Patient Outcomes Are Not Improved by Platelet-Rich Plasma Injection Onto the Capsule at the Time of Closure During Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Purpose: To determine the effect of platelet-rich plasma (PRP) injection onto the capsule at time of closure on outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. Methods: Patients who underwent hip arthroscopy between January 2014 and December 2021 were retrospectively identified. The first cohort included patients who received PRP injection onto the capsule following capsular closure at the conclusion of the case. The second cohort did not receive PRP. Pain scores on a visual analog scale, Modified Harris Hip Scores, Single Assessment Numeric Evaluation (SANE), as well as Patient-Reported Outcomes Measurement Information System Physical Function scores were obtained preoperatively as well as at multiple time points postoperatively up to 2 years. Results: In total, 345 patients were included in the study, with 293 in the PRP cohort and 52 in the non-PRP cohort. There was no significance difference in age (P = .69), sex, or preoperative pain (P = .92) and patient-reported outcome scores between the 2 groups (modified Harris Hip Score, P = .38; Patient-Reported Outcomes Measurement Information System Physical Function, P = .48), except for preoperative SANE scores, which had a greater baseline in the PRP group (P < .001). Using both observed data as well as repeated measure analysis of variance model to estimate for missing data after baseline, we found there were no differences in visual analog scale pain scores nor patient-reported outcome scores at any time point. There was similarly no difference in change from baseline for SANE scores. There was no difference in rate of revision surgery between the 2 cohorts (P = .66). Conclusions: Based on the results of this study, intraoperative PRP injection onto the capsule at the time of capsular closure does not improve outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement syndrome. Level of Evidence: Level III, retrospective comparative study.

Return to play after ulnar collateral ligament reconstruction with concurrent posterior-compartment decompression.

BACKGROUND: Medial ulnar collateral ligament (UCL) injuries and posterior elbow impingement commonly affect throwing athletes. Surgical intervention for each of these pathologies individually has been demonstrated to be successful with high return-to-play (RTP) rates. Our purpose was to report RTP rates for patients treated with concurrent UCL reconstruction (UCLR) and arthroscopic posterior débridement performed by the senior author. MATERIALS AND METHODS: We retrospectively reviewed all elbow medial UCL procedures performed by the senior author from January 2016 through September 2020. The inclusion criteria included an elbow medial UCL operation with arthroscopic posterior-compartment débridement in a throwing athlete. The exclusion criteria included isolated UCLR surgery, non-primary surgery, and revision UCLR with either autograft or allograft. Using a chart review and publicly available information, we were able to determine patients' playing levels after their operations. RESULTS: Twelve patients met the inclusion and exclusion criteria. The average age was 24.27 years (standard deviation, 4.92 years). Of the 12 patients, 10 returned to play at the same level (4 Major League Baseball players and 1 Triple A player) or at a higher level (2 players from Single A to Double A, 1 player from National Collegiate Athletic Association Division I to Single A, 1 player from rookie league to Single A, and 1 player from high school to National Collegiate Athletic Association Division I), 1 did not return to play, and 1 returned to play at a lower level, with an average RTP time of 14.64 months (standard deviation, 2.64 months). Of the 12 patients, 11 were pitchers; of these 11 pitchers, 9 had statistics available both before and after UCLR. Before UCLR, the average statistics for the pitchers were as follows: earned run average, 4.11 ± 0.85; walks and hits per inning pitched, 1.42 ± 0.26; strikeout-to-walk ratio, 3.00 ± 1.83; strikeouts per 9 innings, 8.80 ± 1.14; and innings pitched, 234.88 ± 316.74. After UCLR, their average statistics were as follows: earned run average, 5.24 ± 2.18 (P = .189); walks and hits per inning pitched, 1.55 ± 0.34 (P = .379); strikeout-to-walk ratio, 2.15 ± 0.98 (P = .263); strikeouts per 9 innings, 9.67 ± 1.91 (P = .293); and innings pitched, 138.71 ± 162.97 (P = .487). DISCUSSION AND CONCLUSION: Although surgical intervention to address both posterior impingement and UCL injury is relatively rare (comprising 8.5% of all the senior author's UCLR procedures), our experience demonstrates that primary UCLR with concurrent arthroscopic posterior decompression is a reliable, safe, and successful surgical treatment for patients with UCL injury and posterior impingement and our results show no significant difference in statistical performance in pitchers before surgery vs. after surgery.

Epidemiologic impact of COVID-19 on a multi-subspecialty orthopaedic practice.

The purpose of this study is to report the change in surgical case volume and composition encountered by a multi-subspecialty orthopaedic practice due to COVID-19. We reviewed electronic medical records for patients who had surgery at our institution and collected multiple variables including age and the joint that was operated on. In the post-COVID-19 period, we found a significant increase in the percentage of hip procedures, and a significant decrease in the percentage of hand/wrist procedures. Overall, the total surgical volume of our multi-subspecialty orthopaedic practice decreased due to the COVID-19 pandemic, and the composition of surgical cases changed.