Glenohumeral Internal Rotation Deficit in the Adolescent Overhead Athlete: A Systematic Review and Meta-Analysis.

OBJECTIVE: The objective of this review was to investigate the average glenohumeral internal rotation deficit (GIRD) in the dominant arm of adolescent overhead athletes and to examine the association with shoulder and elbow injuries. DESIGN: Systematic review and meta-analysis. SETTING: MEDLINE, Embase, and PubMed were searched from inception to August 1, 2020. PARTICIPANTS: Adolescent overhead athletes with glenohumeral range of motion (ROM) measurements. INTERVENTIONS: Nonoperative treatments of GIRD. MAIN OUTCOME MEASURES: Glenohumeral ROM measurements comparing the dominant and nondominant extremities were pooled in a meta-analysis. RESULTS: Twenty-five studies were included in this review, which involved 2522 overhead athletes. Pooled internal rotation (IR) deficit of the dominant arm was 9.60° (95% confidence interval [CI] 7.87°-11.32°, P < 0.00001), with an external rotation (ER) gain of 6.78° (95% CI 4.97°-8.59°, P < 0.00001) and a total ROM (TROM) deficit of 1.78° (95% CI -0.70° to 4.26°, P = 0.16). The association between GIRD and shoulder or elbow injury was not clearly defined. Two studies reported treatment, and both used nonoperative treatment in the form of physiotherapy and sleeper stretches. CONCLUSIONS: The adolescent overhead athlete has roughly 10° of IR deficit in their dominant arm, accompanied by nearly 7° of ER gain, with similar ROM measurements for injured and uninjured athletes. Those with pathological GIRD have a greater degree of IR deficit, but without an accompanying compensatory increase in ER, leading to a TROM deficit of nearly 15°. Surgical treatment in the absence of other indications is rare, whereas physiotherapy and sleeper stretches remain the first-line treatment.

The Use of Elbow Arthroscopy for Management of the Pediatric Elbow: A Systematic Review of Indications and Outcomes.

PURPOSE: The purpose of this review was to systematically examine the literature surrounding elbow arthroscopy for pediatric patients and to assess indications, functional outcomes, and complication rates. METHODS: This systematic review was carried out in accordance with PRISMA guidelines. EMBASE, PubMed, and MEDLINE were searched for relevant literature from inception until December 2019, and studies were screened by 2 reviewers independently and in duplicate for those investigating elbow arthroscopy in a pediatric population (<18 years). Editorials, review articles, and case reports were excluded. Demographic data and data on surgical indications, treatment outcomes, and complications were recorded. A methodological quality assessment was performed for all included studies using the Methodological Index for Non-Randomized Studies. RESULTS: Overall, 19 studies, all of level IV evidence, were identified with a total of 492 patients (513 elbows). The patient population was 22.3% female with a mean age of 14.0 years (range, 4.0-15.7) and a mean follow-up time of 33.0 months (range, 7.4-96 months). Twelve studies (263 patients) exclusively recruited patients with osteochondritis dissecans (OCD), although other indications for elbow arthroscopy included arthrofibrosis (50 patients), elbow fracture (37 patients), medial ulnar collateral ligament injury (31 patients), and posterior impingement (17 patients). All 13 reporting studies showed a significant improvement in the elbow flexion-extension arc, and 4 of 5 that reported a functional outcome score before and after surgery demonstrating a significant improvement. Last, the overall complication rates ranged from 0% to 23.8%, with a total of 8 instances of neurological injury (5 ulnar, 2 radial, 1 unspecified), all being transient and resolving within 3 to 6 months. CONCLUSION: Although elbow arthroscopy is primarily being performed for OCD in children and adolescents, there is evidence surrounding several other potential indications. Case series published to date have demonstrated significant improvements in functional outcomes and low rates of major complications. LEVEL OF EVIDENCE: Level IV, systematic review of level IV studies.

Arthroscopic management of greater trochanter pain syndrome and abductor tears has demonstrated promising results in terms of improvement in pain scores and functional outcomes: a scoping review.

