Long-term clinical and radiological outcomes following arthroscopic microfracture of the glenohumeral joint for chondral defects.

Background: The primary aim of this study was to evaluate mid- and long-term outcomes following microfracture in patients with glenohumeral chondral lesions. Methods: This prospective cohort study assessed patients with shoulder pain who were treated with arthroscopic microfracture for full-thickness chondral lesions of the glenohumeral joint. Outcomes included the Simple Shoulder Test at baseline, mid-term (approximately 1 year) and long-term (approximately 10 years), and the Oxford Shoulder Score, shoulder pain (0-10 numerical scale) and radiological assessment using a modified Samilson & Prieto score at long-term follow-up. Data were analyzed with paired t-tests and Wilcoxon's signed rank tests, which were considered significant if P < .05. Results: Twenty-five patients with a mean age of 52.7 ± 12.1 were enrolled. The mean Simple Shoulder Test score improved from baseline to 1 year (6.7 ± 2.5 to 11.0 ± 1.4, P < .001), which was maintained at long-term follow-up (10.3 ± 2.1, P < .001). Additionally, at long-term follow-up, Oxford Shoulder Score and Verbal Pain Score scores were 43 ± 4.8 and 1.1 ± 1.5, respectively while median modified Samilson & Prieto scores increased from 1 preoperatively to 2 at 10 years (P < .001). Conclusion: Patients undergoing microfracture for full-thickness chondral lesions of the glenohumeral joint reported substantial improvements in shoulder pain and function at 1 and 10 years, despite progressive radiological degeneration.

The Australian ankle syndesmosis injury survey.

BACKGROUND & OBJECTIVE: The ankle syndesmosis is frequently disrupted in ankle injuries, with higher incidence in concomitant ankle fractures. There is debate regarding the most appropriate surgical management of these injuries, with the development of suture-button devices challenging the conventional approach of surgical stabilisation with syndesmotic screws. The primary aim of this study was to assess current practice variation at a national level, enabling a comparison with reported practice around the world. The secondary aims were to assess practice variation between operative indications and inconsistencies between surgeon device usage and personal preference should they be injured themselves. METHODS: A 20-item survey detailing surgical experience, diagnosis, surgical management preference and a series of case studies was conducted. The survey was endorsed and promoted by the Australian Orthopaedic Association (AOA). RESULTS: 125 responses were received during the three-month study period. The most commonly used method to stabilise a syndesmotic injury by Australian orthopaedic surgeons was two 3.5 mm screws (26.4%), closely followed by one suture-button (23.2%). Overall, 44% of surgeons employ a dynamic stabilisation method and 54.4% a static stabilisation method. Half of surgeons recommend routine removal of syndesmosis screws, and surgeons tend to use two devices for high Weber C fractures. One third of surgeons who most commonly use screws in their practice would actually prefer a suture-button for management of their own syndesmosis injury. CONCLUSION: Significant variability remains in the management of syndesmosis injuries. This survey of Australian orthopaedic surgeons reveals higher suture-button device use when compared to other countries.

Primary ACL reconstruction using the LARS device is associated with a high failure rate at minimum of 6-year follow-up.

PURPOSE: The Ligament Augmentation and Reconstruction System (LARS®) is a synthetic ligament consisting of fibres made of polyethylene terephthalate. Despite the LARS being used as an anterior cruciate ligament (ACL) device for nearly 30 years and the well-documented complications from earlier synthetic ligament designs, there is a paucity of published medium- to long-term results. The aim of this study is to report the clinical and functional outcomes after ACL reconstruction using the LARS at a minimum follow-up of 6 years. METHODS: Results of a single surgeon's entire cohort of 55 patients who underwent primary LARS ACL surgery were reviewed at a median of 7.8 years (6.0-9.4). Patient-reported outcome measures including the International Knee Documentation Committee (IKDC) score and 36-Item Short Form Health Survey (SF-36) were collected and clinical assessment consisted of range of motion (ROM) and the KT-1000 arthrometer to assess the side-side difference in the operative and non-operative knee. Mechanical failures of the graft were confirmed at revision surgery and a survivorship analysis was performed using the Kaplan-Meier method. RESULTS: The overall mechanical failure rate was 17/51 (33.3%) with ruptures occurring at a median 3.9 years (0.6-8.8 years) following primary LARS ACL surgery. Secondary operative procedures were performed in 39.2% of patients. For intact grafts, there was no statistically significant difference is side-to-side ROM or anterior knee laxity and subjective scores revealed a median IKDC subjective score of 85.1 (26.4-100) and SF-36 physical component score of 94.1. CONCLUSION: The rates of LARS ACL construct failure (33.3%) in this cohort are high and based on these results the LARS should not be considered as a graft option for primary ACL reconstruction. LEVEL OF EVIDENCE: III, cohort study.