Radiographic Analysis of National Football League Players’ Fifth Metatarsal Morphology Relationship to Proximal Fifth Metatarsal Fracture Risk

2018 ◽  
Vol 40 (3) ◽  
pp. 318-322 ◽  
Author(s):  
Sydney C. Karnovsky ◽  
Andrew J. Rosenbaum ◽  
Bridget DeSandis ◽  
Christopher Johnson ◽  
Conor I. Murphy ◽  
...  
Keyword(s):  
At Risk ◽  
National Football League ◽  
Fracture Prevention ◽  
Delayed Union ◽  
Medullary Canal ◽  
Radiographic Analysis ◽  
Level Of Evidence ◽  
Metatarsal Angle ◽  
Significant Difference ◽  
Apex Height

Background: Fractures of the proximal fifth metatarsal are one of the most common foot injuries in athletes. Repetitive stresses endured by the fifth metatarsal can lead to stress fracture, delayed union, and refracture, making optimal treatment challenging. A radiographic analysis of fifth metatarsal morphology and foot type in National Football League (NFL) players was performed to investigate morphologic risk factors for these injuries. Methods: This was a case-control study that looked at NFL players treated between 1992 and 2012, as well as participants at the NFL Combine. Ninety-six feet (51 athletes) were included. Fractures were present in 15 feet. Two reviewers assessed fifth metatarsal morphology and foot type on anteroposterior, lateral, and oblique radiographs. Differences in foot type and metatarsal morphology between athletes with and without fractures were determined. Results: On anteroposterior radiographs, significant differences in apex medullary canal width, 4-5 intermetatarsal angle, fifth metatarsal angle, and talar head uncovering were observed between fractured and non-fractured feet ( P = .001, .003, .004, .008, respectively). On lateral radiographs, significant differences in the fifth metatarsal length, distance to apex, apex height, fifth metatarsal angle, and talocalcaneal angle were observed between fractured and nonfractured feet ( P = .04, .01, .02, .01, .01, respectively). On oblique radiographs, a significant difference was observed in apex height between fractured and nonfractured feet ( P = .002). Conclusion: Individuals with long, narrow, and straight fifth metatarsals with an adducted forefoot were most at risk for fifth metatarsal fractures. With this insight, attempts at fracture prevention can be implemented via footwear modifications, orthoses, and off-loading braces that account for those aforementioned morphologic attributes that place athletes at risk. Level of Evidence: Level III, retrospective comparative study.

scholarly journals Jones Fractures Identified at the National Football League Scouting Combine: Assessment of Prognostic Factors, Computed Tomography Findings, and Initial Career Performance

2018 ◽  
Vol 6 (8) ◽  
pp. 232596711879074 ◽  
Author(s):  
Robert C. Spang ◽  
Daniel B. Haber ◽  
Brendin R. Beaulieu-Jones ◽  
Kristen L. Stupay ◽  
George Sanchez ◽  
...  
Keyword(s):  
Computed Tomography ◽  
National Football League ◽  
Treatment Method ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Specific Performance ◽  
Incomplete Healing ◽  
Bony Healing ◽  
The Mean ◽  
Career Performance

