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1.
BMC Musculoskelet Disord ; 22(1): 749, 2021 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-34465332

RESUMO

BACKGROUND: Rotator cuff retear (RCR) is one of the main postoperative drawbacks. RCR can be considered a multifactorial issue, which causes are related either to biological than biomechanical factors. The aim of this study was to define the incidence of RCR after surgical treatment at different time points and to identify the main factors influencing the postoperative rotator cuff (RC) healing. METHODS: A systematic review and meta-analysis were performed following the PRISMA guidelines. A comprehensive search of the literature was carried out in July 2020, using PubMed and Cochrane Library databases. Only level 1 and 2 clinical evidence studies were included. Studies were included if patients with preoperative repairable full-thickness RC tears were treated surgically, and if studies reported postoperative RCR confirmed by imaging diagnostic. The association between timing of retear and follow-up time points were investigated using an inverse-variance method of pooling data. A subgroup meta-analysis was performed using the DerSimonian and Laird method for the estimation of the between-study variance, i.e., τ2. The association between retear rate after surgery and patients' age, preoperative tear size, fatty infiltration, postoperative rehabilitation protocol, surgical techniques, and RC repairs was determined by expressing the effect measure in terms of odds ratio (OR) with 95% confidence interval (CI). The Mantel-Haenszel method with 95% CIs was used. RESULTS: Thirty-one articles were included in this study. The percentage of RCR after surgery was 15% at 3 months follow-up, 21% at 3-6 months follow-up, 16% at 6-12 months follow-up, 21% at 12-24 months follow-up, 16% at follow-up longer than 24 months. The main factors influencing RC healing are both patient-related (i.e., age, larger tear size, fatty infiltration) and not patient-related (i.e., postoperative rehabilitation protocol, surgical techniques, and procedures). CONCLUSIONS: Postoperative RC healing is influenced by patient-related and non-patient-related factors. Further high-level clinical studies are needed to provide highly relevant clinical results.


Assuntos
Lesões do Manguito Rotador , Manguito Rotador , Artroplastia , Artroscopia , Humanos , Imageamento por Ressonância Magnética , Manguito Rotador/diagnóstico por imagem , Manguito Rotador/cirurgia , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/epidemiologia , Lesões do Manguito Rotador/cirurgia , Resultado do Tratamento
2.
J Am Podiatr Med Assoc ; 111(4)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34478532

RESUMO

BACKGROUND: The aim of the present study was to contribute new and updated information to the literature by comparing the clinical and radiologic results of arthroscopic microfracture, platelet-rich plasma (PRP) after arthroscopic microfracture, and BST-Cargel scaffold application after arthroscopic microfracture in the treatment of talar osteochondral lesions. METHODS: Sixty-two talar osteochondral lesion patients (31 women and 31 men) who underwent ankle arthroscopy in two different centers were randomized into three groups. The first group consisted of patients who underwent only arthroscopic microfracture (MF) (n = 22); the second group consisted of patients who underwent the PRP procedure after arthroscopic MF (PRP; n = 19); and the third group consisted of patients who underwent the BST-Cargel procedure after arthroscopic MF was (BST-Cargel; n = 21). The talar osteochondral lesions in the three groups were classified according to magnetic resonance and arthroscopic images. American Orthopedic Foot and Ankle Society, Foot and Ankle Ability Measurement (overall pain, 15-minute walking, running function), and visual analog scale scores were evaluated preoperatively and postoperatively, and postoperative return time to sports activities was performed. RESULTS: Compared to the preoperative score, postoperative American Orthopedic Foot and Ankle Society score increased 48.80 ± 9.60 in the BST-Cargel group, whereas there was an increase of 46.68 ± 3.65 in the PRP group and 29.63 ± 3.69 in the MF group, which were statistically significant (P < .05).There was a statistically significant postoperative change in the visual analog scale scores of the patients in all three groups compared to the preoperative scores (P < .05). At the end of the follow-up, the Foot and Ankle Ability Measurement overall pain, 15-minute walking, and running function results of all three groups increased significantly postoperatively compared to the preoperative values (P < .005). CONCLUSIONS: BST-Cargel application with microfracture is a method that can be applied easily and safely with arthroscopy to lesions larger than 1.5 cm2 regardless of the size of the cartilage defect, and it has been found to be superior to the other two methods in terms of pain, functional score, radiologic recovery, and return to sports activities.


