Socioeconomic Factors Including Patient Income, Education Level, and Health Insurance Influence Postoperative Secondary Surgery and Hospitalization Rates Following Hip Arthroscopy.

PURPOSE: To evaluate a large cross-sectional sample of patients utilizing administrative database records and analyze the effects of income, insurance type, and education level on outcomes after hip arthroscopy, including 2-year revision surgery, conversion to total hip arthroplasty (THA), and 90-day hospitalizations. METHODS: Current Procedural Terminology codes were used to query the PearlDiver Mariner database from October 2015 to January 2020 for patients undergoing hip arthroscopy with a minimum 2-year follow-up. Patients were categorized by mean family income in their zip code of residence (MFIR), health insurance type, and educational attainment in their zip code of residence (EAR). Two-year revision arthroscopy, conversion to THA, and 90-day hospital readmissions or emergency department (ED) visits were analyzed along socioeconomic strata. RESULTS: Multivariate analysis of 33,326 patients revealed that patients with MFIR between $30,000 and $70,000 had lower odds of 2-year revision arthroscopy (odds ratio [OR], 0.63; P < .001), THA conversion (OR, 0.76; P = .050), and 90-day readmission (OR, 0.53; P = .007) compared to MFIR >$100,000. Compared to patients with commercial insurance, patients with Medicare had lower odds of revision arthroscopy (OR, 0.60; P = .035) and THA conversion (OR, 0.46, P < .001) but greater odds of 90-day readmission (OR, 1.74; P = .007). Patients with Medicaid had higher odds of 90-day ED visits (OR, 1.84; P < .001). Patients with low EAR had higher odds of revision arthroscopy (OR, 1.42; P = .005) and THA conversion (OR, 1.58; P = .002) compared to those with high EAR. CONCLUSIONS: Following hip arthroscopy, patients residing in areas with lower mean family income were less likely to undergo reoperations and readmissions. Medicare patients showed lower reoperation but higher readmission odds, while Medicaid patients showed higher odds of ED visits. Additionally, higher educational attainment in the zip code of residence is protective against future reoperation. LEVEL OF EVIDENCE: Level III, retrospective case series.

WITHDRAWN:Persistent Lack of Female Orthopaedic Sports Medicine Fellows

PURPOSE: The purpose of this study was to evaluate the gender composition of fellows, faculty, and leaders within orthopaedic sports medicine fellowship programs to provide a more complete analysis of gender diversity within this subspecialty. METHODS: Official program websites of orthopaedic sports medicine fellowships listed on the Arthroscopy Association of North America (AANA) fellowship directory were examined. Data collected for analysis included the gender of program directors, fellowship faculty, orthopaedic surgery department faculty, current sports medicine fellows, and fellows who graduated within the last five years. RESULTS: Of the 132 orthopaedic sports medicine fellows in training in the United States in the 2021-2022 academic year, 113 (85.6%) were men and 19 (14.4%) were women (p<0.001). Within the past five years, 419 fellows were listed as completing a sports medicine fellowship, with 375 (89.5%) being men, and 44 (10.5%) being women (p<0.001). There was no significant difference in the gender composition of current fellows compared to the composition of fellows within the last 5 years (p=0.74). When examining gender trends in sports medicine faculty, 639 (86.6%) were men and 99 (13.4%) were women (p<0.001). There were 14 women (14.4%) orthopaedic sports medicine faculty in leadership positions (i.e., program director or assistant program director) compared to 83 men in such positions (85.6%) (p<0.001) CONCLUSIONS: Orthopaedic sports medicine fellowships remain heavily male-dominated on all levels, including fellows, faculty, and leadership. There were no differences in the gender composition of current fellows when compared to those who graduated in the last five years, suggesting persistent gender disparity and the need for novel initiatives to enhance gender diversity in sports medicine.

Complications and re-operations after extensor mechanism repair surgery in a large cross-sectional cohort: females and tobacco-users at highest risk for adverse outcomes.

