Bone-patellar tendon-bone autograft is associated with a higher rate of return to preinjury levels of performance in high-level athletes than anterior cruciate ligament reconstruction using hamstring autograft.

PURPOSE: Return to preinjury levels of performance (RTP) is the main goal after anterior cruciate ligament reconstruction (ACL-R) for athletes when ACL graft rupture is a career-threatening event. The purpose of this study was to elucidate the associated factors for RTP and subsequent ACL injury after ACL-R using bone-patellar tendon-bone (BPTB) or hamstring (HT) autograft in high-level athletes with a minimum postoperative follow-up of 24 months. METHODS: This retrospective study included 157 patients who had preinjury Tegner activity level of 9 and underwent primary ACL-R using BPTB (average age, 16.9 years; 35 males and 36 females) or HT (average age, 17.2 years; 49 males and 37 females). The mean follow-ups were 33.6 months in BPTB and 44.5 months in HT, respectively. The data were obtained based on routine clinical follow-ups and telephone interviews performed by the surgeon. Multivariate logistic regression analysis was conducted to determine the association of patient variables with RTP and subsequent ACL injury. RESULTS: Ninety-nine patients (63.1%) were able to RTP. The rate of RTP in BPTB (74.6%) was significantly higher than that of HT (53.5%) (p < 0.05). The overall average timing of RTP after ACL-R was 10.0 months while that was significantly earlier in BPTB (9.7 months) than in HT (10.5 months) (p < 0.05). Twenty-three (14.6%) and 21 patients (13.4%) had ACL graft ruptures and ACL injuries in the contralateral knees, respectively. Multivariate analyses showed that BPTB (odds ratio [OR], 2.590; 95% confidence interval [CI], 1.300-5.160; p = 0.007) was associated with a higher potential for RTP after ACL-R. The incidence of ACL graft rupture after ACL-R decreased with BPTB (OR, 0.861; 95% CI, 0.770-0.962; p = 0.009). CONCLUSIONS: The use of BPTB autograft was associated with a higher rate of RTP and a lower incidence of ACL graft rupture compared to ACL-R using HT autograft. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Access and adherence to the most recent recommendations regarding resumption of activities after a mild traumatic brain injury.

OBJECTIVES: 1) To examine access and adherence to the Berlin (2016) recommendations for resuming physical and intellectual activities after mild traumatic brain injury (mTBI) (including an exploration of barriers and facilitators). 2) To assess post-mTBI symptoms in relation to recommendation adherence. METHOD: 73 participants who sustained a mTBI completed an online survey with questions about access and adherence to recommendations and validated measures of symptoms. RESULTS: Almost all participants had received recommendations from a health professional after their mTBI. Two thirds of recommendations reported had at least moderate correspondence with the Berlin (2016) recommendations. The vast majority of participants reported weak or partial adherence to these recommendations and only 15.7% reported complete adherence. Overall, adherence to recommendations explained a significant portion of the variance in the severity and number of unresolved post-mTBI symptoms. The most common barriers were: being in a critical period for school or work, pressure to return to work or school, screen use, and presence of symptoms. CONCLUSIONS: Sustained efforts are required to disseminate appropriate recommendations after mTBI. Clinicians should support patients in eliminating barriers to recommendation adherence, as greater adherence may facilitate recovery.

Recreational activity after open hip abductor repair.

BACKGROUND: Hip abductor tear (HAT) is an increasingly diagnosed cause of refractory lateral hip pain and dysfunction, affecting 10-25% of the general population. PURPOSE: (1) to determine the rate of return to activity and to assess the physical and recreational activity of patients undergoing open hip abductor repair (oHATr) and (2) to describe the modification or initiation of new sports disciplines. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A total of 28 patients (29 hips) who underwent an oHATr were prospectively analyzed at a midterm follow-up of 3.5 (range 2-5) years. The sports and recreational activity levels, as well as type of sports practiced before and after surgery, and The Veterans RAND 12 Item Health Survey (VR-12) were assessed via questionnaire. RESULTS: At the final follow-up, all patients were active in sports after surgery. The duration and frequency of sports activities showed a slight decrease (48-42 min per week and 3.2-2.9 sessions per week, respectively) (p = 0.412 and 0.135, respectively). The VR-12 had a score of 45 (13.12-63.18) points for the physical component and 41 (32-53.8) points for the mental component. 100% of the patients would undergo the surgery again. 95% of patients were satisfied with the overall results of the surgical outcome, with 98% satisfied with their hip pain relief and ability to undertake daily and work activities. Moreover, 94% were satisfied with their ability to return to recreational activities. The failure rate in our cohort was approximately 14%. CONCLUSION: All patients who underwent an oHATr were able to return at least to one type of sport. This cohort was highly satisfied with their sports involvement and recreational activity achievement. In addition, 88% of patients reported that oHATr improved sports activity. There was a shift from higher to lower impact sports. Furthermore, just 3 hips present a retear after surgery.

