Microfracture of Acetabular Chondral Lesions Is Not Superior to Other Cartilage Repair Techniques in Patients With Femoroacetabular Impingement Syndrome: A Systematic Review.

PURPOSE: To perform a systematic review to compare clinical outcomes of hip arthroscopy patients undergoing microfracture (MFx) versus other cartilage repair procedures for chondral lesions of the acetabulum. METHODS: A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines by searching PubMed, the Cochrane Library, and Embase to identify comparative studies that directly compared outcomes between MFx and other cartilage repair procedures for full-thickness chondral lesions of the acetabulum identified during hip arthroscopy. The search phrase used was: hip AND arthroscopy AND microfracture. Patients were evaluated based on reoperation rates and patient-reported outcomes. RESULTS: Six studies (all Level III evidence) met inclusion criteria, including a total of 202 patients undergoing microfracture (group A) and 327 patients undergoing another cartilage repair procedure (group B). Mean patient age ranged from 35.0 to 45.0 years. Mean follow-up time ranged from 12.0 to 72.0 months. Significantly better patient-reported outcomes (PROs) were found in patients undergoing treatment with bone marrow aspirate concentrate, microfragmented adipose tissue concentrate, autologous matrix-induced chondrogenesis, and a combination of autologous matrix-induced chondrogenesis and bone marrow aspirate concentrate compared with MFx. No studies found significantly better postoperative PROs in group A. The reoperation rate ranged from 0% to 34.6% in group A and 0% to 15.9% in group B. Three of 5 studies reporting on reoperation rate found a significantly greater reoperation rate in group A, with no difference in the other 2 studies. CONCLUSIONS: The literature on MFx of acetabular chondral lesions is limited and heterogeneous. Based on the available data, MFx alone results in a greater or equivalent reoperation rate and inferior or equivalent PROs compared with other cartilage repair procedures for acetabular chondral lesions in patients with femoroacetabular impingement syndrome. LEVEL OF EVIDENCE: Level III, systematic review of level III studies.

Rotator Cuff Repair With Patch Augmentation Is Associated With Lower Retear Rates for Large Tears: A Systematic Review of Randomized Controlled Trials.

PURPOSE: To perform a systematic review of randomized controlled trials comparing clinical outcomes of rotator cuff repair with and without patch augmentation. METHODS: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching PubMed, the Cochrane Library, and Embase to identify randomized controlled trials that directly compared outcomes between rotator cuff repair (RCR) with versus without patch augmentation. Patients were evaluated based on retear rate, histological outcomes, radiological outcomes, and patient-reported outcomes (Constant score; American Shoulder and Elbow Surgeons [ASES] score; University of California-Los Angeles shoulder scale; Simple Shoulder Test; EuroQol-visual analog scale; Disabilities of the Arm, Shoulder and Hand score; and PENN shoulder score questionnaire). RESULTS: Six studies (1 level I, 5 level II) met inclusion criteria, including 188 patients undergoing RCR alone (Control) and 193 patients undergoing RCR with patch augmentation (Patch). Patient age ranged from 56.0 to 68.0 years. The mean follow-up time ranged from 14.0 to 68.4 months. The average body mass index ranged from 24.4 to 29.4, and the overall percentage of males ranged from 32.5% to 82.3%. Three studies found significantly decreased retear rates with patch augmentation. The retear rate ranged from 34.0% to 65.4% in the Control group and 9.1% to 52.9% in the Patch group. One study found a significant difference for the Constant score favoring the Patch group. Two studies found a significant difference for the ASES score favoring the Patch group. One study found significantly better results with patch augmentation in terms of repaired tendon thickness and footprint coverage, based on magnetic resonance imaging. CONCLUSIONS: Patch augmentation of rotator cuff repairs may be associated with lower retear rates for large tears. There is limited evidence to suggest that patch augmentation is associated with improved patient-reported outcomes. LEVEL OF EVIDENCE: Level II, systematic review of level I and II studies.

Systematic Comparison of Ligament Reconstruction With Tendon Interposition and Suture-Button Suspensionplasty for Trapeziometacarpal Osteoarthritis.

