Arthroscopic-Assisted Coracoclavicular Ligament Reconstruction: Clinical Outcomes and Return to Activity at Mean Six-Year Follow-up

Objectives: Over the past decade, there have been advances in arthroscopic-assisted approaches for coracoclavicular (CC) reconstruction with less surgical morbidity and enhanced visualization while also allowing for the treatment of concomitant glenohumeral pathology. Previous studies reporting outcomes using both open and arthroscopic-assisted techniques are limited by short-term follow-up and small patient populations. It also remains unclear how maintenance of reduction and clinical outcomes correlate with one another. The purpose of our study was to report clinical and functional outcomes including return to pre-injury activity level following arthroscopic-assisted CC ligament reconstruction (AA-CCR) and to determine associations between return to pre-injury activity level, radiographic outcomes and patient-reported outcomes scores following AA-CCR. We hypothesized that patients undergoing AA-CCR would have a high rate of return to pre-injury activity level, clinical outcomes would not be associated with RLOR, and that the treatment of concomitant glenohumeral pathology would not adversely affect outcomes. Methods: A retrospective review of prospectively collected data from an institutional registry of all AA-CCR performed from January 2007-January 2016 was performed. Exclusion criteria included revision CCR, open CCR, and patients with less than two-year follow-up. Demographics and patient characteristics including sex, age at index surgery, grade of AC joint injury, duration between injury and index surgery, concomitant glenohumeral pathologies and procedures performed, complications, and subsequent surgeries were recorded. Grade of AC joint injury was determined using the Rockwood classification, and patients indicated for surgery had at least a Type III injury. Time elapsed between injury and index surgery was recorded and classified as acute (0–30 days) or chronic (> 30 days). The arthroscopic-assisted portion of the CC reconstruction has been prevously described and is as follows: The base of the coracoid then exposed either through a subacromial or intraarticular approach. Passing sutures were then placed around the coracoid for later shuttling of the soft tissue graft (allograft semitendinosus/posterior tibialis/anterior tibialis or autograft semitendinosus, according to surgeon preference) and heavy suture, which was used for ancillary fixation. Postoperative radiographs were obtained at approximately two weeks and six months following surgery. The CC distance was measured at final radiographic follow-up and compared to the unaffected contralateral side on an anteroposterior (AP) radiograph. Radiographic loss of reduction (RLOR), was defined as at least a 25% increase in CC distance as measured from the superior cortex of the coracoid process and the undersurface of the clavicle using a radiographic ruler compared to the contralateral side. Clinical assessment at final follow-up included SANE score, and additionally, patients were asked which sports(s) and/or recreational activity(s) they participated in prior to injury. For each sport or recreational activity, they were then specifically asked: “Were you able to return to the same or higher level of (specific sport or activity) as prior to your injury?” Failure of AA-CCR was defined as any one of the following: 1.) Patient underwent revision AC joint stabilization surgery, 2.) Patient was unable to return to the same or higher level of sport(s) and/or recreational activity(s) as prior to injury, 3.) Patient had RLOR as defined above. For comparative analysis, patients were characterized as having one primary mode of treatment failure. Post-hoc analysis was performed considering that patients may have more than one mode of treatment failure. Results: There were 88 patients (89.8% male) with a mean age of 39.6 years (range 18-65) and minimum 2-year follow-up (mean 6.1 years, range 2.1-10.3). Follow-up rate was 67.7%. Mean time from injury to surgery was 7.2±2.4 months, with 70% chronic injuries and 63.6% grade V. Concomitant arthroscopic procedures were performed in 48.9% of cases. Overall, mean SANE score was 86.3 ± 17.5. Treatment failure occurred in 17.1%, with 8.0% unable to return to activity, 5.7% with RLOR, and 3.4% undergoing revision surgery for failed AA-CCR. Each patient undergoing revision surgery had an identifable traumatic event. All patients with RLOR were able to return to pre-injury activity level. SANE score was lower among patients who were unable to return to activity compared to those with RLOR and compared to non-failures (p=0.0002) (Table 1). Post-hoc analysis considering multiple modes of treatment failure for individual patients demonstrated that SANE score was still significantly lower among those unable to return to pre-injury activity level compared to patients with RLOR and compared to patients considered non-failures (p=0.00003). Ninety three percent of patients who participated in weightlifting, 97% who participated in swimming, and 83% of those who participated in yoga were able to return to their respective activity at the same or higher level as pre-injury at final followup. For all other sporrts, all patients returned to their pre-injury activity level. There were no differences in revision surgery rates, return to activity, or SANE scores according to the specific surgical technique used, Rockwood grade, or if concomitant pathology was treated (Table 2-4). Conclusions: AA-CCR with free tendon grafts resulted in good clinical outcomes and a high rate of return to pre-injury activity level. RLOR did not correlate with return to pre-injury activity level. Concomitant pathology that required treatment did not adversely affect outcomes. Return to pre-injury activity level may be a more clinically relevant outcome measure than radiographic maintenance of AC joint reduction. [Table: see text][Table: see text][Table: see text][Table: see text]

