Balance training benefits chronic ankle instability with generalized joint hypermobility: a prospective cohort study.

BACKGROUND: Balance training is the first choice of treatment for chronic ankle instability (CAI). However, there is a lack of research on the effects of balance training in CAI with generalized joint hypermobility (GJH). This study is to compare the outcomes of balance training in CAI patients with and without GJH. METHODS: Forty CAI patients were assigned into the GJH group (Beighton ≥ 4, 20) and non-GJH group (Beighton < 4, 20) and they received same 3-month supervised balance training. Repeated measure ANOVA and independent t test were used to analyze self-reported questionnaires (Foot and ankle ability measure, FAAM), the number of patients experiencing ankle sprain, isokinetic muscle strength and postural control tests (Star excursion balance test, SEBT and Balance errors system, BES) before training, post-training immediately, and post-training 3 months, respectively. RESULTS: At baseline, no differences were found between groups with except for GJH group having poorer SEBT in the posteromedial direction (83.6 ± 10.1 vs 92.8 ± 12.3, %) and in the posterolateral direction (84.7 ± 11.7 vs 95.7 ± 8.7, %). Following the balance training, GJH group demonstrated lower re-sprain ratio (immediately after training, 11.1% vs 23.5%, 3 month after training, 16.7% vs 29.4%) than non-GJH group, as well as greater FAAM-S score, plantarflexion strength and dorsiflexion strength at post-training immediately and 3 months, and both groups improved similarly in the FAAM-A score, muscle strength and balance control (SEBT in the posterior-lateral and posterior-medial directions, and BES scores) compared with baseline. CONCLUSIONS: CAI patients with GJH gained equally even better postural stability and muscle strength after the balance training than the non-GJH patients. Balance training could still be an effective treatment for CAI patients with GJH before considering surgery. TRIAL REGISTRATION: ChiCTR1900023999, June 21st, 2019.

Arthroscopic Anatomical Double-Bundle Medial Patellofemoral Complex Reconstruction Improves Clinical Outcomes in Treating Recurrent Patellar Dislocation Despite Trochlear Dysplasia, Elevated Tibial Tubercle-Trochlear Groove Distance, and Patellar Alta.

PURPOSE: To evaluate the clinical outcomes of arthroscopically assisted double-bundle medial patellofemoral complex reconstruction (MPFC-R). METHODS: A retrospective review was carried out among adult patients who experienced at least 2 patellar dislocations and underwent primary arthroscopically assisted MPFC-R between January 2014 and November 2019. Dejour classification, tibial tubercle-trochlear groove (TT-TG) distance, and patellar height (with Insall-Salvati index) were measured. Pre- and postoperative patellar tilt were compared. Information on outcome scores, ability to return to sports, postoperative recurrent dislocations, and complications was recorded. RESULTS: A total of 42 MPFC-Rs in 39 patients were included. Mean age at surgery was 22.2 ± 7.6 years; 69.2% of patients were female. Mean follow-up was 47.3 ± 20.2 months. Seventy-four percent of cases had Dejour B (19.0%), C (33.3%), and D (21.4%) trochlear dysplasia; mean TT-TG distance was 19.6 ± 3.5 mm, and mean Insall-Salvati index was 1.21 ± 0.17. Mean patellar tilt decreased from 27.6 ± 11.6° to 9.4 ± 6.5° (P < .001). All patients had statistically significant (P < .001) improvement in mean International Knee Documentation Committee (IKDC) (44.9 ± 18.2 to 87.5 ± 6.9), Lysholm (61.4 ± 16.6 to 94.1 ± 6.4), Kujala (56.0 ± 16.8 to 92.9 ± 5.3), and Tegner score (2.7 ± 1.3 to 4.6 ± 1.4). The majority of patients (96.9%) returned to sports, with 90.3% returning to the same or greater level of activity. No postoperative dislocations or subluxations were reported. CONCLUSIONS: Arthroscopically assisted double-bundle MPFC-R is a promising procedure to treat recurrent patellar instability at 2- to 7-year mid-term follow-up, despite the presence of trochlear dysplasia, elevated TT-TG distance and patellar alta. The improvement of IKDC score exceeded the minimal clinically important difference in 95.2% patients, and 66.7% surpassed the patient acceptable symptomatic state based on postoperative IKDC score with no redislocations being reported at latest follow-up. LEVEL OF EVIDENCE: Level IV, case series, retrospective.

Comparison and analysis of skiing injuries at ski resorts in Chongli, China and Japan.