Reverse total shoulder arthroplasty pain and function: new perspectives from a 10-year multicenter study at the 7-year follow-up.

BACKGROUND: Reverse total shoulder arthroplasty (RTSA) can decrease shoulder pain and improve function. However, results reportedly deteriorate as patients approach mid-term follow-up and little is known about how this impacts physical health-related quality of life (PHRQOL) and mental health-related quality of life (MHRQOL). The study hypothesis was that shoulder function, pain, and medication use for pain would influence PHRQOL and MHRQOL. METHODS: This prospective cohort study involving subjects from 6 orthopedic clinics and 12 fellowship-trained surgeons evaluated the influence of RTSA on PHRQOL, MHRQOL, shoulder function, pain, instability, and medication use over the initial 7 years of a 10-year study, and device survivorship and revision rates. Clinical examination, the American Shoulder and Elbow Surgeons (ASES) score, Short Form (SF)-12 PHRQOL and MHRQOL assessments, the single assessment numeric shoulder function evaluation (SANE), visual analog scale (VAS) shoulder pain and instability scores, shoulder pain, medication use for pain, surgery satisfaction, survivorship and revision rate data were collected pre-RTSA, and at 6-week, 6-month, 1-year, 2-year, 3-year, 5-year, and 7-year follow-ups. RESULTS: Two hundred participants (108 female) of 69 ± 8.3 years of age, with gross rotator cuff deficiency (poor tissue quality or impaired dynamic stability) (n = 92), glenohumeral joint osteoarthritis (n = 88), failed primary total shoulder arthroplasty (n = 8), non-united humeral head fracture (n = 6) or 3-4 section comminuted humeral head fracture (n = 6) underwent pre-RTSA evaluation. Device survivorship was 94%. Friedman two-way ANOVA and Wilcoxon test pairwise comparisons revealed that compared to pre-RTSA, median active shoulder flexion (+ 25°) and external rotation (+ 10°) mobility improved by 6 months (p < 0.0001) and remained improved. Shoulder flexion (+ 1 grade), abduction, external rotation (+ 0.5 grade), and internal rotation strength (+ 1 grade) also improved by 6 months (p < 0.0001) and remained improved. ASES (+ 26.8), SANE (+ 17.5) and VAS pain (- 5.7) scores improved by 6 weeks (p < 0.0001) and remained improved, as medication use for shoulder pain decreased (- 24.6%) (p < 0.0001). SF-12 PHRQOL scores improved by 6 months (+ 11.5) and remained improved (p < 0.0001). Significant Spearman Rho correlations were observed between shoulder function (ASES or SANE) and SF-12 PHRQOL (r ≥ 0.52) and MHRQOL (r ≥ 0.20) scores (p < 0.0001) supporting the relationship between shoulder function and quality of life. Trend analysis revealed changing shoulder function, pain, and PHRQOL relationships between 2 and 3 years, and 5 and 7 years post-RTSA (Chi-Square, p < 0.05). CONCLUSION: Excellent device survival and good-to-excellent perceived shoulder function, and PHRQOL improvements were observed. Secondary objectives of improved shoulder mobility, strength, pain and instability were also achieved. In contrast to previous reports, subjects did not display shoulder mobility or perceived function deterioration by the 7-year follow-up. Following chronic pain relief at 6 weeks post-RTSA, subjects appear to balance PHRQOL and shoulder pain relationships at the 6-month and 1-year post-RTSA follow-ups. Careful evaluation at this time may help patients with higher pain levels and lower function expectations reverse these trends, or patients with lower pain levels and higher function expectations to optimize RTSA use and longevity.