PURPOSE: There is little information on patients most at risk for poor outcomes following surgical repair of extensor mechanism tendon injuries. The purpose of this study is to provide an epidemiological overview of patients undergoing patellar or quadriceps tendon repair and to assess the incidence of postoperative complications, readmissions, and revision repairs among this population. METHODS: Retrospective data were obtained using the PearlDiver database for patellar tendon repair and quadriceps tendon repair patients between 2010 and 2020. Baseline demographics, incidences of 90-day readmissions and postoperative complications, and reoperation rates were collected for each group. Multivariate logistic regression was performed to assess the predictive power of each demographic variable on the incidence of postoperative complications and reoperations. RESULTS: In total, 1543 patients underwent patellar tendon repair and 601 underwent quadriceps tendon repair. Complications within 90-days were observed in 33.7% of patients with patellar tendon repair and 39.2% of patients with quadriceps tendon repair. Reoperation rates were 4.2% and 4.8% for patellar tendon repair and quadriceps tendon repair, respectively. Females in both patellar tendon repair and quadriceps tendon repair groups were at significantly higher risk for post-operative complications (patellar tendon repair OR 3.0, 95% CI 2.4-3.7; quadriceps tendon repair OR 2.9, 95% CI 1.9-4.6; p < 0.001 for both). Older age (p < 0.001), female gender (p < 0.001), CCI (p < 0.001), tobacco use (p < 0.001), and obesity (p < 0.01) were all predictors of experiencing at least one complication following patellar tendon repair. For quadriceps tendon repair, female gender (p < 0.001) and CCI (p < 0.001) were the strongest predictors of experiencing at least one complication, while older age, tobacco use, and obesity (p < 0.05 for all) were also significant independent predictors. CONCLUSION: Patellar tendon repair patients are younger on average than quadriceps tendon repair patients. Although females are less likely to sustain extensor mechanism ruptures compared to males, females are significantly more likely to have at least one complication after quadriceps or patellar tendon repair. These findings may be used by surgeons, patients, and payors to understand who is most at risk for adverse outcomes following extensor mechanism repair surgery, resulting in earlier intervention and counseling to reduce the likelihood of a poor outcome following extensor mechanism repair surgery. LEVEL OF EVIDENCE: Level III.

Patients With a High Femoroepiphyseal Roof With Concomitant Borderline Hip Dysplasia and Femoroacetabular Impingement Syndrome Do Not Demonstrate Inferior Outcomes Following Arthroscopic Hip Surgery.

PURPOSE: The purpose of this study was to compare outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia and hip instability defined radiographically using the femoroepiphyseal acetabular roof (FEAR) index and in patients without radiographic evidence of hip instability. METHODS: Data from consecutive patients with borderline hip dysplasia (lateral center edge angle between 18˚-25˚) who underwent primary hip arthroscopy between April 2012 and June 2017 for the treatment of FAIS were analyzed. Baseline demographic data, radiographic parameters, preoperative, and 2-year postoperative patient-reported outcome measures were collected. The FEAR index was measured by 3 different observers. Patients with an average FEAR index ≥2˚ were categorized as having radiographic evidence of instability as previously published. The analysis was powered to detect a minimal clinically important difference (MCID) for each outcome score. Statistical analysis was performed as appropriate to compare patients with FEAR index ≥2 and <2°. RESULTS: A total of 140 patients met the inclusion criteria. The average age and body mass index of included patients was 31.7 ± 13.2 (P < .325) years and 25.1 ± 5.6 kg/m2 (P < .862). There were no statistically significant demographic differences between the groups. Nineteen (13.0%) patients were found to have a FEAR index of over 2˚. The FEAR index <2° and FEAR index ≥2° groups had a mean preoperative FEAR index (standard deviation, range) of -7.0 (5.2, -26.8 to 1.9) and 4.8 (2.5, 2.0-11.8), respectively. The interrater intraclass correlation coefficient was 0.96. Postoperative patient-reported outcomes and rates of MCID and patient-acceptable symptomatic state achievement were not statistically different between the radiographically stable and unstable groups. (p>0.05 for all). CONCLUSION: Patients with borderline hip dysplasia and radiographic evidence of hip instability, as measured by the FEAR index (≥2°), achieve similar improvement in 2-year outcomes compared to those with radiographically stable hips after arthroscopic treatment of FAIS. CLINICAL RELEVANCE: Retrospective Level III cohort study.

Patient-Reported Outcome Surveys for Femoroacetabular Impingement Syndrome Demonstrate Strong Correlations, High Minimum Clinically Important Difference Agreement and Large Ceiling Effects.

