Arthroscopic Hip Capsular Repair Improves Patient-Reported Outcome Measures and Is Associated With a Decreased Risk of Revision Surgery and Conversion to Total Hip Arthroplasty.

Purpose: To perform a systematic review to assess the effect of capsular repair compared with nonrepair on patient-reported outcome measures (PROMs) and conversion to total hip arthroplasty (THA) after hip arthroscopy in patients with femoroacetabular impingement syndrome. Methods: We initially searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PubMed databases, as well as ongoing clinical trials (https://clinicaltrials.gov), on December 15, 2022. The eligibility criteria were randomized controlled trials (Level Ⅰ) and prospective comparative studies (Level II) of patients who underwent capsular repair and nonrepair via hip arthroscopy with a minimum follow-up period of 2 years. We registered this protocol a priori on PROSPERO (identification No. CRD42021239306). We assessed the risk of bias using the Methodological Index for Non-randomized Studies (MINORS) appraisal tool. Results: This review included 5 studies with a total of 639 patients (270 with capsular repair [average age, 35.4 years; 41% female patients] and 369 with nonrepair [average age, 37.3 years; 38% female patients]). In the included studies, surgical procedures consisting of labral repair and pincer or cam osteoplasty were performed via hip arthroscopy. The modified Harris Hip Score was measured in all the included studies, and the standardized mean difference in PROMs for capsular repair versus nonrepair in the included studies was 0.42 (95% confidence interval [CI], 0.20 to 0.63). A sensitivity analysis of randomized controlled trials achieved consistent results (standardized mean difference in PROMs, 0.31; 95% CI, 0.02 to 0.60). Capsular repair was not associated with a reduction in revision surgery (risk difference, -0.02; 95% CI, -0.06 to 0.03; 26 of 270 patients with capsular repair vs 42 of 369 with nonrepair) but was associated with a reduction in conversion to THA (risk difference, -0.05; 95% CI -0.09 to -0.01; 12 of 270 patients with capsular repair vs 38 of 369 with nonrepair). The average Methodological Index for Non-randomized Studies (MINORS) score in the included studies was 20. Conclusions: Patients who undergo capsular repair in conjunction with other arthroscopic hip preservation techniques have better PROMs and a lower incidence of THA conversion. Level of Evidence: Level II, systematic review of Level I and II investigations.

Retraction: Differences between the Craig's test and computed tomography in measuring femoral anteversion in patients with anterior cruciate ligament injuries.

[This retracts the article on p. 365 in vol. 32 PMCPMC7276780.].

Effect of gait training using Hybrid Assistive Limb on gait ability and the risk for overwork weakness in the lower limb muscles in patients with neuromuscular disease: a proof-of-concept study.

BACKGROUND: Few previous studies have reported the efficacy of robot rehabilitation for improving gait ability or its adverse events in patients with neuromuscular diseases. AIM: The aim of the present study was to elucidate the effects of gait training with a hybrid assistive limb (HAL) on gait ability and to investigate serum enzyme levels associated with skeletal muscle damage. DESIGN: Proof-of-concept study. SETTING: Department of rehabilitation medicine in university hospital. POPULATION: Twenty-one patients with neuromuscular disease (NMD, 13 males and 8 females, mean age of 60.6 years). METHODS: All patients underwent 1 to 5 series of gait rehabilitation which consisted of 9 sessions of HAL training. Gait ability was assessed with the 10-meter walk test and the 2-min walk test before and after HAL training, while serum creatine phosphokinase, aspartate aminotransferase, and lactic acid dehydrogenase values were measured before, midway through, and after HAL training. RESULTS: Gait velocity and step length for 10-meter walk test, and 2-min walk distance were significantly improved after HAL gait training. There was no significant change in serum level of all 3 measured enzymes between the three time points. CONCLUSIONS: HAL gait training with the practical setting as this study improved gait ability in patients with progressive NMD and did not damage skeletal muscle, as indicated by no significant change in serum level of muscle enzymes. CLINICAL REHABILITATION IMPACT: Robot assisted gait training could be safely applied to the patients with NMD, as one of the effective rehabilitation programs to improve gait ability.

Effects of gait training with a voluntary-driven wearable cyborg, Hybrid Assistive Limb (HAL), on quality of life in patients with neuromuscular disease, able to walk independently with aids.

