Purpose
The purpose of this study is to evaluate the reasons why athletes do not return to play (RTP) following anterior cruciate ligament (ACL) reconstruction from a large single-centre database.
...Methods
The institutional ACL registry was screened for patients that had undergone a primary ACLR and had RTP status reported at 24-month follow-up. The reasons that patients were unable to RTP at 24 months were evaluated. The ACL-Return to Sport Index (ACL-RSI) was evaluated at baseline and 24-month follow-up to evaluate psychological ability to RTP.
Results
At 2 years, 1140 patients returned to play, and 222 had not returned to play. The most common reasons athletes were unable to return was fear of reinjury (27.5%), lack of confidence in performance on return (19.4%) and external life factors (16.6%), i.e. work commitments and family reasons. Other reasons for athletes not returning to play were residual knee pain (10%) and subsequent injury (5%). The ACL-RSI score was significantly lower at diagnosis (40.3 vs. 49.3;
p
= 0.003) and 2 years (41.8 vs. 78.7;
p
< 0.0001) in athletes who did not return to play vs. those that did RTP.
Conclusion
The majority of patients that report they have not returned to play do so due to external life and psychological factors associated with their injury, including fear of reinjury and lack of confidence in performance. A small minority of patients were unable to return due to residual knee symptoms or reinjury. Pre-operative psychological assessment and intervention may identify those less likely to RTP and provide an opportunity for targeted interventions to further improve RTP outcomes.
Level of evidence
III.
The purpose of this study was to perform a systematic review and meta-analysis of the current evidence in the literature to determine how arthroscopic Bankart repair (ABR) and remplissage compare ...with ABR alone and the open Latarjet procedure for anterior shoulder instability in patients with concomitant Hill-Sachs lesions.
A literature search was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Studies comparing ABR and remplissage vs. ABR alone or the Latarjet procedure for anterior shoulder instability in patients with Hill-Sachs lesions were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager (version 5.3). P < .05 was considered statistically significant.
Twelve clinical trials were included. There was a significant difference between ABR plus remplissage and ABR alone in total recurrence rate (3.2% vs. 16.8%, P < .05) but not the rate of revision due to recurrence (1.7% vs. 8.5%, P = .06). There was no significant difference between the Latarjet procedure and ABR plus remplissage in total recurrence rate (7.0% vs. 9.8%, P = .39), total revision rate (3.7% vs. 5.7%, P = .41), and rate of revision due to recurrence (1.6% vs. 2.1%, P = .79). There was a significantly lower rate of complications with ABR and remplissage compared with the Latarjet procedure (0.5% vs. 8.6%, P = .003).
In patients with Hill-Sachs lesions and subcritical glenoid bone loss, ABR with remplissage resulted in lower rates of recurrent instability compared with ABR alone while resulting in similar recurrence rates, as well as similar patient-reported outcomes, with lower morbidity and fewer complications, compared with the Latarjet procedure.
Level III; Systematic Review
Abstract Background Bilateral total hip arthroplasty may be performed simultaneously (SIMTHA) or in two staged operations. Aim To assess attitudes towards and utilization of SIMTHA in Irish ...orthopaedic practice, and to assess patient and surgeon factors which are associated with the management of bilateral hip arthritis. Methods A 16-question electronic survey (Google Forms) was distributed via email to consultant Irish orthopaedic surgeons who perform total hip arthroplasty, followed by a reminder 1 month later. A p value < 0.05 was considered significant. Results There were 53 responses from arthroplasty surgeons, with 28% reporting they never perform SIMTHA, 26% have performed ≤ 5 SIMTHA, and 46% do ≥ 1 SIMTHA per year. Amongst the 15 surgeons who do not do SIMTHA, 60% reported a preference for staged arthroplasty, 20% felt it was not feasible in their institution, and a third reported a lack of experience with SIMTHA. There was a significant association between not performing SIMTHA and years of consultant experience ( p = 0.002). There were no institutional guidelines on eligibility criteria for SIMTHA. The most common time interval for staged bilateral arthroplasty was 6–12 weeks (60%). Overall, 56% of surgeons felt SIMTHA is underutilised in the Irish healthcare system; this was associated with greater SIMTHA volume ( p = 0.023). Conclusion Half of the Irish arthroplasty surgeons report SIMTHA is a regular aspect of their practice. Performing SIMTHA is associated with greater arthroplasty volume, more recent consultant appointments, and a perception that the operation is underutilised.
