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BACKGROUND: The success of traditional shoulder hemiarthroplasty (HA) with cobalt-chromium heads is limited by painful glenoid erosion with problematic bone loss. Hemiprostheses with pyrolytic carbon (PyC) heads have shown reduced glenoid erosion in experimental laboratory studies. Few in vivo data are available. METHODS: We performed a single-center consecutive cohort study of 31 of 34 patients (91%) who underwent PyC HA between September 2013 and June 2018. In 11 of these patients, concentric glenoid reaming was additionally performed. The mean follow-up period was 5.5 years (range, 3.5-7 years). Standardized radiographs were taken, and clinical function (Constant score) and pain (visual analog scale score) were recorded. Anteroposterior radiographs were analyzed according to an established method by 2 independent observers: A line parallel to the superior and inferior glenoid rim was translated to the most medial point of the glenoid surface. A further parallel line was placed on the spinoglenoid notch. The distance between these 2 lines was measured. Measurements were scaled using the known diameter of the implanted humeral head component. To assess eccentric erosion, anteroposterior and axial images were classified according to Favard and Walch, respectively. RESULTS: Mean medial glenoid erosion measured 1.4 mm at an average of 5.5 years of follow-up. In the first year, 0.8 mm of erosion was observed, significantly more than the average erosion per year of 0.3 mm (P < .001). Mean erosion per year was 0.4 mm in patients with glenoid reaming vs. 0.2 mm in those without reaming (P = .09). An evolution of glenoid morphology was observed in 6 patients, of whom 4 had a progression of the erosion grade. The prosthesis survival rate was 100%. The Constant score improved from 45.0 preoperatively to 78.0 at 2-3 years postoperatively and 78.8 at latest follow-up (5.5 years postoperatively) (P < .001). The pain score on a visual analog scale decreased from 6.7 (range, 3-9) preoperatively to 2.2 (range, 0-8) at latest follow-up (P < .001). There was a weak correlation (r = 0.37) between erosion and pain improvement (P = .039) and no correlation between erosion and change in Constant score (r = 0.06). CONCLUSION: PyC HA caused little glenoid erosion and a sustained improvement in clinical function in our cohort at mid-term follow-up. PyC demonstrates a biphasic development of glenoid erosion, with a reduced rate after the first year. PyC HA should therefore be considered as an alternative to cobalt-chromium HA and to anatomical total shoulder arthroplasty for patients with a high risk of glenoid component complications.
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Artroplastia do Ombro , Cavidade Glenoide , Articulação do Ombro , Humanos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Seguimentos , Estudos de Coortes , Dor , Cromo , Cobalto , Resultado do Tratamento , Estudos Retrospectivos , Cavidade Glenoide/cirurgia , Amplitude de Movimento ArticularRESUMO
PURPOSE: To investigate the influence of intertubercular groove (IG) morphology on the development of different types of biceps reflection pulley (BRP) injuries. METHODS: A consecutive cohort of 221 patients with ventral shoulder pain and a preoperative diagnosis suspecting BRP injury, who underwent arthroscopy, was retrospectively reviewed. The presence or absence as well as type of pulley injury (medial, lateral or bilateral) was confirmed arthroscopically. The intertubercular groove was evaluated on MRIs after triplanar reconstruction of the axial plane. IG depth, width, medial wall angle (MWA), lateral wall angle (LWA) and total opening angle (TOA) were measured. IG depth and width were expressed in relation to the humeral head diameter. Measurements were performed by two clinicians independently and averaged. RESULTS: Of 166 included patients 43 had bilateral, 65 medial and 38 lateral BRP lesions. 20 patients had intact BRPs and represented the control group. The intra-class correlation coefficient of measurements was 0.843-0.955. Patients with a medial or bilateral BRP injury had a flatter MWA (38.8° or 40.0° vs. 47.9°, p < 0.001), wider TOA (96.1° or 96.6° vs. 82.6°, p < 0.001), greater width (12.5 or 12.3 vs. 10.8 mm, p = 0.013) and shallower depth (5.5 or 5.4 vs. 6.2 mm, p < 0.001) than the control group. Conversely, the IG morphology of those with lateral BRP injuries did not differ significantly from the control group. The odds ratio for a medial or bilateral BRP injury when the TOA exceeded 95° was 6.8 (95% confidence interval 3.04-15.2). CONCLUSION: A dysplastic type of IG morphology with a wide TOA, flat MWA, decreased depth and increased width is associated with the presence of medial and bilateral BRP injuries. A TOA of > 95° increases the likelihood of a medial or bilateral BRP injury 6.8-fold. Lateral BRP injuries are not associated with dysplastic IG morphology. Concomitant LHBT surgery may, therefore, not always be necessary during isolated supraspinatus tendon repair. LEVEL OF EVIDENCE: Level III.