Assuntos
Cartilagem Articular , Fraturas de Estresse , Fraturas Intra-Articulares , Tálus , Artroscopia , Cartilagem Articular/diagnóstico por imagem , Cartilagem Articular/cirurgia , Feminino , Humanos , Masculino , Estudos Prospectivos , Tálus/diagnóstico por imagem , Tálus/cirurgia , Resultado do Tratamento
3.
Acta Ortop Mex ; 35(1): 28-32, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480436

RESUMO

INTRODUCTION: Diagnosis and management of congenital and traumatic articular ailments carry an additional problem in young people. Arthroscopy has improved treatment of these injuries, which are more frequent. OBJECTIVE: To describe the experience of arthroscopic handling in pediatric patients affected with knee disease, managed at a third level hospital in Puebla, Mexico. MATERIAL AND METHODS: Descriptive, retrospective, cross sectional study performed in patients having knee disease, admitted at Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia Puebla, from March first, 2015 to February 28th, 2018. Lysholm and IKDC functional scales and Tegner functional satisfaction scale were applied at zero, six and twelve months. Student's t and Wilcoxon tests were used. RESULTS: 29 young ones of five to 17 years of age became recruited, slightly more women (62.06%). The most frequently affected limb was the left one, with 55.17%. The disorders found are: discoid meniscus, harm of the anterior cruciate ligament, idiopathic inflammatory synovitis, tumor, meniscal injury, chondral damage, patellar hyperlaxity. Lysholm and IKDC registered improvement from the first semester. Tegner registered their ability to go back to previous daily occupations. On the Lysholm scale, there was improvement at six months. On the Tegner scale there was complete incorporation to their activities (previous to the presentation and surgical intervention). At six months subsequent to treatment, the IKDC evidenced improvement and recovery, and reintegration to their activities. Statistically significant differences (p 0.01) resulted, in measurements at zero, six and 12 months. CONCLUSIONS: Congenital and traumatic illnesses were found, the latter ones sports related. Arthroscopic approach registered positive functional results in these children.


Assuntos
Artroscopia , Hospitais , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , México , Estudos Retrospectivos , Resultado do Tratamento
4.
Acta Ortop Mex ; 35(1): 46-50, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-34480439

RESUMO

INTRODUCTION: Posterior ankle arthroscopy allows the diagnosis and treatment of multiple pathologies through minimal trauma. The use of posterior portals associated or not to mechanical distraction, allows a good vision of the posterior ankle, tendons of the region, and subtalar joint. OBJECTIVES: We evaluated intra- and postoperative complications of posterior ankle arthroscopy without joint distraction, and compared them with those described in international literature. MATERIAL AND METHODS: A retrospective study that evaluated 49 patients undergoing posterior ankle arthroscopy for several pathologies. All of them operated by a single surgeon, in two health institutions, for seven years. RESULTS: were analyzed using the visual analog scale and the AOFAS score. Intra- and postoperative complications were recorded. The average follow-up was 28 months. RESULTS: 33 men and 16 women. The average age was 38.6 years old. There were seven complications (14.3%): paresthesia and - or hypoesthesia of the sural nerve (four cases), residual pain in the portal (two cases), and portal scar dehiscence (one patient). The average improvement of VAS was 5.53 points, and the improved AOFAS score was an average of 35.78 points. CONCLUSIONS: Posterior ankle arthroscopy without distraction through the classic postero-lateral and posteromedial portals is a safe technique, with a low rate of complications.


