Background:
Injuries to the hamstring complex most commonly involve the proximal musculotendinous junction of the long head of the biceps femoris (MTJ-BFlh). Nonoperative management of these injuries ...is associated with prolonged rehabilitation and high risk of recurrence. To our knowledge, the surgical management of acute MTJ-BFlh injuries has not been previously reported.
Hypothesis:
Surgical repair of acute MTJ-BFlh injuries enables return to sporting activity with low risk of recurrence.
Study Design:
Case series; Level of evidence, 4.
Methods:
A total of 64 patients (42 male and 22 female) undergoing surgical repair of acute MTJ-BFlh injuries were included. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time after surgery was 29.2 months (range, 24.0-37.1 months).
Results:
All study patients returned to their preinjury levels of sporting activity. Mean ± SD time from surgical intervention to return to sporting activity was 13.4 ± 5.1 weeks. Three patients had reinjury at the operative site: 1 (1.6%) with MTJ-BFlh injury and 2 (3.2%) with myofascial tears. At 3 months after surgery, patients had improved mean passive straight-leg raise (72.0° ± 11.4° vs 24.1° ± 6.8°; P < .001); increased mean isometric hamstring muscle strength at 0° (84.5 % ± 10.4% vs 25.9% ± 8.9%; P < .001), 15° (89.5% ± 7.3% vs 41.2% ± 9.7%; P < .001), and 45° (93.9% ± 5.1% vs 63.4% ± 7.6%; P < .001); higher mean Lower Extremity Functional Scale scores (71.5 ± 5.0 vs 29.8 ± 6.3; P < .001); and improved mean Marx activity rating scores (9.8 ± 2.2 vs 3.8 ± 1.9; P < .001), as compared with preoperative scores. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery.
Conclusion:
Surgical repair of acute MTJ-BFlh injuries enables return to preinjury level of sporting function with low risk of recurrence at short-term follow-up.
Background:
Nonoperative management of proximal semimembranosus injuries is associated with prolonged periods of convalescence and high risk of recurrence. To our knowledge, the outcomes of acute ...surgical repair for complete, nonavulsion proximal semimembranosus injuries have not been previously reported.
Hypothesis:
Acute surgical repair of complete, nonavulsion proximal semimembranosus injuries enables early return to sporting activity with low risk of recurrence.
Study Design:
Case series: Level of evidence, 4.
Methods:
This prospective single-surgeon study included 20 professional athletes undergoing acute primary surgical repair of complete, nonavulsion proximal semimembranosus injuries confirmed on preoperative magnetic resonance imaging. All study patients underwent a standardized postoperative rehabilitation program. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 27.6 months (range, 24.0-34.6 months) from date of surgery.
Results:
Of the 20 patients, 19 (95%) returned to their preinjury level of sporting activity. Mean ± SD time from surgical repair to full sporting activity was 11.9 ± 5.7 weeks. No patients had recurrence of the primary injury. At 3 months after surgery, patients had improved mean passive straight leg raise (71.5° ± 5.9° vs 31.1° ± 7.2°; P < .001); increased mean isometric hamstring muscle strength at 0° (83.8% ± 5.9% vs 48.4% ± 8.3%; P < .001), 15° (77.6% ± 6.0% vs 52.3% ± 14.7%; P < .001), and 45° (88.6% ± 5.4% vs 66.7% ± 13.1%; P < .001); higher mean lower extremity functional scores (64.8 ± 4.6 vs 34.4 ± 5.1; P < .001); and improved Marx activity rating scores (10.7 ± 1.6 vs 5.5 ± 2.0; P < .001) as compared with preoperative values. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery.
Conclusion:
Acute surgical repair of complete, nonavulsion proximal semimembranosus injuries is associated with high patient satisfaction, increased muscle strength, improved functional outcome scores, and high return to preinjury level of sporting activity with low risk of recurrence at short-term follow-up.
Background:
Nonoperative management of injuries to the distal musculotendinous T junction of the biceps femoris is associated with variable periods of rehabilitation and high risk of recurrence. To ...our knowledge, the efficacy of operative treatment in patients with these acute injuries has not been previously reported.
Hypothesis:
Surgical repair of injuries to the distal musculotendinous T junction of the biceps femoris would enable return to preinjury level of sport with low risk of recurrence.
Study Design:
Case series; Level of evidence, 4.