Limb Dominance Effects on Seated Single-Arm Shot-Put Limb Symmetry Indices Following Shoulder Rehabilitation.

CONTEXT: Typically, most clinical return to activity guidelines recommend that an injured shoulder achieve a 90% to 100% functional performance test limb symmetry index (LSI); however, as previous research demonstrated a 103% to 111% dominant limb bias in seated single-arm shot-put test (SSASPT) performance, the typical criteria might not be appropriate for interpreting SSASPT LSI. Thus, the current objective was to evaluate SSASP LSI differences between dominant and nondominant involved shoulders and to determine how many patients met the suggested 90% to 100% LSI criteria, as well as the 103% for dominant (89% for nondominant) normative SSASPT threshold reported in the literature, at the time of discharge. DESIGN: Cross-sectional. METHODS: Patients with shoulder injury or surgery (n = 78) completed the SSASPT at the time of discharge from rehabilitation and were grouped according to whether the involved shoulder was the dominant (n = 42) or nondominant (n = 32) limb. LSI (involved/uninvolved × 100) was computed from the average of 3 SSASPT trial distances completed with each limb. RESULTS: The LSI for the nondominant involved group (88.9% [12.4%]) was significantly less (confidence intervalDiff, -12.1% to -22.1%) than the dominant involved group (106.0% [9.3%]). While 95.2% of patients in the dominant involved group exhibited LSI > 90%, only 43.8% of patients in the nondominant involved group attained LSI > 90%. Across the entire cohort, the odds of a nondominant involved LSI being below the respective SSASPT normative range were 2.04 (95% confidence interval, 0.80-5.21) times higher than the odds of a dominant involved LSI being below the normative range. CONCLUSIONS: Patients with dominant limb involvement exhibited higher LSI than patients with nondominant limb involvement at discharge from rehabilitation. Particularly when the nondominant shoulder is involved, these results suggest that patients with shoulder injury and surgery may require longer rehabilitation to attain higher levels of upper-extremity function.

Arthrodesis in Acute and Chronic Lisfranc's Patients: A Retrospective Cohort Study.

Injury to Lisfranc's joint complex affects the longitudinal and transverse arches of the foot and can significantly alter its biomechanics. Some of the previous studies have suggested primary arthrodesis to be superior to open reduction and internal fixation for treating primarily ligamentous Lisfranc injuries. Additionally, arthrodesis is often used for treating chronic Lisfranc injuries, including those which previously underwent open reduction and internal fixation and subsequently developed arthrosis. The purpose of this study was to retrospectively evaluate the outcomes of arthrodesis at the level of Lisfranc's articulation for both acute and chronic injuries. Patients who underwent midfoot arthrodesis surgical procedures between years 2001 and 2017 were retrospectively reviewed. About 187 patients with an average age of 55.9 ± 13.2 years old and a minimum follow-up of 1 year were included in the study. Median time to return to preoperative activities was 11 weeks. Overall successful joint fusion rate was 81.4%. However, concomitantly fused joints of the midfoot and hindfoot, in addition to the tarsometatarsal joints (TMTJ), were included in the overall fusion rate. Fusion rate at the first TMTJ was 90.2% (101 out of 112), second TMTJ was 94.4% (67 out of 71), and third TMTJ was 97.8% (45 out of 46). The present study demonstrates that patients who undergo arthrodesis for both acute and chronic Lisfranc injuries typically can return to activity in under approximately 3 months postoperatively (acute patients significantly faster) with a high union rate at the TMTJs. However, the overall union rate is significantly lower when concomitant proximal midfoot and rearfoot arthrodesis procedures are performed.

Outcomes of Talar Osteochondral and Transchondral Lesions Using an Algorithmic Approach Based on Size, Location, and Subchondral Plate Integrity: A 10-Year Study on 204 Lesions.