Assuntos
Tornozelo , Artroscopia , Adulto , Articulação do Tornozelo/cirurgia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Tendões
5.
BMC Musculoskelet Disord ; 22(1): 760, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488703

RESUMO

BACKGROUND: Acromial anatomy has been found to be correlated with degenerative full-thickness rotator cuff tears in current studies. However, research on the relationship between acromial anatomy and articular-sided partial thickness of rotator cuff tears (PTRCTs) is still lacking. The purpose of this study was to evaluate whether these imaging graphic parameters exhibit any association between acromial anatomy and degenerative articular-sided PTRCTs. METHODS: Between January 2016 and December 2018, a total of 91 patients without a history of trauma underwent arthroscopy as an articular-sided PTRCT group. In the control group, with age- and sex-matched patients, we selected 91 consecutive outpatient patients who underwent shoulder magnetic resonance imaging (MRI) because of shoulder pain and an MRI diagnosis of only synovial hyperplasia and effusion. MRI was used to measure the acromial type, acromiohumeral distance (AHD), lateral acromial angle (LAA), acromion index (AI), and critical shoulder angle (CSA) by 2 independent observers. RESULTS: The acromion type, AHD and LAA showed no difference between degenerative articular-sided PTRCTs and controls (P = 0.532, 0.277, and 0.108, respectively). AI and CSA were significantly higher in degenerative articular-sided PTRCTs (P = 0.002 and 0.003, respectively). A good correlation was found between AI and CSA to measurement(Pearson correlation coefficient = 0.631). CONCLUSIONS: Our study revealed that higher AI and CSA were found in degenerative articular-sided PTRCTs. Acromial anatomy with a large acromial extension was associated with the occurrence of degenerative articular-sided PTRCTs.


Assuntos
Lesões do Manguito Rotador , Articulação do Ombro , Acrômio/diagnóstico por imagem , Artroscopia , Humanos , Imageamento por Ressonância Magnética , Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/diagnóstico por imagem , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/diagnóstico por imagem
6.
Zhongguo Zhen Jiu ; 41(9): 1010-4, 2021 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-34491651

RESUMO

OBJECTIVE: To compare the effect between acupoint application of Zhanjin Huoxue formula combined with local cold compress and simple local cold compress on swelling and pain after knee arthroscopy in patients with knee osteoarthritis (KOA). METHODS: A total of 62 KOA patients with knee swelling after knee arthroscopy were randomly divided into an observation group and a control group, 31 cases in each group. In the control group, cold compress was adopted after surgery, 3 times a day. On the basis of the treatment as the control group, acupoint application of Zhanjin Huoxue formula (angelicae sinensis radix, chuanxiong rhizome, cinnamon twig, poria, etc.) was applied at Liangqiu (ST 34), Xuehai (SP 10), Zusanli (ST 36), Fenglong (ST 40), Sanyinjiao (SP 6), Yinlingquan (SP 9), Yanglingquan (GB 34), Xuanzhong (GB 39) on the affected side in the observation group, 4 h each time, 2 times a day. The treatment was given 7 days in both groups. Before treatment and 1,3,5 and 7 days into treatment, the pain visual analogue scale (VAS) score and swelling value of knee joint (2 cm above the patella upper pole, patella midline, 5 cm below the patella lower pole) were compared in the two groups. RESULTS: The VAS scores 3, 5 and 7 days into treatment were lower than those before treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). The swelling values of 2 cm above the patella upper pole 3, 5 and 7 days into treatment were lower those before treatment in the two groups (P<0.05), and those in the observation group were lower than the control group (P<0.05). The swelling values of patella midline 1, 3, 5 and 7 days into treatment were lower than those before treatment in the two groups (P<0.05), and except for 1 day into treatment, those in the observation group were lower than the control group (P<0.05). The swelling values of 5 cm below the patella lower pole 1 day into treatment in the observation group and 3, 5 and 7 days into treatment in the two groups were lower those before treatment (P<0.05), and except for 1 day into treatment, those in the observation group were lower than the control group (P<0.05). The total effective rate in the observation group was 93.5% (29/31), which was higher than 74.2% (23/31) in the control group (P<0.05). CONCLUSION: Acupoint application of Zhanjin Huoxue formula combined with cold compress could effectively improve the knee joint swelling and pain after arthroscopy in KOA patients, and the curative effect is better than simple cold compress.


