RESUMO
PURPOSE: The purpose of this study was to determine if severe lateral patella facet osteoarthritis (LPFOA) was related to lower survivorship and poor patient-reported outcomes following fixed-bearing lateral unicompartmental knee arthroplasty (UKA). METHODS: There were 61 patients who underwent a fixed-bearing, non-robotically assisted, lateral UKA between May 7, 2003 and December 18, 2019 and met the inclusion criteria. The patello-femoral joint was examined intraoperatively for chondral damage prior to UKA implantation. Severe LPFOA was defined as Outerbridge grade 3 or 4 changes on the lateral facet. All patients completed subjective functional outcomes questionnaires and a clinical exam at a minimum of 4 years following UKA. RESULTS: Severe LFPFOA was identified in 28 (46%) patients. At a mean follow-up of 10.9 years, there were no significant differences in any Knee Osteoarthritis Outcomes Score (KOOS ) subscale or Kujala scores between patients who had and did not have severe LFPOA. There was no significant difference in the percentage of patients who achieved Patient Acceptable Symptom State (PASS) for the KOOS subscales between groups. Mean survival in patients who did not have severe LFPFOA was 16.6 years [95% CI (confidence interval), 15.4 to 17.7] compared to 18.9 years [95% CI, 17.6 to 20.2] in patients who had severe LFPFOA (P = 0.62). CONCLUSION: Severe LFPFOA did not result in lower survival or inferior functional outcomes compared to patients who did not have severe OA at average 10-year follow-up after fixed-bearing lateral UKA.
RESUMO
BACKGROUND: Anterior cruciate ligament (ACL)-deficient knees are no longer considered a contra-indication for unicompartment knee arthroplasty (UKA). The purpose of this study was to determine if patients who had an ACL-deficient knee who underwent lateral UKAs had similar mean 10-year outcomes compared to ACL-intact lateral UKA knees. METHODS: Patients who underwent a lateral UKA with ACL deficiency by a single surgeon between 2004 and 2016, were identified. Preoperative magnetic resonance images (MRI) were utilized to identify a torn or absent ACL in all knees. The absence of an ACL was confirmed during arthroscopy prior to UKA. Patients were matched 1:2 based on age and sex with patients who underwent lateral UKA where the ACL was intact. The primary patient-reported outcome variable was survival without conversion to total knee arthroplasty. Secondary outcomes included Veterans Rand (VR)-12, the Lysholm score, the Knee Osteoarthritis Outcome Score (KOOS) Activities of Daily Living subscale, and Sport subscale. A power analysis showed that 14 patients were needed to identify differences of 10 points on the KOOS score with a power of 80%(p=0.05). RESULTS: The cohort of ACL-deficient lateral UKA patients included 4 men and 12 women (43 to 82 years of age). The matched control group included 32 patients. The mean age of both groups was 67 years (range, 43 to 85). There were two patients in the ACL-deficient group who failed. At 10 years, survivorship in the ACL-deficient group was 85%, while survival in the ACL-intact group was 100% (P = 0.035). At an average follow-up of 11 years (range, 4 to 19.6), there was no difference in outcome scores between ACL-deficient and ACL-intact patients. CONCLUSION: Fixed-bearing lateral UKA in the ACL-deficient knee resulted in lower survival compared to patients who had an intact ACL. Patient-reported outcomes were similar in both groups. The ACL-deficient patient who wishes to undergo lateral UKA should be counseled on the lower survival.
RESUMO
Background: While prevention protocols have been implemented, skiing-related musculoskeletal injuries and concussions continue to present to emergency departments in the United States. Previous literature has suggested the pediatric population may constitute up to 40% of skiing-related injuries. Purpose: To assess injury trends and the underlying mechanisms of skiing injuries in pediatric patients seen at emergency departments in the United States. Study Design: Descriptive epidemiology study. Methods: The National Electronic Injury Surveillance System (NEISS) was queried for pediatric (age ≤18 years) skiing injuries between January 1, 2012, and December 31, 2022. Injury mechanism, location, disposition, and diagnosis were recorded, and the statistical sample weight assigned by NEISS by hospital was used to calculate national estimates (NEs). Injury trends were evaluated with linear regression analysis. Results: Overall, 2951 pediatric skiing injuries were included (NE = 123,386). The mean age of the patients was 12.4 ± 3.5 years, with 61.3% of the injuries occurring in male patients. Impact with the ground was the most common injury mechanism (NE = 87,407; 70.8%). Fractures were the most common diagnosis (NE = 38,527, 31.2%), followed by strains/sprains (NE = 22,562, 18.3%), contusions/abrasions (NE = 16,257, 13.2%), and concussions (NE = 12,449, 10.1%). The lower leg was the most common fracture site (NE = 9509, 24.7%), followed by the shoulder (NE = 7131, 18.5%) and lower arm (NE = 5876, 15.3%). Analysis of annual injuries revealed no significant trend between 2012 and 2022 (P = .17), with fluctuations apparent throughout the study period. Significant decreases were seen in strains/sprains (P < .01) and contusions/abrasions (P < .01), but not in concussions (P = .57) or fractures (P = .70). Conclusion: Impacts with the snow/ground made up 70.8% of all injuries. Fractures were the most common injury diagnosis, followed by strains/sprains, with the lower leg being most frequently fractured. While strains/sprains and contusions/abrasions showed a significant decline, there were no significant trends in fractures and concussions between 2012 and 2022.
