Lateral Ulnar Collateral Ligament Reconstruction for Posterolateral Rotatory Instability After Failed Common Extensor Origin Release: Outcomes at Minimum 2-Year Follow-up.

BACKGROUND: In patients with chronic lateral epicondylitis who have failed nonoperative treatment, open or percutaneous release of the common extensor origin (CEO) without subsequent reconstruction tends to result in good clinical outcomes. However, surgery can lead to iatrogenic injuries of the lateral collateral ligamentous complex, causing posterolateral rotatory instability (PLRI). PURPOSE: To determine the clinical outcomes of lateral ulnar collateral ligament (LUCL) reconstruction using a triceps tendon graft after failed open CEO surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 103, patients underwent revision surgery at a single institution because of PLRI after failed open release of the CEO (Hohmann procedure) between January 2007 and October 2016. The primary surgery had been performed at other institutions in all cases. Of these patients, 72 were available for follow-up (49 by clinical examination, 23 by telephone interview). Standardized clinical examination; Mayo Elbow Performance Score (MEPS); 11-item version of the Disabilities of the Arm, Shoulder and Hand Score (QuickDASH); subjective elbow value (SEV); and patient satisfaction were assessed at least 2 years after LUCL reconstruction. RESULTS: The mean age of patients in the study was 46.9 years (range, 21-74 years), and the mean follow-up was 2.8 years after revision surgery. The mean MEPS was 78.9, and the mean QuickDASH score reached 20.4. The mean SEV was 78.6%, and 75% of the patients rated the surgery as good to excellent. Complications were detected in 14% of the patients, and 9 needed revision surgery, primarily owing to graft failure with recurrent instability (n = 5). CONCLUSION: LUCL reconstruction in patients with PLRI after release of the CEO can restore elbow stability and achieve high patient satisfaction. However, outcome scores and revision rates in this cohort were inferior to published outcomes of primary LUCL reconstruction for treatment of noniatrogenic or traumatic PLRI.

Is Hip Arthroscopy an Adequate Therapy for the Borderline Dysplastic Hip? Correlation Between Radiologic Findings and Clinical Outcomes.

BACKGROUND: Recent studies have shown that assessment of the lateral center-edge angle (LCEA) between 18° and 25° is not sufficient to adequately classify mildly dysplastic hips and that further radiological features should be considered. However, no correlation between different morphologic features and clinical outcomes has been investigated so far. PURPOSE: To analyze the clinical outcomes of patients with different subtypes of borderline dysplastic hips who underwent arthroscopic surgery. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We examined patients with an LCEA between 18° and 25° who underwent arthroscopic treatment for femoroacetabular impingement syndrome between January 2015 and December 2016. A hierarchical cluster analysis was performed to identify hip morphologic subtypes according to radiographic parameters, including the LCEA, femoro-epiphyseal acetabular roof (FEAR) index, anterior and posterior wall indices (AWI and PWI), Tönnis angle, alpha angle, and femoral neck-shaft angle. In addition, the International Hip Outcome Tool 12 (iHOT-12) and a visual analog scale (VAS) for pain were applied preoperatively and at follow-up, and the results were compared among the different clusters. Previously reported minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) values were used to determine clinically significant improvements. RESULTS: A total of 40 patients were identified. Of these, 36 patients were available for evaluation at a mean follow-up of 43.8 months. In total, 4 sex-independent clusters with different morphologic patterns of the hip were identified: cluster 1, unstable anterolateral deficiency (FEAR index >2°, AWI <0.35); cluster 2, stable anterolateral deficiency (FEAR index <2°, AWI <0.35); cluster 3, stable lateral deficiency (FEAR index >2°, normal AWI and PWI); and cluster 4, stable posterolateral deficiency (FEAR index <2°, PWI <0.85). At follow-up, clusters 1, 2, and 3 showed significantly improved iHOT-12 (P < .0001) and VAS pain (P < .0001) scores, and cluster 4 showed no significant improvements. The MCID of 15.2 points was achieved by all patients in clusters 2 and 3, by 63% of patients in cluster 1, and by 23% of patients in cluster 4. Clusters 2 and 3 differed significantly from clusters 1 and 4 (P = .02). A postoperative PASS score of 60 was achieved by all patients in cluster 3, by 86% of patients in cluster 2, by 63% of patients in cluster 1, and by 20% of patients in cluster 4. The differences between the groups were statistically significant (P = .01). CONCLUSION: Arthroscopic surgery yielded good results in the treatment of stable borderline hip dysplasia with anterolateral and lateral deficiency. In contrast, borderline hip dysplasia with acetabular retroversion showed no improvements after arthroscopic therapy. This study underlines the need for an accurate analysis of all possible radiological signs to adequately classify borderline dysplastic hips.

