What is the Role of Kinesiophobia and Pain Catastrophizing in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome?

PURPOSE: To (1) investigate trends in kinesiophobia and pain catastrophizing after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), and (2) determine whether kinesiophobia and pain catastrophizing scores are associated with achieving minimal clinically important difference (MCID) for any of the hip-specific patient-reported outcome questionnaires. METHODS: Patients undergoing primary hip arthroscopy for treatment of FAIS between December 2016 and March 2017 were prospectively enrolled. Patients received the Tampa Scale of Kinesiophoibia-11 (TSK-11) and Pain Catastrophizing Scale (PCS) questionnaires preoperatively, 6 months, and 1 year postoperatively. They also received the hip-specific patient-reported outcome questionnaires (Hip Outcome Score Activities of Daily Living and Sport-Specific subscales, modified Harris Hip Score, and International Hip Outcome Tool-12), as well as visual analog scale for satisfaction and pain preoperatively and 1-year postoperatively. The threshold for achieving MCID was determined for each hip outcome tool, and patients achieving MCID were compared with those who did not. RESULTS: A total of 85 (80.2%) patients (mean age: 33.7 ± 12.4 years; female: 75.3%) were included in the final analysis. At 1-year follow-up, there was a significant reduction in TSK-11 scores (26.22 ± 5.99 to 18.70 ± 6.49; P < .001) and PCS scores (17.81 ± 10.13 to 4.77 ± 7.57; P < .001) when compared with preoperative scores. 1-year PCS scores were significantly lower in patients achieving MCID compared with patients failing to achieve MCID (3.2 ± 4.4 vs 10.8 ± 15.2; P = .006). There were no significant differences in TSK-11 scores between those achieving and not achieving MCID. CONCLUSIONS: Patient kinesiophobia and pain catastrophizing both show significant improvements 1 year after undergoing hip arthroscopy for FAIS. However, pain catastrophizing scores at 1 year are significantly greater in patients not achieving MCID, whereas no association was identified between kinesiophobia and likelihood for MCID achievement. This suggests PCS may be a more useful tool than TSK-11 during postoperative rehabilitation for identifying patients at risk for not achieving MCID. LEVEL OF EVIDENCE: Level II, prospective case series.

Primary Arthroscopic Repair of a Traumatic Isolated Subscapularis Tendon Rupture in an Adolescent Patient.

Subscapularis tendon tears in the pediatric population are most commonly associated with an avulsion fracture of the lesser tuberosity. Isolated subscapularis tendon ruptures are infrequently reported. According to previous reports, the diagnosis of subscapularis tendon injuries in pediatric patients is often delayed and management is typically conservative. When operative management is indicated, an open deltopectoral approach has been used and may include concomitant open reduction and internal fixation of the lesser tuberosity. The authors report the case of a healthy 15-year-old boy who had an isolated subscapularis tendon rupture. During operative management, labral tape sutures were passed through the subscapularis tendon at the junctions of the inferior one-third and superior two-thirds, along with the superior one-third and inferior two-thirds. Both suture limbs were implanted with a 4.75-mm polyetheretherketone suture anchor within the inferior one-third and superior one-third of the lesser tuberosity footprint. A mini-open subpectoral biceps tenodesis was also performed through an axillary incision. By 8 months postoperatively, the patient exhibited normal function with full range of motion and was allowed to return to sport-related activity. [Orthopedics. 2020;43(3):e182-e186.].

High Rate of Return to Yoga for Athletes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