RESUMO
PURPOSE: The purpose of this study was to determine if preoperative mental health status improves following unicompartmental knee arthroplasty (UKA) in patients with single compartment knee osteoarthritis (OA). METHODS: A total of 163 patients underwent UKA [115 (71%) medial, 48 (29%) lateral] (mean age = 65 ± 11) completed preoperative and minimum 2-year postoperative veterans RAND 12 item health survey (VR-12) mental component score (MCS). VR-12 MCS was the primary outcome measure. Secondary measures included VR-12 physical component summary score (PCS), knee osteoarthritis outcome score (KOOS) and KOOS patient acceptable symptom state at the final follow-up. RESULTS: The median VR-12 MCS improved from 50.5 [interquartile range (IQR): 43.7-56.8] to 55.0 [IQR: 52.3-57.0] (p < 0.001) at a mean follow-up of 9.5 ± 4 years (range 2-19 years) following UKA. Preoperative VR-12 MCS was significantly correlated with patients postoperative VR-12 PCS (ρ = 0.294, p < 0.01), KOOS pain (ρ = 0.201, p = 0.012), KOOS ADL (ρ = 0.243, p = 0.002) and KOOS quality of life (ρ = 0.233, p < 0.01). Sixty-three (39%) patients improved from low VR-12 MCS (<50) to normal VR-12 MCS (≥50). One hundred forty-two (87%) achieved a normal VR-12 MCS score (≥50) postoperatively. CONCLUSION: At a mean of 10-year follow-up, patients who underwent UKA for single compartment osteoarthritic knee pain demonstrated significant improvement in mental health scores. UKA resulted in normal mental health in a majority of patients (87%). The resultant improved mental health scores were associated with improved patient pain and activities of daily living. LEVEL OF EVIDENCE: Level III retrospective cohort study.
Assuntos
Artroplastia do Joelho , Saúde Mental , Osteoartrite do Joelho , Humanos , Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Resultado do Tratamento , Estudos Retrospectivos , Qualidade de VidaRESUMO
PURPOSE: To compare return to sport, functional outcomes, recurrence of instability, and osteoarthritis (OA) between collision/contact and limited/noncontact athletes following arthroscopic labral reconstruction with a modified inferior capsular shift for anterior shoulder instability. METHODS: Athletes underwent an arthroscopic labral reconstruction with a modified inferior capsular shift by the senior author between 1999 and 2018. Inclusion criteria were labral stripping from 12 (just beyond the biceps anchor) to 6 o'clock, less than 20% glenoid bone loss, active sports participation, and no previous surgery. Athletes were divided into collision/contact and limited/noncontact groups. Outcome measures, physical examination, and radiographic evaluation were collected at a minimum 5-year follow-up. Reoperations or any subjective laxity were considered failures. Radiographs were analyzed for OA using the Samilson-Prieto Radiological Classification. RESULTS: Ninety-two patients underwent arthroscopic labral reconstruction with a modified inferior capsular shift. Sixty-four met the inclusion criteria. Thirty-eight (age = 26.0 ± 8.0 years) participated in at least 1 collision/contact sport, and 26 (age = 38.0 ± 9.0 years) participated in limited/noncontact sports. Two (5%) collision/contact and 3 (12%) limited/noncontact athletes had traumatic reinjury requiring revision surgery. Of the remaining athletes (59/64), minimum 5-year follow-up was obtained on 54 (92%), with a mean follow-up of 12 ± 4 years (range 5-23 years). All athletes returned to their original sport at the same level. There was no significant difference between collision/contact and limited/noncontact athletes in timing of return to sports (5.2 ± 1.9 and 6.0 ± 3.1 months, respectively; P = .389). There were no significant differences between groups on any outcomes scores. CONCLUSIONS: Arthroscopic labral reconstruction with a modified inferior capsular shift addressed anterior instability with return to sport for both collision/contact and limited/noncontact athletes with excellent functional and clinical outcomes, full shoulder range of motion, and a low prevalence of advanced OA at minimum 5-year follow-up. This modified technique resulted in a low failure rate in both limited/noncontact and collision/contact athletes.