PURPOSE: Greater trochanteric pain syndrome (GTPS) refers to the constellation of signs and symptoms related to pain in the trochanteric region and has recently replaced the previously ubiquitous term of 'greater trochanteric bursitis'. GTPS is common, particularly in women 50-79 years of age, and the understanding and management of GTPS have expanded considerably in recent years to include management with arthroscopic and endoscopic techniques in recalcitrant cases. The purpose of this scoping literature review was to summarize the current evidence on arthroscopic management of GTPS including sources of evidence, key concepts, and gaps in the literature. METHODS: A thorough electronic database search included studies published from 2009 to June 14, 2020. A total of 52 peer-reviewed articles were identified within the literature on arthroscopic or endoscopic management of GTPS. RESULTS: Of the 52 identified papers, 12 were technique descriptions, 10 papers were review articles, and 30 papers were original clinical papers. Of the 30 clinical papers, 24 (80%) were of level IV evidence, 5 (17%) were of level III evidence, and 1 (3%) was level II evidence. Among the 30 clinical studies, 988 patients were included with 761 (77%) female. Indications for surgical management included a failed trial of conservative management in all 30 studies, typically after a period of 3-6 months. Surgical management consisted of arthroscopic/endoscopic abductor tendon repair in 16 (53%) studies, arthroscopic/endoscopic bursectomy and iliotibial band release in 12 (40%) studies, and arthroscopic/endoscopic gluteal tendon contracture release in 2 (7%) studies. CONCLUSION: Overall, results following arthroscopic management of GTPS and abductor tears have been promising, including significantly improved pain scores and functional outcomes at final post-operative assessment. These studies support continued use and investigation of arthroscopic management strategies of GTPS and pave the way to conduct larger prospective studies to confirm these results in the future. LEVEL OF EVIDENCE: IV.

A high rate of children and adolescents return to sport after surgical treatment of osteochondritis dissecans of the elbow: a systematic review and meta-analysis.

PURPOSE: The purpose of this systematic review was to determine the return to sport rates following surgical management of ostechondritis dissecans of the elbow. METHODS: The databases EMBASE, PubMed, and MEDLINE were searched for relevant literature from database inception until August 2020 and studies were screened by two reviewers independently and in duplicate for studies reporting rates of return to sport following surgical management of posterior shoulder instability. A meta-analysis of proportions was used to combine the rates of return to sport using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS score. RESULTS: Overall, 31 studies met inclusion criteria and comprised of 548 patients (553 elbows) with a median age of 14 (range 10-18.5) and a median follow-up of 39 months (range 5-156). Of the 31 studies included, 14 studies (267 patients) had patients who underwent open stabilization, 11 studies (152 patients) had patients who underwent arthroscopic stabilization, and 6 studies (129 patients) had patients who underwent arthroscopic-assisted stabilization. The pooled rate of return to any level of sport was 97.6% (95% CI 94.8-99.5%, I2 = 32%). In addition, the pooled rate of return to the preinjury level was 79.1% (95% CI 70-87.1%, I2 = 78%). Moreover, the pooled rate of return to sport rate at the competitive level was 86.9% (95% CI 77.3-94.5%, I2 = 64.3%), and the return to sport for overhead athletes was 89.4% (95% CI 82.5-95.1%, I2 = 59%). The overall return to sport after an arthroscopic procedure was 96.4% (95% CI 91.3-99.6%, I2 = 1%) and for an open procedure was 97.8% (95% CI 93.7-99.9%, I2 = 46%). All functional outcome scores showed improvement postoperatively and the most common complication was revision surgery for loose body removal (19 patients). CONCLUSION: Surgical management of osteochondritis dissecans of the elbow resulted in a high rate of return to sport, including in competitive and overhead athletes. Similar rates of return to sport were noted across both open and arthroscopic procedures. LEVEL OF EVIDENCE: Level IV.

Return to Sport After Surgical Management of Proximal Hamstring Avulsions: A Systematic Review and Meta-analysis.

OBJECTIVE: To assess the rates and timing of return to sport for the surgical management of proximal hamstring avulsions (PHAs). METHODS: Three databases, PubMed, MEDLINE, and EMBASE, were searched from database inception until October 7, 2017, by 2 reviewers independently and in duplicate. The inclusion criteria were studies reporting return to sport outcomes for surgical management of acute, chronic, complete, and partial PHA. The rate of return to sports was combined in a meta-analysis of proportions using a random-effects model. RESULTS: Overall, 21 studies with a total of 846 patients met the inclusion criteria, with a mean age of 41.4 years (range, 14-71 years) and a mean follow-up of 37.8 months (range, 6-76 months). Two studies were of prospective comparative design (level II), 2 were retrospective comparative (level III), 8 were prospective case series (level IV), and 9 were retrospective case series (level IV). The overall mean time to return to sport was 5.8 months (range, 1-36 months). The pooled rate of return to any sport participation was 87% [95% confidence interval (CI), 77%-95%]. The pooled rate of return to preinjury level of sport was 77% (95% CI, 66%-86%). CONCLUSIONS: Pooled results suggest a high rate of return to sport after surgical management of PHA; however, this was associated with a lower preinjury level of sport. No major differences in return to sport were found between partial versus complete and acute versus chronic PHA.

