Long-term Outcomes After Arthroscopic Treatment of Femoroacetabular Impingement for Patients With Borderline Dysplasia.

BACKGROUND: Outcomes after isolated hip arthroscopic surgery for patients with dysplasia have been unfavorable. Results have included iatrogenic instability and conversion to total hip arthroplasty at a young age. However, patients with borderline dysplasia (BD) have shown more favorable results at short- and medium-term follow-up. PURPOSE: To assess long-term outcomes after hip arthroscopic surgery for femoroacetabular impingement in patients with BD (lateral center-edge angle [LCEA] = 18°-25°) compared with a control group of patients without dysplasia (LCEA = 26°-40°). STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: We identified a group of 33 patients (38 hips) with BD who were treated for FAI between March 2009 and July 2012. An age- and sex-matched control group of 83 patients (96 hips) was also identified. Patient-reported outcome scores were collected preoperatively and subsequently at a mean of 9.6 years postoperatively. RESULTS: The mean LCEA and Tönnis angle were 22.42°± 2.02° and 6.27°± 3.23° in the BD group, respectively, and 31.71°± 3.52° and 2.42°± 3.02° in the control group, respectively (P < .001). At a mean follow-up of 9.6 years (range, 8.2-11.6 years), there was a significant improvement in all patient-reported outcome scores in both groups (P < .001). There were no significant differences between preoperative and postoperative scores or rates of achieving the minimal clinically important difference between the BD and control groups. Bilateral surgery was noted to be a risk factor for any revision during the follow-up period (P < .001). There were 2 hips (5.3%) that underwent revision surgery in the BD group and 10 hips (10.4%) in the control group; of these, 1 patient in the BD group underwent total hip arthroplasty, and 1 patient who had undergone bilateral surgery in the control group underwent bilateral hip resurfacing. CONCLUSION: Durable outcomes (>9 years) with low revision rates can be expected after hip arthroscopic surgery with an approach that involves labral preservation where possible and careful attention to capsular closure in patients with BD. The observed outcomes were similar to those of a femoroacetabular impingement group with normal coverage. These results highlight the importance of classifying patients into impingement or instability categories and tailoring treatment appropriately with arthroscopic surgery or periacetabular osteotomy, respectively.

Hip Arthroscopy With Bone Marrow Aspirate Injection for Patients With Symptomatic Labral Tears and Early Degenerative Changes Shows Similar Improvement Compared With Patients Undergoing Hip Arthroscopy With Symptomatic Labral Tears Without Arthritis.

PURPOSE: To define the clinical effect of intra-articular injection of iliac crest-derived bone marrow aspirate concentrate (BMAC) at the time of hip arthroscopy in patients with symptomatic labral tears and early radiographic degenerative changes. METHODS: A retrospective review of a prospectively collected hip registry database was performed. Patients with symptomatic labral tears and Tönnis grade 1 or 2 degenerative changes who underwent labrum-preserving hip arthroscopy with BMAC injection were included and were matched with patients who underwent hip arthroscopy without BMAC injection. Patient-reported outcomes (PROs) collected preoperatively and up to 2 years postoperatively included the modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport, and International Hip Outcome Tool 33 score. Clinical relevance was measured with the minimal clinically important difference, patient acceptable symptom state, and substantial clinical benefit for each outcome score. RESULTS: A total of 35 patients underwent labrum-preserving hip arthroscopy with BMAC injection and were matched with 35 control patients. There were no differences in demographic characteristics between the groups (P > .05). The BMAC group consisted of 22 patients (62.9%) with Tönnis grade 1 changes and 13 (37.1%) with Tönnis grade 2 changes, whereas all 35 control patients had Tönnis grade 0 hips. All PROs were significantly improved in both groups at 2 years, with no difference in improvement. The rate of failure requiring conversion to total hip arthroplasty was 14.3% (mean, 1.6 years postoperatively) in the BMAC group and 5.7% (mean, 7 years postoperatively) in the control group (P = .09). The difference in the frequency of patients achieving the minimal clinically important difference, patient acceptable symptom state, and substantial clinical benefit was not statistically significant between cohorts. CONCLUSIONS: In a challenging group of patients with symptomatic labral tears and early radiographic degenerative changes, hip arthroscopy with BMAC injection results in statistically and clinically significant improvement in PROs comparable to a group of patients with nonarthritic hips undergoing hip arthroscopy at short-term follow-up. LEVEL OF EVIDENCE: Level III, retrospective comparative therapeutic trial.

