Smoking Is Associated with Anterior Ankle Impingement After Isolated Autologous Matrix-Induced Chondrogenesis for Osteochondral Lesions of the Talus

Cartilage ◽  
2020 ◽  
pp. 194760352095940
Author(s):  
Arnd F. Viehöfer ◽  
Fabio Casari ◽  
Felix W.A. Waibel ◽  
Silvan Beeler ◽  
Florian B. Imhoff ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Pearson Correlation ◽  
Osteochondral Lesions ◽  
Duration Of Symptoms ◽  
Ankle Impingement ◽  
Increased Risk ◽  
Patient Reported ◽  
Specific Factors ◽  
Anterior Ankle Impingement

Objective To determine potential predictive associations between patient-/lesion-specific factors, clinical outcome and anterior ankle impingement in patients that underwent isolated autologous matrix-induced chondrogenesis (AMIC) for an osteochondral lesion of the talus (OLT). Design Thirty-five patients with a mean age of 34.7 ± 15 years who underwent isolated cartilage repair with AMIC for OLTs were evaluated at a mean follow-up of 4.5 ± 1.9 years. Patients completed AOFAS (American Orthopaedic Foot and Ankle Society) scores at final follow-up, as well as Tegner scores at final follow-up and retrospectively for preinjury and presurgery time points. Pearson correlation and multivariate regression models were used to distinguish associations between patient-/lesion-specific factors, the need for subsequent surgery due to anterior ankle impingement and patient-reported outcomes. Results At final follow-up, AOFAS and Tegner scores averaged 92.6 ± 8.3 and 5.1 ± 1.8, respectively. Both body mass index (BMI) and duration of symptoms were independent predictors for postoperative AOFAS and Δ preinjury to postsurgery Tegner with positive smoking status showing a trend toward worse AOFAS scores, but this did not reach statistical significance ( P = 0.054). Nine patients (25.7%) required subsequent surgery due to anterior ankle impingement. Smoking was the only factor that showed significant correlation with postoperative anterior ankle impingement with an odds ratio of 10.61 when adjusted for BMI and duration of symptoms (95% CI, 1.04-108.57; P = 0.047). Conclusion In particular, patients with normal BMI and chronic symptoms benefit from AMIC for the treatment of OLTs. Conversely, smoking cessation should be considered before AMIC due to the increased risk of subsequent surgery and possibly worse clinical outcome seen in active smokers.

Lower perception of pharmacological treatment increases risk of non-adherence to medication

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
CB Graversen ◽  
JB Valentin ◽  
ML Larsen ◽  
S Riahi ◽  
T Holmberg ◽  
...  
Keyword(s):  
Pharmacological Treatment ◽  
Poisson Regression ◽  
Drug Class ◽  
Angiotensin Receptor Blockers ◽  
Adverse Outcomes ◽  
Adherence To Medication ◽  
Increased Risk ◽  
Patient Reported ◽  
High Level

Abstract Funding Acknowledgements Type of funding sources: Foundation. Main funding source(s): The Danish Heart Foundation Background A large proportion of patients fail to reach optimal adherence to medication following incident ischemic heart disease (IHD) despite amble evidence of the beneficial effect of medication. Non-adherence to medication increases risk of disease-related adverse outcomes but none has explored how perception about pharmacological treatment detail on non-adherence using register-based follow-up data. Purpose To investigate the association between patients’ perception of pharmacological treatment and risk of non-initiation and non-adherence to medication in a population with incident IHD. Methods This cohort study followed 871 patients until 365 days after incident IHD. The study combined patient-reported survey data on perception about pharmacological treatment (categorised by ‘To a high level’, ‘To some level’, and ‘To a lesser level’) with register-based data on reimbursed prescription of cardiovascular medication (antithrombotics, statins, ACE-inhibitors/angiotensin receptor blockers, and β-blockers). Non-initiation was defined as no pick-up of medication in the first 180 days following incident IHD and analysed by Poisson regression. Two different measures evaluated non-adherence in patients initiating treatment: 1) proportion of days covered (PDC) analysed by Poisson regression, and 2) risk of discontinuation analysed by Cox proportional hazard regression. All analyses were adjusted for confounding variables (age, sex, ethnicity, income, educational level, civil status, occupation, charlson comorbidity index, supportive relatives, and individual consultation in medication) identified by directed acyclic graph and obtained from national registers and the survey. Item non-response was handled by multiple imputation and item consistency was evaluated by McDonalds omega. Results Lower perceptions about pharmacological treatment was associated with increased risk of non-initiation and non-adherence to medication irrespectively of drug class and adherence measure in the multiple adjusted analyses (please see figure illustrating results on antithrombotics). A dose-response relationship was observed both at 180- and 365-days of follow-up, but the steepest decline in adherence differed when comparing the two adherence measures (results not shown). Moderate internal consistency was found for the summed measure of perception (McDonalds omega = 0.67). Conclusion Lower perception of pharmacological treatment was associated with subsequent non-initiation and non-adherence to medication, irrespectively of measurement method and drug class. Abstract Figure. Figre: Multiple adjusted analyses