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Lesões do Manguito Rotador , Articulação do Ombro , Humanos , Estudos Retrospectivos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Articulação do Ombro/anatomia & histologia , Ombro/patologia , Manguito Rotador/patologia , Lesões do Manguito Rotador/patologia , Cabeça do Úmero , ArtroscopiaRESUMO
INTRODUCTION: The aim of this study was to retrospectively evaluate the clinical outcome of double intramedullary all-suture anchors' fixation for distal biceps tendon ruptures. MATERIALS AND METHODS: A retrospective case series of patients who underwent primary distal biceps tendon repair with all-suture anchors was conducted. Functional outcome was assessed at a minimum follow-up of at 12 months based on the assessments of the Mayo Elbow Performance Score (MEPS), Andrews-Carson Score (ACS), Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH), and the Visual Analog Scale (VAS) for pain. Maximum isometric strength test for flexion and supination as well as postoperative range of motion (ROM) were determined for both arms. RESULTS: 23 patients treated with all-suture anchors were assessed at follow-up survey (mean age 56.5 ± 11.4 years, 96% male). The follow-up time was 20 months (range Q0.25-Q0.75, 15-23 months). The following outcome results were obtained: MEPS 100 (range Q0.25-Q0.75, 100-100); ACS 200 (range Q0.25-Q0.75, 195-200); QuickDASH 31 (range Q0.25-Q0.75, 30-31); VAS 0 (range Q0.25-Q0.75, 0-0). The mean strength compared to the uninjured side was 95.6% (range Q0.25-Q0.75, 80.9-104%) for flexion and 91.8 ± 11.6% for supination. There was no significant difference in ROM or strength compared to the uninjured side and no complications were observed in any patient. CONCLUSION: Distal biceps tendon refixation using all-suture anchors provides good-to-excellent results in terms of patient-reported and functional outcome. This repair technique appears to be a viable surgical option, although further long-term results are needed. LEVEL OF EVIDENCE: Level IV (case series).
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Cotovelo , Traumatismos dos Tendões , Humanos , Masculino , Pessoa de Meia-Idade , Idoso , Feminino , Estudos Retrospectivos , Âncoras de Sutura , Resultado do Tratamento , Traumatismos dos Tendões/cirurgia , Tendões , Amplitude de Movimento Articular , Ruptura/cirurgiaRESUMO
INTRODUCTION: A novel three-dimensional classification to comprehensively describe degenerative arthritis of the shoulder (DAS) was recently published by our group. The purpose of the present work was to investigate intra- and interobserver agreement as well as validity for the three-dimensional classification. MATERIALS AND METHODS: Preoperative computed tomography (CT) scans of 100 patients who had undergone shoulder arthroplasty for DAS were randomly selected. Four observers independently classified the CT scans twice, with an interval of 4 weeks, after prior three-dimensional reconstruction of the scapula plane using a clinical image viewing software. Shoulders were classified according to biplanar humeroscapular alignment as posterior, centered or anterior (> 20% posterior, centered, > 5% anterior subluxation of humeral head radius) and superior, centered or inferior (> 5% inferior, centered, > 20% superior subluxation of humeral head radius). Glenoid erosion was graded 1-3. Gold-standard values based on precise measurements from the primary study were used for validity calculations. Observers timed themselves during classification. Cohen's weighted κ was employed for agreement analysis. RESULTS: Intraobserver agreement was substantial (κ = 0.71). Interobserver agreement was moderate with a mean κ of 0.46. When the additional descriptors extra-posterior and extra-superior were included, agreement did not change substantially (κ = 0.44). When agreement for biplanar alignment alone was analyzed, κ was 0.55. The validity analysis reached moderate agreement (κ = 0.48). Observers took on average 2 min and 47 s (range 45 s to 4 min and 1 s) per CT for classification. CONCLUSIONS: The three-dimensional classification for DAS is valid. Despite being more comprehensive, the classification shows intra- and interobserver agreement comparable to previously established classifications for DAS. Being quantifiable, this has potential for improvement with automated algorithm-based software analysis in the future. The classification can be applied in under 5 min and thus can be used in clinical practice.