Male Gender and Competitive Athlete Status Are Associated With Better Outcomes Following Hip Arthroscopy In Patients With Global Acetabular Retroversion.

Purpose: To evaluate outcomes of hip arthroscopy in patients with global acetabular retroversion and to identify correlations between sex, radiographic measurements, athlete status, and return to play with patient-reported outcomes (PROs). Methods: Retrospective study of patients with global acetabular retroversion who underwent arthroscopic femoroacetabular impingement (FAI) surgery was performed. Global acetabular retroversion was defined by 3 criteria: the crossover sign, ischial spine sign, and posterior wall sign on an anteroposterior (AP) pelvic radiograph. Radiographs were used to measure lateral center edge angle, alpha angle, and anterior and posterior wall indices. Femoral version was measured with 3-dimensional computed tomography. Demographics included age, gender, athlete status, return to play, and reoperation. PROs included modified Harris Hip Score, Hip Outcome Score (HOS), Hip Disability and Osteoarthritis Outcome Score, visual analog scale (VAS), and Veterans RAND-12. Spearman correlation determined correlation with perioperative PROs. Generalized estimating equation determined independent predictors. Significance was set at P = .05. Results: From 2013 to 2019, 149 patients (65.0% female) with 160 hips with FAI and global acetabular retroversion underwent hip arthroscopy. Follow-up averaged 29.6 months. All PROs demonstrated significant improvement with the exception of the Veterans RAND-12 Mental. Female patients scored significantly lower on most postoperative PROs and had greater VAS scores (P = .0002-0.0402). A greater proportion of male subjects met the minimum clinically important difference for the modified Harris Hip Score (88.00% vs 78.79%) Low femoral version correlated with greater HOS ADL, HOS Sport, and Hip Disability and Osteoarthritis Outcome Score Sport scores (P = .0077-0.0177). Athletes reported lower preoperative VAS scores, and higher perioperative scores in multiple PROs (P = .0004-0.0486). Nine hips (5.63%) underwent reoperation. Conclusions: Patients with global acetabular retroversion and FAI undergoing hip arthroscopy report good outcomes at short-term follow-up. Male subjects and athletes had superior outcomes compared to female subjects and nonathletes. Radiographic measurements did not correlate with outcomes with exception of low femoral version. Athletes reported lower preoperative pain scores and greater postoperative PROs than nonathletes. Level of Evidence: Level IV, therapeutic case series.

Repair of gluteus medius tears with bioinductive collagen patch augmentation: initial evaluation of safety and imaging.

The purpose of this study was to perform an initial, prospective evaluation of imaging findings and outcomes after open surgical repair of gluteus medius tendon tears with bioinductive collagen patch augmentation. A prospective study was performed of patients with clinical and magnetic resonance imaging (MRI) evidence of symptomatic gluteus medius tears who underwent open, double-row suture anchor repair with bioinductive bovine collagen patch augmentation. Preoperative and 6-month postoperative MRIs were reviewed by a fellowship-trained musculoskeletal radiologist, and outcome scores were recorded preoperatively and 6 months postoperatively [Hip Outcome Score (HOS) Sport; HOS Activities of Daily Living (HOS ADL); Modified Harris Hip Score (mHHS) and International Hip Outcomes Tool (iHOT-33)]. Nine patients, four high-grade tears (≥50% tendon thickness) and five low-grade tears (<50% thickness) underwent surgical repair. At 6 months, 7/9 (77.8%) of tendons were qualitatively classified as completely healed on MRI, with no complications. Mean tendon thickness increased significantly: mediolateral dimension by 5.8 mm (P < 0.001), anteroposterior dimension by 4.1 mm (P = 0.02) and cross-sectional area (CSA) by 48.4 mm2 (P = 0.001). Gluteus medius and minimus CSA did not change significantly (P > 0.05). Patients demonstrated improvements in mean scores for HOS ADL, mHHS and iHOT that met defined minimum clinically important differences (P < 0.05). Open surgical repair of gluteus medius tendon tears with bioinductive collagen patch augmentation is safe and associated with increased tendon thickness on postoperative MRI. Early outcome scores are encouraging and should be evaluated after patients have completed postoperative rehabilitation to measure the whole effect of treatment.

