Significant Increase in Early Reoperation After Latarjet-Bristow Procedure Versus Arthroscopic Bankart Repair for Anterior Shoulder Instability: A Propensity-Score Matched Analysis.

PURPOSE: To compare the 30-day outcomes, including length of stay, short-term complications, hospital readmission, all-cause reoperation, and death after arthroscopic Bankart (AB) and Latarjet. METHODS: Patients in the National Surgical Quality Improvement Program database who had undergone either AB or Latarjet-Bristow (LB) procedures for anterior shoulder instability from 2012 to 2018 were identified using Current Procedural Terminology codes. Nearest neighbor propensity score matching was used to address any potential demographic differences. The 30-day incidence of postoperative complications were compared, and univariate and multivariate logistic regressions were used to identify risk factors associated with the incidence of post-operative complications. RESULTS: A total of 7,519 patients were identified, with 6,990 (93.0%) undergoing AB and 529 (7.0%) LB. After propensity score matching, the baseline demographics were not significantly different (P > .05). There was no significant difference in rate of total adverse events between the AB and LB cohorts (P = .06). There was a significant difference in the rate of return to the operating room between LB (1.9%) when compared to AB (0%) (P < .001). Of reoperations, 40% were due to need for revision stabilization (0.8% of all LB cases) and 40% were for irrigation and debridement. There was also a significant difference in operative time (AB = 87 minutes, LB = 131 minutes; P < .0001). CONCLUSIONS: Overall 30-day complication rates were low for both groups, with similar rates among AB and LB patients. However, there was a statistically significant increased rate of short-term reoperation or revision stabilization in the LB cohort. LEVEL OF EVIDENCE: Level III, retrospective comparative prognostic trial.

NSQIP data collection up to 30 postoperative days is sufficient to capture some complications in orthopedic surgeries.

PURPOSE: The primary aim of this study is to determine if the 30-day follow-up period used by the National Surgical Quality Improvement Program (NSIQP) is an appropriate timeframe to capture complications after orthopedic surgeries. METHODS: The 2019 NSQIP data were used. The independent variables were complication type. The dependent variable was days to complication. A Shapiro-Wilk test was used to determine if the data were normally distributed. RESULTS: 271,397 orthopedic cases were included. Myocardial infarction, pneumonia, ventilator over 48 h, progressive renal insufficiency, acute renal failure, stroke, and cardiac arrest had positive skewness and positive kurtosis. Deep incisional surgical site infection (SSI), organ/space SSI, wound disruption, unplanned reoperation one, unplanned reoperation two, readmission two, and readmission three had negative kurtosis and negative skewness. Complications with positive kurtosis and positive skewness are more likely to be confined to the 30-day postoperative period, whereas complications with negative skewness and negative kurtosis may be underreported within the 30-day follow-up. CONCLUSIONS: These findings are useful in their ability to inform future orthopedic research using NSQIP which continues to generate new data for surgeons to consider for their postoperative care and complication management.

Metabolic phenotypes reflect patient sex and injury status: A cross-sectional analysis of human synovial fluid.

OBJECTIVE: Osteoarthritis is a heterogeneous disease. The objective was to compare differences in underlying cellular mechanisms and endogenous repair pathways between synovial fluid (SF) from male and female participants with different injuries to improve the current understanding of the pathophysiology of downstream post-traumatic osteoarthritis (PTOA). DESIGN: SF from n = 33 knee arthroscopy patients between 18 and 70 years with no prior knee injuries was obtained pre-procedure and injury pathology assigned post-procedure. SF was extracted and analyzed via liquid chromatography-mass spectrometry metabolomic profiling to examine differences in metabolism between injury pathologies (ligament, meniscal, and combined ligament and meniscal) and patient sex. Samples were pooled and underwent secondary fragmentation to identify metabolites. RESULTS: Different knee injuries uniquely altered SF metabolites and downstream pathways including amino acid, lipid, and inflammatory-associated metabolic pathways. Notably, sexual dimorphic metabolic phenotypes were examined between males and females and within injury pathology. Cervonyl carnitine and other identified metabolites differed in concentrations between sexes. CONCLUSIONS: These results suggest that different injuries and patient sex are associated with distinct metabolic phenotypes. Considering these phenotypic associations, a greater understanding of metabolic mechanisms associated with specific injuries, sex, and PTOA development may yield data regarding how endogenous repair pathways differ between male and female injury types. Ongoing metabolomic analysis of SF in injured male and female patients can be performed to monitor PTOA development and progression.