Methods:
This prospective single-surgeon study included 34 professional athletes (mean age, 26.4 ± 3.1 years; 31 male 91.2%; 3 female 8.8%; body mass index, 25 ± 2.0 kg/m2) undergoing primary surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris. All study patients underwent a standardized postoperative rehabilitation program. Predefined study outcomes relating to time for return to sporting activity, patient satisfaction, range of motion, hamstring muscle strength, passive range of motion, functional progress, and complications were recorded at regular intervals after surgery. Mean follow-up time was 28.4 months (range, 24.0-36.3 months) from date of surgery.
Results:
All study patients returned to their preinjury level of sporting activity. Mean time from surgical repair to full sporting activity was 11.7 ± 3.6 weeks. No patients had recurrence of the primary injury. At 1-year follow-up, 18 patients (52.9%) were very satisfied and 16 patients (47.1%) were satisfied with the outcomes of their surgery. At 3 months after surgery, patients had improved mean passive straight leg raise (69.7° ± 11.7° vs 24.1° ± 7.4°; P < .001); increased mean isometric hamstring muscle strength at 0° (93.1% ± 5.4% vs 63.1% ± 7.7%; P < .001), 45° (76.8% ± 9.7% vs 24.8% ± 8.3%; P < .001), and 90° (96.4% ± 3.9% vs 85.6% ± 5.9%; P < .001); higher mean lower extremity functional scores (64.5 ± 4.5 vs 27.2 ± 5.4; P < .001); and improved mean Marx Activity Rating Scale scores (10.7 ± 2.7 vs 2.2 ± 2.1; P < .001) compared with preoperative values. High patient satisfaction and functional outcome scores were maintained at 1 and 2 years after surgery.
Conclusion:
Surgical repair of acute injuries to the distal musculotendinous T junction of the biceps femoris is associated with high patient satisfaction, increased muscle strength, improved functional outcome scores, and high return to preinjury level of sporting activity with low risk of recurrence at short-term follow-up.
Robotic-arm assisted surgery aims to reduce manual errors and improve the accuracy of implant positioning during total hip arthroplasty. The objective of this study is to compare the accuracy of ...implant positioning, restoration of hip biomechanics, patient satisfaction, functional outcomes, implant survivorship, cost-effectiveness, and complications in conventional manual total hip arthroplasty (CO THA) versus robotic-arm assisted total hip arthroplasty (RO THA). Preoperative pelvic computerised tomography (CT) scans will be used to create patient-specific, virtual, three-dimensional reconstructions for surgical planning in both treatment groups.
This prospective randomised controlled trial will include 60 patients with symptomatic hip osteoarthritis undergoing primary THA. Following informed consent, patients will be randomised to CO THA (control group) or RO THA (investigation group) at a ratio of 1:1 using an online random number generator. Observers will review patients at regular intervals for 2 years after surgery to record predefined study outcomes relating to the accuracy of implant positioning, hip biomechanics, postoperative rehabilitation, clinical progress, functional outcomes, cost-effectiveness, and complications. Primary and secondary objectives will be used to quantify and draw inferences on differences in the efficacy of treatment between the two groups. Intention-to-treat and per-protocol population analysis will be undertaken. Intention to treat relates to the allocated treatment (CO THA or RO THA), and per-protocol refers to the actual treatment received by the patient. The following statistical methods will be employed to analyse the data: descriptive statistics, independent t test, paired t test, analysis of variance, Fisher exact test, chi-square test, and graphical displays. Ethical approval was obtained from the London-Bromley Research Ethics Committee, UK. The study is sponsored by University College London, UK.
This study compares a comprehensive and robust range of clinical, functional, and radiological outcomes in CT-planned CO THA versus CT-planned RO THA. The findings of this study will enable an improved understanding of the differences in CO THA versus RO THA with respect to patient satisfaction, functional outcomes, implant survivorship, cost-effectiveness, and complications.
ClinicalTrials.gov NCT04095845 . Registered on 19 September 2019.
The direct superior approach (DSA) is a minimally invasive modification of the posterior approach (PA) that preserves the iliotibial band and short external rotators except for the piriformis or ...conjoint tendon during total hip arthroplasty (THA). The objective of this study is to compare patient satisfaction, functional outcomes, accuracy of implant positioning, component stability, gait, cost-effectiveness, and complications in the DSA versus PA for THA.