RESUMO
BACKGROUND: Lateral facet patellar osteoarthritis (LFPOA) has been reported as a contraindication for medial unicompartmental (UKA). The purpose of this paper was to determine if severe LFPOA was related to lower survivorship and patient-reported outcomes following medial UKA. METHODS: A total of 170 medial UKAs were performed. Severe LFPOA was defined as Outerbridge grade 3 to 4 damage on the lateral facet cartilage surfaces of the patella as noted intraoperatively. There were 122 of 170 patients (72%) who had noLFPOA and 48 of 170 patients (28%) who had had severe LFPOA. A routine patelloplasty was performed in all patients. Patients completed the Veterans RAND 12-Item Health Survey (VR-12) Mental Component Score (MCS) and Physical Component Score (PCS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Knee Society Score. RESULTS: There were 4 patients in the noLFPOA group who required total knee arthroplasty and 2 in the LFPOA group. There was no significant difference in mean survival time: noLFPOA = 17.2 years [95% confidence interval (CI): 17 to 18] and LFPOA = 18.0 years [95% CI: 17 to 19] (P = .94). At mean follow-up of 10 years, there were no significant differences in knee flexion or extension. Patello-femoral crepitus without pain was noted in 7 patients who had LFPOA and 21 patients who had noLFPOA. There were no significant differences in VR-12 MCS, PCS, KOOS subscales, or Knee Society Score between groups. Patient acceptable symptom state (PASS) was achieved in 80% (90 of 112) for KOOS ADL in the noLFPOA group and 82% (36 of 44) in the LFPOA group (P = .68). PASS was achieved in 82% (92 of 112) for KOOS Sport in the noLFPOA group and 82% (36/44) in the LFPOA group (P = .87). CONCLUSION: At a mean of 10 years, patients who had LFPOA had equivalent survivorship and functional outcomes to patients who did not have LFPOA. These long-term results suggest that asymptomatic grade 3 or 4 LFPOA is not a contraindication to medial UKA.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Patela , Humanos , Patela/cirurgia , Seguimentos , Estudos Retrospectivos , Osteoartrite do Joelho/cirurgiaRESUMO
BACKGROUND: Return to sport is essential information when an athlete contemplates surgical intervention. Young athletes, <30 years of age, may undergo complex cartilage procedures or femoral/tibial osteotomies to successfully treat single-compartment knee osteoarthritis. Unicompartmental knee arthroplasty (UKA) may offer an attractive alternative option to middle-aged/older athletes with timely return to the same sport without a lengthy rehabilitation. PURPOSE: The purpose of this study was to determine if athletes are able to return to the same level of vigorous and moderate sports after fixed-bearing intramedullary nonrobotic UKA and the specific sports activities that these athletes continued to participate in at a minimum of 5 years. We hypothesized that UKA in the appropriately selected middle-aged/older athlete would yield high return to sport after UKA with high patient satisfaction. We also hypothesized that UKA would allow athletes to return to their sports of choice. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We identified 245 patients who underwent a UKA by a single surgeon between 2003 and 2017. Athletes were included if they participated in vigorous or moderate sports, as defined by the American College of Sports Medicine, and had minimum 5-year follow-up. The primary outcome was return to vigorous or moderate sports after UKA. Secondary outcomes included the Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living score, KOOS Sport and Recreation score, Lysholm score, Patient Acceptable Symptom State (PASS) analysis, and radiographic analysis. RESULTS: An overall 169 athletes met the inclusion criteria and were evaluated for return to sports. A total of 98% (165/169) returned to vigorous or moderate sports participation. The mean ± SD time to return to sport was 5.2 ± 2.3 months in the 39- to 50-year-old cohort, 5.8 ± 3.2 months in athletes aged 51 to 64 years, and 5.2 ± 3.0 months in athletes aged ≥65 years. A total of 143 athletes had minimum 5-year clinical and radiographic follow-up (mean, 10 years; range, 5-19 years). Maintenance of vigorous and moderate sport was seen in 99% (142/143) of athletes at a mean 10 years. In athletes who participated in vigorous sports, the mean Lysholm score was 85 ± 17, and 83% reached the PASS for KOOS Sport and Recreation. Radiographic analysis revealed no evidence of implant loosening (ie, subsidence, radiolucency) or osteolysis, and limb alignment and posterior slope of the implant were within normal limits. CONCLUSION: Athletes returned to sport at a mean 5 months after UKA implantation, with 98% (165/169) participating in vigorous or moderate sports. UKA is recommended as an alternative procedure in middle-aged and older athletes with single-compartment osteoarthritis who are contemplating a return to vigorous or moderate sport.
Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Pessoa de Meia-Idade , Humanos , Idoso , Adulto , Artroplastia do Joelho/métodos , Volta ao Esporte , Estudos de Coortes , Atividades Cotidianas , Articulação do Joelho/cirurgia , Atletas , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Resultado do Tratamento , Estudos RetrospectivosRESUMO
Unicompartmental knee arthroplasty (UKA) has become an increasingly used procedure for patients with unicompartmental knee osteoarthritis. The success of UKA relies on appropriate patient selection and patient optimization before surgery is performed. Improved prosthesis design and surgical techniques for medial and lateral and fixed and mobile bearing UKA have also contributed to improved knee biomechanics, faster recovery, and improved outcomes. Indications, factors affecting patient selection, the role of limb alignment, and the surgical pearls for fixed and mobile bearing and medial and lateral UKA are important topics for discussion.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Desenho de Prótese , Resultado do TratamentoRESUMO
Background: Orthopaedic surgery trainees who aim to specialize in total joint arthroplasty commonly complete an additional year of fellowship training. Limited information regarding individual programs is readily available to potential applicants. The purpose of this study is to determine what information applicants value when considering an adult reconstruction fellowship program. Methods: An anonymous survey was distributed to all 470 junior members of AAHKS. The 12-question survey gathered demographic information as well as average weighted scores (1-10) of various components regarding fellowship education, recruitment, and experiences. Subgroup analysis was performed on survey responses based on the following 3 different categories: Gender, year of training, and geographical location. Results: A total of 135 respondents completed the survey (135 of 470, 28.7% response rate). Sixty-two (45.9%) participants held the position of postgraduate year 5, 43 (31.9%) participants held the position of postgraduate year 4. Exposure to operative techniques in revision surgery (9.62), exposure to operative techniques in primary surgery (9.51), and ability to obtain desired job opportunity after fellowship (8.89) were the 3 most considered components. Higher level trainees valued information regarding average number of hours worked relative to junior trainees (P = .046). Geographic differences were noted in the following 3 variables: the number of cases performed (P = .010), whether fellows had a dedicated clinic and/or operating room (P = .002), and the average number of hours worked (P = .020). Conclusions: Amongst the 3 domains studied, applicants most valued educational components, such as exposure to various techniques surrounding total joint arthroplasty. There is a need for a centralized, comprehensive database that contains information applicants value most and this database should be customizable toward training level and location.
RESUMO
BACKGROUND: The optimal alignment strategy in unicompartmental knee arthroplasty (UKA) is debated. Recent studies have suggested that kinematic alignment may lead to improved biomechanics and outcomes. The aim of the present study was to determine if pre-arthritic/kinematic alignment of knees would result in sustained long-term restoration of function, without conversion to total knee arthroplasty (TKA), following non-robotically assisted, fixed-bearing medial UKA. METHODS: A total of 236 UKAs were performed from 2000 to 2015. Of these, a total of 150 medial UKAs met the inclusion criteria and were included in the study. There were 76 UKAs performed in female patients. The mean age was 65 ± 10 years and the mean body mass index was 28.6 ± 5 kg/m2. Patients with ≥15° of varus alignment preoperatively were excluded. Varus deformity was evaluated with use of the hip-knee-ankle angle (HKAA). Pre-arthritic/kinematic alignment was estimated with use of an arithmetic HKAA (aHKA, calculated as the medial proximal tibial angle minus the lateral distal femoral angle). We defined pre-arthritic/kinematic alignment as a postoperative HKAA within 3° of the aHKA. The primary outcome measures were the Knee Injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living and Sport subscales, including the percentage of patients who met the patient acceptable symptom state (PASS) for these measures. Failure was defined as conversion to TKA. RESULTS: The mean follow-up was 10 years (range, 4 to 20 years), with a mean survival time estimate of 18.3 years (95% confidence interval [CI], 17.8 to 18.8). The rate of conversion to TKA was 3% (5 of 150 UKAs). Postoperatively, 127 (85%) of 150 knees were pre-arthritic/kinematically aligned, and 23 knees (15%) were not. Patients with compared to those without pre-arthritic/kinematically aligned knees had significantly longer mean survival (18.6 years; 95% CI, 18.2 to 19) compared with 15.4 years; 95% CI, 13.4 to 17.5, respectively; p = 0.008) and higher KOOS Activities of Daily Living (92 compared with 74; p < 0.001) and Sport subscale scores (74 compared with 36; p < 0.001). A greater proportion of knees in the pre-arthritic/kinematically aligned cohort met the PASS for the KOOS Activities of Daily Living (85%, 106 of 125 knees) and Sport subscales (109 of 125, 87%) compared with the non-pre-arthritic/kinematically aligned cohort (28% and 57%, respectively; p < 0.01). CONCLUSIONS: Pre-arthritic/kinematically aligned knees in this non-robotically assisted fixed-bearing medial UKA cohort had superior outcomes, including the KOOS Activities of Daily Living and Sport subscales and achievement of the PASS for these measures, compared with non-pre-arthritic/kinematically aligned at an average of 10 years after UKA. Knees that fell within 3° of a simple aHKA measurement on a 3-foot (1-m)-long standing radiograph had greater longevity and return to activities. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Atividades Cotidianas , Idoso , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Feminino , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Estudos RetrospectivosRESUMO
BACKGROUND: Lateral unicompartmental knee arthroplasty (UKA) is an excellent option to alleviate disability and restore function in patients with lateral compartment knee osteoarthritis (OA). The purpose of the present study was to determine the survivorship and long-term outcomes in both younger/middle-aged and older patients with lateral compartment OA following non-robotically-assisted, fixed-bearing lateral UKA and to determine if an acceptable symptom state can be achieved. METHODS: All patients were managed with fixed-bearing lateral UKA by a single surgeon utilizing a lateral parapatellar approach without robotic assistance. The primary outcome variables were the Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living (ADL) and Sport subscale scores. In addition, the other KOOS subscores, the Lysholm score, the achievement of the Patient Acceptable Symptom State (PASS), and the Veterans RAND (VR-12) Physical Component Summary score (PCS) and Mental Component Summary score (MCS) were collected. Failure was defined as conversion to total knee arthroplasty (TKA). Patients were divided into 2 cohorts: younger/middle-aged patients (<60 years of age) and older patients (≥60 years of age). RESULTS: A cohort of 256 patients underwent medial (n = 193) or lateral (n = 63) UKA. Sixty-one patients met the inclusion criteria. At mean of 10 years (range, 4 to 17 years) of follow-up, there were no significant differences between the groups in terms of any patient-reported outcome measures (p > 0.05). The percentage of patients in whom PASS was achieved on the KOOS ADL and Sport subscores was 82% and 88%, respectively, in the younger cohort and 80% and 80%, respectively, in the older cohort. The mean survival estimate of the prothesis was 15.3 years (95% confidence interval [CI], 14.5 to 16.2 years) for the entire cohort. The estimated rate of implant survival in the younger cohort was 100% at 5 and 10 years, and the estimated rate of implant survival in the older cohort was 98% at 5 years and 96% at 10 years. CONCLUSIONS: Lateral fixed-bearing, non-robotic UKA for the treatment of isolated lateral compartment OA resulted in >80% of patients reaching an acceptable symptom state in terms of both activities of daily living and sporting activities. UKA provides an excellent option that provides longevity with high PASS rates and return to activities with a low risk of complications and failure. LEVEL OF EVIDENCE: Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Atividades Cotidianas , Idoso , Artroplastia do Joelho/métodos , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Pessoa de Meia-Idade , Osteoartrite do Joelho/etiologia , Osteoartrite do Joelho/cirurgia , Reoperação , Estudos Retrospectivos , Sobrevivência , Resultado do TratamentoRESUMO
BACKGROUND: The Knee Injury and Osteoarthritis Outcome Score (KOOS) was developed to document outcomes from knee injury, including the impact of osteoarthritis on knee function. The purpose of this study is to determine the reliability and validity of the KOOS subscales for evaluating outcomes following unicompartmental knee arthroplasty (UKA). METHODS: KOOS Pain, Activities of Daily Living (ADL), Sport, Symptoms, and Quality of Life (QoL) scores collected from 172 patients who underwent UKA were used in the analysis. KOOS subscales were tested for reliability and validity of scores through a Rasch model analysis. RESULTS: KOOS Sport, KOOS ADL, and KOOS QoL had good evidence of reliability with acceptable person reliability, person separation, and item reliability. For overall scale functioning, KOOS Pain, Symptoms, and ADL all had 1 question that did not have an acceptable value for infit or outfit mean square value. Questions in KOOS Sport and QoL all had acceptable values. There was a positive, linear relationship between the Short-Form 12 Physical Component Summary and the KOOS subscales which indicated good evidence of convergent validity. These associations were also seen when the cohort was separated in medial and lateral UKA. CONCLUSION: Two of the 5 KOOS subscales (KOOS Sport and KOOS QoL) were considered adequate in measuring outcomes, as well as reliability. The KOOS ADL had borderline values; however, it had adequate infit and outfit values. The KOOS Pain and Symptom score performed poorly in this analysis. For documenting outcomes following UKA, this study supports the use of KOOS ADL, Sport, and QoL.