Patient-Reported Outcomes Measurement Information System Mobility Computerized Adaptive Testing Maintains High Correlation and Low Test Burden Compared With Legacy Hip-Specific Instruments in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement.

PURPOSE: To evaluate the reliability, construct validity, and responsiveness of the lower extremity-specific Patient-Reported Outcomes Measurement Information System (PROMIS) Mobility (MO) bank in patients who underwent hip arthroscopic surgery for femoroacetabular impingement. METHODS: Patients who underwent primary hip arthroscopic surgery at a large academic musculoskeletal specialty center between November 2019 and November 2020 completed the following baseline and 6-month measures: PROMIS MO, PROMIS Pain Interference (PI), PROMIS Physical Function (PF), modified Harris Hip Score, International Hip Outcome Tool 33, visual analog scale, and Single Assessment Numeric Evaluation. Construct validity was evaluated using Spearman correlation coefficients. The number of questions until completion was recorded as a marker of test burden. The percentage of patients scoring at the extreme high (ceiling) or low (floor) for each measure was recorded to measure inclusivity. Responsiveness was tested by comparing differences between baseline and 6-month measures, controlling for age and sex, using generalized estimating equations. Magnitudes of responsiveness were assessed through the effect size (Cohen d). RESULTS: In this study, 660 patients (50% female patients) aged 32 ± 14 years were evaluated. PROMIS MO showed a strong correlation with PROMIS PF (r = 0.84, P < .001), the International Hip Outcome Tool 33 (r = 0.73, P < .001), PROMIS PI (r = -0.76, P < .001), and the modified Harris Hip Score (r = 0.73, P < .001). Neither PROMIS MO, PROMIS PI, nor PROMIS PF met the conventional criteria for floor or ceiling effects (≥15%). The mean number of questions answered (± standard deviation) was 4.7 ± 2.1 for PROMIS MO, 4.1 ± 0.6 for PROMIS PI, and 4.1 ± 0.6 for PROMIS PF. From baseline to 6 months, the PROMIS and legacy measures exhibited significant responsiveness (P < .05), with similar effect sizes between the patient-reported outcome measures. CONCLUSIONS: This longitudinal study reveals that in patients undergoing hip arthroscopy, PROMIS MO computerized adaptive testing maintains high correlation with legacy hip-specific instruments, significant responsiveness to change, and low test burden compared with legacy measures, with no ceiling or floor effects at 6-month postoperative follow-up. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Safety and Efficacy of Forearm Tourniquet Compared to Upper Arm Tourniquet for Local Intravenous Regional Anesthesia in Hand Surgery: A Randomized Clinical Trial.

BACKGROUND: Forearm tourniquets may offer decreased doses of anesthetic, shorter procedure times, and less pain compared to upper arm tourniquets. There is limited data comparing the clinical efficacy of forearm Bier blocks to conventional upper arm Bier blocks. The purpose of this study was to assess the effectiveness, complications, duration, cost, and patient satisfaction between forearm and upper arm Bier blocks during surgery. METHODS: Sixty-six carpal tunnel release, ganglion excision, or trigger finger procedures were performed. Patients were randomized to 3 groups: upper arm tourniquet for 25 minutes, forearm tourniquet for 25 minutes, or forearm tourniquet with immediate deflation following the procedure (<25 minutes). The efficacy of surgical anesthesia, tourniquet discomfort, and supplementary local anesthetic administration were recorded. Pain was assessed intraoperatively and postoperatively. Patient satisfaction was assessed on the first postoperative day. RESULTS: No difference was observed between groups with respect to pain, satisfaction, or administration of supplemental medication. The tourniquet time for the group with immediate deflation following procedure was shorter by an average of 9.3 minutes. Total hospital charges were 9.95% cheaper with immediate tourniquet deflation compared to procedures where the tourniquet remained inflated for at least 25 minutes. CONCLUSION: The forearm Bier block is a safe, efficient, cost-effective technique for intravenous regional anesthesia during hand surgery, and tourniquet deflation immediately following the procedure (<25 minutes) does not increase incidence of complications. The forearm tourniquet reduces the dose of local anesthetic and therefore risk for systemic toxicity, with similar effectiveness as compared to the upper arm technique.Level of Evidence: II.