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Osteoartrite , Articulação do Ombro , Humanos , Ombro/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Tomografia Computadorizada por Raios X , Artroplastia , Reprodutibilidade dos Testes , Variações Dependentes do Observador , Osteoartrite/cirurgiaRESUMO
PURPOSE: Quadriceps tendon ruptures (QTR) occur predominantly in middle-aged patients through violent eccentric contraction that occurs either when trying to regain balance or during a fall on the hyperflexed knee. The aim of this study was to quantify midterm postoperative results, including strength potential measured via standardized strength tests following acute (< six weeks) quadriceps tendon refixation using suture anchors. METHODS: All consecutive patients with QTR who underwent surgical suture anchor refixation between 2012 and 2019 at a single institution with a minimum follow-up of 12 months were retrospectively evaluated. Outcome measures included Tegner Activity Scale (TAS), Lysholm score, International Knee Documentation Committee subjective knee form (IKDC), Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, return to work rates, and Visual Analog Scale (VAS) for pain. Additionally, a standardized clinical examination and an isometric strength assessment of knee extension and flexion were performed. RESULTS: A total of 17 patients (median age 61.0 [25-75% IQR 50.5-72.5]) were available for final assessment at a mean follow-up of 47.1 ± SD 25.4 months. The majority of patients were male (82.4%) and most injuries occurred due to a fall on the hyperflexed knee (76.5%). The average time interval between trauma and surgery was 12.7 ± 7.5 days. Patients achieved a moderate level of activity postoperatively with a median TAS of 4 (3-5.5) and reported good to excellent outcome scores (Lysholm score: 97 (86.5-100); IKDC: 80.7 ± 13.5; KOOS subscales: pain 97.2 (93.1-100), symptoms 92.9 (82.5-100), activities of daily living 97.1 (93.4-100), sport and recreation function 80 (40-97.5) and knee-related quality of life 87.5 (62.5-100). All patients were able to fully return to work and reported little pain [VAS: 0 (0-0)]. No postoperative complications were reported. Strength measurements revealed a significant deficit of knee extension strength in comparison to the contralateral side (p = 0.011). CONCLUSION: Suture anchor refixation of acute QTR leads to good functional results and high patient satisfaction without major complications. Isometric knee extension strength, however, may not be fully restored compared to the unaffected side.