Background: Jones fractures result in subsequent dysfunction and remain an issue for athletes. Purpose: To (1) describe the epidemiology, treatment, and impact of Jones fractures identified at the National Football League (NFL) Scouting Combine on players’ early careers and (2) establish the value of computed tomography (CT) to determine bony healing after a fracture in prospective players. Study Design: Cohort study; Level of evidence, 3. Methods: All players who attended the combine between 2009 and 2015 were retrospectively reviewed to identify their history of Jones fractures. The playing position, treatment method, and number of missed collegiate games were recorded. The mean overall draft pick number, number of games started and played, snap percentage, and position-specific performance scores (fantasy score) over the first 2 years in the NFL were compared between players with fractures and controls. An imaging classification system was applied based on grading of each quadrant of the fifth metatarsal (plantar, dorsal, medial, lateral), with a score of 0 for not healed or 1 for healed. Results: Overall, the number of Jones fractures identified was 72 in 2285 athletes (3.2%), with all treated via intramedullary screw fixation. The mean overall draft pick number for players with fractures was 111.2 ± 67.9 compared with 99.0 ± 65.9 for controls ( P = .12). Performance scores for players with fractures were lower than those for controls across all positions, with a significant difference in running backs (2.6 vs 4.0, respectively; P < .001) and defensive linemen (1.4 vs 2.3, respectively; P = .02). The mean CT score was 2.5 ± 1.3. Of the 32 athletes who underwent imaging, 16 Jones fractures (50.0%) were healed or nearly healed, 12 (37.5%) were partially healed, and 4 (12.5%) showed little or no healing. The plantar cortex demonstrated the least healing (18/32; 56.3%), followed by the lateral cortex (15/32; 46.9%). Players with a mean score <1 were found to have fewer games started (2.7 ± 2.5) than those with 1 to 3 cortices healed (17.4 ± 10.4) or all cortices healed (8.7 ± 11.2). Conclusion: Based on CT, 50% of all players with a previous Jones fracture demonstrated incomplete healing. Moreover, position-specific performance scores over the first 2 years of a player’s career were lower across all positions for those with fractures compared with controls. Players with CT scores <1 were found to start fewer games and were drafted later than controls.

Outcomes of Lisfranc Injuries in the National Football League

2016 ◽  
Vol 44 (7) ◽  
pp. 1810-1817 ◽  
Author(s):  
Kevin J. McHale ◽  
Joshua C. Rozell ◽  
Andrew H. Milby ◽  
James L. Carey ◽  
Brian J. Sennett
Keyword(s):  
Athletic Performance ◽  
National Football League ◽  
Statistical Significance ◽  
Control Groups ◽  
Level Of Evidence ◽  
Similar Time ◽  
Lisfranc Injury ◽  
Significant Difference ◽  
Lisfranc Injuries ◽  
Return To Competition

Background: Tarsometatarsal (Lisfranc) joint injuries commonly occur in National Football League (NFL) competition; however, the career effect of these injuries is unknown. Purpose: To define the time to return to competition for NFL players who sustained Lisfranc injuries and to quantify the effect on athletic performance. Study Design: Case-control study; Level of evidence, 3. Methods: Data on NFL players who sustained a Lisfranc injury between 2000 and 2010 were collected for analysis. Outcomes data included time to return to competition, total games played after season of injury, yearly total yards and touchdowns for offensive players, and yearly total tackles, sacks, and interceptions for defensive players. Offensive power ratings ( OPR = [ total yards/10] + [ total touchdowns × 6]) and defensive power ratings ( DPR = total tackles + [ total sacks × 2] + [ total interceptions × 2]) were calculated for the injury season and for 3 seasons before and after the injury season. Offensive and defensive control groups consisted of all players without an identified Lisfranc injury who competed in the 2005 season. Results: The study group was composed of 28 NFL athletes who sustained Lisfranc injuries during the study period, including 11 offensive and 17 defensive players. While 2 of 28 (7.1%) players never returned to the NFL, 26 (92.9%) athletes returned to competition at a median of 11.1 (interquartile range [IQR], 10.3-12.5) months from time of injury and missed a median of 8.5 (IQR, 6.3-13.0) regular-season games. Analysis of pre- and postinjury athletic performance revealed no statistically significant changes after return to sport after Lisfranc injury. The magnitude of change in median OPR and DPR observed in offensive and defensive Lisfranc-injured study groups, −34.8 (IQR, −64.4 to 1.4) and −13.5 (−30.9 to 4.3), respectively, was greater than that observed in offensive and defensive control groups, −18.8 (−52.9 to 31.5) and −5.0 (−22.0 to 14.0), respectively; however, these differences did not reach statistical significance ( P = .33 and .21, respectively). Evaluation of the durability of injured players after the season of injury revealed no statistically significant difference in career length compared with controls. Conclusion: More than 90% of NFL athletes who sustained Lisfranc injuries returned to play in the NFL at a median of 11.1 months from time of injury. Offensive and defensive players experienced a decrease in performance after return from injury that did not reach statistical significance compared with their respective control groups over a similar time period.