The management of transchondral and osteochondral talar lesions has evolved, with microfracturing originally considered the best initial treatment. Despite talar lesions being a tri-dimensional defect, most studies use 2-dimensional parameters to grade them. We propose in this study that tri-dimensional sizing may be more appropriate in evaluation for treatment. The present study evaluated the outcomes of treatment of talar lesions performed by a single surgeon, creating and using an algorithm based on volume, location, and integrity of the subchondral plate. The lesions were classified as "small" (up to 125 mm3), "medium" (125 mm3-1500 mm3), and "large" (>1500 mm3) based upon evaluation of the preoperative magnetic resonance imagining. Location of the lesion was also noted on a 9-region grid pattern of the talar dome. These 3 parameters dictated whether a lesion required microfracturing or retrograde drilling, autogenous or allogenous bone graft, and whether an open versus an arthroscopic approach was required. Over a 10-year period, surgery was performed on 204 lesions. Overall, the average time to return to activity was 7.93 ± 5.00 (range 2-36) months. The average preoperative American Orthopaedic Foot and Ankle score was 76.44 ± 10.98 (range 52-86), and the average postoperative American Orthopaedic Foot and Ankle score was 96.12 ± 3.46 (range 81-100), p = .0001. By using the proposed algorithm, the outcome and return to activity for most patients can be better predicted, regardless of the size or location of the osteochondral lesion. The treatment algorithm implemented in the present investigation yielded overall acceptable results, with only 7 of the 204 lesions needing additional surgery.

Sesamoidectomy in Athletes: Outcomes From 2-Centers.

Sesamoid pain can arise from avascular necrosis, fracture, osteochondrosis, and advanced degeneration. Disorders of the sesamoids in athletes can be debilitating. Total sesamoidectomy of the involved sesamoid is considered an effective surgical treatment when conservative measures have failed. There is limited literature evaluating the outcome of sesamoidectomy in athletically active patients. Our 2-center study reports on 68 patients (70 procedures; 2 male patients were operated on both feet in separate procedures approximately 3 years apart; 41 (58.6%) tibial and 29 (41.4%) fibular sesamoidectomies; 24 males and 44 females, average age 28.4 ± 12.2 years) who underwent total sesamoidectomy from 01/2001 to 12/2019. In our cohort, the average time to return to activity (RTA) was 11.1 ± 5.1 weeks, with no statistically significant difference between gender and age, or between fibular and tibial sesamoidectomy in relation to RTA. There was a minimum follow-up of 1 year, with an average of 106.6 ± 66.6 months. The total incidence of complication rate was 5.7%. In athletes in whom conservative management has failed, sesamoidectomy is safe, and allows predictable return to their chosen sport. To our knowledge, none of the patients subsequently developed pathology to the remaining sesamoid.

Reliable improvements in participation in low-impact sports following implantation of a patellofemoral inlay arthroplasty at mid-term follow-up.

PURPOSE: The aim of this study was, to investigate the rate of return to sports (RTS) and physical activity after implantation of PFIA and to identify factors predictive of improved postoperative sporting ability. METHODS: Sixty-two patients with a mean age of 46 ± 11 years, who underwent implantation of PFIA at the senior authors' institution, were enrolled. They were prospectively evaluated preoperatively and at a minimum of 2 years postoperatively with a mean follow-up of 60 ± 25 months. Clinical outcomes, return to sports and activity, type of sport or activity, subjective satisfaction, and frequency were evaluated by questionnaire. RESULTS: The transformed overall Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score improved from 67 ± 16 to 77 ± 19 (p = 0.003), Tegner activity scale results improved from 3 ± 2 points to 4 ± 1 points (p < 0.001), and scores on the visual analog scale (VAS) pain scale decreased from 6 ± 2 points to 3 ± 2 points (p < 0.001). The sports frequency increased from 1 ± 2 sessions to 2 ± 1 sessions per week (p = 0.001). Ninety-four percent of the patients who did not fail could return to the same or higher level of sports, with 74% of the patients reporting an improved ability to perform sports. No preoperative factors could be detected to significantly influence RTS after surgery. CONCLUSIONS: PFIA is a valid treatment option for the active patient with end-stage isolated patellofemoral OA. Reliable improvements in knee function, pain, and participation in low-impact sports were found. LEVEL OF EVIDENCE: IV.

New plates with polyaxial locking system and PSI technique in medial open wedge high tibial osteotomy: preliminary results.

