Does Capsular Closure Affect Clinical Outcomes in Hip Arthroscopy? A Prospective Randomized Controlled Trial.

BACKGROUND: There is increasing concern of iatrogenic hip instability after capsulotomy during surgery. Greater emphasis is now being placed on capsular closure during surgery. There are no prospective studies that address whether capsular closure has any effect on outcomes. PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate patient outcomes after interportal capsulotomy repair compared with no repair. We hypothesized that restoration of normal capsular anatomy with interportal repair will achieve clinical outcomes similar to those for no repair. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: Adult patients with femoral acetabular impingement indicated for hip arthroscopy were randomized into either the capsular repair (CR) or the no repair (NR) groups. All patients underwent standard hip arthroscopy with labral repair with or without CAM/pincer lesion resection. Clinical outcomes were measured via the Hip Outcome Score-Activities of Daily Living (HOS-ADL) subscale, Hip Outcome Score-Sport Specific (HOS-SS) subscale, modified Harris Hip Score (mHHS), visual analog scale for pain, International Hip Outcome Tool, and Veterans RAND 12-Item Health Survey (VR-12). RESULTS: A total of 54 patients (56 hips) were included (26 men and 30 women) with a mean age of 33 years. The HOS-ADL score significantly improved at 2 years in both the NR group (from 68.1 ± 20.5 to 88.6 ± 20.0; P < .001) and the CR group (from 59.2 ± 18.8 to 91.7 ± 12.3; P < .001). The HOS-SS score also significantly improved in both the NR group (from 41.1 ± 25.8 to 84.1 ± 21.9; P < .001) and the CR group (from 32.7 ± 23.7 to 77.7 ± 23.0; P < .001). Improvement was noted for all secondary outcome measures; however, there was no significant difference between the groups at any time point. Between 1 and 2 years, the NR group showed significant worsening on the HOS-ADL (-1.21 ± 5.09 vs 4.28 ± 7.91; P = .044), mHHS (1.08 ± 10.04 vs 10.12 ± 11.76; P = .042), and VR-12 Physical (-2.15 ± 5.52 vs 4.49 ± 7.30; P = .014) subsets compared with the CR group. CONCLUSION: There was significant improvement in the VR-12 Physical subscale at 2 years postoperatively in the capsular CR group compared with the NR group. Capsular closure appears to have no detrimental effect on functional outcome scores after hip arthroscopy. We recommend restoration of native anatomy if possible when performing hip arthroscopy.

Posterior capsule injection of local anesthetic for post-operative pain control after ACL reconstruction: a prospective, randomized trial.

PURPOSE: Alternative modalities to optimize pain control after anterior cruciate ligament reconstruction (ACLR) are continually being explored. The purpose of this study was to compare femoral nerve block (FNB) only vs FNB with posterior capsule injection (PCI) of the knee for pain control in patients undergoing ACLR. METHODS: Patients undergoing primary ACLR were randomized to receive either FNB only or FNB with PCI. Following surgery, patient's pain was evaluated in the postoperative care unit (PACU) and at home for 4 days. Pain levels were measured via visual analog scale (VAS) and calculating opioid consumption. Outcomes of interest included postoperative pain levels and opioid consumption. RESULTS: A total of 42 patients were evaluated, with 21 patients randomized to each study arm. Outcomes showed significant pain reduction in both anterior and posterior knee VAS scores in the PACU in those that received PCI (anterior VAS: 39.6 vs 21.3 (SD = 12.9), p < 0.01; posterior VAS: 25.4 vs 15.3 (SD = 8.05), p = 0.01). Moreover, the PCI group also showed significantly less opioid consumption compared to FNB only (23.5 vs 17.4 pills, p = 0.03). There were no differences found in pain scores between groups in home VAS sores. CONCLUSIONS: These finding suggest the use of arthroscopically assisted injection of local anesthetic to the posterior capsule of the knee significantly reduces early post-operative pain and dramatically reduces the number of opoid medication taken after ACLR. LEVEL OF EVIDENCE: Prospective, randomized, control trial, Level I.

Arthroscopic tenodesis of the long head of the biceps.

The long head of the biceps (LHB) is commonly implicated in shoulder pathology due to its anatomic course and intimacy with the rotator cuff and superior labrum of the glenoid. Treatment of tendinosis of the LHB may be required secondary to partial thickness tears, instability/subluxation, associated rotator cuff tears, or SLAP (superior labrum, anterior to posterior) lesions. Treatment options include open or arthroscopic techniques for tenodesis vs tenotomy. Controversy exists in the orthopedic literature regarding the preferred procedure. The all-arthroscopic biceps tenodesis technique is a viable and reproducible option for treatment. This article provides a review of the all-arthroscopic biceps tenodesis technique using proximal interference screw fixation and its subsequent postoperative regimen. All-arthroscopic biceps tenodesis maintains elbow flexion and supination power, minimizes cosmetic deformities, and leads to less fatigue soreness after active flexion. Thus, arthroscopic biceps tenodesis should be offered and encouraged as a treatment option for younger, active patients.