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Surgical outcomes with anatomic reduction of high-grade spondylolisthesis revisited: an analysis of 101 patients

Journal of Neurosurgery Spine ◽

10.3171/2021.3.spine202091 ◽

2021 ◽

pp. 1-11

Author(s):

Heiko Koller ◽

Karoline Mühlenkamp ◽

Wolfang Hitzl ◽

Juliane Koller ◽

Luis Ferraris ◽

...

Keyword(s):

Clinical Outcomes ◽

Revision Surgery ◽

Predictive Value ◽

Lumbar Lordosis ◽

Foot Drop ◽

High Grade ◽

Complete Reduction ◽

Preoperative Deformity ◽

L5 Corpectomy

OBJECTIVE The ideal strategy for high-grade L5–S1 isthmic spondylolisthesis (HGS) remains controversial. Critical questions include the impact of reduction on clinical outcomes, rate of pseudarthrosis, and postoperative foot drop. The scope of this study was to delineate predictors of radiographic and clinical outcome factors after surgery for HGS and to identify risk factors of foot drop. METHODS This was a single-center analysis of patients who were admitted for HGS, defined as grade III or greater L5 translation according to the Meyerding (MD) classification. Complete postoperative reduction was defined as MD grade I or less and L5 slip < 20%. Forty-six patients completed health-related quality-of-life questionnaires (Oswestry Disability Index, Physical Component Summary of SF-36, and visual analog scale) and ≥ 2 years’ follow-up (average 105 months). A 540° approach was used in 61 patients, a 360° approach was used in 40, and L5 corpectomy was used in 17. Radiographic analysis included measures of global spinopelvic balance (e.g., pelvic incidence [PI], lumbar lordosis) and measurement of lumbosacral kyphosis angle (LSA), L4 slope (L4S), L5 slip (%), and postoperative increase of L5–S1 height. RESULTS The authors included 101 patients with > 1 year of clinical and radiographic follow-up. The mean age was 26 years. Average preoperative MD grade was 3.8 and average L5 slip was 81%; complete reduction was achieved in 55 and 42 patients, respectively, according to these criteria. At follow-up, LSA correlated with all clinical outcomes (r ≥ 0.4, p < 0.05). Forty patients experienced a major complication. Risk was increased in patients with greater preoperative deformity (i.e., LSA) (p = 0.04) and those who underwent L5 corpectomy (p < 0.01) and correlated with greater deformity correction. Thirty-one patients needed revision surgery, including 17 for pseudarthrosis. Patients who needed revision surgery had greater preoperative deformity (i.e., MD grade and L5 slip) (p < 0.01), greater PI (p = 0.02), and greater postoperative L4S (p < 0.01) and were older (p = 0.02), and these patients more often underwent L5 corpectomy (p < 0.01). Complete reduction was associated with lower likelihood of pseudarthrosis (p = 0.08) and resulted in better lumbar lordosis correction (p = 0.03). Thirty patients had foot drop, and these patients had greater MD grade and L5 slip (p < 0.01) and greater preoperative LSA (p < 0.01). These patients with foot drop more often required L5 corpectomy (p < 0.01). Change in preoperative L4S (p = 0.02), LSA (p < 0.01), and L5–S1 height (p = 0.02) were significantly different between patients with foot drop and those without foot drop. A significant risk model was established that included L4S change and PI as independent variables and foot drop as a dependent variable (82% negative predictive value and 71% positive predictive value, p < 0.01). CONCLUSIONS Multivariable analysis identified factors associated with foot drop, major complications, and need for revision surgery, including degree of deformity (MD grade and L5 slip) and correction of LSA. Functional outcome correlated with LSA correction.

