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2021 ◽  
pp. 036354652110591
Author(s):  
Joo-Hwan Kim ◽  
Dong Jin Ryu ◽  
Sung-Sahn Lee ◽  
Seung Pil Jang ◽  
Jae Sung Park ◽  
...  

Background: During high tibial osteotomy (HTO), the superficial medial collateral ligament (sMCL) is cut or released at any degree to expose the osteotomy site and achieve the targeted alignment correction according to the surgeon’s preference. However, it is still unclear whether transection of sMCL increases valgus laxity. Purpose: We aimed to assess the outcomes and safety of sMCL transection, especially focusing on iatrogenic valgus instability. Study Design: Case series; Level of evidence, 4. Methods: Seventy-two patients (89 knees) who underwent medial open wedge HTO (MOWHTO) with transection of the sMCL between October 2013 and September 2018 were retrospectively investigated. Clinical evaluations, including the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Tegner and Lysholm scores, were performed preoperatively and at 2 years postoperatively. The radiographic parameters hip-knee-ankle (HKA) angle, joint line convergence angle on standing radiographs (standing JLCA), and weightbearing line (WBL) ratio were assessed preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. To evaluate valgus laxity, we assessed the valgus JLCA and medial joint opening (MJO) at the aforementioned time points using valgus stress radiographs. Results: All clinical results at the 2-year follow-up were significantly improved compared with those obtained at the preoperative assessment ( P < .001). The postoperative HKA angle significantly differed from the preoperative one, and no significant valgus progression was observed during follow-up (preoperative, 8.5°± 2.7°; 3 months, –3.5°± 2.0°; 6 months, –3.2°± 2.3°; 1 year, –3.1°± 2.3°; 2 years, –2.9°± 2.5°; P < .001) The mean WBL ratio was 62.5% ± 9.0% at 2 years postoperatively. The postoperative valgus JLCA at all follow-up points did not significantly change compared with the preoperative valgus JLCA (preoperative, –0.1°± 2.1°; 3 months, –0.2°± 2.4°; 6 months, –0.1°± 2.5°; 1 year, 0.1°± 2.5°; 2 years, 0.2°± 2.2°) The postoperative MJO at all follow-up points did not significantly change compared with the preoperative MJO (preoperative, 7.1 ± 1.7 mm; 3 months, 7.0 ± 1.7 mm; 6 months, 6.9 ± 1.9 mm; 1 year, 6.7 ± 1.8 mm; 2 years, 6.8 ± 1.8 mm). Conclusion: Transection of the sMCL during MOWHTO does not increase valgus laxity and could yield desirable clinical and radiographic results.


PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259698
Author(s):  
Asem Qadeer ◽  
Puja B. Parikh ◽  
Charles A. Ramkishun ◽  
Justin Tai ◽  
Jignesh K. Patel

Background Little data exists regarding the association of chronic obstructive pulmonary disease (COPD) on outcomes in the setting of in-hospital cardiac arrest (IHCA). We sought to assess the impact of COPD on mortality and neurologic outcomes in adults with IHCA. Methods The study population included 593 consecutive hospitalized patients with IHCA undergoing ACLS-guided resuscitation at an academic tertiary medical center from 2012–2018. The primary and secondary outcomes of interest were survival to discharge and favorable neurological outcome (defined as a Glasgow Outcome Score of 4–5) respectively. Results Of the 593 patients studied, 162 (27.3%) had COPD while 431 (72.7%) did not. Patients with COPD were older, more often female, and had higher Charlson Comorbidity score. Location of cardiac arrest, initial rhythm, duration of cardiopulmonary resuscitation, and rates of defibrillation and return of spontaneous circulation were similar in both groups. Patients with COPD had significantly lower rates of survival to discharge (10.5% vs 21.6%, p = 0.002) and favorable neurologic outcomes (7.4% vs 15.9%, p = 0.007). In multivariable analyses, COPD was independently associated with lower rates of survival to discharge [odds ratio (OR) 0.54, 95% confidence interval (CI) 0.30–0.98, p = 0.041]. Conclusions In this contemporary prospective registry of adults with IHCA, COPD was independently associated with significantly lower rates of survival to discharge.


