Platelet-Rich Plasma Augmentation of Arthroscopic Hip Surgery for Femoroacetabular Impingement: A Prospective Study With 24-Month Follow-up.

PURPOSE: The objective of this study is to evaluate the clinical and immunologic effects of intra-articular doses of platelet-rich plasma (PRP) in arthroscopic hip surgery for femoroacetabular impingement. METHODS: Preoperatively, patients were randomized either to receive an intra-articular injection of PRP (group I, n = 30) or not to receive PRP (group II, n = 27) at the end of hip arthroscopic surgery. To evaluate the clinical outcome and follow-up, we used the modified Harris Hip Score (mHHS) 3, 6, and 24 months after surgery. Pain was evaluated using a visual analog scale 24 hours, 48 hours, 3 months, and 6 months after surgery. The radiologic outcome was analyzed using radiographs and magnetic resonance imaging (MRI) obtained before surgery and 6 months after surgery. Labral integration and joint effusion were evaluated with MRI at 6 months. For statistical analysis, an independent t test and the Wilcoxon rank sum test were used (P < .05 was considered statistically significant). RESULTS: The visual analog scale score 48 hours after surgery was 3.04 in group I compared with 5.28 in group II (P < .05). At the 3-month follow-up, the mHHS was 91.79 in group I versus 90.97 in group II (P = .65). At the 24-month follow-up, the mHHS was 93.41 in group I (P = .56) versus 92.32 in group II (P = .52). At the 6-month follow-up, MRI showed no effusion in 36.7% of patients in group I versus 21.1% of patients in group II (P = .013). Regarding labral integration, no statistical differences were observed between the groups (P = .76). CONCLUSIONS: In this randomized study, PRP resulted in lower postoperative pain scores at 48 hours and fewer joint effusions at 6 months. These findings suggest that PRP may have a benefit regarding postoperative inflammation; however, the long-term clinical benefit is unclear. LEVEL OF EVIDENCE: Level II, lesser-quality randomized controlled trial.

Arthroscopically determined degree of injury after shoulder dislocation relates to recurrence rate.

BACKGROUND: The glenohumeral joint is the most mobile articulation in the body and the most commonly dislocated diarthrodial joint with peaks in the incidence of dislocation occurring during the second and sixth decades. Age at the time of the initial dislocation is inversely related to the recurrence rate. Traumatic anterior instability is often associated with intraarticular injuries. The frequency of injuries may increase with dislocation or subluxation episodes. QUESTIONS/PURPOSES: We compared the frequency of lesions associated with traumatic anterior instability in patients with primary and recurrent instability. METHODS: We retrospectively reviewed 96 selected patients with traumatic anterior instability treated arthroscopically between 2005 and 2008. Forty-five had arthroscopy after a first episode of dislocation (Group I) and 51 had two or more episodes of instability (Group II). We compared the frequencies and percentage of intraarticular lesions in both groups. RESULTS: We observed a Bankart lesion in all patients of both groups. The posterior Bankart lesion was observed more frequently in Group II than in Group I: 47% versus 28%. SLAP lesions were observed in 12% in Group I and 24% in Group II. In 10 patients in Group II, there was an associated rotator cuff tear. CONCLUSIONS: Patients with recurrent shoulder dislocation had a higher arthroscopic degree of injury. These patients presented more posterior labral lesions, SLAP tears, and rotator cuff pathology than patients with a first episode of shoulder dislocation. LEVEL OF EVIDENCE: Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Longitudinal tears of peroneus longus and brevis tendons: a gouty infiltration.

The natural history of recurrent uric acid deposition includes joint destruction, as well as tendon weakening and rupture. Simultaneous rupture of the peroneus longus and brevis tendons secondary to tophaceous gout is very rare. In the present report, we describe the case of a 37-year-old man who had a history of recurrent ankle pain and 4 previous episodes of acute gout localized to his ipsilateral first metatarsophalangeal joint. The physical examination revealed the ankle pain to actually be localized to the peroneal tendons immediately distal to the fibular malleolar groove. Magnetic resonance imaging showed longitudinal tears in the peroneus longus and brevis. Surgical exploration and repair of the ruptured tendons revealed the presence of monosodium urate deposition within the substance of the tendons at the rupture sites. The tendons were debrided and repaired using longus to brevis tenodesis. The postoperative course was unremarkable and entailed referral to a rheumatologist for metabolic management. After more than a 1-year period of follow-up, the patient was ambulating without difficulties wearing regular shoe gear.