Preoperative Evaluation of the Lower Extremity-Specific PROMIS Mobility Bank in Patients with ACL Tears.

PURPOSE: The purpose of this study was to preoperatively assess the Patient-Reported Outcomes Measurement Information System (PROMIS) Item Bank v2.0-Mobility in patients with anterior cruciate ligament (ACL) tears to (1) determine construct validity by correlating with legacy patient-reported outcomes (PROs), (2) evaluate test burden, (3) determine the presence of floor or ceiling effects, and (4) revisit the conventional threshold for inclusiveness (floor/ceiling effects) in the modern era of computer adaptive testing (CAT)-based PROs. METHODS: Patients at a large academic musculoskeletal specialty center diagnosed with ACL tears indicated for surgery were administered the following outcomes measures before surgery: PROMIS Mobility CAT, PROMIS Pain Interference CAT (PROMIS PI), International Knee Documentation Committee (IKDC), the Marx Knee Activity Rating Scale (Marx), and Single Assessment Numeric Evaluation (SANE). Construct validity was evaluated using Spearman correlation coefficients. Correlation strengths were defined as high (≥0.7), high-moderate (0.61-0.69), moderate (0.4-0.6), moderate-weak (0.31-0.39) and weak (≤0.3). Number of questions to completion were recorded as a marker of test burden. The percentage of patients scoring at the extreme high (ceiling) or low (floor) of each measure was recorded to measure inclusivity. RESULTS: A total of 1126 patients were evaluated. The mean number of questions answered (± standard deviation) was 4.7 ± 2.1 for PROMIS Mobility and 4.5 ± 1.9 for PROMIS PI. PROMIS Mobility demonstrated a high correlation with IKDC, (r = 0.81, P < .001), a high-moderate correlation with PROMIS PI (r = -0.63), and a moderate correlation with SANE (r = 0.46, P < .01). Neither PROMIS Mobility nor PROMIS PI met conventional criteria for floor or ceiling effects (>15%). CONCLUSIONS: The PROMIS Mobility measure maintains construct validity, because its scores correlate strongly with other PROs measuring physical function with high efficiency among preoperative patients with ACL injuries. Although ceiling effects of PROMIS Mobility CAT were below the conventional significance threshold of 15% at the preoperative timepoint in this population, this study provides critical feedback for redesigning the Mobility bank. LEVEL OF EVIDENCE: Level III (Diagnostic study).

The Role of Telehealth in Sideline Management of Sports-Related Injuries.

The COVID-19 pandemic has affected the ability of the sports medicine physician to be present to participate in in-person sideline evaluation of the injured athlete. The purpose of this review is to assess existing literature regarding the utilization of telehealth for sideline evaluation and management of the injured athlete, as well as to identify further areas of research. With the rapid incorporation of telehealth visits, the utilization and capabilities of telemedicine continue to expand. A number of evidence-based resources are available to support medical providers to develop and utilize video evaluation for the sideline evaluation of sports-related injuries. Future research, including the development of validated, modified examination techniques and technologies, will allow for improved interactive physical examinations, which may be better utilized for sideline evaluation.

Return to Collegiate Athletics After Distal Femoral Osteotomy: A Report of Three Cases and Review of the Literature.