Editorial Commentary: Gadolinium Intra-Articular Contrast Magnetic Resonance Imaging Is Not Required for Every Patient Undergoing Hip Arthroscopy, but Contrast Magnetic Resonance Imaging Plus Computed Tomography With 3-Dimensional Reconstruction Are Essential for Patients Requiring Revision.

For arthroscopic hip surgeons, accurate identification of symptomatic pathology is required. Gadolinium-contrast magnetic resonance arthrography (MRA) is an important imaging option but not necessarily for every patient. Contrast carries some risks, and for patients with acute pathology, effusion may mitigate against the need for contrast. In addition, higher field 3T magnetic resonance imaging shows exceptional detail, comparable sensitivity, and superior specificity to MRA. However, in the revision setting, contrast is indicated to delineate recurrent labral tear versus postsurgical changes, as well as to best show the degree of capsular deficiency. In addition, in the revision setting, computed tomography scan without contrast with 3-dimensional reconstruction also is indicated to evaluate for acetabular dysplasia, surgical over-resection on the acetabular and femoral side, and femoral version. Each patient should be carefully evaluated; MRA with intra-articular contrast is a valuable tool, but not always required.

Increased Age, Operative Time, American Society of Anesthesiologists Classification, Functional Dependency, and Comorbidity Burden Are Risk Factors for Adverse Events After Meniscectomy and Meniscus Repair: 10-Year Analysis of 64,223 Patients.

PURPOSE: To use the National Surgical Quality Improvement Program (NSQIP) database to identify risk factors for 30-day adverse events and hospital readmission following isolated and unilateral meniscectomy or meniscus repair. METHODS: A retrospective review of the NSQIP database from the years 2012 to 2021 identified all patients undergoing isolated, unilateral meniscectomy or meniscus repair. Multivariable analyses were performed for each procedure to identify patient characteristics associated with any adverse event (AAE) or unplanned hospital readmission within 30 days of surgery. RESULTS: From 2012 to 2021, 59,450 (93%) patients underwent meniscectomy, and 4,773 (7%) patients underwent meniscus repair. Overall adverse event rate was 0.95% after meniscectomy and 1.40% after repair. Risk factors for AAE after meniscectomy included increased age (odds ratio [OR] = 1.010; P = .009), increased operative time (OR = 1.003; P = 0.011), American Society of Anesthesiologists (ASA) class IV (OR = 2.048; P = .045), functional dependency (OR = 3.527; P = .001), and current smoking (OR = 1.308; P = .018). Risk factors for AAE after meniscus repair included age (OR = 1.024; P = .016), operative time (OR = 1.004; P = .038), and bleeding disorders (OR = 7.000; P = .014). ASA class III increased risk of hospital readmission after both procedures (OR = 1.906; P = .008; OR = 4.101; P = .038), and medical comorbidities of heart failure (OR = 3.924; P = .016), hypertension (OR = 1.412; P = .011), and chronic obstructive pulmonary disease (OR = 2.350; P < .001) increased readmission risk after meniscectomy only. CONCLUSIONS: Per analysis of the ACS-NSQIP database, surgical treatment of meniscal tears in the knee has been performed frequently over the past 10 years, with meniscectomies comprising over 90% of cases. Increased age and operative time were associated with a modest risk of adverse events after both meniscectomy and meniscus repair. Increased comorbidity burden, evidenced by ASA class, dependent functional status, current smoking, and systemic medical conditions, such as heart failure, hypertension, chronic obstructive pulmonary disease, and bleeding disorders, greatly increased rates of unfavorable outcomes within 30 days of meniscus surgery. LEVEL OF EVIDENCE: Level III, retrospective prognostic comparative investigation.

Female Sex, Older Age, Earlier Surgery, Anticoagulant Use, and Meniscal Repair Are Associated With Increased Risk of Manipulation Under Anesthesia or Lysis of Adhesions for Arthrofibrosis After Anterior Cruciate Ligament Reconstruction: A Systematic Review.