Assuntos
Artroplastia do Joelho , Traumatismos do Joelho , Osteoartrite do Joelho , Atividades Cotidianas , Humanos , Traumatismos do Joelho/cirurgia , Dor/cirurgia , Qualidade de Vida , Reprodutibilidade dos TestesRESUMO
ABSTRACT: The most common form of shoulder instability involves the anterior glenohumeral joint. Often it is associated with labral and bony injuries with subsequent recurrent instability. To determine optimal management, clinicians should perform a detailed history and physical examination, including appropriate diagnostic imaging to assess for concomitant humeral and glenoid bony deficiencies and other soft-tissue pathologies. Early surgical intervention may reduce risk of recurrence, particularly in young, active athletes. This article highlights the relevant anatomy, pathoanatomy, diagnostic examination including radiologic imaging, management, and prevention of complications for anterior shoulder instability. Minimizing recurrence is key to restoring function for patients to safely return to recreational and sporting activities, and to perform activities of daily living.
Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Atividades Cotidianas , Algoritmos , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/cirurgia , Recidiva , Ombro/patologia , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/terapia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/patologiaRESUMO
BACKGROUND: The aim of this study is to determine if there is a difference in the percentage of patients who reach Patient Acceptable Symptom State (PASS) when comparing anterior cruciate ligament (ACL)-deficient and ACL-intact knees following fixed-bearing medial and lateral unicompartmental knee arthroplasty (UKA). METHODS: A consecutive series of 215 knees that underwent UKA (medial = 158, lateral = 57) were included in the study. The Knee Osteoarthritis Outcome Score functional score [KOOS activities of daily living (ADL)] and KOOS Sport were used as the primary outcome variables. A KOOS ADL PASS of 87.5 and KOOS Sport PASS of 43.8 were previously described for total knee arthroplasty (TKA). Failure was defined as conversion to TKA. RESULTS: There were 157 in the ACL-intact group and 58 in the ACL-deficient group. Conversion to TKA was 3.7%. The failure rate in the ACL-deficient group was 5% (3/58) and 3% (5/157) in the ACL-intact group (P = .447). The mean survival for the entire group was 18.1 years (95% confidence interval 17.6-18.6). At 10 years, the survival was 94.3% (standard error = 0.028) in the ACL-deficient group and 97.6% (standard error = 0.014) in the ACL-intact group. At a mean 10 ± 3.5 years, with 93% follow-up, 83% in the ACL-deficient group and 80% in the ACL-intact group reached PASS for KOOS ADL (P = .218). For KOOS Sport, 85% of the ACL-deficient group compared to 81% in the ACL-intact group (P = .374) reached PASS. CONCLUSION: The ACL-deficient cohort results were not significantly different compared to ACL-intact knees in both medial and lateral compartment UKA. Fixed-bearing medial and lateral UKA resulted in low failure rate and excellent long-term outcomes.
Assuntos
Artroplastia do Joelho , Distinções e Prêmios , Osteoartrite do Joelho , Atividades Cotidianas , Ligamento Cruzado Anterior/cirurgia , Artroplastia do Joelho/métodos , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgiaRESUMO
Partial thickness rotator cuff tears (PRCTs) are a challenging disease entity. Optimal management of PRCTs continues to be controversial. Although advances in magnetic resonance imaging and ultrasonography have aided in early diagnosis, arthroscopic evaluation remains the benchmark for diagnosis. Conservative treatment is often the first line of management for most patients; however, evidence suggests that surgical intervention may limit tear progression and the long-term sequelae. Surgical decision making is driven by factors such as age, arm dominance, etiology, activity level, tear thickness, and tear location. Many surgical options have been described in the literature to treat PRCTs including arthroscopic débridement, transosseous, in situ repair techniques, and tear completion and repair. Biologic supplements have also become an attractive alternative to aid in healing; however, the long-term efficacy of these modalities is largely unknown. This article will provide a detailed review of the etiology and natural history of PRCTs, as well as diagnosis, and current management to guide clinical decision-making and formulate an algorithm for management of PRCTs for the orthopaedic surgeon.
