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.

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.

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.