PURPOSE: To determine what patient or surgical factors are associated with an increased risk of arthrofibrosis requiring manipulation under anesthesia (MUA) or lysis of adhesions (LOA) after anterior cruciate ligament reconstruction (ACLR). METHODS: A systematic review was performed in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Cochrane, Embase, and Medline databases were searched for studies published through February 2023. Inclusion criteria were studies that identified risk factors for MUA and/or LOA after ACLR. Studies investigating arthrofibrosis after multiligamentous knee injuries or ACL repair were excluded. RESULTS: Eleven studies including a total of 333,876 ACLRs with 4,842 subsequent MUA or LOA (1.45%) were analyzed. Increasing age was associated with an increased risk in 3 studies (P < .001, P < .05, P < .01) but was found to have no association another two. Other factors that were identified by multiple studies as risk factors for MUA/LOA were female sex (4 studies), earlier surgery (5 studies), use of anticoagulants other than aspirin (2 studies), and concomitant meniscal repair (4 studies). CONCLUSIONS: In total, 1.45% of the patients who underwent ACLR and were included in this systematic review had to undergo a subsequent MUA/LOA to treat arthrofibrosis. Female sex, older age, earlier surgery, use of anticoagulants other than aspirin, and concomitant meniscal repair were associated with increased risk of MUA/LOA. The modifiable risks, including use of anticoagulants and time between injury and surgery, can be considered when making treatment decisions. LEVEL OF EVIDENCE: Level IV, systematic review of Level III/IV evidence.

Editorial Commentary: Hip Labral Reconstruction: A Necessary Skill for Hip Arthroscopy Surgeons.

The surgical treatment of labral deficiency has generated a tremendous amount of discussion and controversy among hip arthroscopists. The surgical reconstruction of the labrum has been viewed as the natural next step, after debridement and repair, in the advancement of our ability to treat patients with hip labral pathology. However, the indications for labral replacement and the profile of patients who would benefit from this complex intervention are still under debate. Every hip arthroscopist must have the technical ability to perform reconstruction when indicated. Repair or debridement does not always achieve best patient outcome.

Arthroscopic and Open or Mini-Open Rotator Cuff Repair Trends and Complication Rates Among American Board of Orthopaedic Surgeons Part II Examinees (2007-2017).

PURPOSE: To ascertain trends and reported complication rates of arthroscopic and open or mini-open rotator cuff repairs (RCRs) reported by American Board of Orthopaedic Surgery (ABOS) Part II examinees between 2007-2017. METHODS: The ABOS database was queried for both arthroscopic RCR (International Classification of Diseases code 29827) and open or mini-open RCR (International Classification of Diseases codes 23410 and 23412) performed by Part II examinees from 2007-2017. A comparison between overall procedure rates, as well as reported complications (anesthetic, medical, surgical, reoperations, and readmissions) associated with the respective repair technique, was performed. RESULTS: From 2007-2017, a total of 31,907 RCRs were reported by Part II examinees. Of those, 85.2% (n = 27,189) were arthroscopic whereas 14.8% (n = 4,718) were open or mini-open. The rate of arthroscopic RCR increased from 73% (n = 2,138) in 2007 to 90% (n = 2,031) in 2017, whereas the rate of open or mini-open RCR decreased from 27% (n = 771) to 10% (n = 234) during the same period. Rates of reported annual complications were significantly lower for arthroscopic RCR (7.4%-16.2%) than for open or mini-open RCR (12.9%-30.3%) for each of the past 6 years (2012-2017) (P < .001). Arthroscopic RCR had an overall lower cumulative occurrence of complications than open or mini-open RCR over the past decade (2007-2017) (P < .001). The relative risk of complications for arthroscopic RCR compared with open RCR was 0.71 (95% confidence interval, 0.66-0.77). CONCLUSIONS: ABOS Part II examinees reported an increased practice of arthroscopic RCR in comparison with open or mini-open RCR over the past 10 years. Reported annual complication rates have been significantly lower for arthroscopic RCR over the past 6 years, with an overall lower cumulative rate from 2007-2017. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Re-revision Anterior Cruciate Ligament Reconstruction: An Evaluation From the Norwegian Knee Ligament Registry.

