scholarly journals CLINICAL OUTCOMES OF OPERATIVE MANAGEMENT OF CAPITELLAR OSTEOCHONDRITIS DISSECANS IN ADOLESCENT ATHLETES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0009
Author(s):  
Richard M. Michelin ◽  
Bryn R. Gornick ◽  
John A. Schlechter
Keyword(s):  
Operative Treatment ◽  
Osteochondritis Dissecans ◽  
Return To Sport ◽  
Bone Age ◽  
Return To Sports ◽  
Adolescent Athletes ◽  
Duration Of Symptoms ◽  
Marrow Stimulation ◽  
Diagnostic Arthroscopy

Background: Capitellar osteochondritis dissecans (OCD) is commonly encountered in youth athletes. There are limited reports on long term outcomes using validated outcome scores following surgical treatment of elbow OCD in adolescents. Purpose: To examine the outcomes of operative treatment of elbow OCD in adolescent athletes and investigate return to sport rate as well as athletic and daily function. Methods: 17 adolescent athletes (average age 14.2 ± 1.5 years) and 18 elbows with OCD treated arthroscopically were retrospectively reviewed. The average duration of symptoms prior to surgery was 15.4 ± 12.5 months and average follow up was 4.4 ± 3.7 years. Data points examined included pre-operative lesion grade/size, range of motion (ROM), and bone age; intra-operative lesion grade/size; and post-operative ROM, Kerlan-Jobe Orthopaedic Clinic (KJOC) Overhead Athlete Shoulder and Elbow score, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score. Results: All patients were treated with initial diagnostic arthroscopy. 14/17 patients were definitively treated with arthroscopic debridement and marrow stimulation/microfracture. 3/17 patients required open treatment with two patients amendable to osteochondral fixation and one patient to open marrow stimulation/microfracture. 14/17 athletes returned to their sport post-operatively with 12/17 returning to the same level or higher, and 2/17 returning to a lower level of recreational play. 3/17 athletes did not return to sports but advised that this was by choice not due to their elbow OCD. Overall, there were significant improvements in elbow ROM post-operatively as well as excellent QuickDASH (average 1.9 ± 4.4) and KJOC scores (average 93 ± 8.0) seen amongst all athletes. There was no correlation between pre-operative lesion grade/size, bone age, or open versus arthroscopic treatment with outcome. Conclusion: Operative treatment of elbow OCD in adolescent athletes not only leads to high return to sports rates but also high levels of athletic and daily functional activity long term.

scholarly journals Long Term Clinical–Functional and Ultrasound Outcomes in Recreational Athletes after Achilles Tendon Rupture: Ma and Griffith Versus Tenolig

Medicina ◽  
2021 ◽  
Vol 57 (10) ◽  
pp. 1073
Author(s):  
Carlo Biz ◽  
Mariachiara Cerchiaro ◽  
Elisa Belluzzi ◽  
Nicola Luigi Bragazzi ◽  
Giacomo De Guttry ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Return To Sport ◽  
Functional Results ◽  
Return To Sports ◽  
Recreational Athletes ◽  
Sport Activities ◽  
Long Term Follow Up

Background and Objectives: The purpose of this retrospective study was to compare the long-term clinical–functional and ultrasound outcomes of recreational athletes treated with two percutaneous techniques: Ma and Griffith (M&G) and the Tenolig technique (TT). Materials and Methods: recreational athletes, between 18 and 50 years of age, affected by acute Achilles tendon rupture (AATR), treated by M&G or Tenolig techniques were recruited. Clinical–functional outcomes were evaluated using Achilles Tendon Rupture Score (ATRS), AOFAS Ankle–Hindfoot score, VAS (for pain and satisfaction) questionnaires, and ultrasound analysis (focal thickening, hypoechoic areas, presence of calcifications, tendinitis and alteration of normal fibrillar architecture). Results: 90 patients were included: 50 treated by M&G, 40 by TT. In all, 90% of patients resumed sports activities, with pre-injury levels in 56% of cases after M&G and in 60% after TT. In the M&G group, the averages of the questionnaires were ATRS 90.70 points, AOFAS 91.03, VAS satisfaction 7.08, and VAS pain 1.58. In the TT group: ATRS 90.38 points, AOFAS 90.28, VAS satisfaction 7.76, and VAS pain 1.34. The TT group showed a significantly higher satisfaction and return to sport activities within a shorter time. In the M&G group, ultrasound check showed a significantly greater incidence of thickening and an alteration of fibrillar architecture in the treated tendon. Three infections were reported, including one deep after M&G, two superficial in the TT group, and two re-ruptures in the Tenolig group following a further trauma. Conclusions: At long-term follow-up, M&G and TT are both valid techniques for the treatment of AATRs in recreational athletes, achieving comparable clinical–functional results. However, TT seems to have a higher patient satisfaction rate, a faster return to sports and physical activities, and fewer ultrasound signs of tendinitis. Finally, the cost of the device makes this technique more expensive.