PURPOSE: The rapid development of winter sports requires investigation on injuries in Chongli district, Zhangjiakou city, one of the ski sites of the 2022 Winter Olympics. Careful evaluation is required to observe which injuries are caused under what circumstances, and then we can make corresponding preventive measures and recommendations based on the results. METHODS: In this retrospective study, the data of injury cases at ski resorts in China (Chongli district) and Japan were analyzed to provide a reference for the ongoing injury prevention at ski resorts. We collected data on injuries at Wanlong and Fulong ski resorts in Chongli district during the 2017-2018 and 2018-2019 ski seasons. We referred to the skiing injury report issued in February 2020 of a nationwide ski safety statistical service - Japan Ski Safety Association. The causes of injury and specific injured body parts were analyzed based on the data of Chinese and Japanese ski resorts. Statistical significance has been calculated using the Chi-square test. RESULTS: During the 2019-2020 ski season in Japanese ski resorts, the number of reported injuries per 10,000 skiers was 0.93, of which 457 (17.3%) were over 50 years old, accounting for a large proportion of injuries, meanwhile in Chongli ski resort, the injury rate of skiers aged 50 and over was 7.1%. The knee joint (23.7% at Wanlong ski resort and 28.4% in Japanese ski resorts) was the most injured body part among Chongli and Japanese skiers. Among snowboarders, shoulder joint injury (17.7% in Japanese ski resorts) was the most common, and injury on hands and fingers (16.3% in Wanlong ski resorts) was the most common. Head injury rates are similar in Chongli, China and Japanese ski resorts (8.2% and 8.7%, respectively). CONCLUSION: Our analysis demonstrated that injury data recorded among young skiers was higher in Chinese ski resorts (Chongli district) than that in Japanese ski resorts, and elderly skiers made up a larger proportion of skiing injuries in Japanese resorts. Thus, according to our research, the protection of knee joints, shoulder joints, and hands and fingers should be taken seriously. It should pay attention to the teaching of ski poles (for finger protection), and use protective devices such as knee pads, helmets, etc.

Arthroscopic modified Broström procedure achieves faster return to sports than open procedure for chronic ankle instability.

PURPOSE: To compare the clinical outcomes, rate of return to sports, postural control, and muscle strength between the arthroscopic and open modified Broström procedure for chronic lateral ankle instability (CLAI) patients. METHODS: From September 2018 to April 2019, 70 patients diagnosed with CLAI were prospectively included with arthroscopic modified Broström procedure (n = 36) and open modified Broström procedure (n = 34). They were evaluated at five time points (preoperation and 3 months, 6 months, 1 year and 2 years postoperatively). The main results examined the rate of return to sports, American Orthopaedic Foot and Ankle Society Score (AOFAS), Foot and Ankle Ability Measure (FAAM), visual analogue scale (VAS), centre of pressure (COP) excursion velocity, time to boundary (TTB), plantar pressure, isokinetic muscle strength and complications. RESULTS: Compared with the open group, the arthroscopic group demonstrated a significantly shorter period of return to the preinjury sport (13.2 ± 2.4 weeks vs. 18.7 ± 3.1 weeks, P = 0.023) and a higher early sport ratio (80.6 vs. 61.8%, P = 0.011) combined with better FAAM sports and AOFAS at 3 months and 6 months postoperatively and VAS at 3 months postoperatively. In addition, better anterior-posterior postural control stability, less time to peak force under lateral hindfoot and better dorsiflexion strength were shown in the arthroscopic group at 6 months postoperatively. No significant difference was found in clinical scores, posture control or muscle strength at the 1- or 2-year follow-up between the two groups. CONCLUSIONS: Shorter period and higher rates of return to sport activities and better clinical scores, posture control and muscle strength were achieved in the arthroscopic group at 6 months postoperatively, and no clinical differences were found between arthroscopic and open modified Broström procedure 1 year or 2 years postoperatively. Arthroscopic modified Broström procedure is a reliable procedure for CLAI injuries with the demand for fast exercise recovery. CLINICAL REGISTRATION: ChiCTR1900023999. LEVEL OF EVIDENCE: II.

Meniscus repair with simultaneous anterior cruciate ligament reconstruction: Clinical outcomes, failure rates and subsequent processing.