PURPOSE: To identify the rate of re-revision anterior cruciate ligament reconstruction (ACLR) to estimate the influence of patient-related factors on the risk of re-revision ACLR. The secondary aim of the study was to report the intra-articular findings and patient-related factors at the time of revision ACLR and to compare these with the findings in a matched controlled group of primary ACLR. METHODS: Patients with primary ACLR without a subsequent need of revision and patients with a revision ACLR identified in the Norwegian Knee Ligament Registry from June 2004 through September 2016 were included. Using age at operation, sex, activity at injury, and year of ACLR as covariates, a propensity score matched control group of primary ACLR patients for the revision ACLR patients was identified. For the revision ACLR patients, re-revision ACLR rates at 1, 2, 5, and 8 years were estimated with Kaplan-Meier analysis; the hazard ratio for a re-revision ACLR was estimated using a multivariable Cox regression model. RESULTS: The cumulative estimated proportion of patients undergoing a re-revision ACLR at 1, 2, 5, and 8 years after the original revision ACLR was 0.4%, 3.0%, 6.5%, and 9.0% respectively. There was no significant difference between the control and revision ACLR groups regarding cartilage injury (P = .72) or associated ligament injury (P = .17). Revision ACLR patients did have fewer meniscal injuries (P < .001). There were no intraoperative findings or surgical techniques identified as a predictor for a higher risk of re-revision ACLR. CONCLUSIONS: Based on a review of a large ligament reconstruction registry,one can expect 9% of patients to undergo a re-revision ALCR at 8 years of follow up. Revision ACLR did not have an increase in cartilage injuries or associated ligament injuries and had significantly fewer meniscal injuries compared with a primary ACLR control group. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Outcomes of Arthroscopic Management of Trochanteric Bursitis in Patients With Femoroacetabular Impingement: A Comparison of Two Matched Patient Groups.

PURPOSE: To determine the prevalence of chronic trochanteric bursitis (TB) in patient being treated for femoroacetabular impingement (FAI) and determine the effectiveness of arthroscopic bursectomy and iliotibial band lengthening (AB-ITB-L) at the time of hip arthroscopy for FAI. METHODS: Patients diagnosed with primary FAI and chronic TB were included in the study. Patients were included if they underwent hip arthroscopy with labral repair, femoral and/or acetabular osteoplasty, and AB-ITB-L. Patients were matched by age and gender to patients without chronic TB. RESULTS: The prevalence of chronic TB with FAI was 7% (90/1,278). Females were 5.3 times more likely to have TB compared with males (95% confidence interval: 3.2-8.7). Patients more than 30 years of age were 2.5 times more likely to have TB (95% confidence interval: 1.48-4.4). Of the 90 patients diagnosed with TB, 72 (54 female, 18 male) with an average age of 36.7 years underwent AB-ITB-L at the time of their index hip arthroscopy for FAI. All 72 patients had associated intra-articular pathology consisting of a combined cam and pincer pathology. The TB (average follow-up = 42 ± 9.9 months) and non-TB group (average follow-up = 42 ± 9.1 months) both had significant improvement from preoperative to postoperative scores for Hip Outcome Score Activities Daily Living, Hip Outcome Score Sport, Modified Harris Hip Score, Western Ontario and McMaster Universities Arthritis Index, Short Form (SF)-12 Physical Component score, and SF-12 Mental Component Score. There was no significant difference between the 2 groups in postoperative patient reported outcome scores. CONCLUSIONS: The occurrence of chronic TB in the FAI population, which did not adequately respond to nonoperative management, for a single surgeon high volume hip arthroscopy practice was 7%, and was more commonly seen in women older than 30 years. Patients who undergo concomitant AB-ITB-L for chronic TB report excellent pain relief, and have equivalent results and outcome scores that are not inferior when compared with patients with primary FAI without chronic TB. LEVEL OF EVIDENCE: Level III, retrospective matched case control study.

A Systematic Review of Arthroscopic Versus Open Tenotomy of Iliopsoas Tendonitis After Total Hip Replacement.

