Purpose The aim of this study was to determine the prevalence of radiographic findings suggestive of femoroacetabular impingement (FAI) in asymptomatic individuals. Methods A systematic review was ...performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies reporting radiographic, computed tomographic, or magnetic resonance imaging (MRI) findings that were suggestive of FAI in asymptomatic volunteers were included. Cam, pincer, and combined pathologic conditions were investigated. Results We identified 26 studies for inclusion, comprising 2,114 asymptomatic hips (57.2% men; 42.8% women). The mean participant age was 25.3 ± 1.5 years. The mean alpha angle in asymptomatic hips was 54.1° ± 5.1°. The prevalence of an asymptomatic cam deformity was 37% (range, 7% to 100% between studies)—54.8% in athletes versus 23.1% in the general population. Of the 17 studies that measured alpha angles, 9 used MRI and 9 used radiography (1 study used both). The mean lateral and anterior center edge angles (CEAs) were 31.2° and 30°, respectively. The prevalence of asymptomatic hips with pincer deformity was 67% (range 61% to 76% between studies). Pincer deformity was poorly defined (4 studies 15%; focal anterior overcoverage, acetabular retroversion, abnormal CEA or acetabular index, coxa profunda, acetabular protrusio, ischial spine sign, crossover sign, and posterior wall sign). Only 7 studies reported on labral injury, which was found on MRI without intra-articular contrast in 68.1% of hips. Conclusions FAI morphologic features and labral injuries are common in asymptomatic patients. Clinical decision making should carefully analyze the association of patient history and physical examination with radiographic imaging. Level of Evidence Level IV, systematic review if Level II-IV studies.
Knee meniscectomy is the most common procedure performed by orthopaedic surgeons. While it is generally believed that loss of meniscal tissue leads to osteoarthritis and poor knee function, many ...variables may significantly influence this outcome. Through literature search engines including PubMed and Ovid, 4 randomized controlled trials, 2 prospective cohorts, and 23 retrospective cohorts that fit the criteria for level I, II, and III level of evidence were included in this systematic review. For the level III evidence studies, follow-up of 5 years or more was required. Preoperative and intraoperative predictors of poor clinical or radiographic outcomes included total meniscectomy or removal of the peripheral meniscal rim, lateral meniscectomy, degenerative meniscal tears, presence of chondral damage, presence of hand osteoarthritis suggestive of genetic predisposition, and increased body mass index. Variables that were not predictive of outcome or were inconclusive or had mixed results included meniscal tear pattern, age, mechanical alignment, sex of patient, activity level, and meniscal tears associated with anterior cruciate ligament (ACL) reconstruction. While an intact meniscus or meniscal repair was generally favorable in the ACL-reconstructed knees, meniscal repair of degenerative meniscal tissue was not favorable. There is a lack of uniformity in the literature on this subject with a preponderance of lower level evidence. Although randomized controlled trials are considered to be the gold standard in medical research, a multicenter prospective cohort design may be more appropriate in assessing the long-term outcome of meniscal surgery and the role that multiple preoperative and intraoperative variables may play in clinical outcomes. In addition, future studies should include factors not assessed or adequately evaluated by several of the included studies, such as meniscal tear pattern, age, mechanical alignment, sex of the patient, activity level, meniscal tears associated with other injuries such as the ACL, smoking, and the effect of previous surgery.
Background:
Hip capsular management after hip arthroscopic surgery for femoroacetabular impingement (FAI) is controversial.
Purpose/Hypothesis:
To compare the clinical outcomes of patients undergoing ...hip arthroscopic surgery for FAI with T-capsulotomy with partial capsular repair (PR; closed vertical incision, open interportal incision) versus complete capsular repair (CR; full closure of both incisions). The hypothesis was that there would be improved clinical outcomes in patients undergoing CR compared with those undergoing PR.
Study Design:
Cohort study; Level of evidence, 3.
Methods:
Consecutive patients undergoing hip arthroscopic surgery for FAI by a single fellowship-trained surgeon from January 2011 to January 2012 were prospectively collected and analyzed. Inclusion criteria included all patients between ages 16 and 65 years with physical examination and radiographic findings consistent with symptomatic FAI, with a minimum 2-year follow-up. For analysis, patients were matched according to sex and age ±2 years. Primary clinical outcomes were measured via the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sport-Specific (HOS-SS) subscales, the modified Harris Hip Score (mHHS), patient satisfaction (measured on a visual analog scale), and clinical improvement at baseline, 6 months, 1 year, and 2 years. Statistical analysis was performed utilizing Student paired and unpaired t tests, with P < .05 considered significant.