PURPOSE: To determine the correlation between different patient-reported outcome (PRO) measurements used to assess outcomes after arthroscopic treatment of femoroacetabular impingement syndrome (FAIS) in a single cohort of patients. METHODS: Patients undergoing primary hip arthroscopy for FAIS (without dysplasia, arthritis, or joint hypermobility) were retrospectively analyzed from a prospectively collected cohort. PROs collected before surgery and at 2-year follow-up included the Visual Analog Scale (VAS) for pain, modified Harris Hip Score (mHHS), Hip Disability and Osteoarthritis Outcome Scores (HOOS) with subscales for symptoms, pain, activities of daily living (ADL), sport, and quality of life (QoL), and the physical and mental components of the Short Form-12 (SF-12 PCS and SF-12 MCS). RESULTS: Three hundred patients with 2 years' follow-up (mean age 35.1 ± 11.3, BMI 24.7 ± 3.8, 52.7% female, median Tönnis grade 1) were identified. All patients underwent femoroplasty and labral repair. There was a strong correlation among nearly all the PRO surveys at 2-year follow-up, with the highest correlations identified between mHHS and HOOS-Pain (r = .86, P < .001) and mHHS and HOOS-ADL (r = .85, P < .001). Preoperative scores and the change from preoperative to postoperative scores demonstrated an overall moderate correlation between surveys. There was a consistently weak correlation between the SF-12 MCS and all other PROs. There were strong agreements (67%-77%) in the patients achieving minimal clinically important differences (MCID) for each PRO survey. All surveys except the SF-12 demonstrated a ceiling effect after surgery, with 13% to 43% of patients achieving the maximum score. CONCLUSIONS: PRO surveys used for FAIS demonstrate strong correlations, especially in the evaluation of patients during the postoperative period. MCID for VAS, mHHS, and HOOS demonstrate strong agreement, whereas large ceiling effects were seen with the mHHS and HOOS. The results support a more efficient use of PRO scores while being able to accurately capture patient outcomes. LEVEL OF EVIDENCE: IV, retrospective case series.

Bone Marrow Lesions on Preoperative Magnetic Resonance Imaging Correlate With Outcomes Following Isolated Osteochondral Allograft Transplantation.

PURPOSE: The purpose of this study was to investigate the role of preoperative bone marrow lesion (BML) size and location on (1) postoperative patient reported outcomes and (2) postoperative failure and time to failure after osteochondral allograft (OCA) transplantation. METHODS: Consecutive patients from 2 senior surgeons who underwent isolated OCA transplantation to the knee from 2009-2018 were identified for the case series. Preoperative magnetic resonance imaging (MRI) was evaluated for BMLs based on 2 classification systems (Welsch et al. and Costa-Paz et al.) by 2 independent graders. BMLs associated with minimum 1-year postoperative outcomes were evaluated, and the effect of BML classification on survivorship was investigated with Kaplan-Meier curves. RESULTS: The 77 patients who underwent isolated OCA transplantation (mean follow-up: 39.46 ± 22.67 months) and had preoperative MRIs were included. Within this cohort, 82% of patients demonstrated a BML. The preoperative Costa-Paz et al. classification was significantly positively correlated with the postoperative Visual Analog Scale, International Knee Documentation Committee and Veterans RAND 12-Item Health Survey raw scores for both graders (P < 0.05). Failure occurred in 5 of 65 (8%) patients at a mean of 22.86 ± 12.04 months postoperatively. The presence of BML alone did not significantly affect survival (P = 0.780). However, for 1 grader, the Welsch et al. classification was associated with increased risk of graft failure (P = 0.031). CONCLUSION: Preoperative subchondral BMLs were present in 82% of patients undergoing OCA transplantation. We found that more severe BMLs based on the Costa-Paz classification, with increasing involvement in the juxta-articular surface, were correlated with higher postoperative patient-reported functional outcomes after OCA. BMLs may be associated with an increase in graft failure, but their role in this remains unclear. LEVEL OF EVIDENCE: IV, Retrospective Case Series.

Hip Arthroscopy Volume and Reoperations in a Large Cross-Sectional Population: High Rate of Subsequent Revision Hip Arthroscopy in Young Patients and Total Hip Arthroplasty in Older Patients.