PURPOSE: To conduct a systematic review of the literature comparing patient outcomes following arthroscopic and open operative management of iliopsoas tendonitis (IPT) following total hip replacement (THR). METHODS: This review study was conducted in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement. Inclusion criteria were as follows: outcome studies following open or arthroscopic iliopsoas tendon release after THR with at least 6 months of follow-up, English language, and human studies. The exclusion criteria included case reports, articles evaluating nonsurgical management or cup revision, and articles without a specific diagnosis of IPT or in which results between open and arthroscopic treatment were reported in conjunction. RESULTS: A total of 131 studies were initially retrieved, with 7 satisfying all inclusion criteria (4 studies on arthroscopic tenotomy and 3 studies on open tenotomy). The review included a total of 88 patients with IPT-61 patients treated arthroscopically and 27 patients treated with open tenotomy. In total, 77 of the 88 patients demonstrated successful outcomes following surgery. In the group treated with arthroscopy, 91.8% (56/61) of patients had successful outcomes, whereas in those treated with open tenotomy, 77.8% (21/27) of patients had successful outcomes. Of patients with signs of mechanical impingement from acetabular component overhang, those who underwent open tenotomy had complete pain relief in 6/8 patients (75%) compared to arthroscopic tenotomy in which there was relief in 40/43 patients (93%). CONCLUSIONS: Arthroscopic iliopsoas release for management of IPT is suggested to be an effective minimally invasive operative technique that may also yield a lower complication rate in comparison to open tenotomy. Tenotomy, both arthroscopic and open, are successful treatment options for IPT, including those with signs of mechanical impingement, and are recommended prior to cup revision. LEVEL OF EVIDENCE: Level IV, systematic review of level IV studies.

Five-Year Outcomes After Arthroscopic Repair of Partial-Thickness Supraspinatus Tears.

PURPOSE: To investigate clinical outcomes in patients who underwent arthroscopic repair of isolated partial-thickness rotator cuff tears (PTRCTs) of the supraspinatus tendon with a minimum follow-up period of 5 years. METHODS: All patients who had undergone arthroscopic repair of isolated PTRCTs at least 5 years earlier were included. Preoperatively and postoperatively, the American Shoulder and Elbow Surgeons, QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire), and Short Form 12 Physical Component Summary scores were collected, along with postoperative satisfaction (10-point scale) and return to activity. The associations between (1) patient age and outcome scores and (2) location of partial-thickness tear (articular vs bursal sided) and outcome scores were evaluated. Failure was defined as revision surgery of the rotator cuff repair. RESULTS: The study included 24 shoulders (24 patients comprising 9 women and 15 men). Follow-up data were available on 20 shoulders (7 women and 13 men, 83% follow-up) at a mean of 6 ± 1 years postoperatively. The mean age at index surgery was 55 ± 11 years; 6 bursal- and 14 articular-sided tears were repaired. No patient required revision surgery. All scores significantly improved from preoperatively to postoperatively (P < .05); the median satisfaction rating (1, not satisfied; 10, completely satisfied) was 10 (range, 1-10). Neither patient age nor tear location correlated with outcome scores (P > .05). Seventeen patients indicated that they participated in previous recreational activity. Of these patients, 13 (76%) returned to the original level or a similar level of activity, 3 (18%) returned to activity at a lower level, and only 1 (6%) indicated an inability to return to activity. CONCLUSIONS: Patients undergoing arthroscopic repair of PTRCTs can expect excellent clinical outcomes with low failure rates at midterm follow-up given that no patient progressed to revision rotator cuff repair during follow-up. The return-to-activity rate was very high after repair of isolated PTRCTs. Neither patient age nor tear location was associated with outcome scores. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Subpectoral Biceps Tenodesis for Tenosynovitis of the Long Head of the Biceps in Active Patients Younger Than 45 Years Old.

PURPOSE: The objective of this study was to assess the outcomes after subpectoral biceps tenodesis (BT) for long head of the biceps (LHB) tenosynovitis in active patients <45 years old. METHODS: This was an Institutional Review Board-approved, retrospective outcomes study with prospectively collected data. Patients treated with subpectoral BT were included if they met the following criteria: age <45 years, anterior shoulder pain with arthroscopically confirmed LHB tenosynovitis, no concomitant procedures other than debridement and decompression procedures, and minimum 2 years out from surgery. Patients were excluded from analysis if they refused participation. The American Shoulder and Elbow Surgeons (ASES), Short Form-12, Quick Disabilities of the Arm, Shoulder and Hand, Single Assessment Numeric Evaluation, and pain scores as well as sports participation preoperatively and at a minimum of 2 years postoperatively were obtained. Pre- and postoperative scores were compared using paired samples t-test and Wilcoxon signed-rank test. RESULTS: Thirty patients met the inclusion criteria. Two of these patients refused to participate in follow-up and were excluded from analysis. Of the remaining 28 patients (17 male, 11 female; 37.0 ± 8.0 years), minimum 2-year outcomes were available for 24 (13 males, 11 females: 37.7 ± 8.2 years; 85.7%). Mean follow-up was 3.1 years (range, 2.0 to 7.3 years). There were significant improvements in all outcome measures including ASES score (P < .001), with a postoperative mean of 95.8 ± 7.8, visual analog scale "pain today" (P < .001), and pain affecting activities of daily living (P < .001). Seventeen of 20 (85%) patients who answered the question about postoperative sport participation were able to return to sport. Mean patient satisfaction was 9.2/10 (standard deviation, +1.7). There were no postoperative complications such as Popeye deformity or cramping. There were no clinical failures. CONCLUSIONS: Subpectoral BT is an excellent treatment option for active patients <45 years old with LHB tenosynovitis and chronic anterior shoulder pain, resulting in decreased pain, improved function, high satisfaction, and improved quality of life. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Arthroscopic Repair of Isolated Partial- and Full-Thickness Upper Third Subscapularis Tendon Tears: Minimum 2-Year Outcomes After Single-Anchor Repair and Biceps Tenodesis.

