Reliability and responsiveness of the Swedish short Hip-RSI.

Purpose: The aim of this study was to examine test-retest reliability and responsiveness of the short version (6-item) Hip Return to Sport after Injury (Hip-RSI) scale in patients following hip arthroscopy. Methods: The study included 100 hip arthroscopy patients responding to a digital survey including the short version (6-item) Hip-RSI, International Hip Outcome Tool (short version) (iHOT-12) and RTS status 3, 6 and 9 months following surgery. The Hip-RSI was administered twice at 3-month follow-up. Test-retest reliability was evaluated using intraclass correlation coefficients. Responsiveness was tested by correlations between changes in Hip-RSI and iHOT-12 scores and by comparing change in Hip-RSI scores of patients who progressed on the return to sport (RTS) continuum (from return to any sport to return to performance) to patients who did not, using independent samples t-tests. Results: Hip-RSI was found to have excellent test-retest reliability on the individual (intraclass correlation coefficient, ICC [95% confidence interval, CI]: 0.90 [0.83-0.94]) and group level (ICC [95% CI]: 0.95 [0.91-0.97]) with a standard error of measurement of 5.53 and smallest detectable change of 15.3 on the individual and 2.2 on the group level. Hip-RSI was found responsive to change through positive correlations of changes in scores with changes in iHOT-12 scores from 3 to 6 months (r [95% CI]: 0.51 [0.35-0.65]; p < 0.001) and from 3 to 9 months following arthroscopy (r [95% CI]: 0.61 [0.57-0.79); p < 0.001). Further responsiveness was shown by significant mean changes in scores among patients that progressed on the RTS-continuum (3-6 months: 8.6 [95% CI: 3.8- 13.5); 3-9 months: 12.6 [5.6-19.7]). Conclusion: The short version (6-item) Hip-RSI demonstrated excellent test-retest reliability and responsiveness to change in the evaluation of psychological readiness to RTS following hip arthroscopy. Level of Evidence: Level II.

Validity and Reliability of Finger-Strength Testing in 6 Common Grip Techniques for the Assessment of Bouldering Ability in Men.

OBJECTIVE: To determine the criterion validity and test-retest reliability of isometric finger-strength testing in 6 differentiated grip techniques for the assessment of bouldering ability among male climbers. METHODS: We recruited participants at climbing gyms in Sweden and through online advertisements. We included climbers over 15 years of age with a minimum bouldering performance level of 17 International Rock Climbing and Research Association (IRCRA) for men and 15 IRCRA for women. We tested unilateral, maximal isometric peak finger strength in the front 3 drag, half crimp, closed crimp, 35 sloper, 45 × 90-mm, and 90 × 90-mm pinch through maximal force deloaded of a force plate. We analyzed criterion validity, test-retest reliability, and capacity to determine bouldering performance ability using a stepwise multivariable regression model. RESULTS: Women were excluded from the analysis due to insufficient sample size (n = 16). Thirty-two male participants were included in the primary analysis. The median (interquartile range) age in the advanced and elite group was 27 (25; 35) and 23 (22; 32) years, respectively. The half crimp for the participants' weak and strong hand displayed the highest ability to determine bouldering grade performance, explaining 48% to 58% of the variance. In the stepwise regression, maximal strength in the half crimp and the front 3 drag collectively explained 66% of the variance for performance. CONCLUSION: Strength in the half crimp proved the most important performance indicator. The results of this study provide a reliable and valid framework for maximal isometric peak finger-strength testing in advanced and elite male boulderers.

Mental health problems, sleep quality and overuse injuries in advanced Swedish rock-climbers - the CLIMB study.