Assuntos
Osteoartrite do Joelho , Pontos de Acupuntura , Artroscopia , Humanos , Articulação do Joelho , Osteoartrite do Joelho/terapia , Dor , Resultado do Tratamento
7.
Sports Med Arthrosc Rev ; 29(3): e34-e43, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34398120

RESUMO

The menisci play a vital role in maintaining knee function and protecting the chondral surfaces. Acute and chronic tears are common injuries among both young athletes and older patients with early degenerative changes. The progression of physiological derangement and chondral injury after meniscus injury and meniscectomy have prompted interest in expanding meniscus repair techniques. Recent literature encourages an attempt at repair in tear patterns previously declared irreparable if the tissue quality allows. The orthopedic surgeon should understand the multitude of techniques available to them and be prepared to combine techniques to optimize the quality of their repair construct. While biological augmentation may show some promising early results, the quality of the current data precludes strong recommendations in their favor.


Assuntos
Lesões do Menisco Tibial/terapia , Artroscopia , Traumatismos em Atletas/cirurgia , Traumatismos em Atletas/terapia , Cartilagem/lesões , Humanos , Meniscectomia/efeitos adversos , Procedimentos Ortopédicos , Estimulação Física/métodos , Plasma Rico em Plaquetas , Complicações Pós-Operatórias , Ruptura/cirurgia , Transplante de Células-Tronco , Lesões do Menisco Tibial/cirurgia
8.
Sports Med Arthrosc Rev ; 29(3): 158-167, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34398121

RESUMO

The importance of the menisci in providing joint stability and their role in load transmission within the knee are well understood. A growing body of literature has emerged on 2 distinct injury patterns to these crucial anatomic structures, ramp lesions and root tears. Ramp lesions may be characterized as tears at the posterior meniscocapsular junction, while root tears involve bony or soft tissue avulsion of the meniscal insertions at the anterior or posterior intercondylar regions. In this 2-part review, we present an overview of the current available literature on ramp lesions and meniscal root tears, summarizing the unique anatomic considerations, etiology, biomechanics, management decisions, clinical outcomes pertinent to these very distinct injuries.


Assuntos
Lesões do Menisco Tibial , Lesões do Ligamento Cruzado Anterior/complicações , Artroscopia , Fenômenos Biomecânicos , Humanos , Imageamento por Ressonância Magnética , Ilustração Médica , Meniscos Tibiais/anatomia & histologia , Meniscos Tibiais/diagnóstico por imagem , Fatores de Risco , Ruptura/diagnóstico por imagem , Ruptura/etiologia , Ruptura/reabilitação , Ruptura/cirurgia , Lesões do Menisco Tibial/diagnóstico por imagem , Lesões do Menisco Tibial/etiologia , Lesões do Menisco Tibial/reabilitação , Lesões do Menisco Tibial/cirurgia
10.
J Orthop Traumatol ; 22(1): 32, 2021 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-34350524

RESUMO

BACKGROUND: Using the database of the German Cartilage Registry (KnorpelRegister DGOU), this study aims to present patient- and joint-related baseline data in a large cohort of patients with cam-derived femoroacetabular impingement syndrome (FAI) and to detect symptom-determining factors. MATERIALS AND METHODS: Requiring cam morphology as the primary pathology, 362 patients were found to be eligible for inclusion in the study. The assessment of preoperative baseline data was performed using the patient-reported outcome measure-International Hip Outcome Tool (iHOT-33). Descriptive statistics were performed to present baseline data. Univariate and multiple regression with post hoc testing were used to identify patient- and joint-related factors that might affect the preoperative iHOT-33 and its subscores, respectively. RESULTS: The study collective's mean age was 36.71 ± 10.89 years, with 246 (68%) of them being male. The preoperative mean iHOT-33 total was 46.31 ± 20.33 with the subsection "sports and recreational activities" presenting the strongest decline (26.49 ± 20.68). The parameters "age," "sex," "body mass index" (BMI), and the confirmation of "previous surgery on the affected hip" were identified to statistically affect the preoperative iHOT-33. In fact, a significantly lower mean baseline score was found in patients aged > 40 years (p < 0.001), female sex (p < 0.001), BMI ≥ 25 kg/m2 (p = 0.002) and in patients with previous surgery on the affected hip (p = 0.022). In contrast, the parameters defect grade and size, labral tears, and symptom duration delivered no significant results. CONCLUSIONS: A distinct reduction in the baseline iHOT-33, with mean total scores being more than halved, was revealed. The parameters "age > 40 years," "female sex," "BMI ≥ 25," and confirmation of "previous surgery on the affected hip" were detected as significantly associated with decreased preoperative iHOT-33 scores. These results help to identify symptom-defining baseline characteristics of cam-derived FAI syndrome. TRIAL REGISTRATION: The German Cartilage Registry is conducted in accordance with the Declaration of Helsinki and registered at germanctr.de (DRKS00005617). Registered 3 January 2014-retrospectively registered. The registration of data was approved by the local ethics committees of every participating institution. Primary approval was given by the ethics committee at the University of Freiburg (No. 105/13). https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005617.


