Editorial Commentary: Acetabular Labral Repair-Is A Knotless Anchor Better?

Knotless anchors have an important role in arthroscopic acetabular labral repair. Different anchors show 2 primary failure modes: suture breakage and suture pullout from the anchor ("eyelet failure"). Knotless anchors show minimal displacement at physiological loads and should perform well for arthroscopic labral repair. Surgeons should consider the suture-passing device size and use a device that creates as small of a labral hole as possible.

Femoral Neck Stress Injuries: Analysis of 156 Cases in a U.S. Military Population and Proposal of a New MRI Classification System.

OBJECTIVE: The objective of this study is to formulate a new MRI classification system for fatigue-type femoral neck stress injuries (FNSIs) that is based on patient management and return-to-duty (RTD) time. MATERIALS AND METHODS: A retrospective review of 156 consecutive FNSIs in 127 U.S. Army soldiers over a 24-month period was performed. The width of marrow edema for low-grade FNSIs and the measurement of macroscopic fracture as a percentage of femoral neck width for high-grade FNSIs were recorded. RTD time was available for 90 soldiers. Nonparametric testing, univariate linear regression, and survival analysis on RTD time were used in conjunction with patient management criteria to develop a new FNSI MRI classification system. RESULTS: The FNSI incidence was 0.09%, and all FNSIs were compressive-sided injuries. RTD time was significantly longer for high-grade FNSIs versus low-grade FNSIs (p < 0.001). Our FNSI MRI classification system showed a significant difference in RTD time between grades 1 and 2 (p = 0.001-0.029), 1 and 3 (p < 0.001), and 1 and 4 (p = 0.001-0.01). There was no significant RTD time difference between the remaining grades. The rates of completing basic training (BT) and requiring medical discharge were significantly associated with the FNSI MRI grades (p = 0.038 and p = 0.001, respectively). CONCLUSION: The proposed FNSI MRI classification system provides a robust framework for patient management optimization by permitting differentiation between operative and nonoperative candidates, by allowing accurate prediction of RTD time, and by estimating the risk of not completing BT and requiring medical discharge from the military.

FUNCTIONAL OUTCOMES OF HIP ARTHROSCOPY IN AN ACTIVE DUTY MILITARY POPULATION UTILIZING A CRITERION-BASED EARLY WEIGHT BEARING PROGRESSION.

INTRODUCTION: Hip arthroscopy allows surgeons to address intra-articular pathology of the hip while avoiding more invasive open surgical dislocation. However the post-operative rehabilitation protocols have varied greatly in the literature, with many having prolonged periods of limited motion and weight bearing. PURPOSE: The purpose of this study was to describe a criterion-based early weight bearing protocol following hip arthroscopy and investigate functional outcomes in the subjects who were active duty military. METHODS: Active duty personnel undergoing hip arthroscopy for symptomatic femoroacetabular impingement were prospectively assessed in a controlled environment for the ability to incorporate early postoperative weight-bearing with the following criteria: no increased pain complaint with weight bearing and normalized gait pattern. Modified Harris Hip (HHS) and Hip Outcome score (HOS) were performed preoperatively and at six months post-op. Participants were progressed with a standard hip arthroscopy protocol. Hip flexion was limited to not exceed 90 degrees for the first three weeks post-op, with progression back to running beginning at three months. Final discharge was dependent upon the ability to run two miles at military specified pace and do a single leg broad jump within six inches of the contralateral leg without an increase in pain. RESULTS: Eleven participants met inclusion criteria over the study period. Crutch use was discontinued at an average of five days following surgery based on established weight bearing criteria. Only one participant required continued crutch use at 15 days. Participants' functional outcome was improved postoperatively, as demonstrated by significant increases in HOS and HHS. At the six month follow up, eight of 11 participants were able to take and complete a full Army Physical Fitness Test. CONCLUSIONS: Following completion of the early weight bearing rehabilitation protocol, 81% of participants were able to progress to full weight bearing by four days post-operative, with normalized pain-free gait patterns. Active duty personnel utilizing an early weight bearing protocol following hip arthroscopy demonstrated significant functional improvement at six months. LEVEL OF EVIDENCE: Level 4, Case-series.

Gender and age differences in growth factor concentrations from platelet-rich plasma in adults.

The use of platelet-rich plasma (PRP) to facilitate healing of orthopedic-related injuries has gained popularity; however, the clinical benefits are not consistent. Differences may result from variations in growth factor (GF) levels in normal populations. The purpose of this study was to determine if GF levels present in activated PRP preparations differed by gender and age (≤ 25 versus >25 years) in a healthy population (N = 102). All GFs analyzed (epidermal growth factor [EGF], hepatocyte growth factor [HGF], insulin growth factor-1 [IGF-1], platelet-derived growth factor-AB [PDGF-AB], platelet-derived growth factor-BB [PDGF-BB], transforming growth factor beta-1 [TGFß-1], and vascular endothelial growth factor) had higher levels for females and for those ≤ 25 years old. Of the GFs tested, four of seven were significantly higher (p < 0.05) for females (EGF, HGF, IGF-1, PDGF-BB), the most significant being IGF-1 (female, 85.0; male, 69.3 ng/mL; p < 0.01). Five of seven GFs achieved significance (p < 0.05) for people ≤ 25 years old (EGF, IGF-1, PDGP-AB, PDGF-BB, and TGFß-1), with IGF and PDGF-AB achieving p < 0.001 (≤ 25 years, 85.1; >25 years, 56.8, and ≤ 25 years, 7.66; >25 years, 5.77 ng/mL, respectively). Finally, for both genders, most of the GFs were positively correlated with all GFs. This study demonstrated that both age and gender account for variations in specific GFs present in PRP, and this may partially explain some of the inconsistent results of PRP clinical trials.