scholarly journals Arthroscopic Microfracture for Osteochondral Lesions of the Talus in Old Age Patient

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0031
Author(s):  
Hong S. Lee ◽  
Kiwon Young ◽  
Tae-Hoon Park ◽  
Hong Seop Lee
Keyword(s):  
Clinical Outcome ◽  
Old Age ◽  
Effective Procedure ◽  
Osteochondral Lesions ◽  
Foot And Ankle ◽  
Patient’S Satisfaction ◽  
Arthroscopic Microfracture ◽  
Lost To Follow Up ◽  
Outcome Evaluations

Category: Ankle; Arthroscopy Introduction/Purpose: The purpose of the present study was to evaluate the outcomes of arthroscopic microfracture for osteochondral lesions of the talus, in patients of older than 60 years old. Methods: Sixteen patients (16 ankles) with osteochondral lesions of the talus were treated by arthroscopic microfracture from October 2012 to June 2019. As two patients were lost to follow-up, Fourteen patients (14 ankles) participated in the study. There were 6 men (42.9%) and 8 women (57.1%) of average age 67.4years (range 60-77) at the time of surgery. Clinical outcome evaluations were performed using Foot and Ankle Outcome Score (FAOS) and patient’s satisfaction after surgery at a mean follow-up of 50.8 months. Results: Mean FAOS scores improved from SYMPTOM 68.2 points (range 39-86), PAIN 65.1 points (range 36-94), ADL 69.4 points (range 32-99), SPORTS 45.4 points (range 25-80), QOL 47.1 points (range 13-94) preoperatively to SYMPTOM 94.8 points (range 68-100), PAIN 91.1 points (range 48-100), ADL 93.3 points (range 59-100), SPORTS 71.8 points (range 30-100), QOL 79.8 points (range 25-100) at final follow up. Very satisfaction in 4 (29%), Satisfaction in 7 (50%), Fair in 2 (14%), Dissatisfaction in 1 (7%), and reason for dissatisfaction was persistent pain after surgery. Conclusion: Arthroscopic microfracture for osteochondral lesions of the talus is a safe and effective procedure for old age patient.

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.

Twenty-Year Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review of Prospectively Collected Data

2021 ◽  
pp. 036354652110273
Author(s):  
Joshua S. Everhart ◽  
Sercan Yalcin ◽  
Kurt P. Spindler
Keyword(s):  
Systematic Review ◽  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Cruciate Ligament ◽  
Knee Function ◽  
Increased Risk ◽  
Patient Reported ◽  
The Mean ◽  
Anterior Cruciate