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Predictors of Clinical Outcomes After Proximal Hamstring Repair

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118823712 ◽

2019 ◽

Vol 7 (2) ◽

pp. 232596711882371 ◽

Cited By ~ 13

Author(s):

Eric N. Bowman ◽

Nathan E. Marshall ◽

Michael B. Gerhardt ◽

Michael B. Banffy

Keyword(s):

Patient Satisfaction ◽

Clinical Outcomes ◽

Outcome Measures ◽

Activity Level ◽

Medical Comorbidities ◽

Outcome Scores ◽

The Mean ◽

Tegner Score ◽

Proximal Hamstring

Background: Proximal hamstring avulsions cause considerable morbidity. Operative repair results in improved pain, function, and patient satisfaction; however, outcomes remain variable. Purpose: To evaluate the predictors of clinical outcomes after proximal hamstring repair. Study Design: Case series; Level of evidence, 4. Methods: We retrospectively reviewed proximal hamstring avulsions repaired between January 2014 and June 2017 with at least 1-year follow-up. Independent variables included patient demographics, medical comorbidities, tear characteristics, and repair technique. Primary outcome measures were the Single Assessment Numerical Evaluation (SANE), International Hip Outcome Tool–12 (iHOT-12), and Kerlan-Jobe Orthopaedic Clinic (KJOC) Athletic Hip score. Secondary outcome measures included satisfaction, visual analog scale for pain, Tegner score, and timing of return to sports. Results: Of 102 proximal hamstring repairs, 86 were eligible, 58 were enrolled and analyzed (67%), and patient-reported outcomes were available for 45 (52%), with a mean 29-month follow-up. The mean patient age was 51 years, and 57% were female. Acute tears accounted for 66%; 78% were complete avulsions. Open repair was performed on 90%. Overall satisfaction was 94%, although runners were less satisfied compared with other athletes ( P = .029). A majority of patients (88%) returned to sports by 7.6 months, on average, with 72% returning at the same level. Runners returned at 6.3 months, on average, but to the same level 50% of the time and at a decreased number of miles per week compared to nonrunners (15.7 vs 7.8, respectively; P < .001). Postoperatively, 78% had good/excellent SANE Activity scores, but the mean Tegner score decreased (from 5.5 to 5.1). Acute tears had higher SANE Activity scores. The mean iHOT-12 and KJOC scores were 99 and 77, respectively. Endoscopic repairs had equivalent outcome scores to open repairs, although conclusions were limited given the small number of patients in the endoscopic group. Greater satisfaction was noted in patients older than 50 years ( P = .024), although they were less likely to return to running ( P = .010). Conclusion: Overall, patient satisfaction and functionality were high. With the numbers available, we were unable to detect any significant differences in functional outcome scores based on patient age, sex, body mass index, smoking status, medical comorbidities, tear grade, activity level, or open versus endoscopic technique. Acute tears had better SANE Activity scores. Runners should be cautioned that they may be unable to return to the same preinjury activity level after proximal hamstring repair. Clinical Relevance: When counseling patients with proximal hamstring tears, runners and those with chronic tears should set appropriate expectations.