PURPOSE: To report contemporary trends in hip arthroscopy case volume in the United States using a large cross-sectional cohort with accurate laterality tracking for assessment of revision surgery and rates of conversion to total hip arthroplasty (THA). METHODS: Using Current Procedural Terminology codes, we queried the Mariner PearlDiver dataset for patients who underwent hip arthroscopy from 2010 to 2017. Patient demographics were recorded and subsequent hip arthroscopy procedures and THA conversion within 2 years after surgery were tracked using International Classification of Diseases, Tenth Revision codes to accurately identify laterality. Emergency department and hospital admission within 30 days after surgery were queried. RESULTS: Of the 53,103 patients undergoing hip arthroscopy procedures, hip arthroscopy case volume increased 2-fold from 2010 to 2014 but remained relatively unchanged from 2014 to 2017. The most common age group undergoing surgery was 40 to 49 years, and female patients represented 70% of cases. Two-year subsequent surgery rate was 19%, with 15.1% undergoing a revision arthroscopy and 3.9% converting to THA. The most common revision arthroscopy procedures were femoroplasty (9.5%), labral repair (8.5%), and acetabuloplasty (4.3%). Younger patients were more likely to undergo revision arthroscopy (18% age 10-19 years; 15% age 20-29 years). Older patients had a significant risk for conversion to THA within 2 years (36% age 60-69 years; 28% age 50-59 years). Female patients also demonstrated a slightly greater rate of conversion to THA (4.1% female, 3.5% male, P <.0001). Patients 20 to 29 years had the greatest risk of emergency department admission (5.4%) and hospital admission (0.8%) within 30 days of surgery. CONCLUSIONS: The rise in hip arthroscopy procedures may be starting to plateau in the United States. Cross-sectional data also indicate that there is a greater than previously reported rate of revision hip arthroscopy in patients younger than 30 years of age and conversion to THA in patients older than 50 years of age. LEVEL OF EVIDENCE: III, cross-sectional study.

Establishing the Minimal Clinically Important Difference and Patient-Acceptable Symptomatic State After Arthroscopic Meniscal Repair and Associated Variables for Achievement.

PURPOSE: To establish the minimal clinically important difference (MCID) and patient-acceptable symptomatic state (PASS) after arthroscopic meniscal repair and identify the factors associated with achieving these outcomes. METHODS: This is a retrospective study with prospectively collected data. Patient-reported outcome measures (PROMs) were collected from April 2017 to March 2020. All patients who underwent arthroscopic meniscal repair and completed both preoperative and postoperative PROMs were included in the analysis. MCID and PASS were calculated via half the standard deviation of the delta PRO change from baseline (for International Knee Documentation Committee Score [IKDC]) and via anchor-based methodology (Knee Injury and Osteoarthritis Outcome Score [KOOS] subscales). RESULTS: Sixty patients were included in the final analysis. The established MCID threshold values were 10.9 for IKDC, 12.3 for KOOS Symptoms, 11.8 for KOOS Pain, 11.4 for KOOS Activities of Daily Living (ADL), 16.7 for KOOS Sport, and 16.9 for KOOS Quality of Life (QoL). Postoperative scores greater than the following values corresponded to the PASS: 69.0 for IKDC, 75.0 for KOOS Symptoms, 80.6 for KOOS Pain, 92.7 for KOOS ADL, 80.0 for KOOS Sport, and 56.3 for KOOS QoL. Higher preoperative PRO scores were associated with lower likelihood of achieving MCID. Concomitant ligament procedures were associated with a higher likelihood of achieving PASS. Tears to both menisci were associated with decreased likelihood of achieving MCID and PASS for IKDC. Horizontal tears were associated with decreased likelihood of achieving PASS for IKDC and KOOS. Complex tears were associated with decreased likelihood of achieving MCID for KOOS. CONCLUSION: Clinically meaningful outcomes such as MCID and PASS were established for meniscal repair surgery using selected PROMs for IKDC and KOOS subscales. Variables more likely to be associated with achieving these outcomes include lower preoperative PRO score and concomitant ligament procedure, whereas higher preoperative PRO score, tearing of both medial and lateral menisci, and horizontal and complex tear classifications were associated with decreased likelihood of achieving these outcomes. LEVEL OF EVIDENCE: IV, retrospective case series.

Outcomes are comparable using free bone block autografts versus allografts for the management of anterior shoulder instability with glenoid bone loss: a systematic review and meta-analysis of "The Non-Latarjet".