Assuntos
Impacto Femoroacetabular , Adulto , Idoso , Artroscopia , Cartilagem , Análise de Dados , Feminino , Impacto Femoroacetabular/epidemiologia , Impacto Femoroacetabular/cirurgia , Articulação do Quadril/cirurgia , Humanos , Recém-Nascido , Masculino , Sistema de Registros , Resultado do Tratamento
11.
J Orthop Traumatol ; 22(1): 34, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34357462

RESUMO

The acetabular labrum is an important structure that contributes to hip joint stability and function. Diagnosing labral tears involves a comprehensive assessment of clinical symptoms, physical examinations, imaging examinations, and arthroscopic confirmation. As arthroscopy is an invasive surgery, adjuvant imaging of the acetabular labrum is increasingly imperative for orthopedists to diagnose and assess labral lesions prior to hip arthroscopy for surgical management. This article reviews the current imaging strategies for the evaluation of labrum lesions.


Assuntos
Acetábulo , Cartilagem Articular , Acetábulo/diagnóstico por imagem , Artroscopia , Cartilagem Articular/diagnóstico por imagem , Diagnóstico por Imagem , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos
12.
BMC Musculoskelet Disord ; 22(1): 714, 2021 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-34419023

RESUMO

BACKGROUND: Comorbidities and socioeconomic issues impact outcome of rotator cuff tear (RCT) repair. There are no data on RCT repair outcome from developing regions. We determined the impact of obesity and smoking following RCT repair in a low-income population. METHODS: This is a retrospective case series. Forty-seven shoulders of 42 patients subjected to open or arthroscopic repair of a RCT with a minimum of 2 years follow-up were cross-sectionally evaluated. Patients were seen in the Orthopaedic Service of the Hospital Geral de Fortaleza-CE, Brazil between March and September 2018. RCT were classified as partial or full-thickness lesions. Fatty infiltration (Goutallier) and tendon retraction (Patte) were recorded as well as obesity (BMI > 30), literacy [>/≤ 8 school years (SY)] and smoking status 6 months prior to surgery (present/absent). Outcomes included pain (visual analogue scale; VAS, 0-10 cm), range of motion [active forward flexion and external rotation (ER)], UCLA and ASES scoring. RESULTS: Patients were 59.9 ± 7.4 years-old, 35(74.4%) female with 19 (17.1-30.2 IQR) median of months from diagnosis to surgery and 25 median months of follow-up (26.9-34.0 IQR); over 90% declared < 900.00 US$ monthly family income and two-thirds had ≤8 SY. Forty patients (85.1%) had full-thickness tears, 7 (14.9%) had Goutallier ≥3 and over 80% had < Patte III stage. Outcomes were similar regardless of fatty infiltration or tendon retraction staging. There were 17 (36.1%) smokers and 13 (27.6%) obese patients. Outcome was similar when comparing obese vs non-obese patients. Smokers had more pain (P = 0.043) and less ER (P = 0.029) with a trend towards worse UCLA and ASES scores as compared to non-smokers though differences did not achieve minimal clinically important difference (MCID) proposed for surgical RCT treatment. After adjusting for obesity, VAS and ER values in smokers were no longer significant (P = 0.2474 and 0.4872, respectively). CONCLUSIONS: Our data document outcomes following RCT repair in a low-income population. Smoking status but not obesity impacted RCT repair outcome though not reaching MCID for surgical treatment.