Results:
A total of 64 patients were included in the study, with 32 patients (12 male, 20 female) in each group. The average follow-up was 29.9 ± 2.6 months. There were no significant demographic differences between the groups. The CR group demonstrated significantly superior outcomes in the HOS-SS at 6 months (PR: 63.8 ± 31.1 vs CR: 72.2 ± 16.1; P = .039), 1 year (PR: 72.7 ± 14.7 vs CR: 82.5 ± 10.7; P = .006), and 2.5 years (PR: 83.6 ± 9.6 vs CR: 87.3 ± 8.3; P < .0001) after surgery. Patient satisfaction at final follow-up was significantly better in the CR group (PR: 8.4 ± 1.0 vs CR: 8.6 ± 1.1; P = .025). Both groups demonstrated significant improvements in the HOS-ADL (PR: 64.6 ± 17.0 to 90.7 ± 8.4 P < .0001; CR: 66.1 ± 15.7 to 92.1 ± 7.9 P < .0001) and HOS-SS (PR: 39.4 ± 23.9 to 83.6 ± 9.6 P < .0001; CR: 39.1 ± 24.2 to 87.3 ± 8.3 P < .0001) at final follow-up. There were no significant differences between the groups in the HOS-ADL at any time point. There were no significant differences in the mHHS between the groups at final follow-up (PR: 82.5 ± 5.0 vs CR: 83.0 ± 4.4; P = .364). The overall revision rate was 6.25%; all patients (n = 4) who required revision arthroscopic surgery were in the PR group (13% of 32 patients), while no patients in the CR group required revision surgery.
Conclusion:
While significant improvements were seen at 6 months, 1 year, and 2.5 years of follow-up regardless of the closure technique, patients who underwent CR of the hip capsule demonstrated superior sport-specific outcomes compared with those undergoing PR. There was a 13% revision rate in the PR group, but no patients in the CR group required revision surgery. While longer term outcome studies are needed to determine if these results are maintained over time, these data suggest improved outcomes after CR compared with PR at 2.5 years after hip arthroscopic surgery for FAI.
Factors such as age and sex are postulated to play a role in outcomes following arthroscopy for femoroacetabular impingement; however, to our knowledge, no data currently delineate outcomes on the ...basis of these factors. The purpose of this study was to compare clinical outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement according to sex and age.
One hundred and fifty patients undergoing hip arthroscopy for femoroacetabular impingement by a single fellowship-trained surgeon were prospectively analyzed, with 25 patients in each of the following groups: female patients younger than 30 years of age, female patients 30 to 45 years of age, female patients older than 45 years of age, male patients younger than 30 years of age, male patients 30 to 45 years of age, and male patients older than 45 years of age. The primary outcomes included the Hip Outcome Score Activities of Daily Living Subscale (HOS-ADL), Hip Outcome Score Sport-Specific Subscale (HOS-Sport), the modified Harris hip score (mHHS), and clinical improvement at the time of follow-up.
At a minimum 2-year follow-up, all groups demonstrated significant improvements in the HOS-ADL, the HOS-Sport, and the mHHS (p < 0.0001). Female patients older than 45 years of age scored significantly worse on the HOS-ADL, HOS-Sport, and mHHS compared with female patients younger than 30 years of age (p < 0.0001 for all) and female patients 30 to 45 years of age (p < 0.017 for all). Male patients older than 45 years of age scored significantly worse on all outcomes compared with male patients younger than 30 years of age (p ≤ 0.011 for all) and male patients 30 to 45 years of age (p ≤ 0.021 for all). Incorporating both sexes, patients older than 45 years of age scored significantly worse on all outcomes compared with patients younger than 30 years of age (p < 0.0001 for all) and patients 30 to 45 years of age (p ≤ 0.001 for all). Female patients older than 45 years of age had significantly reduced radiographic preoperative joint space width compared with the two other female groups and the male groups who were 45 years of age or younger (p < 0.05 for all).
Although all patients had significant improvements in all outcomes following hip arthroscopy, patients older than 45 years of age performed worse than younger patients, with female patients older than 45 years of age demonstrating the lowest outcome scores. In the age group of 45 years or younger, female patients performed as well as male patients in terms of hip clinical outcome scores. Overall, care must be individualized to optimize outcomes following hip arthroscopy for femoroacetabular impingement.
Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Purpose The purpose of this study was to examine the hip capsule in a subset of symptomatic patients who underwent capsular closure during hip arthroscopy. Methods All patients undergoing primary hip ...arthroscopy for femoroacetabular impingement (FAI) with routine capsular closure between January 1, 2012, and December 31, 2015, were eligible. Only patients with unilateral surgery and a postoperative magnetic resonance imaging (MRI; ordered for persistent symptoms) were included. Four independent reviewers evaluated each hip capsule for thickness and the absence or presence of defects. Results During the study, 1,463 patients had hip arthroscopy for FAI with routine capsular closure, and 53 (3.6%) underwent a postoperative MRI. Fourteen of the 53 were excluded owing to revision status or additional procedures. The final study population included 39 patients (23 female patients and 16 male patients), with an average patient age of 31.7 ± 11.4 years and an average body mass index of 23.3 ± 2.9. There were 3 (7.5%) capsular defects, and the intraclass correlation coefficient (ICC) was 0.82. The operative hip capsule was significantly thicker in the zone of capsulotomy, and subsequent repair as compared with the unaffected, contralateral hip capsule (5.0 ± 1.2 mm vs 4.6 ± 1.4 mm; P = .02), ICC 0.83. Additionally, males had thicker hip capsules as compared with their female counterparts, on the operative side (5.4 ± 1.1 mm vs 4.5 ± 1.2 mm; P = .02) and the nonoperative side (4.8 ± 1.6 mm vs 4.1 ± 0.9 mm; P = .08). Conclusions In a subset of symptomatic patients after hip arthroscopy for FAI, the majority (92.5%) of the repaired hip capsules remained closed at greater than 1 year of follow-up. The hip capsule adjacent to the capsulotomy and subsequent repair is thickened compared with the same location on the contralateral, nonoperative hip. Aside from gender, patient-related and FAI-related factors do not correlate with capsular thickness nor do they seem to correlate with the propensity to develop a capsular defect. Level of Evidence Level IV, prognostic case series.
Purpose To investigate the relation between cam, acetabular version, and pelvic incidence. Methods This was a retrospective analysis of 65 patients with symptomatic hip pain and radiographic signs of ...femoroacetabular impingement (FAI). Twenty-seven patients were used as a control. All patients received a CT scan of the pelvis that included the sacral endplate. Alpha angle, acetabular version, and pelvic incidence (PI) were measured on 2D CT. Patients were then assigned to one of four groups: control, cam (alpha angle > 55°, version > 15°), retroverted (alpha angle < 55°, version < 15°), or mixed (alpha angle > 55°, version < 15°). Results The PI in mixed-type FAI was 46.7° ± 3.7°, which showed a statistically significant decrease from the PI of the control group, 56.1° ± 4.4° ( P = .01). The PI for cam-only deformity was 50.8° ± 4.6°, and the PI for retroverted-only deformity was 51.0° ± 4.6°. Neither was statistically different from the control. Conclusions This study suggests that mixed-type FAI may develop as a response to decreased PI. This result is consistent with previous reports showing decreased PI associated with cam and retroversion deformities. Although the cause of FAI remains controversial, the potential impact of sagittal balance of the pelvis, and specifically, decreased PI, should not be ignored. Level of Evidence Level IV, therapeutic case series.
Context:
Wearable performance devices and sensors are becoming more readily available to the general population and athletic teams. Advances in technology have allowed individual endurance athletes, ...sports teams, and physicians to monitor functional movements, workloads, and biometric markers to maximize performance and minimize injury. Movement sensors include pedometers, accelerometers/gyroscopes, and global positioning satellite (GPS) devices. Physiologic sensors include heart rate monitors, sleep monitors, temperature sensors, and integrated sensors. The purpose of this review is to familiarize health care professionals and team physicians with the various available types of wearable sensors, discuss their current utilization, and present future applications in sports medicine.
Evidence Acquisition:
Data were obtained from peer-reviewed literature through a search of the PubMed database. Included studies searched development, outcomes, and validation of wearable performance devices such as GPS, accelerometers, and physiologic monitors in sports.
Study Design:
Clinical review.
Level of Evidence:
Level 4.
Results:
Wearable sensors provide a method of monitoring real-time physiologic and movement parameters during training and competitive sports. These parameters can be used to detect position-specific patterns in movement, design more efficient sports-specific training programs for performance optimization, and screen for potential causes of injury. More recent advances in movement sensors have improved accuracy in detecting high-acceleration movements during competitive sports.
Conclusion:
Wearable devices are valuable instruments for the improvement of sports performance. Evidence for use of these devices in professional sports is still limited. Future developments are needed to establish training protocols using data from wearable devices.
