Outcomes of bioabsorbable fixation in the treatment of osteochondral lesions of the knee in adolescent patients.

BACKGROUND: Bioabsorbable fixation in managing osteochondral lesions is increasing in popularity. The purpose was to report on outcomes using bioabsorbable fixation nails for osteochondral lesions of the knee in a pediatric and adolescent population. METHODS: A retrospective review of pediatric patients undergoing surgery with bioabsorbable fixation for knee osteochondral lesions was performed. Demographic, clinical, and surgical data was collected including symptom duration, lesion location, size, use of bone grafting, and number of implants. Return to activities was documented. Patients recommended revision surgery were compared to those who were not. RESULTS: 47 patients with median age 13.9 years and 25.5% female were included with median clinical follow-up of 47.3 weeks. 87.2% of patients were cleared for full activities. Four male patients (8.5%) were recommended revision surgery, of whom three underwent surgery including removal of loose bioabsorbable fixation. Demographic data did not differ between the group with successful versus failed primary surgery (p > 0.05). Symptom duration was more acute (<1 month) in the four recommended revision surgery (75% versus 9.3%, p = 0.008). The group recommended revision also had larger lesion size (median 5.4 cm2 versus 2 cm2, p = 0.04). Distal femoral physeal status, lesion location, necessity for bone grafting, and number of implants did not differ between groups. CONCLUSIONS: Adolescents had a high return to activity following bioabsorbable fixation for knee osteochondral lesions with 87.2% cleared for full return. In the 8.5% of patients who were deemed to have failed primary fixation, symptoms were more likely to be acute in nature with larger lesion sizes.

Younger Patients Are More Likely to Undergo Arthroscopic Meniscal Repair and Revision Meniscal Surgery in a Large Cross-Sectional Cohort.

PURPOSE: To evaluate recent trends in the treatment of meniscal tears with arthroscopic repair and debridement and to assess revision surgery within 2 years using a large cross-sectional database. METHODS: Patients with a diagnosis of meniscal tear from 2010 to 2017 were queried using the Mariner data set from PearlDiver. Patient demographic data were analyzed and tracked via International Classification of Diseases, Tenth Revision codes to investigate subsequent ipsilateral meniscal procedures and conversion to total knee arthroplasty within 2 years after index meniscal surgery. RESULTS: Of the 1,383,161 patients with a diagnosis of meniscal tear, 53.0% underwent surgical treatment. Surgical treatment consisted of meniscal debridement in 96.6% of patients and meniscal repair in 3.4%. The percentage of meniscal repairs increased from 2.7% to 4.4% over the 8-year period evaluated, whereas the percentage of meniscal debridement decreased from 97.3% to 95.6% (P < .0001). Younger patients were more likely to undergo meniscal repair (23% of those aged 10-19 years) than older patients (<1% of those aged ≥60 years). Among the 191,729 patients with International Classification of Diseases, Tenth Revision coding and 2-year follow-up, 10.6% of patients with index meniscal repair required a revision meniscal operation and 1.2% underwent conversion to arthroplasty. Subsequent meniscal procedures within 2 years after index meniscal repair included meniscal debridement in 81.6% of patients and revision repair in 18.4%. Patients who initially underwent meniscal debridement were less likely to undergo revision meniscal surgery (5.1%), but 4.7% required conversion to arthroplasty. Patients aged 10 to 19 years were most likely to undergo revision meniscal procedures after both index meniscal repair (12.8%) and meniscal debridement (8.8%). CONCLUSIONS: The rate of meniscal repair is increasing over time, with patients younger than 30 years most likely to undergo repair for a meniscal tear. Revision surgery for meniscal repair or debridement is more common in adolescents and patients who undergo an index meniscal repair. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Surgical Complications After Reverse Total Shoulder Arthroplasty and Total Shoulder Arthroplasty in the United States.