PURPOSEThe purpose of this study was to systematically review and analyze the current evidence in the literature to determine the relative complication rates of the singleincision versus ...dual-incision approach to distal biceps tendon repair. METHODSThe literature search was performed based on the PRISMA guidelines. Cohort studies comparing the single-incision or dual-incision approach to biceps tendon repair alone were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager Version 5.3. A p-value < 0.05 was considered to be statistically significant. RESULTSTwelve clinical studies with varying levels of evidence (LOE I: 1, LOE II: 1, LOE III: 10) with 2,429 patients were included. Overall, there was a significantly lower rate of total complications with the dual-incision approach (16.1% vs. 23.1%, p < 0.01) and a lower rate of neurological injuries (9.1% vs. 24.1%, p < 0.01). There was a lower rate of lateral antebrachial cutaneous nerve injuries with the dual-incision approach (5.2% vs. 19.5%, p < 0.01), and superficial radial nerve injuries (2.5% vs. 4.8%, p < 0.01), but there was no significant difference in the rate of posterior interosseous nerve injuries (2.2% vs. 1.2%, p = 0.20). There was a significantly lower rate of heterotopic bone formation with the single-incision approach (1.3% vs. 2.7%, p = 0.01). CONCLUSIONThe dual-incision approach decreases the risk of total, overall postoperative complications and sensory nerve injuries following distal biceps repair. However, it has a higher risk of heterotopic bone formation.
Category:
Ankle; Hindfoot; Sports; Trauma
Introduction/Purpose:
While surgery is often indicated in the treatment of chronic ankle instability (CAI), there lacks consensus on which procedure is ...preferable in light of the multiple different procedures available. In this systematic review, we evaluate the recent literature on the anatomical reconstruction of the lateral ligaments in the treatment of CAI in an effort to identify differences in clinical and radiological outcomes between allograft and autograft reconstruction techniques.
Methods:
A systematic search of PubMed, EMBASE, and Cochrane Library databases was performed in October 2019 resulting in 13 studies ranging from the years 1991 to 2017. The studies included were carefully evaluated with regards to the level of evidence (LOE) and quality of evidence (QOE), clinical and radiological outcomes, complications, revision rates and return to sport.
Results:
Thirteen studies including a total of 296 ankles were included; Within the autograft group, the weighted mean AOFAS improved from 66.9 to 95.9 at a weighted mean follow-up of 29.6 months, KPSSAF scores improved from 48 to 92.2 at a weighted mean follow-up of 37 months, VAS scores improved from 6.8 to 0.2 at a weighted mean follow up of 33.5 months, and the complication rate was 7.7% at a follow up of 31.2 months. Within the allograft group the AOFAS improved from 53.7 to 89.3 at a follow-up of 35.5 months, KPSSAF scores improved from 42.8 to 90.4 at a follow up of 34 months, VAS scores improved from 7.3 to 1.9 at a follow up of 38 months, and the complication rate was 7% at a follow up of 34.9 months.
Conclusion:
The current systematic review demonstrated that anatomical reconstruction of CAI resulted in favorable clinical and radiological outcomes, low complication and revision rates and excellent return to sport rates in the short-term follow-up.
Comparison of autograft and allograft reconstruction techniques for chronic lateral ankle instability showed minor differences both clinically and radiologically but none which would suggest superiority of one technique over another.
