Comparison of Clinical and Radiographic Outcomes Between Central and Lateral Lesions After Osteochondral Autograft Transplantation for Osteochondritis Dissecans of the Humeral Capitellum

2017 ◽  
Vol 45 (14) ◽  
pp. 3331-3339 ◽  
Author(s):  
Takeshi Matsuura ◽  
Yusuke Hashimoto ◽  
Kazuya Nishino ◽  
Yohei Nishida ◽  
Shinji Takahashi ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Rate Of Return ◽  
Return To Sports ◽  
Central Group ◽  
Osteochondral Autograft ◽  
Radiographic Outcomes ◽  
Lateral Group ◽  
The Mean ◽  
Central Lesions

Background: Clinical studies have reported satisfactory results after osteochondral autograft transplantation (OAT) for central lesions of unstable osteochondritis dissecans (OCD) of the elbow. However, the outcomes after OAT for lateral lesions remain unclear. Hypothesis: The clinical outcomes of OAT would be better for central lesions than for lateral lesions. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively evaluated 103 juvenile athletes (mean age, 13.2 years; range, 11-16 years) who underwent OAT for symptomatic OCD of the humeral capitellum from 2003 to 2014. Sixteen patients were excluded because they did not fit the inclusion criteria. The final cohort of 87 patients was divided by lesion type into central lesion (n = 43) and lateral lesion (n = 44) groups. When possible, a single large plug was created for grafting and trimmed to reconstruct the rounded joint surface. The clinical, radiographic, and magnetic resonance imaging outcomes were evaluated for each group at a mean follow-up of 43 months (range, 24-100 months). Results: There were no significant differences in the age, sex, height, weight, duration of symptoms, follow-up time, preoperative range of motion, or Timmerman and Andrews score between the 2 groups. The preoperative osteoarthritic changes (0 of 43 for central vs 5 of 44 cases for lateral; P = .023), mean lesion size (12.2 ± 2.9 vs 18.2 ± 7.0 mm; P < .001), and graft number (1.6 vs 2.8; P < .001) were significantly greater in the lateral group versus the central group. The mean range of extension (2.3° ± 5.4° vs −3.2° ± 8.7°; P < .001) and Timmerman and Andrews score (194 vs 185; P = .006) at the final follow-up were significantly better for patients in the central group. More patients in the lateral group had postoperative radial head subluxation (0 of 43 vs 6 of 44; P = .012) and osteoarthritic changes (1 of 43 vs 9 of 44; P = .008). The mean MOCART score showed no significant differences between the groups (78.0 ± 15.7 vs 72.6 ± 20.9; P = .181). The rate of return to sports at the previous level was 100% in the central group and 86% in the lateral group ( P = .012). Conclusion: The clinical and radiographic outcomes after OAT associated with unstable OCD of the humeral capitellum were better for central lesions than for lateral lesions. However, satisfactory outcomes and a high rate of return to sports were obtained for unstable lateral lesions after OAT.

Clinical Outcome After Arthroscopic Debridement and Microfracture for Osteochondritis Dissecans of the Capitellum

2017 ◽  
Vol 45 (10) ◽  
pp. 2312-2318 ◽  
Author(s):  
Rens Bexkens ◽  
Kim I.M. van den Ende ◽  
Paul T. Ogink ◽  
Christiaan J.A. van Bergen ◽  
Michel P.J. van den Bekerom ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Linear Regression Analysis ◽  
Case Series ◽  
Loose Body ◽  
Return To Sports ◽  
Arthroscopic Debridement ◽  
Duration Of Symptoms ◽  
Point Increase ◽  
The Mean