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.

Long term results of operative treatment of knee osteochondritis dissecans

2012 ◽  
Vol 124 (19-20) ◽  
pp. 699-703 ◽  
Author(s):  
Samo K. Fokter ◽  
Andrej Strahovnik ◽  
Darjan Kos ◽  
Andraž Dovnik ◽  
Nina Fokter
Keyword(s):  
Operative Treatment ◽  
Osteochondritis Dissecans ◽  
Long Term Results

scholarly journals SURGICAL OUTCOMES OF ACCESSORY NAVICULAR IN ADOLESCENT ATHLETES

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0014
Author(s):  
A Yang ◽  
WL. Hennrikus ◽  
Penn State Hershey Pediatric Bone ◽  
PA Hershey ◽  
Keyword(s):  
Family History ◽  
Growth Plate ◽  
Surgical Outcomes ◽  
Return To Sports ◽  
Adolescent Athletes ◽  
Flat Foot ◽  
Pes Planus ◽  
Duration Of Symptoms ◽  
Accessory Navicular

Introduction: An accessory navicular (AN) is a plantar medial enlargement of the navicular bone of the foot. Patients with AN present with a foot bump. Only some patients are symptomatic with pain. The purpose of this study is to report the surgical outcomes in a consecutive series of adolescent athletes with symptomatic AN. Methods: The study was approved by the College of Medicine IRB. 16 patients were evaluated. Patient gender, age, complaints, family history, sports played, conservative treatments attempted, duration of symptoms, surgical technique, complications, outcomes, average follow up, time to return to normal activity, # that returned to sports, and the time to return to sports were recorded. Radiographs were used to identify the type of AN (Coughlin system), skeletal maturity, and presence of pes planus. Pes planus was determined by standing lateral foot radiograph talo-first metatarsal angle. Results: 16 patients and 17 feet were studied. 15 were female (94%). The average age at surgery was 13 years (range 10 to 18 years). 0 patients had a family history of AN. The presenting complaint was foot pain and a bump. Sports including 2 basketball, 2 cheer, 4 gymnastics, 3 soccer, 1 volleyball, 1 dance, 1 softball, 2 multiple sports. The average duration of symptoms was 22 months (range 1 to 36 months). Conservative care methods attempted included: shoe inserts, activity modification, anti-inflammatory medications, icing, crutches, and changes in footwear. Pre-op radiographs demonstrated 9 Coughlin Type 1, 3 Type 2, and 5 Type 3 AN’s. Pre-op radiographs demonstrated 8 feet (47%) had flat foot. 9 feet (53%) had fused the calcaneal growth plate. All patients had a simple excision of the AN and 13 feet (76%) had an additional reefing of the posterior tibial tendon. The average time to return to normal activities was 13 weeks (range 8 to 16 weeks). 15/16 patients (94%) were able to return to their pre surgery sports. The average follow-up time was 8.5 months. At final follow up, 13 feet (76%) reported no pain, 3 (18%) with minimal pain, and 1 (6%) with no change in pain. No complications were reported. Discussion and Conclusion: Symptomatic AN is more common in females. Surgical success was unrelated to a closed growth plate. Surgery eliminated pain in 76% of patients and allowed 94% of patients to return to sport. Residual pain in 4 patients was correlated with a pre-op flat foot (4/8 patients: 50%).

scholarly journals Outcomes of the Latarjet procedure with minimum 5- and 10-year follow-up: A systematic review

2020 ◽  
Vol 12 (5) ◽  
pp. 315-329
Author(s):  
Ron Gilat ◽  
Ophelie Lavoie-Gagne ◽  
Eric D Haunschild ◽  
Derrick M Knapik ◽  
Kevin C Parvaresh ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Return To Sport ◽  
Anterior Shoulder Instability ◽  
Return To Sports ◽  
Latarjet Procedure ◽  
Recurrent Instability ◽  
Follow Up Studies ◽  
Long Term Follow Up