scholarly journals Prevalence and Impact of Hip Arthroscopic Surgery on Future Participation in Elite American Football Athletes

2018 ◽  
Vol 6 (2) ◽  
pp. 232596711775230 ◽  
Author(s):  
Derrick M. Knapik ◽  
Joe Sheehan ◽  
Shane J. Nho ◽  
James E. Voos ◽  
Michael J. Salata
Keyword(s):  
National Football League ◽  
Arthroscopic Surgery ◽  
American Football ◽  
Current Status ◽  
Level Of Evidence ◽  
Labral Tears ◽  
Significant Difference ◽  
History Of ◽  
Not At Risk ◽  
The Impact

Background: Intra-articular injuries to the hip in elite athletes represent a source of significant pain and disability. Hip arthroscopic surgery has become the gold standard for the treatment of disorders involving the hip joint. Purpose: To examine the incidence of and abnormalities treated with hip arthroscopic surgery as well as the impact on future participation in American football athletes invited to the National Football League (NFL) Scouting Combine with a history of hip arthroscopic surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Athletes invited to the NFL Combine from 2012 to 2015 were evaluated for a history of hip arthroscopic surgery. Athlete demographics, imaging findings, and physical examination results were gathered using the NFL Combine database. Information on prospective participation in the NFL with regard to draft status, games played, games started, and current status was gathered using publicly available databases and compared against all other athletes participating in the combine. Results: Fourteen athletes (15 hips) had a history of arthroscopic hip surgery. Acetabular labral tears were treated in 93% (14 hips), with femoroacetabular impingement decompression performed in 33% (5 hips). Compared with athletes who had no history of hip arthroscopic surgery, those undergoing arthroscopic surgery did not possess a lower likelihood of being drafted (66% vs 71%, respectively; P = .78) or of being on an active roster (52% vs 43%, respectively; P = .44) after their first season in the NFL. Moreover, there was no significant difference in the number of regular-season games played (10.9 ± 4.8 with arthroscopic surgery vs 11.0 ± 5.1 without; P = .96) or started (7.0 ± 3.6 with arthroscopic surgery vs 7.1 ± 5.3 without; P = .98). Conclusion: American football athletes invited to the NFL Combine with a history of hip arthroscopic surgery were not at risk for diminished participation when compared with all other athletes during their first season in the NFL.

Characteristics and Outcomes of Arthroscopic Femoroacetabular Impingement Surgery in the National Football League

2017 ◽  
Vol 46 (1) ◽  
pp. 144-148 ◽  
Author(s):  
Benedict U. Nwachukwu ◽  
Asheesh Bedi ◽  
Ajay Premkumar ◽  
Pete Draovitch ◽  
Bryan T. Kelly
Keyword(s):  
Femoroacetabular Impingement ◽  
National Football League ◽  
Arthroscopic Surgery ◽  
High Rate ◽  
Return To Play ◽  
Labral Repair ◽  
Control Group ◽  
Football Players ◽  
Level Of Evidence ◽  
Significant Difference

