Cadaveric Analysis of Key Anatomic Structures of Athletic Pubalgia.

PURPOSE: This study proposes to establish in-depth inspection of the anatomic structures involved with the pathology of athletic pubalgia in a cadaver model. METHODS: Eight male fresh frozen cadavers were dissected in a layered fashion. The rectus abdominis (RA) and adductor longus (AL) tendon insertions were isolated to quantify the size of the anatomic footprint and distance from the surrounding anatomy. RESULTS: The RA insertional footprint was 1.65 cm (SD, 0.18) in width by 1.02 cm (SD, 0.26) in length, and the AL insertional footprint on the underside of the pubis was 1.95 cm (SD, 0.28) in length by 1.23 cm (SD, 0.33) in width. The ilioinguinal nerve was 2.49 cm (SD, 0.36) lateral to the center of the RA footprint and 2.01 cm (SD, 0.37) lateral to the center of the AL footprint. The spermatic cord and the genitofemoral nerve were just lateral to the ilioinguinal nerve and were 2.76 cm (SD, 0.44) and 2.66 cm (SD, 0.46) from the rectus and AL footprints, respectively. CONCLUSION: Surgeons should be cognizant of these anatomic relations during both initial dissection and tendon repair to optimize repair and avoid iatrogenic injury to critical structures in the anterior pelvis.

A Review of Abductor Tendon Tears: The Hidden Lesion of the Hip.

¼: Greater trochanteric pain syndrome consists of a group of associated conditions involving the lateral hip that can be debilitating to patients, mostly women between ages 40 and 60 years. ¼: Abductor tendon tears are becoming a more recognized cause of lateral hip pain in patients without hip osteoarthritis. ¼: Diagnosis of this condition is critical to patient care because misdiagnosis often leads to unnecessary prolonged pain and even unnecessary procedures that address different pathologies. ¼: Treatment strategies consists of nonoperative modalities such as nonsteroidal anti-inflammatory medications, corticosteroid injections, and physical therapy, but for refractory cases, surgical techniques including repair, augmentation, and reconstruction have been well-described in the literature providing patients with acceptable outcomes.

The brief resilience scale is associated with pre- and short-term postoperative outcomes following hip arthroscopy.

BACKGROUND: Despite improving diagnostic and surgical techniques, some patients do not respond as well as others following hip arthroscopy. In most musculoskeletal studies, predictors for surgical outcomes focus solely on physical health prior to surgery. However, there likely exists a relationship between a patient's mental health and their postoperative patient-reported outcome measures (PROMs). METHODS: 40 patients who met indications for hip arthroscopy were enrolled in this prospective cohort study. All patients completed a baseline Brief Resilience Scale (BRS) and 4validated PROMs: modified Harris Hip Score (mHHS), visual analogue scale for pain (VAS), Hip Outcomes Score for Activities of Daily Living (HOS-Daily), and Hip Outcomes Score for Sports-Related Activities (HOS-Sport). For a secondary measure of psychometric evaluation, past medical histories of anxiety/depression were recorded. Patients were stratified into Low Resilience (LR < 21), Normal Resilience (NR 22-24), and High Resilience (HR > 25) by tertile to determine differences in PROMs. Comparisons and correlations of pre- and postoperative outcomes between resilience groups were performed. RESULTS: In comparing the LR and HR groups, there was a significant relationship between resilience and all PROMs both preoperatively and 6 months postoperatively (p < 0.05), with the exception of the HOS-Sports. Pearson Correlation Coefficients confirmed this trend in the mHHS and the HOS-Daily. Additionally, there were sixteen patients who were discharged prior to 6-month follow-up with an average resilience above the mean of total population (p < 0.0001). Resilience was associated with return to activity (p = 0.017). A past history of anxiety/depression was associated with lower resilience (p = 0.039). CONCLUSIONS: This study showed that HR hip arthroscopy patients had better PROMs than LR patients both preoperatively and postoperatively. HR patients were able to return to activity earlier and had lower rates of preoperative anxiety/depression. The BRS is a simple in-office screening tool, which may help guide patient and doctor communication and expectations.

Total Hip Arthroplasty After Hip Arthroscopy Has Increased Complications and Revision Risk.

