgery ◽

Alpha Angle ◽

Labral Tear ◽

Labral Repair ◽

Harris Hip Score ◽

Labral Tears ◽

Femoroacetabular Impingement Syndrome ◽

Patient Reported ◽

The Mean

Background: Labral tears are the most common abnormalities in patients undergoing hip arthroscopic surgery. Appropriate management is crucial, as it has been shown that better overall outcomes can be achieved with labral restoration. Purpose: To report the patient-reported outcomes (PROs) at minimum 2-year follow-up of patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique in the setting of femoroacetabular impingement syndrome (FAIS). Study Design: Case series; Level of evidence, 4. Methods: Data were prospectively collected for patients who underwent hip arthroscopic surgery for FAIS for labral tear repair using the knotless controlled-tension anatomic technique. Patients were excluded if they had prior hip conditions, prior ipsilateral surgery, Tönnis grade >1, a lateral center-edge angle (LCEA) <25°, or workers’ compensation claims. Preoperative and postoperative scores at minimum 2-year follow-up were recorded for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score (NAHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain. The proportion of patients who achieved the minimal clinically important difference (MCID) or patient acceptable symptomatic state (PASS) for the mHHS, HOS-SSS, and iHOT-12 were also reported. Results: A total of 309 hips were included. The mean patient age was 36.2 years (range, 12.8-75.9 years). The mean preoperative LCEA and alpha angle were 31.9° and 57.1°, respectively. A significant improvement on the mHHS (62.6 ± 15.7 preoperatively vs 86.9 ± 16.2 at 2-year follow-up), NAHS (63.1 ± 16.7 vs 86.1 ± 16.7), and HOS-SSS (39.8 ± 22.0 vs 74.2 ± 27.3) was found ( P < .001 for all). A significant decrease was shown for VAS scores ( P < .001). Also, 78.6% and 82.2% of patients achieved the MCID and PASS for the mHHS, respectively; 60.8% and 69.9% of patients met the MCID and PASS for the HOS-SSS, respectively; and the MCID for the iHOT-12 was met by 77.3% of patients. Conclusion: In the setting of FAIS and labral tears, patients who underwent hip arthroscopic surgery for labral tear repair using the knotless controlled-tension anatomic technique demonstrated significant improvement in several validated PRO measures, the VAS pain score, and patient satisfaction at a minimum 2 years of follow-up. Based on this evidence, labral tear repair using the knotless controlled-tension anatomic technique seems to be a safe option.

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The Effect of Capsulectomy on Hip Joint Biomechanics

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117733433 ◽

2017 ◽

Vol 5 (10) ◽

pp. 232596711773343 ◽

Cited By ~ 6

Author(s):

Neil K. Bakshi ◽

Jen L. Bayer ◽

Erin M.R. Bigelow ◽

Omar F. Jameel ◽

Jon K. Sekiya

Keyword(s):