PURPOSE: To retrospectively analyze the clinical outcomes of meniscus repair with simultaneous anterior cruciate ligament (ACL) reconstruction and explore the causes of failure of meniscus repair. METHODS: From May 2013 to July 2018, the clinical data of 165 patients who were treated with meniscus surgery and simultaneous ACL reconstruction, including 69 cases of meniscus repair (repair group) and 96 cases of partial meniscectomy (partial meniscectomy group) were retrospectively analyzed. The exclusion criteria were as follows: (1) ACL rupture associated with fracture, collateral ligament injury, or complex ligament injury; (2) a history of knee surgery; or (3) a significant degree of osteoarthritis. The 69 patients in the repair group were divided into the non-failure group (62 cases) and the failure group (7 cases) depending on the repair effect. Postoperative outcomes of the repair group and the partial meniscectomy group were compared. General conditions and postoperative outcomes of the failure group and the non-failure group were compared. During the median follow-up period of 28 months (range, 4 - 65 months) after the second arthroscopy, postoperative outcomes of seven patients in the failure group were summarized. SPSS 25.0 statistical software was used for statistical analysis. A p value less than 0.05 was considered statistically significant. RESULTS: Seven patients in the failure group who underwent the second arthroscopy were followed up for (30 ± 17.4) months and their postoperative outcomes were summarized. Compared with the partial meniscectomy group, the International Knee Documentation Committee scores of patients in the repair group improved significantly (p = 0.031). Compared with the non-failure group, more patients in the failure group were younger than 24 years (p = 0.030). The median follow-up period was 39.5 months. All patients recovered well after subsequent partial meniscectomy and relieved clinical symptoms. Visual analog scale scores decreased significantly (p = 0.026), and the International Knee Documentation Committee and Lysholm scores improved significantly (p = 0.046 for both). CONCLUSION: The failure rate of meniscus repair in this study was 10.1% (7/69), all of which were medial meniscus tears. However, the surgical outcomes of ACL reconstruction were not affected, and there might be a role for graft protection. Therefore, meniscus retears can be successful treated by performing subsequent partial meniscectomy in patients with repair failure.

Secondary Effects of the Rupture and Reconstruction of the Interosseous Talocalcaneal Ligament on the Peritalar Joints.

BACKGROUND The interosseous talocalcaneal ligament (ITCL) is the main soft-tissue contributor to subtalar joint stability. The role of ITCL reconstruction in retaining this stability is minimally reported. Therefore, we conducted this study to investigate the effects of rupture and reconstruction of the ITCL on the subtalar and peritalar joints. MATERIAL AND METHODS This experimental study randomly divided 72 rabbits into 3 equal groups of 24 rabbits each. Group I underwent reconstruction surgery, group II underwent resection, and group III was the control group. The cartilages between the talocrural and calcaneocrural joints, and between the subtalar and talonavicular joints on both sides were assessed by gross observation, ink staining, histology, and immunohistochemistry at weeks 4, 8, 16, and 32, postoperatively. RESULTS In group II, the quantitative ink staining analysis revealed degeneration of the articular cartilages on the talonavicular joint (T=2.070, P=0.038) and the posterior subtalar joint (T=2.121, P=0.034) compared with the 2 sides of the same rabbit at 4 and 8 postoperative weeks. Comparing the operated sides of all the groups showed the posterior subtalar joints (Hc=9.563, P=0.008) and talonavicular joints (Hc=9.714, P=0.008) had an obvious difference at postoperative week 4; and in the calcaneocrural joints (Hc=6.750, P=0.034), it was noticed at postoperative week 8. Histology and immunohistochemistry findings confirm these observations. CONCLUSIONS An ITCL resection can lead to the progressive degeneration of the talonavicular and posterior subtalar joints, while an ITCL reconstruction can be beneficial in restoring the stability of these joints, preventing or postponing their degeneration, and protecting the articular cartilages.

Characteristics and predictors of muscle strength deficit in mechanical ankle instability.

PURPOSE: Muscle strength training is a common strategy for treating chronic ankle instability (CAI), but the effectiveness decreases for mechanical ankle instability (MAI) patients with initial severe ligament injuries. The purpose of this study was to investigate the characteristics and the potential predictors of muscle strength deficit in MAI patients, with a view to proposing a more targeted muscle strength training strategy. METHODS: A total of 220 MAI patients with confirmed initial lateral ankle ligament rupture and a postinjury duration of more than 6 months were included. All patients underwent a Biodex isokinetic examination of the ankle joints of both the affected and unaffected sides. Then, the associations between the limb symmetry index (LSI) (mean peak torque of the injury side divided by that of the healthy side) and the patients' sex, body mass index, postinjury duration, presence of intra-articular osteochondral lesions, presence of osteophytes and ligament injury pattern (i.e., isolated anterior talofibular ligament (ATFL) injury or combined with calcaneofibular ligament injury) were analysed. RESULTS: There was significantly weaker muscle strength on the affected side than on the unaffected side in all directions (p < 0.05). The LSI in plantar flexion was significantly lower than that in dorsiflexion at 60°/s (0.87 vs 0.98, p < 0.001). A lower LSI in eversion was significantly correlated with female sex (0.82 vs 0.94, p = 0.016) and isolated ATFL injury (0.86 vs 0.95, p = 0.012). No other factors were found to be associated with muscle strength deficits. CONCLUSION: MAI patients showed significant muscle strength deficits on the affected side, especially in plantar flexion. There were greater strength deficits in eversion in females and individuals with an isolated ATFL injury. Thus, a muscle strength training programme for MAI patients was proposed that focused more on plantar flexion training and eversion training for females and those with an isolated ATFL injury.