Assuntos
Lesões do Manguito Rotador , Idoso , Artroscopia , Feminino , Humanos , Pessoa de Meia-Idade , Obesidade/diagnóstico , Obesidade/epidemiologia , Pobreza , Lesões do Manguito Rotador/epidemiologia , Lesões do Manguito Rotador/cirurgia , Fumar , Resultado do Tratamento
13.
Arthroscopy ; 37(8): 2395-2396, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353550

RESUMO

In this issue of Arthroscopy, readers will find the first of what are designed to be a series of peer-reviewed Orthoregeneration Network (ON) Foundation review articles. The ON Foundation is an independent, nonprofit, international foundation dedicated to promoting research and education in the field of orthopaedic tissue regeneration. ON defines "Orthoregeneration … as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and optimally, provide an environment for tissue regeneration" making use of treatments, including "drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli." The article is accessible and could be of interest to all readers, including clinicians, as well as basic scientists and researchers. It brings us great pleasure to collaborate with the ON Foundation and introduce the ON Foundation Reviews to the readers of Arthroscopy.


Assuntos
Produtos Biológicos , Ortopedia , Artroscopia , Produtos Biológicos/uso terapêutico , Terapia Biológica , Cicatrização
14.
Arthroscopy ; 37(8): 2409-2411, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353552

RESUMO

Many clinical results of surgical treatment of recurrent anterior shoulder instability confirm the importance of anterior bone grafting of the glenoid defect. Some studies even propose to perform a graft, even when there is no bony defect. Short- and middle-term studies report comparable results between bone grafting and Latarjet procedure. But one of the main questions that still remains is the quality and efficiency of the capsule. If Latarjet is the gold standard in anterior shoulder stabilization with very good results at very long follow-up, it is probably because the capsule is replaced by the conjoint tendon. Because Latarjet is a difficult surgery and has some complexes and/or challenging complications and because it is a nonanatomic procedure, there is a true place for anterior bone grafting. This anterior grafting under arthroscopy provides excellent results, but it is mandatory to be sure that the shoulder capsule is working. Clinical, functional, and imaging studies of this capsule need to be performed for a better understanding of the unstable shoulder function and treatment.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Artroscopia , Transplante Ósseo , Humanos , Instabilidade Articular/cirurgia , Escápula/cirurgia , Ombro , Articulação do Ombro/cirurgia
15.
Arthroscopy ; 37(8): 2440-2443, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353554

RESUMO

The management of a patient with a first-time anterior shoulder dislocation has been the subject of longstanding debate among shoulder surgeons. A number of prognostic factors for recurrent instability have been proposed, including younger age, male sex, contact sports, and glenoid bone loss. Predictive tools and scores have been developed to assist in risk stratifying this patient population; however, no universally agreed upon, clinically validated algorithm exists. More recently, there has been emerging evidence favoring early surgical stabilization, as it has been shown to result in better overall outcomes compared with patients undergoing surgery following episodes of recurrent instability. With each subsequent dislocation or subluxation event, there is increased glenoid bone loss (and development of inverted-pear glenoid), a greater prevalence of engaging (i.e., off-track) Hill-Sachs lesions, more extensive labral tears, a greater risk of rotator cuff involvement (in the older patient), and increased plastic and/or permanent deformation, elongation, and compromise of the antero-inferior glenohumeral joint capsule and associated inferior glenohumeral ligament complex. Moreover, there is now sufficient evidence to suggest that recurrence comes at a cost, as it is a major risk factor for poor outcomes following arthroscopic stabilization. However, one risk is overtreatment, potentially exposing those individuals who would not have had another instability event due to an unnecessary procedure. We should continue to use the available evidence within the literature to help risk-stratify patients and develop an individualized treatment plan through a shared decision-making process with the patient.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Artroscopia , Humanos , Instabilidade Articular/cirurgia , Masculino , Recidiva , Medição de Risco , Ombro , Luxação do Ombro/cirurgia , Articulação do Ombro/cirurgia
16.
Arthroscopy ; 37(8): 2485-2487, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353557