Clinical and radiographic predictors of failed hip arthroscopy in the management of dysplasia: a systematic review and proposal for classification.

PURPOSE: As indications for hip arthroscopy continue to expand, its efficacy in patients with more complex deformities of the hip, such as those with acetabular dysplasia, remains controversial. The purpose of this systematic review is to identify the predictors of failed hip arthroscopy in dysplastic hips and to propose a standardize prognostic sub-classification of dysplasia. METHODS: This systematic review was performed in accordance with the (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) PRISMA guidelines. Three databases [EMBASE, PubMed, and Ovid (MEDLINE)] were searched using terms including "hip arthroscopy" and "dysplasia". Studies were screened and data extracted in duplicate. Study quality was assessed using the Methodological Index for Non-Randomized Studies criteria. Due to the non-uniform nature of study data, findings were presented in descriptive summary form. RESULTS: Thirteen studies were included in this systematic review, comprising 712 dysplastic patients (773 hips) with mean age 34.2 years and 74.1% females. Most studies defined hip dysplasia by a lateral centre-edge angle (LCEA) of 20°-25° (borderline) or 15°-20° (moderate). Failure was defined as progression to revision arthroscopy, peri-acetabular osteotomy, or total hip arthroplasty. Overall, failure rate was 192/743 (25.8%) at an average of 28.1 months following index arthroscopy. Smaller LCEA, larger Tönnis angle, broken Shenton line, and decreased joint space (≤ 2 mm) were radiographic predictors of failure. Severe cartilage lesions to the femoral head or acetabulum were associated with failure in five studies. Labral debridement led to more failures than labral repair. CONCLUSION: Overall, hip arthroscopy yielded good outcomes in mildly dysplastic hips without severe chondral damage. Hip arthroscopy is expected to result in a failed outcome in individuals with moderate-to-severe hip dysplasia (LCEA < 15°), severe cartilage lesions, larger Tönnis angle (> 20°), broken Shenton line, and decreased joint space (≤ 2 mm). Arthroscopic surgery may be more effective in individuals with borderline-to-mild (LCEA 15°-25°) acetabular dysplasia in the absence of severe cartilaginous lesions (7-year survival: 89.6%). A standardized prognostic classification of hip dysplasia based on the LCEA and Tönnis angle is proposed. LEVEL OF EVIDENCE: Systematic review of non-randomized studies, Level IV.

Correction to: Clinical and radiographic predictors of failed hip arthroscopy in the management of dysplasia: a systematic review and proposal for classification.

Unfortunately, the author name was incorrectly published in the original publication as Sochi Uchida insted of Soshi Uchida. The author name is corrected here by this Erratum. The â€‹original â€‹article â€‹has â€‹been â€‹corrected.

The dimensions of the hip capsule can be measured using magnetic resonance imaging and may have a role in arthroscopic planning.

PURPOSE: The purpose of this study was to systematically evaluate the dimensions and thickness of the hip joint capsule. Secondarily, the study assessed whether there were any described correlations between capsule thickness and stability of the hip joint. METHODS: Four databases (PubMed, Ovid [MEDLINE], Cochrane Database, and EMBASE) were searched from database inception to May 2018, and two reviewers independently and in duplicate screened the resulting literature. Methodological quality of all included papers was assessed using the Methodological index for non-randomized studies (MINORS) criteria. Mean differences were combined in a meta-analysis using a random effects model when possible. RESULTS: A total of 14 studies (1 level I, 1 level II, 4 level III, 5 level IV) were identified including 796 patients (1013 hips) with a mean age of 39.5 years (range 2-95). Of the included patients, 55.2% were female and they were followed up for a mean of 7.6 months (range 1-12.5 months). The thickness of the capsule was measured in cadaveric specimens, ultrasound, and magnetic resonance imaging (MRI), with MRI measurements reported most consistently and with the least variation. Mean thickness of the anterior capsule in patients without hip disease on MRI ranged from 4.4 and 4.7 mm. Mean thickness of the anterior capsule in patients with FAI ranged between 4.9 and 5.0 mm. Males had significantly thicker capsules than females (mean difference = 1.92 mm, 0.35-3.49, P = 0.02). Clinical laxity of the hip joint, as well as female gender was correlated with thinner anterior joint capsules. CONCLUSION: The thickness of the anterior hip capsule can be measured consistently using MRI. A thinner anterior capsule may be associated with clinical laxity of the hip joint. The relevance of capsular thickness on postoperative instability following hip arthroscopy is poorly understood and warrants further investigation. The thickness of the anterior hip capsule, as measured on MRI, has the potential to be used as part of the clinical decision-making in capsular management strategies. LEVEL OF EVIDENCE: IV.