The effect of cyclic knee motion on the elongation of four-strand hamstring autograft in anterior cruciate ligament reconstruction: an in-situ pilot study.

BACKGROUND: Pretension of the viscoelastic graft by cyclic knee motion has been confirmed to decrease the graft creep and improve the outcome of anterior cruciate ligament (ACL) reconstruction. The purpose of the present study was to investigate the effect of cyclic knee motion on the elongation of the four-strand hamstring tendon autograft in situ and to explore the stable level cycle, in which the tendon length achieved a stable level. METHODS: The study was performed with 53 consecutive patients undergoing transtibial ACL reconstruction with four strand hamstring tendon from Aug 2013 to Apr 2015. 43 males and 10 females were included with mean age of 29 ± 10 years. The pretension of the tendons was operated by cyclical knee motion ranging from 0 to 110°after the femoral fixation with Endo-button. The tendon length after 10, 20, 30 and 40 cycles was measured respectively and compared by repeated measure ANOVA. Then multivariate logistic regression was used to investigate the effect of the patients' parameters (age, gender, height, body weight, tendon length, etc.) on the elongation of the graft and the stable level cycle. RESULTS: The mean lengthening of the graft at 10, 20, 30 and 40 times was 3.0 ± 1.4 mm, 4.3 ± 1.5 mm, 4.8 ± 1.7 mm and 4.8 ± 1.8 mm respectively. No significant correlation was found between the elongation and the patients' parameters. There was significant difference of the tendon length from 0 to 30 cycles (F = 264.8, df = 1.95, p<0.001). However, the tendon length achieved a stable level after 30 cycles and the median elongation from 30 cycles to 40 cycles was 0 (0-1) mm with no significant difference (F = 2.039, p = 0.159). The male and female tendon length achieved to a stable level at 20 cycles and 30 cycles respectively but with no significant difference (p = 0.074). CONCLUSIONS: The four-strand hamstring tendon was elongated after cyclic knee motion and the elongation achieved a stable level after 30 cycles for the transtibial technique. Both of the tendon elongation and the stable level cycle were not correlated with patients' gender, age, preoperative duration, graft diameter and length.

[Effect of anterior cruciate ligament rupture on hamstring: quadriceps ratio during isokinetic knee extension and flexion at 30 degrees of flexion].

OBJECTIVE: To evaluate the change in hamstring (H):quadriceps (Q) ratio following anterior cruciate ligament (ACL) rupture during isokinetic knee extension and flexion at 30 degrees of flexion which is important for knee dynamic function. METHODS: A study was performed in 25 male complete unilateral ACL ruptures. Isokinetic concentric and eccentric quadriceps and hamstring muscle tests in both the deficient knees and intact knees were performed at 60°/s, respectively. At 30 degrees of flexion, the average torque of quadriceps and hamstring, Qe:Qc ratios (ratios of eccentric quadriceps to concentric quadriceps muscle torque), He:Hc ratios (eccentric hamstring to concentric hamstring), Hc:Qc ratios (concentric hamstring to concentric quadriceps), He:Qc ratios (eccentric hamstring to concentric quadriceps), and Hc:Qe ratios (concentric hamstring to eccentric quadriceps) were calculated. Wilcoxon matched-pairs signed-ranks test was used. RESULTS: At 30 degrees of knee flexion, a significant reduction (P<0.05) in the average torque of quadriceps was observed at concentric and eccentric 60°/s produced by the deficient-side compared with the intact side. In addition, Hc:Qc, He:Qc, and Qe:Qc significantly increased on the ACL-deficient side. CONCLUSION: The change in H :Q ratio in the mode of isokinetic 60°/s at 30 degrees of knee flexion might therefore be a new tool to objectively document muscle function in ACL-deficient knee.

Prospective randomized comparison of anatomic single- and double-bundle anterior cruciate ligament reconstruction.