INTRODUCTION: Shoulder arthroplasty has become popular in the treatment of degenerative shoulder conditions in the United States. Shoulder arthroplasty usage has expanded to younger patients with increased surgical indications. METHODS: Reverse total shoulder arthroplasty (RTSA) and TSA patient records with the 1-year follow-up between 2015 and 2018 were queried from the nationwide PearlDiver Mariner Shoulder Database using International Classification of Disease-10 codes. Chi-square analysis was done to compare the demographics, surgical complications, and revision procedures between RTSA and TSA. RESULTS: From 2010 to 2018, there was an increase in shoulder arthroplasty cases because of RTSA. The overall surgical complication and revision procedure rates were 2.26% and 3.56% for RTSA, and 6.36% and 2.42% for TSA. Patients older than 50 years had statistically lower surgical complications after RTSA than TSA (2.25% versus 3.94%, P < 0.05), whereas no statistical difference between RTSA and TSA for patients younger than 50 years (10.06% versus 7.45%, P = 0.19). Male patients had higher RTSA complication rates (3.12% versus 2.28%, P < 0.05), whereas female patients had higher TSA (4.86% versus 5.92%, P < 0.05). History of tobacco, depression, and obesity were risk factors for higher complications. CONCLUSION: RTSA has become more commonly done than TSA in the United States. Older patients who underwent shoulder arthroplasty had lower surgical complication. TSA had a higher surgical complication rate than RTSA for patients older than 50 years.

Arthroscopic Glenoid Reconstruction With Iliac Crest Bone Block Transfer in the Beach Chair Position.

Large anterior glenoid defects pose significant challenges for shoulder stability. Arthroscopic glenoid reconstruction techniques using distal tibia allograft have been proposed as alternatives to open or arthroscopic Latarjet procedures but can increase operating room costs. Iliac crest bone block autograft is a cost-effective option without concern for the graft being undersized. Previous techniques have described arthroscopic glenoid reconstruction in the lateral position, but the beach chair position provides ease of access to both the iliac crest bone graft harvest and arthroscopic bone transfer, as well as facilitates possible conversion to an open approach if necessary. We present our surgical technique for performing an arthroscopic glenoid reconstruction with iliac crest autograft bone block transfer in the beach chair position.

A Systematic Approach to Arthroscopic Femoroplasty With Conservative Management of the Hip Capsule.

As hip arthroscopy has become increasingly used to treat femoroacetabular impingement, the importance of a complete femoroplasty to properly address cam impingement has been demonstrated. In doing so, different capsulotomy techniques have been described for gaining access to the hip joint as well as the peripheral compartment for cam resection. The periportal capsulotomy technique allows joint access while preserving the structural integrity of the iliofemoral ligament, obviating the need for capsular closure. We present a systematic approach and surgical technique for performing a complete arthroscopic femoroplasty while maintaining conservative hip capsule management through a periportal capsulotomy.

Comparing Patient-Reported Outcome Measurements for Femoroacetabular Impingement Syndrome.

BACKGROUND: There is much debate in the current literature with regard to the most appropriate hip-specific patient-reported outcome (PRO) measurement for assessment of femoroacetabular impingement syndrome (FAIS) and outcomes after surgical treatment. Despite systematic reviews assessing the validity of classic hip-specific PROs as well as newer PROs developed to target the young, active population, there lacks a direct comparison of the question content between each PRO. PURPOSE: To compare the question composition and degree of overlap between commonly used PROs for FAIS. STUDY DESIGN: Cross-sectional study. METHODS: A literature review yielded the 6 most commonly cited PROs for assessment of FAIS: modified Harris Hip Score (mHHS), Hip disability and Osteoarthritis Outcome Score (HOOS), Copenhagen Hip and Groin Outcome Score (HAGOS), Nonarthritic Hip Score (NAHS), international Hip Outcome Tool (iHOT-33), and Hip Outcome Score (HOS). Questions from each PRO were classified as identical, similar, or unique after pooled comparison, and the number of overlapping (identical or similar) questions between each PRO was determined. Questions were then classified into 5 domains: pain, symptoms, functional activities, sports, and quality of life, and variations in questions assessing each domain based on PRO were analyzed. RESULTS: Analysis of 164 total questions from 6 PROs showed that 87 questions (53%) were identical between 2 or more PROs, 39 (24%) were similar, and 38 (23%) were unique. The iHOT-33 contained the highest number of unique questions, with 13 of 33 (39.4%), while the HOOS contained the lowest number of unique questions, with 3 of 40 (7.5%). The HOOS, HAGOS, and iHOT-33 contained questions assessing all 5 domains of patient outcomes; the NAHS did not evaluate quality of life; the mHHS only assessed pain, symptoms, and functional activities; and the HOS only assessed functional activities and sports. CONCLUSION: As there is a high percentage of overlapping (identical or similar) questions between the most commonly used hip-specific PROs for FAIS, multiple tests may be appropriate for use. The iHOT-33, HOOS, and HAGOS are well suited for the general population as they offer comprehensive assessments across all domains, while the HOS provides added focus to sports/activity assessments for athletes and highly active patients.