OBJECTIVES: To examine the prevalence of mental health problems (depression, anxiety, and stress), sleep quality, and disability due to overuse injuries in advanced and elite rock-climbers. The rock-climbers were compared to a group of non-climbing controls. METHODS: A self-selected sample of advanced and elite Swedish rock-climbing athletes was recruited through the Swedish Rock-climbing Federation, local rock-climbing gyms and through social media. A control group, matched in size was recruited. Participants in the control group answered an online survey of validated questionnaires, examining symptoms of stress, anxiety, depression, sleep quality. The climbing participants answered the same survey as the non-climbing controls but with additional questions regarding musculoskeletal problems and disabilities related to these. Outcome measures used were the Depression Anxiety Stress Scale, Pittsburgh Sleep Quality Index and The Oslo Sports Trauma Research Center Overuse Injury Questionnaire. RESULTS: A total of 183 participants were included in the rock-climbing group, and 180 participants in the control group. In the rock-climbing group the mean age (SD) was 28.2 (8.3) years among women and 30.5 (9.6) years in men. The mean BMI of women was 21.2 (2.2) and 22.8 (2.1) in men. A total of 30.6% of the rock-climbing group (26.7% of men, 35.9% of women) reported at least moderate levels of symptoms of depression and 23.1% (17.2% men, 30.8% women) at least moderate levels of symptoms of anxiety. A total of 48.4% of rock-climbers (39.1% men, and 61.6% women) reported at least moderate levels of symptoms of stress. Among the rock-climbers, 45.0% reported having poor sleep quality. There were no statistical significant differences (p = 0.052-0.96) in mental health problems or sleeping problems between the rock-climbers and the controls. Among rock-climbers, reports of one-week prevalence of injury related problems was: Finger and hand (49.5%), Shoulder (35.2%), Knee (29.1%), Lumbar back (26.4%), Arm (25.3%), Thoracic back and neck (17.0%), and Foot and lower leg (12.1%). CONCLUSION: The overall results indicate high levels of symptoms of mental health problems and poor sleep quality in both rock-climbers and controls. Although no significant differences between the climbing group and the control group was displayed, symptoms that warrant clinical attention is high. Overuse injuries were commonly reported among the rock-climbers in all examined injury locations. Previous studies reporting mental health problems to be more prevalent among athletes were contradicted in this study. The results display the need for a broader perspective regarding climbers general health and the need to provide structured care and adequate support in order to come to terms with these concerns.

A comparison between physical therapy clinics with high and low rehabilitation volumes of patients with ACL reconstruction.

BACKGROUND: Treatment volume can impact outcomes after surgical procedures of the knee between surgeons with high- and low-patient-volumes. However, the difference between physical therapeutic clinics with high- and low-volumes has not been widely researched. This registry study aims to investigate how patient volume affects knee function outcomes after anterior cruciate ligament (ACL) reconstruction at physical therapy (PT) clinics in terms of odds for a second ACL injury, return to pre-injury level of activity, perceived knee function, and recovery of strength and hop performance. METHOD: Data were extracted from the Project ACL, a local rehabilitation registry. High- and low-volume clinics were defined based on the number of patients who attended different clinics. High-volume clinics were defined as those with > 100 patient registrations in Project ACL during the study period while low-volume clinics were those with ≤ 100 patient registrations. High- and low-volume clinics were compared, based on muscle function and patient-reported outcomes across 4 follow-ups, 2-, 4-, 8-, and 12 months, during the first year after ACL reconstruction, and odds of second ACL injury up to 2 years after ACL reconstruction. RESULT: Of the 115 rehabilitation clinics included, 111 were classified as low-volume clinics and included 733 patients, and 4 as high-volume clinics which included 1221 patients. There were 31 (1.6%) second ACL injuries to the ipsilateral or contralateral side within the first 12 months and 68 (4.0%) within 2 years. No difference in the incidence of a second ACL injury, within 12 months follow-up odds ratio (OR) 0.95 [95% CI 0.46-1.97] or within 2 years follow-up OR 1.13 [95% CI 0.68-1.88], was found between high- and low-volume clinics. There were early (2 months) and non-clinically relevant differences in patient-reported outcomes (PROs) and physical activity levels early after ACL reconstruction in favor of high-volume clinics. One year after ACL reconstruction, no differences were observed between high- and low-volume clinics in terms of PROs, muscle function, and return to pre-injury level of activity. CONCLUSION: No clinically relevant difference in the incidence of secondary ACL injuries in patients who underwent rehabilitation after ACL reconstruction at high- or low-volume physical therapist clinics was found. In addition, no clinically relevant differences in outcomes were found during the first year in terms of patient-reported outcomes, recovery of muscle function, or return to pre-injury level of activity.