PURPOSE: To determine if anatomic double-bundle anterior cruciate ligament (ACL) reconstruction is superior to anatomic single-bundle reconstruction in restoring the stabilities and functions of the knee joint. METHODS: A prospective randomized clinical study was done to compare the results of 32 cases of anatomic single-bundle ACL reconstruction and 34 cases of anatomic double-bundle ACL reconstruction with average follow-up of 16.3 ± 3.1 months. Tunnel placements of all the cases were measured on 3D CT. Clinical results were collected after reconstruction; graft's appearance, meniscus status and cartilage state under arthroscopy were compared and analysed too. RESULTS: Tunnel placements, confirmed with 3D CT, were in the anatomic positions as described in literature both in SB and DB group. No differences were found between SB and DB groups in clinical outcome scores, pivot shift test and KT 1000 measurements (average side-to-side difference for anterior tibial translation was 0.7 mm in SB group and 1.0 mm in DB group). More than 70 % of the single-bundle graft and AM bundle graft in DB group appeared excellent, but only 44.1 % of PL bundle grafts in DB group were excellent and 11.8 % were in poor state. No new menisci tear was found either in SB or DB group, however, in DB group cartilage damages in medial patella-femoral joint occurred in 38.2 % cases. This rate was significantly higher than in the SB group which is only 9.3 %. CONCLUSION: Both single- and double-bundle anatomic ACL reconstruction can restore the knee's stability and functions very well. However, more incidences of poor PL status and medial patellar-femoral cartilage damage may occur in double-bundle ACL reconstruction.

Clinical features and prognosis of discoid medial meniscus.

PURPOSE: To evaluate the clinical manifestations and the outcome of surgical treatment of discoid medial meniscus. METHODS: Records of 13 patients with discoid medial meniscus were retrospectively reviewed for their epidemiology, clinical manifestations, operation methods, treatment outcome and radiographic characteristics. RESULTS: The 13 cases of discoid medial meniscal injury took up 1.5 ‰ of the overall meniscal injuries treated at our institute during the 44-year period. Patients presented with knee pain (13 patients), giving away (10 patients), swelling (9 patients) and snapping (9 patients). The most common physical signs were medial joint line tenderness (13 patients) and positive McMurray test (11 patients). Ten patients required total meniscectomy. There were excellent short-term results: the median Tegner score was 7, and the mean Lysholm score was 94.8 ± 2.4 at two-year follow-up. However, the long-term outcome was not as good with degenerative changes in the medial compartment of all the involved knees. CONCLUSION: The discoid medial meniscus is extremely rare. The clinical signs and symptoms of discoid medial meniscal injuries are similar to those of any other meniscal injury. No Wrisberg-ligament type abnormality was found. Meniscectomy for discoid medial meniscus produced promising short-term results and deteriorating long-term results with secondary degeneration of cartilage in the medial compartment. LEVEL OF EVIDENCE: Retrospective case series, Level IV.

[Measurement of bone tunnel width with computed tomography versus plain radiography after anterior cruciate ligament single-bundle reconstruction].

OBJECTIVE: To compare the measurements of bone tunnel width with computed tomography (CT) and plain radiography two years after anterior cruciate ligament single-bundle reconstruction. METHODS: Twenty patients underwent primary anterior cruciate ligament single-bundle reconstruction with hamstring autografts. There were 10 females and 10 males. Tibial and femoral bone tunnel widths were measured with CT and plain radiography at least two years post-operation. The average follow-up period was 26 months (range, 24-31). The tunnel measurements were taken at the widest point of tibial and femoral tunnels on sagittal and coronal CT and plain radiography perpendicularly to the longitudinal axis of tunnels. All data were statistically analyzed. RESULTS: The tibial tunnel width of one case decreased on CT while all others increased. The average tibial tunnel width on coronal plain radiography was 0.9 ± 0.6 mm (range, 0.3-2.2) larger than that on CT. And the average width on sagittal plain radiography was 0.9 ± 0.5 mm (range, 0.1-2.1) larger than that on CT. Both were statistically significant. All femoral tunnel widths increased, except in 2 cases. The average femoral tunnel widths on coronal and sagittal plain radiography were both significantly larger than those on CT. And the difference were 0.7 ± 0.6 mm (range, 0-1.7) and 0.9 ± 0.7 mm (range, 0.1-2.7) respectively. CONCLUSION: Bone tunnel measurements on plain radiography are significantly larger than those on CT after anterior cruciate ligament reconstruction.

[Comparison of single and double bundle isolate posterior cruciate ligament reconstruction with hamstring autograft].