Hip Joint ◽

Repeated Measures ◽

Arthroscopic Surgery ◽

Compressive Force ◽

Neutral Position ◽

Anterior Translation ◽

Bonferroni Adjustment ◽

Hip Stability ◽

Labral Tears ◽

Significant Difference

Background: Capsulectomy is performed during hip arthroscopic surgery in young adult patients with hip pain to improve intraoperative visualization. The stability of the hip joint after anterior capsulectomy is relatively unknown. Purpose: To evaluate anterior hip stability in capsular sectioned states with a labral injury to test whether the load required for anterior translation would decrease with greater capsular injuries. Study Design: Controlled laboratory study. Methods: Sixteen hips from 8 of 10 human cadaveric pelvises (mean age, 54.25 years) were prepared/mounted onto a custom-built fixture and tested in 5 states: intact capsule, intact labrum (all intact); sutured capsule, intact labrum (sutured intact); sutured capsule, 1-cm partial labrectomy (sutured labrectomy); partial capsulectomy, 1-cm partial labrectomy (partial capsulectomy); and total capsulectomy, 1-cm partial labrectomy (total capsulectomy). Each hip was tested in a neutral position with a 20-N compressive force. The load at 12 mm of anterior translation was recorded for each state after 2 preconditioning trials. Results: A repeated-measures analysis of variance with Bonferroni adjustment showed no difference between the all-intact versus sutured-intact states and demonstrated no significant difference between the sutured-intact and sutured-labrectomy states. There were significant differences between the sutured-labrectomy and partial capsulectomy ( P = .01), sutured-labrectomy and total capsulectomy ( P < .001), and partial capsulectomy and total capsulectomy ( P = .04) states. Conclusion: The findings demonstrate that the capsule/labrum plays an important role in anterior hip stability and that the iliofemoral ligament is crucial for preventing anterior translation in labral-injured states. In addition, the ischiofemoral and pubofemoral ligaments provide resistance to anterior translation in iliofemoral- and labral-deficient states. Intraoperative capsulectomy should be avoided in patients with large, irreparable labral tears to prevent postoperative anterior hip instability. Clinical Relevance: This study quantifies the roles of the capsulolabral structures in anterior hip stability and demonstrates the importance of maintaining/repairing them during hip arthroscopic surgery.

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Arthroscopic Circumferential Acetabular Labral Reconstruction for Irreparable Labra in the Revision Setting: Patient-Reported Outcome Scores and Rate of Achieving the Minimal Clinically Important Difference at a Minimum 2-Year Follow-up

The American Journal of Sports Medicine ◽

10.1177/03635465211005742 ◽

2021 ◽

pp. 036354652110057

Author(s):

Benjamin G. Domb ◽

Cynthia Kyin ◽

Cammille C. Go ◽

Jacob Shapira ◽

Philip J. Rosinsky ◽

...

Keyword(s):

Health Survey ◽

Minimal Clinically Important Difference ◽

Short Form ◽

Arthroscopic Surgery ◽

Patient Reported Outcome ◽

Harris Hip Score ◽

Clinically Important Difference ◽

Labral Tears ◽

Patient Reported

Background: There is a paucity in the literature reporting patient-reported outcome (PRO) scores and the minimal clinically important difference (MCID) after revision hip arthroscopic surgery with circumferential labral reconstruction. Purpose: To report minimum 2-year PRO scores and the rate of achieving the MCID in patients who underwent revision hip arthroscopic surgery with circumferential labral reconstruction in the setting of irreparable labral tears. Study Design: Case series; Level of evidence, 4. Methods: Data were retrospectively reviewed for all patients who underwent revision hip arthroscopic surgery between February 2016 and November 2017. Patients were included if they had undergone circumferential labral reconstruction and had preoperative and postoperative scores for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score Sport-Specific Subscale (HOS-SSS), International Hip Outcome Tool (iHOT-12), 12-Item Short Form Health Survey physical and mental components (SF-12 P and SF-12 M, respectively), Veterans RAND 12-Item Health Survey physical and mental components (VR-12 P and VR-12 M, respectively), and visual analog scale (VAS) for pain. Exclusion criteria were Tönnis grade >1, Legg-Calve-Perthes disease, slipped capital femoral epiphysis, fractures, hip dysplasia, or revision labral treatment different from circumferential labral reconstruction. The MCID was calculated. Secondary surgical procedures were documented. Results: A total of 26 hips (26 patients; 61.5% female) were included. The mean age and body mass index were 33.2 ± 10.4 years and 25.5 ± 4.9, respectively. Significant improvements were reported for the mHHS (17.0 ± 19.5; P = .0002), NAHS (17.9 ± 16.7; P < .0001), HOS-SSS (21.7 ± 23.1; P = .0005), VAS (–2.2 ± 3.0; P = .006), iHOT-12 (25.8 ± 32.5; P = .0007), SF-12 P (8.5 ± 11.2; P = .001), and VR-12 P (8.9 ± 11.6; P = .001). Rates of meeting the MCID for the mHHS, NAHS, HOS-SSS, iHOT-12, and VAS were 76.9%, 80.0%, 65.0%, 62.5%, and 69.2%, respectively. No case of re-revision arthroscopic surgery was documented, but 1 case of conversion to total hip arthroplasty was documented at 38.6 months. Conclusion: In the setting of revision hip arthroscopic surgery and irreparable labral tears, circumferential labral reconstruction resulted in significant improvements in all PRO and VAS scores at a minimum 2-year follow-up with a high rate of achieving the MCID.