BACKGROUND: There has been an increase in hip arthroscopy (HA) over the last decade. After HA, some patients may ultimately require a total hip arthroplasty (THA). However, there is a scarcity of research investigating the outcomes in patients undergoing THA with a history of ipsilateral HA. METHODS: The PearlDiver research program (www.pearldiverinc.com) was queried to capture all patients undergoing THA between 2015 and 2020. Propensity matching was performed to match patients undergoing THA with and without a history of ipsilateral THA. Rates of 30-day medical complications, 1-year surgical complications, and THA revision were compared using multivariate logistic regression. Kaplan-Meier analysis was conducted to estimate survival probabilities of each of the groups with patients undergoing THA . RESULTS: After propensity matching, cohorts of 1940 patients undergoing THA without prior HA and 1940 patients undergoing a THA with prior HA were isolated for analysis. The mean time from HA to THA was 1127 days (standard deviation 858). Patients with a history of ipsilateral HA had an increased risk for dislocation (odds ratio [OR] 1.56, P = .03) and overall decreased implant survival within 4 years of undergoing THA (OR 1.53; P = .05). Furthermore, our data demonstrate the timing of previous HA to be associated with the risk of complications, as illustrated by the increased risk for dislocation (OR 1.75, P = .03), aseptic loosening (OR 2.18, P = .03), and revision surgery at 2 (OR 1.92, P = .02) and 4 years (OR 2.05, P = .01) in patients undergoing THA within 1 year of HA compared twitho patients undergoing THA more than 1 year after HA or with no previous history of HA. CONCLUSION: Patients undergoing THA after HA are at an increased risk for surgical complications, as well as the need for revision surgery.

COVID-19 and Review of Current Recommendations for Return to Athletic Play.

In December 2019 a respiratory illness known as Coronavirus 2 (SARS-CoV-2, COVID-19) broke out in a region in China and rapidly spread to become a pandemic affecting all sporting events worldwide. The Summer Olympics scheduled to be held in Tokyo were postponed until 2021, and all professional leagues in the United States postponed or canceled events. As the United States has begun to open up, there remains uncertainty of when sporting events can safely be held. Many professional leagues and the National Collegiate Athletic Association have established guidelines and recommendations for their athletes to compete safely. In this article, we review the protocols that have been established to allow athletes to return to play, and we review briefly the effects COVID-19 infection may have on athletes.

A Clinician's Guide to Femoacetabular Impingement in Athletes.

Femoroacetabular impingement (FAI) is the most common cause of hip pain in both professional and recreational athletes. It is caused by abnormal bone development on both the acetabulum and proximal femur as a result of genetic factors and in reaction to high-volume athletics participation. Athletes typically become symptomatic after reaching skeletal maturity and commonly describe deep groin pain that worsens with activities such as squatting, cutting, or pivoting motions. For this reason, sports such as hockey, football, and soccer can be particularly irritating to an athlete with FAI. Moreover, the athlete with FAI often presents with contaminant hip and pelvis pathologies such as athletic pubalgia and iliopsoas tendinopathy that must also be addressed. While this pain often limits performance or participation in sports, perhaps the most significant ramification of FAI is the role it plays in driving early onset osteoarthritis. Fortunately, FAI can be reliably diagnosed through careful history taking, appropriate provocative physical exam maneuvers, and familiarity with hallmark radiographic features. The aims of this review are to provide clinicians with information regarding the pathogenesis of FAI, to thoroughly describe the classic history and physical exam elements, and to introduce various management strategies for athletes suffering from FAI.

Diagnosis and Management of Hip Abductor Insufficiency.

Greater Trochanteric Pain Syndrome (GTPS) is a common cause of lateral hip pain, with an incidence of 1.8 per 1000 patients, most commonly occurring between the fourth and sixth decades of life. When GTPS fails to improve with conservative management, hip abductor insufficiency should be suspected. The diagnosis of hip abductor insufficiency is made by a combination of physical exam findings and imaging studies, with Magnetic Resonance Imaging (MRI) being the diagnostic study of choice. Initial conservative management consists of activity modification, physical therapy, non-steroidal anti-inflam- matories and corticosteroid injections. If conservative management fails, this may be suggestive of a hip abductor tear. Surgical intervention has been shown to provide excellent outcomes, and may be necessary if a tear is present. The purpose of this paper is to review and raise awareness of hip abductor insufficiency as an under- diagnosed and under-treated condition that can limit patient mobility and quality of life.