Medial open-wedge (MOW) high tibial osteotomy (HTO) is proven treatment option, indicated in medial unicompartimental knee osteoarthritis (OA) and in varus OA. New devices and techniques were developed in last years, such as Activemotion plates with polyaxial locking system (Dualtec System®, NewClip-Technics) and PSI technique. We describe outcomes and rate of complications in patients treated with Activemotion plates and PSI technique. From January 2019 to August 2019 a sample of 77 cases (72 NCT plates, 5 PSI technique) was observed, evaluating the rate of complications and the return to activity. The rate of complications is 2.6% and the mean time to return to activity is 10 weeks. MOW HTO with Activemotion plate has showed good results with a low rate of complications. About PSI technique, the preliminary results are excellent, but we need to increase the sample.

Functional impairment after successful surgical reconstruction for proximal hamstring avulsion.

PURPOSE: Surgical refixation procedures after hamstring avulsion injuries show satisfying to excellent outcome results. However, for post-operative evaluation so far, used outcome scores were partially not injury-specific, heterogeneous, difficult to compare, and possibly overestimated due to ceiling effects. A new injury-specific assessment tool has recently been published, potentially depicting more realistic outcome results. Thus, the aim of our study was to evaluate patients after hamstring refixation surgery using previously utilized as well as the new Perth hamstring assessment tool (PHAT). METHODS: A series of operated hamstring injuries were retrospectively evaluated using the PHAT as well as the widespread, customized Lower Extremity Functional Scale (C-LEFS) and the customized Marx score (C-Marx). Scores as well as potential ceiling effects were evaluated individually, and compared and correlated to each other. RESULTS: Sixty-four patients were enrolled into the survey. Forty-nine questionnaires (76%) could be evaluated. The mean total PHAT score (0-100) after 28 months (SD ± 17.0) was 74.1 (SD ± 22.5) points. Mean total C-LEFS (0-80) revealed 61.4 (SD ± 18.1) points, and the mean total C-Marx score (20) was 19.4 (SD ± 1.6) points. Pearson's correlation between the individual questionnaires was high between the PHAT and the C-LEFS (r = 0.81) and low between the PHAT and C-Marx (r = 0.52) and between C-LEFS and C-Marx (r = 0.48). CONCLUSION: The presented study confirms good subjective functional outcomes after surgical intervention of hamstring avulsions in all scores. Nevertheless, using the PHAT, residual complaints are more common than often described in previous studies interpreting "conventional" scores. For future decision and patient guidance, more studies using injury-specific assessments such as the PHAT in combination with objective measurements are eligible.

Cementless unicompartmental knee replacement allows early return to normal activity.

BACKGROUND: Physical activity and regular participation in recreational sports gain importance in patients' lifestyle after knee arthroplasty. Cementless unicompartimental Knee replacement with the Oxford System has been introduced into clinical routine. Currently there is no data reporting on the physical activity, return to sports rate and quality of live after medial cementless Oxford Unicompartimental Knee Replacement (OUKR). METHODS: This retrospective cohort study reports on the functional outcome of the first 27 consecutive patients (30 knees) that were consecutively treated with a cementless medial OUKR between 2007 and 2009 in our hospital. Physical activity and quality of life were measured using the Tegner-Score, the UCLA-Activity Score, the Schulthess Clinical Activity Questionnaire and the SF-36 Score. The patients' satisfaction with the outcome was measured using a visual analogue scale. RESULTS: Mean age at surgery was 62.5 years. Patients showed a rapid recovery with 17 out of 27 patients returning to sports within 3 months, 24 within 6 months after surgery. The Return-to-activity-rate was 100%. 10 out of 27 patients showed a high activity level (UCLA ≥7 points) with a mean postoperative UCLA-Score of 6.1 points. CONCLUSIONS: Patients recover rapidly after cementless OUKR with a return to sports rate of 100% and patients are able to participate in high impact sports disciplines.

A Prospective Evaluation of the Influence of an Electronic Clinical Practice Guidelines on Concussion Patients' Future Activities and Outcomes.