Background: The authors present three cases of high-level athletes with successful return to competitive collegiate athletics following distal femoral osteotomy for knee lateral compartment overload. Conclusion: Distal femoral varus osteotomy (DFO) is used to treat valgus knee malalignment and to offload the lateral knee compartment in the setting of symptomatic cartilage or meniscus pathology. DFO can be considered a viable treatment for collegiate athletes, with satisfactory outcomes and ability to return to sport participation at pre-injury functional levels.Level of Evidence: IV.

Correlation of 3D Joint Space Width From Weightbearing CT With Outcomes After Intra-articular Calcaneal Fracture.

BACKGROUND: Posttraumatic osteoarthritis (PTOA) of the subtalar joint is a serious, disabling, and frequent complication following intra-articular calcaneal fractures (IACFs). Using plain radiographs to assess the subtalar joint for PTOA is imprecise and insensitive, hindering progress toward improving treatment and assessing outcomes. This study explored how low-dose weightbearing computed tomography (WBCT) can be used to provide reliable, quantitative 3D measures of subtalar joint space width (JSW) following IACF and correlated the 3D JSW with clinical outcomes. METHODS: After institutional review board approval, 21 patients (15 male; age, 28-70 years) who sustained IACFs and were treated with percutaneous surgical reduction underwent WBCT scans at follow-up visits 2 to 15 years (average, 7.8 years) after surgical treatment. Subtalar joint 3D JSW was computed after a semiautomated protocol was used to segment the talus and calcaneus from the WBCT data. Mean and minimum 3D JSW measurements were calculated and compared with Kellgren-Lawrence (KL) radiographic osteoarthritis grade, RAND-36 Physical (PCS) and Mental (MCS) Component Scores, and visual analog scale (VAS) pain scores. Spearman's rank correlation was used to detect the strength of association between variables, with significance set at P < .05. RESULTS: Mean 3D JSW values measured from WBCT for patients with IACFs ranged from 0.9 to 2.5 mm (1.7 ± 0.4 mm) over the entire subtalar joint. Intra- and interrater reliabilities for the WBCT-based JSW measurement technique were 0.95 (95% CI, 0.91-0.97) and 0.97 (95% CI, 0.95-0.98), respectively. Mean and minimum 3D JSW values correlated inversely with VAS pain scores and KL grade (P < .05), particularly in central and posterior subtalar regions. CONCLUSION: WBCT-based methods were used to quantify the preservation/loss of JSW in patients with IACFs, enabling more accurate, definitive measurement of subtalar PTOA. The results of this study demonstrate that WBCT can be utilized to objectively assess subtalar PTOA and help us to better understand how arthritic changes affect actual patient experience. LEVEL OF EVIDENCE: Level III, prognostic comparative study.

Female Team Physician Representation in Professional and Collegiate Athletics.

BACKGROUND: Although a sex-based balance in US graduate medical education has been well-documented, a discrepancy remains in orthopaedic surgery. In orthopaedic sports medicine, the representation of women as team physicians has not previously been characterized. PURPOSE: To quantify the sex-related composition of team physicians of select National Collegiate Athletic Association (NCAA) Division I collegiate and professional teams. Additionally, the authors assess the sex-related composition of orthopaedic surgeon team physicians specifically and compare these proportions to the sex-related composition of orthopaedic surgeon membership of the American Orthopaedic Society for Sports Medicine (AOSSM). STUDY DESIGN: Cross-sectional study. METHODS: Publicly available sex-related data were collected for team physicians in select NCAA Division I collegiate conferences and professional sports organizations. Subspecialty characteristics and sex distribution were described by use of percentages. Chi-square tests were used to assess whether sex distributions of team physicians in collegiate and professional sports were (1) representative between the populations of female and male physicians compared with the general public and (2) representative of the sex-based composition of orthopaedic surgeons nationally. RESULTS: Women represented 12.7% (112/879) of all team physicians and 6.8% (30/443) of all orthopaedic surgeons (P < .0001). More than half (53.9%; 413/767) of male and 26.8% (30/112) of female team physicians were orthopaedic surgeons. In collegiate athletics, women comprised 18.1% of all team physicians and 7.7% of orthopaedic surgeon team physicians. In professional sports, women comprised 6.7% of all team physicians and 6.3% of orthopaedic surgeon team physicians, with the greatest proportion in the Women's National Basketball Association (31.3%). CONCLUSION: Women comprise a minority of team physicians in select NCAA Division I collegiate and professional sports organizations. When compared with the composition of AOSSM orthopaedic surgeon membership, expected female orthopaedic surgeon representation varies between conferences and leagues with little statistical significance. Although efforts have been made to increase sex-based diversity in orthopaedic surgery, results of this study suggest that barriers affecting female orthopaedic surgeons as team physicians should be identified and addressed.