Background: Various surgical treatment techniques have been developed to treat capitellar osteochondritis dissecans; however, the optimal technique remains the subject of ongoing debate. Purpose: To evaluate clinical outcomes after arthroscopic debridement and microfracture for advanced capitellar osteochondritis dissecans. Study Design: Case series; Level of evidence, 4. Methods: Between 2008 and 2015, the authors followed 77 consecutive patients (81 elbows) who underwent arthroscopic debridement and microfracture, and loose body removal if needed, for advanced capitellar osteochondritis dissecans. Seventy-one patients (75 elbows) with a minimum follow-up of 1 year were included. The mean age was 16 years (SD, ±3.3 years; range, 11-26 years) and the mean follow-up length was 3.5 years (SD, ±1.9 years; range, 1-8.2 years). Based on CT and/or MRI results, 71 lesions were classified as unstable and 4 as stable. Clinical elbow outcome (pain, function, and social-psychological effect) was assessed using the Oxford Elbow Score (OES) at final follow-up (OES range, 0-48). Range of motion and return to sports were recorded. Multivariable linear regression analysis was performed to determine predictors of postoperative OES. Results: Intraoperatively, there were 3 grade 1 lesions, 2 grade 2 lesions, 10 grade 3 lesions, 1 grade 4 lesion, and 59 grade 5 lesions. The mean postoperative OES was 40.8 (SD, ±8.0). An open capitellar physis was a predictor of better elbow outcome (5.8-point increase; P = .025), as well as loose body removal/grade 4-5 lesions (6.9-point increase; P = .0020) and shorter duration of preoperative symptoms (1.4-point increase per year; P = .029). Flexion slightly improved from 134° to 139° ( P < .001); extension deficit slightly improved from 8° to 3° ( P < .001). Pronation ( P = .47) and supination did not improve ( P = .065). Thirty-seven patients (55%) returned to their primary sport at the same level, and 5 patients (7%) returned to a lower level. Seventeen patients (25%) did not return to sport due to elbow-related symptoms, and 10 patients (13%) did not return due to non–elbow-related reasons. No complications were recorded. Conclusion: Arthroscopic debridement and microfracture for advanced capitellar osteochondritis dissecans provide good clinical results, especially in patients with open growth plate, loose body removal, and shorter duration of symptoms. However, only 62% of patients in this study returned to sports.

Investigation for Lesional Onset Site and Patellofemoral Joint Anatomy in Juvenile Femoral Trochlear Osteochondritis Dissecans : A Case Control Study

2021 ◽  
Author(s):  
Mitsuhiro Kimura ◽  
Junsuke Nakase ◽  
Yoshinori Ohashi ◽  
Kazuki Asai ◽  
Rikuto Yoshimizu ◽  
...  
Keyword(s):  
Osteochondritis Dissecans ◽  
Patellofemoral Joint ◽  
Femoral Condyle ◽  
Lateral View ◽  
Tibial Tubercle ◽  
Trochlear Groove ◽  
Return To Sports ◽  
Patellar Tilt ◽  
The Mean

Abstract Background: Femoral trochlear osteochondritis dissecans is an uncommon disease, and its cause remains unknown. We investigated the site of osteochondritis dissecans lesions and the patellofemoral joint anatomy of femoral trochlear osteochondritis dissecans in 15 knees, and assessed the clinical outcomes of the surgical treatments. Methods: We conducted a retrospective study of 15 knees in 14 patients who underwent surgery. The mean age was 13.2 ± 1.0 years at the time of surgery. All patients played athletic sports and experienced no traumatic events. We determined the site of osteochondritis dissecans lesions using the modified Cahill and Berg classification on magnetic resonance imaging scans. We also evaluated the patellofemoral structures with sulcus angle, facet ratio, patellar tilt, patellar height, and tibial tubercle-trochlear groove distance. Results: We performed osteochondral autograft transplantation surgery in nine knees, internal fixation in four knees, and drilling in two knees. The mean follow-up period was 34.5 ± 14.0 months, and the period of return to sports was 6.1 ± 1 months. At the final follow-up, the mean Tegner activity scale was 7.2 ± 1.4 (preoperative score was 7.7 ± 1.0), and the Lysholm knee score was 98.5 (range, 89-100). The area of most preponderance was in the medial portion of the lateral femoral condyle in the frontal view, and in the segment superior two-thirds of the anterior region in the lateral view. There were no anatomical abnormalities in the patellofemoral structures. Conclusions: Femoral trochlear osteochondritis dissecans lesions occurred in virtually identical sites, and there were no anatomical abnormalities. This disease seemed to be related to the repetitive and persistent loading from the patella at slight knee flexion. In almost all cases, satisfactory postoperative results were obtained for osteochondritis dissecans regardless of the stage or surgical method.