The Ambiguity of Names and Landmarks in Radiographs of the Pediatric Pelvis: Variations and a Historical Perspective.

For over a century, the plain radiograph has been used to measure and predict the development of pediatric hip conditions. Classic measurements, such as the acetabular index, the center-edge angle, and the migration percentage, have stood the test of time and remain the default tools for any pediatric orthopaedic surgeons. However, in contemporary research, the terminology regarding these measurements has become markedly inconsistent. A substantial number of synonyms, acronyms, and similar, but not identical, terms are used to label measurements. This is perhaps unsurprising, considering decades of use and numerous suggested modifications. The results of treatment cannot be reliably compared if the measured parameters are not identical, and scientific analysis of disease requires consistent terminology. In this review, we aim both to provide historical definitions and identification of radiographic landmarks commonly used in three parameters of interest on pediatric AP radiographs and to examine the variability of landmarks and definitions in contemporary research.

Incidence of bony Bankart lesions in Sweden: a study of 790 cases from the Swedish fracture register.

BACKGROUND: A bony Bankart lesion directly affects the stability of the shoulder by reducing the glenoid joint-contact area. The aim of this study was to report on the epidemiological data relating to bony Bankart lesions in Sweden using the Swedish fracture register. The purpose is to evaluate age and sex distribution in the population with bony Bankart lesions, its impact on treatment strategy and further to analyse patient-reported outcomes. METHODS: This was an epidemiological descriptive study. The inclusion criteria were all patients with a unilateral bony Bankart lesion registered between April 2012 and April 2019. The patients' specific data (age, sex, type and time of injury, treatment option and patient-reported outcomes) were extracted from the Swedish fracture register database. RESULTS: A total of 790 unilateral bony Bankart fractures were identified. The majority of the patients were male (58.7%). The median age for all patients at the time of injury was 57 years. Females had a higher median age of 66 years, compared with males, 51 years. Most of the bony Bankart lesions, 662 (91.8%), were registered as a low-energy trauma. More than two-thirds of all treatment registered cases, 509/734 patients (69.3%), were treated non-surgically, 225 (30.7%) were treated surgically, while, in 17 patients (7.5% of all surgically treated patients), the treatment was changed from non-surgical to surgical due to recurrent instability. Surgical treatment was chosen for 149 (35%) of the males and for 76 (25%) of the females. Patient quality of life decreased slightly in both surgically and non-surgically treated groups 1 year after bony Bankart injury. CONCLUSION: This national register-based study provides detailed information on the epidemiology, choice of treatment and patient-reported outcomes in a large cohort of bony Bankart lesions. Most bony Bankart lesions affected males between 40 and 75 years after low-energy falls and non-surgical treatment dominated.

Protocol for a 2-year longitudinal study of eating disturbances, mental health problems and overuse injuries in rock climbers (CLIMB).