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Clinical Outcomes of ProChondrix® Osteochondral Allograft in the Knee: A Case Series

10.21203/rs.3.rs-625313/v1 ◽

2021 ◽

Author(s):

Michael S. Barnum ◽

Evan D. Boyd ◽

Annabelle P. Davey ◽

Andrew Slauterbeck ◽

James R. Slauterbeck

Keyword(s):

Clinical Outcome ◽

Clinical Outcomes ◽

Cartilage Defect ◽

Femoral Condyle ◽

Case Series ◽

Activity Level ◽

Osteochondral Allograft ◽

Cartilage Restoration ◽

Patient Reported

Abstract PurposeFocal articular cartilage injuries are common and may lead to progression of osteoarthritis. The complications associated with traditional treatment strategies have influenced the development of new biotechnologies, such as the ProChondrix® osteochondral allograft. Clinical evidence on the outcomes associated with ProChondrix® osteochondral allografts are limited. Thus, the primary purpose of this study was to evaluate the clinical outcomes following treatment of an isolated cartilage defect with a ProChondrix® osteochondral allograft implant.MethodsRetrospective analysis of patients who underwent a cartilage restoration procedure using ProChondrix® osteochondral allograft has been performed. Patients completed patient-reported outcome surveys which included the Knee injury and Osteoarthritis Outcome Score (KOOS), consisting of the 5 subscales of Pain, Symptoms, Activities of Daily Living, Sports and Recreation, and Quality of Life, the Marx Activity Scale, and the visual analog pain scale.ResultsSix patients underwent a cartilage restoration procedure using ProChondrix® between January 2016 and December 2019. Three males and three females were included with a median age of 33.5 years (range 18–48 years). The median follow-up duration was 15 months (range 9–24 months). There were 4 patellar grafts, 1 medial femoral condyle graft, and 1 lateral femoral condyle graft, with a median defect size of 18.5mm (range 13-20mm). At the most recent clinical follow-up, all six patients were pain free and all patients had returned to pre-op activity level.ConclusionTo our knowledge, this is the first study to report the clinical outcome, activity level, and patient orientated outcomes in a case series of patients following treatment of an isolated cartilage defect with a ProChondrix® osteochondral allograft implant. Our study demonstrates promising short-term results in patient reported clinical outcome scores.

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Clinical Outcomes of Revision Hip Arthroscopy for Synovial Chondromatosis

10.21203/rs.3.rs-151396/v1 ◽

2021 ◽

Author(s):

Guanying Gao ◽

Hongjie Huang ◽

Jianquan Wang ◽

Yingfang Ao ◽

Yan Xu

Keyword(s):

Clinical Outcomes ◽

Revision Surgery ◽

Hip Arthroscopy ◽

Synovial Chondromatosis ◽

Harris Hip Score ◽

Radiographic Evaluation ◽

Patient Reported ◽

Before And After ◽

Outcome Tool

Abstract Background: Synovial chondromatosis (SC) is a relatively rare disease and there were few studies on causes and clinical outcomes of revision surgery for SC. The purpose of this study was to evaluate clinical outcomes of revision hip arthroscopy for synovial chondromatosis.Methods: We evaluated consecutive patients who underwent revision hip arthroscopy for SC in our hospital between January 2008 and January 2020. Radiographic evaluation was made before and after surgery. Preoperative patient-reported outcomes (PROs) and PROs at final follow-up were obtained, including visual analog scale (VAS) for pain, the International Hip Outcome Tool-12 (iHOT-12) and modified Harris Hip Score (mHHS).Results: A total of 8 patients (mean age, 39.5 years; age range, 27-62 years; 5 males and 3 females) were included in this study. The recurrence rate of hip SC in our hospital was 6.8%. The average follow-up period after surgery was 47.3 months (range, 12–120 months). Before surgery, mean mHHS was 60.6±17.3 (range, 20-77), mean iHOT-12 was 43.8±13.7 (range, 18-69), and mean VAS was 3.1±1.7 (range, 1-7). At the final post-operative follow-up, mean mHHS was 83.8±16.6 (range, 43-91), iHOT-12 was 80.6±19.7 (range, 32-90), and mean VAS was 0.6±1.8 (range, 0-5). All results demonstrated statistically significant improvement (P < 0.05). Recurrence of SC was found in 2 patients 1 year and 4 years after revision hip arthroscopy, respectively.Conclusion: Hip arthroscopy had good clinical outcomes for revision surgery of SC.