OBJECTIVE: To determine if double bundle hamstring autograft posterior cruciate ligament (PCL) reconstruction could bring better outcomes than single bundle. METHODS: From June 2007 to June 2009, there were 22 subjects, including 16 male and 6 female patients with an average (37 ± 13) years old (16-54 years old) were reconstructed with single bundle PCL reconstruction (single bundle group), 24 subjects, including 18 male and 6 female patients with an average (37 ± 10) years old (17 - 52 years old) were reconstructed with double bundle PCL reconstruction (double bundle group). There were no differences between the two groups on patients' demographics and the duration from the injury to the operation (P > 0.05). Clinical outcomes, KT2000 and tunnel placements of all the patients were measured and analyzed. RESULTS: The two groups were retrospectively studied and compared with a (29 ± 9) months (24 - 55 months) follow-up. Operation duration of double bundle group was (92 ± 8) minutes which was significantly longer than the single bundle group (78 ± 13) minutes (t = 2.474, P < 0.05). IKDC, Lysholm and Tegner scores were all significantly improved at the last follow-up of both groups (single bundle group: t = 9.578, 13.115 and 8.165, P < 0.01; double bundle group: t = 4.390, 5.522 and 4.313, P < 0.05). Post operative KT2000 side-to-side difference of the double bundle group was significantly smaller than that of the single bundle group under maximum posterior force with the knee in 90° flexion ((1.5 ± 1.5) mm vs. (4.0 ± 2.9) mm, t = 2.538, P = 0.019). There were 66.7% of the patients of double bundle group were normal which was significantly higher than 31.8% of the single bundle group on the IKDC knee examination form (χ² = 5.576, P = 0.018). CONCLUSIONS: Single or double bundle PCL reconstruction could restore the knee's stability and function satisfied. There are no differences between two groups in clinical scores, but double group manifestes a better anterior-posterior stability.

Delayed Wound Healing After Achilles Tendon Suture: An Arthroscopic Solution.

This technical note describes an arthroscopic technique for treating delayed wound healing after Achilles tendon suture. Ankle arthroscopy is used to clean up the inflammatory tissues and foreign bodies that lead to delayed wound healing, with the advantages of simple postoperative care and low infection risk. This method may provide a less traumatic and low-risk option for the treatment of delayed wound healing after Achilles tendon surgery. The purpose of this technical note is to describe surgical procedures and related recommendations.

Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Chinese Patients: A Minimum 2-Year Follow-up Study.

Background: Most of the research data of arthroscopic treatment for femoroacetabular impingement syndrome (FAIS) have been generated from Western populations. Purpose: To report the minimum 2-year follow-up results after hip arthroscopy for FAIS in Chinese patients. Study Design: Case series; Level of evidence, 4. Methods: A total of 434 hips that underwent primary hip arthroscopy for FAIS between 2016 and 2018 were included. Excluded were patients with previous ipsilateral hip surgery, ipsilateral surgery during the follow-up time, preoperative lateral center-edge angle <25°, Tönnis grade ≥2, sacroiliac joint disease, or incomplete preoperative radiographs or medical records. Preoperative and postoperative patient-reported outcomes (PROs; modified Harris Hip Score [mHHS], Hip Outcome Score-Activities of Daily Living [HOS-ADL], international Hip Outcome Tool, 12-component form [iHOT-12], and visual analog scale [VAS] for pain) were compared with the 2-tailed paired Student t test. Radiographic measures, intraoperative findings, performed procedures, complications, and revision surgery were also reported. The Spearman rank correlation was used to determine the association between patient characteristics and improvement in PRO scores. Results: Included were 272 hips with a mean follow-up of 39.4 ± 8.1 months. Overall, 243 hips (89.3%) underwent labral repair. The PROs from baseline to final follow-up were 64.7 to 90.0 for HOS-ADL, 41.1 to 73.4 for iHOT-12, 62.8 to 89.6 for mHHS, and 6.1 to 1.7 for VAS (P < .001 for all). Younger age was correlated significantly with improved iHOT-12 scores (r = -0.230; P < .001), and shorter symptom duration was significantly correlated with improved HOS-ADL (r = -0.190; P = .003), iHOT-12 (r = -0.146; P = .024), and VAS pain (r = -0.143; P = .027) scores. The overall complication and revision hip arthroscopy rates were 4.0% and 3.3% respectively. At the final follow-up, no patient required conversion to total hip arthroplasty (THA). Conclusion: At 2 years after hip arthroscopy for FAIS, Chinese patients demonstrated statistically significant improvement in PROs, with a low rate of revision surgery or conversion to THA. Shorter symptom duration and younger age were significantly positively correlated with improvement in PROs.

