(1) To evaluate minimum 10-year PROs (patient-reported outcomes) and survivorship after primary hip arthroscopy and (2) to identify predictors of failure for secondary arthroscopy and conversion to ...total hip arthroplasty (THA).
A systematic review of the literature was conducted with the following key words: “hip arthroscopy,” “long-term,” “outcomes,” “ten-year,” “survivorship,” “10-year,” “15-year,” “fifteen-year,” 20-year,” “twenty-year,” and “femoroacetabular impingement” in PubMed and Embase in March 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Level I to Level IV evidence was included and reported on minimum 10-year outcomes or greater after primary hip arthroscopy. Long-term studies were defined as minimum 10-year follow-up in accordance with established standards in the literature. Case reports, review articles, technique articles, and opinion articles were excluded. Articles not in English were excluded. Title, author, publication date, study design, demographic, number of hips, follow-up time, study period, indications for hip arthroscopy, PROs, predictors of failure for THA, and rates of secondary surgeries were recorded. Survivorship was defined as a nonconversion to THA. P < .05 was defined as statistical significance.
Twelve studies met the inclusion criteria. In total, 4 studies were Level III, and 8 studies were Level IV. A total of 1,344 hips were included, and follow-up ranged from 10 to 20 years. Femoroacetabular impingement syndrome was the most common indication for hip arthroscopy. Ten of the 12 studies reported on PROs, and 8 studies reported significant improvement after hip arthroscopy at long-term follow-up. The remaining 2 studies reported favorable outcomes that satisfied clinical benefit thresholds at minimum 10-year follow-up. Five studies reported clinical benefit where each patient cohort achieved 80% minimal clinically important difference and 75% patient acceptable symptomatic state for at least one PRO. Rates of secondary arthroscopy ranged from 4.5% to 24%, and rates of conversion to THA varied from 0% to 44.1%. Older age and chondral damage were the most commonly cited predictors for conversion to THA. Conclusions: At long-term follow-up, patients who underwent primary hip arthroscopy demonstrated favorable outcomes and variable rates of secondary surgeries. Patients undergoing hip arthroscopy within the last 20 years with Tönnis grade <1 and labral repair experienced greater than 90% survivorship. Chondral damage and older age were the most cited predictors for conversion to THA.
Level IV, systematic review of Level III and Level IV studies
Cutibacterium acnes (C.Acnes) is the most common microbe implicated in periprosthetic infection in shoulder arthroplasty. This is an update on a previous pilot study where we demonstrated the ...persistence of C. Acnes on the skin and contamination of the scalpel used for initial skin incision despite a robust pre surgical skin prep protocol.14
A consecutive case series of patients undergoing primary or revision anatomic or reverse total shoulder arthroplasty by a single fellowship-trained surgeon at a tertiary referral hospital from November 2019 to December 2022 was collected. The scalpel blade used for initial skin incision for all patients was swabbed with cultures being held for 21 days according to C.Acnes specific protocol. Demographic data, medical comorbidities, surgical information, culture results, and any infections were documented.
100 patients (51 males, 49 females) meeting inclusion criteria were identified (mean age 66.91, range 44-93 years). Cultures returned positive for C.Acnes in 12 patients (12%) 11/12 being male OR 13.2 (95% Cl 1.73. 194.87). No association was found between positive culture and age, BMI, medical comorbidities or procedure type. There were no postoperative infections in this patient cohort and they will continue to be monitored for development of infection.
Despite stringent pre-surgical preparation and scrub protocols a significant portion of patients undergoing shoulder arthroplasty have C.Acnes in culturable quantities on their skin at the time of incision. C.Acnes contamination is much more common in male patients. These findings should be taken into consideration in regard to preventive measures such as discarding the initial scalpel and avoiding unnecessary dermal contact during the procedure.
Background:
Soccer has one of the highest incidences of anterior cruciate ligament (ACL) injuries for both males and females. Several injury prevention programs have been developed to address this ...concern. However, an analysis of the pooled effect has yet to be elicited.
Purpose:
To conduct a systematic review and meta-analysis of ACL and knee injury prevention programs for soccer players, assess the heterogeneity among the studies, and evaluate the reported effectiveness of the prevention programs.
Study Design:
Systematic review and meta-analysis.
Methods:
A systematic search of the literature was conducted on PubMed (Medline), Embase, CINAHL, and Central-Cochrane Database. Studies were limited to randomized controlled trials (RCTs) of injury prevention programs specific to the knee and/or ACL in soccer players. The Cochrane Q test and I
2 index were independently used to assess heterogeneity among the studies. The pooled risk difference, assessing knee and/or ACL injury rates between intervention and control groups, was calculated by random-effects models with use of the DerSimonian-Laird method. Publication bias was assessed with a funnel plot and Egger weighted regression technique.
