High Survival Rate and Satisfaction at more than 11 years of follow-up of Hip Arthroscopy for Femoroacetabular Impingement Syndrome: Impact of Preoperative Functional Scores, Osteoarthritis, and Chondrolabral Junction Damage on Failure Long-Term 72.6% Survival in Hip Arthroscopy.

PURPOSE: The purpose of the study was to investigate the survival and durability of clinical improvements following hip arthoscopy (HA) for femoroacetabular impingement syndrome (FAIS) at a minimum of 10-year follow-up. The primary objective was to determine the long-term survival, defined as: lack of conversion to total hip replacement (THR) or subsequent hip joint preservation surgery (HJPS). The secondary objective was to determine which preoperative factors were predictive of failure. METHODS: Data from patients who underwent HA for FAIS between March 2003 and May 2012 were collected and retrospectively reviewed. Patients who underwent evaluation at a minimum 10-year follow-up, assessed according to hip outcome score - activities of daily living (HOS-ADL) and sport-specific subscale (HOS-SSS), and non-arthritic hip score (NAHS) were included. Satisfaction ratings were collected. Statistical analysis assessed within-group differences and survival. RESULTS: 95 patients with an average follow-up of 11.8 years were included. Mean age was 39.5 ± 11.0 years. Overall THR conversion rate was 24.2%, with a mean time of 3.4 ± 3.2 years. 3.2% required HJPS revision at a mean 3.2 ± 3 years. Survivorship was 72.6% at ten years. 28 patients (73.6% and 75.6%) achieved the minimal clinically important difference (MCID) for HOS-ADL and HOS-SSS, while 33 (84.6%) for NAHS. Patient Acceptable Symptom State (PASS) was achieved by 42 (61.7%), 43 (65.1%) and 44 (64.7%) patients respectively. Comparative analysis between patients who preserved their hip and those who underwent HJPS revision or THR highlighted that Tönnis ≥ 2, chondrolabral junction damage, and lower preoperative scores are associated with failure. CONCLUSION: HA for FAIS demonstrated durable results, with an accepatable THR conversion rate and sustained clinical benefits. 91.3% of the patients who preserved their hip were satisfied. Tönnis 2, MRA signs of chondrolabral junction damage and lower preoperative functional status are strongly associated with failure.

In-Office Needle Arthroscopy (IONA): may a traditionally orthopedic procedure enter the portfolio of interventional radiology?

Arthroscopy has historically proved to allow accurate evaluation of the intra-articular structures of the knee, thanks the possibility of direct vision and palpation, and reduced perioperative morbidity. Over the last decade, the diagnostic role of arthroscopy has been further increased by its quite effective use in the treatment of the lesions. The recent and important advances in the technological-instrumental field have produced a safe visualization system used to pose a diagnosis in an outpatient setting, employing reduced-diameter arthroscopes (In-Office Needle Arthroscopy, IONA). The accuracy of MRI is unanimously recognized, but it shows some weaknesses when compared to arthroscopy that is the gold standard technique in case of chondral lesions, meniscal tears, or atypical synovial pathologies. In this short report, we propose the interventional musculoskeletal radiologist as possible performer of IONA, in specific settings, providing the patient, suffering from acute and chronic knee joint diseases, with a complete diagnostic approach, when MRI is not definitive.

Surgical interventions for external snapping hip syndrome.

PURPOSE: Snapping hip is a common clinical condition, characterized by an audible or palpable snap of the hip joint. When the snap is perceived at the lateral side of the hip, this condition is known as external snapping hip or lateral coxa saltans, which is usually asymptomatic. Snapping hip syndrome (SHS) refers to a painful snap, which is more common in athletes who require increased hip range of motion. The aim of this article is to review the most common endoscopic techniques for the treatment of ESHS, as well as their results and limitations. METHODS: This is a review of the current literature of endoscopic surgical procedures and of the results of the treatment of external snapping hip syndrome. RESULTS: The pathogenesis of SHS is mechanical. The initial treatment attempt is conservative, and usually provides good results. Patients who do not respond to conservative management are candidate for surgery. The endoscopic release of the ilio-tibial band or the endoscopic release of the femoral insertion of the gluteus maximum tendon is the most popular technique. CONCLUSION: Endoscopic techniques provide fewer complications compared to open surgery, a lower recurrence rate and good clinical outcomes. More comparative studies with a longer follow-up are required to adequate evaluate the full role of endoscopic techniques in periarticular hip surgery. LEVEL OF EVIDENCE: Level V.