The effectiveness and sustainability of supervised balance training in chronic ankle instability with grade III ligament injury: a one-year prospective study.

BACKGROUND: To determine the effectiveness and sustainability of supervised balance training in people with chronic ankle instability (CAI) with grade III ligament injury. METHODS: Twenty young adults (12 males and 8 females) diagnosed with CAI with grade III ligament injury underwent 3 months of supervised balance training. The self-reported functional questionnaire, plantar pressure (walking and single leg standing), and isokinetic ankle strength were consecutively evaluated at pre-training, 3 months, 6 months and one year. Paired T tests were used to explore changes in muscle strength and plantar pressures following the supervised balance training. According to whether the patient had sprain recurrence, the patients were divided into sprain recurrence group and control group. The risk factors of sprain recurrence were explored with univariate analysis and multivariable logistic regression. RESULTS: The self-reported functional scores, the plantar pressure distribution and the muscle strength showed significant immediate improvements after 3 months of supervised balance training. At 6 months post-training, peak force under 2nd metatarsal, time to peak force under the medial hindfoot, time to boundary measurements and dorsiflexion, and eversion strength were partly declined to the pre-training level. 16 patients (80%) resumed the daily life and sports without sprain recurrence during the follow-up. Four patients (20%) reported ankle sprain during the follow-up, and the sprain recurrence group showed significantly higher Beighton scores (p = 0.012) and weaker initial inversion strength (p = 0.022) than the control group. CONCLUSIONS: Three months' of supervised balance training could effectively improve postural control and muscle strength of CAI cases with grade III ligament injury, although these improvements would partially deceased over time. Additional strength exercises for dorsiflexion and eversion should be supplemented from 6 months. Higher Beighton score and initial inversion muscle strength weakness might increase the risk of sprain recurrence. TRIAL REGISTRATION: ChiCTR, ChiCTR1900023999, Registered 21 June 2019, https://www.chictr.org.cn/edit.aspx?pid=39984&htm=4.

The position of the posterolateral bundle femoral tunnel during arthroscopic double-bundle anterior cruciate ligament reconstruction: a cadaveric study.

PURPOSE: The purpose was to find a simple guideline to help establish accurate positioning of the posterolateral bundle (PLB) femoral bone tunnel during double-bundle anterior cruciate ligament reconstruction by measuring the distance between the center of the PLB femoral footprint to the shallow and the deep articular cartilage borders of the lateral wall of the intercondylar notch. METHODS: The femoral insertions of the anteromedial bundle and PLB of the anterior cruciate ligament were dissected in 22 male cadaveric knees, aged 25 to 45 years. By use of the intercondylar notch as the landmark, the distances between the center of the PLB femoral footprint and the shallow and the deep articular cartilage borders of the lateral wall of the intercondylar notch were measured with the knees flexed at 90°. The measured data (mean ± standard deviation) were evaluated and compared. RESULTS: The center of the PLB was positioned 8.60 ± 1.52 mm and 8.65 ± 1.54 mm from the shallow and the deep cartilage borders of the lateral wall of the intercondylar notch, respectively (P = .95). The distance between the center of the PLB footprint to the low cartilage border of the lateral intercondylar wall was 5.05 ± 0.76 mm. CONCLUSIONS: The findings suggest that the position of the center of the PLB femoral footprint is at the middle of the line joining the shallow and the deep borders of the femoral cartilage. CLINICAL RELEVANCE: Surgeons can use our results as a guideline and use the PLB footprint remnant as a reference at the same time to locate the femoral PLB tunnel in a simple, easy, and repeatable way.

[Preliminary report on lateral ulnar collateral ligament reconstruction or repair for treatment of posterolateral rotatory instability of elbow].

OBJECTIVE: To explore the preliminary results of lateral ulnar collateral ligament (LUCL) reconstruction or repair for posterolateral rotatory instability (PLRI) of elbow. METHODS: Between December 2006 and September 2010, 9 consecutive patients (9 elbows) undergoing surgical reconstruction or repair of LUCL for the treatment of elbow PLRI were studied. Surgical reconstruction of LUCL was performed with a tendon graft in 6 elbows and reattachment of LUCL to humerus in 3. The mean patient age was 28 years (range: 17 - 48). All patients had a previous history of elbow injury. Among them, 6 had a history of elbow dislocation. The average duration of symptoms was 10.7 months (range: 5 days - 30 months). The outcomes were graded with respects to objective and subjective stability, pain and range of motion as defined by Nestor. RESULTS: All patients were followed up. The mean follow-up period was 20 months (range: 4 - 49). Postoperatively, no patient had residual instability or a positive pivot shift test in elbow. Their outcomes were graded as excellent (n = 6), good (n = 2) and fair (n = 1). Subjective assessment revealed that all were satisfied with their surgical outcomes. CONCLUSION: An accurate recognition of PLRI of elbow is important for its appropriate management. Tendon graft is recommended for the reconstruction of LUCL. Surgical ligament reconstruction or repair is the preferred treatment option for restoring normal functions and elbow stability. Further studies are warranted because of a limited number of patients in the present study.