Intra-articular administration of peripheral blood stem cells with platelet-rich plasma regenerated articular cartilage and improved clinical outcomes for knee chondral lesions.

PURPOSE: To determine whether intra-articular injections of peripheral blood stem cells improved the regeneration of articular cartilage in patients with osteochondral knee injuries. METHODS: This prospective study included 20 patients with grade 3b knee osteochondral lesions who underwent knee arthroscopies. All were white, and all had performed physical activity at least five times a week. International Knee Documentation Committee (IKDC) and visual analog scale scores were recorded before surgery, six months and one year after surgery, and then yearly until five years after surgery. Magnetic resonance imaging scans were obtained six months preoperatively and then yearly and were evaluated by musculoskeletal radiologists blinded to the patient data. Tissue repair was quantified using the International Cartilage Repair Society morphologic score system. Unpaired t-tests were used for comparisons between the time points. RESULTS: The mean preoperative IKDC score was 50.5 (42-61). At the six-month follow-up, the mean values were 60.79 (P = 0.32) and 90.97. At the six-month follow-up, the mean values were 70.8 (P = 0.043). At the end of the five-year follow-up, the IKDC was 82.2 (P = 0.024). At five-year follow-up, the visual analog scale score was 1.1 (P = 0.0018). The main morphologic score system score was 3.2 preoperatively and 9.7 ±â€¯1.6 at five-year follow-up (P = 0.0021). No infection, tumors, or synovitis were reported at the end of the follow-up. CONCLUSIONS: Intra-articular peripheral blood stem cells with platelet-rich plasma regenerated articular cartilage and improved clinical outcomes for knee chondral lesions at five years of follow-up.

Evaluation of atraumatic hip instability measured by triaxial accelerometry during walking.

Hip joint instability has been targeted as an important issue that affects normal hip function. The diagnosis of hip instability could be very challenging and currently, there is no definitive diagnostic test. Hip instability results in an excessive amount of translation of femoroacetabular articulation, leading to changes on the dynamic loading of the hip. These changes in femoroacetabular translation could be evaluated by human movement analysis methods. The purpose of this study was to describe the triaxial and overall magnitude of acceleration in patients diagnosed with hip instability during gait cycle and compare those results with a control group. Our hypothesis was that acceleration values obtained from the instability group would be higher than asymptomatic controls. Ten patients with previously diagnosed hip instability were included and 10 healthy and asymptomatic subjects were enrolled as control group. Triaxial accelerometers attached bilaterally to the skin over the greater trochanter were used to record acceleration during walking on a treadmill. The overall magnitude of acceleration and the axial, anteroposterior and mediolateral accelerations (x/y/z) were obtained during gait. Mean overall magnitude of acceleration was higher in the hip instability group compared with the control group, 1.51 g (SD: 0.23) versus 1.07 g (SD: 0.16) (P = 0.022). The axial, anteroposterior and mediolateral accelerations significantly differed between the two groups. The axial and mediolateral accelerations showed to be higher for the hip instability group while the anteroposterior axis acceleration was lower.

Solitary osteochondroma long-term follow-up.

A series of 113 osteochondromas were treated in our institution with a long-term follow-up. A retrospective study of the cases of solitary osteochondroma diagnosed and treated in our center from 1970 to 2002 was done. A diagnosis for clinical findings in 73% of the patients was made. The most frequent location was the distal femur. Six patients had a recurrence and in two patients the lesions became malignant and chondrosarcoma developed. Relapse of the exostosis is rare, occurring in an estimated 2% of the resections. The growth of an osteochondroma and/or the presence of pain in older patients suggest possible malignancy.

Patellar Tendon Stiffness in Elite Breakdancers Assessed by Myotonometric Measurement.

Studies that have investigated the epidemiology of injuries in breakdancing have concluded that the second most common injury site is the knee and that the majority of breakdancers have experienced overuse syndrome. Tendon stiffness, the relationship between force applied to a tendon and the resulting displacement, has been identified as a primary mechanical factor in such injuries. However, patellar tendon stiffness has not yet been evaluated in elite breakdancers. Hence, the purpose of this study was to determine mean patellar tendon stiffness in this population by using myotonometric measurements and to compare those results with healthy control subjects. Twenty-five elite male breakdancers and 25 male control subjects were included in the study. A Myoton Pro device was used to assess their tendon stiffness. The mean patellar tendon stiffness of the breakdancers was 1,045 ± 202 Nm and 1,084 ± 193 Nm for the dominant and non-dominant limb, respectively; for the control group it was 902 ± 166 Nm and 862 ± 159 Nm for the dominant and non-dominant limb, respectively. Statistical analyses showed higher stiffness values for breakdancers compared to controls for both limbs. This is consistent with studies reporting patellar tendon adaptation after training.