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Return to Play After Hip Arthroscopy Among Tennis Players: Outcomes with Minimum Five-Year Follow-up

10.21203/rs.2.14819/v1 ◽

2019 ◽

Author(s):

David R. Maldonado ◽

Mitchell J. Yelton ◽

Philip J. Rosinsky ◽

Jacob Shapira ◽

Mitchell Meghpara ◽

...

Keyword(s):

Hip Arthroscopy ◽

Arthroscopic Surgery ◽

Return To Sport ◽

Return To Play ◽

Harris Hip Score ◽

Tennis Players ◽

Labral Tears ◽

Patient Reported ◽

Modified Harris Hip Score

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Minimum 2-Year Outcomes of Hip Arthroscopic Surgery in Patients With Acetabular Overcoverage and Profunda Acetabulae Compared With Matched Controls With Normal Acetabular Coverage

The American Journal of Sports Medicine ◽

10.1177/0363546517708769 ◽

2017 ◽

Vol 45 (11) ◽

pp. 2483-2492 ◽

Cited By ~ 11

Author(s):

Sivashankar Chandrasekaran ◽

Nader Darwish ◽

Edwin O. Chaharbakhshi ◽

Carlos Suarez-Ahedo ◽

Parth Lodhia ◽

...

Keyword(s):

Patient Satisfaction ◽

Arthroscopic Surgery ◽

Control Group ◽

Study Group ◽

Acetabular Coverage ◽

Inclusion Criteria ◽

Arthroscopic Management ◽

Labral Tears ◽

Lower Magnitude

Background: Advancements in instrumentation and techniques have extended the scope of hip arthroscopic surgery to treat complex osseous deformities that were previously best addressed with an open approach. Global pincer-type femoroacetabular impingement is an example of an abnormality requiring osseous correction with a technically challenging access point. Purpose: To report on the patterns of clinical presentation and intra-articular derangements, radiological associations, and minimum 2-year outcomes after hip arthroscopic surgery in patients with a lateral center edge angle (LCEA) >40° and profunda acetabulae in comparison with matched controls with normal acetabular coverage. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all patients undergoing hip arthroscopic surgery during the study period from April 2008 to April 2013. All patients who had undergone hip arthroscopic surgery for symptomatic labral tears not responsive to a minimum of 3 months of physical therapy with both an LCEA >40° and profunda acetabulae, as defined by the ilioischial line lateral to the medial border of the teardrop, and without a history of hip surgery or hip conditions were included. This group was matched in a 1-to-1 ratio with a control group that had also undergone the arthroscopic management of symptomatic labral tears refractory to a minimum of 3 months of physical therapy with an LCEA between 25° and 40° according to age within 3 years, sex, body mass index category, Tönnis grade, labral treatment, and capsular treatment. Range of motion, impingement signs, and radiographic indices of coverage and version were recorded for each group. Four patient-reported outcome (PRO) scores, the visual analog scale (VAS) for pain, patient satisfaction, revision hip arthroscopic surgery, and conversion to total hip arthroplasty (THA) were also recorded. Results: Thirty-nine patients met the inclusion criteria for the study (overcoverage) group, of which 36 (92.3%) patients had a minimum 2-year follow-up; 215 patients satisfied the inclusion criteria for the control (normal coverage) group, of which 183 (85.1%) had a minimum 2-year follow-up. Thirty-six patients were matched in each group using the above criteria. There was no difference with respect to range of motion and impingement signs between the groups. The study group had significantly higher radiological markers of overcoverage but not retroversion compared with the control group. The study group had a significantly higher incidence of Seldes type 2 tears compared with the control group: 50.0% versus 19.4%, respectively ( P = .013). Both groups demonstrated significant improvements in the mean scores of all PROs, but the study group had a lower magnitude of improvement for all the PROs compared with the control group, with the modified Harris Hip Score (mHHS) achieving statistical significance: 13.5 versus 21.7 points, respectively ( P = .032). The study group had a significantly lower mean patient satisfaction score compared with the control group: 6.61 versus 7.91, respectively ( P = .019). The study group also had a significantly higher incidence of conversion to THA compared with the control group: 4 versus 0, respectively ( P = .040). Conclusion: Hip arthroscopic surgery for the management of symptomatic labral tears in patients with combined overcoverage and coxa profunda is associated with improvements in patient outcomes and pain at a minimum 2-year follow-up. However, the degree of improvement is of lower magnitude compared with a matched cohort with normal coverage undergoing the arthroscopic management of symptomatic labral tears. While hips with lateral overcoverage combined with coxa profunda may have a smaller potential for improvement compared with hips with normal coverage, this type of osseous morphology is still repairable with arthroscopic treatment.

