Capsular Repair, Labral Repair, and Femoroplasty are Increasingly Performed for the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome.

PURPOSE: To provide an updated assessment of hip arthroscopy use by using an institutional database that is specific to the treatment of femoroacetabular impingement syndrome (FAIS). METHODS: All patients undergoing hip arthroscopy for the treatment of FAIS were retrospectively identified between the years 2014 and 2022 via Current Procedural Terminology coding in a multi-institutional, single health system database. A longitudinal analysis was performed to identify trends in the use of arthroscopic techniques including capsular and labral treatment, osteoplasty, and traction set-up. RESULTS: During the study, 789 arthroscopic hip procedures in 733 patients were analyzed (56 staged bilateral). Between 2016 and 2022, the number of hip arthroscopies performed each year increased by 1,490% (R2 = 0.87, P = .001). Capsular repair (R2 = 0.92, P < .001), labral repair (R2 = 0.75, P = .002), and femoroplasty (R2 = 0.70, P = .004) were performed in an increasing proportion of cases over our study period whereas labral debridement (R2 = -0.84, P < .001) became less used. Postless traction systems were employed in 84% (663/789) of hip arthroscopies overall, were used in at least 70% of hip arthroscopies each year, and did not undergo any significant changes in use (R2 = 0.02, P = .73). CONCLUSIONS: Capsular repair, labral repair, and femoroplasty were increasingly performed for the arthroscopic treatment of FAIS whereas the use of labral debridement decreased significantly over our study period. Postless traction systems were used in the majority of cases each year. CLINICAL RELEVANCE: As comparative literature continues to define the safety and efficacy of hip arthroscopy, understanding how novel techniques or procedures are incorporated in clinical practice is important.

Publication Rates of Abstracts Presented at American Orthopaedic Society for Sports Medicine Annual Meetings From 2016 to 2019.

Background: Research in the form of poster and podium abstracts is disseminated at subspecialty society meetings. The quality of this research can be defined by exploring the ultimate publication rate of the presented abstracts. Purpose: To investigate (1) the manuscript publication rate of abstracts presented at the American Orthopaedic Society for Sports Medicine (AOSSM) annual meeting; (2) whether abstract format (poster vs podium) influences overall or 2-year publication rates and time to publication; (3) the abstract factors that are associated with increased publication rate; and (4) whether publication quality as measured by journal of publication, level of evidence (LOE), and number of citations differs between posters and podiums. Study Design: Cross-sectional study. Methods: Poster and podium abstracts that were presented at the AOSSM annual meetings between January 1, 2016, and December 31, 2019, were included. The PubMed and GoogleScholar databases were searched by abstract title and authors to determine whether the related manuscript had been published. For published manuscripts, the journal, journal impact factor (IF), time to publication, authors, and LOE were recorded. Results: The manuscripts of 664 abstracts (341 poster, 323 podium presentations) were published during the study period. The overall publication rate was 52.4%. Publication within 2 years of the meeting was found to be higher in podium abstracts (45.8%) compared with poster abstracts (37.8%) (P = .0366). Podium abstracts had a shorter time to publication (P < .001), higher LOE (P = .0166), more citations (P < .0001), and were published in higher IF journals (P = .0028). Poster presentations were more likely to undergo a change in first author between the time of the conference and future publication (P = .0300). The most common journal of publication was the American Journal of Sports Medicine (36.8%). Conclusion: Abstracts presented at the AOSSM annual meeting had a high rate of publication within 2 years. There was no difference in publication rates between podium and poster abstracts, but podium abstracts had a shorter time to publication and more future citations and were published in journals with higher IFs.

A review of chronic pectoralis major tears: what options are available?

Rupture of the pectoralis major muscle typically occurs in the young, active male. Acute management of these injuries is recommended; however, what if the patient presents with a chronic tear of the pectoralis major? Physical exams and magnetic resonance imaging can help identify the injury and guide the physician with a plan for management. Nonoperative management is feasible, but is recommended for elderly, low-demand patients whose functional goals are minimal. Repair of chronic tears should be reserved for younger, healthier patients with high functional demands. Although operative management provides better functional outcomes, operative treatment of chronic pectoralis tears can be challenging. Tendon retraction, poor tendinous substance and quality of tissue, muscle atrophy, scar formation, and altered anatomy make direct repairs complicated, often necessitating auto- or allograft use. We review the various graft options and fixation methods that can be used when treating patients with chronic pectoralis major tears.

Comparison of Sports Medicine Questions on the Orthopaedic In-Training Examination Between 2009 and 2012 and 2017 and 2020 Reveals an Increasing Number of References.