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FAI SURGERY IN THE ADOLESCENT POPULATION: MILD DEFORMITIES AND LACK OF SPORTS PARTICIPATION ARE ASSOCIATED WITH AN INCREASED RISK OF TREATMENT FAILURE

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00019 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0001

Author(s):

Jeffrey J. Nepple ◽

Yi-Meng Yen ◽

Ira Zaltz ◽

David Podeszwa ◽

Ernest L. Sink ◽

...

Keyword(s):

Surgical Treatment ◽

Treatment Failure ◽

Clinical Outcomes ◽

Failure Rate ◽

Revision Surgery ◽

Alpha Angle ◽

Clinical Failure ◽

Female Patients ◽

Adolescent Population ◽

Adolescent Patients

Background: Femoroacetabular impingement (FAI) is as prevalent in adolescents as in adults, yet few studies have analyzed treatment outcomes in the adolescent population. The purpose of this study was to determine the clinical outcomes of FAI surgery in adolescent patients and to identify predictors of treatment failure. Methods: A cohort of 126 adolescent patients (<18 years) undergoing surgery for symptomatic FAI were prospectively assessed among a larger multicenter cohort. The adolescent subgroup included 74 (58.7%) males and 52 (41.3%) females, had a mean age of 16.1 years (range 11.3-18.0), and a mean follow-up of 3.7 years. Mild cam FAI was defined by an alpha angle less than 55 degrees. Clinical outcomes were analyzed with the mHHS, HOOS (5 domains), and UCLA activity score. Failure was defined as revision surgery or clinical failure (failure to reach MCID (minimally clinically important difference) or PASS (patient acceptable symptoms state) for modified Harris Hip score. Statistical analysis was performed to identify factors significantly associated with failure. Results: There was clinically important improvement in all PROs (mHHS, all HOOS domains) for the overall cohort and 81% of patients met criteria for a successful outcome. The failure rate (revision surgery or clinical failure) of the overall cohort was 19%, including revision surgery in 8.7%. Female patients were significantly more likely than male patients to be classified as a failure (25.7% vs. 9.1%, p=0.017, OR 2.6), in part because of a lower preoperative mHHS (59.1 vs. 67.0, p<0.001). Mild cam FAI (alpha less than 55 degrees) was present in 31.5% of cases including 39.1% of females and 14.5% of males. Maximal alpha angle was significantly inversely associated with the failure rate (37.5% for alpha<55, 19.2% for alpha 55-63, and 6.8% for alpha>63, p<0.005). Non-athletes were at a significantly greater risk of failure compared to athletes (26.5% vs. 10.3%, p=0.043, OR 2.3). Multivariable logistic regression identified mild cam FAI and lack of participation in sports as predictive of failure (p=0.005 and p=0.04), while gender was no longer significantly associated with failure after controlling for other variables. Conclusions: Adolescent patients undergoing surgical treatment of FAI demonstrate significant improvement at early followup. However, mild cam FAI deformities (which are common in adolescent female patients) and lack of participation in sports are independently associated with higher rates of treatment failure. These factors associated with treatment failure should be considered in surgical treatment decision-making and patient counseling.

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Comparison of clinical outcomes of three-corner arthrodesis and bicolumnar arthrodesis for advanced wrist osteoarthritis

Journal of Hand Surgery (European Volume) ◽

10.1177/1753193420905484 ◽

2020 ◽

Vol 45 (7) ◽

pp. 679-686 ◽

Cited By ~ 1

Author(s):

Marc Olivier Gauci ◽

Thomas Waitzenegger ◽

Pierre-Emmanuel Chammas ◽

Bertrand Coulet ◽

Cyril Lazerges ◽

...