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Âncoras de Sutura , Traumatismos dos Tendões , Pessoa de Meia-Idade , Humanos , Masculino , Feminino , Atividades Cotidianas , Qualidade de Vida , Estudos Retrospectivos , Articulação do Joelho , Tendões , Traumatismos dos Tendões/cirurgia , Dor , Resultado do TratamentoRESUMO
PURPOSE: Proximal rectus femoris avulsions (PRFA) are relatively rare injuries that occur predominantly among young soccer players. The aim of this study was to evaluate midterm postoperative results including strength potential via standardized strength measurements after proximal rectus femoris tendon refixation. It was hypothesized that the majority of competitive athletes return to competition (RTC) after refixation of the rectus femoris tendon without significant strength or functional deficits compared to the contralateral side. METHODS: Patients with an acute (< 6 weeks) PRFA who underwent surgical refixation between 2012 and 2019 with a minimum follow-up of 12 months were evaluated. The outcome measures compiled were the median Tegner Activity Scale (TAS) and mean RTC time frames, Harris Hip Score (HHS), Hip and Groin Outcome Score (HAGOS) subscales, International Hip Outcome Tool-33 (iHOT-33), and Visual Analog Scale (VAS) for pain. In addition, a standardized isometric strength assessment of knee flexion, knee extension, and hip flexion was performed to evaluate the functional result of the injured limb in comparison to the uninjured side. RESULTS: Out of 20 patients, 16 (80%) patients were available for final assessment at a mean follow-up of 44.8 ± SD 28.9 months. All patients were male with 87.5% sustaining injuries while playing soccer. The average time interval between trauma and surgery was 18.4 ± 8.5 days. RTC was possible for 14 out of 15 previously competitive athletes (93.3%) at a mean 10.5 ± 3.4 months after trauma. Patients achieved a high level of activity postoperatively with a median (interquartile range) TAS of 9 (7-9) and reported good to excellent outcome scores (HHS: 100 (96-100); HAGOS: symptoms 94.6 (89.3-100), pain 97.5 (92.5-100), function in daily living 100 (95-100), function in sport and recreation 98.4 (87.5-100), participation in physical activities 100 (87.5-100), quality of life 83.1 ± 15.6; iHot-33: 95.1 (81.6-99.8)). No postoperative complications were reported. Range of motion, isometric knee flexion and extension, as well as hip flexion strength levels were not statistically different between the affected and contralateral legs. The majority of patients were "very satisfied" (56.3%) or "satisfied" (37.5%) with the postoperative result and reported little pain (VAS 0 (0-0.5)). CONCLUSION: Surgical treatment of acute PRFA yields excellent postoperative results in a young and highly active cohort. Hip flexion and knee extension strength was restored fully without major surgical complications. LEVEL OF EVIDENCE: Retrospective cohort study; III.
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Músculo Quadríceps , Qualidade de Vida , Atletas , Feminino , Humanos , Masculino , Dor , Músculo Quadríceps/cirurgia , Estudos Retrospectivos , Resultado do TratamentoRESUMO
INTRODUCTION: The goal of this study was to provide an insight into the clinical results after modular short-stem shoulder arthroplasty for various indications. MATERIALS AND METHODS: A consecutive cohort study of 76 patients followed up for 23-55 (mean 31.4) months. 23 anatomical (TSA), 32 reverse (RSA) and 21 hemi-prostheses with a pyrocarbon head (PyC), using a modular short stem with proximal porous coating were implanted. Range of motion, pain and Constant score (CS) were recorded. Comparisons of pre- vs postoperative outcomes, between prosthesis types and indications, were made. RESULTS: All prosthesis types brought about a significant improvement (p < 0.05) in all measured outcomes. TSA had a significantly higher increase in the CS than PyC and RSA (p = 0.002 and 0.003, respectively). TSA produced superior gains in all ROM compared with RSA (p < 0.02). RSA brought about significantly smaller improvements in internal rotation than TSA and PyC (p = 0.0001 and 0.008, respectively). TSA had greater pain relief than PyC (p = 0.02). TSA with Walch A glenoids seemed to improve more than type B in the CS. PyC patients with Walch B glenoids improved more than Walch A (p = 0.03). When implanted due to Osteoarthritis (OA), PyC had a comparable final outcome to TSA (p = 0.95), although the preoperatively worse TSA patients had a greater improvement in the CS (p = 0.026). The outcome of RSA did not differ between indications, but Walch A glenoids tended to improve more. CONCLUSIONS: Using a second-generation short-stem shoulder prostheses, TSA achieves the best clinical improvements overall, especially for OA with a Walch A glenoid. Despite refixation of the subscapularis tendon in all cases, RSA has inferior internal rotation than TSA and PyC, suggesting a mechanical limitation. OA, a Walch B glenoid and arthritis caused by instability seem to be ideal indications when considering PyC.
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Artroplastia do Ombro , Articulação do Ombro , Prótese de Ombro , Carbono , Estudos de Coortes , Humanos , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação do Ombro/cirurgia , Resultado do TratamentoRESUMO
Rupture of the pectoralis major muscle (PMR) is a rare injury that occurs primarily during strength training. The case of a 31-year-old professional basketball player who suffered a rupture of the pectoralis major muscle (PM) at the myotendinous junction while performing bench presses is presented. Due to persistent pain and decreased muscle function, surgery was performed 3 weeks after the initial trauma. The patient returned to playing basketball pain-free with full range of motion 3 months following refixation of the PM. This article discusses the distinct characteristics of this injury in the context of the current literature and the operative approach is presented in detail.