High Rate of Overlapping Question Content Among Commonly Used Patient-Reported Outcome Measurements for Anterior Cruciate Ligament Injury.

PURPOSE: To precisely compare the questions and content between the most commonly cited knee-specific patient-reported outcome measurements (PROs) for anterior cruciate ligament (ACL) injury. METHODS: A literature review through Medline from November 1, 2018, to November 1, 2020, was performed to find the most cited knee-specific PROs for assessment of ACL injuries. Each question was then classified as 1) identical, similar, or unique; 2) pertaining to 1 of 6 domains (pain, symptoms, functional activities, occupational activities, sports/recreation, and quality of life). The PROs were then compared to each other to assess question overlap and domain coverage. RESULTS: A total of 133 questions were analyzed from the seven most common PROs: International Knee Documentation Committee (IKDC) form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Knee Scoring Scale, Tegner Activity Scale, Marx Scale, Knee Outcome Survey (KOS), and Cincinnati Knee Rating System (CKRS). The total distribution of identical (31.6%), similar (31.6%), and unique (36.8%) questions was found to be relatively even. However, this distribution varied within each PRO. KOS and Lysholm had the highest percentages of identical questions (64% and 62.5%, respectively). KOOS had the highest number of unique questions (26/42, 61.9%), while Tegner held the highest percentage (11/16, 68.8%). Sports/recreation was the only domain assessed by all PROs. CONCLUSION: Nearly two-thirds of questions overlap between the commonly used PROs for ACL injury. Although sports/recreation is assessed by all PROs, each has its own pattern of coverage across this and other domains. LEVEL OF EVIDENCE: IV, cross-sectional study.

Functional Outcomes of Patella Fractures Treated With Anterior Plate Osteosynthesis at One Year.

OBJECTIVES: To evaluate the functional outcomes of patients with displaced patellar fractures treated with anterior plate constructs. DESIGN: Prospective cohort and retrospective clinical and radiographic assessment. SETTING: Level I Trauma Center. PATIENTS/PARTICIPANTS: Between 2014 and 2018, 18 patients who underwent operative intervention for an isolated, displaced patella fracture (OTA/AO 34C1-3) with a minimum of 1-year follow-up agreed to participate in the study. The mean follow-up was 19.5 ± 6.0 months. INTERVENTION: Patients were treated with 2.4 or 2.7-mm plates and supplemental screws or cerclage wires. MAIN OUTCOME MEASUREMENTS: Patients were evaluated with the Short Form-36 Survey and the Knee Injury and Osteoarthritis Outcome Scores and asked about symptomatic implants. The range of motion was assessed by goniometer. RESULTS: The cohort had no wound complications, infections, nonunion, loss of reduction, or implant failure. Active knee flexion was 131 ± 7 degrees. Five patients (28%) endorsed implant irritation. Only one patient (5.5%) underwent implant removal, which consisted of transverse screw removal alone. Twelve of the 14 patients (86%), who were previously employed, returned to work at 10 ± 7 weeks. All Knee Injury and Osteoarthritis Outcome Scores subscale scores and the Short Form-36 Survey scores for physical functioning, limitations due to physical health, limitations due to mental health, and social functioning were significantly lower than reference population norms (P < 0.05). CONCLUSIONS: Anterior plating provides reliable fixation for displaced patellar fractures and results in a low incidence of implant irritation. However, patients who had anterior fixation for displaced patella fractures continue to exhibit functional deficits at 1-year postoperatively. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.