A novel biplanar medial opening-wedge high tibial osteotomy: the Z-shaped technique. A case series at 7.2 years follow-up.

BACKGROUND: High tibial osteotomy (HTO) provides reliable and good long-term results, if performed with correct indications, but different techniques and types of fixation have been described. The purpose of this study is to present a novel modified biplanar medial opening-wedge (MOW) HTO technique where the osteotomies are performed in a Z-shaped fashion, and to present the medium-term clinical and radiographic results. MATERIALS AND METHODS: We present a case series of 75 patients (80 knees) with mean age of 45.8 years, affected by isolated medial knee osteoarthritis and symptomatic varus knee malalignment, who underwent novel biplanar Z-shaped MOWHTO. Clinical and radiological outcomes were collected, retrospectively before surgery and at median follow-up of 7.2 years (95% CI 5.6-9.2 months) after surgery. Clinical results and satisfaction were assessed by visual analog scale (VAS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Likert scale. Radiological assessment involved the evaluation of the medial proximal tibial angle (MPTA), tibial slope (TS), Caton-Deschamps index, and knee osteoarthritis grade according to Ahlbäck classification. Pre- and postoperative results were compared using the two-tailed t-test or Wilcoxon's test of independent samples for paired data or nonparametric analog. P < 0.05 was considered significant. RESULTS: At medium-term follow-up, Z-shaped MOWHTO showed a survival rate of 95 ± 1.7% with failure occurring in four knees due to symptom recurrence and osteoarthritis progression. No perioperative complications were observed (intraarticular fracture, delayed union or nonunion, and neurological injury). Mean bone healing time was 12 weeks. Clinical scores showed significant improvement at last follow-up and a good grade of satisfaction. MPTA increased significantly, while Caton-Deschamps index decreased significantly. No significant TS increase was found. CONCLUSIONS: Modified biplanar Z-shaped MOWHTO is a safe and reliable technique that offers satisfactory clinical and radiological medium-term outcomes with low knee arthroplasty conversion rate. The unique three-dimensional geometrical conformation potentially provides a favorable environment for bone healing, increased anteroposterior and rotational stability, and safer opening-wedge loading force application with low lateral hinge fracture risk. LEVEL OF EVIDENCE: Level IV, retrospective observational case series study. Trial registration The study protocol was approved by the Internal Review Board of our Institution (authorization number 54/2019, 20 November 2019).

Femoral neck fractures: Key points to consider for fixation or replacement a narrative review of recent literature.

INTRODUCTION: Femoral neck fractures (FNF) are frequent injuries and not rarely complicated by non-union, implant failure, and avascular necrosis. Some of these fractures represent a dilemma for trauma surgeons. Which fracture should be fixed? Which replaced with a prosthesis? How? The aim of this narrative review is to investigate the literature in order to provide the most updated and evidence-based knowledge about FNF' treatment. MATERIALS AND METHODS: A literature research has been performed to find the essential key points to consider when dealing with FNF and their treatment. The most representative papers and the new meta-analysis were matched with authors' experience to give a concise but comprehensive view of the problem. Timing, age, comorbidities, vascularization of the femoral head, displacement, instability, comminution of the fracture, bone quality, and surgeon experience seem to be the major topics to consider in the decision making. We then focus on the optimal fixation or replacement as suggested by the literature. RESULTS: Age is the main independent factor to consider. Timing seems essential in the elderly population to reduce mortality and important in the younger patients to reduce complications. Vascular supply should be always considered. Displacement, instability, and comminution of the fracture are negative prognostic factors for fixation as well as, theoretically, bone quality. In the elderly hip replacement is mostly indicated. A stable and solid fixation is mandatory to allow early mobilization. Sliding Hip Screws (SHS) seem preferable to cannulated screws for displaced/unstable (Pauwels II-III, posterior comminution) and basicervical fracture patterns or in smokers. There is a tendency toward Total Hip Arthroplasty (THA) also in the elderly if the patient is an indipendent ambulator without severe comorbidities. Dual mobility cups are gaining popularity in THA for FNF. CONCLUSIONS: FNF are frequent injuries and represent, in some cases, a dilemma for the trauma surgeon. Age, timing, comorbidities, bone quality, femoral head vascularization, fracture displacement, intrinsic instability, and comminution as surgeon experience should be carefully evaluated before surgery. A case-to-case analysis of the patient-related factors helps the surgeon to make the right choice and reduce the well-known complications.