Author(s):  
Christoph Stotter ◽  
Stefan Nehrer ◽  
Thomas Klestil ◽  
Philippe Reuter

Zusammenfassung Operationsziel Offene Therapie osteochondraler Läsionen des Kniegelenks zur vollständigen Auffüllung knöcherner Defekte und Wiederherstellung der Gelenkfläche. Indikationen Fokale, symptomatische osteochondrale Defekte des Kniegelenks ab einer Knochendefekttiefe von ≥ 5 mm und Größe von ≥ 1,5 cm2. Kontraindikationen Arthrose (> KL Grad 2), „kissing lesions“ (ICRS > Grad 2), Alter > 50 Jahre, unbehandelte Bandinstabilitäten oder Beinachsenfehstellungen zum Nachteil des betroffenen Gelenkkompartiments, fehlendes Defektcontainment, entzündliche Gelenkerkrankungen. Operationstechnik Zweizeitiger Eingriff: Ersteingriff (arthroskopische Knorpelprobenentnahme): Defektevaluierung, Entnahme von Knorpelstücken für die Chondrozytenkultivierung, bei Bedarf Behandlung von Begleitpathologien. Zweiteingriff (offene Defektbehandlung): Arthrotomie, Präparation des knöchernen Defekts, Auffüllung mit autologen Spongiosazylindern aus dem Beckenkamm, Knorpeldefektpräparation (kann größer als knöcherner Defekt sein) und matrixgestützte autologe Chondrozytentransplantation. Weiterbehandlung Ersteingriff: frühfunktionelle Nachbehandlung mit schmerzorientierter Vollbelastung je nach Begleiteingriffen. Zweiteingriff: keine Drainage, funktionelle Kniegelenkorthese in Streckstellung für 1 Woche, danach schrittweise Freigabe der Flexion, Teilbelastung für 6 Wochen, Motorschiene (CPM) ab dem 1. postoperativen Tag. Ergebnisse Seit 2018 sind 8 Patienten (mittleres Alter 29,4 Jahre, Spanne 18 bis 36) mit der beschriebenen Technik behandelt worden. Alle Patienten konnten nach durchschnittlich 12 Monaten nachuntersucht werden. Der Gesamt-KOOS (Knee injury and Osteoarthritis Outcome Score) verbesserte sich im Mittel von 45,8 auf 81,3, und die postoperativen radiologischen Kontrollen zeigten die Einheilung der Spongiosazylinder bei allen Patienten. Der MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) Score ergab 80,4 Punkte.


2021 ◽  
pp. 036354652110560
Author(s):  
Thomas D. Alter ◽  
Derrick M. Knapik ◽  
Reagan S. Chapman ◽  
Ian M. Clapp ◽  
Nicholas A. Trasolini ◽  
...  

Background: Data on outcomes in patients with borderline hip dysplasia (BHD) who undergo hip arthroscopy remain limited, particularly in regard to return to sport (RTS). Purpose: To evaluate outcomes in patients with BHD and their ability to RTS after hip arthroscopy for treatment of femoroacetabular impingement syndrome (FAIS). Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients with self-reported athletic activity and radiographic evidence of BHD, characterized by a lateral femoral center-edge angle (LCEA) between 18° and 25° and a Tönnis angle >10°, who underwent hip arthroscopy for FAIS between November 2014 and March 2017 were identified. Patient characteristics and clinical outcomes including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction were analyzed at minimum 2-year follow-up. In addition, all patients completed an RTS survey. Results: A total of 41 patients with a mean age and body mass index (BMI) of 29.6 ± 13.4 years and 25.3 ± 5.6, respectively, were included. Mean LCEA and Tönnis angle for the study population were 22.7°± 1.8° and 13.3°± 2.9°, respectively. A total of 31 (75.6%) patients were able to RTS after hip arthroscopy at a mean of 8.3 ± 3.2 months. A total of 14 patients (45.2%) were able to RTS at the same level of activity, 16 patients (51.6%) returned to a lower level of activity, and only 1 (3.2%) patient returned to a higher level of activity. Of the 11 high school and collegiate athletes, 10 (90.9%) were able to RTS. All patients demonstrated significant improvements in all patient-reported outcome measures (PROMs) as well as in pain scores at a mean of 26.1 ± 5.4 months after surgery. Patients who were able to RTS had a lower preoperative BMI than patients who did not RTS. Analysis of minimum 2-year PROMs demonstrated better HOS-ADL, HOS-SS, mHHS, iHOT-12, and VAS outcomes for pain in patients able to RTS versus those who did not RTS ( P < .05). Conclusion: Of the patients with BHD studied here, 75.6% of patients successfully returned to sport at a mean of 8.3 ± 3.2 months after hip arthroscopy for FAIS. Of the patients who successfully returned to sport, 45.2% returned at the same level, and 3.2% returned at a higher activity level.


