Treatment of Chronic Proximal Hamstring Tendinopathy with Surgical Debridement and Suture Anchor Repair.

We evaluated outcomes following surgical debridement and suture anchor repair of chronic proximal hamstring tendinopathy without sciatic nerve decompression. Chart review identified eight patients (one bilateral) who met study requirements. All eight patients were available for follow-up at a mean of 6.7 years and none underwent re-operation on the index hip during the follow-up period. Seven patients completed patient-reported outcome scores. The mean LEFS score was 81.1, and the mean SANE score was 74.9. The mean Marx activity score was 2.8, and the mean Custom Marx score was 23.3. Pain relief was excellent. The mean numeric pain score at rest was 0.6, while the mean numeric pain score with activity was 4.0. Treatment of chronic, recalcitrant proximal hamstring tendinopathy with surgical debridement and suture anchor repair without exploration of the sciatic nerve results in excellent pain relief, good function, and low re-operation risk. (Journal of Surgical Orthopaedic Advances 31(1):061-064, 2022).

Physiotherapists' ability to diagnose and manage shoulder disorders in an outpatient orthopedic clinic: results from a concordance study.

BACKGROUND: Advanced practice physiotherapy has emerged as a promising solution to improve health care access because access to orthopedic care is limited in several countries. However, evidence supporting advanced practice physiotherapy models for the management of shoulder pain remains scarce. The purpose of this study was to establish diagnostic, surgical triage, and medical imaging agreement between advanced practice physiotherapists (APPs) and orthopedic surgeons (OSs) for the management of patients with shoulder disorders in an outpatient orthopedic clinic. METHODS: Patients referred to an OS for shoulder complaints were recruited and independently assessed by an OS and an APP. Each provider completed a standardized form indicating diagnosis, imaging test requests, and triage of surgical candidates. Patient satisfaction with care was recorded with the 9-item Visit-Specific Satisfaction Questionnaire (VSQ-9). Inter-rater concordance was calculated with the Cohen κ, prevalence-adjusted bias-adjusted κ, and associated 95% confidence interval (CI). We used χ2 tests to compare differences between providers in terms of treatment plan options and Student t tests to compare patient satisfaction between providers. RESULTS: Fifty participants were evaluated. Good diagnostic agreement was observed between providers (κ, 0.80; 95% CI, 0.67-0.93). Agreement for triage of surgical candidates was moderate (κ, 0.46; 95% CI, 0.21-0.71) as APPs tended to refer patients more often to OSs for further evaluation. Imaging test request agreement was moderate as well (κ, 0.42; 95% CI, 0.19-0.66). Patient satisfaction with care was high, with no significant differences found between providers (P = .70). CONCLUSION: APPs could improve access to orthopedic care for shoulder disorders by safely initiating patient care without compromising satisfaction. These results support further development and evaluation of APP care for orthopedic patients presenting with shoulder disorders.

Accelerated rehabilitation results in good outcomes following acute repair of proximal hamstring ruptures.

PURPOSE: To assess outcomes of patients who underwent proximal hamstring repair utilizing an accelerated rehabilitation protocol with immediate weight bearing as tolerated and no bracing. METHODS: Retrospective chart review identified 47 proximal hamstring tendon repairs with suture anchors in 43 patients performed during 2008-2015. Rehabilitation included no immobilization or limited weightbearing. Patients were contacted by phone to assess outcomes utilizing the lower extremity functional score (LEFS), single-assessment numeric evaluation (SANE), and Marx activity scale. Overall patient-reported scores were calculated and results of acute and chronic repairs compared. RESULTS: Thirty-four patients (38 repairs, 80.8%) were available for follow-up at mean of 4.1 ± 2.0 years following repair. There were two re-tears: one complete rupture 5 weeks postoperative and one partial rupture 10 weeks postoperative in the chronic group. Patients in general reported low pain and good function with a mean LEFS score of 87 ± 21%, a mean SANE score of 88.1 ± 11.6, and a mean numeric pain score of 8.5 ± 15.3 in the last week and 12.2 ± 21.1 with activity. The acute repair group was noted to have a higher mean LEFS score (93.7 versus 79.8%, p = 0.004) and SANE score (91.3 versus 83.8, p = 0.047), and lower pain with activity (21.7 versus 4.8, p < 0.001) as compared to the chronic group. CONCLUSIONS: Repair of acute proximal hamstring ruptures results in good function and pain relief with the use of a rehabilitation protocol that does not require weight-bearing restrictions or bracing. LEVEL OF EVIDENCE: III, therapeutic.