PURPOSE: To investigate outcomes of arthroscopic single-anchor repair and biceps tenodesis of partial- and full-thickness tears of the upper third subscapularis (SSC). METHODS: Thirty-three patients with arthroscopically confirmed isolated SSC tears, Lafosse type I (>50% of the tendon thickness involved), or type II were included. All patients underwent arthroscopic subcoracoid decompression, coracoplasty if the coracohumeral distance was narrowed, biceps tenodesis, and a single-anchor repair of the upper third SSC. No other reconstructive procedures were performed. Subjective evaluations included American Shoulder and Elbow Surgeons, Short-Form 12, Quick Disabilities of the Arm, Shoulder and Hand, Single Assessment Numeric Evaluation, and visual analog scale pain scores preoperatively and at minimum 2 years postoperatively. RESULTS: Thirty-one patients (n = 25 male, n = 6 female) were included in the final collective, because 2 patients refused participation. Minimum 2-year follow-up data were available for 28 of the 31 patients (90.3%). The mean age at the time of surgery was 54.8 (range, 36-71) years. The mean follow-up was 4.1 (range, 2.0-8.0) years. The results of all outcome measures improved significantly postoperatively compared with preoperative scores (P < .05). Patients with single-anchor repair of type II SSC tears (n = 17) had a significantly higher mean postoperative American Shoulder and Elbow Surgeons score (93.7 ± 10.8) than patients with single-anchor repair of type I SSC tears (n = 11; 86.7 ± 10.9; P = .027). CONCLUSIONS: Arthroscopic single-anchor repair of upper third SSC tendon tears led to improved function and decreased pain with high patient satisfaction. Outcomes of full-thickness upper third SSC tears were more favorable compared with outcomes of high grade partial-thickness upper third SSC tears. LEVEL OF EVIDENCE: Level IV, retrospective therapeutic case series.

Isolated Biceps Reflection Pulley Tears Treated With Subpectoral Biceps Tenodesis: Minimum 2-Year Outcomes.

PURPOSE: To investigate if patients younger than 50 years old had improved functional outcomes after subpectoral biceps tenodesis (BT) for the treatment of biceps reflection pulley (BRP) lesions at minimum 2-year postoperative follow-up. METHODS: Patients who had arthroscopically confirmed BRP tears that were treated with subpectoral BT and were at least 2 years out from surgery were included; patients were excluded if they had concomitant reconstructive or reparative procedures at index surgery. Patient-centered outcomes including return to activity, American Shoulder and Elbow Surgeons (ASES), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), and Short Form-12 Physical Component Summary (SF-12 PCS) scores, and patient satisfaction were collected. The pre- and postoperative scores were compared with a Wilcoxon test. Failure was defined as revision BT. RESULTS: Between January 2006 and July 2014, of 1,184 patients who underwent open subpectoral BT, 14 patients (6 male, 8 female) with mean age 37 (range, 16-49 years) met the inclusion criteria. Minimum 2-year outcomes data were available for all 14 patients (100% follow-up). The mean follow-up was 3.6 ± 1.3 years. There were significant improvements postoperatively for all outcome scores (P = .017 ASES, P = .002 QuickDASH, P = .003 SF-12 PCS). There was no correlation between age and outcome scores (P > .05). Median patient satisfaction was 9 of 10. Five patients (36%) reported return to recreational activity with no modifications; 9 (64%) indicated a return to activity with modifications. The 5 patients who returned to recreational activity with no modification had significantly less time from initial injury/onset of symptoms until surgery in comparison with the 9 patients who modified their activity (P = .028). No complications or reoperations were reported. CONCLUSIONS: Patients younger than 50 years old with a symptomatic isolated BRP lesion experienced excellent results, high return to recreational activity, little postoperative pain, and high degrees of satisfaction when treated with subpectoral BT. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Total hip arthroplasty in very young bone marrow transplant patients.