Outcome after Combined Lateral Extra-articular Tenodesis and Anterior Cruciate Ligament Revision in Professional Soccer Players

2018 ◽  
Vol 32 (09) ◽  
pp. 906-910 ◽  
Author(s):  
Mattia Alessio-Mazzola ◽  
Matteo Formica ◽  
Antonio Russo ◽  
Francesca Sanguineti ◽  
Andrea Giorgio Capello ◽  
...  
Keyword(s):  
Pivot Shift ◽  
Cruciate Ligament ◽  
Lysholm Score ◽  
Rate Of Return ◽  
Soccer Players ◽  
Return To Sports ◽  
Professional Soccer ◽  
The Mean ◽  
Anterior Cruciate

AbstractWe report the functional outcome after combined anterior cruciate ligament (ACL) reconstruction and lateral extra-articular tenodesis (LET) for ACL re-rupture and high-grade pivot shift in professional soccer players. For this retrospective review, the medical records of 24 professional soccer players were analyzed. The mean age at surgery was 23.8 ± 4.2 years and the mean follow-up was 42.2 ± 16.9 months. Pre- and postoperative assessment included the KT-1000 Lachman test, pivot shift test, International Knee Documentation Committee (IKDC) subjective knee evaluation, Tegner activity scale (TAS), and Lysholm score. The rate of return to sports and the level of play at final follow-up were recorded. ACL revision was performed with an autologous bone–patellar tendon–bone autograft or a hamstring graft. LET was performed using an extra-articular MacIntosh procedure as modified by Arnold–Coker. Anterior–posterior laxity was significantly reduced at the final clinical assessment (p < 0.0001): 22 patients (91.7%) had a negative pivot shift and 2 (8.3%) had residual glide (+), with significant improvement (p < 0.0001). The mean subjective IKDC and Lysholm score improved from 69.5 ± 11.1 (range: 56–90) to 88.4 ± 8.9 (range: 62.1–100) and from 58.1 ± 11.7 (range: 33–72) to 97.4 ± 3.2 (range: 88–100), respectively, with significant improvement (p < 0.0001) over preoperative values. The overall failure rate was 8.3%. There were no differences between mean preinjury and final TAS scores (p > 0.05). The rate of return to sports at the same level was 91.7% and the mean time to return to sports was 9.2 ± 2.2 months. Mid-term functional outcome after combined extra-articular reconstruction and ACL revision surgery was satisfactory, with a reduction in residual postoperative rotatory instability and degree of pivot shift.

scholarly journals Return to Sports After Primary Reverse Shoulder Arthroplasty: Outcomes at Mean 4-Year Follow-up

2021 ◽  
Vol 9 (6) ◽  
pp. 232596712110123
Author(s):  
Jennifer Tangtiphaiboontana ◽  
Kristin C. Mara ◽  
Andrew R. Jensen ◽  
Christopher L. Camp ◽  
Mark E. Morrey ◽  
...  
Keyword(s):  
Shoulder Arthroplasty ◽  
Sport Participation ◽  
Reverse Shoulder Arthroplasty ◽  
Case Series ◽  
Rate Of Return ◽  
Return To Sports ◽  
Limited Information ◽  
High Demand ◽  
The Mean