2021 ◽  
pp. 036354652110551
Author(s):  
Andrew E. Jimenez ◽  
Peter F. Monahan ◽  
Jade S. Owens ◽  
David R. Maldonado ◽  
Benjamin R. Saks ◽  
...  

Background: The effect of low body mass index (BMI) on outcomes in female athletes is unknown. Purpose: (1) To report minimum 2-year patient-reported outcomes and return to sports for high-level female athletes with low BMI undergoing hip arthroscopy for femoroacetabular impingement syndrome and (2) to compare results with those of a propensity-matched control group of high-level female athletes with a normal BMI. Study Design: Cohort study; Level of evidence, 3. Methods: Data were collected on all professional, collegiate, and high school female athletes who had a low BMI and underwent primary hip arthroscopy between September 2009 and March 2017 at our institute. Return-to-sports status and minimum 2-year patient-reported outcomes were collected for the modified Harris Hip Score (mHHS), Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and visual analog scale (VAS) for pain. The percentage of patients achieving the minimal clinically important difference (MCID), Patient Acceptable Symptom State (PASS), and maximum outcome improvement satisfaction threshold (MOIST) was also recorded. These patients were propensity matched to high-level female athletes with a normal BMI for comparison. Results: A total of 21 high-level female athletes (25 hips) with a mean ± SD follow-up of 58.9 ± 31.5 months were included. They demonstrated significant improvement from preoperatively to latest follow-up for the mHHS, Nonarthritic Hip Score, Hip Outcome Score–Sport Specific Subscale, and VAS ( P < .001). When outcomes were compared with those of the control group, female athletes with low BMI demonstrated lower rates of achieving the MCID for the mHHS (54.5% vs 77.4%; P = .041), PASS for the International Hip Outcome Tool–12 (45.5% vs 72.6%; P = .022), and MOIST for the VAS (31.8% vs 56.5%; P = .047). There were no other significant differences in the rate of achieving the MCID, PASS, or MOIST between the groups ( P > .05). Female athletes with low BMI also had higher rates of revision when compared with the control group (27.2% vs 10.6%; P = .049), but there were comparable return-to-sports rates (75.0% vs 74.5%; P > .05). Conclusion: High-level female athletes with low BMI undergoing primary hip arthroscopy for femoroacetabular impingement syndrome demonstrated significant improvement in patient-reported outcomes and acceptable rates of return to play. When compared with a control group with normal BMI, they exhibited higher rates of revision and lower rates of achieving the MCID for the mHHS, PASS for the International Hip Outcome Tool–12, and MOIST for the VAS.


2021 ◽  
pp. 036354652110569
Author(s):  
Volker Schöffl ◽  
Isabelle Schöffl ◽  
Sascha Flohé ◽  
Yasser El-Sheikh ◽  
Christoph Lutter

Background: Finger epiphyseal growth plate stress injuries are the most frequent sport-specific injuries in adolescent climbers. Definitive diagnostic and therapeutic guidelines are pending. Purpose: To evaluate a diagnostic-therapeutic algorithm for finger epiphyseal growth plate stress injuries in adolescent climbers. Study Design: Case series; Level of evidence, 4. Methods: On the basis of previous work on diagnostics and treatment of finger epiphyseal growth plate stress injuries (EGPIs) in adolescent climbers, we developed a new algorithm for management of these injuries, which was implemented into our clinical work. During a 4-year period, we performed a prospective multicentered analysis of our patients treated according to the algorithm. Climbing-specific background was evaluated (training years, climbing level, training methods, etc); injuries were analyzed (Salter-Harris classification and UIAA MedCom score [Union Internationale des Associations d’Alpinisme]); and treatments and outcomes were recorded: union, time to return to climbing, VAS (visual analog scale), QuickDASH (shortened version of the Disabilities of the Arm, Shoulder, and Hand), and a climbing-specific outcome score. Results: Within the observation period, 27 patients with 37 independent EGPIs of the fingers were recorded (mean ± SD age, 14.7 ± 1.5 years; 19 male, 8 female; 66.7% competitive athletes). Regarding maturity at time of injury, the mean age at injury did not differ by sex. Average UIAA climbing level was 9.5 ± 0.8, with 6 ± 4.6 years of climbing or bouldering and 14 ± 9.1 hours of weekly climbing-specific training volume. Among the 37 injuries there were 7 epiphyseal strains, 2 Salter-Harris I fractures, and 28 Salter-Harris III fractures (UIAA 1, n = 7; UIAA 2, n = 30). Thirty-six injuries developed through repetitive stress, while 1 had an acute onset. Twenty-eight injuries were treated nonoperatively and 9 surgically. Osseous union was achieved in all cases, and there were no recurrences. The time between the start of treatment and the return to sport was 40.1 ± 65.2 days. The climbing-specific outcome score was excellent in 34 patients and good in 3. VAS decreased from 2.3 ± 0.6 to 0.1 ± 0.4 after treatment and QuickDASH from 48.1 ± 7.9 to 28.5 ± 3.3. Conclusion: The proposed management algorithm led to osseous union in all cases. Effective treatment of EGPIs of the fingers may include nonsurgical or surgical intervention, depending on the time course and severity of the injury. Further awareness of EGPI is important to help prevent these injuries in the future.