Robot-assisted gait training using a voluntary-driven wearable cyborg, Hybrid Assistive Limb (HAL), has been shown to improve the mobility of patients with neurological disorders; however, its effect on the quality of life (QOL) of patients is not clear. The aim of this study was to assess the effects of HAL-assisted gait training on QOL and mobility in patients with neuromuscular diseases (NMDs). Ten patients with NMDs (seven men and three women, mean age: 57 ± 11 years), with impairment in mobility but could walk alone with aids underwent two courses of gait training with HAL over 6 months, and the single course consisted of nine sessions of training for 4 weeks. We compared the findings of the 2 min walk test, 10 m walk test, the Short Form-36 (SF-36) questionnaire, and the Hospital Anxiety and Depression Scale at baseline, after the 1st training, before the 2nd training, and after the 2nd training using the Friedman test. A significant improvement was observed in the 2 min walking distance from baseline (93 ± 50 m) to after the 2nd training (115 ± 48 m, P = 0.034), as well as in the domains of vitality (P = 0.019) and mental component summary score (P = 0.019) of SF-36. The improvement in 10 m walking speed was significantly correlated with that in the physical functioning (R = 0.831, P = 0.003) and role physical (R = 0.697, P = 0.025) domains in the SF-36. Our findings suggest that HAL-assisted gait training is effective in improving QOL associated with mental health as well as gait ability in selected patients with NMDs.

Differences between the Craig's test and computed tomography in measuring femoral anteversion in patients with anterior cruciate ligament injuries.

[Purpose] This study aimed to compare the Craig's test and computed tomography (CT) in measuring the femoral anteversion angle (FAA) in patients with anterior cruciate ligament (ACL) injuries. The relationship between the FAA measured on CT, and the range of axial rotation of the hip joint and muscle tightness around the hip joint was also investigated. [Participants and Methods] Twenty-six patients who received CT examination within 3 months after ACL reconstruction were enrolled in this study. The Craig's test, internal and external rotation of the hip, the Ely test, Ober's test, and FAA on the CT were assessed. [Results] The FAA on the Craig's test and CT in female patients was 24.3 ± 3.9° and 23.0 ± 10.3°, respectively on the uninjured side and 25.0 ± 5.2° and 20.3 ± 11.2°, respectively on the injured side, indicating no significant correlation between the 2 measurement techniques. In contrast, the FAA on the CT was significantly correlated with the range of internal rotation of the hip, which was 40.5 ± 6.1° on the uninjured side and 37.8 ± 5.6° on the injured side. [Conclusion] The results suggest that measuring the internal hip rotation range rather than the Craig's test, provides more reliable estimates of the magnitude of FAA, and may help to evaluate the risk of ACL injuries in female athletes.

The effects of ball impact position on shoulder muscle activation during spiking in male volleyball players.

BACKGROUND: The ball impact position during spiking in volleyball may influence the pattern of activation of shoulder girdle muscles and, therefore, could be a significant risk factor for shoulder injury. METHODS: Activation of 10 muscles in the dominant shoulder was evaluated using surface electromyography (EMG) in 11 male volleyball players, during spiking in a static standing position, with the goal being to precisely control the specified ball impact positions, without a run-up or ball setting. The following 4 ball impact positions were evaluated: standard, posterior, medial, and lateral. The EMG amplitude, normalized to the maximal voluntary isometric contraction of the respective muscles, was compared for each phase of the spiking movement between the standard position and the other 3 different impact positions, using the Dunnett test. RESULTS: The following between-position differences were noted for the deltoid muscle: increased activation of the anterior deltoid during the acceleration phase for the posterior position (P = .041), increase in the posterior deltoid during the acceleration phase for the lateral position (P = .04), and increase in the middle deltoid during the deceleration phase for the lateral position (P = .005). CONCLUSION: A posterior or lateral shift in the position of ball impact may cause an increase in the activity of the deltoid muscle that would cause a decrease in the centripetal force of the humeral head through the acceleration and deceleration phases. As such, neuromuscular exercises, combined with strengthening of the rotator cuff muscle, might reduce the risk of shoulder injury during performance of the volleyball spiking movement.

Glenohumeral Rotational Deficit and Suprascapular Neuropathy in the Hitting Shoulder in Male Collegiate Volleyball Players.