INTRODUCTION: Rock climbing is a rapidly growing sport in which performance may be affected by participant's weight and leanness, and there may be pressure on athletes with respect to their eating behaviour and body weight. However, there is sparse research performed on climbers, constituting a knowledge gap which the present study aims to fill. The primary outcomes of the study are to examine disordered eating and overuse injuries in rock climbers. Secondary variables are body image, indicators of relative energy deficiency, mental health problems, compulsive training, perfectionism, sleep quality and bone density. METHOD AND ANALYSIS: This prospective longitudinal study aims to recruit Swedish competitive rock climbers (>13 years) via the Swedish Climbing Federation. A non-athlete control group will be recruited via social media (n=equal of the climbing group). Data will be collected using streamlined validated web-based questionnaires with three follow-ups over 2 years. Inclusion criteria for rock climbers will be a minimum advanced level according to International Rock-Climbing Research Association. The non-athlete control group is matched for age and gender. Exclusion criteria are having competed at an elite level in any sport as well as training more often than twice per week. Statistical analyses will include multinominal logistic regression, multivariate analysis of variance (MANOVA) and structural equation modelling (SEM). We will assess effect measure modification when relevant and conduct sensitivity analyses to assess the impact of lost to follow-up. ETHICS AND DISSEMINATION: The Rock-Climbers' Longitudinal attitudes towards Injuries, Mental health and Body image study, CLIMB, was approved by the Swedish ethics authority (2021-05557-01). Results will be disseminated through peer-reviewed research papers, reports, research conferences, student theses and stakeholder communications. TRIAL REGISTRATION NUMBER: NCT05587270.

The Glenoid Track Paradigm Does Not Reliably Affect Military Surgeons' Approach to Managing Shoulder Instability.

Purpose: To report the frequencies of surgical stabilization procedures performed by military shoulder surgeons and to use decision tree analysis to describe how bipolar bone loss affects surgeons' decision to perform arthroscopic versus open stabilization procedures. Methods: The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database was queried for anterior shoulder stabilization procedures from 2016 to 2021. A nonparametric decision tree analysis was used to generate a framework for classifying surgeon decision making based on specified injury characteristics (labral tear location, glenoid bone loss [GBL], Hill-Sachs lesion [HSL] size, and on-track vs off-track HSL). Results: A total of 525 procedures were included in the final analysis, with a mean patient age of 25.9 ± 7.2 years and a mean GBL percentage of 3.6% ± 6.8%. HSLs were described based on size as absent (n = 354), mild (n = 129), moderate (n = 40), and severe (n = 2) and as on-track versus off-track in 223 cases, with 17% (n = 38) characterized as off-track. Arthroscopic labral repair (n = 428, 82%) was the most common procedure, whereas open repair (n = 10, 1.9%) and glenoid augmentation (n = 44, 8.4%) were performed infrequently. Decision tree analysis identified a GBL threshold of 17% or greater that resulted in an 89% probability of glenoid augmentation. Shoulders with GBL less than 17% combined with a mild or absent HSL had a 95% probability of an isolated arthroscopic labral repair, whereas a moderate or severe HSL resulted in a 79% probability of arthroscopic repair with remplissage. The presence of an off-track HSL did not contribute to the decision-making process as defined by the algorithm and data available. Conclusions: Among military shoulder surgeons, GBL of 17% or greater is predictive of a glenoid augmentation procedure whereas HSL size is predictive of remplissage for GBL less than 17%. However, the on-track/off-track paradigm does not appear to affect military surgeons' decision making. Level of Evidence: Level III, retrospective cohort study.

Low occurrence of MRI spinal changes in elite climbing athletes; a cross-sectional study.

OBJECTIVES: To examine the occurrence of magnetic resonance imaging (MRI) changes in the thoracolumbar spine among elite climbing athletes. METHODS: All climbers of the Swedish national sport climbing team (n = 8), and individuals having trained for selection to the national team (n = 11), were prospectively included. A control group, matched in age and sex, were recruited. All participants underwent a thoracolumbar MRI (1.5 T, T1- and T2-weighted imaging), evaluated according to Pfirrmann classification, modified Endplate defect score, Modic changes, apophyseal injuries and spondylolisthesis. Pfirrmann ≥ 3, Endplate defect score ≥ 2 and Modic ≥ 1 was defined as degenerative findings. RESULTS: Fifteen individuals, 8 women, participated in both the climbing group (mean age 23.1, SD 3.2 years) and the control group respectively (mean age 24.3, SD 1.5 years). In the climbing group, 6.1% of the thoracic and 10.6% of the lumbar intervertebral discs showed signs of degeneration according to Pfirrmann. One disc with a grade above 3 was present. Modic changes in the thoracic/lumbar spine were prevalent in 1.7%/1.3% of the vertebrae. Degenerative endplate changes according to the Endplate defect score were found in 8.9% and 6.6% of the thoracic and lumbar spinal segments of the climbing group, respectively. Two apophyseal injuries were found, while no participants displayed signs of spondylolisthesis. There was no difference in point-prevalence of radiographic spinal changes between climbers and controls (0.07 < p < 1.0). CONCLUSION: In this small cross-sectional study, only a low proportion of elite climbers displayed changes of the spinal endplates or intervertebral discs, as opposed to other sports with high spinal loads. Most observed abnormalities were low grade degenerative changes and did not differ statistically compared to controls.