Medial Patellofemoral Ligament Reconstruction in Skeletally Immature Patients: A Systematic Review and Meta-analysis.

BACKGROUND: Given the proximity of the medial patellofemoral ligament (MPFL) femoral insertion to the distal femoral physis in skeletally immature patients, multiple techniques for femoral graft fixation have been described. PURPOSE: To systematically review the literature and evaluate outcomes and complications following MPFL reconstruction in skeletally immature patients. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A comprehensive literature search was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines through use of the PubMed, Embase, and Cochrane Central databases. All original, English-language studies reporting outcomes or complications following MPFL reconstruction in skeletally immature patients were included. Skeletally mature patients were excluded. Data regarding demographics, surgical technique, graft type, outcomes, and complications were recorded. Study quality was assessed by use of the modified Coleman methodology score. Statistical analysis was performed through use of chi-square and weighted mean pooled cohort statistics, where appropriate, with significance set at P < .05. RESULTS: 7 studies that entailed 132 MPFL reconstructions (126 patients) met the inclusion criteria. Females comprised 57.9% of the cohort (73 females), and the mean age was 13.2 years (range, 6-17 years). Mean postoperative follow-up was 4.8 years (range, 1.4-10 years). All of the grafts used were autograft, with gracilis tendon (n = 80; 60.6%) being the most common. Methods of femoral fixation included interference screw (n = 52; 39.4%), suture anchor (n = 51; 38.6%), and soft tissue pulley around the medial collateral ligament or adductor tendon (n = 29; 21.9%). Pooled Kujala scores improved from 59.1 to 84.6 after MPFL reconstruction. The total reported complication rate was 25.0% (n = 33) and included 5 redislocations (3.8%) and 15 subluxation events (11.4%). No cases of premature physeal closure were noted, and there were 3 reports of donor site pain (2.3%). Neither autograft choice (P > .804) nor method of femoral fixation (P > .416) influenced recurrent instability or overall complication rates. CONCLUSION: These findings suggest that MPFL reconstruction in skeletally immature patients is a viable treatment option, with significant improvement in patient-reported outcomes and redislocation event rates of less than 5% at nearly 5-year follow-up. Further high-quality research is needed to determine optimal graft options and surgical technique while considering recurrent instability, donor site morbidity, and potential injury to the adjacent physis.

Breaking Barriers: A Brief Overview of Diversity in Orthopedic Surgery.

Diversity within the field of orthopedic surgery has been slow to progress, even well into the 21st century. Despite the barriers broken in 1932 by Ruth Jackson - the first female member of the American Academy of Orthopedic Surgeons (AAOS) - gender, racial and ethnic diversity continues to be lacking. Research has shown there are clear advantages of a diverse physician population, not only in medicine and patient care but in commercial industry as well. Although the representation of females and underrepresented minorities (URM) in orthopedics is increasing, it is doing so at a slower rate as compared to other surgical subspecialties. Targeted efforts have been made to investigate and promote gender and cultural diversity in orthopedic surgery. New programs and initiatives have been developed to promote diversity in orthopedics through mentorship and enhancing visibility of females and URM in the field.

Trends Associated with Open Versus Arthroscopic Rotator Cuff Repair.