Keyword(s):

Clinical Outcomes ◽

Revision Surgery ◽

Functional Outcomes ◽

Type I ◽

Type Ii ◽

Level Of Evidence ◽

Wrist Motion

We retrospectively compared results of 27 wrists with bicolumnar arthrodesis with mean follow-up of 67 months to 28 wrists with three-corner arthrodesis adding triquetral excision with mean follow-up of 74 months in 54 patients (55 wrists). Minimal follow-up was 2 years for all patients. Capitolunate nonunion occurred in three wrists with bicolumnar arthrodesis and six wrists with three-corner arthrodesis, and radiolunate arthritis developed in four wrists with three-corner arthrodesis. Among patients with bicolumnar arthrodesis, hamatolunate arthritis occurred in seven wrists, all with a Viegas type II lunate; and pisotriquetral arthritis occurred in three wrists. At mean 5 years after surgery, 45 wrists had not needed revision surgery, and both groups had similar revision rates. The wrists with three-corner arthrodesis and bicolumnar arthrodesis had similar functional outcomes, and range of wrist motion was not significantly different between the two groups. We concluded that bicolumnar arthrodesis results in greater longevity than three-corner arthrodesis for a type I lunate. We do not recommend bicolumnar arthrodesis for type II lunate. We also concluded that three-corner arthrodesis has a greater incidence of radiolunate arthritis and capitolunate nonunion. Level of evidence: III

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Clinical outcomes of middle fossa craniotomy for superior semicircular canal dehiscence repair

Journal of Neurosurgery ◽

10.3171/2015.8.jns15391 ◽

2016 ◽

Vol 125 (5) ◽

pp. 1187-1193 ◽

Cited By ~ 15

Author(s):

Lawrance K. Chung ◽

Nolan Ung ◽

Marko Spasic ◽

Daniel T. Nagasawa ◽

Panayiotis E. Pelargos ◽

...

Keyword(s):

Los Angeles ◽

Clinical Outcomes ◽

Semicircular Canal ◽

Surgical Repair ◽

High Rate ◽

Middle Fossa ◽

Superior Semicircular Canal Dehiscence ◽

Superior Semicircular Canal ◽

Canal Dehiscence

OBJECTIVE Superior semicircular canal dehiscence (SSCD) is a rare disorder characterized by the formation of a third opening in the inner ear between the superior semicircular canal and the middle cranial fossa. Aberrant communication through this opening causes a syndrome of hearing loss, pulsatile tinnitus, disequilibrium, and autophony. This study analyzed the clinical outcomes of a single-institution series of patients with SSCD undergoing surgical repair by the same otolaryngologist and neurosurgeon. METHODS All patients who underwent SSCD repair at the University of California, Los Angeles, between March 2011 and November 2014 were included. All patients had their SSCD repaired via middle fossa craniotomy by the same otolaryngologist and neurosurgeon. Outcomes were analyzed with Fisher's exact test. RESULTS A total of 18 patients with a mean age of 56.2 years (range 27–84 years) and an average follow-up of 5.0 months (range 0.2–21.8 months) underwent 21 cases of SSCD repair. Following treatment, all patients (100%) reported resolution in ≥ 1 symptom associated with SSCD. Autophony (p = 0.0005), tinnitus (p = 0.0059), and sound- and/or pressure-induced dizziness (p = 0.0437) showed significant symptomatic resolution. Following treatment, 29% (2/7) of patients developed imbalance, 20% (1/5) of patients developed sound- and/or pressure-induced dizziness, and 18% (2/11) of patients developed aural fullness. Among patients with improved symptoms following surgical repair, none reported recurrence of symptoms at subsequent follow-up visits. CONCLUSIONS SSCD remains an underdiagnosed and undertreated condition. Surgical repair of SSCD using a middle fossa craniotomy is associated with a high rate of symptom resolution. Continued investigation using a larger patient cohort and longer-term follow-up could further demonstrate the effectiveness of using middle fossa craniotomy for SSCD repair.