What Makes Suture Anchor Use Safe in Hip Arthroscopy? A Systematic Review of Techniques and Safety Profile.

PURPOSE: To perform a systematic review that assesses the current literature on suture anchor placement for the purpose of identifying factors that lead to suture anchor perforation and techniques that reduce the likelihood of complications. It was hypothesized that suture anchor placement in hip arthroscopy would generally be safe, with the exception of the complications of articular cartilage violation and psoas tunnel perforation. Perioperative factors, related to patient, surgeon, and technical variables, may influence the safety of suture anchor insertion. METHODS: Three databases (PubMed, Ovid MEDLINE, and Embase) were searched, and 2 reviewers independently screened the resulting literature. The inclusion criteria were clinical and biomechanical studies examining the use of suture anchors in hip arthroscopy. The methodologic quality of all included articles was assessed using the Methodological Index for Non-Randomized Studies criteria and the Cochrane risk-of-bias assessment tool. Results are presented according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using descriptive statistics. RESULTS: We included 14 studies in this review, comprising 4 case series (491 patients; 56.6% female patients; mean age, 33.9 years), 9 controlled cadaveric or laboratory studies (111 cadaveric hips and 12 synthetic acetabular bone blocks; 42.2% female hips; mean age, 60.0 years) with a mean Quality Appraisal for Cadaveric Studies score of 11, and 1 randomized controlled trial (37 hips; 55.6% female hips; mean age, 34.2 years). Anterior cortical perforation into the psoas tunnel by suture anchors led to pain and impingement of pelvic neurovascular structures. The anterior acetabular positions (3- to 4-o'clock position) had the thinnest bone, smallest rim angles, and highest incidence of articular perforation. Drilling angles from 10° to 20° measured off the coronal plane were acceptable. The midanterior and distal anterolateral portals were used successfully, with 1 study reporting difficulty placing anchors at anterior locations through the distal anterolateral portal. One study showed that curved suture anchor drill guides allow for a better trajectory away from the articular cartilage. Small-diameter (≤1.8-mm) all-suture anchors had a lower in vivo incidence of articular perforation with similar stability and pullout strength to other anchor types in biomechanical studies. CONCLUSIONS: Suture anchors at anterior acetabular rim positions (3- to 4-o'clock position) should be inserted with caution. Large-diameter (≥2.3-mm) suture anchors increase the likelihood of articular perforation without increasing labral stability. Inserting small-diameter (≤1.8-mm) all-suture anchors from 10° to 20° drilling angles may increase safe insertion angles from all cutaneous portals. Direct arthroscopic visualization, the use of fluoroscopy, distal-proximal insertion, and the use of nitinol wire can help prevent articular violation. LEVEL OF EVIDENCE: Level IV, systematic review of Level I to IV studies.

Athletes experience a high rate of return to sport following hip arthroscopy.

PURPOSE: The purpose of this systematic review was to evaluate the rate at which patients return to sport following arthroscopic hip surgery. METHODS: The databases MEDLINE, EMBASE, and PubMed were searched by two reviewers, and titles, abstracts, and full-text articles screened in duplicate. English language studies investigating hip arthroscopy with reported return to sport outcomes were included. A meta-analysis of proportions was used to combine the rate of return to sports using a random effects model. RESULTS: Overall, 38 studies with 1773 patients (72% male), with a mean age of 27.6 years (range 11-65) and mean follow-up of 28.1 months (range 3-144) were included in this review. The pooled rate of return to sport was: 93% [95% confidence interval (CI) = 87-97%] at any level of participation; 82% (95% CI = 74-88%) at preoperative level of sporting activity; 89% (95% CI = 84-93%) for competitive athletes; 95% (95% CI = 89-98%) in pediatric patients; and 94% (95% CI 89.2-98.0%) in professional athletes. There was significant correlation between a shorter duration of preoperative symptoms and a higher rate of return to sports (Pearson correlation coefficient = - 0.711, p = 0.021). CONCLUSION: Hip arthroscopy yields a high rate of return to sport, in addition to marked improvement in pain and function in the majority of patients. The highest rates of return to sport were noted in pediatric patients, professional athletes, and those with a shorter duration of preoperative symptoms. This study provides clinicians with evidence-based data on athletes' abilities to return to sport after arthroscopic hip surgery and identifies sub-populations with the highest rates of return to sport. LEVEL OF EVIDENCE: IV, systematic review of Level II-IV studies.