RESUMO

Successful outcomes after psoas tenotomies have been reported and proposed in the setting of recalcitrant internal snapping and psoas impingement. However, case reports citing hip flexion weakness and iatrogenic instability created concern regarding the role for psoas tenotomies. Despite these concerns, some recent studies reporting improved outcomes after endoscopic psoas tenotomies breathe further life into this controversial topic. Psoas tenotomy in the setting of a borderline dysplastic hip likely carries an even greater risk for iatrogenic instability. It might be critical to evaluate for clinical signs and symptoms of instability in addition to radiographic parameters to avoid this potentially devastating complication. In addition, the traditional definition of borderline dysplasia is based on lateral acetabular coverage that might be less important than anterior acetabular coverage and femoral version when contemplating psoas tenotomies on the basis of the dynamic anterior stabilizing effect of the iliopsoas myotendinous unit. Surgeons should also be extremely cautious when considering psoas tenotomy in an athletic population with the potential for persistent weakness and limited data hinting at inferior sports specific outcomes. In the end, it is not clear whether the psoas tenotomy "drives" the improvements seen in some studies, or whether many of these patients ultimately battle their way into a minimally clinically important difference "despite" the psoas tenotomy.


Assuntos
Articulação do Quadril , Tenotomia , Artroscopia , Atletas , Humanos , Doença Iatrogênica
17.
Arthroscopy ; 37(8): 2655-2656, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34353567

RESUMO

The hip capsule is clearly a significant part of the hip and the considerations that we need to take into account when performing hip arthroscopy. Any study that adds some further clarity to this important structure is welcome and appreciated. The inherent problem with all of these articles is the lack of application to the reality of a living, breathing patient whose capsule changes following time zero of the capsular intervention and also whose negative intra-articular pressure is immediately violated and not recreated following any intervention that is undertaken. Hip capsular closure and perhaps even imbrication is indicated in some cases, but in many cases, it is a nonissue.


Assuntos
Artroscopia , Articulação do Quadril , Articulação do Quadril/cirurgia , Humanos
18.
Medicine (Baltimore) ; 100(32): e26791, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397881

RESUMO

ABSTRACT: The aim of this study was to evaluate the effect on the results of patients applied with arthroscopic full layer total layer rotator cuff repair made according to the shape and size of the tear.The study included a total of 120 patients applied with arthroscopic full layer rotator cuff repair as single or double row repair. The patients were separated into 3 groups of 40 according to the shape of the tear, as Group A (crescent type), Group B (U type), and Group C (L type).The mean age of the whole sample was 66.68 ±â€Š6.86 years (range, 50-81 years). A statistically significant difference was determined between the groups in respect of constant murley (CM), American shoulder and elbow surgeons score (ASES), and University of California Los Angeles score (UCLA) scores (P < .05). The scores of Group A of all the scales were found to be higher than those of Group C (P < .05). In single row and double row repair of small and medium-sized tears of all shapes, no significant difference was determined in respect of the CM and UCLA scores (P > .05).No significant difference was determined between single and double row repair of crescent type tears of all sizes. In large U-shaped tears, the CM, ASES, and UCLA scores were determined to be high in double row repair.


Assuntos
Artroscopia/métodos , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Articulação do Ombro/cirurgia , Técnicas de Sutura , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Recidiva , Ruptura , Articulação do Ombro/fisiopatologia , Resultado do Tratamento
19.
Am J Sports Med ; 49(11): 2968-2976, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34339329