Background: With the expanding use of reverse shoulder arthroplasty (RSA) to treat various shoulder conditions, there has been a rise in the number of RSAs performed, especially in physically active patients. Limited information regarding sports after RSA is available to properly counsel patients on postoperative expectations. Purpose: To assess the rate of return to sports as well as the ability to return to the same level of preoperative intensity, frequency, and duration of sport after primary RSA. Study Design: Case series; Level of evidence, 4. Methods: This was a retrospective review of patients who underwent primary RSA at our institution between 2014 and 2016. Shoulder motion, Subjective Shoulder Value score, American Shoulder and Elbow Surgeons score, pre- and postoperative sports activities, and barriers to return to sport were assessed in 109 patients after RSA (93 patients with unilateral RSA and 16 patients with bilateral RSA). The mean age at the time of surgery was 70 years (range, 34-86 years), with a mean follow-up of 3.9 years (range, 2-12 years). Results: The mean rate of return to sports was 70.1% (range, 0%-100%). There was no difference in return to sports between those with uni- and bilateral RSA ( P = .64). Fishing, swimming, elliptical/treadmill, and hunting were the most common sports after RSA with return rates of 91%, 73%, 86%, and 82% respectively. A majority of patients returned to the same level of preoperative intensity, frequency, and duration for all sports except for climbing and swimming. There was a lower mean rate of return for high-demand sports (62.9%) compared with low- and medium-demand sports (76.7%) ( P = .005). The most common reasons for inability to return to sports included limited motion, fear of injury, and weakness. Conclusion: Patients who had undergone primary uni- or bilateral RSA reported a 70.1% rate of return to sports with maintenance of the same level of intensity, duration, and frequency of preoperative sport participation. Rates of return to high-demand sports were lower than low- and medium-demand sports. Patients also had difficulty returning to overhead sports.

scholarly journals Return to Play after Arthroscopic Microfracture for Osteochondral Lesions of the Talus in Young Elite Athletes

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0029
Author(s):  
Sung-Jae Kim ◽  
Kyung-tai Lee
Keyword(s):  
Elite Athletes ◽  
Return To Play ◽  
Rate Of Return ◽  
Osteochondral Lesions ◽  
Return To Sports ◽  
Sports Activity ◽  
Vas Score ◽  
Arthroscopic Microfracture ◽  
The Mean

Category: Ankle; Arthroscopy Introduction/Purpose: The current scientific evidence for the clinical and sports-related outcomes of the surgical treatment of osteochondral lesions of the talus (OLTs) with arthroscopic microfracture (MF) in elite athletes is scarce. The purpose of curretn study is to evaluate the clinical outcomes and return to sports activity after arthroscopic MF for OLTs in elite athletes. Methods: The files of 41 elite athletes (mean age 19.34 +- 3.76 years) who had undergone arthroscopic MF for OLTs at our institution between January 2011 and September 2015 were retrospectively reviewed. The Foot and Ankle Outcome Score (FAOS), American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot and visual analog pain (VAS) score, time and rate of ‘return-to-competition’ (RTC, defined as return to an official match for at least one minute after treatment), and rate of ‘return- to-play’ (RTP, defined as participation in at least two entire seasons after treatment) were used to evaluate the outcomes. We compared athletes who were able to RTP (RTP-group) with those who were not (No-RTP group). Results: The mean follow-up was 54.9 +- 13.72 months. All five subscales of preoperative FAOS were significantly improved at the final follow-up. The mean preoperative AOFAS hindfoot score of 74.46 +- 8.10 improved to 91.62 +- 2.99 (P < 0.001) at the final follow-up. The mean preoperative VAS score of 5.44 +- 1.57 improved to 2.66 +- 1.04 (P < 0.001). All patients achieved RTC (100%) at mean time of 5.45 +- 3.18 months, and 74.4% of patients were able to RTP. The RTP-group showed significantly smaller lesions compared to the No-RTP group (71.52 +- 43.29 vs. 107.00 +- 45.28 mm2, P = 0.009). The cut-off OLT size for predicting RTP was 84.0 mm2, with a sensitivity of 90.0% and specificity of 75.9%. Conclusion: All athletes were able to RTC at average of 5.45 months after MF for OLTs, and 74.4% were able to RTP. The only prognostic variable for RTP was lesion size, and its predictive cut-off was 84 mm2.