Preoperative Patient Factors Affecting Length of Stay following Total Knee Arthroplasty: A Systematic Review and Meta-Analysis.

BACKGROUND: Total knee arthroplasty (TKA) yields substantial improvements in quality of life for patients with severe osteoarthritis. Previous research has shown that TKA outcomes are inferior in patients with certain demographic and clinical factors. Length of stay (LOS) following TKA is a major component of costs incurred by healthcare providers. It is hypothesized that patient-related factors may influence LOS following TKA. The purpose of this systematic review and meta-analysis is to investigate these factors. METHODS: Three databases (PubMed, Embase, and OVID Medline) were searched using variants of the terms "total knee arthroplasty" and "length of stay". Studies were screened and data abstracted in duplicate. The primary outcome was the effect of prognostic variables on LOS following TKA. Meta-analysis was performed using the Review Manager (RevMan) software (version 5.3. Copenhagen: The Nordic Cochrane Center, The Cochrane Collaboration, 2014). RESULTS: A total of 68 studies met all inclusion criteria for this review. These studies comprised 21,494,459 patients undergoing TKA with mean age 66.82 years (range, 15-95 years) and 63.8% (12,165,160 of 19,060,572 reported) females. The mean MINORS score was 7, suggesting that studies had a low quality of evidence. Mean LOS following TKA has steadily decreased over the past 4 decades, partially because of the implementation of fast-track programs. Demographic factors associated with increased LOS were age >70 years (mean difference [MD] = 0.81; 95% confidence interval [CI] = 0.38-1.24), female gender (MD = 0.32; 95% CI = 0.29-0.48), body mass index >30 (MD = 0.09; 95% CI = 0.01-0.16), and non-White race (MD = 0.20; 95% CI = 0.10-0.29). Clinical factors associated with increased LOS were American Society of Anesthesiologists score 3-4 vs 1-2 (MD = 1.12; 95% CI = 0.58 to 1.66), Charlson Comorbidity Index > 0 vs 0 (MD = 0.77; 95% CI = 0.32 to 1.22), and preoperative hemoglobin < 130 g/L (MD = 0.66; 95% CI = 0.34 to 0.98). CONCLUSION: This systematic review and meta-analysis showed that increased age, female gender, body mass index ≥ 30, non-White race, American Society of Anesthesiologists > 2, Charlson Comorbidity Index > 0, and preoperative hemoglobin < 130 g/L were predictors of increased LOS. Mean LOS has steadily decreased over the past decades with the implementation of perioperative "fast-track" programs. Future research should investigate the benefits of preoperative risk factor modification on LOS, in addition to novel surgical approaches, anesthetic adjuvants, and physiotherapy modifications. LEVEL OF EVIDENCE: IV, systematic review, and meta-analysis of level III and IV evidence.

Return to Sport and Clinical Outcomes After Surgical Management of Acromioclavicular Joint Dislocation: A Systematic Review.

PURPOSE: To evaluate the rate at which athletes return to sport after surgical management of acute and chronic acromioclavicular (AC) joint dislocations. METHODS: Three databases-PubMed, MEDLINE, and EMBASE-were searched from database inception until October 28, 2017, by 2 reviewers independently and in duplicate. The inclusion criteria were English language studies that reported return to sport outcomes in patients undergoing surgical management of AC joint dislocations. RESULTS: Overall, 12 studies with a combined total of 315 patients met the inclusion criteria, with a mean age of 33.8 years (range, 18-65 years) and a mean follow-up of 34.9 months (range, 6-126 months). Of the 12 included studies, 1 was a prospective comparative study (Level II), 1 was a retrospective comparative study (Level III), 1 was a prospective case series (Level IV), and 9 were retrospective case series (Level IV). The rates of return to any level of sport ranged from 94% to 100% (I2 = 0%), whereas the rates of return to the preinjury level of sport ranged from 62% to 100% (I2 = 61%). The pooled rate of return to preinjury level of sport in type V AC joint separations was 86.2% (95% confidence interval = 68.1%-98.0%), whereas that after type III or IV AC joint injuries was 89.6% (95% confidence interval = 79.9%-96.9%). CONCLUSIONS: An almost perfect rate of return to sport participation after surgical management of AC joint dislocations have been reported, with most returning to their preinjury level of sport. The rates of return to sport were comparable across the different types of injuries and surgical procedures. LEVEL OF EVIDENCE: Level IV, systematic review of Level II, III, and IV investigations.