High-level soccer players have a low rate of return to performance after hip arthroscopy for femoroacetabular impingement syndrome.

PURPOSE: Femoroacetabular impingement syndrome (FAIS) is a known cause of impaired sports performance in athletes and the relationship between FAIS and soccer players has previously been described. Hip arthroscopy is a viable treatment option that can facilitate athletes' return to sport (RTS). The aim of this study was to evaluate the RTS and return to performance (RTP) with objective measurements in high-level soccer players after hip arthroscopy for FAIS. METHOD: Soccer players, with a hip sports activity scale (HSAS) level of 7 or 8 before symptom onset and undergoing hip arthroscopy for FAIS between 2011 and 2019 were identified in the Gothenburg hip arthroscopic registry. A total of 83 high-level soccer players, with a mean age of 23.9 (SD 4.4) years at surgery, were included. To verify the activity level and further stratify players as elite or sub-elite, player statistics were collected from soccer-specific scout webpages and the Swedish national soccer association. The return to sport was defined as return to one game of soccer. Return to performance was defined as playing at the same level, or higher, and participating in at least 80% of the number of games played the season before symptom onset or the season before surgery either the first or second season after hip arthroscopy. RESULTS: In total, 71 (85.5%, 95% confidence interval (CI) 76.1-92.3%) of the players returned to sport the first or second season after surgery. Compared to the season before symptom onset, 31 (37.3%, 95% CI 27.0-48.7%) players returned to performance the first or second season after surgery, and 32 (38.6%, 95% CI 28.1-49.9%) players returned to performance the first or second season after surgery compared to the season before surgery. CONCLUSION: A high rate of elite and sub-elite soccer players return to soccer after hip arthroscopy for FAIS. However, less than half of the players RTP when evaluating performance through level of play and number of games played. LEVEL OF EVIDENCE: Level IV.

Posterior tibial plateau impaction fractures are not associated with increased knee instability: a quantitative pivot shift analysis.

PURPOSE: This study aimed to evaluate posterolateral tibial plateau impaction fractures and how they contribute to rotatory knee laxity using quantitative pivot shift analysis. It was hypothesised that neither the presence of nor the degree of involvement of the plateau would affect rotatory knee laxity in the ACL-deficient knee. METHODS: A retrospective review of prospectively collected data on 284 patients with complete anterior cruciate ligament (ACL) injuries was conducted. Posterolateral tibial plateau impaction fractures were identified on preoperative MRI. The patients were divided into two cohorts: "fractures" or "no fractures". The cohort with fractures was further categorised based on fracture morphology: "extra-articular", "articular-impaction", or "displaced-articular fragment". All data were collected during examination under anaesthesia performed immediately prior to ACL reconstruction. This included a standard pivot shift test graded by the examiner and quantitative data including anterior tibial translation (mm) via Rolimeter, quantitative pivot shift (QPS) examination (mm) via PIVOT tablet technology, and acceleration (m/sec2) during the pivot shift test via accelerometer. Quantitative examinations were compared with the contralateral knee. RESULTS: There were 112 patients with posterolateral tibial plateau impaction fractures (112/284, 39%). Of these, 71/112 (63%) were "extra-articular", 28/112 (25%) "articular-impaction", and 13/112 (12%) "displaced-articular". Regarding the two groups with or without fractures, there was no difference in subjective pivot shift (2 ± 0 vs 2 ± 0, respectively, n.s.), QPS (2.4 ± 1.6 mm vs 2.7 ± 2.2 mm, respectively, n.s.), anterior tibial translation measurements (6 ± 3 mm vs 5 ± 3 mm, respectively, n.s.), or acceleration of the knee during the pivot (1.7 ± 2.3 m/s2 vs 1.8 ± 3.1 m/s2, respectively, n.s.). When the fractures were further subdivided, subgroup analysis revealed no significant differences noted in any of the measured examinations between the fracture subtypes. CONCLUSION: This study showed that the posterolateral tibial plateau impaction fractures are commonly encountered in the setting of ACL tears; however, contrary to previous reports, they do not significantly increase rotatory knee laxity. This suggests that this type of concomitant injury may not need to be addressed at the time of ACL reconstruction. LEVEL OF EVIDENCE: Level III.