PURPOSE: Glenoid augmentation using free bone blocks for anterior shoulder instability has been proposed as an alternative to or bail-out for the Latarjet procedure. The purpose of this investigation was to systematically review and compare outcomes of patients undergoing glenoid augmentation using free bone block autografts versus allografts. METHODS: A systematic review using PubMed, MEDLINE, Embase, and the Cochrane Library databases was performed in line with the PRISMA statement. Studies reporting outcomes of patients treated with free bone block procedures for anterior shoulder instability with minimum 2-year follow-up were included. Random effects modelling was used to compare patient-reported outcomes, return to sports, recurrent instability, non-instability related complications, and development of arthritis between free bone block autografts and allografts. RESULTS: Eighteen studies comprising of 623 patients met the inclusion criteria for this investigation. There were six studies reporting on the use of allografts (of these, two used distal tibial, three iliac crest, and one femoral head allograft) in 173 patients and twelve studies utilizing autografts (of these, ten used iliac crest and two used free coracoid autograft) in 450 patients. Mean age was 28.7 ± 4.1 years for the allograft group and 27.8 ± 3.8 years for the autograft group (n.s). Mean follow-up was 98 months in autograft studies and 50.8 months for allograft studies (range 24-444 months, n.s). Overall mean increase in Rowe score was 56.2 with comparable increases between autografts and allografts (n.s). Pooled recurrent instability rates were 3% (95% CI, 1-7%; I2 = 77%) and did not differ between the groups (n.s). Arthritic progression was evident in 11% of autografts (95% CI, 2-27%; I2 = 90%) and 1% (95% CI, 0-8%; I2 = 63%) of allografts (n.s). The overall incidence of non-instability related complications was 5% (95% CI, 2-10%; I2 = 81%) and was similar between the groups (n.s). Pooled return to sports rate was 88% (95% CI, 76-96%; I2 = 76%). CONCLUSION: Glenoid augmentation using free bone block autograft or allograft in the setting of recurrent anterior shoulder instability with glenoid bone loss is effective and safe. Outcomes and complication incidence using autografts and allografts were comparable. Due to the high degree of heterogeneity in the data and outcomes reported in available studies, which consist primarily of retrospective case series, future prospective trials investigating long-term outcomes using free bone block autograft versus allograft for anterior shoulder instability with glenoid bone loss are warranted. LEVEL OF EVIDENCE: IV.

Arthroscopic Latarjet: Indications, Techniques, and Results.

The Latarjet procedure to treat instability was first described by the eponymous surgeon in 1954. Long-term results from this procedure have been favorable. In 2007, Lafosse et al. first described an all-arthroscopic technique for the Latarjet procedure. In the United States, the Latarjet procedure is most predictably indicated by surgeons in cases of significant glenoid bone loss, revision instability, and patients engaging in high-risk sport. In some European centers, the Latarjet has broader indications and is often also used as a first-line surgical intervention when conservative treatment has failed, including for those without bone loss or with multidirectional instability. • Achieve exposure of the inferior pole of coracoid and anterior glenoid rim; • coracoid is prepared; axillary nerve and brachial plexus are exposed; • coracoid portal is created; • coracoid is drilled and osteotomy is made; • coracoid transferred to anterior glenoid rim through split in subscapularis; • the bone graft is fixed in place with screws. Arthroscopic Latarjet can have a difficult learning curve compared with the open procedure. Both arthroscopic and open Latarjet have similar complication rates. The most common complications include graft fracture, non-union, and infection and are less than 2%. Arthroscopic Latarjet is reported to be less painful initially, but this equalizes by 1 month. Studies have shown that arthroscopic Latarjet results in excellent graft position. Recurrent instability for arthroscopic Latarjet ranges from 0.3% to 4.8% and is comparable with open Latarjet procedures. In summary, the arthroscopic Latarjet procedure results in less pain early, excellent coracoid graft position, and has a similar complication rate to open Latarjet.

Complications After Pediatric ACL Reconstruction: A Meta-analysis.

BACKGROUND: The purpose of this meta-analysis is to review clinical outcomes and complications following pediatric anterior cruciate ligament (ACL) reconstruction. METHODS: The PubMed and EMBASE databases were searched for studies on ACL ruptures in the skeletally immature from 1985 to 2016. Full-text studies in English and performed on humans were included (n=5718). Titles included discussed operative intervention on skeletally immature patients with ACL tears (n=160). Studies that reported rerupture and/or complications with ACL reconstruction specific to the pediatric population, specifically growth disturbance, were then included in a secondary analysis (n=45). Complications not specific to the pediatric population were excluded. Demographics, graft type, surgical technique, follow-up, growth disturbance, rerupture, and patient-reported outcome scores were collected. Data were analyzed in aggregate. RESULTS: In total, 45 studies were included with 1321 patients and 1392 knees. The average age was 13.0 years, 67% were male, and mean follow-up was 49.6 months. There were 115 (8.7%) reruptures in the initial 160 studies reviewed. In total, 94.6% of patients with rerupture required revision ACL surgery. There were 58 total growth disturbances (16 required corrective surgery, or 27.6%). Eighteen knees (3.7%) developed angular deformity, most commonly valgus. There were 37 patients (7.5%) had at least a 1 cm limb-length discrepancy. A total of 23 studies reported International Knee Documentation Committee scores (range, 81 to 100, 88% grade A or B). In total, 20 studies reported excellent Lysholm scores with mean scores of 94.6. CONCLUSIONS: Growth disturbance can occur with any of the reconstruction techniques. Proper surgical technique is likely more important than the specific reconstruction technique utilized. Patients with rerupture require surgery at much higher rates than those with growth disturbance. Although much attention has been focused on growth disturbance, we suggest that equal attention be given to the prevention of rerupture in this age group. LEVEL OF EVIDENCE: Level III.