This prospective double-blinded randomised control trial will include 80 patients with symptomatic hip osteoarthritis undergoing primary THA. Following informed consent, patients will be randomised to THA using the PA (control group) or DSA (investigation group) at a ratio of 1:1 using an online random number generator. Blinded observers will review patients at regular intervals for 2 years after surgery to record predefined study outcomes relating to postoperative rehabilitation, clinical progress, functional outcomes, accuracy of implant positioning, gait analysis on force plate treadmill, implant migration with radiosteriometric analysis, cost-effectiveness, and complications. A superiority study design will be used to evaluate whether the DSA provides improved outcomes compared to the PA for THA. Evaluation of study outcomes in DSA and PA will be used to quantify and draw inferences on differences in the efficacy of treatment between the two groups. Intention-to-treat and per-protocol population analysis will be undertaken. The following statistical methods will be employed to analyse the data: descriptive statistics, independent t test, paired t test, analysis of variance, Fisher exact test, chi-square test, and graphical displays. Ethical approval was obtained from the London-Fulham Research Ethics Committee, UK. The study is sponsored by University College London, UK.
This study compares a comprehensive and robust range of clinical, functional, and radiological outcomes in THA performed using the PA versus DSA. The findings of this study will provide an improved understanding of the differences in the PA versus DSA for THA with respect to patient satisfaction, functional outcomes, implant survivorship, gait, cost-effectiveness, and complications.
ClinicalTrials.gov, NCT04191993. Registered on 10 December 2019.
There remains a paucity of clinical studies assessing how any differences in accuracy of implant positioning between robotic-arm assisted unicompartmental knee arthroplasty (RO UKA) and conventional ...jig-based unicompartmental knee arthroplasty (CO UKA) translate to patient satisfaction, functional outcomes, and implant survivorship. The objectives of this study are to compare accuracy of implant positioning, limb alignment, patient satisfaction, functional outcomes, implant survivorship, cost-effectiveness, and complications in CO UKA versus RO UKA. Computer navigation will be used to assess intraoperative knee kinematics in all patients undergoing CO UKA.
This prospective randomised controlled trial will include 140 patients with symptomatic medial compartment knee arthritis undergoing primary UKA. Following informed consent, patients will be randomised to CO UKA (control group) or RO UKA (investigation group) at a ratio of 1:1 using an online random number generator. The primary objective of this study is to compare accuracy of implant positioning in CO UKA versus RO UKA. The secondary objectives are to compare the following outcomes between the two treatment groups: limb alignment, surgical efficiency, postoperative functional rehabilitation, functional outcomes, quality of life, range of motion, resource use, cost effectivness, and complications. Observers will review patients at regular intervals for 2 years after surgery to record predefined study outcomes pertaining to these objectives. Ethical approval was obtained from the London-Bloomsbury Research Ethics Committee, UK. The study is sponsored by University College London, UK.
This study compares a comprehensive and robust range of clinical, functional, and radiological outcomes in CO UKA versus RO UKA. The findings of this study will provide an improved understanding of the differences in CO UKA versus RO UKA with respect to accuracy of implant positioning, patient satisfaction, functional outcomes, implant survivorship, cost-effectiveness, and complications.
ClinicalTrials.gov NCT04095637 . Registered on 19 September 2019.
The primary aim of this study was to compare the postoperative systemic inflammatory response in conventional jig-based total knee arthroplasty (conventional TKA) versus robotic-arm assisted total ...knee arthroplasty (robotic TKA). Secondary aims were to compare the macroscopic soft tissue injury, femoral and tibial bone trauma, localized thermal response, and the accuracy of component positioning between the two treatment groups.
This prospective randomized controlled trial included 30 patients with osteoarthritis of the knee undergoing conventional TKA versus robotic TKA. Predefined serum markers of inflammation and localized knee temperature were collected preoperatively and postoperatively at six hours, day 1, day 2, day 7, and day 28 following TKA. Blinded observers used the Macroscopic Soft Tissue Injury (MASTI) classification system to grade intraoperative periarticular soft tissue injury and bone trauma. Plain radiographs were used to assess the accuracy of achieving the planned postioning of the components in both groups.
Patients undergoing conventional TKA and robotic TKA had comparable changes in the postoperative systemic inflammatory and localized thermal response at six hours, day 1, day 2, and day 28 after surgery. Robotic TKA had significantly reduced levels of interleukin-6 (p < 0.001), tumour necrosis factor-α (p = 0.021), ESR (p = 0.001), CRP (p = 0.004), lactate dehydrogenase (p = 0.007), and creatine kinase (p = 0.004) at day 7 after surgery compared with conventional TKA. Robotic TKA was associated with significantly improved preservation of the periarticular soft tissue envelope (p < 0.001), and reduced femoral (p = 0.012) and tibial (p = 0.023) bone trauma compared with conventional TKA. Robotic TKA significantly improved the accuracy of achieving the planned limb alignment (p < 0.001), femoral component positioning (p < 0.001), and tibial component positioning (p < 0.001) compared with conventional TKA.