Arthroscopic iliopsoas tenotomy after total hip arthroplasty: safe method for the right patient.

PURPOSE: To evaluate the outcome of arthroscopic treatment for iliopsoas impingement after total hip arthroplasty (THA) 2 years after surgery using patient reported outcomes (PROM). METHODS: In this study 12 patients (13 hips) were included from a local hip arthroscopy registry. Patients completed web-based PROMs preoperatively and at a minimum of 2 years postoperatively. The PROMs included the International Hip Outcome Tool short version (iHOT-12), the Copenhagen Hip and Groin Outcome Score (HAGOS), the European Quality of Life-5 Dimensions Questionnaire (EQ-5D), the Hip Sports Activity Scale (HSAS) for physical activity level, the Visual Analog Scale (VAS) for overall hip function and a single question regarding overall satisfaction with the surgery. RESULTS: The mean age was 64.4 years (±15.1SD), mean body mass index (BMI) was 26.6 (±4.3SD), mean follow-up time was 49.8 months (±25SD). Comparing PROMs preoperatively with 2-year follow up showed an improvement for many of the PROMs used. The PROMs scores were iHOT-12 (24.9 vs 34.5, p = 0.13), HAGOS subscales (symptoms 38.2 vs 54.5, p = 0.05; pain 36 vs 53, p = 0.04; sport 14.1 vs 35.1, p = 0.03; daily activity 31 vs 47.5, p = 0.04; physical activity 21.8 vs 24, p = 0.76; quality of life 24 vs 35, p = 0.03), EQ-VAS (57.9 vs 58, p = 0.08), EQ-5D (0.34 vs 0.13, p = 0.07) and VAS for overall hip function (43.1 vs 46.2, p = 0.14). In total, 10 out of the 12 patients (83%) were satisfied with the intervention. CONCLUSION: Patients undergoing surgery for iliopsoas impingement after previous THA showed improved self-reported hip function where most patients were satisfied with treatment.

Sports activity and quality of life improve after isolated ACL, isolated PCL, and combined ACL/PCL reconstruction.

PURPOSE: To compare patient-reported outcomes following isolated anterior cruciate ligament reconstruction (ACL-R), isolated posterior cruciate ligament reconstruction (PCL-R), and combined ACL-R and PCL-R (ACL/PCL-R), at a minimum follow-up of 2 years. METHODS: This was a prospective observational registry cohort study based on the Swedish National Knee Ligament Registry. Patients undergoing isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R between 2005 and 2019 were eligible for inclusion. Demographic characteristics as well as injury- and surgery-related data were queried from the SNKLR. To evaluate functional outcomes, the Knee Injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1- and 2-year follow-ups and compared between the treatment groups. RESULTS: In total, 45,169 patients underwent isolated ACL-R, 192 patients isolated PCL-R, and 203 patients combined ACL/PCL-R. Preoperatively, and at the 1- and 2-year follow-ups, KOOS subscales were highest for the isolated ACL-R group, followed by the isolated PCL-R, and lowest for the combined ACL/PCL-R groups. Significant improvements were observed across all treatment groups in the majority of KOOS subscales between the preoperative, and 1- and 2-year follow-ups. All treatment groups showed the greatest improvements between the preoperative and 2-year follow-ups in the knee-related quality of life (mean improvement: isolated ACL-R, + 28 points; isolated PCL-R, + 23 points; combined ACL/PCL-R, + 21 points) and the function in sport and recreation (mean improvement: isolated ACL-R, + 26 points; isolated PCL-R, + 20 points; combined ACL/PCL-R, + 19 points) subscales. CONCLUSION: Clinically relevant improvements in knee function can be expected after isolated ACL-R, isolated PCL-R, and combined ACL/PCL-R. Functional improvements were particularly pronounced in the KOOS function in sport and recreation subscale, indicating the importance of knee stability for sports activity. This study facilitates more comprehensive patient education about functional expectations after surgical treatment of isolated and combined ACL and PCL injuries. LEVEL OF EVIDENCE: Level 2.