No Difference in Outcomes Following Osteochondral Allograft with Fresh Precut Cores Compared to Hemi-Condylar Allografts

Cartilage ◽  
2021 ◽  
pp. 194760352110219
Author(s):  
Danielle H. Markus ◽  
Anna M. Blaeser ◽  
Eoghan T. Hurley ◽  
Brian J. Mannino ◽  
Kirk A. Campbell ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Knee Injury ◽  
Lesion Size ◽  
Osteochondral Allograft ◽  
Osteochondral Lesions ◽  
Radiographic Outcomes ◽  
Significant Difference ◽  
Patient Reported ◽  
The Mean

Objective The purpose of the current study is to evaluate the clinical and radiographic outcomes at early to midterm follow-up between fresh precut cores versus hemi-condylar osteochondral allograft (OCAs) in the treatment of symptomatic osteochondral lesions. Design A retrospective review of patients who underwent an OCA was performed. Patient matching between those with OCA harvested from an allograft condyle/patella or a fresh precut allograft core was performed to generate 2 comparable groups. The cartilage at the graft site was assessed with use of a modified Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) scoring system and patient-reported outcomes were collected. Results Overall, 52 total patients who underwent OCA with either fresh precut OCA cores ( n = 26) and hemi-condylar OCA ( n = 26) were pair matched at a mean follow-up of 34.0 months (range 12 months to 99 months). The mean ages were 31.5 ± 10.7 for fresh precut cores and 30.9 ± 9.8 for hemi-condylar ( P = 0.673). Males accounted for 36.4% of the overall cohort, and the mean lesion size for fresh precut OCA core was 19.6 mm2 compared to 21.2 mm2 for whole condyle ( P = 0.178). There was no significant difference in patient-reported outcomes including Visual Analogue Scale, Knee Injury and Osteoarthritis Outcome Score for Joint Replacement, and Tegner ( P > 0.5 for each), or in MOCART score (69.2 vs. 68.3, P = 0.93). Conclusions This study found that there was no difference in patient-reported clinical outcomes or MOCART scores following OCA implantation using fresh precut OCA cores or size matched condylar grafts at early to midterm follow-up.

Criteria for Return to Play After Hip Arthroscopy in the Treatment of Femoroacetabular Impingement: A Systematic Review

2021 ◽  
pp. 036354652110389
Author(s):  
Martin S. Davey ◽  
Eoghan T. Hurley ◽  
Matthew G. Davey ◽  
Jordan W. Fried ◽  
Andrew J. Hughes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Femoroacetabular Impingement ◽  
Hip Arthroscopy ◽  
Operative Management ◽  
Return To Play ◽  
Return To Sports ◽  
Level Of Evidence ◽  
The Mean

Background: Femoroacetabular impingement (FAI) is a common pathology in athletes that often requires operative management in the form of hip arthroscopy. Purpose: To systematically review the rates and level of return to play (RTP) and the criteria used for RTP after hip arthroscopy for FAI in athletes. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature, based on the PRISMA guidelines, was performed using PubMed, Embase, and Scopus databases. Studies reporting outcomes after the use of hip arthroscopy for FAI were included. Outcomes analyzed were RTP rate, RTP level, and criteria used for RTP. Statistical analysis was performed using SPSS software. Results: Our review found 130 studies, which included 14,069 patients (14,517 hips) and had a mean methodological quality of evidence (MQOE) of 40.4 (range, 5-67). The majority of patients were female (53.7%), the mean patient age was 30.4 years (range, 15-47 years), and the mean follow-up was 29.7 months (range, 6-75 months). A total of 81 studies reported RTP rates, with an overall RTP rate of 85.4% over a mean period of 6.6 months. Additionally, 49 studies reported the rate of RTP at preinjury level as 72.6%. Specific RTP criteria were reported in 97 studies (77.2%), with time being the most commonly reported item, which was reported in 80 studies (69.2%). A total of 45 studies (57.9%) advised RTP at 3 to 6 months after hip arthroscopy. Conclusion: The overall rate of reported RTP was high after hip arthroscopy for FAI. However, more than one-fourth of athletes who returned to sports did not return at their preinjury level. Development of validated rehabilitation criteria for safe return to sports after hip arthroscopy for FAI could potentially improve clinical outcomes while also increasing rates of RTP at preinjury levels.

scholarly journals Revascularization versus apical barrier technique with mineral trioxide aggregate plug: A systematic review