Purpose: To provide an updated analysis of the sports medicine section of the Orthopedic In-Training Examination (OITE). Methods: A cross-sectional review of OITE sports medicine questions from 2009 to 2012 and 2017-2020 was performed. Subtopics, taxonomy, references, and use of imaging modalities were recorded and changes between the time periods were analyzed. Results: The most tested sports medicine subtopics included ACL (12.6%), rotator cuff (10.5%), and throwing injuries to the shoulder (7.4%) in the early subset, while ACL (10%), rotator cuff (6.25%), shoulder instability (6.25%), and throwing injuries to the elbow (6.25%) were the most common in the later subset. The American Journal of Sports Medicine (28.3%) was the most cited journal referenced from 2009 to 2012, while The Journal of the American Academy of Orthopaedic Surgeons (17.5%) was most referenced in questions from 2017 to 2020. The number of references per question increased from the early to the late subset (P < .001). There was a trend toward an increased taxonomy type one questions (P = .114), while type 2 questions had a decreased trend (P = .263) when comparing the new subset to the early group. Conclusion: When comparing sports medicine OITE questions from 2009 to 2012 and 2017 to 2020, there was an increase in the number of references per question. Subtopics, taxonomy, lag time, and use of imaging modalities did not show statistically significant changes. Clinical Relevance: This study provides a detailed analysis of the sports medicine section of the OITE, which can be used by residents and program directors to direct their preparation for the annual examination. The results of this study may help examining boards align their examinations and provide a benchmark for future studies.

An updated analysis of shoulder and elbow questions on the Orthopedic In-Training Examination.

BACKGROUND: The Orthopedic In-Training Examination (OITE) is an annual examination for orthopedic surgery residents used to assess orthopedic knowledge across a national standard. Having an updated understanding of currently tested topics and resources is useful to help residents guide their education. PURPOSE: The purpose of this study is to analyze the shoulder and elbow domain of the OITE in an effort to provide current trends and commonly tested topics. METHODS: All OITE questions related to shoulder and elbow topics over the years 2009-2013 and 2017-2020 were analyzed. Subcategories, the number and types of references used, publication lag time, imaging modalities, taxonomic classification, and resident performance were recorded. RESULTS: Shoulder and elbow topics comprised 8.61% of all OITE questions from 2009-2013 and 2017-2020. The most commonly tested shoulder topics were rotator cuff arthropathy and reverse total shoulder arthroplasty (13.6%), followed by hemiarthroplasty and total shoulder arthroplasty (12.9%), rotator cuff-related pathology (12.9%), anterior shoulder instability and/or dislocation (10.2%), and general anatomy (10.2%). The most commonly tested elbow topics were trauma (21%), ulnar collateral ligament injuries (12.12%), general anatomy (10%), and arthroplasty (10%). Decisions regarding management or appropriate next steps (taxonomy T3) comprised 39% of all question types. The incorporation of imaging modalities continues to be an important component of the OITE questions. The Journal of Shoulder and Elbow Surgery (JSES), the Journal of the American Academy of Orthopedic Surgeons (JAAOS), the Journal of Bone and Joint Surgery (JBJS), and the American Journal of Sports Medicine (AJSM) comprised 65% of articles referenced in all questions over our analysis period. CONCLUSION: This study provides an updated analysis of trends within the shoulder and elbow domain of the OITE. Application of these data can aid residents in their preparation for the examination.

Increased Regular Season Soft Tissue Injury Rates in National Football League (NFL) Players May Be Associated With the Canceled 2020 NFL Preseason Due to COVID-19.

Introduction The purpose of this study is to evaluate the rates of regular season soft tissue injuries in National Football League (NFL) players during the 2020 season, which had a canceled preseason due to the COVID-19 pandemic. Methods This study retrospectively reviewed the injury rates of the 2020-2021 NFL regular season in comparison to the 2018-2019 NFL regular season using publicly available injury data. The focus of our analysis was comparing the following soft tissue injuries: hamstring, groin, calf, quadriceps, thigh, knee - anterior cruciate ligament (ACL), pectoral, and Achilles. The week of injury occurrence, duration of injury in weeks, position of the injured player, and age of the NFL player at injury were obtained. Injury rates were calculated per 1000 athletic exposures with 95% confidence intervals (CIs). A chi-square test and Student's t-test were utilized as appropriate. Results There were 1370 total injuries in the 2018-2019 regular NFL season and 2086 total injuries reported in the 2020-2021 regular NFL season. The total number of injuries per 1000 athletic exposures was significantly higher in the 2020-2021 NFL season compared to the 2018-2019 NFL season (88.57 versus 58.17, p < 0.001). The rates of injuries per 1000 athletic exposures for hamstring (9.98 versus 5.31, p = 0.043), groin (5.56 versus 2.46, p = 0.007), calf (4.08 versus 1.61, p = 0.006), quadriceps (2.00 versus 0.72, p = 0.030), and thigh (1.23 versus 0.30, p = 0.012) injuries were significantly higher in the 2020-2021 regular NFL season compared to the 2018-2019 NFL regular season. Conclusions The 2020-2021 NFL season had a significantly higher incidence of soft tissue injuries compared to the 2018-2019 regular NFL season, which may have been associated with the absent preseason due to the COVID-19 pandemic and an abrupt increase in the athletic workload of players.