Background The purpose of this study was to evaluate mid- and long-term outcomes following the Latarjet procedure for anterior shoulder instability. Methods PubMed, MEDLINE, Embase, and Cochrane libraries were systematically searched, in line with PRISMA guidelines, for studies reporting on outcomes following the Latarjet procedure with minimum five-year follow-up. Outcomes of studies with follow-up between 5 and 10 years were compared to those with minimum follow-up of 10 years. Results Fifteen studies reporting on 1052 Latarjet procedures were included. Recurrent instability occurred in 127 patients, with an overall random summary estimates in studies with a minimum five-year follow-up of 0–18% (I2 = 90%) compared to 5–26% (I2 = 59%) for studies with a minimum 10-year follow-up. Overall rates for return to sports, non-instability related complications, and progression of arthritis estimated at 65–100% (I2 = 87%), 0–20% (I2 = 85%), and 8–42% (I2 = 89%) for the minimum five-year follow-up studies and 62–93% (I2 = 86%), 0–9% (I2 = 28%), and 9–71% (I2 = 91%) for the minimum 10-year follow-up studies, respectively. All studies reported good-to-excellent mean PRO scores at final follow-up. Conclusions The Latarjet is a safe and effective procedure for patients with shoulder instability. The majority of patients return to sport, though at long-term follow-up, a trend towards an increased incidence of recurrent instability is appreciated, while a significant number may demonstrate arthritis progression.

scholarly journals Clinical Outcome and Return to Competition after Microfracture in the Athlete’s Knee

Cartilage ◽  
2010 ◽  
Vol 1 (2) ◽  
pp. 113-120 ◽  
Author(s):  
Kai Mithoefer ◽  
Thomas J. Gill ◽  
Brian J. Cole ◽  
Riley J. Williams ◽  
Bert R. Mandelbaum
Keyword(s):  
Functional Outcome ◽  
Cartilage Repair ◽  
Return To Sport ◽  
Sports Participation ◽  
Return To Sports ◽  
Sports Activity ◽  
Systematic Analysis ◽  
Duration Of Symptoms ◽  
Athletic Competition ◽  
Return To Competition

Microfracture is frequently used for articular cartilage repair in athletes. This study aimed to define the strength and weaknesses of this minimally invasive cartilage repair technique in the athletic population in an effort to optimize indications, functional outcome, and athletic participation after microfracture in the athlete’s knee. A systematic analysis of original studies using microfracture in athletes was performed. Functional outcome was assessed by activity outcome scores, ability to return to sports participation, timing of the return to sport, level of postoperative sports activity, and continuation of athletic competition over time. Thirteen studies describing 821 athletes were included in the analysis with an average follow-up of 42 months. Good or excellent results were reported in 67% of athletes with normal International Knee Documentation Committee (IKDC) scores in 80% and significant increase of Lysholm scores, Tegner activity scores, and Knee injury and Osteoarthritis Outcome Score (KOOS) sports subscales. Return to sports was achieved in 66% at an average of 8 months after surgery, with return to competition at the preinjury level in 67%. Forty-nine percent of athletes continued to compete without change in level of play, while decreasing function was observed in 42% after 2 to 5 years. Athlete’s age, preoperative duration of symptoms, level of play, lesion size, and repair tissue morphology affected sports activity after microfracture. Microfracture improves knee function and frequently allows for return to sports at the preinjury level, but deterioration of athletic function occurs in some patients. Several independent factors were identified that can help to optimize the return to athletic competition after microfracture in the athlete’s knee.

scholarly journals Operative Treatment of Bipartite Patella in Pediatric and Adolescent Athletes: A Retrospective Comparison With a Nonoperatively Treated Cohort

2020 ◽  
Vol 8 (12) ◽  
pp. 232596712096712
Author(s):  
Jennifer Kallini ◽  
Lyle J. Micheli ◽  
Patricia E. Miller ◽  
Dennis E. Kramer ◽  
Mininder S. Kocher ◽  
...  
Keyword(s):  
Operative Treatment ◽  
Knee Pain ◽  
Surgical Techniques ◽  
Lateral Release ◽  
Return To Sports ◽  
Treatment Technique ◽  
Adolescent Athletes ◽  
Bipartite Patella ◽  
Competitive Athletes ◽  
Fragment Excision