[Arthroscopic Bankart repair with suture anchors: results and risk factors of recurrence of instability].

OBJECTIVE: To evaluate retrospectively the results of arthroscopic Bankart repair using suture anchors for recurrent anterior shoulder dislocation with a minimum 1-year follow-up and to assess risk factors for recurrence. METHODS: From March 2002 to March 2010, 259 patients with recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with suture anchors. And 188 patients (50 athletes, 138 nonathletes) were available for follow-up. The mean age at the time of surgery was 25.3 years (range, 13 - 58 years). The mean follow-up was 38.6 months (range, 12 - 110 months). All of the 188 patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Society (ASES) shoulder score and Rowe score system. The rate of recurrent instability, range of motion, and risk factors for postoperative recurrence were evaluated. The ASES score was 72.6 preoperatively, and Rowe score was 33.4. RESULTS: The ASES scores improved significantly to 91.9 postoperatively (P < 0.001). The Rowe scores improved to 81.9 postoperatively (P < 0.001). And 152 patients were greatly satisfied with the results, 16 satisfied and 20 unsatisfied. The satisfactory rate was 89.4%. 24 patients (12.8%) suffered a recurrence after surgery, 14 athletes and 10 nonathletes. The recurrence rates were 28.0% in the athlete group and 7.2% in the nonathlete group. On average there was no significant loss of external rotation postoperatively (average, 75.2° preoperatively and 67.2° postoperatively). Patients under age 20, and athlete patients were associated with recurrence (P < 0.05). Other factors including length of time until surgery, type of anchors, number of anchors, presence of bony Bankart lesion, presence of a superior labrum, anterior and posterior tear, presence of posterior or inferior labrum lesion, presence of rotator cuff tear, ligamentous laxity and rotator interval closure did not influence the recurrence rate (P > 0.05). CONCLUSIONS: Arthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation. Identification of risk factors for recurrence allows for consideration of open stabilization. In the series, patients under age 20 and athlete patients are the most important risk factors for recurrence.

Extracapsular subcutaneous endoscopic treatment for refractory lateral epicondylalgia: technique, retrospective results, and prognostic factors.

BACKGROUND: The extracapsular subcutaneous endoscopic treatment is a new and under-researched approach to the endoscopic treatment of refractory lateral epicondylalgia. We aimed to introduce the techniques of the method and the mid-long term clinical effects. Furthermore, we intended to identify demographic and surgical-related factors correlated with prognosis of extracapsular subcutaneous method. METHODS: Patients with a minimum of 6 months of conservative treatment for lateral epicondylalgia were recruited from March 2012 to July 2018. Key surgical techniques including microfracture and endoscopic suture were used. Visual analog scale (VAS), Mayo Elbow Performance Score (MEPS), and Disability of Arm (Shoulder and Hand, DASH) scores were used to evaluate clinical results. Univariable analysis and multivariable logistic regression were used to analyze effects of demographic characteristics and treatment techniques on prognosis. RESULTS: Seventy-eight patients were treated with modified subcutaneous extracapsular surgery. No serious complications such as neurovascular injury or infection occurred. Postoperative VAS, MEPS, and DASH scores significantly improved (P<0.001). Age was associated with prognosis regarding VAS score (P=0.023). Older age was an independent relevant factor for poor prognosis regarding VAS score (OR =0.914, 95% CI: 0.842-0.993, P=0.033), and microfracture during surgery related to poor prognosis for DASH score (OR =0.056, 95% CI: 0.004-0.783, P=0.032). Plaster fixation was an independent factor related to good prognosis regarding DASH score (OR =11.156, 95% CI: 1.009-123.363, P=0.049). CONCLUSIONS: Extracapsular subcutaneous method of refractory lateral epicondylalgia has satisfactory and stable clinical results with high safety. Techniques of extracapsular method include debridement, microfracture, and tendon suture under endoscope. Young age, no microfracture, and postoperative plaster fixation were associated with good long-term prognosis.