Ligament reconstruction tendon interposition (LRTI) and suture-button suspensionplasty (SBS) are both common treatment options for trapeziometacarpal osteoarthritis. The primary purpose of this systematic review was to compare the subjective improvement in patient-reported outcomes in regard to disability for patients undergoing LRTI and SBS for trapeziometacarpal osteoarthritis. A secondary purpose was to compare the subjective improvement, objective outcome scores, and complication rates following both procedures. We performed a systematic review using PubMed, Scopus, and Embase to compare the clinical outcomes of LRTI and SBS. Inclusion criteria were level I-IV evidence articles reporting postoperative Disabilities of the Arm, Shoulder, and Hand (DASH) or QuickDASH scores. Study methodological quality, risk of bias, and recommendation strength were assessed. This systematic review included 31 studies for final analysis with 1289 thumbs undergoing LRTI (25 studies) and 113 thumbs undergoing SBS (6 studies). Both procedures demonstrated similar improvement in DASH and/or QuickDASH scores, while key pinch and grip strength inconsistently improved following both procedures. Complication rate was similar between the 2 procedures; LRTI 12% and SBS 13%. Although both LRTI and SBS seem to provide improved short-term patient-reported functional improvement and objective strength, there was significant heterogeneity within the included studies, and those studies discussing SBS were of lower quality evidence than those of LRTI. Thus, to truly delineate whether a difference exists between these 2 techniques for the treatment of first carpometacarpal joint arthritis, larger prospectively designed studies of high-quality evidence are necessary.

Patient perception of medial patellofemoral ligament reconstruction on Instagram.

To date, there is limited social media evaluation of patients after medial patellofemoral ligament (MPFL) reconstruction and analysis of their perceived surgical outcome. The purpose of this study was to examine patient perceived outcomes after MPFL reconstruction via social media analysis on Instagram. A total of 486 posts containing "#MPFL" were included in the assessment. The tone of the post was examined in relation to demographic variables and the content of the post. When comparing posts containing positive vs. negative tone, those referencing rehabilitation (P < 0.0001) and activities of daily living (ADLs) (P = 0.0002) were more likely to be positive. Posts referencing surgical incision or scar (P = 0.02) or postoperative instability/dislocation (P < 0.0001) were more likely to have a negative tone. Multivariable logistic regression identified references to incision/scar (odds ratio [OR]: 0.446, P = 0.0264) and instability/dislocation (OR: 0.071, P < 0.0001) as strong negative predictors of positive tone. However, referencing rehabilitation (OR: 2.464, P = 0.0091) or ADLs (OR: 2.251, P = 0.0187) substantially increased the likelihood of a positive post tone. In conclusion, positive tone was associated with improved rehabilitation and ability to perform ADLs postoperatively. In contrast, negative tone was associated with dissatisfaction with the scar/incision, as well as postoperative patellar instability.

Instagram and Anterior Cervical Discectomy and Fusion Surgery: An Analysis of Social Media and Its Relationship to Patient Perception of Surgery.

BACKGROUND: Multiple studies have utilized social media to evaluate patient-perceived outcomes after surgery. To the authors knowledge, no published studies have evaluated patient-perceived outcomes after ACDF surgery through social media analysis. OBJECTIVE: To analyze posts shared on Instagram referencing anterior cervical discectomy and fusion (ACDF) for tone, gender, activities of daily living (ADLs), rehabilitation, incision, pain, neurological injury, complications, and content of post. STUDY DESIGN: Cross-sectional study. METHODS: Public instragram posts were isolated and evaluated using the hashtag "#ACDF." Each individual post was analyzed by the authors for the variables previously listed. In total, 529 posts were included for investigation and analysis of patient perception of ACDF through social media. RESULTS: Of all included posts, approximately 95% of posts had a positive tone. There was statistical significance between positive tone and ADLs (P = 0.0379) and rehabilitation (P = 0.0118), as well as negative tone with persistent pain (P ≤ 0.001), incision/scar (P = .0143), and surgical complications (need for reoperation/nonunion/infection) (P = 0.0259). CONCLUSIONS: Reported outcomes after ACDF have not been evaluated through social media avenues. This analysis of patients sharing their experiences on social media after ACDF demonstrates that returning to ADL, rehabilitation, pain, and incisions are of the utmost importance to patients.

Sex-related Anthropometrics in a Lower-Body Mobility Assessment Among Professional Soccer Athletes.