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Músculos Peitorais , Treinamento Resistido , Adulto , Humanos , Músculos Peitorais/diagnóstico por imagem , Músculos Peitorais/cirurgia , Amplitude de Movimento Articular , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , TendõesRESUMO
BACKGROUND: Little is known about the way the newest generation of stems integrate into the proximal humerus and their effect on the surrounding bone. Factors that may influence ingrowth have not been investigated. METHODS: A consecutive cohort study was conducted that examined 74 anatomical, reverse, or pyrocarbon hemiprostheses, using a curved modular short stem with a proximal porous coating 2-5 years postoperatively (mean 35 months). X-rays were reviewed by 2 examiners independently. Bone loss was scored with 1 point per zone with partial and 2 points per zone with complete resorption (10 zones). The Constant score was used for clinical correlation. Multiple linear regression was employed to investigate correlations between variables. RESULTS: No subsidence or shift of the stems occurred. Two of 74 patients showed 1 zone of periprosthetic lucency of 1 mm. The filling ratio averaged 0.54 (range: 0.36-0.75). Thirty patients (40.5%) displayed bone resorption, first seen at 16.6 months (range: 3-40 months), commonly in zones 1 and 5. A total of 22 patients had ≥1 zone with partial resorption, and 8 (10.8%) developed full thickness resorption after 32 (range: 10-49) months.One new finding was that female sex and older age accounted for 51% of the variation of the filling ratio. A high filling ratio, especially when >0.55, correlated with bone resorption (P < .001). Age, sex, and prosthesis type did not directly predict bone resorption. Bony sclerosis correlated with a high filling ratio (P = .019) and thereby indirectly with resorption. A direct correlation between sclerosis and resorption was narrowly insignificant (P = .058) once correcting for the filling ratio. Reverse shoulder prosthesis had a higher filling ratio than total shoulder prosthesis patients (P < .001), resulting indirectly in more bone resorption. The preoperative diagnosis did not significantly correlate with the filling ratio (P = .59) or the resorption score (P = .69). A varus or valgus alignment did not predict resorption (P = .21) or the formation of sclerotic lines (P = .93). Bone loss did not correlate with clinical results. CONCLUSIONS: These short stems are firmly anchored 2-5 years postoperatively. However, significant bone loss, linked to a high filling ratio (>0.55), is observed proximally around these stems. The development of sclerotic lines around the stem indicates oversizing. Other factors were not found to have a significant effect on stem ingrowth. The implantation of stems with a large filling ratio is more common in older females and in patients receiving reverse shoulder prosthesis. Autologous impaction bone grafting could downsize the required stem. If adequate hold is not afforded by a suitably small stem, cementation is advisable.