Arthroscopic Management of Septic Arthritis of the Native Shoulder: A Systematic Review.

PURPOSE: To investigate arthroscopic management of native shoulder joint septic arthritis-specifically, indications, patient outcomes, and complications. METHODS: PubMed, MEDLINE, and Embase were used to search the literature, and data abstraction was performed independently and in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist guided reporting and data abstraction. The quality of all included studies was assessed with the Methodological Index for Non-randomized Studies (MINORS) criteria. The results are presented in a narrative summary fashion using descriptive statistics including means, proportions, ranges, κ values, and intraclass correlation coefficient values. RESULTS: Overall, 27 studies (19 case reports and 8 case series) were identified, including 115 patients (121 shoulders). The mean follow-up period was 29.1 months (range, 1-199 months). The indications for shoulder arthroscopy owing to infection included pain; limited range of motion; swelling, erythema, and tenderness; fever; elevated leukocyte count, erythrocyte sedimentation rate, and/or C-reactive protein level; synovial aspirate findings; and/or imaging findings. Overall, 46 patients (40%) achieved infection eradication and functional improvement after a single arthroscopic procedure. However, 43 patients (37%) had ongoing symptoms or complications, including 32 (30%) who required revision arthroscopic procedures, 7 (6%) who underwent open arthrotomy for septic arthritis management, 2 (2%) in whom avascular necrosis of the humeral head developed, 1 (1%) in whom adhesive capsulitis developed, and 1 (1%) in whom an irregular profile of the humeral epiphysis developed on plain radiographs. CONCLUSIONS: Arthroscopic management of native shoulder septic arthritis can yield alleviation of pain and a return to full range of motion, daily activities, and sports. However, there is a high reoperation rate, which may correlate with poor patient prognostic factors. This systematic review did not show the superiority of either arthroscopic surgery or open arthrotomy for the management of shoulder septic arthritis. LEVEL OF EVIDENCE: Level IV, systematic review of Level IV studies.

Over 90 % of children and adolescents return to sport after anterior cruciate ligament reconstruction: a systematic review and meta-analysis.

PURPOSE: To evaluate the rate at which children and adolescent athletes return to sporting activities after anterior cruciate ligament (ACL) reconstruction. METHODS: Three databases, PubMed, MEDLINE, and EMBASE, were searched from database inception until September 9, 2017 by two reviewers independently and in duplicate. The inclusion criteria were English language studies that reported return to sport outcomes. Book chapters, conference papers, review articles, and technical reports were excluded. The rate of return to sports was combined in a meta-analysis of proportions using a random-effects model. RESULTS: Overall, 20 studies with a combined total of 1156 ACL reconstructions met the inclusion criteria, with a mean age of 14.3 years (range 6-19) and a mean follow-up time of 6.5 years (range 1-22). All studies were level IV evidence (14 retrospective case series and 6 prospective case series). The pooled rate of return to any sport participation was 92.0% [95% confidence interval (CI), 86-96%]. The pooled rate of return to pre-injury level of sport was 78.6% (95% CI 71-86%) and that to competitive level of sport was 81.0% (95% CI 62-94%). A total of 93 of the 717 assessed athletes (13%) sustained re-injuries with graft ruptures, and in 91 of 652 patients (14%), contralateral ACL injuries were reported on final follow-up. CONCLUSION: Pooled results suggest a high rate of return to sport following ACL reconstruction in children and adolescent athletes; however, this is associated with a relatively high rate of graft rupture and a similar rate of contralateral ACL injury. This study provides clinicians with evidence-based data on the ability of children and adolescent athletes to return to sport after ACL reconstruction, an important consideration for athletes of this population with ACL injuries. LEVEL OF EVIDENCE: IV, systematic review of level IV studies.

Earlier anterior cruciate ligament reconstruction is associated with a decreased risk of medial meniscal and articular cartilage damage in children and adolescents: a systematic review and meta-analysis.