Robotic TKA was associated with a transient reduction in the early (day 7) postoperative inflammatory response but there was no difference in the immediate (< 48 hours) or late (day 28) postoperative systemic inflammatory response compared with conventional TKA. Robotic TKA was associated with decreased iatrogenic periarticular soft tissue injury, reduced femoral and tibial bone trauma, and improved accuracy of component positioning compared with conventional TKA. Cite this article:
2021;103-B(1):113-122.
Background:
Chronic incomplete proximal hamstring avulsion injuries are debilitating injuries associated with prolonged periods of convalescence and poor return to preinjury level of function. This ...study explores the efficacy of operative intervention for these injuries on patient satisfaction, muscle strength, range of motion, functional performance, return to preinjury level of sporting activity, and injury recurrence.
Hypothesis:
Surgical intervention of chronic incomplete proximal hamstring avulsion injuries enables return to preinjury level of sporting function with low risk of clinical recurrence.
Study Design:
Case series: Level of evidence, 4.
Methods:
This prospective single-surgeon study included 41 patients with incomplete proximal hamstring avulsion injuries refractory to 6 months of nonoperative treatment. All study patients underwent primary operative repair of the avulsed proximal hamstring tendon and received standardized postoperative rehabilitation. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 28.2 months (range, 25.0-35.0 months) from date of surgery.
Results:
All patients returned to their preinjury level of sporting activity. Mean ± SD time from surgery to return to full sporting activity was 22.2 ± 6.7 weeks. There were no episodes of clinical recurrence. At 3 months after surgery, 39 patients (95.1%) were satisfied/very satisfied with the outcomes of their surgery, and as compared with preoperative values, improvements were recorded in isometric hamstring muscle strength at 0° (84.9% ± 10.9% vs 40.4% ± 8.8%; P < .001), 15° (89.6% ± 7.6% vs 44.2% ± 11.1%; P < .001), and 45° (94.1% ± 5.1% vs 66.4% ± 9.0%; P < .001); mean passive straight leg raise angle (71.2°± 13.5° vs 45.4°± 11.9°; P < .001); mean lower extremity functional score (70.9 ± 5.1 vs 48.4 ± 5.2; P < .001); and mean Marx activity rating score (5.6 ± 2.8 vs 2.7 ± 1.0; P < .001). High patient satisfaction and functional outcome scores were maintained at 1- and 2-year follow-up.
Conclusion:
Operative repair of chronic incomplete proximal hamstring avulsion injuries enabled return to preoperative level of sporting function with no episodes of clinical recurrence at short-term follow-up. Surgical intervention was associated with high patient satisfaction and improved isometric hamstring muscle strength, range of motion, and functional outcome scores as compared with preoperative values. High patient satisfaction and improved functional outcomes were sustained at 2-year follow-up.
Robotic total knee arthroplasty (TKA) improves the accuracy of implant positioning and reduces outliers in achieving the planned limb alignment compared to conventional jig-based TKA. Robotic TKA ...does not have a learning curve effect for achieving the planned implant positioning. The learning curve for achieving operative times comparable to conventional jig-based TKA is 7–20 robotic TKA cases. Cadaveric studies have shown robotic TKA is associated with reduced iatrogenic injury to the periarticular soft tissue envelope compared to conventional jig-based TKA. Robotic TKA is associated with decreased postoperative pain, enhanced early functional rehabilitation, and decreased time to hospital discharge compared to conventional jig-based TKA. However, there are no differences in medium- to long-term functional outcomes between conventional jig-based TKA and robotic TKA. Limitations of robotic TKA include high installation costs, additional radiation exposure, learning curves for gaining surgical proficiency, and compatibility of the robotic technology with a limited number of implant designs. Further higher quality studies are required to compare differences in conventional TKA versus robotic TKA in relation to long-term functional outcomes, implant survivorship, time to revision surgery, and cost-effectiveness.
Cite this article: EFORT Open Rev 2019;4:611-617. DOI: 10.1302/2058-5241.4.190022
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