2018 ◽  
Vol 32 (1) ◽  
pp. 9-16 ◽  
Author(s):  
Luiz Alexandre Chisini ◽  
Guillermo Grazioli ◽  
Alejandro Francia ◽  
Alissa Schmidt San Martin ◽  
Flavio Fernando Demarco ◽  
...  
Keyword(s):  
Clinical Success ◽  
Mineral Trioxide Aggregate ◽  
Clinical Success Rate ◽  
Permanent Teeth ◽  
Radiographic Outcomes ◽  
Bias Risk ◽  
Radiographic Measurements ◽  
High Bias ◽  
The Mean

Aim: To compare the clinical and radiographic outcomes observed in Necrotic Immature Permanent Teeth (NIPT) after revascularization or apexification with MTA-apical plug. Methodology: PubMed/MEDLINE, Web of science and Scopus were the databases used, up to July 30th, 2017, for article research. Independent reviewers read the titles and abstracts of all reports that met inclusion/exclusion criteria: prospective or retrospective clinical studies comparing the revascularization of root canal and apexification. Clinical success of therapies, deposition and thickening of lateral dentinal walls (root width) and the continuation of root development (root length) were investigated. Bias risk of included studies was assessed using the Cochrane risk of bias. Results: From 1642 records, five papers fulfilled all inclusion criteria. Overall, 91 teeth were submitted to revascularization and 64 teeth to apexification with MTA. The mean follow-up was 23.2 months in revascularization and 21.8 in apexification. Clinical success rate was of 87.9% in the revascularization group and 90.6% in the apexification group. An increase on lateral dentinal walls thickening was observed in most revascularization cases (13%) while MTA as apical plug suggest a mild resorption of the root (1.3%). High bias risk was observed on included studies. Conclusions: Apexification with MTA-apical plug provides similar clinical success to revascularization. However, radiographic measurements showed an improvement in thickening of lateral dentinal walls in most of the revascularization cases in addition to a higher dental development. However, these results should be interpreted with caution.

Are the Classic and the Congruent Arc Latarjet Procedures Equally Effective for the Treatment of Recurrent Shoulder Instability in Athletes?

2020 ◽  
Vol 48 (9) ◽  
pp. 2081-2089
Author(s):  
Luciano A. Rossi ◽  
Ignacio Tanoira ◽  
Tomás Gorodischer ◽  
Ignacio Pasqualini ◽  
Domingo Luis Muscolo ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Bone Block ◽  
Return To Sports ◽  
Glenohumeral Instability ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Functional Scores ◽  
The Mean ◽  
Anterior Glenohumeral Instability

Background: There is a lack of evidence in the literature comparing outcomes between the classic and the congruent arc Latarjet procedures in athletes. Purpose: To compare return to sports, functional outcomes, and complications between the classic and the congruent arc Latarjet procedures in athletes with recurrent glenohumeral instability. Study Design: Cohort study; Level of evidence, 3. Methods: Between June 2009 and June 2017, 145 athletes with recurrent anterior glenohumeral instability underwent surgery with the Latarjet as a primary procedure in our institution. The classic procedure was used in 66 patients, and the congruent arc method was used in 79 patients. Return to sports, range of motion (ROM), the Rowe score, a visual analog scale (VAS) for pain in sports activity, and the Athletic Shoulder Outcome Scoring System (ASOSS) were used to assess functional outcomes. Recurrences were also evaluated. The postoperative bone block position and consolidation were assessed with computed tomography. Results: In the total population, the mean follow-up was 41.3 months (range, 24-90 months) and the mean age was 25.3 years (range, 18-45 years). In total, 90% of patients were able to return to sports; of these, 91% returned at their preinjury level of play. No significant difference in shoulder ROM was found between preoperative and postoperative results. The Rowe, VAS, and ASOSS scores showed statistical improvement after operation ( P < .001). The Rowe score increased from a preoperative mean of 42.8 points to a postoperative mean of 95.2 points ( P < .01). Subjective pain during sports improved from 3.2 points preoperatively to 0.7 points at last follow-up ( P < .01). The ASOSS score improved significantly from a preoperative mean of 46.4 points to a postoperative mean of 88.4 points ( P < .01). No significant differences in shoulder ROM and functional scores were found between patients who received the classic vs congruent arc procedures. There were 5 recurrences (3.5%): 3 dislocations (2%) and 2 subluxations (1%). No significant difference in the recurrence rate was noted between groups. The bone block healed in 134 cases (92%). Conclusion: In athletes with recurrent anterior glenohumeral instability, the Latarjet procedure produced excellent functional outcomes. Most athletes returned to sports at their preinjury level, and the rate of recurrence was very low, regardless of whether the patients received surgery with the classic or congruent arc technique.