Background: Previous studies have reported that hip abnormalities may account for 10% of injuries in professional football players. The effect of femoroacetabular impingement (FAI) and arthroscopic FAI surgery in National Football League (NFL) athletes has not been well studied. Purpose: To investigate the effect of arthroscopic FAI surgery on return to play (RTP) and RTP performance in NFL players. Study Design: Cohort study; Level of evidence, 3. Methods: NFL athletes undergoing arthroscopic FAI surgery at a single institution between 2006 and 2014 were identified. Medical records were reviewed for demographic, clinical, and operative variables. RTP and RTP performance were assessed based on a review of publicly available NFL player statistics. RTP and RTP performance data included time to RTP; games played before and after the injury; yearly total yards and touchdowns for offensive players; and yearly total tackles, sacks, and interceptions for defensive players. The offensive power rating (OPR = [total yards/10] + [total touchdowns × 6]) and defensive power rating (DPR = total tackles + [total sacks × 2] + [total interceptions × 2]) were calculated. Paired t tests comparing preinjury and postinjury seasons were performed. A matched cohort of NFL players was created to compare trends for OPR, DPR, and career longevity. Results: Forty-eight hips in 40 NFL players (mean age, 25.6 years) with symptomatic FAI were included; 8 players underwent staged bilateral hip arthroscopic procedures. The majority of players were offensive (n = 24; 60.0%), with offensive lineman (n = 11; 27.5%) being the most common of all positions. Of the 48 included hips, all had labral tears, and 41 (85.4%) underwent labral repair. Forty-two of the 48 hips (87.5%) underwent cam decompression, and 10 (20.8%) underwent rim decompression. Of the 40 included players, 37 (92.5%) achieved RTP to professional competition after their hip arthroscopic surgery at a mean of 6.0 months. Before the injury, included patients played in a mean of 11.0 games compared with 9.5 games in their postoperative season ( P = .26). The mean OPR and DPR demonstrated a nonsignificant decline in the postoperative season (preinjury OPR, 40.2; postinjury OPR, 32.3; P = .34) (preinjury DPR, 49.6; postinjury DPR, 36.4; P = .10). A similar decline in the OPR and DPR across seasons was observed in the control group. NFL athletes played, on average, 3.3 ± 1.5 seasons after undergoing hip arthroscopic surgery; this was not significantly different from the controls (2.5 ± 1.5 seasons; P = .47). There was no significant difference in mean annual salaries based on contracts negotiated before the injury and the first negotiated contract after surgery ($3.3 million vs $3.6 million, respectively; P = .58). Conclusion: There was a very high rate of RTP in the NFL after arthroscopic FAI surgery; this rate is higher than what has been previously reported for other orthopaedic procedures in NFL athletes. Additionally, these NFL athletes achieved RTP at a faster time frame (6 months) than previously reported for other procedures. These findings have important implications for counseling elite football players about the expected outcome of arthroscopic FAI surgery.

scholarly journals Platelet-Rich Plasma Shortens Return to Play in National Football League Players With Acute Hamstring Injuries

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091173 ◽  
Author(s):  
James P. Bradley ◽  
Tracye J. Lawyer ◽  
Sonia Ruef ◽  
Jeffrey D. Towers ◽  
Justin W. Arner
Keyword(s):  
National Football League ◽  
Platelet Rich Plasma ◽  
Nonoperative Treatment ◽  
Return To Play ◽  
Professional Athletes ◽  
Hamstring Injury ◽  
Level Of Evidence ◽  
Hamstring Injuries ◽  
Recurrent Injury ◽  
Significant Difference

Background: Hamstring injuries are prevalent in professional athletes and can lead to significant time loss, with recurrent injury being common. The efficacy of platelet-rich plasma (PRP) for augmentation of nonoperative treatment of partial musculotendinous hamstring injuries is not well established. Hypothesis: The addition of PRP injections to nonoperative treatment for acute partial musculotendinous hamstring injuries will lead to a shortened return to play in National Football League (NFL) players. Study Design: Cohort study; Level of evidence, 3. Methods: NFL players from a single team who sustained acute grade 2 hamstring injuries, as diagnosed on magnetic resonance imaging (MRI) by a musculoskeletal radiologist from 2009 to 2018, were retrospectively reviewed. Average days, practices, and games missed were recorded. Players who did and did not receive PRP (leukocyte-poor) injections were compared. Those who received PRP did so within 24 to 48 hours after injury. Results: A total of 108 NFL players had MRI evidence of a hamstring injury, and of those, 69 athletes sustained grade 2 injuries. Thirty players received augmented treatment with PRP injections and 39 players underwent nonoperative treatment alone. Average time missed in those treated with PRP injections was 22.5 days, 18.2 practices, and 1.3 games. In those who did not receive PRP injections, time missed was 25.7 days ( P = .81), 22.8 practices ( P = .68), and 2.9 games ( P < .05). Conclusion: Augmentation with PRP injections for acute grade 2 hamstring injuries in NFL players showed no significant difference in days missed or time to return to practice but did allow for faster return to play, with a 1 game overall difference. Owing to the possible large financial impact of returning to play 1 game sooner, PRP injections for treatment of grade 2 hamstring injuries may be advantageous in professional athletes.