Concerns remain about total hip arthroplasty (THA) performed in very young patients, especially those with complex medical history such as allogeneic bone marrow transplantation (ABMT). This study retrospectively reviews the perioperative courses and functional outcomes of ABMT patients <21 years old undergoing primary uncemented THA. Nine THAs were performed in five ABMT patients at an average age of 19.7 years. The interval between ABMT and THA was 73.0 months with clinical follow-up of 25.8 months. Harris Hip Scores (HHS) increased dramatically from preoperatively 44.5 (range, 31.1-53.4) to postoperatively 85.2 (range, 72.0-96.0) and all patients subjectively reported a good (four hips) to excellent (five hips) overall outcome. There was one reoperation for periprosthetic fracture fixation but there were no infections or revisions performed. Despite the history of severe hematopoietic conditions requiring ABMT, these very young patients do appear to have improved pain and function following primary THA with short-term follow-up.

Shoulder Hemiarthroplasty Is Associated With Higher 30-Day Complication Rates Compared With Total Shoulder Arthroplasty for Glenohumeral Osteoarthritis: A Propensity Score Matched Analysis.

BACKGROUND: Anatomical total shoulder arthroplasty (TSA) and shoulder hemiarthroplasty (HA) have both been shown to have good outcomes in patients with osteoarthritis of the glenohumeral joint. However, evidence comparing perioperative complications between these procedures in this population is heterogeneous. MATERIALS AND METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried between the years 2012 and 2021 (10 years in total) for records of patients who underwent either TSA or HA for osteoarthritis of the glenohumeral joint. Patients in each group underwent a 1:1 propensity match for demographic variables. Bivariate and multivariate analyses were performed to compare complications and risk factors between these cohorts. RESULTS: A total of 4376 propensity-matched patients, with 2188 receiving TSA and 2188 receiving HA, were included in the primary analyses. The HA cohort had a higher rate of any adverse event (7.18% vs 4.8%, P=.001), death (0.69% vs 0.1%, P=.004), sepsis (0.46% vs 0.1%, P=.043), postoperative transfusion (4.62% vs 2.2%, P<.001), postoperative intubation (0.5% vs 0.1%, P=.026), and extended length of stay (23.77% vs 13.1%, P<.001). HA was found to increase the odds of developing these complications when baseline demographics were controlled. Older age (odds ratio, 1.040; 95% CI, 1.021-1.059; P<.001) and lower body mass index (odds ratio, 0.949; 95% CI, 0.923-0.975; P<.001) increased the odds of having any adverse event in the HA cohort but not in the TSA cohort. CONCLUSION: Compared with TSA, HA appears to be associated with significantly higher rates of 30-day postoperative complications when performed for glenohumeral osteoarthritis. [Orthopedics. 2024;47(4):217-224.].

Evaluating the risk of return to the operating room across all elective orthopaedic procedures.