Prevalence of FAI radiographic hip abnormalities in elite soccer players: are there differences related to skeletal maturity?

BACKGROUND: Femoroacetabular impingement (FAI) can be a source of hip pain in young adults. Some reports have revealed that participation in high-impact sports may play a role in the development of cam deformity, and there is a higher prevalence of signs of cam impingement in asymptomatic adolescents who participate in soccer and basketball than in non-athlete controls; however, current evidence is scarce regarding the initiation and development of deformities. PURPOSE: The aim of this study was to evaluate the prevalence of radiographic hip abnormalities related to FAI in young elite soccer players and compare this with findings in a group of adult elite soccer players. SUBJECTS AND METHODS: Anteroposterior pelvic and cross-table hip radiographs were obtained for 75 young elite soccer players with skeletal immaturity (group 1) and for 75 adult elite soccer players (group 2), all of whom were previously asymptomatic and had no history of hip disease. After exclusion, group 1 included 72 patients, and group 2 included 70 patients. Radiological signs of FAI were evaluated. RESULTS: 34 subjects in groups 1 and 2 demonstrated cam morphology. The prevalence of pincer morphology was 30 in group 1 and 36 in group 2. However, these differences were not statistically significant. CONCLUSION: We found no differences in the prevalence of FAI radiological signs between soccer players in their late adolescence and adult soccer players.

Unusual bilateral rim fracture in femoroacetabular impingement.

This is a report of one case of bilateral acetabular rim fracture in association with femoroacetabular impingement (FAI), which was treated with a hip arthroscopic procedure, performing a partial resection, a labral reinsertion, and a subsequential internal fixation with cannulated screws. Up to date, there are in the literature only two reports of rim fracture and "os acetabuli" in association with FAI. In the case we present, the pincer and cam resection were performed without complications; the technique used was published previously. With this technique the head of the screw lays hidden by the reattached labrum. We removed partially the fractured rim fragment and the internal fixation of the remaining portion was achieved with a screw. In the event of a complete resection of the fragment, it would have ended with a LCE angle of 18° and a high probability of hip instability. We believe that this bilateral case helps establish the efficacy and reproducibility of the technique described by Larson.

CT scan study of atlantoaxial rotatory mobility in asymptomatic adult subjects: a basis for better understanding C1-C2 rotatory fixation and subluxation.

STUDY DESIGN: Normal rotation was evaluated in a group of 40 asymptomatic adults. OBJECTIVE: To determine the normal rotational limits of C1-C2 in adults and define when a rotatory fixation occurs in the limits of normality or in subluxation. The term subluxation should be used only when C1-C2 is rotated beyond normal limits. SUMMARY OF BACKGROUND DATA: Concepts about rotatory fixation were established by accepting that it may occur within the limits of normal range of motion. Although nowadays CT is the current image method used to evaluate any case of torticollis, no study has been performed in adult population on what really normal rotation look like in CT scans. METHODS: The study included the measurement of the rotational movement of the neck and a CT scan study of the articular processes of C1-C2 in maximal, left and right, active rotation. A superposition of 6 consecutive slices was carried out, obtaining a linear contour of the axial view of C1-C2. Rotation angle and contact surface loss were measured. RESULTS: The average neck rotation angle was 79 degrees (range: 74 degrees to 81 degrees ). The superposition of the images taken in every rotational direction showed a wide contact loss between the correspondent C1-C2 articular surfaces (42.4%-85.7%; average: 70%). The report of these images, carried out by 3 independent radiologists, concluded that there was a rotatory subluxation in all these cases. CONCLUSION: Our results coincide with our previous published ones conducted in children, and lead us to conclude that a CT scan showing wide-but incomplete-rotational facet displacement is not sufficient to define subluxation. We perceive that there is a risk of overdiagnosis and overtreatment (C1-C2 arthrodesis) when evaluating upper cervical spine rotational problems. The concept of both rotatory fixation and subluxation should be revised, and quantifying the rotational angle and contact surface loss between C1-C2 can be very useful.