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Minimum 5-Year Clinical Outcomes, Survivorship, and Return to Sports After Hamstring Tendon Autograft Reconstruction for Sternoclavicular Joint Instability

The American Journal of Sports Medicine ◽

10.1177/0363546519900896 ◽

2020 ◽

Vol 48 (4) ◽

pp. 939-946 ◽

Cited By ~ 4

Author(s):

Lucca Lacheta ◽

Travis J. Dekker ◽

Brandon T. Goldenberg ◽

Marilee P. Horan ◽

Samuel I. Rosenberg ◽

...

Keyword(s):

Patient Satisfaction ◽

Clinical Outcomes ◽

Joint Instability ◽

Hamstring Tendon ◽

High Rate ◽

Return To Sports ◽

Joint Reconstruction ◽

Hamstring Tendon Autograft ◽

Tendon Autograft

Background: Instability of the sternoclavicular (SC) joint is a rare but potentially devastating pathologic condition, particularly when it occurs in young or active patients, where it can lead to persistent pain and impairment of shoulder function. SC joint reconstruction using a hamstring tendon autograft is a commonly used treatment option, but midterm results are still lacking. Purpose/Hypothesis: The purpose of this study was to assess the clinical outcomes, survivorship, and return-to-sports rate after SC joint reconstruction using a hamstring tendon autograft in patients suffering from SC joint instability. We hypothesized that SC joint reconstruction would result in good clinical outcomes, high rate of survivorship, and a high rate of return to sports. Study Design: Case series; Level of evidence, 4. 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, short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, 12-Item Short Form Health Survey (SF-12) physical component summary (PCS), and patient satisfaction. Survivorship of reconstruction was defined as no further revision surgery or clinical failure such as recurrent instability or subluxation events. Return to sports and pain were assessed using a customized questionnaire. Results: A total of 22 shoulders that underwent SC joint reconstruction, with a mean patient age of 31.3 years (range, 15.8-57.0 years) at the time of surgery, were included. At the final evaluation, 18 shoulders, with a mean follow-up of 6.0 years (range, 5.0-7.3 years), completed a minimum 5-year follow-up. All clinical outcome scores improved significantly from preoperatively 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 SF-12 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. There were 2 patients with failed treatment at 82 and 336 days postoperatively because of instability or pain who underwent 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 questions, 15 (17 shoulders, 77%) participated in recreational or professional sports before the injury. At final follow-up, 14 patients (16 of 17 shoulders, 94%) returned to their preinjury level of sports. The visual analog scale score for pain today ( P = .004) and pain at its worst ( P = .004) improved significantly from preoperatively to postoperatively. Conclusion: SC joint reconstruction with a hamstring tendon autograft for SC joint instability resulted in significantly improved clinical outcomes with high patient satisfaction and 90% survivorship at midterm follow-up. Furthermore, 94% of this young and high-demand patient population returned to their previous level of sports. Concerns in terms of advanced postinstability arthritis were not confirmed because a significant decrease in pain was found after a minimum 5-year follow-up.

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Factors lead to return to sports and recreational activity after total knee replacement

SICOT-J ◽

10.1051/sicotj/2020009 ◽

2020 ◽

Vol 6 ◽

pp. 11 ◽

Cited By ~ 4

Author(s):

Jeremy Plassard ◽

Jean Baptiste Masson ◽

Matthieu Malatray ◽

John Swan ◽

Francesco Luceri ◽

...