scholarly journals Comparison of the rate of delayed/nonunion in fifth metatarsal fractures receiving anti-inflammatory medications

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Brandon Barnds ◽  
Matt Heenan ◽  
Jack Ayres ◽  
Armin Tarakemeh ◽  
J. Paul Schroeppel ◽  
...  
Keyword(s):  
Acute Effect ◽  
Delayed Union ◽  
Nonoperative Treatment ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Fracture Nonunion ◽  
Metatarsal Fractures ◽  
Icd Codes ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Abstract Purpose Controversy exists regarding the acute effect of non-steroidal anti-inflammatory drugs (NSAIDs) on early fracture healing. The purpose of this study was to analyze the rate of nonunion or delayed union in patients with fifth metatarsal (5th MT) fractures. We hypothesize that the use of NSAIDs would increase the rate of nonunion/delayed union in 5th MT fractures. Methods Using PearlDiver, a national insurance database was analyzed. ICD codes were used to identify patients diagnosed with 5th MT fracture from 2007-2018. Patients were grouped by initial management (nonoperative vs. open reduction and internal fixation (ORIF) or non/malunion repair within 60 days) and sub-grouped by whether they had been prescribed at least one pre-defined NSAID. Subsequent ORIF or nonunion/malunion repair operative intervention was used as a surrogate for fracture nonunion/delayed union. Results Of the 10,991 subjects with a diagnosis of 5th MT, 10,626 (96.7%) underwent initial nonoperative treatment, 1,409 of which (13.3%) received prescription NSAIDS within 60 days of diagnosis. 16/1,409 (1.14%) subjects who received anti-inflammatory prescriptions underwent ORIF or repair of non/malunion at least 60 days after diagnosis while 46/9,217 (0.50%; P=0.003483) subjects who did not receive anti-inflammatory prescriptions underwent ORIF or repair of non/malunion at least 60 days after diagnosis. In the 365 subjects who underwent early repair/ORIF (within 60 days), there was no significant difference in the rate of nonunion/delayed union. Conclusion The rate of nonunion/delayed union of 5th MT fractures was significantly higher in subjects receiving NSAIDs within 60 days of initial diagnosis in patients managed non-operatively. Level of evidence Level III

Early Screw Fixation versus Casting in the Treatment of Acute Jones Fractures

2005 ◽  
Vol 33 (7) ◽  
pp. 970-975 ◽  
Author(s):  
Timothy S. Mologne ◽  
Jeffrey M. Lundeen ◽  
Mark F. Clapper ◽  
Thomas J. O’Brien
Keyword(s):  
Screw Fixation ◽  
Delayed Union ◽  
Controlled Clinical Trial ◽  
Return To Sports ◽  
Level Of Evidence ◽  
Surgery Group ◽  
Significant Difference ◽  
Surgical Fixation ◽  
Cast Group ◽  
The Times