Background: The functional movement screen (FMS™) and Y-balance test (YBT) are commonly used to evaluate mobility in athletes. Purpose: The primary aim of this investigation was to determine the relationship between demographic and anthropometric factors such as sex, body composition, and skeletal dimension and scoring on YBT and FMS™ in male and female professional soccer athletes. Study Design: Cross Sectional. Methods: During pre-season assessments, athletes from two professional soccer clubs were recruited and underwent body composition and skeletal dimension analysis via dual-energy X-ray absorptiometry (DEXA) scans. Balance and mobility were assessed using the YBT and FMS™. A two-tailed t-test was used to compare YBT between sexes. Chi-square was used for sex comparisons of FMS™ scores. Correlation analysis was used to determine if body composition and/or skeletal dimensions correlated with YBT or FMS™ measures. Type-I error; α=0.05. Results: 40 Participants were successfully recruited: (24 males: 27±5yr, 79±9kg; |16 females: 25±3yr, 63±4kg). YBT: Correlations were found between anterior reach and height (r=-0.36), total lean mass (LM)(r=-0.39), and trunk LM(r=-0.39) as well as between posterolateral reach and pelvic width (PW)(r=0.42), femur length (r=0.44), and tibia length (r=0.51)(all p<0.05). FMS™: The deep squat score was correlated with height(r=-0.40), PW(r=0.40), LM(r=-0.43), and trunk LM (r =-0.40)(p<0.05). Inline lunge scores were correlated with height(r=-0.63), PW(r=0.60), LM(r=-0.77), trunk LM(r=-0.73), and leg LM(r=0.70)(all p<0.05). Straight leg raise scores were correlated with PW (r=0.45, p<0.05). Females scored higher for the three lower body FMS™ measures where correlations were observed (p<0.05). Conclusions: Lower body FMS™ scores differ between male and female professional soccer athletes and are related to anthropometric factors that may influence screening and outcomes for the FMS™ and YBT, respectively. Thus, these anatomical factors likely need to be taken into account when assessing baseline performance and risk of injury to improve screening efficacy. Level of Evidence: Level 3b.

Return-to-Sport Time and Postoperative Performance in MLB Players Undergoing Wrist Arthroscopy.

BACKGROUND: Wrist injuries are common in sports and can result in prolonged time missed from playing. This study aimed to determine in Major League Baseball-players after arthroscopic wrist surgery the return-to-sport (RTS) rate, postoperative career length, and changes in performance compared with preoperative statistics and matched controls. METHODS: Major League Baseball players who underwent arthroscopic wrist surgery from 1990 to 2019 were identified. Demographic and performance data were collected for each player, and matched controls were identified. Comparisons were made via paired samples Student t tests. RESULTS: Twenty-six players (27 surgeries) were identified. The average age of included players was 28.9 ± 2.9 years with an average professional experience of 5.2 ± 3.4 years. Eighty-four percent of players returned to sport, with an average RTS time of 5.0 ± 2.7 months. A statistically significant (P < .05) decrease was seen in preoperative and postoperative runs scored per season (95.6 ± 91.3 vs 41.0 ± 29.5), batting average (BA) (0.270 ± 0.024 vs 0.240 ± 0.036), and average wins above replacement (WAR) (1.5 ± 1.1 vs 0.8 ± 0.9). CONCLUSION: Major League Baseball players who underwent arthroscopic wrist surgery had an RTS rate of 84% at a mean time of 5.0 months. There was no significant difference in performance statistics between cases postoperatively and matched controls overall, with some differences in performance found when categorized by position. However, a significant decrease in performance among case players was observed between preoperative and postoperative performance, including runs per season, BA, and WAR.

The Role of N-acetylcysteine in the Treatment of Accidental Submersion of the Hands in Liquid Nitrogen.

N-acetylcysteine (NAC) is a compound with numerous uses, especially in cases which require prevention of cellular damage. To the authors' knowledge, no reports of NAC as treatment for liquid nitrogen (LN2) injuries currently exist. We present a case in which a 40-year-old woman accidentally submerged her hands in LN2 while working in a lab. The patient was treated with NAC, antibiotics, and wound care. Six months post-injury, the patient had full range of motion, full sensation, full function, and no pain. Therefore, NAC, in combination with dressing changes and antibiotics, can be used to successfully treat patients with LN2 burns.

Technique for Intraoperative Neuromonitoring During Periacetabular Osteotomy After Concomitant Hip Arthroscopy.

Intraoperative neurologic injury during periacetabular osteotomy (PAO) for the treatment of symptomatic acetabular dysplasia is a major complication that can lead to permanent disability and limit the benefit of correcting the acetabular dysplasia. Current literature reflects the evolution of hip-preservation surgery for symptomatic acetabular dysplasia to include hip arthroscopy to address the intra-articular abnormalities, including labral tears, chondral lesions, and femoral cam morphology. A growing number of young hip surgeons and surgeon teams are subscribing to this approach and now performing concomitant hip arthroscopy and PAO. The value of intraoperative neuromonitoring cannot be understated, both in terms of surgeon confidence as well as patient safety, particularly during the learning curve of PAO, with or without hip arthroscopy. We present our current technique for the application of neuromonitoring to allow free mobility of the operative leg and continuous monitoring during PAO. This reproducible technique allows the use of nonsterile neuromonitoring to be used through a sterile conduit, positioned to allow free mobility of the operative extremity and performance of the PAO. We believe this technique provides additional safety benefit and increases awareness regarding neurologic compromise, particularly for the low-volume PAO surgeon or during the procedural learning curve.