Background: Several long-term (≥20 years) follow-up studies after anterior cruciate ligament (ACL) reconstruction have been published in recent years, allowing for a systematic evaluation of outcomes. Purpose: To summarize outcomes at ≥20 years after ACL reconstruction and identify patient and surgical factors that affect these results. Study Design: Systematic review; Level of evidence, 4. Methods: Prospective studies of primary ACL reconstructions with hamstring or bone–patellar tendon—bone (BTB) autograft via an arthroscopic or a mini-open technique and with a mean follow-up of ≥20 years were identified. When possible, the mean scores for each outcome measure were calculated. Factors identified in individual studies as predictive of outcomes were described. Results: Five studies met the inclusion and exclusion criteria with a total of 2012 patients. The pooled mean follow-up for patient-reported outcome measures was 44.2% (range, 29.6%-92.7%) and in-person evaluation was 33.2% (range, 29.6%-48.9%). Four studies (n = 584) reported graft tears at a mean rate of 11.8% (range, 2%-18.5%) and 4 studies (n = 773) reported a contralateral ACL injury rate of 12.2% (range, 5.8%-30%). Repeat non-ACL arthroscopic surgery (4 studies; n = 177) to the ipsilateral knee occurred in 10.4% (range, 9.5%-18.3%) and knee arthroplasty (1 study; n = 217) in 5%. The pooled mean of the International Knee Documentation Committee subjective knee function (IKDC) score was 79.1 (SD, 21.8 [3 studies; n = 644]). In 2 studies (n?= 221), 57.5% of patients continued to participate in strenuous activities. The IKDC-objective score was normal or nearly normal in 82.3% (n = 496; 3 studies), with low rates of clinically significant residual laxity. Moderate-severe radiographic osteoarthritis (OA) (IKDC grade C or D) was present in 25.9% of patients (n = 605; 3 studies). Medial meniscectomy is associated with increased risk of radiographic OA. Radiographic OA severity is associated with worse patient-reported knee function, but the association with knee pain is unclear. Conclusion: Currently available prospective evidence for ACL reconstruction with hamstring or BTB autograft provides several insights into outcomes at 20 years. The rates of follow-up at 20 years range from 30% to 93%. IKDC-objective scores were normal or nearly normal in 82% and the mean IKDC-subjective score was 79 points.

Arthroscopic Treatment of Anterior Ankle Impingement

1997 ◽  
Vol 18 (7) ◽  
pp. 418-423 ◽  
Author(s):  
Alberto Branca ◽  
Luigi Di Palma ◽  
Carmelo Bucca ◽  
Camilla Sagarriga Visconti ◽  
M. Di Mille
Keyword(s):  
Preoperative Evaluation ◽  
Stage Iv ◽  
Ankle Arthroscopy ◽  
Stage Iii ◽  
Joint Cartilage ◽  
Ankle Impingement ◽  
Radiological Classification ◽  
Invasive Techniques ◽  
Anterior Ankle Impingement

Ankle arthroscopy has recently allowed the elaboration of less invasive techniques for the treatment of anterior impingement. Its indications, advantages, and drawbacks in this application are discussed. Between 1987 and 1994, 133 patients were treated for ankle impingement. Among them, 58 patients, 37 men and 21 women (mean age, 28.5 years), who had failed a trial of conservative treatment were treated by means of tibiotalar arthroscopy. Twenty-seven were athletes engaged in sports with abnormal stressing of the ankle. According to McDermott's radiological classification, there were 15 stage I cases, 23 stage II, 13 stage III, and 7 stage IV. Preoperative evaluation with a modified version of McGuire's scoring system gave 50 cases rated as “poor” (<60 points) and 8 cases rated as “fair” (60–67 points). Treatment consisted of removal of adhesions, cartilage shaving, and removal of the bone impingement with powered instruments, curettes, or small osteotomes. Follow-up was from 8 to 62 months (mean, 21.5 months). The postoperative McGuire ratings were 37 good, 13 fair, and 8 poor. There were no major complications. Recurrence of impingement was observed in four cases of stage III and IV. The conclusion is drawn that ankle arthroscopy is a sound method for the treatment of anterior impingement. Even in cases with severe joint cartilage impairment, it plays a therapeutic role as a means of postponing a possible arthrodesis.

scholarly journals Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation

2018 ◽  
Vol 21 (5) ◽  
pp. 449-455 ◽  
Author(s):  
Julio D. Montejo ◽  
Joaquin Q. Camara-Quintana ◽  
Daniel Duran ◽  
Jeannine M. Rockefeller ◽  
Sierra B. Conine ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Pediatric Patients ◽  
Lumbar Disc ◽  
Low Back ◽  
Duration Of Symptoms ◽  
Patient Reported ◽  
The Mean