OBJECTIVE: Repetitive overhead movements stress the dominant shoulder of volleyball players, potentially causing glenohumeral internal rotation deficit (GIRD) and suprascapular neuropathy. The aim of this study was to determine the prevalence of pathological GIRD and suprascapular neuropathy in male collegiate volleyball players. METHODS: We evaluated 22 male collegiate volleyball players and compared the range of motion, the isometric shoulder strength, the thickness of the infraspinatus (ISP) muscle, and the latency and amplitude of the suprascapular nerve [in a nerve conduction study (NCS)] between the hitting and contralateral shoulders. Correlations between the physical findings and each parameter were also determined. RESULTS: The internal rotation angle of the hitting shoulder (55.1±8.7°) was significantly less than that of the contralateral shoulder (64.5±10.2°) (P<0.001); pathological GIRD (≥20°) was found in four players (18.2%). Three players (13.6%) showed abnormal electrophysiological findings of the suprascapular nerve on the ISP muscle in the hitting shoulder. The external-to-internal rotation (ER/IR) torque ratio in the hitting shoulder (99±18%) was significantly lower than that in the contralateral shoulder (106±12%) (P=0.04); no significant differences were observed in ISP muscle thickness or NCS data between the hitting and contralateral shoulders. CONCLUSION: The prevalence of pathological GIRD in male collegiate volleyball players was consistent with that of previous studies. Meanwhile, the prevalence of suprascapular neuropathy was less than that previously reported in high-level volleyball players. Preventive posterior rotator cuff strengthening programs are recommended to correct imbalances between ER and IR in the hitting shoulder, thereby decreasing the risk of shoulder injury.

Can arthroscopic Bankart repairs using suture anchors restore equivalent stability to open repairs in the management of traumatic anterior shoulder dislocation? A meta-analysis.

BACKGROUND: Recently, arthroscopic Bankart repairs have become much more popular than open repairs for the treatment of recurrent anterior shoulder instability. However, it is unclear whether the modern arthroscopic Bankart repairs using suture anchors could restore equivalent stability to open repairs. We conducted a meta-analysis to compare arthroscopic Bankart repairs using suture anchors and open repairs in regard to clinical outcomes. METHODS: A literature review was performed according to the PRISMA guidelines. PubMed was searched from January 1966 to January 2017. Studies were identified using the terms 'anterior shoulder dislocation' or 'recurrent anterior shoulder dislocation' and 'Bankart repair'. The search yielded 36 publications. After reading the full-text articles, we included four randomized controlled trials and five retrospective studies that compared arthroscopic and open repairs using suture anchors. RESULTS: No significant differences were found between the two procedures in frank re-dislocation and revision surgery due to recurrence. However, the overall recurrent instability including not only re-dislocation but also subluxation and apprehension was significantly higher in arthroscopic repairs than in open repairs, while a significantly higher Rowe score and lower loss of external rotation at 90° of abduction were observed following arthroscopic repairs compared to open repairs. CONCLUSIONS: Modern arthroscopic Bankart repairs using suture anchors provide an equivalent outcome compared to open repairs in terms of apparent re-dislocation, but overall recurrent instability including subluxation or apprehension was still significantly higher in arthroscopic repairs than in open repairs.

Intraoperative comparison of knee laxity between anterior cruciate ligament-reconstructed knee and contralateral stable knee using navigation system.

PURPOSE: The objective of this study was to compare knee laxity between anterior cruciate ligament (ACL)-reconstructed knees and contralateral stable knees by use of intraoperative navigation. METHODS: Five patients with ipsilateral ACL-deficient knees with contralateral stable knees without any ligament injuries were included in this study. Anteroposterior (AP) knee laxity during anterior drawer force applied manually and range of tibial rotation and AP knee laxity during internal and external rotational torque applied manually in both the ACL-deficient knee and the contralateral stable knee were measured by use of a navigation system from 15 degrees to 90 degrees of knee flexion. After the temporary fixation of the posterolateral bundle, anteromedial bundle (AMB), or double-bundle (DB) reconstruction, knee laxity was measured again and compared with that of the stable knee. RESULTS: The mean laxities for PLB reconstruction were significantly greater than those of the contralateral stable knee at more than 75 degrees of knee flexion (P < .05). The mean laxities for AMB or DB reconstruction were not significantly different from those of the contralateral stable knee at all knee flexion angles. Those for AMB reconstruction were within +1.6 mm and those for DB reconstruction were within -2.0 mm of those of the contralateral stable knee. The mean rotations for all reconstructions were significantly less than those of the contralateral stable knee at less than 30 degrees of knee flexion (P < .05). CONCLUSIONS: DB and AMB reconstructions could restore knee laxity closer to the level of the contralateral stable knee. Because normal knee laxity is different in each individual, evaluation of contralateral stable knee laxity during ACL reconstruction surgery would be helpful for restoration to the level of the specific preinjury knee laxity. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Results of arthroscopic fixation of osteochondritis dissecans lesion of the knee with cylindrical autogenous osteochondral plugs.