Purpose To evaluate the effect of capsulotomy size and subsequent repair on the biomechanical stability of hip joint kinematics through external rotation of a cadaveric hip in neutral flexion. ...Methods Eight fresh-frozen cadaveric hip specimens were used in this study. Each hip was tested under torsional loads of 6 N·m applied by a servohydraulic frame and transmitted by a pulley system. The test conditions were (1) neutral flexion with the capsule intact, (2) neutral flexion with a 4-cm interportal capsulotomy, (3) neutral flexion with a 6-cm capsulotomy, and (4) neutral flexion with capsulotomy repair. Soft tissue was retained during all interventions. Measures indicating joint kinematics (range of motion ROM, hysteresis area HA, and neutral zone NZ) were obtained for each condition. Results For all hip specimens, the average ROM, HA, and NZ were calculated relative to the intact capsular state (100%) and expressed in terms of percentage (± SD). The findings for ROM were as follows: intact, 100%; 4 cm, 107.42% ± 5.69%; 6 cm, 113.40% ± 7.92%; and repair, 99.78% ± 3.77%. The findings for HA were as follows: intact, 100%; 4 cm, 108.30% ± 9.30%; 6 cm, 115.30% ± 13.92%; and repair, 99.47% ± 4.12%. The findings for NZ were as follows: intact, 100%; 4 cm, 139.61% ± 62.35%; 6 cm, 169.25% ± 78.19%; and repair, 132.03% ± 64.38%. Statistically significant differences in ROM existed between the intact and 4-cm conditions ( P = .039), the intact and 6-cm conditions ( P < .0001), the 4-cm and repair conditions ( P = .033), and the 6-cm and repair conditions ( P < .0001). There was no statistically significant difference between the intact and repair conditions ( P > .99) or between the 4- and 6-cm conditions ( P = .126). Conclusions Under laboratory-based conditions, larger-sized capsulotomies were accompanied by increases in all three measures of joint mobility: ROM, HA, and NZ at time zero. Complete capsular closure effectively restored these measures when compared with the intact condition. Clinical Relevance Cadaveric models consisting of the hip joint with surrounding soft tissue were used under laboratory testing conditions to investigate potential iatrogenic joint instability resulting from expansive capsulotomies, showing that complete capsular closure leads to reconstitution of original joint stability properties at time zero.
Electron transporting (n-channel) polymer semiconductors for field-effect transistors are rare. In this investigation, the synthesis and characterization of new electron-depleted ...N-alkyl-2,2′-bithiophene-3,3′-dicarboximide-based π-conjugated homopolymers and copolymers containing the 2,2′-bithiophene unit are reported. A novel design approach is employed using computational modeling to identify favorable monomer properties such as core planarity, solubilizing substituent tailorability, and appropriate electron affinity with gratifying results. Monomeric model compounds are synthesized to confirm these properties, and a crystal structure reveals a short 3.43 Å π−π stacking distance with favorable solubilizing substituent orientations. A family of 10 homopolymers and bithiophene copolymers is then synthesized via Yamamoto and Stille polymerizations, respectively. Two of these polymers are processable in common organic solvents: the homopolymer poly(N-(2-octyldodecyl)-2,2′-bithiophene-3,3′-dicarboximide) (P1) exhibits n-channel FET activity, and the copolymer poly(N-(2-octyldodecyl)-2,2′:5′,2′′:5′′,2′′′-quaterthiophene-3,3′-dicarboximide) (P2) exhibits air-stable p-channel FET operation. After annealing, P1 films exhibit a very high degree of crystallinity and an electron mobility > 0.01 cm2 V−1 s−1 with a current on−off ratio of 107, which is remarkably independent of film-deposition conditions. Extraordinarily, P1 films also exhibit terracing in AFM images with a step height matching the X-ray diffraction d spacing, a rare phenomenon for polymeric organic semiconductors. Another fascinating property of these materials is the air-stable p-channel FET performance of annealed P2 films, which exhibit a hole mobility of ∼0.01 cm2 V−1 s−1 and a current on−off ratio of 107.
To provide further clarity regarding the management of patients with abnormal femoral version in the setting of hip arthroscopy and will discuss the definition of femoral version, the diagnostic and ...clinical evaluation of abnormal femoral version, and several described measurement techniques.
A systematic review was conducted in literature published before August 2021 that measured femoral version and reported patient-reported outcomes measures or rates of subsequent procedures following hip arthroscopy. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and the electronic databases, PubMed, OvidMedLine, Scopus, and Web of Science were searched. Two blinded reviews screened and evaluated data quality using the Newcastle-Ottawa Scale.
Eighteen studies were included with 11 studies reporting patient outcomes and 7 studies reporting rates of subsequent procedures. The most commonly used definition of femoral version was 5° to 20° of femoral anteversion. Computed tomography scan was the most commonly used imaging modality. The majority of studies (7 of 11) demonstrated that femoral version does not have an impact on patient-reported outcomes measures and is not predictive of clinically meaningful improvement scores. However, in select studies, patients with femoral retroversion were found to experience slightly inferior outcomes following hip arthroscopy for femoroacetabular impingement. While femoral retroversion may be a risk factor for subsequent procedures, 3 of 7 studies refute this claim. Although in patients with borderline hip dysplasia, excessive femoral anteversion led to greater rates of subsequent hip procedures.
While the majority of studies show that femoral version does not have an impact on patient-reported outcomes following hip arthroscopy, those with femoral retroversion and with excessive anteversion with coexisting borderline hip dysplasia need to be educated on their increased risk of subsequent operation. Ultimately, this review suggests that clinical improvement can likely be achieved regardless of femoral version.
IV; systematic review of Level I-IV studies.
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