PURPOSE: To evaluate the association between surgical timing and the incidence of secondary meniscal or chondral damage in children and adolescents with anterior cruciate ligament (ACL) ruptures. METHODS: Three electronic databases, PubMed, MEDLINE, and EMBASE, were systematically searched from database inception until October 16, 2017 by two reviewers independently and in duplicate. The inclusion criteria were English language studies that reported the incidence of meniscal and articular cartilage damage in children or adolescent athletes with ACL injuries as well as the timing of their ACL reconstruction (ACLR). Risk ratios were combined in a meta-analysis using a random effects model. RESULTS: A total of nine studies including 1353 children and adolescents met the inclusion criteria. The mean age of patients included was 14.2 years (range 6-19), and 45% were female. There was a significantly decreased risk of concomitant medial meniscal injury in those reconstructed early (26%) compared to those with delayed reconstruction (47%) [pooled risk ratio (RR) = 0.49, 95% CI 0.36-0.65, p < 0.00001]. There was also a significantly reduced risk of medial femoral chondral (RR = 0.48, 95% CI 0.31-0.75, p = 0.001), lateral femoral chondral (RR = 0.38, 95% CI 0.20-0.75, p = 0.005), tibial chondral (RR = 0.45, 95% CI 0.27-0.75, p = 0.002), and patellofemoral chondral (RR = 0.41, 95% CI 0.20-0.82, p = 0.01) damage in the early reconstruction group in comparison to the delayed group. CONCLUSION: Pooled results from observational studies suggest that early ACLR results in a significantly decreased risk of secondary medial meniscal injury, as well as secondary medial, lateral, and patellofemoral compartment chondral damage in children and adolescents. This study provides clinicians with valuable information regarding the benefits of early ACL reconstruction in children and adolescents, and can be used in the decision making for athletes in this population. LEVEL OF EVIDENCE: IV.

Return to sport following arthroscopic Bankart repair: a systematic review.

HYPOTHESIS AND BACKGROUND: The purpose of this systematic review was to determine the return-to-sport rate following arthroscopic Bankart repair, and it was hypothesized that patients would experience a high rate of return to sport. METHODS: The MEDLINE, Embase, and PubMed databases were searched by 2 reviewers, and the titles, abstracts, and full texts were screened independently. The inclusion criteria were English-language studies investigating arthroscopic Bankart repair in patients of all ages participating in sports at all levels with reported return-to-sport outcomes. A meta-analysis of proportions was used to combine the rate of return to sport using a random-effects model. RESULTS: Overall, 34 studies met the inclusion criteria, with a mean follow-up time of 46 months (range, 3-138 months). The pooled rate of return to participation in any sport was 81% (95% confidence interval [CI], 74%-87%). In addition, the pooled rate of return to the preinjury level was 66% (95% CI, 57%-74%) (n = 1441). Moreover, the pooled rate of return to a competitive level of sport was 82% (95% CI, 79%-88%) (n = 273), while the pooled rate of return to the preinjury level of competitive sports was 88% (95% CI, 66%-99%). CONCLUSION: Arthroscopic Bankart repair yields a high rate of return to sport, in addition to significant alleviation of pain and improved functional outcomes in the majority of patients. However, approximately one-third of athletes do not return to their preinjury level of sports.

A scoping review of intimate partner violence educational programs for health care professionals.

Multiple intimate partner violence (IPV) educational programs have been developed for health care professionals (HCPs); however, program content and effectiveness vary substantially. The purpose of this scoping review was to identify and synthesize the literature evaluating IPV education programs for HCPs to identify key areas for potential evidence-based recommendations and focus future research priorities. We conducted a systematic literature search using broad eligibility criteria to identify studies published between January 2000 and July 2015 that evaluated the effectiveness of IPV education programs in health care settings. All potentially eligible references were screened independently by two reviewers. Data extraction was completed independently by two reviewers for all eligible studies. Descriptive statistics were used to summarize all data. We identified 65 eligible studies, 55% of which reported positive program effectiveness. Effective programs often reported the use of online training components, delivery by an IPV educator/expert or physician/surgeon, the inclusion of a treatment protocol and resources for patients and HCPs, and included more than five training sessions lasting no more than one hours each. Our results demonstrate that IPV educational programs are heterogeneous and that a wide variety of methodologies have been used to evaluate their effectiveness.

Does the Level of Evidence of Paper Presentations at the Arthroscopy Association of North America Annual Meetings From 2006-2010 Correlate With the 5-Year Publication Rate or the Impact Factor of the Publishing Journal?