Open Surgical Stabilization of Glenohumeral Dislocations.

Traumatic anterior shoulder dislocations are the most common dislocations of the shoulder, and the recurrence rate is high when they are treated nonoperatively in young patients (<30 years old). This has led to a trend toward early surgical stabilization. Originally open Bankart repair was considered the standard of care, with good clinical outcomes and a low recurrence rate. However, the majority of Bankart repairs are now performed with newer arthroscopic techniques because of their potential advantages and similar results. Both open and arthroscopic repairs have been shown to decrease the recurrence rate to 6% to 23%. Although arthroscopic Bankart repair is now more common, open repair should be considered for younger patients participating in contact sports or military activity, osseous Bankart lesions, revision cases, shoulder instability with "subcritical" (20% to 25%) glenoid bone loss, ligamentous laxity, or cases not considered repairable with arthroscopic techniques. Therefore, knowing how to perform an open Bankart repair is essential. The major steps of the procedure are (1) preoperative planning, (2) induction of anesthesia, (3) patient positioning and setup, (4) examination under anesthesia, (5) possible arthroscopic examination of the shoulder, (6) incision along the anterior axillary fold, (7) exposure using the deltopectoral interval, (8) clavipectoral fascia incision, (9) vertical tenotomy of the subscapularis tendon, (10) dissection of the capsule from the subscapularis, (11) assessment of the quality of the capsule, (12) "T" capsulotomy, (13) repair of the Bankart lesion, (14) anterior capsulorrhaphy, (15) subscapularis repair, (16) possible closure of the rotator interval, (17) wound closure, and (18) postoperative rehabilitation. Studies have shown that surgical stabilization after traumatic anterior shoulder instability decreases the recurrence rate, and open and arthroscopic techniques have similar clinical outcomes.

Fixation of juvenile osteochondritis dissecans lesions of the knee using poly 96L/4D-lactide copolymer bioabsorbable implants.

BACKGROUND: The fixation of juvenile osteochondritis dissecans (OCD) lesions has been described using metal implants, staples, bone pegs, and bioabsorbable implants. Bioabsorbable fixation has potential benefits including not requiring a second surgery for implant removal, no interference on postoperative magnetic resonance imaging (MRI) scans, and a potentially lower incidence of prominent hardware. The possible complications of bioabsorbable fixation include synovitis, loss of fixation owing to noncompressive properties, and sterile abscess formation. The results of bioabsorbable fixation of juvenile OCD lesions of the knee have not been well studied. The purpose of this study was to evaluate the efficacy and safety of a bioabsorbable copolymer fixation in the management of unstable OCD lesions of the knee in adolescents. METHODS: This is a retrospective case series of patients with unstable OCD lesions of the knee that were treated with poly 96L/4D-lactide copolymer bioabsorable implants. Information was gathered through 3 standardized and validated knee-function questionnaires, participants' medical records, plain films, MRIs, and pain level and satisfaction scale questionnaires. RESULTS: Twenty-four knees in 24 patients were evaluated. The mean age at the time of surgery was 14.4 years. The mean follow-up was 39.6 months. The mean International Knee Documentation Committee score at follow-up was 84.9, the mean Lysholm score was 88.0, and the mean Tegner score was 7.9. Plain films at an average of 19.2 months postoperatively revealed interval healing in 9 patients, no significant change in 1 patient, complete healing in 13 patients, and loose bodies with no interval healing in 1 patient. MRIs were obtained postoperatively in 17 knees, with a mean follow-up of 22.4 months. Interval healing was present in 16 of 17 MRIs, consistent with the plain film findings. Twenty-two of 24 patients had good-to-excellent outcomes. CONCLUSION: Poly 96L/4D-lactide copolymer bioabsorable implants seem to be safe and effective for the management of unstable juvenile OCD lesions of the knee. They offer stability for the healing OCD lesions, with minimal reaction from degradation products.