Background There is considerable variability in the literature concerning the optimal treatment of acute Jones fractures. Hypothesis Early surgical fixation of acute Jones fractures will result in shorter times to union and return to athletics compared with cast treatment. Study Design Randomized controlled clinical trial; Level of evidence, 1. Methods Eighteen patients were randomized to cast treatment, and 19 patients were randomized to screw fixation. Success of treatment and the times to union and return to sports were calculated for each patient. Results Mean follow-up was 25.3 months (range, 15-42 months). Eight of 18 (44%) in the cast group were considered treatment failures: 5 nonunions, 1 delayed union, and 2 refractures. One of 19 patients in the surgery group was considered a treatment failure. For the surgery group, the median times to union and return to sports were 7.5 and 8.0 weeks, respectively. For the cast group, the median times were 14.5 and 15.0 weeks, respectively. The Mann-Whitney test showed a statistically significant difference between the groups in both parameters, with P <. 001. Conclusion There is a high incidence (44%) of failure after cast treatment of acute Jones fractures. Early screw fixation results in quicker times to union and return to sports compared with cast treatment.

Rate of Delayed Union With Early Weightbearing Following Intramedullary Screw Fixation of Jones Fractures

2020 ◽  
Vol 41 (11) ◽  
pp. 1325-1334
Author(s):  
Austin M. Looney ◽  
John R. Renehan ◽  
Daniel M. Dean ◽  
Anu Murthy ◽  
Thomas H. Sanders ◽  
...  
Keyword(s):  
Functional Recovery ◽  
Screw Fixation ◽  
Delayed Union ◽  
Therapeutic Level ◽  
Level Of Evidence ◽  
Significant Difference ◽  
Retrospective Comparative Study ◽  
Intramedullary Screw ◽  
Delay Fracture Healing

Background: Jones fractures of the proximal fifth metatarsal are predisposed to delayed union and nonunion due to a tenuous blood supply. Solid intramedullary (IM) screw fixation is recommended to improve healing, traditionally followed by delayed weightbearing (DWB). However, early weightbearing (EWB) postoperatively may facilitate functional recovery. The purpose of this study was to compare union rates and time to union after solid IM screw fixation of Jones fractures in patients treated with an EWB protocol to those treated with a DWB protocol, as well as to identify any factors that may be predictive of delayed or nonunion. Methods: True Jones (zone 2 fifth metatarsal base) fractures treated from April 2012 through January 2018 with IM screw fixation and 6 months follow-up were identified (41 fractures in 40 patients; mean ± SD age, 45.3 ± 17.9 years). Patients were divided into EWB and DWB cohorts (within or beyond 2 weeks, respectively). Delayed union (12.5 weeks) was statistically derived from established literature. Union times were compared between cohorts. Regression analyses were conducted to investigate possible confounders contributing to delayed union. There were 20 fractures in the EWB cohort and 21 fractures in the DWB cohort. Results: There was no significant difference in healing times (EWB: 25% by 6th week, 55% by the 12th week, 20% delayed; DWB: 33% by 6th week, 43% by 12th week, 24% delayed; P = .819) or delayed unions (EWB, 20% vs DWB, 24%; P > .999). There were no nonunions. No significant confounding risk factors were identified. Conclusion: Postoperative protocols using early weightbearing following solid IM screw fixation of Jones fractures appear to be safe and do not delay fracture healing or increase the risk of delayed union. Older age may be a risk for delayed union, but larger studies are needed to evaluate this with appropriate power in light of possible confounders. EWB protocols may allow better functional recovery without compromising outcomes by increasing the risk of delayed union. Level of Evidence: Therapeutic level III, retrospective comparative study.

Nonunion Rates in Hind- and Midfoot Arthrodesis in Current, Ex-, and Nonsmokers

2020 ◽  
pp. 107110072097126
Author(s):  
Jack Allport ◽  
Jayasree Ramaskandhan ◽  
Malik S. Siddique
Keyword(s):  
Risk Factor ◽  
Cohort Study ◽  
Relative Risk ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Smoking Status ◽  
Time Frame ◽  
Modifiable Risk Factor ◽  
Level Of Evidence ◽  
Significant Difference