OBJECTIVELumbar disc herniation (LDH) in the pediatric population is rare and exhibits unique characteristics compared with adult LDH. There are limited data regarding the safety and efficacy of minimally invasive surgery (MIS) using tubular retractors in pediatric patients with LDH. Here, the outcomes of MIS tubular microdiscectomy for the treatment of pediatric LDH are evaluated.METHODSTwelve consecutive pediatric patients with LDH were treated with MIS tubular microdiscectomy at the authors’ institution between July 2011 and October 2015. Data were gathered from retrospective chart review and from mail or electronic questionnaires. The Macnab criteria and the Oswestry Disability Index (ODI) were used for outcome measurements.RESULTSThe mean age at surgery was 17 ± 1.6 years (range 13–19 years). Seven patients were female (58%). Prior to surgical intervention, 100% of patients underwent conservative treatment, and 50% had epidural steroid injections. Preoperative low-back and leg pain, positive straight leg raise, and myotomal leg weakness were noted in 100%, 83%, and 67% of patients, respectively. The median duration of symptoms prior to surgery was 9 months (range 1–36 months). The LDH level was L5–S1 in 75% of patients and L4–5 in 25%. The mean ± SD operative time was 90 ± 21 minutes, the estimated blood loss was ≤ 25 ml in 92% of patients (maximum 50 ml), and no intraoperative or postoperative complications were noted at 30 days. The median hospital length of stay was 1 day (range 0–3 days). The median follow-up duration was 2.2 years (range 0–5.8 years). One patient experienced reherniation at 18 months after the initial operation and required a second same-level MIS tubular microdiscectomy to achieve resolution of symptoms. Of the 11 patients seen for follow-up, 10 patients (91%) reported excellent or good satisfaction according to the Macnab criteria at the last follow-up. Only 1 patient reported a fair level of satisfaction by using the same criteria. Seven patients completed an ODI evaluation at the last follow-up. For these 7 patients, the mean ODI low-back pain score was 19.7% (SEM 2.8%).CONCLUSIONSTo the authors’ knowledge, this is the longest outcomes study and the largest series of pediatric patients with LDH who were treated with MIS microdiscectomy using tubular retractors. These data suggest that MIS tubular microdiscectomy is safe and efficacious for pediatric LDH. Larger prospective cohort studies with longer follow-up are needed to better evaluate the long-term efficacy of MIS tubular microdiscectomy versus other open and MIS techniques for the treatment of pediatric LDH.

Abstract 1122‐000152: Flow Diverter Use in Acutely Presented Dissecting Aneurysms, 2 Years Follow Up of 53 Cases

2021 ◽  
Vol 1 (S1) ◽  
Author(s):  
Ossama Y Mansour ◽  
Aser Goma
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Clinical Outcome ◽  
Flow Diverter ◽  
Parent Artery ◽  
Modified Rankin Scale ◽  
Alternative Treatment Option ◽  
Increased Risk ◽  
Flow Diverters ◽  
Dissecting Aneurysms

Introduction : Acute dissecting aneurysms are among the uncommon causes of subarachnoid hemorrhage. Established endovascular treatment options include parent artery occlusion and stent‐assisted coiling, but appear to be associated with an increased risk of ischemic stroke. reconstruction of the vessels with flow diverters is an alternative therapeutic option. Methods : This is a retrospective analysis of 53 consecutive acutely ruptured dissecting aneurysms treated with flow diverters. The primary end point was favorable aneurysm occlusion, defined as OKM C1‐3 and D . Secondary end points were procedure‐related complications and clinical outcome. Results : 23 aneurysms (43.4%%) arose from the intradural portion of the vertebral artery, 10 (18.8%) were located on the posterior inferior cerebellar artery and 3 (5.6%) posterior cerebral artery, 7 (13.2%) MCA, (18.8%) ICA . 45 aneurysms presented by SAH while 8 presented by Ischemic manifestation. Flow diverter placement was technically successful in all cases . immediate postoperative rerupture occurred in two case (3.7%), thromboembolic complications in 3 cases (5.7%). Median clinical follow‐up was 640 days and median angiographic follow‐up was 690 days. ten patients (18.9%) with poor‐grade subarachnoid hemorrhage died in the acute phase. Favorable clinical outcome (modified Rankin scale ≤2) was observed in 27 of 53 patients (51%) and a moderate outcome (modified Rankin scale 3/4) was observed in 12 of 53 patients (22.6%). All aneurysms showed complete occlusion at follow‐up. Conclusions : Flow diverters might be a feasible, alternative treatment option for acutely symptomatic dissecting aneurysms and may effectively prevent rebleeding in ruptured aneurysms.