Mental health, preoperative disability, and postoperative outcomes in patients undergoing shoulder arthroplasty.

BACKGROUND: Mental health conditions are associated with poor outcomes in patients with chronic disease as well as various orthopedic conditions. The purpose of this study was to describe the relationship between mental health, preoperative disability, and postoperative outcomes in patients undergoing shoulder arthroplasty. METHODS: Data, including mental health diagnoses, were prospectively collected from patients undergoing total shoulder arthroplasty or reverse total shoulder arthroplasty from 2009 to 2015 at a single academic institution. Shoulder range of motion, visual analog scale, 12-Item Short Form Health Survey, and American Shoulder and Elbow Surgeons scores were collected preoperatively and at 1 and 2 years postoperatively. Data were analyzed using multivariate mixed-effect regression analysis. RESULTS: The study included 280 patients, 105 (37.5%) of whom had a mental health diagnosis of depression, anxiety, schizophrenia, or bipolar disorder. Both groups of patients had similar shoulder range of motion, pain, and function before shoulder arthroplasty. Hospital length of stay, discharge destination, and readmissions were similar for both groups. There were similar improvements in pain, function, and range of motion after shoulder arthroplasty in patients with and without diagnosed mental health conditions. CONCLUSIONS: Overall, the presence of a psychiatric diagnosis was not predictive of outcomes. Although psychiatric conditions are often considered surgical comorbidities, mental health diagnoses should not be a barrier to performing clinically indicated shoulder arthroplasty, because both groups of patients appear to benefit from pain relief and improved shoulder function.

The effect of patient gender on outcomes after reverse total shoulder arthroplasty.

BACKGROUND: Gender differences may exist for patients undergoing shoulder arthroplasty. Limited data suggest that women may have worse preoperative disability and outcomes. Our objective was to determine whether gender influences preoperative disability and patient-reported outcomes after reverse total shoulder arthroplasty. METHODS: Data were prospectively collected for patients who underwent reverse total shoulder arthroplasty for rotator cuff arthropathy or osteoarthritis with a rotator cuff tear at a single institution between 2009 and 2015. Range of motion, visual analog scale, 12-Item Short Form Health Survey (SF-12), and American Shoulder and Elbow Surgeons (ASES) scores were collected at the preoperative, 1-year, and 2-year postoperative time points. Data were analyzed using multivariate mixed-effect regression analysis. RESULTS: There were 117 patients included. Men and women had similar demographics, preoperative range of motion, pain, and function. Length of stay was similar (men, 2.32 days; women, 2.58 days; P = .18). Controlling for patient variables, men achieved higher ASES function (P = .009) and SF-12 Physical Component Summary (P = .008) scores compared with women. There was no difference between men and women in ASES pain and SF-12 Mental Component Summary scores, visual analog scale score, or range of motion. CONCLUSION: Improvements in pain and range of motion were similar in men and women; however, men achieved higher ASES function and SF-12 Physical Component Summary scores. Women may be more functionally impaired on the basis of differences in activities of daily living. These results may be used to guide discussion about expected benefits after reverse shoulder arthroplasty.

Preoperative patient-reported scores can predict postoperative outcomes after shoulder arthroplasty.