RESUMO

BACKGROUND: There is a paucity of literature evaluating patient outcomes in patients undergoing revision labral repair and labral reconstruction. PURPOSE: To compare outcomes in patients undergoing revision hip arthroscopy for treatment of labral tears by labral repair or labral reconstruction. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective review of a prospectively maintained multicenter database of patients undergoing hip arthroscopy was performed. An a priori power analysis determined that a total of 62 patients were required. Patients undergoing revision hip arthroscopy for labral tears with completed 2-year outcome scores were included. Patients undergoing primary hip arthroscopy, labral debridement, concomitant gluteal repair, and patients with hip dysplasia (lateral center-edge angle <20°) were excluded. Patients were grouped into revision labral repair and labral reconstruction groups. Patient demographics and patient-reported outcomes (PROs) including Hip Outcome Score - Activities of Daily Living, Hip Outcome Score - Sport Subscale, modified Harris Hip Score, international Hip Outcome Tool-12, visual analog scale for pain and satisfaction, and achievement of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were analyzed. RESULTS: A total of 40 patients underwent revision labral repair and 55 patients underwent labral reconstruction. Patients undergoing revision labral repair were younger (mean age, 30.0 ± 10.7 years vs 34.4 ± 9.7 years; P = .048), had lower rates of labral degeneration (25.0% vs 62.7%; P = .004), and had lower rates of severe complexity of tears (21.1% vs 66.0%; P = .003). However, the labral repair group had higher rates of articular cartilage damage (62.5% vs 33.3%; P = .009). There were no differences in any preoperative or 2-year postoperative PROs. Furthermore, no differences were seen in achievement of MCID or PASS in any PRO. CONCLUSION: In this multicenter study on revision hip arthroscopy, patients undergoing revision labral repair were younger and had better labral characteristics but greater cartilage damage compared with patients undergoing labral reconstructions. Despite these differences, patients who underwent labral repair reported similar outcomes to those undergoing labral reconstruction.


Assuntos
Artroscopia , Impacto Femoroacetabular , Atividades Cotidianas , Adulto , Estudos de Coortes , Impacto Femoroacetabular/cirurgia , Seguimentos , Articulação do Quadril , Humanos , Medidas de Resultados Relatados pelo Paciente , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
20.
Am J Sports Med ; 49(11): 2960-2967, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34357811

RESUMO

BACKGROUND: There is a lack of midterm or long-term outcome data on nonoperative management of femoroacetabular impingement (FAI) syndrome in adolescents despite expanding research mostly focused on arthroscopic management. PURPOSE: To present 5-year outcome data utilizing a nonoperative protocol on a consecutive series of patients presenting to our clinic with FAI syndrome. STUDY DESIGN: Cohort study, Level of evidence, 2. METHODS: A total of 100 patients (62% female; mean age 15 years) who presented to the clinic for evaluation of hip pain and had at least 1 hip with a positive impingement sign were prospectively recruited. The management protocol consisted of an initial trial of rest, physical therapy, and activity modification. Patients who remained symptomatic were offered an intra-articular steroid injection. Patients with recurrent symptoms were then offered arthroscopic treatment. Patient-reported outcomes (PROs), including the modified Harris Hip Score (mHHS) and the Nonarthritic Hip Score (NAHS) were then collected at a mean 1, 2, and 5 years after the initial evaluation. RESULTS: At enrollment, the mean mHHS and NAHS were 69.6 ± 12.9 and 75.5 ± 15.2, respectively. A total of 51 patients (n = 69 hips) were available at a mean 5-year follow-up, with the mean mHHS and NAHS of 89.5 ± 10.8 and 88.1 ± 12, respectively. There was no significant difference in the mHHS or the NAHS between activity modification and physical therapy, injection, or arthroscopic surgery groups at 5-year follow-up (P > .6) and no difference in the proportion of hips meeting the minimal clinically important difference (MCID) for the mHHS based on treatment course (P = .99). There was no significant difference in the mHHS or the NAHS between FAI types at any time point, or in the proportion of hips that met the MCID among FAI types (P = .64). Also, 11 out of 12 hips that required surgery had surgery in less than 2 years. One hip underwent surgery at 5 years after the initial visit. There was no significant drop-off in the mHHS or the NAHS between the 2-year and 5-year time periods (P > .3). CONCLUSION: Nonoperative management of FAI syndrome is effective in a majority of adolescent patients, with significant improvements in PROs persisting at a mean 5-year follow-up.


Assuntos
Impacto Femoroacetabular , Adolescente , Artroscopia , Estudos de Coortes , Feminino , Impacto Femoroacetabular/cirurgia , Seguimentos , Articulação do Quadril , Humanos , Masculino , Estudos Prospectivos , Resultado do Tratamento
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