Keyword(s):

Case Series ◽

Activity Level ◽

Satisfaction Score ◽

Return To Sports ◽

Recreational Activity ◽

High Satisfaction ◽

Ucla Score ◽

Total Knee ◽

The Mean

Introduction: The number of total knee replacements performed (TKR) is increasing and so are patient expectations and functional demands. The mean age at which orthopedic surgeons may indicate TKR is decreasing, and therefore return to sport (RTS) after TKR is often an important expectation for patients. The aim of this study was to analyze the mid-term RTS, recreational activities, satisfaction level, and forgotten joint level after TKR. Methods: Between January 2015 and December 2016, 536 TKR (same implant design, same technique) were performed in our center. The mean age at survey was 69 years with a mean follow-up of 43 months. All patients who did not have a follow-up in the last 6 months were called. Finally, 443 TKR were analyzed. RTS was assessed using the University of California Los Angeles Scale (UCLA), forgotten joint score (FJS), and Satisfaction Score. Results: In this study, 85% of patients had RTS after TKR with a mean UCLA score increasing from 4.48 to 5.92 and a high satisfaction rate. Satisfaction with activity level was 93% (satisfied and very satisfied patients). The RTS is more important for people with a higher preoperative UCLA score and a lower American Society of Anesthesiologist score (ASA). Each point increase in ASA score is associated with reduced probability to RTS by 52%. Discussion: RTS and recreational activity were likely after TKR with a high satisfaction score. Preoperative condition and activity are the two most significant predictive factors for RTS. Level of evidence: Retrospective case series, level IV.

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Clinical Outcomes of Multiple Osteochondral Allograft Transplantation of the Knee: An Analysis of Snowman Technique and Multifocal Lesions

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00093 ◽

2018 ◽

Vol 6 (7_suppl4) ◽

pp. 2325967118S0009 ◽

Cited By ~ 1

Author(s):

Eric J. Cotter ◽

Charles P. Hannon ◽

Drew A. Lansdown ◽

Rachel M. Frank ◽

Brian Robert Waterman ◽

...

Keyword(s):

Clinical Outcomes ◽

Short Form ◽

Femoral Condyle ◽

Survival Rates ◽

International Knee Documentation Committee ◽

High Rate ◽

Osteochondral Allograft ◽

Allograft Transplantation ◽

Rate Of Failure

Objectives: To report the clinical outcomes of snowman technique osteochondral allograft transplantation (OCA) and clinical outcomes of multifocal OCA. Methods: Consecutive patients who underwent either a primary snowman OCA or multifocal (i.e. bipolar patellofemoral, patellofemoral and a condyle or bicondylar) with a minimum 2-year follow-up by a single surgeon from 4/2003 to 4/2015 were isolated. Failure was defined as revision OCA, conversion to arthroplasty, or gross appearance of graft degeneration on 2nd look arthroscopy. Results: Twenty-six patients (28 knees) were isolated with 22 patients (24 knees; 85.7%) having 2-year clinical follow-up. Nine of 11 patients (81.8%) who underwent isolated condylar snowman allografts met inclusion criteria at mean follow-up of 7.4±3.6 years, while 13 additional patients (15 knees; 88.2%) underwent multifocal OCA at mean follow-up of 6.4±3.9 years. All 9 patients who received isolated snowman OCA were to the medial femoral condyle. Reoperations were common with 44.4% (N=4) of the snowman group and 20% of multifocal OCA (N=3) undergoing at least 1 reoperation. There were 3 failures (33.3%) in the snowman technique group at a mean 7.7±5.5 years and 1 failure in the multifocal OCA group at 4.5 years. All 4 failures underwent TKA. Patients who underwent multifocal OCA demonstrated significant improvements in the International Knee Documentation Committee score, Knee Injury and Osteoarthritis subscores, Western Ontario and McMaster Universities Osteoarthritis Index subscores, and the Short-Form-12 physical component (P <0.05 for all). Patients who underwent snowman OCA demonstrated significant improvement in KOOS pain subscore and WOMAC overall scores (P<0.05 for both) Table 1]. Conclusion: While in a small cohort, patients who underwent snowman OCA had a high rate of reoperation (44.4%) and a high rate of failure (33.3%). Comparatively, patients who underwent multifocal OCA had reoperation and graft survival rates comparable to published literature for focal OCA. [Table: see text]

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