Assuntos
Lesões do Manguito Rotador , Artroscopia , Humanos , Imageamento por Ressonância Magnética , Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/diagnóstico , Lesões do Manguito Rotador/cirurgia , Ruptura , Resultado do Tratamento , UltrassonografiaRESUMO
AIMS: The patient-acceptable symptom state (PASS) is a level of wellbeing, which is measured by the patient. The aim of this study was to determine if the proportion of patients who achieved an acceptable level of function (PASS) after medial unicompartmental knee arthroplasty (UKA) was different based on the status of the anterior cruciate ligament (ACL) at the time of surgery. METHODS: A total of 114 patients who underwent UKA for isolated medial osteoarthritis (OA) of the knee were included in the study. Their mean age was 65 years (SD 10). No patient underwent a bilateral procedure. Those who had undergone ACL reconstruction during the previous five years were excluded. The Knee injury Osteoarthritis Outcome Score Activities of Daily Living (KOOS ADL) function score was used as the primary outcome measure with a PASS of 87.5, as described for total knee arthroplasty (TKA). Patients completed all other KOOS subscales, Lysholm score, the Western Ontario and McMaster Universities Osteoarthritis Index, and the Veterans Rand 12-item health survey score. Failure was defined as conversion to TKA. RESULTS: Survivorship at ten years was 97% in both the ACL-deficient and ACL-intact groups. The mean survival was 16.1 years (95% confidence interval (CI) 15.3 to 16.8) for the ACL-deficient group and 15.6 years (95% CI 14.8 to 16.361) for the ACL-intact group (p = 0.878). At a mean of nine years (SD 3.5) in the ACL-deficient group, 32 patients (87%) reached the PASS for the KOOS ADL. In the ACL-intact group, at a mean of 8.6 years (SD 3) follow-up, 63 patients (85%) reached PASS for the KOOS ADL. There was no significant difference in the percentage of patients who reached PASS for all KOOS subscales and Lysholm between the two groups. CONCLUSION: PASS was achieved in 85% of all UKAs for KOOS ADL, similar to reports for TKA. Fixed-bearing, medial, non-robotically-assisted UKA resulted in 97% survival at ten years in both the ACL-deficient and ACL-intact groups. There was no significant difference in all outcomes between the two groups. Understanding PASS will allow better communication between surgeons and patients to improve the surgical management of patients with single compartment OA of the knee. This study provides mid- to long-term data supporting the use of PASS to document outcomes following UKA. PASS was met in more than 85% of patients with no differences between ACL-deficient and ACL-intact knees at a mean follow-up of nine years. Cite this article: Bone Joint J 2021;103-B(8):1367-1372.
Assuntos
Ligamento Cruzado Anterior , Artroplastia do Joelho/métodos , Doenças Musculoesqueléticas/complicações , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/cirurgia , Medidas de Resultados Relatados pelo Paciente , Idoso , Feminino , Humanos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Estudos Prospectivos , Avaliação de SintomasRESUMO
BACKGROUND: Excessive posterior tibial slope in medial unicompartmental knee arthroplasty (UKA) has been implicated in early failure. The purpose of this study was to evaluate the relationship between preoperative posterior tibial slope and postoperative slope of the implant (PSI) on outcomes in patients with anterior cruciate ligament (ACL) intact and ACL-deficient knees after fixed-bearing medial UKA. METHODS: Patients who underwent a medial UKA between 2002 and 2017 with a minimum 3-year follow-up were included. Preoperative posterior tibial slope and postoperative PSI were measured. Outcomes measures included Knee Injury and Osteoarthritis Outcomes Score (KOOS) subscales, Lysholm, and VR-12. Failure was defined as conversion to total knee arthroplasty. RESULTS: Of 241 knees undergoing UKA, 131 patients (70 women, 61 men; average age of 65 ± 10 years (average BMI of 27.9 ± 4) were included. For all patients, survivorship was 98% at 5 years and 96% at 10 years with a mean survival time for UKA was 15.2 years [95% CI: 14.6-15.7]. No failure had a PSI >7°. There were no superficial or deep infections. There were no significant differences in outcome scores between the ACL intact and the ACL-deficient group; therefore, the data were combined for analysis. At mean 8-year follow-up, KOOS pain scores were better in patients with PSI ≤7° (87 ± 16) than those with PSI >7° (81 ± 15). 76% of patients with PSI ≤7° reached the Patient Acceptable Symptom State for KOOS pain; whereas, 59% of patients with PSI >7° reached PASS for KOOS pain (P = .015). CONCLUSION: Patients with postoperative posterior slope of the tibial implant >7° had significantly worse postoperative pain, without conversion to TKA, and with maintenance of high function. In ACL deficient and intact knees, nonrobotically-assisted, fixed-bearing medial UKA had a 96% survivorship at 10 years.
Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Idoso , Ligamento Cruzado Anterior/cirurgia , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Tíbia/cirurgiaRESUMO
Suprascapular nerve compression at the spinoglenoid notch can lead to posterior shoulder pain, muscle weakness, and longstanding muscle atrophy of the infraspinatus. Although rare, it is most commonly seen in overhead athletes and laborers who perform repetitive overhead activities. Early diagnosis requires a thorough history and physical examination including imaging, diagnostic injections, and electromyography to avoid a missed diagnosis. While a course of nonoperative treatment is most often prescribed, early surgical intervention may be prudent to avoid irreversible damage especially if a space occupying lesion is present. This article will describe the history, physical examination findings, diagnostic workup, and our surgical technique for arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch through a simple posterior approach avoiding the subacromial space.
RESUMO
PURPOSE: To assess the proximity of neurovascular structures in a layered approach during medial portal placement and determine standardized measurements for establishing a portal medial to the coracoid used in arthroscopic Latarjet-type procedures. METHODS: Twelve shoulders (6 right and 6 left) in 6 fresh frozen cadaveric torsos were mounted in the modified beach-chair position. A standard posterior portal and 3 anterior portals-central, lateral, and medial-were used. A long spinal needle was placed along the path of the medial portal to the lateral tip of the coracoid, superficial to the conjoined tendon and pectoralis minor. A second long spinal needle was directed toward the medial base of the coracoid, penetrating the pectoralis minor. Superficial and deep plane dissections were performed, and distances to surrounding neurovascular structures were recorded. RESULTS: In the superficial plane, the cephalic vein and lateral pectoral nerve were located a mean distance (± standard deviation) of 4.6 ± 1.9 mm and 9.4 ± 2.6 mm from the spinal needle, respectively. In the deep plane, the axillary nerve was 24.9 ± 7.4 mm from the needle; the lateral cord of the brachial plexus, 25.5 ± 8.1 mm; the axillary artery, 34.1 ± 6.0 mm; and the musculocutaneous nerve, 42.2 ± 9.2 mm. The portal was consistently established 45.0 to 50.0 mm distal and 30.0 to 35.0 mm medial to the coracoid, which was a minimum distance of 10 mm to the lateral pectoral nerve. CONCLUSIONS: In a cadaveric model, the creation of a medial trans-pectoralis major portal used in the arthroscopic Bankart-Bristow-Latarjet procedure can avoid compromise of vital neurovascular structures, alleviating concerns of creating a portal medial to the coracoid. Portal placement 45.0 to 50.0 mm distal and 30.0 to 35.0 mm medial to the palpable tip of the coracoid process may be a safe approach to perform the arthroscopic Bankart-Bristow-Latarjet procedure. CLINICAL RELEVANCE: Creation of a portal medial to the level of the coracoid may pose a risk to neurovascular structures. This cadaveric study establishes a working zone for medial trans-pectoralis portal placement, which avoids vital neurovascular structures, and provides standardized measurements for establishing this portal for use in the arthroscopic Bankart-Bristow-Latarjet procedure.
Assuntos
Artroscopia/métodos , Músculos Peitorais/cirurgia , Ombro/cirurgia , Idoso , Idoso de 80 Anos ou mais , Cadáver , Processo Coracoide/anatomia & histologia , Processo Coracoide/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Peitorais/anatomia & histologia , Ombro/anatomia & histologia , Tendões/anatomia & histologia , Tendões/cirurgiaRESUMO
The goal of operative intervention for pantrapezial arthritis is to relieve pain, maintain or improve motion, stability, and strength, and restore function. The purpose of this article is to present a volar approach to thumb carpometacarpal suspension arthroplasty using an absorbable interference screw for flexor carpi radialis ligament reconstruction and tendon interposition in the treatment of pantrapezial arthritis. This technique allows for visualization of the volar beak and avoidance of the radial artery and the branches of the superficial radial nerve while allowing optimal surgical manipulation for suspensionplasty with interference screw fixation and tendon interposition at the carpometacarpal joint.