Background: Nonunion rates in hind or midfoot arthrodesis have been reported as high as 41%. The most notable and readily modifiable risk factor that has been identified is smoking. In 2018, 14.4% of the UK population were active smokers. We examined the effect of smoking status on union rates for a large cohort of patients undergoing hind- or midfoot arthrodesis. Methods: In total, 381 consecutive primary joint arthrodeses were identified from a single surgeon’s logbook (analysis performed on a per joint basis, with a triple fusion reported as 3 separate joints). Patients were divided based on self-reported smoking status. Primary outcome was clinical union. Delayed union, infection, and the need for ultrasound bone stimulation were secondary outcomes. Results: Smoking prevalence was 14.0%, and 32.2% were ex-smokers. Groups were comparable for sex, diabetes, and body mass index. Smokers were younger and had fewer comorbidities. Nonunion rates were higher in smokers (relative risk, 5.81; 95% CI, 2.54-13.29; P < .001) with no statistically significant difference between ex-smokers and nonsmokers. Smokers had higher rates of infection ( P = .05) and bone stimulator use ( P < .001). Among smokers, there was a trend toward slower union with heavier smoking ( P = .004). Conclusion: This large retrospective cohort study confirmed previous evidence that smoking has a considerable negative effect on union in arthrodesis. The 5.81 relative risk in a modifiable risk factor is extremely high. Arthrodesis surgery should be undertaken with extreme caution in smokers. Our study shows that after cessation of smoking, the risk returns to normal, but we were unable to quantify the time frame. Level of Evidence: Level III, retrospective cohort study.

Arthroscopic Repair of the Hip Abductor Musculotendinous Unit: The Effect of Microfracture on Clinical Outcomes

2021 ◽  
pp. 036354652199967
Author(s):  
Baris Kocaoglu ◽  
Ahmet Emre Paksoy ◽  
Simone Cerciello ◽  
Matthieu Ollivier ◽  
Romain Seil ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Surgical Repair ◽  
Gluteus Medius ◽  
Arthroscopic Repair ◽  
Harris Hip Score ◽  
Level Of Evidence ◽  
Outcome Score ◽  
Significant Difference ◽  
Hip Abductor ◽  
Tendon Tears

Background: Endoscopic surgical repair has become a common procedure for treating patients with hip abductor tendon tears. Considering that retear rates are high after the repair of gluteus medius and minimus tendons, exploring alternative strategies to enhance structural healing is important. Purpose/Hypothesis: The purpose of this study was to evaluate the effect of adding microfracture to single-row repair (SR) on outcomes after the surgical repair of gluteus medius and minimus tendons and compare with SR and double-row repair (DR) without microfracture. We hypothesized that microfracture of the trochanteric footprint with SR would lead to superior clinical outcomes and lower clinically evident retear rates compared with SR and DR without the addition of microfracture. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 50 patients who underwent primary arthroscopic repair of hip gluteus medius and minimus tendon tears were investigated. Patients were divided into 3 groups: DR, 16 patients; SR, 14 patients; and SR with microfracture (SRM), 20 patients. Patients were evaluated with a visual analog scale (VAS) for pain as well as the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sport Specific (HOS-SS), and modified Harris Hip Score (mHHS) both preoperatively and at a minimum 2-year follow-up (mean, 30 months). Results: Among the SR, SRM, and DR groups, the greatest decrease in VAS scores and increase in mHHS, HOS-ADL, and HOS-SS scores were seen in the SRM group, and all the differences were significant ( P < .001 to P = .006). The abductor tendon retear rates were 31.3%, 35.7%, and 15.0% in the DR, SR, and SRM groups, respectively. Retear rates were lower in the SRM group compared with the SR and DR groups ( P = .042); however, there was no significant difference between the SR and DR groups ( P = .32) in terms of retear rates. Conclusion: Endoscopic SR with microfracture was a safe, practical, and effective technique and had the potential advantage of enhancing biological healing at the footprint. The addition of microfracturing the trochanteric footprint significantly lowered the retear rate and provided better functional outcomes than SR and DR without microfracture.

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