Stiffness after arthroscopic rotator cuff repair: a rehabilitation problem or a surgical indication?

HYPOTHESIS: The purpose of this study was to determine the incidence of clinically significant postoperative stiffness after arthroscopic rotator cuff repair and its resolution. The study also sought to determine clinical and surgical factors that may be associated with increased rates of postoperative stiffness. METHODS: We conducted a level III retrospective review of a consecutive series of arthroscopic rotator cuff repairs. During a 5-year period, the senior author (C.J.R.) performed 150 arthroscopic rotator cuff repairs at our institution. Demographic data, comorbid medical conditions, descriptions of rotator cuff tears (including size and level of retraction), and concomitant surgical procedures were evaluated on their correlation with stiffness. All office visits were reviewed to determine preoperative and postoperative motion. Patients were followed up at 1 week, 3 weeks, 6-8 weeks, 3 months, about 6 months, and 1 year postoperatively. RESULTS: In our analysis of tear types, we were unable to associate stiffness with the type of tear, the tendon torn, or the number of tendons torn or with whether the tendons were retracted. However, we were able to associate female sex, workers' compensation insurance, and a concomitant biceps procedure with stiffness at several time points. The incidence of stiffness was highest at 12 weeks, with 7.3% of patients presenting with stiffness. The rate of stiffness decreased with continued follow-up. Stiffness was found in 3.3% of patients at 16-24 weeks and in 1.6% of patients at 1 year. CONCLUSIONS: Prolonged physical therapy will result in resolution of stiffness in the vast majority of cases, often obviating the return to the operating room for capsular release and lysis of adhesions or mobilization under anesthesia.

Pectoralis major tendon reconstruction using semitendinosus allograft following rupture at the musculotendinous junction.

BACKGROUND: Pectoralis major (PM) rupture is an uncommon sports injury that has become more prevalent in the past 20 years as a result of an increase in recreational weight lifting and sports participation. Ruptures occur most commonly at the tendon insertion (65%) and musculotendinous junction (27%). This study describes an open technique and clinical outcomes after reconstruction of a PM rupture at the musculotendinous junction. METHODS: In this case series, 6 patients with PM ruptures at the musculotendinous junction were enrolled, with a 12-month follow-up period. The diagnosis was made with magnetic resonance imaging and correlated with clinical examination findings. All patients underwent PM reconstruction with a semitendinosus allograft, followed by a graduated rehabilitation protocol. Postoperative outcomes were assessed using the American Shoulder and Elbow Surgeons score, Constant score, visual analog scale score, cosmesis, return of strength, and overall satisfaction. RESULTS: The average age at the time of surgery was 39.5 years. At the 12-month follow-up visit, the average outcome scores were as follows: American Shoulder and Elbow Surgeons score, 98.3; Constant score, 98; and visual analog scale score, 0.67. All patients were pleased with their cosmetic outcomes, as well as return of strength, and showed overall satisfaction with their postoperative results. CONCLUSIONS: On review of the literature, this study is the first to describe the use of an isolated semitendinosus allograft to reconstruct a PM tendon following rupture at the musculotendinous junction. The excellent clinical outcomes suggest that the described technique can be a reliable tool in the orthopedic surgeon's armamentarium when approaching this uncommon PM tear.

Iatrogenic Obturator Hip Dislocation with Intrapelvic Migration.

Obturator hip dislocations are rare, typically resulting from high-energy trauma in native hips. These types of dislocations are treated with closed reduction under sedation. Open reduction and internal fixation may be performed in the presence of associated fractures. Still rarer are obturator hip dislocations that penetrate through the obturator foramen itself. These types of dislocations have only been reported three other times in the literature, all within native hips. To date, there have been no reports of foraminal obturator dislocations after total hip arthroplasty. We report of the first periprosthetic foraminal obturator hip dislocation, which was caused iatrogenically during attempts at closed reduction of a posterior hip dislocation in the setting of a chronic greater trochanter fracture. Altered joint biomechanics stemming from a weak hip abductor mechanism rendered the patient vulnerable to this specific dislocation subtype, which ultimately required open surgical intervention. An early assessment and identification of this dislocation prevented excessive closed reduction maneuvers, which otherwise could have had detrimental consequences including damage to vital intrapelvic structures. This case report raises awareness to this very rare, yet potential complication after total hip arthroplasty.