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Selective Debridement With Labral Preservation Using Narrow Indications in the Hip: Minimum 5-Year Outcomes With a Matched-Pair Labral Repair Control Group

The American Journal of Sports Medicine ◽

10.1177/0363546517739566 ◽

2017 ◽

Vol 46 (2) ◽

pp. 297-304 ◽

Cited By ~ 24

Author(s):

Austin W. Chen ◽

Leslie C. Yuen ◽

Victor Ortiz-Declet ◽

Jody Litrenta ◽

David R. Maldonado ◽

...

Keyword(s):

Patient Satisfaction ◽

Health Survey ◽

Arthroscopic Surgery ◽

Labral Repair ◽

Matched Pair ◽

Control Group ◽

Pair Comparison ◽

Labral Tears ◽

The Mean

Background: Arthroscopic labral debridement in the hip can be an effective treatment for labral tears but has demonstrated inferior outcomes compared with labral repair. Thus, the role for labral debridement has become unclear. Hypothesis/Purpose: The purpose was to evaluate the outcomes of a selective debridement with labral preservation (SDLP) group with a minimum 5-year follow-up. It was hypothesized that, with narrow indications, SDLP would produce statistically improved patient-reported outcome (PRO) scores, comparable with those of a matched-pair labral repair control group. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all patients undergoing primary hip arthroscopic surgery between February 2008 and September 2011. Exclusion criteria were acetabular or femoral head Outerbridge grade 4 chondral damage, preoperative Tnnis grade ≥2, workers’ compensation claims, previous hip conditions, severe dysplasia (lateral center-edge angle <18°), or previous ipsilateral hip surgery. Patients who underwent arthroscopic labral debridement and had preoperative and minimum 5-year PRO scores, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), and Hip Outcome Score–Sports-Specific Subscale (HOS-SSS) as well as the visual analog scale (VAS) for pain, were included. In a nested matched-pair comparison, the SDLP group was matched 1:1 to an arthroscopic labral repair control group based on age ±5 years, body mass index ±5 kg/m2, sex, and Seldes tear type. Results: One hundred twenty-five hips were eligible for inclusion, of which 101 (80.8%) hips had a minimum 5-year follow-up. All PRO scores were significantly improved ( P < .001) at latest follow-up (mHHS, 63.4 to 82.4; NAHS, 57.4 to 83.6; HOS-SSS, 44.2 to 74.5). The mean VAS score decreased from 5.8 to 2.3 ( P < .001). The mean patient satisfaction score was 8.1. Four (4.0%) patients underwent second-look arthroscopic surgery (mean, 18.5 months), and 14 (13.9%) patients converted to total hip arthroplasty (mean, 46.9 months). In the matched-pair comparison, 69 in the SDLP group were matched 1:1 with those undergoing labral repair. Outcomes at latest follow-up of the SDLP group were comparable with those of the control group, respectively: mHHS, 83.0 vs 86.1 ( P = .084); NAHS, 85.0 vs 85.4 ( P = .415); HOS-SSS, 74.8 vs 76.8 ( P = .219); VAS, 2.3 vs 2.0 ( P = .277); international Hip Outcome Tool–12 (iHOT-12), 73.8 vs 76.4 ( P = .136); Short Form Health Survey–12 (SF-12) mental, 57.4 vs 55.1 ( P = .031); SF-12 physical, 48.7 vs 48.9 ( P = .357); Veterans RAND Health Survey–12 (VR-12) mental, 61.6 vs 59.8 ( P = .160); VR-12 physical, 50.1 vs 50.2 ( P = .340); and patient satisfaction, 8.0 vs 8.3 ( P = .211). Conclusion: In select cases of stable labral tears, SDLP may allow the preservation of a functional labrum. At a minimum 5-year follow-up, SDLP using narrow indications produced favorable outcomes comparable with a matched-pair labral repair group.