BACKGROUND: Although elective procedures have life-changing potential, all surgeries come with an inherent risk of reoperation. There is a gap in knowledge investigating the risk of reoperation across orthopaedics. We aimed to identify the elective orthopaedic procedures with the highest rate of unplanned reoperation and the reasons for these procedures having such high reoperation rates. METHODS: Patients in the NSQIP database were identified using CPT and ICD-10 codes. We isolated 612,815 orthopaedics procedures from 2018 to 2020 and identified the 10 CPT codes with the greatest rate of unplanned return to the operating room. For each index procedure, we identified the ICD-10 codes for the reoperation procedure and categorized them into infection, mechanical failure, fracture, wound disruption, hematoma or seroma, nerve pathology, other, and unspecified. RESULTS: Below knee amputation (BKA) (CPT 27880) had the highest reoperation rate of 6.92% (37 of 535 patients). Posterior-approach thoracic (5.86%) or cervical (4.14%) arthrodesis and cervical laminectomy (3.85%), revision total hip arthroplasty (5.23%), conversion to total hip arthroplasty (4.33%), and revision shoulder arthroplasty (4.22%) were among the remaining highest reoperation rates. The overall leading causes of reoperation were infection (30.1%), mechanical failure (21.1%), and hematoma or seroma (9.4%) for the 10 procedures with the highest reoperation rates. CONCLUSIONS: This study successfully identified the elective orthopaedic procedures with the highest 30-day return to OR rates. These include BKA, posterior thoracic and cervical spinal arthrodesis, revision hip arthroplasty, revision total shoulder arthroplasty, and cervical laminectomy. With this data, we can identify areas across orthopaedics in which revising protocols may improve patient outcomes and limit the burden of reoperations on patients and the healthcare system. Future studies should focus on the long-term physical and financial impact that these reoperations may have on patients and hospital systems. LEVEL OF CLINICAL EVIDENCE: IV.

Partial Patellar Tendon Tears in Athletes: A Systematic Review of Treatment Options, Outcomes, and Return to Sport.

Introduction: Partial patellar tendon tears (PPTTs) are overuse injuries in sports with frequent jumping, such as basketball and volleyball. There are several treatment options, including both operative and non-operative modalities. Current literature is largely focused broadly on patellar tendinopathy; however, there are few studies which specifically evaluate treatment outcomes for PPTTs. Objective: To systematically review the literature on treatment options, clinical outcomes, and return to sport (RTS) in athletes with a PPTT. Methods: PubMed, Embase, and Cochrane were searched through May 1st, 2023 for studies reporting treatment outcomes in athletes with partial patellar tendon tears. Data was extracted on the following topics: treatment modalities, surgical failures/reoperations, surgical complications, RTS, and postoperative time to RTS. Results: The review covers 11 studies with 454 athletes: 343 males (86.2%) and 55 females (13.8%). The average age was 25.8 years, ranging from 15 to 55 years. 169 patients (37.2%) received only non-operative treatments, while 295 (65.0%) underwent surgery. 267 patients (92.1%) returned to sports after 3.9 months of treatment. The average follow-up was 55.8 months. Conclusion: Our review of current literature on PPTTs in athletes illustrates over 90% return to sport following either conservative or surgical treatment. There is currently little data that directly compares the treatment options to establish an evidence-based "gold-standard" treatment plan. The data we present suggests that current treatment options are satisfactory but would benefit from future study.

Decreased Strength, Complication Rate and Higher Satisfaction in Conservative Treatment of Partial Distal Biceps Tendon Rupture Compared to Surgical Treatment: A Systematic Review.

Background: Treatment modalities for partial distal biceps tendon (DBT) ruptures include conservative management (immobilization, medication, and physical therapy) or surgery. Selecting treatment modality can present a challenge to both patient and provider. Hypothesis: It was hypothesized that patients undergoing surgical treatment for partial DBT rupture would have higher complications but better overall strength, range of motion (ROM), and patient satisfaction. Study Design: Systematic Review. Methods: A systematic review was performed in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Cochrane, Embase, and Medline databases were searched for studies published through May 2023. Studies were included if they examined patients with a partial DBT rupture who underwent treatment. Exclusion criteria were non-human studies, studies not in English, reviews, technical notes, letters to the editor, surgical technique papers, and studies reported in a prior review. Results: 13 studies consisting of 290 patients with a partial DBT tear were included in this review. 75% of the patients were male and the ages ranged from 23 - 75 years. The follow up for the patients ranged from 1 - 94 months. 55 patients underwent conservative treatment versus 256 patients underwent surgical treatment. Outcomes examined by the studies included pain, strength, range of motion (ROM), complications, patient reported outcomes (PROs), return to activity, and patient satisfaction. Conclusion: Treatment for partial DBT tear via surgery or conservative treatment both produce good clinical outcomes. There are similar outcomes between treatment options for pain and ROM. Conservative treatment had some poorer outcomes in terms of strength after treatment. Surgical treatment had more complications and a few patients with decreased satisfaction. Overall, both are viable treatment options, requiring a physician and patient discussion regarding the pros and cons of both options as a part of a shared decision-making process that incorporates patient priorities.