2021 ◽  
pp. bjsports-2021-104412
Author(s):  
Karl Bang Christensen ◽  
Mikkel Bek Clausen ◽  
Enda King ◽  
Andrew Franklyn-Miller ◽  
Joar Harøy ◽  
...  

BkgroundNo studies have tested the validity of the Copenhagen Hip and Groin Outcome Score (HAGOS) using modern test theory, across different cultures and languages.ObjectiveTo validate the Danish, English and Norwegian versions of HAGOS and its six subscales (Symptoms (S, Item 1–7), Pain (P, Item 1–10), activities of daily living (Item 1–5), Sport and recreation (Sport/rec, Item 1–8), Participation in physical activity (item 1–2) and quality of life (item 1–5)) by evaluating differential item functioning (DIF) and measurement invariance across the three language versions in male multidirectional team athletes with groin pain. Second, to modify subscales depending on goodness-of-fit to the item response theory models and calculate conversion tables if language DIF was observed.MethodsWe included individual responses to the Danish (n=157), English (n=146) and Norwegian (n=149) language versions of HAGOS from 452 athletes (median age 24 years old, range 20–28) with groin pain. Overall fit, model fit, individual item fit, local response dependence and measurement invariance was examined using confirmatory factor analysis and graphical Rasch models.ResultsThe removal of seven misfitting items (S2, P1, P2, A4, SP1, SP5, Q3) resulted in 6 HAGOS subscales with acceptable psychometric properties. For the Symptoms, Pain and Sports subscales evidence of DIF was disclosed between the three different language-versions of HAGOS and conversion tables were created.ConclusionsA revised HAGOS derived using modern test theory provides valid measurements for male multidirectional athletes with groin pain across different cultures and languages. Conversion tables must be applied to compare HAGOS scores from Danish, Norwegian and English language versions.


Author(s):  
Zeeshan M. Akhtar ◽  
Emily R. Hunt ◽  
Brooks N. Platt ◽  
Alex L. Turner ◽  
Cale A. Jacobs ◽  
...  

AbstractDoxycycline has been shown to reduce fibroblast activity in the treatment of multiple pathologies, and was utilized as part of the postoperative medication protocol to help prevent adhesions from developing after hip arthroscopy. The purpose of this study was to compare early postoperative pain outcomes between consecutive case series of femoroacetabular impingement syndrome (FAIS) patients treated with or without a 7-day postoperative course of doxycycline following hip arthroscopy. We hypothesized that the doxycycline-treated group would have superior patient-reported outcomes at 6 weeks, and the effect would be more pronounced for patients with low preoperative mental health scores.Our institutional review board–approved prospective outcomes registry was queried for patients who had undergone arthroscopic femoral osteochondroplasty and/or labral repair or reconstruction secondary to FAIS performed by a single, fellowship-trained surgeon. A 7-day postoperative course of doxycycline was initiated in 2018. Six-week postoperative Hip Disability and Osteoarthritis Outcome Score (HOOS) global (HOOSglobal) and International Hip Outcome Tool (iHOT) scores were compared between the consecutive series treated with versus without doxycycline. Additional subgroup analysis was performed on patients with low preoperative Veterans RAND 12-Item Health Survey (VR-12) mental component scores to determine possible additional benefit of postoperative doxycycline in this group.A total of 134 patients (98 female, 36 male, age = 36.2 ± 13.4 years, body mass index [BMI] = 27.2 ± 5 kg/m2) were identified between 2013 and 2020. There were no differences between the control (n = 84) and doxycycline group (n = 50) in age, sex, or BMI. Postoperative HOOSglobal scores (control = 58.5 ± 13.1, doxycycline = 58.7 ± 14.7, p = 0.96) and iHOT scores (control = 54.4 ± 22.2, doxycycline = 52.3 ± 24.8, p = 0.61) did not differ between groups. The subset of 83 patients with low preoperative mental scores showed no differences in HOOSglobal (control = 51.6 ± 13.3, doxycycline = 57.3 ± 7.4, p = 0.12) or iHOT scores (control = 45.5 ± 20.3, doxycycline = 53.6 ± 23.1, p = 0.250).Our results do not support the hypothesis that postoperative doxycycline leads to significant improvement in early postoperative pain scores or functional outcomes in patients undergoing hip arthroscopy for FAIS.