BACKGROUND: Total shoulder arthroplasty and reverse total shoulder arthroplasty are increasingly used to improve pain and function in patients with glenohumeral arthritis or cuff tear arthropathy. Our objective was to determine if preoperative patient-reported outcome measures predict which patients will achieve clinically meaningful improvements after shoulder arthroplasty. METHODS: Preoperative and 1-year postoperative 12-Item Short Form Health Survey (SF-12) Physical Component Summary (PCS) and Mental Component Summary (MCS) scores and American Shoulder and Elbow Surgeons (ASES) pain and function scores were prospectively collected from 107 patients who underwent total or reverse shoulder arthroplasty. The minimum clinically important difference (MCID) defined meaningful clinical improvement. Receiver operating characteristic analysis was used to calculate threshold values and C statistic. Multivariate logistic regression analysis was performed to determine preoperative measures that were indicative of achieving the MCID postoperatively. RESULTS: Threshold values below which patients were more likely to achieve MCID were 12 for ASES function, 25 for ASES pain, 46 for SF-12 PCS, and 42 for SF-12 MCS. Multivariate analysis revealed that preoperative ASES function (area under the curve, 0.79; P = .006) and ASES pain (area under the curve, 0.90; P < .001) measures were predictive of achieving the MCID postoperatively. Patients with higher preoperative SF-12 MCS scores had a higher likelihood of achieving MCID for each measure. CONCLUSION: We determined threshold values that predict clinically meaningful improvement after shoulder arthroplasty. Patients with higher preoperative mental health scores and lower physical function and pain scores were more likely to gain significant benefits from surgery. These results can be used to facilitate shared decision-making and to forecast expected benefits after shoulder arthroplasty.

Proximal Hamstring Repair With All-Suture Anchors and an Accelerated Rehabilitation and Bracing Protocol Demonstrates Good Outcomes at 1-Year Follow-Up.

Purpose: To evaluate patient-reported outcomes and risk for rerupture after surgical treatment of proximal hamstring tendon ruptures using all-suture anchors and a unique postoperative bracing strategy. Methods: A retrospective review of a prospectively collected database was conducted of patients undergoing proximal hamstring repair or reconstruction from 2020 to 2022 at a tertiary, academic institution. Patients were included if they reached minimum 1-year follow-up and completed postoperative patient-reported outcomes. The surgical protocol for proximal hamstring repairs included all-suture anchors placed either in an open or endoscopic fashion in the ischial tuberosity. After surgery, all patients underwent an accelerated rehabilitation protocol, including 6 weeks touchdown weight-bearing in a hinged knee brace locked in extension for ambulation, allowing passive knee flexion to 90° while seated. Descriptive statistics were used to analyze the data. Results: Twenty-one patients were included (mean age 50.4 ± 9.5 years, body mass index 24.4 ± 3.5, 66.7% female). Lower Extremity Functional Scale score achieved postoperatively was 74.2 ± 7.5 (out of 80). Patients had minimal pain (mean visual analog scale pain score of 0.9 ± 1.2). 61.9% of patients were able to return to the same level of activity after based on Tegner score by 1 year. Postoperative Single Assessment Numeric Evaluation activity of daily living was 94.3 ± 8.3, and Single Assessment Numeric Evaluation Sports was 82.3 ± 19.0. Mean Short Form Survey (SF-12) postoperative scores were 51.6 ± 6.8 for SF-12 Physical Component Score and 53.9 ± 9.7 for Mental Component Score. 95.2% (20 of 21) patients were satisfied with their outcome. There were no reruptures, infections, or reoperations. One patient of 21 (4.8%) incurred a postoperative deep venous thrombosis, which was treated with therapeutic anticoagulation for 3 months. Conclusions: All-suture anchors for proximal hamstring repair with a unique accelerated postoperative rehabilitation and bracing protocol result in good outcomes and patient satisfaction with minimal risk of complications. Level of Evidence: Level IV, case series, therapeutic.

Delayed hip arthroscopy for femoroacetabular impingement syndrome does not increase revision but does increase rates of chronic opiate use.

Introduction: In recent years, the utilization of hip arthroscopy to treat femoroacetabular impingement syndrome (FAIS) has increased due to its low complication rates, positive impact on patient-reported outcomes (PROs), and association with faster rehabilitation. Despite this, there are high rates of revision and conversion to total hip arthroplasty (THA) in some of these patients. It is unclear whether time from initial FAIS diagnosis to surgery is a risk factor for poor outcomes. In this study, we examined the relationship between timing of hip arthroscopy for FAIS and rates of 2-year revision hip procedures, 2-year conversion to total hip arthroplasty (THA), post-operative medical complications, and opioid prescriptions. Methods: This is a retrospective cohort study utilizing the PearlDiver database. Current Procedural Terminology (CPT) and International Classification of Diseases (ICD) codes were used to identify patients who had surgery for FAIS with minimum 2 years follow-up available. Patients were stratified by 3-month intervals into 5 groups based on time from diagnosis of FAIS to hip arthroscopy. Multivariate logistic regression was performed to determine factors independently associated with continued opiate use and subsequent surgeries. Results: A total of 14,677 patients were included in the study. The 2-year rate of revision hip arthroscopy was 4.2%. As time from diagnosis to surgery increased, even in multivariate regression analysis, there was a higher risk of filling an opioid prescription 90 days after surgery (P < 0.001). Regression analysis demonstrated that timing of surgery was not associated with 2-year revision hip arthroscopy or conversion to THA. Age, sex, obesity, and tobacco use were significant predictors of revision hip arthroscopy and conversion to THA (p < 0.001). Conclusion: There is no significant difference between timing of surgery for FAIS and odds of revision or conversion to THA. Prolonged opiate use after hip arthroscopy was significantly higher as duration from initial FAIS diagnosis to surgery increased. Age, sex, obesity, and tobacco use are significant predictors for revision, conversion to THA, and continued opiate prescriptions.