Background: Bipartite patella (BPP) is a developmental anomaly that forms when incomplete patellar ossification leaves a residual fibrocartilaginous synchondrosis between ossification centers. Repetitive traction forces across the synchondrosis can cause knee pain, most commonly presenting in adolescence. Symptoms frequently resolve with nonoperative management. Few surgical case series exist to guide treatment approaches for refractory pain. Purpose: To investigate the clinical features, surgical techniques, and outcomes associated with operative treatment of symptomatic BPP in pediatric and adolescent athletes and to compare features of the series with a large control group managed nonoperatively. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective medical record review was conducted of all patients aged ≤20 years who were diagnosed with symptomatic, radiologically confirmed BPP between 2003 and 2018 at a single tertiary-care pediatric hospital (N = 266). Demographic and clinical variables were analyzed, and additional radiologic and perioperative variables were collected for the surgical subcohort. Results: Of the 266 patients included, 27 were treated operatively (10.2%). When compared with those treated nonoperatively (with rest, physical therapy, cryotherapy, and anti-inflammatory medications), the operatively managed group experienced a longer duration of symptoms before first presentation (21.5 vs 7.6 months; P < .001) and were more likely to be older (mean age, 15.4 vs 12.4 years; P < .001), female (59.3% vs 35.6%; P = .03), and competitive athletes (100% vs 84.5%; P = .02). In the 27 patients treated operatively, procedures were categorized as isolated fragment excision (n = 9), fragment excision with lateral release (n = 8), isolated lateral release (n = 5), fragment screw fixation (n = 4), and synchondrosis drilling (n = 1). The mean time between surgery and return to sports was 2.2 months. Four patients (14.8%) reported residual symptoms requiring secondary surgery, including lateral release (n = 1), excision of residual fragment (n = 1), and fixation screw removal (n = 2). Conclusion: BPP can cause knee pain in adolescent athletes and is generally responsive to nonoperative treatment. Patients undergoing surgical treatment—most commonly female competitive athletes with prolonged symptoms—represented 10% of cases. A variety of surgical techniques may be effective, with a 15% risk of persistent or recurrent symptoms warranting reoperation. Prospective multicenter investigations are needed to identify optimal candidates for earlier interventions and the optimal operative treatment technique.

Percutaneous mechanical thrombectomy in the treatment of acute and subacute occlusions of the peripheral arteries and bypasses

VASA ◽  
2016 ◽  
Vol 45 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Frantisek Stanek ◽  
Radoslava Ouhrabkova ◽  
David Prochazka
Keyword(s):  
Mechanical Thrombectomy ◽  
Clinical Success ◽  
Major Amputation ◽  
Peripheral Arteries ◽  
Duration Of Symptoms ◽  
Efficient Treatment ◽  
Percutaneous Mechanical Thrombectomy ◽  
Single Centre Study ◽  
Crural Arteries

Abstract. Background: The aim of this prospective single-centre study was to analyse the immediate results, failures and complications of percutaneous mechanical thrombectomy using the Rotarex catheter in the treatment of acute and subacute occlusions of peripheral arteries and bypasses, as well as to evaluate long-term outcomes of this method. Patients and methods: Patients with acute (duration of symptoms < 14 days) or subacute (duration of symptoms > 14 days and < 3 months) occlusions of peripheral arteries and bypasses were selected consecutively for treatment. The cohort consisted of 113 patients, aged 18 - 92 years (median 72 years). In all, 128 procedures were performed. Results: Angiographic success was obtained in 120 interventions (93.8 %). Reasons for failures were rethrombosis of a partially recanalised segment in six procedures, and embolism into crural arteries in one intervention - percutaneous aspiration thromboembolectomy (PAT) and/or thrombolysis were ineffective in all these cases. Breakage of the Rotarex catheter happened in one procedure. Embolisation into crural arteries as a transitory complication solvable with PAT and/or thrombolysis occurred in four cases. Rethrombosis was more frequent in bypasses than in native arteries (p = 0.0069), in patients with longer occlusions (p = 0.026) and those with poorer distal runoff (p = 0.048). Embolisation happened more often in patients with a shorter duration of symptoms (p = 0.0001). Clinical success was achieved in 82.5 %. Major amputation was performed in 10 % of cases. Cumulative patency rates were 75 % after one month, 71 % after six months, 38 % after 12 months, 33 % after 18 months and 30 % after 24, 30, 36 and 42 months. Conclusions: Rotarex thrombectomy has excellent immediate results with a low rate of failures and complications. In comparison to thrombolysis, it enables the fast and efficient treatment of acute and subacute occlusions of peripheral arteries in one session.

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