BACKGROUND: Patients with mild traumatic brain injury or concussion commonly present to the emergency department for assessment; providing patients with information on usual symptoms and their progression may encourage faster recovery. OBJECTIVES: This study aimed to document the role of an electronic clinical practice guideline (eCPG) patient handout on concussion recovery in adult patients discharged from the hospital. METHODS: A prospective cohort study was carried out in 3 Canadian urban emergency departments. Adults (≥17 years of age) with a Glasgow Coma Scale score of 13 to 15 who sustained a concussion were recruited by on-site research assistants. Physician use of a concussion-specific eCPG was documented from physician and patient reports. Patient follow-up calls at 30 and 90 days documented return to work/school activities and patient symptoms. Multivariate analyses were performed using logistic regression methods. RESULTS: Overall, 250 patients were enrolled; the median age was 35 (interquartile range 23-49) and 52% were female. Approximately half (n = 119, 48%) of patients received the eCPG handout, and return to work/school recommendations varied. Symptoms persisted in 60% of patients at 30 days; patients in the eCPG group had fewer symptoms (odds ratio 0.57, 95% confidence interval 0.33-0.99). At 90 days, 40% of patients reported persistent symptoms, with no significant difference between groups. CONCLUSION: An eCPG handout improved patients' short-term outcomes; however, physician use and adherence to guideline recommendations was low. To further facilitate physician compliance and therefore patient recovery, barriers to use of the eCPG handout need to be identified and addressed.

Functional outcomes following lateral ulnar collateral ligament reconstruction for symptomatic posterolateral rotatory instability of the elbow in an athletic population.

HYPOTHESIS: The purpose of this investigation was to characterize the functional and surgical outcomes following lateral ulnar collateral ligament (LUCL) reconstruction for posterolateral rotatory instability in an athletic population. METHODS: All US military service members who underwent LUCL reconstruction between 2008 and 2013 were identified. A retrospective chart review was performed, and the prospective Mayo Elbow Performance Score and QuickDASH (short version of Disabilities of the Arm, Shoulder and Hand questionnaire) score were obtained. The primary outcomes were return to preinjury activity and resolution of symptoms. RESULTS: We identified 23 patients with a mean age of 31.6 ± 7.2 years (range, 19-46 years), and 87% were men. A history of instability and/or dislocation was reported by 11 patients (48%), and 8 patients (35%) had undergone prior elbow surgery. At final follow-up of 4.6 ± 1.8 years (range, 2.2-7.6 years), all patients demonstrated significant decreases in pain (average pain score, 4 vs 1.34) with resolution of instability and achieved a functional arc of motion. After surgical reconstruction, 83% were able to return to prior activity, whereas 4 patients (17%) underwent medical separation, including 3 with elbow disability precluding continued service (13%). Overall 83% of patients reported good to excellent outcomes by the Mayo Elbow Performance Score, and 96% of patients reported no significant disability by the QuickDASH disability evaluation. Postoperatively, 4 patients (17%) experienced complications, with 3 (13%) requiring reoperation. CONCLUSION: Although the diagnosis and surgical management of isolated LUCL injury are relatively infrequent, LUCL reconstruction for posterolateral rotatory instability offers a reliable return to preinjury level of function among active individuals with intense upper extremity demands. However, although function reliably improves, the rate of perioperative complications is greater than 15%.

Return-to-activity after anatomical reconstruction of acute high-grade acromioclavicular separation.

BACKGROUND: To evaluate return-to-activity (RtA) after anatomical reconstruction of acute high-grade acromioclavicular joint (ACJ) separation. METHODS: A total of 42 patients with anatomical reconstruction of acute high-grade ACJ-separation (Rockwood Type V) were surveyed to determine RtA at a mean 31 months follow-up (f-u). Sports disciplines, intensity, level of competition, participation in overhead and/or contact sports, as well as activity scales (DASH-Sport-Module, Tegner Activity Scale) were evaluated. Functional outcome evaluation included Constant score and QuickDASH. RESULTS: All patients (42/42) participated in sporting activities at f-u. Neither participation in overhead/contact sports, nor level of activity declined significantly (n.s.). 62 % (n = 26) of patients reported subjective sports specific ACJ integrity to be at least the same as prior to the trauma. Sporting intensity (hours/week: 7.3 h to 5.4 h, p = .004) and level of competition (p = .02) were reduced. If activity changed, in 50 % other reasons but clinical symptoms/impairment were named for modified behavior. QuickDASH (mean 6, range 0-54, SD 11) and DASH-Sport-Module (mean 6, range 0-56, SD 13) revealed only minor disabilities at f-u. Over time Constant score improved significant to an excellent score (mean 94, range 86-100, SD 4; p < .001). Functional outcome was not correlated with RtA (n.s.). CONCLUSION: All patients participated in sporting activities after anatomical reconstruction of high-grade (Rockwood Type V) ACJ-separation. With a high functional outcome there was no significant change in activity level (Tegner) and participation in overhead and/or contact sports observed. There was no correlation between functional outcome and RtA. Limiting, there were alterations in time spent for sporting activities and level of competition observed. But in 50 % those were not related to ACJ symptoms/impairment. Unrelated to successful re-established integrity and function of the ACJ it should be considered that patients decided not return-to-activity but are very content with the procedure.