Suture bridge transosseous equivalent repair is stronger than transosseous tied braided-tape.

BACKGROUND: This study biomechanically compares two methods of supraspinatus repair: single row transosseous braided-tape (BT) and suture bridge transosseous equivalent (SBTE) with 2 medial anchors and 2 lateral anchors. The purpose is to test the hypothesis that BT provides superior or equal biomechanical strength compared to SBTE. METHODS: Nine pairs of frozen cadaveric shoulders were selected and both repair techniques were tested on each pair, using a biomechanical testing unit to measure cyclic loading and ultimate load to failure. Moreover, tendon displacement was measured using the percentage of footprint exposed during the cyclic loading phase. RESULTS: Mean specimen age was 71 years (6 males, 3 females), and mean volumetric bone mineral density was 134 mg/cm3. BT mean ultimate load was 266 ± 81 Newton (N) compared to 398 ± 69 N for SBTE and this difference of 131 N was statistically significant p = 0.025. There was a strong positive correlation between bone mineral density and SBTE construct ultimate load. The difference between the percentage of footprint exposed after cyclic loading of the two repairs was statistically significant with the exception of the 10-80 N load (p < 0.05). The failure mode was suture cutout through the tendon in 88% (7/8) of specimens for both techniques. CONCLUSION: SBTE repair with bone anchors provides superior biomechanical strength compared to BT repair in terms of ultimate load and cyclic loading. The tendon-suture junction is the weakness of both methods. These models simulate a complete tear with total loss of contact with rotator interval and infraspinatus. Future studies could focus on a more isolated physiologic supraspinatus tear pattern. LEVEL OF EVIDENCE: Basic science study (Level II).

Validity, reliability and responsiveness of a French translation of the Western Ontario Osteoarthritis of the Shoulder index (WOOS).

INTRODUCTION: While several general questionnaires can be used to evaluate shoulder conditions, very few tools specifically evaluate the impact of shoulder osteoarthritis. The Western Ontario Osteoarthritis of the Shoulder index (WOOS) is a patient-reported outcome measure with excellent psychometric properties intended for patients suffering from shoulder osteoarthritis. Unfortunately, there is no validated French version of this questionnaire. OBJECTIVE: Produce a validated French version of the WOOS that is suitable for the Francophone populations of Europe and North America. MATERIAL AND METHODS: A validated protocol was used to create a French version of the WOOS (WOOS-Fr). Included were patients whose first language was French, who could read French and who had shoulder osteoarthritis destined for treatment (surgical treatment=arthroplasty). The WOOS-Fr was compared to the Disability of the Arm, Shoulder and Hand-French translation (F-QuickDASH-D/S) to assess its validity. Reliability and responsiveness were also analyzed. RESULTS: A French version of the WOOS (WOOS-Fr) was accepted by a multinational committee. The WOOS-Fr was validated in 71 French-speaking subjects. A strong positive correlation was found between the WOOS-Fr and the F-QuickDASH-D/S during the initial evaluation. The intra-class correlation (ICC) of the total WOOS-Fr score indicated good reliability between the initial WOOS and the 1-week WOOS (ICC: 0.84; 95% CI: [0.767; 0.896]; p-value: <0.001) in 57 patients. The responsiveness between the initial WOOS-Fr and at 1 year postoperative was high in the 36 operated patients (standardized mean response of 1.95). DISCUSSION: A French translation of the WOOS questionnaire was created and validated for use in French-speaking populations. This questionnaire will make it easier to evaluate the psychometric results of patients with shoulder osteoarthritis in Francophone countries. LEVEL OF EVIDENCE: III; multicenter cohort study.

Epidemiology and Diagnosis of Anterior Cruciate Ligament Injuries.