scholarly journals Twenty-Two-Year Outcome of Cartilage Repair Surgery by Perichondrium Transplantation

Cartilage ◽  
2020 ◽  
pp. 194760352095814 ◽  
Author(s):  
Maarten P. F. Janssen ◽  
Esther G. M. van der Linden ◽  
Tim A. E. J. Boymans ◽  
Tim J. M. Welting ◽  
Lodewijk W. van Rhijn ◽  
...  
Keyword(s):  
Cartilage Repair ◽  
Revision Surgery ◽  
Treatment Success ◽  
Patient Characteristics ◽  
Long Term Outcome ◽  
Major Revision ◽  
Increased Risk ◽  
Patient Reported ◽  
Ikdc Score

Objective The main purpose of the present study was to assess the risk for major revision surgery after perichondrium transplantation (PT) at a minimum of 22 years postoperatively and to evaluate the influence of patient characteristics. Design Primary outcome was treatment success or failure. Failure of PT was defined as revision surgery in which the transplant was removed, such as (unicondylar) knee arthroplasty or patellectomy. The functioning of nonfailed patients was evaluated using the International Knee Documentation Committee (IKDC) score. In addition, the influence of patient characteristics was evaluated. Results Ninety knees in 88 patients, aged 16 to 55 years with symptomatic cartilage defects, were treated by PT. Eighty knees in 78 patients were eligible for analysis and 10 patients were lost to follow-up. Twenty-eight knees in 26 patients had undergone major revision surgery. Previous surgery and a longer time of symptoms prior to PT were significantly associated with an increased risk for failure of cartilage repair. Functioning of the remaining 52 patients and influence of patient characteristics was analyzed using their IKDC score. Their median IKDC score was 39.08, but a relatively young age at transplantation was associated with a higher IKDC score. Conclusions This 22-year follow-up study of PT, with objective outcome parameters next to patient-reported outcome measurements in a unique group of patients, shows that overall 66% was without major revision surgery and patient characteristics also influence long-term outcome of cartilage repair surgery.

Diagnosis and treatment of anterior ankle impingement: state of the art

2020 ◽  
Vol 5 (5) ◽  
pp. 295-303
Author(s):  
Pedro Diniz ◽  
Duarte André Sousa ◽  
Jorge Pablo Batista ◽  
Nasef Abdelatif ◽  
Helder Pereira
Keyword(s):  
Soft Tissue ◽  
Conservative Treatment ◽  
Plantar Flexion ◽  
Weight Bearing ◽  
Osteochondral Lesion ◽  
Osteochondral Lesions ◽  
X Rays ◽  
Ankle Pain ◽  
Ankle Impingement ◽  
Anterior Ankle Impingement

The aim of this paper is to discuss anterior ankle impingement (AAI) regarding diagnosis, interventions, techniques and future perspectives. AAI is a pain syndrome due to soft tissue or bony impingement. Impingement caused by soft tissues is frequently found in the anterolateral compartment of the ankle, whereas impingement caused by bony spurs is generally located in the anteromedial compartment. Typical complaints are chronic ankle pain, limited dorsiflexion and swelling. The most important feature is recognisable tenderness on palpation, which helps distinguish this condition from an osteochondral lesion, which is characterised with deep ankle pain. Although the diagnosis is mainly based on clinical assessment, imaging is helpful for differential diagnosis and preoperative planning. Standard X-rays, using anteroposterior, lateral and an anteromedial oblique view for detecting bony spurs, are sufficient to make the diagnosis. CT can be used to accurately assess the extent and size of a bony spur. MRI is useful to evaluate soft tissue lesions and exclude concomitant pathology, like osteochondral lesions or stress fractures. Conservative treatment is the first-line treatment. In cases where conservative treatment has been unsuccessful, surgery may be indicated. Arthroscopic debridement is considered the gold standard to treat AAI. Rehabilitation protocol includes full weight-bearing and exercises to stimulate active dorsiflexion-plantar flexion and avoid stiffness.