Translation of the Mayo Elbow Performance Score (MEPS) into German (MEPS-G). / Die Übertragung des Mayo Elbow Performance Score (MEPS) ins Deutsche (MEPS-G).

BACKGROUND: The Mayo Elbow Performance Score is a clinical assessment to rate the performance of the elbow from a medical and/or therapeutic perspective. It is simple and efficient to operate and therefore frequently used in research as well as in clinics. However, an adequate translation of the MEPS into the German language and a verification of the quality criteria for the use in the German health system are currently lacking. GOAL OF THE STUDY: The aim of this study is to translate the MEPS and to review the applicability of the German version (MEPS-G) in Germany. MATERIALS AND METHODS: The translation was undertaken on the basis of a guideline for cultural adaptation. Two independent translations were created, combined and translated back into English by two native speakers. The back translations were reviewed and the German version was amended accordingly. The suitability of the final questionnaire was verified in a pretest with 73 participants. RESULTS: The MEPS was converted into the German version MEPS-G and was tested. Apart from minor adjustments, the questionnaire was translated into German without difficulty. The time to complete the assessment was on average 2.5 min (± 1.6). CONCLUSION: First analyses of the psychometric properties of the German MEPS showed identical values as the English version. The detailed quality criteria will be reviewed in a subsequent study.

Long-term outcome after all inside meniscal repair using the FasT-Fix system.

PURPOSE: Meniscal surgery is one of the most performed orthopaedic procedures. Because of its chondroprotective properties, meniscal repair should be attempted whenever possible. Several techniques are described in literature, e.g. all-inside repair using FasT-Fix System from Smith & Nephew. The aim of this study was to evaluate the outcome at a minimum of 12 years following meniscal repair using FasT-Fix System. MATERIALS AND METHODS: Patients who underwent meniscal repair using FasT-Fix System in the time from 2001 to 2003 were analyzed. We included isolated meniscal tears and combined tears with a concomitant ACL rupture. A median 12-year follow-up was conducted in 2015. Failure was defined as a new surgical procedure to the same meniscus. Moreover, functional outcome was evaluated using the KOOS and tegner activity score (TAS). RESULTS: At follow-up 27% had undergone further surgery to the repaired meniscus. There was no significant difference between isolated and combined group (p = 0.582). The failure rate was significantly higher in females (female 48% versus male 15%; p = 0.005). Comparing sports there was a significantly higher failure rate within soccer and indoor sports group (p = 0.002).Comparing isolated and combined injury groups there was no difference in the TAS (p > 0.05). Only 1 item of KOOS showed no significant difference: 95.33 versus 94.48 for daily life activities (p > 0.05). The other items showed significant differences.49 out of 51 patients with combined injuries suffered an additional ACL rupture. There was no significant difference regarding the meniscal repair failure rate when comparing the groups of simultaneous and delayed ACL repair (p = 0.521). CONCLUSIONS: At 12 years' follow-up 73% had a successful surgery. KOOS was significantly better within isolated meniscus tears. Both groups showed no difference in the TAS. There were no differences regarding failure rate in the comparison of simultaneous or delayed ACL-reconstruction.