BACKGROUND: In situ fixation of unstable lesions of osteochondral dissecans of the knees with cylindrical osteochondral autograft transplantation has been reported to provide excellent results with healing of the osteochondral dissecans fragment. PURPOSE: To evaluate the clinical results and magnetic resonance imaging findings of the osteochondral dissecans of knees treated with in situ fixation of the osteochondral fragments with osteochondral autograft transplantation. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twelve knees (12 patients; mean age, 16.0 years) with osteochondral dissecans lesions were treated with in situ fixation with autogenous osteochondral plugs. The mean lesion size was 2.4 cm(2) (range, 1.0-4.9 cm(2)). The osteochondral dissecans lesions were located on the medial femoral condyle in 10 patients and on the lateral femoral condyle in 2 patients. Seven lesions were located in the weightbearing area. The International Cartilage Repair Society classification in arthroscopic findings was grade II in 1 patient, grade III in 8 patients, and grade IV in 3 patients. All patients were evaluated with the Hughston Rating Scale form with the mean follow-up at 4.5 years (range, 2.8-5.9 years). The interface between the osteochondral fragment and subchondral bone and changes in donor site of the osteochondral graft were evaluated with T2-weighted magnetic resonance image up to 12 months postoperatively. RESULTS: The Hughston Rating Scale scored 8 knees as excellent, 3 as good, and 1 as fair. The interface between the osteochondral fragment and subchondral bone had disappeared on magnetic resonance image by 3 months postoperatively in all cases. No complications arising from the donor site area were observed. Signal intensity of donor site changed from high signal preoperatively to homogeneous surrounding cancellous bone by 1 year postoperatively. CONCLUSION: Biological fixation of the osteochondral dissecans lesion with cylindrical osteochondral autograft provided healing of the osteochondral fragments.

Effect of the iliotibial band on knee biomechanics during a simulated pivot shift test.

The purpose of this study was to evaluate the effect of the iliotibial band (ITB) on the kinematics of anterior cruciate ligament (ACL) intact and deficient knees and also on the in situ force in the ACL during a simulated pivot shift test. A combination of 10 N-m valgus and 5 N-m internal tibial torques was applied to 10 human cadaveric knees at 15 degrees, 30 degrees, 45 degrees, and 60 degrees of flexion using a robotic/universal force-moment sensor testing system. ITB forces of 0, 22, 44, and 88 N were also applied. An 88 N ITB force significantly decreased coupled anterior tibial translation of ACL deficient knees by 32%-45% at high flexion angles, but did not have a significant effect at low flexion angles. Further, an 88 N ITB force significantly decreased in situ forces in the ACL at all flexion angles by 23%-40%. These results indicate that during the pivot shift test, the ITB can improve tibial reduction at high flexion angles while not affecting subluxation at low flexion angles. Additionally, the action of the ITB as an ACL agonist suggests that its use as an ACL graft might hinder knee stability in response to rotatory load.

Anatomical double-bundle anterior cruciate ligament reconstruction after valgus high tibial osteotomy: a biomechanical study.

BACKGROUND: Although anatomical double-bundle anterior cruciate ligament reconstruction can successfully restore normal knee biomechanics for knees with typical varus-valgus alignment, the efficacy of the same reconstruction method for knees after a valgus high tibial osteotomy is unclear. HYPOTHESIS: Anatomical double-bundle anterior cruciate ligament reconstruction for valgus knees after a high tibial osteotomy cannot restore normal knee kinematics and can result in abnormally high in situ forces in the ligament graft. STUDY DESIGN: Controlled laboratory study. METHODS: Ten cadaveric knees were subjected to valgus high tibial osteotomy followed by an anatomical double-bundle anterior cruciate ligament reconstruction. The valgus knees were tested using a robotic/universal force-moment sensor system before and after the ligament reconstruction. The knee kinematics in response to anterior tibial load and combined rotatory loads, as well as the corresponding in situ forces of the anterior cruciate ligament bundles and grafts, were compared between the ligament-intact and ligament-reconstructed valgus knees. RESULTS: After reconstruction, the anterior tibial translation and internal tibial rotation for the valgus knee decreased approximately 2 mm and 2 degrees , respectively, at low flexion angles compared with those of the anterior cruciate ligament-intact knee (P < .05). The in situ forces in the posterolateral graft became 56% to 200% higher than those in the posterolateral bundle of the intact anterior cruciate ligament (P < .05). CONCLUSION: Performing an anatomical double-bundle anterior cruciate ligament reconstruction on knees after valgus high tibial osteotomy may overconstrain the knee and result in high forces in the posterolateral graft, which could predispose it to failure. CLINICAL RELEVANCE: Modifications of anterior cruciate ligament reconstruction procedures to reduce posterolateral graft force may be needed for valgus knees after a high tibial osteotomy.