scholarly journals Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports after Hamstring Autograft Reconstruction for Sternoclavicular Joint Instability

2020 ◽  
Vol 8 (7_suppl6) ◽  
pp. 2325967120S0033
Author(s):  
Lucca Lacheta ◽  
Brandon Goldenberg ◽  
Marilee Horan ◽  
Sam Rosenberg ◽  
Jonas Pogorzelski ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Clinical Outcomes ◽  
Joint Instability ◽  
Hamstring Tendon ◽  
Rate Of Return ◽  
Return To Sports ◽  
Joint Reconstruction ◽  
Hamstring Tendon Autograft ◽  
Tendon Autograft

Objectives: Instability of the sternoclavicular (SC) joint is a rare but potentially devastating pathology, particularly when it occurs in young or active patients, where it can lead to persistent pain and impairment of shoulder function. SC reconstruction using a hamstring tendon autograft is a commonly used treatment option, but mid-term results are still lacking. To assess clinical outcomes, survivorship, and return to sports rate after SC joint reconstruction using hamstring tendon autograft in patients suffering from SC joint instability. We hypothesized that SC joint reconstruction would result in good clinical outcomes, a high survivorship, and a high rate of return to sports. Methods: All patients who underwent SC joint reconstruction with a hamstring tendon autograft for SC joint instability, with a minimum 5-year follow up, were included. Patient reported outcomes were assessed prospectively by the use of the American Shoulder and Elbow Surgeons (ASES) Score, Single Assessment Numerical Evaluation (SANE) Score, Quick Disabilities of the Arm, Shoulder and Hand (DASH) Score, General heath physical component of the SF-12 (PCS) and patient satisfaction. Survivorship of reconstruction was defined as no further SC joint dislocation events or revision surgery. Return to sports and pain were assessed using a customized questionnaire. Results: 22 SC joint reconstructions with a mean age of 31.3 (range 15.8 - 57.0 years) at the time of surgery were included. At final evaluation, 18 SC joint reconstructions with a mean follow up of 6.0 years (range 5.0 – 7.3 years) were eligible for minimum 5-year follow-up. All clinical outcome scores improved significantly pre- to postoperatively, ASES (50.0 to 91.0; p = .005), SANE (45.9 to 86.0; p = .007), QuickDASH (44.2 to 12.1; p = .003), and PCS (39.4 to 50.9; p = .001). Median postoperative satisfaction was 9 (range 7 - 10). The construct survivorship was 90% at 5-year follow-up. Two patients failed at 82 and 336 days postoperatively and were revised with revision SC joint reconstruction and capsulorrhaphy. Another patient had a superficial wound infection, which was debrided once, and resulted in a good clinical outcome. Of the patients who answered optional sports activity questionnaires, 17 (77%) shoulders participated in recreational or professional sports before injury. At final follow-up, 16/17 (94%) shoulders returned to their pre-injury level of sport or better. The VAS score for pain today (p = 0.004) and pain at its worst (p = 0.004) improved significantly pre- to postoperatively. Conclusions: SC joint reconstruction with hamstring tendon autograft for SC joint instability resulted in significantly improved clinical outcomes with high patient satisfaction and 90% survivorship at mid-term follow up. Furthermore, a reliable rate of return to previous level of sports was observed in this young and high-demanding patient population. Concerns in terms of advanced post-instability arthritis were not confirmed since a significant decrease in pain was found after minimum 5-year follow-up.

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