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Return to Play After Hip Arthroscopy Among Tennis Players: Outcomes with Minimum Five-Year Follow-up

10.21203/rs.2.14819/v3 ◽

2020 ◽

Author(s):

David R. Maldonado ◽

Mitchell J. Yelton ◽

Philip J. Rosinsky ◽

Jacob Shapira ◽

Mitchell Meghpara ◽

...

Keyword(s):

Hip Arthroscopy ◽

Cartilage Damage ◽

Arthroscopic Surgery ◽

Return To Sport ◽

Return To Play ◽

Harris Hip Score ◽

Tennis Players ◽

Labral Tears ◽

Patient Reported

Abstract Background: Playing tennis is associated with various movements that can lead to labral injuries and may require arthroscopic surgery. While hip arthroscopies have demonstrated good outcomes in athletes, there is limited literature reporting Patient Reported Outcomes (PROs) and return to play in competitive or recreational tennis players after hip arthroscopic surgery. Therefore, the purpose of the present study was to (1) report minimum five-year PROs and return to sport in tennis players who underwent hip arthroscopic surgery and (2) compare outcomes between recreational and competitive tennis players.Methods: Data for patients who underwent hip arthroscopy surgery in the setting of femoroacetabular impingement (FAI) and labral tears between March 2009 and January 2014 and who played tennis at any level within one-year of surgery were retrospectively reviewed. Patients with preoperative and minimum five-year postoperative scores for the following PROs were included: modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sport Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain. Patients with preoperative Tönnis osteoarthritis Grade >1, Workers’ Compensation claims, age > 60 years old, or previous ipsilateral hip surgeries or conditions were excluded. Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) for mHHS and HOS-SSS were calculated. Results: Of 28 patients, 31 hips met all inclusion and exclusion criteria of which 28 (90.3%) had minimum 5-year follow-up (mean: 72.8 ± 13.9 months). There were 3 professional, 3 collegiate, 2 high school, 2 organized amateur, and 18 recreational level tennis players. All PROs significantly improved at latest follow-up: mHHS from 67.0 to 86.7 (P < 0.001), NAHS from 65.9 to 87.2 (P < 0.001), HOS-SSS from 50.0 to 77.9 (P = 0.009), and VAS from 5.4 to 1.8 (P < 0.001). There was a 75.0% return to sport rate. Additionally, 66.7% of patients achieved MCID and 83.3% achieved PASS for mHHS, and 63.6% achieved MCID and 58.3% achieved PASS for HOS-SSS.Conclusion: Regardless of the level of participation, tennis players who underwent hip arthroscopic surgery reported statistically significant PRO improvements. A favorable rate of return to sport was also achieved by players with a continued interest in playing. The severity of cartilage damage was shown to not influence rate of returned to sport nor PROs in this population. The data here may be useful in counseling tennis players of various levels who are considering arthroscopic treatment of a hip injury.

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