Long-term Results of Arthroscopic Rotator Cuff Repair: Initial Tear Size Matters: A Prospective Study on Clinical and Radiological Results at a Minimum Follow-up of 10 Years.

BACKGROUND: Arthroscopic techniques are now considered the gold standard for treatment of most rotator cuff (RC) tears; however, no consensus exists on the maintenance of results over time, and long-term follow-up data have been reported for few cohorts of patients. PURPOSE: To present the long-term results associated with the arthroscopic treatment of RC tears and to evaluate associations between preoperative factors and RC integrity at final follow-up. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A total of 169 patients were contacted at least 10 years after arthroscopic RC surgery and were invited to a clinical evaluation. Information on preoperative conditions, tear size, subjective satisfaction, and functional scores was collected; isometric strength and range of motion were also measured; and each patient underwent an ultrasound examination to evaluate supraspinatus integrity and a shoulder radiograph to evaluate osteoarthritis. RESULTS: A total of 149 patients (88.2% of the eligible patients) were available for a complete telephonic interview, and 102 patients were available for the final evaluation. Ultrasound revealed an intact supraspinatus in 54 patients (53.47%). By adding the 10 patients who underwent revision surgery to the nonintact group, this percentage would drop to 48.65%. Tear size was associated with supraspinatus integrity in univariate analysis (hazard ratio, 3.04; 95% CI, 1.63-5.69; P = .001) and multivariable analysis (hazard ratio, 2.18; 95% CI, 1.03-4.62; P = .04). However, no significant differences were encountered in the subjective and functional scores collected, with the exception of the Constant-Murley Score, which was significantly higher in patients with smaller tears at the index procedure. Strength testing also revealed significantly superior abduction and flexion strength in this group, and radiographs showed a significantly higher acromion-humeral distance and lower grades of osteoarthritis. Patients with an intact supraspinatus at final follow-up showed superior results in all functional scores, greater satisfaction, superior abduction and flexion strength, higher acromion-humeral distance, and lower grades of osteoarthritis. CONCLUSION: RC tear size at the time of surgery significantly affects supraspinatus integrity at a minimum follow-up of 10 years. However, a larger tear is not associated with an inferior subjective result, although it negatively influences abduction and flexion strength, range of motion, and osteoarthritis progression. Intraoperative efforts to obtain a durable RC repair are encouraged, since supraspinatus integrity at final follow-up influences clinical and functional outcomes, patient satisfaction, and osteoarthritis progression.

Effect of a Collagen-Based Compound on Morpho-Functional Properties of Cultured Human Tenocytes.

BACKGROUND: Greater Trochanter Pain Syndrome (GTPS) is the main reason for recalcitrant lateral hip pain. Gluteus medius and minimus tendinopathy plays a key role in this setting. An injectable medical compound containing collagen type I (MD-Tissue, Guna) has been produced with the aim to counteract the physiological and pathological degeneration of tendons. In this study we aimed at characterizing the effect of this medical compound on cultured human gluteal tenocytes, focusing on the collagen turnover pathways, in order to understand how this medical compound could influence tendon biology and healing. METHODS: Tenocytes were obtained from gluteal tendon fragments collected in eight patients without any gluteal tendon pathology undergoing total hip replacement through an anterior approach. Cell proliferation and migration were investigated by growth curves and wound healing assay, respectively. The expression of genes and proteins involved in collagen turnover were analysed by real-time PCR, Slot blot and SDS-zymography. RESULTS: Our data show that tenocytes cultured on MD-Tissue, compared to controls, have increased proliferation rate and migration potential. MD-Tissue induced collagen type I (COL-I) secretion and mRNA levels of tissue inhibitor of matrix metalloproteinases (MMP)-1 (TIMP-1). Meanwhile, lysyl hydroxylase 2b and matrix metalloproteinases (MMP)-1 and -2, involved, respectively, in collagen maturation and degradation, were not affected. CONCLUSIONS: Considered as a whole, our results suggest that MD-Tissue could induce in tenocytes an anabolic phenotype by stimulating tenocyte proliferation and migration and COL-I synthesis, maturation, and secretion, thus favouring tendon repair. In particular, based on its effect on gluteal tenocytes, MD-Tissue could be effective in the discouraging treatment of GTPS. From now a rigorous clinical investigation is desirable to understand the real clinical potentials of this compound.