Benefits of a Postoperative Hip Orthosis After Routine Arthroscopy of the Hip: A Retrospective Cohort Study.

Background: No consensus currently exists among orthopaedic surgeons regarding the benefits of hip orthosis after routine hip arthroscopy. Purpose: To compare patient-reported outcome measures (PROMs) and reoperation rates between patients who were braced versus those who were not braced after routine hip arthroscopy. Study Design: Cohort study; Level of evidence, 3. Methods: A retrospective review was conducted of 193 patients who underwent hip arthroscopy for femoroacetabular impingement (FAI) from January 1, 2018, to December 31, 2021, by 2 orthopedic surgeons at a single institution. Patients before July 1, 2019, were immobilized in a hip orthosis after hip arthroscopy (braced group; n = 101), whereas those after July 1, 2019, were not (nonbraced group; n = 92). Baseline PROMs (visual analog scale for pain, modified Harris Hip Score, Single Assessment Numeric Evaluation, and Veterans Rand 12-Item Health Survey [VR-12] Physical Component Summary and Mental Component Summary) were obtained for all patients and were repeated postoperatively at 2 weeks, 4 weeks, 3 months, 6 months, 1 year, and 2 years. The study groups were compared to evaluate differences in PROMs over time and 2-year postoperative reoperation rates. Group comparisons were also stratified by patient sex. Results: There were no significant differences on any PROM between the braced and nonbraced cohorts at any timepoint. There were also no significant group differences in reoperation rates, with 8 braced patients (7.9%) undergoing reoperation and 1 nonbraced patient (2.3%) undergoing reoperation (P = .208). In the sex-stratified analyses, nonbraced male patients had significantly higher VAS pain and lower VR-12 Mental Component Summary scores at 6 months postoperatively compared with braced male patients (P = .043 and .026, respectively). Conclusion: The study findings suggested that the use of an orthosis after routine hip arthroscopy for FAI does not improve patient-reported outcomes or negatively affect the 2-year reoperation rate. Postoperative bracing increases perioperative cost, and by foregoing routine bracing, patients may avoid the morbidity associated with wearing a brace for a prolonged period.

Stiffness and Instability After MPFL Reconstruction Using a Fluoroscopic Versus Open Technique to Localize the Femoral Attachment Site: A Systematic Review and Meta-analysis.

Background: Open and fluoroscopic techniques have been described for localization of the femoral attachment site in medial patellofemoral ligament (MPFL) reconstruction. No study to date has evaluated if one technique is superior to another in terms of complications. Purpose: To review the literature comparing clinical outcomes of MPFL reconstruction using the fluoroscopic versus open technique to localize the site of femoral graft placement. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature review was performed via PubMed, Embase, and CINAHL to identify articles published between the inception of these databases and March 1, 2022, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This search yielded 4183 publications for initial review. Studies with at least a 2-year follow-up and complete reporting of patient-reported outcomes, range of motion, recurrent instability, and/or complications (ie, stiffness, infection, persistent pain) were included. We excluded studies of patients with collagen disorders; revision surgeries; surgeries with concomitant procedures; synthetic MPFL reconstruction; MPFL repairs; combined open and radiographic technique; and case series that included <10 patients. A proportional meta-analysis was performed by calculating the pooled estimate of incidence with 95% CIs using a fixed-effects model with double arcsine transformation (Freeman-Tukey) for each type of surgical technique (fluoroscopic or open). Results: A total of 29 studies met our inclusion criteria, of which 15 studies (566 patients) used the open technique and 14 studies (620 patients) used fluoroscopy. There were no significant differences between the open and fluoroscopic techniques in the incidence of postoperative apprehension (P = .4826), postoperative subjective instability (P = .1095), postoperative objective instability (P = .5583), reoperations (P = .7981), recurrent dislocation (P = .6690), or arthrofibrosis (P = .8118). Conclusion: Both open and radiographic localization of the femoral graft position in MPFL reconstruction offer similar outcomes and rates of complications.

Chronic glenohumeral dislocations treated with arthroplasty: a systematic review.