[Hip pain]. / ABC om Höftsmärta hos vuxna.

Hip pain is difficult to assess and structured diagnostics is important. To facilitate the evaluation of hip pain, we recommend dividing hip pain between intra- and extra-articular pain, where the latter further can be divided into different entities. Plain radiographics are warranted before referral to orthopaedic specialist. Furthermore, the need of a magnetic resonance imaging (MRI) should be decided by the orthopaedic surgeon.

Return to Sport for Professional and Subelite Ice Hockey Players After Arthroscopic Surgery for Femoroacetabular Impingement Syndrome.

Background: Femoroacetabular impingement syndrome (FAIS) is a common cause of hip pain, which can prevent ice hockey players from sports participation. Hip arthroscopy is often performed to relieve pain and enable the player to return to sport (RTS) and return to performance (RTP). Purpose: To determine the RTS and RTP rates for ice hockey players at the professional and subelite levels after hip arthroscopy for FAIS. Study Design: Case series; Level of evidence, 4. Methods: High-level ice hockey players who underwent hip arthroscopy for FAIS between 2011 and 2019 were identified using a local hip arthroscopy registry. The player's level was confirmed with ice hockey-specific web pages and was stratified as subelite or professional. Data on the players' careers were extracted from these web pages. Player position was divided into goalkeepers, defensemen, and forwards. Data on participation in games included the season before onset of symptoms, the season before surgery, and the first and second seasons after surgery. RTS was defined as returning to ice hockey after surgery, and RTP was considered as returning to the same league at a comparable level to before symptoms. Results: A total of 80 ice hockey players were included. Comparing presymptom performance with the first season after surgery, the RTS rate was 72%, of which 94% of the players returned to the same or higher level of play. Comparing the presurgery season with the first season after surgery, the RTS rate was 78%. At the second season after surgery, 64% of players still played ice hockey, with a significantly higher return rate among professional players compared with subelite players (96% vs 69%; P = .014). Overall, 85% goalkeepers, 74% forwards, and 60% defensemen returned to sport. Only 28% played at least the same number of games during the first season after surgery as they did during the presymptom season. Conclusion: High-level ice hockey players who underwent hip arthroscopy for FAIS had a high RTS rate, in which the majority returned to the same league. However, only 28% played the same number of games the first season after surgery as they did at the presymptom level. Professional ice hockey players returned more frequently than players on the subelite level.

Protocol for a multicenter prospective cohort study evaluating arthroscopic and non-surgical treatment for microinstability of the hip joint.