Results:
Nine studies met the inclusion criteria as RCTs. A total of 11,562 athletes were included, of whom 7889 were analyzed for ACL-specific injuries. Moderate heterogeneity was found among studies of knee injury prevention (P = .041); however, there was insignificant variation found among studies of ACL injury prevention programs (P = .222). For studies of knee injury prevention programs, the risk ratio was 0.74 (95% CI, 0.55-0.89), and a significant reduction in risk of knee injury was found in the prevention group (P = .039). For studies of ACL injury prevention programs, the risk ratio was 0.66 (95% CI, 0.33-1.32), and a nonsignificant reduction in risk of ACL injury was found in the prevention group (P = .238). No evidence of publication bias was found among studies of either knee or ACL injury prevention programs.
Conclusion:
This systematic review and meta-analysis of ACL and knee injury prevention program studies found a statistically significant reduction in injury risk for knee injuries but did not find a statistically significant reduction of ACL injuries.
To evaluate midterm outcomes, long-term outcomes, and survivorship in the borderline dysplastic population after primary hip arthroscopy.
A systematic review of current literature was performed with ...the following key words: “hip, “arthroscopy,” “borderline dysplasia,” “borderline hip dysplasia,” “developmental dysplasia,” “ten-year,” “survivorship,” “10-year,” “5-year,” “five year,” “mid-term,” “long-term,” “outcomes,” “arthroscopic,” and “femoroacetabular impingement” in PubMed, Cochrane, and Scopus in March 2022 using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. The following information was recorded: title, author, publication date, study design, demographic, number of hips, follow-up time, study period, indications for hip arthroscopy, patient-reported outcomes (PROs), characteristics of patients converting to total hip arthroplasty (THA), and rates of secondary surgeries and conversion to THA were recorded. Survivorship was defined as not converting to THA. Kappa values for the title/abstract and full-text screening were calculated. Forest plots were created for PROs that were included in 3 or more studies.
Six articles comprising 413 hips were included in the study. Three studies were Level III evidence, and 3 studies were Level IV evidence. Average follow-up ranged from 5.7 to 12.2 years. One study defined borderline hip dysplasia as lateral center-edge angle 18-25° and 5 defined it as lateral center-edge angle 20-25°. All studies included PROs and reported significant improvement after surgery in at least one PRO. Three studies reported clinical benefit and across the studies at least 70% of patients achieved minimum clinically important difference in at least one PRO. Rates of undergoing revision hip arthroscopy and THA ranged from 2.1% to 7% and 0% to 24%, respectively. Tönnis grade 2, Tönnis angle >15, and Outerbridge Grade IV cartilage damage were identified as predictors of conversion to THA.
Patients with borderline hip dysplasia undergoing primary hip arthroscopy demonstrated significant improvement in PROs at midterm and long-term follow-up. Survivorship at midterm follow-up was 98.2% (328/334 hips) and 76.3% (29/38 hips) at long-term follow-up.
Level IV, systematic review of Level III and Level IV studies.
Purpose of Review
The goal of this review is to provide an overview of current surgical treatment options for tibial tubercle osteotomies as a treatment for recurrent patellofemoral instability. As ...such we sought to provide the reader with the most current answers to why treatment practices have changed and how this has affected the outcome of surgical treatment for patellar instability.
Recent Findings
As our understanding of patellofemoral biomechanics have grown, appropriate surgical and non-surgical treatment options have followed suit to address these findings.
Summary
A clear understanding of the pathomechanics causing the patient’s patellar instability is germane to choosing the most appropriate surgical intervention to address this instability. Likewise, understanding the goal of the intervention chosen—e.g., unloading, realignment—is paramount. These surgical techniques may be technically challenging and surgical specialists with experience in these techniques are recommended for optimal outcomes.
Soccer has one of the highest rates of ankle injury in sports for both males and females. Several injury prevention programs have been developed to address this concern. The purposes of this study ...were to conduct a meta-analysis of ankle injury prevention programs for soccer players, assess the heterogeneity among the studies, and evaluate the reported effectiveness of the prevention programs.
A systematic search of the literature was conducted in PubMed (MEDLINE), Embase, CINAHL (Cumulative Index to Nursing and Allied Health), and the Cochrane Central Register of Controlled Trials (CENTRAL) database. Studies were limited to clinical investigations of injury prevention programs specific to the ankle in soccer players. Title, abstract, and full-text review were utilized to identify articles that met the inclusion criteria. The Cochrane Q test and I(2) index were independently used to assess heterogeneity among the studies. Sensitivity analyses were performed to assess heterogeneity. The pooled risk difference was calculated by random-effects models with use of the DerSimonian-Laird method. Publication bias was assessed with a funnel plot and Egger weighted regression technique.
Ten studies met the inclusion criteria as randomized controlled trials. A total of 4,121 female and male soccer athletes were analyzed for ankle injuries. Significant heterogeneity was found among studies of ankle injury prevention (p = 0.002), with an I(2) index of 65.2%. For studies of ankle injury prevention programs, the risk ratio was 0.60 (95% confidence interval, 0.40 to 0.92) and a significant reduction in the risk of ankle injury was found in the prevention group (p = 0.002). No evidence of publication bias was found among the included studies.