PURPOSE: The purpose of this study was to determine the proportion of paper (podium) presentations at the 2006-2010 Arthroscopy Association of North America (AANA) annual scientific meetings that were ultimately published in a peer-reviewed journal. Furthermore, we aimed to evaluate whether the level of evidence correlated with the publication rate of these presentations or the impact factor (IF) of the publishing journal. METHODS: Paper presentations from the 2006-2010 AANA annual meetings were included for evaluation. Clinical studies were graded for quality using the level of evidence by 2 independent reviewers. A comprehensive strategy was used to search the databases PubMed, Medline, and Embase for publications in scientific journals that corresponded to the presentations and were published within 5 years of the presentation date. RESULTS: Three hundred twenty-eight presentations were evaluated. Overall, 179 peer-reviewed publications corresponding to particular meeting presentations were identified, for a 5-year publication rate of 55%. There was no correlation between the publication rate and the level of evidence (P = .836), the type of study (P = .628), or the joint of focus (P = .07) of the presentations. The mean IF of journals that published Level I studies (4.8 [standard error, 2.3]) was significantly higher than the mean IF of journals that published Level II, III, or IV studies (2.58 [standard error, 0.10]) (P = .017). CONCLUSIONS: Between 2006 and 2010, presentations of the highest level of evidence at AANA meetings were subsequently published at a similar rate to presentations of lower levels of evidence, albeit in journals with higher IFs. CLINICAL RELEVANCE: This study is an important initial evaluation of the ultimate clinical impact of AANA meeting presentations. The study type, joint of focus, and level of evidence of the presentations all had no correlation with the rate at which these presentations were ultimately published.

Level of evidence of free papers presented at the European Society of Sports Traumatology, Knee Surgery and Arthroscopy congress from 2008 to 2016.

PURPOSE: The European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) congress is an important venue, and the research presented can be a critical source of information used to impact clinical decisions and health policies. The purpose of this study was to evaluate the level of evidence of clinical free papers presented at the ESSKA congress from 2008 to 2016. Moreover, this study evaluated whether there were any changes in the distribution of level of evidence over time. METHODS: Two reviewers screened the free papers presented at the ESSKA biannual congresses 2008-2016 for clinical evidence. Clinical papers included observational studies and trials involving direct interaction between an investigator and human subjects. Biomechanical studies, technique demonstrations, cadaveric studies, and panel discussions were excluded. The reviewers independently graded their level of evidence from level I (e.g. high-quality randomized trials) to level IV (e.g. case series and reports) using the classification system published by the American Academy of Orthopaedic Surgeons. RESULTS: Of 1036 free papers that were identified, 729 met the inclusion criteria and were evaluated. Overall, 18% of studies were level I, 24% level II, 25% level III, and 33% level IV evidence. There was a significant improvement in level of evidence over time (p < 0.0001), with the proportion of level I studies increasing most dramatically (9% in 2008, 20% in 2012, 24% in 2016). Free papers studying the knee had higher levels of evidence than those evaluating other joints (p = 0.002). CONCLUSION: The level of evidence of clinical free papers presented at the ESSKA congress between 2008 and 2016 is high relative to other orthopaedic meetings. Moreover, there has been a significant improvement in the level of evidence over time. LEVEL OF EVIDENCE: Systematic review, Level IV.

Level of clinical evidence presented at the open and closed American Shoulder and Elbow Surgeons annual meeting over 10 years (2005-2014).

BACKGROUND: The American Shoulder and Elbow Surgeons (ASES) annual scientific meetings are premier forums whereby orthopaedic surgeons are informed of the latest research advances in shoulder and elbow surgery. The purpose of the present study was to assess the Level of evidence (LOE) in the clinical papers presented at both the open and closed ASES annual scientific meetings from 2005 to 2014. Secondarily, the study evaluated whether there were any changes in the distribution of LOE over this period of time. METHODS: Two reviewers independently evaluated the abstracts of 532 paper presentations at either the open or closed ASES annual meetings. The independent reviewers first screened the abstracts for clinical evidence and excluded cadaveric, biomechanical, technique, and review studies. The included abstracts were then independently graded for methodological quality using LOE from Level I (highest quality) to IV (lowest quality) based on the classification system created by The American Academy of Orthopaedic Surgeons (AAOS). RESULTS: Overall, 421 presentations were included and graded for LOE. In general, 17% of the presentations were graded level I; 15% level II; 25% level III; and 43% assigned a LOE of IV. Chi-square analysis demonstrated a statistically significant improvement in the LOE of presentations at the open and closed ASES meetings combined (p = 0.028) between the years 2005 and 2014. In particular, the proportion of presentations graded as level IV significantly decreased over this period (p = <0.001). CONCLUSIONS: While most presentations at the ASES annual scientific meetings were of lower LOEs the percentage of level I evidence is greater than that reported at other Orthopaedic meetings. There has been a significant improvement in the LOE of clinical research at open and closed ASES meetings from 2005 to 2014. Specifically, the proportion of level IV studies have dramatically decreased over time.