BACKGROUND: Femoroacetabular impingement syndrome (FAIS) is most commonly diagnosed in patients who perform activities that require repetitive hip flexion and rotational loading. Yoga is an activity growing in popularity that involves these motions. The purpose of this study was to evaluate patients' ability to return to yoga after hip arthroscopy for FAIS. HYPOTHESIS: There would be a high rate of return to yoga after hip arthroscopy. STUDY DESIGN: Retrospective analysis. LEVEL OF EVIDENCE: Level 4. METHODS: Consecutive patients with FAIS who had identified themselves as participating in yoga and had undergone hip arthroscopy for the treatment of FAIS between 2012 and 2015 were reviewed. Demographic data were collected and assessed for all patients, as well as preoperative physical examination, imaging, and patient-reported outcome (PRO) scores, including the modified Harris Hip Score (mHHS), Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sports-Specific (HOS-SS) subscales, and visual analog scale (VAS) for pain. Postoperatively, examination and PRO data were collected at a minimum 1 year after surgery, including a yoga-specific questionnaire. RESULTS: A total of 42 patients (90% female; mean age, 35 ± 9 years; mean body mass index, 23.1 ± 3.2 kg/m2) were included. Thirty patients (71%) had to discontinue their yoga routine preoperatively because of hip-related symptoms at a mean 9.5 ± 8.2 months before surgery. After surgery, 39 patients (93%) were able to return to yoga at a mean 5.3 ± 2.2 months after surgery. Two of the 3 patients who did not return to yoga noted loss of interest as their reason for stopping, while 1 patient was unable to return because of persistent hip pain. Nineteen patients (45%) returned to a higher level of yoga practice, 17 patients (40%) returned to the same level, and 3 patients (7%) returned to a lower level. There was no difference in the number of hours spent practicing yoga per week pre- and postoperatively (2.7 ± 1.9 vs 2.5 ± 1.3 hours; P = 0.44). All patients demonstrated significant improvement in all PROs as well as pain scores after surgery (HOS-ADL, 67.4 ± 18.3 to 93.1 ± 6.9 [ P < 0.001]; HOS-SS, 45.6 ± 24.7 to 81.5 ± 18.8 [ P < 0.001]; mHHS, 62.3 ± 11.3 to 86.8 ± 12.3 [ P < 0.0001]; VAS pain, 6.3 ± 2.2 to 0.90 ± 1.1 [ P < 0.001]). CONCLUSION: Patients participating in yoga return to yoga 93% of the time and at a mean 5.3 ± 2.2 months after hip arthroscopy for FAIS. CLINICAL RELEVANCE: Information regarding surgical outcomes is critical in counseling patients, particularly female athletes, on their expectations with respect to returning to yoga after hip arthroscopy for FAIS.

Structure-activity relationships of antibacterial and biocompatible copolymers.

The development of polymers that are both bactericidal and biocompatible would have many applications and are currently of research interest. Following the development of strongly bactericidal copolymers of 4-vinylpyridine and poly(ethylene glycol) methyl ether methacrylate, biocompatibility assays have been completed on these materials to measure their potential biocompatibility. In this article, a new methodology for measuring protein interaction was developed for water-soluble polymers by coupling proteins to surfaces and then measuring the adsorption of copolymers onto these surfaces. Ellipsometry was then used to measure the thickness of adsorbed polymers as a measurement of biocompatibility. These results were then compared and correlated with the results of other biocompatibility assays previously conducted on these polymers, affording a greater understanding of the biocompatibility of the copolymers as well as improving the understanding of the effect of hydrophilic and hydrophobic groups that is vital for the development of these materials.

Hemocompatibility of hydrophilic antimicrobial copolymers of alkylated 4-vinylpyridine.

Quaternized poly(vinylpyridine) (PVP) is a polymer with inherent antimicrobial properties that is effective against Gram-positive bacteria, Gram-negative bacteria, viruses, and yeast cells. However, quaternized PVP has poor biocompatibility, which prevents its use in biomaterial applications. Copolymerization was examined as a method of modifying the structure to incorporate biocompatibility. Polyethyleneglycol methyl ether methacrylate (PEGMA) and hydroxyethyl methacrylate (HEMA) are polymers generally known to be biocompatible and thus were chosen as comonomers. Random copolymers of 4-vinylpyridine and PEGMA or HEMA were synthesized via free radical polymerization and quaternized with bromohexane. Copolymer biocompatibility was characterized by interaction with human red blood cells to analyze hemolysis. Hemolysis of human red blood cells was conducted on insoluble films and on water-soluble polymers in a serial dilution study. Hemolysis results demonstrated that blood compatibility does not depend on PEG chain length in PEGMA incorporated copolymers. Results indicate a critical weight ratio of PEGMA to VP in copolymers separating the no-hemolysis regime from 100% hemolysis.

Synergistic activity of hydrophilic modification in antibiotic polymers.

Quaternized poly(vinylpyridine) is known to kill up to 99% of drug-resistant gram-positive and -negative bacteria but shows minimal biocompatibility. We report enhanced bactericidal activity of vinylpyridine through copolymerization with hydroxyethyl methacrylate and poly(ethylene gycol) methyl ether methacrylate. Copolymers with increasing comonomer content were synthesized by radical polymerization and quaternized with hexylbromide. We assessed the effects of the changes in polymer composition on the bactericidal activity of the surface activity using a bioluminescent pathogenic strain of Escherichia coli (O157:H7). By recording the photoluminescence emitted by these bacteria in contact with the copolymers, it was shown that several of the copolymers possess better antibacterial efficiency than quaternized poly(vinylpyridine). Results indicate that several of the copolymers synthesized possess antibacterial activity approximately 20 times greater than the pure quaternized poly(vinylpyridine) homopolymer, while only containing 1 wt % hexylated pyridinium. This behavior is explained by the increased surface wettability of the copolymers containing lesser amounts of poly(vinylpyridine), as bactericidal behavior correlates to the hydrophilicity of the system as measured by contact angles. A hydrophilicity based design-paradigm can significantly improve both the efficacy and the biocompatibility of antibacterial materials.