Sports after shoulder arthroplasty: a comparative analysis of hemiarthroplasty and reverse total shoulder replacement.

BACKGROUND: Traditionally, fewer postoperative sport restrictions are imposed on hemiarthroplasty (HHA) patients on than reverse total shoulder arthroplasty (RTSA) patients. However, functional outcomes have been shown to be superior in RTSA. No direct comparison of RTSA vs HHA has been done on rates of return to sports in patients with glenohumeral arthritis and rotator cuff dysfunction, proximal humeral fractures, or rheumatoid arthritis. METHODS: This is a retrospective review of consecutive RTSA and HHA patients collected from our institution's shoulder arthroplasty registry. All patients playing sports preoperatively with minimum 1-year follow-up were included. Final follow-up included an additional patient-reported questionnaire with questions regarding physical fitness and sport activities. RESULTS: The study included 102 RTSA and 71 HHA patients. Average age at surgery was 72.3 years for RTSA compared with 65.6 years for HHA (P < .001). Patients undergoing RTSA had improved visual analog scale scores compared with HHA (-5.6 vs -4.2, P = .007), returned to sports after RTSA at a significantly higher rate (85.9% vs 66.7%, P = .02), and were more likely to be satisfied with their ability to play sports (P = .013). HHA patients were also more likely to have postoperative complaints than RTSA patients (63% vs 29%, P < .0001). No sports-related complications occurred. Female sex, age <70 years, surgery on the dominant extremity, and a preoperative diagnosis of arthritis with rotator cuff dysfunction predicted a higher likelihood of return to sports for patients undergoing RTSA compared with HHA. CONCLUSIONS: Despite traditional sport restrictions placed on RTSA, patients undergoing RTSA can return to sports at rates higher than those undergoing HHA, with fewer postoperative complaints.

Comparison of Limb Loading Characteristics and Subjective Functional Outcomes Between Sexes Following ACLR.

CONTEXT: ACL reconstruction (ACLR) patients commonly adopt poor movement patterns that potentially place them at an increased risk for reinjury if untreated. Limb loading characteristics during functional tasks can highlight movement compensations. OBJECTIVE: Examine loading symmetry during a bilateral bodyweight squatting task between sexes, compare loading metrics between limbs and sexes, and describe the relationship between loading metrics and patient reported outcomes (PROs) following ACLR. DESIGN: Cross-Sectional Study. SETTING: Laboratory. PATIENTS OR OTHER PARTICIPANTS: 142 patients (71M/71F, 24.4±11.10yrs) with a primary, unilateral, uncomplicated ACLR completed a squatting assessment and PROs at approximately 5.2 months post-ACLR. MAIN OUTCOME MEASURE(S): Normalized limb loading peak force (N/kg) and unilateral cumulative load (%) were collected bilaterally during the squatting task. Limb symmetry index (%) was calculated for normalized peak force. Our first objective compared limb loading symmetry (%) between sexes using independent samples t-test. Our second objective assessed differences in limb loading metrics between limbs and sexes were analyzed via an analysis of covariance. Our third objective was assessed using Spearman Rho correlations to determine the relationship between limb loading metrics and PROs. RESULTS: The majority of individuals (91/142, 64.1%) offloaded their ACLR limb (ACLR: 6.6±1.56 N/kg; contralateral: 7.3±1.61 N/kg, p<0.001). Females significantly offloaded their ACLR limb (ACLR: 6.3±1.38 N/kg; contralateral: 7.2±1.62 N/kg, p<0.001) where males did not significantly offload their ACLR limb (ACLR 6.98±1.65 N/kg; contralateral: 7.4±1.60, p=0.07). Weak relationships were observed (ρ-value range: -0.23 to 0.19) across limb loading metrics and PROs. CONCLUSION: Individuals approximately five months following ACLR, on average, offloaded their ACLR limb compared to the contralateral limb. Patients' tendency to offload their weight during a squat was influenced by sex. Relationships between limb loading metrics and PROs indicate patients who load their limbs disproportionately have a lower perception in their capability to complete activities of daily living and lower subjective knee function.