2021 ◽  
pp. 036354652110571
Author(s):  
Nathaniel P. Mercer ◽  
Alan P. Samsonov ◽  
John F. Dankert ◽  
John G. Kennedy

Background: Autologous osteochondral transplantation (AOT) using a cylindrical graft in the treatment of osteochondral lesions of the talus (OLTs) is typically indicated for patients with larger lesions. However, with lesions that are irregular in shape, the AOT graft may not completely replace the lesion. For these lesions, we utilize extracellular matrix cartilage allograft (EMCA) augmentation in AOT to act as a physiologic grout at the host-graft interface. Purpose: To determine if the combination of EMCA with concentrated bone marrow aspirate (CBMA) would improve integration of the host-graft interface and subsequently reduce postoperative cyst formation after AOT. It was also hypothesized that EMCA in conjunction with CBMA would demonstrate improved MOCART (magnetic resonance observation of cartilage repair tissue) scores and functional outcome scores at a minimum 2 years after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective analysis was performed comparing patients treated with AOT/CBMA alone and AOT with CBMA/EMCA. Clinical outcomes were evaluated with the Foot and Ankle Outcome Score. Magnetic resonance imaging appearance was evaluated with the use of the MOCART (magnetic resonance observation of cartilage repair tissue) score. Cyst formation was also evaluated on postoperative magnetic resonance imaging. Results: A total of 26 patients were included in the AOT + CBMA/EMCA group (10 male, 16 female), and 34 patients were included in the AOT/CBMA group (17 male, 17 female). The mean Foot and Ankle Outcome Score significantly improved in both groups ( P < .001) across all subscales (symptoms, pain, activities of daily living, sports activities, and quality of life), but there was no significant difference between groups at final follow-up. There was no significant difference in mean MOCART scores between the groups ( P = .118). In the AOT/CBMA group, 3 patients (8.8%) complained of knee pain, and 1 (2.9%) required additional surgery (hardware removal). In the AOT + CBMA/EMCA group, 2 patients (7.7%) complained of knee pain, and 6 patients (23%) required additional surgery (3 hardware removals and 3 arthroscopic debridements of scar tissue in the ankle). Conclusion: We found that while EMCA with CBMA has benefit in regeneration and repair of OLT treated with bone marrow stimulation, there appears to be little benefit of EMCA over CBMA alone as a physiologic grout at the graft-host interface in OLT treated with AOT.


Author(s):  
Sudhakar Viswas ◽  

Background: Knee osteoarthritis (OA)is a chronic joint disease, primarily occurring in aged population. Rehabilitation of knee osteoarthritis aims to reduce pain and disability by strengthening, raising endurance, range of motion, proprioception and improving aerobic fitness. Aim and Objectives: This study aimed to analyse and compare the impact of strengthening and proprioceptive exercises on balance and activities of daily living in knee OAin population of west Delhi, India. Material & Methods- Thirty OA patients were enrolled from Khetarpal hospital, Delhi, after taking ethical approval and informed consent. A study was explained to subjects and data was obtained as per proforma. Age of patients ranged from 50-80 years. Diagnosis was established based on radiological examination shown in the knee joint X-ray. Statistical analysis was performed by using SPSS software (Version 26). Results- Patients treated with the strengthening and proprioceptive exercises showed t-value on Berg balance scale(BBS)as -16.12 and 13.15 respectively, and the parameter of Knee Injury and Osteoarthritis Outcome Score (KOOS) showed -13.21 and 13.481 respectively, were statistically significant. Conclusion-The study groups showed, both the exercises helped reduce pain and improved the balance of daily-based activities. Furthermore, both the groups showed a significant improvement in BBS and KOOS scales.


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