BACKGROUND: Rotator cuff (RTC) repair is performed using open/mini-open or arthroscopic procedures, and the use of arthroscopic techniques is increasing. The extent to which surgery has transitioned from open to arthroscopic techniques has yet to be elucidated. QUESTIONS/PURPOSES: The purpose of this study was to evaluate trends in open and arthroscopic rotator cuff repair in the USA and describe tendencies in treatment across gender, age, and geographic region. We hypothesized that surgeons would be more likely to perform arthroscopic rotator cuff repair, with similar trends across the USA. METHODS: A retrospective review of a comprehensive national insurance database (Humana) was performed using the PearlDiver software for all patients who underwent RTC repair between January 2007 and June 2015. Patients were identified by Current Procedural Terminology (CPT) codes. χ 2 tests evaluated the proportion of arthroscopic surgeries by gender and geographic region; logistic regression analysis assessed differences from 2007 to 2015. RESULTS: In the study period, 54,740 patients underwent RTC repair (68% arthroscopic, 52% male), with the highest frequency of RTC repair in patients between 65 and 69 years old. The proportion of open RTC repair increased with increasing patient age, with no significant difference between men and women. The proportion of arthroscopic RTC surgeries increased from 56.9% in 2007 to 75.1% in 2015. The overall trend was 188% increase in total RTC repairs. Arthroscopic repair was more frequent than open repair in all US regions, with the highest proportion in the South. CONCLUSION: Arthroscopic RTC surgery predominates and continues to rise. With increasing patient age, there was an increase in the proportion of open repair. The majority of RTC repairs were performed in patients between 65 and 69 years of age.

Return to Collegiate Hockey After Repair of Chronic Biceps Femoris Tendon Transection at the Knee: A Case Report.

CASE: A 22-year-old man sustained complete transection of his right distal biceps femoris tendon by a hockey skate. He experienced persistent pain and disability, symptoms of peroneal neuritis, and an inability to return to hockey. At 3-months postinjury, he underwent biceps femoris repair and peroneal neurolysis. At 9-months postoperatively, the patient returned to full activity and played a full season collegiate hockey. CONCLUSIONS: Isolated distal biceps femoris transection is rare and may be associated with peroneal neuritis. Primary repair and peroneal neurolysis is a viable treatment option (even 3 months postinjury), with satisfactory outcomes and full return to high-level activity.

Trends in Hip Arthroscopic Labral Repair: An American Board of Orthopaedic Surgery Database Study.

PURPOSE: The purpose of this study is to evaluate the trends in labral repair in American Board of Orthopaedic Surgery Part II candidates performing hip arthroscopy. METHODS: Candidates who performed arthroscopic hip surgery between 2011 and 2015 during their American Board of Orthopaedic Surgery Part II board collection period were identified using Current Procedural Terminology codes (29860, 29861, 29862, 29863, 29914, 29915, 29916). The proportion of hip arthroscopy cases including labral repair (Current Procedural Terminology code 29916) were calculated for each year and analyzed by fellowship training experience. Trends in labral repair utilization were calculated using univariate and regression analyses, with significance set at P < .05. RESULTS: During the study period, 1,606 hip labral repair cases were performed, with a 35% increase in utilization between 2011 and 2015. Overall, labral repair was performed in 64.8% (1,606/2,480) of hip arthroscopy cases, with a significant increase between 2011 and 2015 (47.4% vs 79.2%; P < .001). Of the hip arthroscopy cases including labral repair, 80.4% (1,291/1,606) were performed by candidates with sports medicine fellowship training. The proportion of hip arthroscopy cases including labral repair was highest for surgeons with sports medicine fellowship training compared with those without sports medicine fellowship training (66.1% vs 59.8%; P = .007). Candidates with sports medicine training performing at least 1 labral repair each year increased from 68% to 89% over the study period (P = .0007). The average number of labral repairs per candidate increased significantly over the duration of the study period (P = .0072). CONCLUSIONS: Labral repair utilization during hip arthroscopy procedures nearly doubled from 2011 to 2015 for American Board of Orthopaedic Surgery Part II candidates, reflecting a significant change in practice. Current data suggest that nearly 80% of hip arthroscopy procedures include labral repair. These trends may reflect the current practice patterns at academic institutions with sports medicine fellowships.