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Artroplastia do Ombro/instrumentação , Reabsorção Óssea/diagnóstico por imagem , Osso e Ossos/patologia , Osseointegração , Articulação do Ombro/diagnóstico por imagem , Prótese de Ombro , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Osso e Ossos/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Úmero/cirurgia , Masculino , Pessoa de Meia-Idade , Porosidade , Desenho de Prótese , Radiografia , Radiologia , Esclerose , Fatores Sexuais , Articulação do Ombro/fisiopatologia , Fatores de Tempo , Adulto JovemRESUMO
Background: Seminal classifications of degenerative arthritis of the shoulder (DAS) describe either cuff tear arthropathy in the coronal plane or primary osteoarthritis in the cross-sectional plane. None consider a biplanar eccentricity. Purpose/Hypothesis: The purpose of this study was to investigate humeroscapular alignment (HSA) of patients with DAS in both the anteroposterior (A-P) and superoinferior (S-I) planes on computed tomography (CT) after 3-dimensional (3D) reconstruction and develop a classification based on biplanar HSA in 9 quadrants. It was hypothesized that biplanar eccentricity would occur frequently. Study Design: Cross-sectional study; Level of evidence, 3. Methods: The authors analyzed 130 CT scans of patients who had undergone shoulder arthroplasty. The glenoid center, trigonum, and inferior angle of the scapula were aligned in a single plane using 3D reconstruction software. Subluxation of the HSA was measured as the distance from the center of rotation of the humeral head to the scapular axis (line from trigonum through glenoid center) and was expressed as a percentage of the radius of the humeral head in both the A-P and the S-I directions. HSA was described in terms of A-P alignment first (posterior/central/anterior), then S-I alignment (superior/central/inferior), for a total of 9 different alignment combinations. Additionally, glenoid erosion was graded 1-3. Results: Subluxation of the HSA was 74.1% posterior to 23.5% anterior in the A-P direction and 17.2% inferior to 68.6% superior in the S-I direction. A central HSA was calculated as between 20% posterior to 5% anterior (A-P) and 5% inferior to 20% superior (S-I), after a graphical analysis. Posterior subluxation >60% of the radius was labeled as extraposterior, and static acetabularization was labeled as extrasuperior. Overall, 21 patients had central-central, 40 centrosuperior, and 1 centroinferior alignment. Of 60 shoulders with posterior subluxation, alignment was posterocentral in 31, posterosuperior in 25, and posteroinferior in 5. There were 3 patients with anterocentral and 4 anterosuperior subluxation; in addition, 4 cases with extraposterior and 17 with extrasuperior subluxation were identified. Conclusion: There was a high prevalence of biplanar eccentricity in DAS. The 3D classification system using combined HSA and glenoid erosion can be applied to describe DAS comprehensively.
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OBJECTIVE: Irreparable rotator cuff injuries in young patients with moderate to high levels of physical activity remain a challenging pathology for shoulder surgeons. Irreparable anterior rotator cuff injuries require treatment that seeks to restore the dynamic anterior forces of the glenohumeral joint. Among surgical treatment options, transfer of the pectoralis major and minor muscle, have shown good functional outcomes. This technique attempts to reproduce the vector of the subscapular muscle in cases with irreparable tear. Restoration of the dynamic external and internal couple forces to maintain the humeral head in the center of rotation. INDICATIONS: Pectoralis major transfer (PMa): Irreparable subscapularis tendon (SSC) tear in active patients without osteoarthritis. Pectoralis minor transfer (PMi): Irreparable superior SSC tear with concomitant irreparable supraspinatus tendon (SSP) tear in active patients with no osteoarthritis. CONTRAINDICATIONS: Primary osteoarthritis Samilson grade C, cuff tear arthropathy Hamada III-V, infection, axillary nerve palsy, older patients with low physical demand, combination with irreparable SSP/infraspinatus tendon (ISP) tear for PMa or combination with irreparable ISP tear for PMi. SURGICAL TECHNIQUE: General anesthesia and beach-chair position with the arm freely mobile in an arm holder. Deltopectoral approach. Exposure of the humeral head and confirmation of the irreparability of the subscapularis tendon. PMa: Detachment of the tendon to be transferred from the humeral insertion, blunt anatomic dissection medially. Exposure of the conjoined tendon and coracoid process. PMi: Detachment of the tendon with an osteotomy at the coracoid process. Passing the PMa or PMi tendon under the conjoined tendon. The PMa tendon is fixed in a 2-row configuration, the PMi in a single row with suture anchors to the lesser tuberosity. POSTOPERATIVE MANAGEMENT: Shoulder abduction sling (30°) for 6 weeks. Assisted range-of-motion (ROM) exercises with abduction/adduction 60-0-0°, internal/external rotation free-0-0° for 6 weeks. Free active ROM exercises after 6 weeks, muscle strengthening after 12 weeks. RESULTS: The pectoralis major and minor transfer shows an improvement in strength and range of motion in young active patients and an improved Constant score (CS) in long-term follow-up examinations.