Anterior cruciate ligament (ACL) injuries are increasingly common in the United States. This may be related to the increase in high school sports participation, particularly in female athletes. A significant proportion of these injuries are caused by noncontact mechanisms. The incidence of these noncontact injuries may be significantly reduced by enrolling young athletes in jump-training programs. The diagnosis of ACL injuries involves a focused history and physical examination, which can provide a high index of suspicion. Although radiographs are important to rule out associated injuries, the gold standard for diagnosis of ACL injuries is MRI, which has shown excellent accuracy.

Braided tape is equivalent to modified Mason-Allen multi-strand #2 suture in subscapularis muscle repair: results of a biomechanical study.

BACKGROUND: To help determine the optimal fixation method for subscapularis tendon repair in arthroplasty, the present study compares single-passage transosseous tape (BT) and modified Mason-Allen #2 suture (MA). METHODS: Eighteen human cadaveric shoulders were randomized to two repair constructs after arthroplasty preparation. Both techniques included two transosseous passages through the bicipital groove and then through the tendon at the level of the anatomical neck. Construct was tested using a traction machine, measuring cyclic loading and ultimate load to failure. RESULTS: The mean age of our specimens was 71 years. No significant difference was observed between the repair techniques in both mean ultimate load and cyclic loading. The mean (SD) ultimate load (UL) for BT was 293 (84) N and 342 (117) N for MA, which was not statistically significant (p = 0.374). The majority of repairs failed in the tendon. Bone cut-out was observed with the MA but not for the BT repair. No correlation was found between bone density and UL for BT (r = -0.09) but there was strong correlation for MA (r = 0.63). CONCLUSIONS: The MA repair appears to be more dependant on bone mineral density for ultimate load, indicating that braided-tape might be better suited for osteoporotic patients to avoid bone cut-out.

Anterior Cruciate Ligament Reconstruction Using a Combination of Autograft and Allograft Tendon: A MOON Cohort Study.

BACKGROUND: Anterior cruciate ligament (ACL) reconstruction with hamstring autografts less than 8.5 mm in diameter is associated with worse patient-reported outcome scores and increased risk of revision surgery compared with reconstructions performed with larger grafts. One proposed solution to small autograft harvest is to create a hybrid graft by augmenting autografts with allograft tissue to increase graft diameter. PURPOSE: To compare hybrid autograft/allograft ACL reconstruction to autograft ACL reconstruction, specifically analyzing the patient-reported outcome scores and the risk of revision surgery at 2 years postoperative. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: From the years 2002 to 2009, a total of 34 patients were identified from a prospectively collected database as having undergone hybrid ACL reconstruction. Twenty-seven of 34 (79.4%) patients had a 2-year follow-up. These 27 patients were matched by age (within 1 year) and sex to 27 patients who underwent hamstring autograft ACL reconstruction during the same period. At the 2-year mark, revision surgery risk and patient-reported outcome scores were compared between the 2 groups. RESULTS: The mean age for the hybrid and matched groups (±SD) was 20.9 ± 7.0 years. Both the hybrid and control groups had 17 males and 10 females. There was no significant difference in preoperative patient-reported outcome scores, meniscus tears, or cartilage lesions between the 2 groups. Graft size was larger in the hybrid group (9.5 ± 0.6 mm) than in the autograft group (8.4 ± 0.9 mm) (P < .001). At 2 years postoperative, patient-reported outcome scores were similar between the hybrid and autograft groups. Revision surgery was required in 5 (18.5%) patients who underwent hybrid reconstruction compared with 2 (7.4%) of those who underwent autograft reconstruction (P = .26). CONCLUSION: Patients who undergo ACL reconstruction with hybrid hamstring grafts and hamstring autografts report similar patient-reported outcome scores at 2 years postoperative but may be at increased risk for revision ACL reconstruction.

Braided tape suture provides superior bone pull-through strength than wire suture in greater tuberosity of the humerus.

INTRODUCTION: The purpose of this study is to compare the pull-through strength of transosseous braided tape suture with wire suture in proximal humeri bones (greater tuberosity). METHODS: A biomechanical study on eight cadaveric human specimens where two transosseous sutures were randomly applied on each specimen (anterior and posterior). Force/displacement curves were obtained for each specimen and the maximum pull-through load was noted. RESULTS: There is a significant difference in maximal pull-through strength favoring braided tape suture over wire suture. CONCLUSIONS: Transosseous braided tape suture provides almost twice the bone pull-through strength and is slightly correlated to volumetric bone mineral density.