Effects of knee flexion angles for graft fixation on force distribution in double-bundle anterior cruciate ligament grafts.

BACKGROUND: In double-bundle anterior cruciate ligament reconstruction, overloading either 1 of the 2 grafts should be avoided to decrease the risk of graft failure. HYPOTHESIS: Overloading of the posterolateral graft may occur when it is fixed at 30 degrees of knee flexion because the posterolateral bundle is elongated as the knee approaches extension. STUDY DESIGN: Controlled laboratory study. METHODS: Ten human cadaveric knees were tested at (1) intact, (2) anterior cruciate ligament-deficient, (3) double-bundle anterior cruciate ligament reconstruction with the anteromedial and posterolateral grafts fixed at 60 degrees of flexion and full extension, respectively (fixation 60/FE), and (4) double-bundle anterior cruciate ligament reconstruction with both grafts fixed at 30 degrees of flexion simultaneously (fixation 30/30). Two external loading conditions simulating clinical examinations were used: (1) 134-N anterior tibial load and (2) combined rotatory loads of 10 N x m valgus and 5 N x m internal tibial torques. Data on knee kinematics and in situ forces in the 2 bundles of the intact anterior cruciate ligament and the respective grafts were obtained. RESULTS: In response to 134-N anterior tibial load, knee kinematics and in situ force in the grafts were similar to the intact knee for both fixation protocols. The force in the anteromedial graft for fixation 60/FE was 34% higher, whereas the posterolateral graft for fixation 30/30 was 46% higher, compared with the intact anteromedial and posterolateral bundles, respectively. In response to combined rotatory loads, the posterolateral graft for fixation 30/30 carried 67% higher load than did the intact posterolateral bundle. CONCLUSION: Fixation 30/30 overloaded the posterolateral graft, whereas fixation 60/FE overloaded the anteromedial graft. CLINICAL RELEVANCE: In double-bundle anterior cruciate ligament reconstruction, even though overall forces in the graft are the same as intact anterior cruciate ligament, the force distributions may not be the same as the intact bundles, and overloading of 1 of the 2 grafts may occur.

Split lesions of the peroneus brevis tendon in the Japanese population: an anatomic and histologic study of 112 cadaveric ankles.

Split lesions of the peroneus brevis tendon are believed to be rare and have received little attention in populations of Asian countries. The purpose of this study was to investigate the incidence of split lesions in the Japanese population. The peroneus tendons of 112 ankles from 30 male and 26 female adult human embalmed cadavers with an average age of 76.9 years (range, 55-93) were dissected. The presence of split lesions, determined by either thinning or longitudinal splitting of the peroneus brevis tendon, was examined. Forty-two ankles (37.5%) had split lesions, of which 21 (50%) showed a thinning appearance without splitting, and 12 (28.6%) had well-defined, full-thickness longitudinal tears. The incidence of split lesions of the peroneus brevis tendon in the Japanese population was similar to that in studies of the U.S. population, but the condition of the lesions was less severe. Although the clinical presence is expected to be extremely rare, we must consider a neglected split lesion of the peroneus brevis tendon when residual pain is observed in the retrofibular location.

The effect of local and general fatigue on knee proprioception.

PURPOSE: The purpose of this study was to compare the effects of local and general fatigue loads on knee proprioception. TYPE OF STUDY: Experimental controlled study. METHODS: Proprioception of the knee joint was evaluated by measuring absolute angular error (AAE) at matching defined index angles before and after 2 different types of fatigue protocols (local load and general load) in 27 healthy male volunteers. Local load was provided with maximum isokinetic knee flexion-extension on the isokinetic dynamometer, and general load was 5 minutes running on a treadmill. RESULTS: After local load, a significant decrease in peak torque of knee flexors and extensors was found, but no significant change in AAE was seen. In contrast, after general load, a significant increase of AAE was noted without significant muscle weakness. CONCLUSIONS: The different results in previous studies evaluating the effect of fatigue on knee proprioception may have been affected by the difference of fatigue protocols, whether local or general load. Although local load was intended to produce local fatigue of the knee, which may cause dysfunction of muscle mechanoreceptors, general load may have produced general fatigue and affected other mechanisms in the proprioceptional pathway. The results of the present study suggest that decreased reproduction ability after general load is not due to the loss of peripheral afferent signals, but to other factors, especially deficiency of central processing of proprioceptive signals. CLINICAL RELEVANCE: To prevent knee injury caused by fatigue-induced proprioceptional decline, muscle endurance training alone is not enough, and neuromuscular training, including central motor programming, is essential.