BACKGROUND: Microinstability of the hip joint is a proposed cause of hip pain and reduced function in young individuals. The underlying mechanism is thought to be extraphysiological hip motion due to bony deficiency and/or soft tissue deficiency or decreased soft tissue function. Recently, the condition has gained increased attention, and despite the fact that treatment today includes both non-surgical and surgical approaches, there is limited evidence on diagnostic specificity and treatment effects. The aim of this study is to evaluate clinical outcomes of both non-surgical and surgical treatment for microinstability of the hip joint. METHODS: A multicenter prospective cohort study is planned to evaluating the outcome of physical therapy aimed at stabilizing the hip joint, as well as arthroscopic plication of the hip joint capsule, if the physical therapy fails. Outcomes will be evaluated using hip-specific patient-reported outcome measures: the short version of the International Hip Outcome Tool and the Copenhagen Hip and Groin Outcome Score, strength and function tests, health-related quality of life as determined using the European Quality of Life-5 Dimensions and the European Quality of Life-Visual Analog Scale, sports activity levels according to the Hip Sport Activity Scale, and reported complications. Patients will be evaluated at 6, 12 and 24 months after each treatment. DISCUSSION: It is important to evaluate the clinical outcomes of both non-surgical and surgical treatment for suspected microinstability of the hip joint, and the planned prospective evaluation will contribute to the understanding of non-surgical as well as surgical treatment outcomes, including complications. TRIAL REGISTRATION: Clinicaltrials.gov: NCT04934462 . Registered June 22 2021.

More anatomic tunnel placement for anterior cruciate ligament reconstruction by surgeons with high volume compared to low volume.

PURPOSE: Correct placement of the femoral and tibial tunnels in the anatomic footprint during anterior cruciate ligament reconstruction (ACLR) is paramount for restoring rotatory knee stability. Recent studies have looked at surgeon volume and its outcomes on procedures such as total knee arthroplasty and infection rates, but only few studies have specifically examined tunnel placement after ACLR based on surgeon volume. The purpose of this study was to compare the placement of femoral and tibial tunnels during ACLR between high-volume and low-volume surgeons. It was hypothesized that high-volume surgeons would have more anatomic tunnel placement compared with low-volume surgeons. METHODS: A retrospective review of all ACLR performed between 2015 and 2019 at an integrated health care system consisting of both academic and community hospitals with 68 orthopaedic surgeons was conducted. Surgeon volume was categorized as less than 35 ACLR per year (low volume) and 35 or more ACLR per year (high volume). Femoral tunnel placement for each patient was determined using an exact strict lateral radiograph (less than 6 mm of offset between the posterior halves of the medial and lateral condyles) taken after the primary ACLR using the quadrant method. The centre of the femoral tunnel was measured in relation to the posterior-anterior (PA) and proximal-distal (PD) dimensions (normal centre of anatomic footprint: PA 25% and PD 29%). Tibial tunnel placement for each patient was determined on the same lateral radiographs by measuring the mid-sagittal tibial diameter and the centre of the tibial attachment area of the ACL from the anterior tibial margin (normal centre of anatomic footprint: 43%). Each lateral radiograph was reviewed by one of two blinded reviewers. RESULTS: A total of 4500 patients were reviewed, of which 645 patients met all the inclusion/exclusion criteria and were included in the final analysis. There were 228 patients in the low-volume group and 417 patients in the high-volume group. Low-volume surgeons performed a mean of 5 ACLRs per year, whereas surgeons in the high-volume group performed a mean of 40 ACLRs per year. In the PA dimension, the low-volume group had significantly more anterior femoral tunnel placement compared with the high-volume group (32 ± 10% vs 28 ± 9%, p < 0.01). In the PD dimension, the low-volume group had statistically significant more proximal femoral tunnel placement compared to the high-volume group (32 ± 9% vs 35 ± 9%, p < 0.01). For the tibial tunnel, the low-volume group had significantly more posterior tibial tunnel placement compared with the high-volume group (41 ± 10% vs 38 ± 7%, p < 0.01). CONCLUSION: Low-volume surgeons placed their femoral tunnels significantly more anterior and proximal (high) during ACLR, and placed their tibial tunnels significantly more posterior, compared with high-volume surgeons. Prior research has indicated that anatomic placement of the femoral and tibial tunnels during ACLR leads to improved rotatory knee stability. The findings of this study demonstrate the importance of surgical volume and experience during ACLR. LEVEL OF EVIDENCE: III.