This meta-analysis of studies regarding ankle injury prevention programs identified a significant reduction in the risk of ankle injury. Future high-quality research designs with a low risk of bias are necessary to further evaluate the effectiveness of specific exercises and the optimal timing and age at intervention for the prevention of ankle injuries in the athletic soccer player.
Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Introduction
Total ankle arthroplasty (TAA) has become increasingly utilized over the past 20 years to treat osteoarthritis of the ankle. The efficacy and safety of this procedure has been previously ...reported, but relatively few studies have documented the risk of postoperative complications associated with TAA over the past 10 years. Thus, the aim of this study is to provide a current report on the safety of TAA, particularly in association with a number of preoperative risk factors.
Methods
A retrospective review of all patients in the American College of Surgeons National Surgical Quality Improvement Program database who underwent TAA between 2012 and 2018 was performed. A total of 1333 patients were included in this analysis. Penalized logistic regression to consider small numbers of the postoperative complications was used to identify factors associated with incidence of the complications.
Results
The rate of readmission and superficial wound infection were found to be 1.4% and 0.6%, respectively. Risk factors associated with a prolonged hospital stay were black race, Hispanic race, and smoking. Diabetes was associated with a significantly increased risk of readmission. Age, sex, body mass index, and steroid use were not associated with increased risk of postoperative complications.
Conclusion
In this study, the rate of surgical site infection and readmission in TAA was found to be relatively low, compared to published data on total knee arthroplasty and total hip arthroplasty. Both race and smoking increase the risk of prolonged hospital stay, while diabetes increases the risk of readmission.
Levels of Evidence:
Level III, retrospective comparative trial.
Cutibacterium acnes is found in skin flora of the shoulder and is the most common microbe identified in periprosthetic shoulder infections. The purpose of this study is to determine if there is C ...acnes present on the incision scalpel in patients undergoing shoulder arthroplasty despite extensive skin preparation techniques to prevent wound contamination.
The authors collected a consecutive case series of patients meeting inclusion criteria. Patients were included if they underwent either primary or revision shoulder arthroplasty at the tertiary care hospital with the senior author during the study period. Culture swab samples, testing for presence of C acnes, were collected from 17 consecutive patients who underwent shoulder arthroplasty with a single fellowship-trained surgeon between November 2019 and March 2020. Culture reports were recorded as “positive” or “negative” after 21 days. Institutional review board approval of the study protocol was obtained. The null hypothesis was that there would be no cases with knife blades “culture positive” for C acnes.
17 patients were identified and fit inclusion criteria. There were 12 men (mean age 64.3 years, range 48-79 years) and 5 women (mean age 69.8 years, range 59-79 years). Two patients (11.8%) were found to have C acnes growth on the skin knife. Both patients were male and older than 70 years undergoing primary reverse shoulder arthroplasty with no history of previous shoulder infections.
The presence of C acnes on the skin blade in 2 patients validates concerns that there is C acnes present in dermal tissue despite extensive attention to eradication of these microbes. There was a high rate of C acnes contamination on scalpel blades used for initial skin incisions and the authors conclude that there is value in discarding these blades from the surgical field.
Context:
Bone loss is a major factor in determining surgical choice in patients with anterior glenohumeral instability. Although bone loss has been described, there is no consensus on glenoid, ...humeral head, and bipolar bone loss limits for which arthroscopic-only management with Bankart repair can be performed.
Objective:
To provide guidelines for selecting a more complex repair or reconstruction (in lieu of arthroscopic-only Bankart repair) in the setting of glenohumeral instability based on available literature.
Data Sources:
An electronic search of the literature for the period from 2000 to 2019 was performed using PubMed (MEDLINE).
Study Selection:
Studies were included if they quantified bone loss (humeral head or glenoid) in the setting of anterior instability treated with arthroscopic Bankart repair.
Study Design:
Systematic review.
Level of Evidence:
Level 4.
Data Extraction:
Study design, level of evidence, patient demographics, follow-up, recurrence rates, and measures of bone loss (glenoid, humeral head, bipolar).
Results:
A total of 14 studies met the inclusion criteria. Of these, 10 measured glenoid bone loss, 5 measured humeral head bone loss, and 2 measured “tracking” without explicit measurement of humeral head bone loss. Measurement techniques for glenoid and humeral head bone loss varied widely. Recommendations for maximum glenoid bone loss for arthroscopic repair were largely <15% of glenoid width in recent studies. Recommendations regarding humeral head loss were more variable (many authors providing only qualitative descriptions) with increasing attention on glenohumeral tracking.
Conclusion:
It is essential that a standardized method of glenoid and humeral head bone loss measurements be performed preoperatively to assess which patients will have successful stabilization after arthroscopic Bankart repair. Glenoid bone loss should be <15%, and humeral head lesions should be “on track” if an arthroscopic-only Bankart is planned. If there is greater bone loss, adjunct or open procedures should be performed.
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