Return to surfing following hip arthroplasty.

BACKGROUND: To date, no previous studies have explored return to surfing after hip arthroplasty. The objective of this study is to analyse return to a risky activity following hip arthroplasty. METHODS: A retrospective chart review was conducted on all primary total hip arthroplasties (THA) and hip resurfacing arthroplasties (HRA) performed by the senior author from 2014 to 2021. Patients identified as surfers were contacted to complete a survey including surfing history and patient-reported outcomes. RESULTS: 83 hips in 67 patients were contacted. There were 66 THAs and 17 HRAs. 81 hips were performed through a posterior approach and 2 through an anterior approach. At an average of 67 months, there were no dislocations and no patients reported hip pain while surfing. Time to resume surfing was a median of 16 (range 8-144) weeks. Among 13 patients who did not return to surfing, 8 cited new lifestyle restrictions, 4 attributed it to other arthritic joints, and only 1 patient attributed their limitation to the replaced hip. This group had taken significantly more time off from surfing prior to surgery. CONCLUSIONS: Return to surfing following THA and HRA is common and safe in our study population with no complications and specifically no dislocations. Patients with other sites of arthritis and patients who have more extensive time away from surfing prior to surgery are less likely to return to sport. While surfing is clearly not without risk, patients can generally expect a high rate of successful return to surfing after hip arthroplasty.

Return to activity is a multi-faceted variable not a discrete yes-no.

OBJECTIVES: To develop a patient reported outcome that allow for tracking of return to activity after injury. By acknowledging that return to activity is not a discrete Yes/No question where participants return to their baseline activity may be unrelated to their treatment a more comprehensive understanding and measurement of the outcome of treatment after injury as it relates to activity participation was developed and evaluated. METHODS: Item development and evaluation were undertaken with the final version tested in an ongoing observational clinical trial. Descriptive statistics and test-re-test analysis using intra class correlation and percent agreement were used. RESULTS: A 5-item set of questions was identified that assess return to activity from a multi-faceted perspective. The final 5-items records preferred activity, days and hours per week of participation, impact of change in participation in activity, degree of limitation in participation and if it is related to injury or external factors. . Over 30% of the population reported that their participation in their preferred activity was no longer active and not related to their injury but other factors demonstrating the importance of documenting more than one variable. CONCLUSION: The Minnesota Activity Scale provides standardized questions to comprehensively assess return to activity as a marker of treatment effectiveness. LEVEL OF EVIDENCE: V.

Rehabilitation and return to activity criteria after operative management of chronic exertional compartment syndrome of the leg: a systematic review.

OBJECTIVES: Endurance athletes with chronic exertional compartment syndrome (CECS) frequently require fasciotomy to return to activity, but there are no existing comprehensive evidence-based rehabilitation guidelines. We aimed to summarize rehabilitation protocols and return to activity criteria after CECS surgery. METHODS: Through a systematic literature review, we identified 27 articles that explicitly defined physician-imposed restrictions or guidelines for patients to resume athletic activities following CECS surgery. RESULTS: Common rehabilitation parameters included running restrictions (51.9%), postoperative leg compression (48.1%), immediate postoperative ambulation (44.4%), and early range of motion exercises (37.0%). Most studies (70.4%) reported return to activity timelines, but few (11.1%) utilized subjective criteria for guiding return to activity. No studies utilized objective functional criteria. CONCLUSIONS: Rehabilitation and return to activity guidelines after CECS surgery remain poorly defined, and further investigation is needed to develop such guidelines that will enable endurance athletes to safely return to activities and minimize recurrence.