scholarly journals Surgical Decompression for Thoracic Outlet Syndrome in Adolescent Patients

2019 ◽  
Vol 7 (7_suppl5) ◽  
pp. 2325967119S0037
Author(s):  
Erin Fynan Ransom ◽  
Heather Minton ◽  
Bradley Young ◽  
Brent Ponce ◽  
Gerald McGwin ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Thoracic Outlet Syndrome ◽  
Patient Characteristics ◽  
Mechanism Of Injury ◽  
First Rib ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Quick Dash

Objectives: Thoracic outlet syndrome represents a complex combination of symptoms in the upper extremity that occurs due to compression of the neurovascular structures of the thoracic outlet or subcoracoid space. It can be seen in overhead athletes and is commonly misdiagnosed as other shoulder pathology. This study seeks to highlight patient characteristics, intraoperative findings, and both short term and long term outcomes of thoracic outlet decompression in the adolescent population as well as a comparison of outcomes by mechanism of injury including athletes. Methods: A retrospective chart review was performed of patients between the ages of 13 and 21 with a clinical diagnosis of TOS that were treated surgically by a single surgeon between 2000 and 2015. Data points including preoperative patient characteristics and intraoperative findings were collected. In addition, patient reported outcome scores including quickDASH, CBSQ, VAS, and SANE were obtained for a cohort of patients with long-term follow up ranging from 2 to 15 years. Results: The study population consisted of 54 adolescents (61 extremities) aged 13-21 at the time of presentation. There was a 3:1 female to male ratio. Patients saw an average of 2.08 other healthcare providers before referral to our institution. The most common surgical procedures included neurolysis of the brachial plexus (60; 98.4%), anterior scalenectomy (59; 96.7%), middle scalenectomy (54; 88.5%), excision of the first rib (28; 45.9%), excision of cervical rib (5; 8.2%), and subclavian artery manipulation (50, 81.9%). A second incision in the subcoracoid space was utilized in 28 (45.9%) extremities for exploration of the infraclavicular brachial plexus with release of the coracocostal ligament in 26 of these 28 patients (92.9%). Long-term follow-up data, including patient reported outcomes, was collected for 24/54 patients (44%). In this patient subset, the average follow-up was 69.5 months and ranged from 24 months to 180 months. The average preoperative VAS was recorded at 8.2 with an average postoperative VAS of 2.0, showing an improvement of 6.2 points. The average preoperative SANE score was 28.9 and the average postoperative SANE score was 85.4 with an improvement in 56.5. The average postoperative quickDASH score was 11.4. The average postoperative CBSQ score was 27.4 . The average postoperative NTOS Index score was 17.2. Subgroup analysis was performed analyzing patients having a first rib excision versus patients where their first rib was left intact. There was no difference regarding clinical outcome measures in these groups including CBSQ, VAS, SANE score, quick DASH and NTOS index. An additional subgroup analysis was performed comparing mechanism of injury including overuse from sports, trauma, and idiopathic causes. There was also no difference regarding clinical outcome measures in these groups including CBSQ, VAS, SANE score, quick DASH and NTOS index. Conclusion: We found no difference in clinical outcome scores in patients treated with rib resection versus patients with the first rib left intact. We also found no difference in outcomes with respect to mechanism of injury including overhead sports athletes. Overall, patients did well long-term after decompression of the thoracic outlet. Thoracic outlet syndrome should be considered in the differential diagnosis of athletes with upper extremity pain especially if they have neurologic findings.

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