To evaluate the clinical outcomes and rate of return to play (RTP) in patients who underwent arthroscopic Bankart repair and open subpectoral biceps tenodesis.
A retrospective review of patients who ...underwent combined arthroscopic Bankart repair and open subpectoral biceps tenodesis by a single surgeon between 2012 and 2016 was performed. RTP, the level of return, and the timing of return were assessed. Visual analog scale for pain, Rowe score, Shoulder Instability-Return to Sport after Injury score, and Subjective Shoulder Value were evaluated.
The study included 14 patients, with a mean follow-up of 34.2 ± 12.1 months. Of the 14 patients, 13 (92.9%) returned to sport at a mean of 4.8 ± 1.2 months and 9 (64.3%) returned to the same or higher level of sport. At final follow-up, the mean Rowe was 80.0 ± 16.3, the mean Subjective Shoulder Value was 81.0 ± 15.1, the mean Shoulder Instability-Return to Sport after Injury was 57.3 ± 25.6, and the mean visual analog scale score was 2.6 ± 1.5. One patient had a recurrent dislocation, whereas no patients underwent a further operation on the ipsilateral shoulder.
Patients undergoing arthroscopic Bankart repair combined with open subpectoral biceps tenodesis had a high rate of RTP with a low rate of recurrent instability.
IV, Therapeutic Case Series.
Category:
Ankle; Trauma
Introduction/Purpose:
It is controversial whether routine arthroscopy is beneficial at the time of ankle fracture fixation. This may be, in part, due to sparse information ...regarding the incidence of chondral injury in the setting of ankle fractures.The purpose of this study is to systematically review the incidence of chondral injures in patients with ankle fractures and to further characterize intra-articular chondral injuries of the talus, tibial plafond, medial malleolus, and lateral malleolus in patients who undergo ankle arthroscopy following an ankle fracture.
Methods:
The literature search was performed based on the PRISMA guidelines. Studies evaluating the incidence of chondral lesions at the time of arthroscopy for ankle fractures were included. The incidence of intraarticular chondral lesions was recorded, as well as location within the ankle, ankle fracture type, time of arthroscopy, characterization of chondral injury, complications, and outcome if available. All statistical analyses were carried out with statistical software package SPSS 24.0 (SPSS, Chicago, IL, USA). Multiple comparisons were used to compare incidence rates of chondral injury based on Weber classification, malleolar fracture type, and Lauge-Hansen classification, using Pearson chi-square test. For all analyses, p < 0.05 was considered statistically significant.
Results:
Fifteen studies with 1,355 ankle fractures were included. Of those ankles, 738 demonstrated evidence of chondral or osteochondral lesion (54.5%). Overall, 648 ankles had chondral lesions on the talus (47.8%), 207 ankles had lesions on the tibial plafond (15.3%), 165 has lesions of the lateral malleolus (12.2%), and 133 had lesions of the medial malleolus (9.8%). Weber C group had significantly higher incidence than Weber A group (p=0.015). Trimalleolar and isolated lateral malleolar fracture groups had significantly higher incidence of chondral injury than bimalleolar and isolated medial malleolar fracture groups (p<0.001). A significant difference was found in occurrence rate of chondral injury among Lauge-Hansen classification, with supination-adduction having the lowest incidence (p=0.001).
Conclusion:
Our study found a high incidence of intra-articular chondral lesion in the setting of ankle fractures as demonstrated by arthroscopy, with more than half of all patients having a chondral lesion. Talar lesions were most common. This study may help direct greater attention to the Talus as a source of chondral injury particularly in higher grade fracture patterns.
Category:
Ankle; Sports
Introduction/Purpose:
Anatomical reconstruction has gained increased attention in recent years and is indicated for patients with poor-quality ligaments, previously failed ...lateral ligament repair, generalized ligamentous laxity, or in patients with a high BMI. The purpose of this systematic review was to evaluate the current literature on anatomical reconstruction of the lateral ligaments in the treatment of chronic ankle instability.