Sex-based Differences in Patient Perspectives and Experiences With Shoulder, Hip, and Knee Arthroplasty.

INTRODUCTION: Sex disparities in presentation of osteoarthritis and utilization of joint replacement surgery (JRS) have been demonstrated. The role of patients' unique perspectives on JRS on their treatment decisions is poorly understood. METHODS: JRS candidates who were offered JRS but declined surgical treatment completed this survey. Survey questions included demographic information, patient experiences and current opinions around JRS, patient experiences with providers, goals and concerns, and barriers to JRS. RESULTS: More women experience barriers to undergoing JRS compared with men (53% versus 16%; P = 0.014). While both men and women indicated pain relief as their primary goal for treatment, women were significantly more likely to prioritize regaining the ability to complete daily tasks and responsibilities when compared with men (P = 0.007). Both men and women indicated that low symptom severity and nonsurgical treatment options were the reasons for not undergoing JRS (P = 0.455). Compared with men, women trended toward feeling that they were not sufficiently educated about JRS (P = 0.051). CONCLUSION: Women have unique perspectives and goals for JRS that may pose sex-specific barriers to care. A better understanding of how patients' gendered experiences affect their decision making is necessary to improve treatment of osteoarthritis and decrease disparities in care.

Stronger Athlete Identity Is a Risk Factor for More Severe Depressive Symptoms After Musculoskeletal Injury in Pediatric Athletes: a Systematic Review.

PURPOSE OF REVIEW: Treatment for musculoskeletal sports injuries often neglects the psychological components of health and recovery. Pediatric patients require particular consideration of their psychosocial and cognitive development. This systematic review investigates the effects of musculoskeletal injury on mental health in pediatric athletes. RECENT FINDINGS: Athlete identity may increase in adolescence and is associated with worse mental health post-injury. Psychological models suggest loss of identity, uncertainty, and fear mediate the association between injury and symptoms of anxiety, depression, post-traumatic stress disorder, and obsessive-compulsive disorder. Fear, identity, and uncertainty also influence return to sport. In the reviewed literature, there were 19 psychological screening tools and 8 different physical health measures with various adaptations to athlete developmental level. In pediatric patients, no interventions were studied to reduce the psychosocial impacts of injury. Musculoskeletal injury is associated with worse mental health in pediatric athletes, and stronger athlete identity is a risk factor for the development of depressive symptoms. Psychological interventions that reduce uncertainty and address fear may help mitigate these risks. More research is needed on screening and interventions to improve mental health post-injury.

Mental Health and Involuntary Retirement from Sports Post-Musculoskeletal Injury in Adult Athletes: a Systematic Review.

PURPOSE OF REVIEW: The psychological aspects of musculoskeletal injury are often overlooked in the rehabilitation process. This review examines the effects of musculoskeletal injury on mental health in adult athletes and identifies themes to guide further research. RECENT FINDINGS: Athletes are at risk for mental health struggles due to high athletic identity and identity foreclosure. Injured athletes have specifically been shown to have higher rates of anxiety and depression when compared to the general population. There is a lack of intervention-based research on the psychological well-being of athletes, and there are no systematic reviews synthesizing the impact of musculoskeletal injury on the mental health of adult athletes across a variety of sports. Across professional, college-level, and amateur athletes, musculoskeletal injury is associated with worse mental health scores, including higher distress, higher anxiety and depression, lower social functioning, and lower health-related quality of life. For adults, involuntary retirement from sports due to musculoskeletal injury is a common theme associated with increased psychological distress, anxiety, and depression. In the reviewed literature, 22 unique mental health and 12 distinct physical health screening tools were used. Two articles studied interventions addressing mental health post-injury. Further research using an integrated physical and psychological approach to recovery is warranted and may improve mental and physical outcomes for injured athletes.