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Lesões do Manguito Rotador , Manguito Rotador , Humanos , Músculos Peitorais/cirurgia , Lesões do Manguito Rotador/cirurgia , Transferência Tendinosa , Resultado do TratamentoRESUMO
BACKGROUND: Brazilian jiu jitsu (BJJ) is a growing martial art that focuses on grappling techniques. PURPOSE: To quantify the 3-year incidence of BJJ-related injuries and detect common injury patterns as well as risk factors among those practicing BJJ. It was hypothesized that there would be a high incidence of injuries, they would be caused by submissions in sparring situations, and they would occur predominantly at the extremities. STUDY DESIGN: Descriptive epidemiology study. METHODS: Active BJJ athletes were invited to take an English-language online survey developed by orthopaedic surgeons together with BJJ athletes and a sports scientist. Data were recorded regarding athlete demographics, sporting activity level, injuries within the past 3 years that caused at least a 2-week time loss, injury mechanisms, and return to sport. RESULTS: Overall, 1140 responses were received from 62 different countries; 88.9% of all athletes were male, and 63.9% were regular competitors. Within the investigated cohort, 1052 injuries were recorded in 784 athletes, for an injury incidence of 308 per 1000 athletes per year. The lower extremity (45.7%) and upper extremity (30.2%) were predominant sites of injury, with injuries to the knee (27.1%) being the most common. The most frequent knee injuries were meniscal injuries (n = 65), anterior cruciate ligament (ACL) tears (n = 36), and medial collateral ligament injuries (n = 36). ACL tears were especially associated with long time frames for return to sport. Most injuries occurred during sparring (77.6%) and were caused by submissions (29.7%) and takedowns (26.4%). Competing regularly (P = .003), older age (P < .001), and higher belt rank (P = .003) were significant risk factors for injury. CONCLUSION: Injury incidence was high among BJJ athletes surveyed, with 2 out of 3 athletes reporting at least 1 injury within a 3-year period that caused a 2-week absence from training. Most injuries occurred during sparring, and we believe that a high potential for injury reduction lies in drawing awareness to common injury patterns and sites in athletes.
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BACKGROUND: The number of patients presenting for total knee replacement who are classified as obese is increasing. The functional benefits of performing TKR in these patients are unclear. AIM: To assess the influence pre-operative body mass index has upon knee specific function, general health status and patient satisfaction at 3 years following total knee replacement. DESIGN: Retrospective comparative cohort study using prospectively collected data from an institutional arthroplasty register. METHODS: 1367 patients were assessed using the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) and Medical Outcomes Trust Short Form-36 (SF-36) scores supplemented by a validated measure of satisfaction pre-operatively and subsequently at 1,2 and 3 year post-operatively. Comparisons were made by dividing the cohort into 4 groups based on body mass index (BMI) 18.5-25.0 kg/m(2) (nâ=â253);>25.0-30.0 kg/m(2) (nâ=â559);>30.0-35.0 kg/m(2) (nâ=â373);>35.0 kg/m(2) (nâ=â182). RESULTS: Despite lower pre-operative, 1 and 3 year WOMAC and SF-36 scores patients with the highest BMIs >35.0 kg/m(2) experienced similar improvements to patients with a 'normal' BMI (18.5-25.0 kg/m(2)) at 1 year (Difference in WOMAC improvementâ=â0.0 (95%CI -5.2 to 5.2), pâ=â1.00) and this improvement was sustained at up to 3 years (Difference in 1 year to 3 year improvementâ=â2.2 (95%CI: -2.1 to 6.5), pâ=â1.00). This effect was also observed for the SF-36 mental and physical component scores. Despite equivalent functional improvements levels of satisfaction in the >35.0 kg/m(2) group were lower than for any other BMI group (>35.0 kg/m(2)â=â84.6% satisfied versus 18.5-5.0 kg/m(2)â=â93.3% satisfied,pâ=â0.01) as was the proportion of patients who stated they would have the operation again (>35.0 kg/m(2)â=â69.6% versus 18.5-25.0 kg/m(2)â=â82.2%,pâ=â0.01). CONCLUSION: Obese and morbidly obese patients gain as much functional benefit from total knee replacement as patients with lesser body mass indexes. This benefit is maintained for up to 3 years following surgery. However, these patients are less satisfied with their knee replacement and almost a third would not have the operation again.