Methods:
A systematic search of Pubmed, EMBASE and Cochrane Library databases was performed during October 2019. The studies included were carefully evaluated with regard to level of evidence (LOE) and quality of evidence (QOE), clinical and radiological outcomes, complications, revision rates and return to sport.
Results:
Thirteen studies including a total of 296 ankles were included; 92% of studies were LOE III or IV and the QOE in all studies was of poor or fair quality. Within the autograft group, the AOFAS improved from 66.9 to 95.9, KPSSAF scores improved from 48 to 92.2, VAS scores improved from 6.8 to 0.2 at a follow up of 33.5 months, and the complication rate was 7.7%. Within the allograft group the AOFAS improved from 53.7 to 89.3, KPSSAF scores improved from 42.8 to 90.4, VAS scores improved from 7.3 to 1.9, and the complication rate was 7%. The overall rate of return to sport was 89%.
Conclusion:
The current systematic review demonstrated favorable results for both autograft and allograft reconstruction techniques in the treatment of chronic ankle instability. On comparing autograft and allograft techniques, minor differences were found both clinically and radiologically, with no overall evidence supporting one technique over the other
Purpose: The purpose of this study was to systematically review and analyze the current evidence in the literature to determine the relative complication rates of the single-incision versus ...dual-incision approach to distal biceps tendon repair. Methods: The literature search was performed based on the PRISMA guidelines. Cohort studies comparing the single-incision or dual-incision approach to biceps tendon repair alone were included. Clinical outcomes were compared, with all statistical analysis performed using Review Manager Version 5.3. A p-value < 0.05 was considered to be statistically significant. Results: Twelve clinical studies with varying levels of evidence (LOE I: 1, LOE II: 1, WE III: 10) with 2,429 patients were included. Overall, there was a significantly lower rate of total complications with the dual-incision approach (16.1% vs. 23.1%, p < 0.01) and a lower rate of neurological injuries (9.1% vs. 24. l%,p<0.01). There was a lower rate of lateral antebrachial cutaneous nerve injuries with the dual-incision approach (5.2% vs. 19.5%, p< 0.01), and superficial radial nerve injuries (2.5% vs. 4.8%, p < 0.01), but there was no significant difference in the rate of posterior interosseous nerve injuries (2.2% vs. 1.2%, p = 0.20). There was a significantly lower rate of heterotopic bone formation with the single-incision approach (1.3% vs. 2.7%, p = 0.01). Conclusion: The dual-incision approach decreases the risk of total, overall postoperative complications and sensory nerve injuries following distal biceps repair. However, it has a higher risk of heterotopic bone formation.
Background:
An international consensus group of experts was convened to collaboratively advance toward consensus opinions based on the best available evidence on key topics within cartilage repair of ...the ankle. The purpose of this article is to present the consensus statements on osteochondral lesions of the tibial plafond (OLTP) and on ankle instability with ankle cartilage lesions developed at the 2019 International Consensus Meeting on Cartilage Repair of the Ankle.
Methods:
Forty-three experts in cartilage repair of the ankle were convened and participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted within 4 working groups focusing on specific topics within cartilage repair of the ankle, after which a comprehensive literature review was performed and the available evidence for each statement was graded. Discussion and debate occurred in cases where statements were not agreed on in unanimous fashion within the working groups. A final vote was then held.
Results:
A total of 11 statements on OLTP reached consensus. Four achieved unanimous support and 7 reached strong consensus (greater than 75% agreement). A total of 8 statements on ankle instability with ankle cartilage lesions reached consensus during the 2019 International Consensus Meeting on Cartilage Repair of the Ankle. One achieved unanimous support, and seven reached strong consensus (greater than 75% agreement).
Conclusion:
These consensus statements may assist clinicians in the management of these difficult clinical pathologies.
Level of Evidence:
Level V, mechanism-based reasoning.
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