Background: The aim of this systematic review was to summarize the clinical outcomes and associated predictors of outcomes for chronic glenohumeral dislocations treated with arthroplasty. Methods: A systematic literature search was performed with Embase, PubMed, CENTRAL, BIOSIS, and CINAHL databases from the inception of these databases through January 1, 2021 to identify all articles that examined outcomes or predictors of outcomes of arthroplasty in patients with chronic glenohumeral dislocations. Studies that examined outcomes for patients with a chronic glenohumeral dislocation (≥3 weeks) treated with hemiarthroplasty, anatomic total shoulder arthroplasty, or reverse total shoulder arthroplasty were included. Those with acute or subacute dislocations (<3 weeks), fracture dislocations, and those treated with joint preserving treatment modalities were excluded. Results: We identified 195 articles; of which, 22 (201 patients/205 shoulders) met our inclusion criteria. A total of 14 studies reported outcomes of hemiarthroplasty, 10 studies reported outcomes of anatomic total shoulder arthroplasty, and 9 studies reported outcomes of reverse total shoulder arthroplasty. All studies documented clinical improvement after arthroplasty. Among 16 studies that measured range of motion, all 16 studies demonstrated improvement in range of motion postoperatively. Thirty-one reoperations (15%) were performed across all studies. Conclusion: We found improved clinical outcomes after arthroplasty for the treatment of chronic glenohumeral fewer dislocations at a long-term follow-up. Some evidence suggests that reverse total shoulder arthroplasty may have superior outcomes and less complications compared with hemiarthroplasty and anatomic total shoulder arthroplasty. There is insufficient evidence regarding the potential influence that duration of dislocation, direction of dislocation, addition of concomitant procedures, or humeral component retroversion have on outcomes.

An Up-to-Date Review of the Meniscus Literature: A Systematic Summary of Systematic Reviews and Meta-analyses.

BACKGROUND: A large number of systematic reviews and meta-analyses regarding the meniscus have been published. PURPOSE: To provide a qualitative summary of the published systematic reviews and meta-analyses regarding the meniscus. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic search of all meta-analyses and systematic reviews regarding the meniscus and published between July 2009 and July 2019 was performed with PubMed, CINAHL, EMBASE, and the Cochrane database. Published abstracts, narrative reviews, articles not written in English, commentaries, study protocols, and topics that were not focused on the meniscus were excluded. The most pertinent results were extracted and summarized from each study. RESULTS: A total of 332 articles were found, of which 142 were included. Included articles were summarized and divided into 16 topics: epidemiology, diagnosis, histology, biomechanics, comorbid pathology, animal models, arthroscopic partial meniscectomy (APM), meniscal repair, meniscal root repairs, meniscal allograft transplantation (MAT), meniscal implants and scaffolds, mesenchymal stem cells and growth factors, postoperative rehabilitation, postoperative imaging assessment, patient-reported outcome measures, and cost-effectiveness. The majority of articles focused on APM (20%), MAT (18%), and meniscal repair (17%). CONCLUSION: This summary of systematic reviews and meta-analyses delivers surgeons a single source of the current evidence regarding the meniscus.

Postoperative radiographic observations following transphyseal anterior cruciate ligament reconstruction in skeletally immature patients.

OBJECTIVE: To characterize the changes to bone tunnels, graft fixation devices, and physes that occur on radiographs of skeletally immature individuals at least 2 years after transphyseal anterior cruciate ligament reconstruction (ACLR). MATERIALS AND METHODS: Skeletally immature patients who underwent transphyseal ACLR were recruited to complete postoperative assessment at ≥ 2 years. The dimensions of tibial and femoral bone tunnels, position of graft fixation devices, and presence of growth arrest were assessed on radiographs, and pain visual analog and International Knee Documentation Committee scores were obtained. Paired t tests were used for comparisons. RESULTS: Nine patients were included with an average follow-up of 4.6 years postoperatively. There were no cases of premature physeal closure postoperatively and clinical outcome measures were excellent in all patients. The length of the intra-articular portion of anterior cruciate ligament graft increased postoperatively (P = 0.01). Distance between the tibial hardware and proximal tibial physis also increased over time on anteroposterior (P = 0.001) and lateral (P = 0.003) radiographs. However, the distance between the femoral hardware and distal femoral physis was unchanged and in five patients was associated with proximal femoral tunnel enlargement. CONCLUSION: Proximal femoral tunnel expansion and lack of proximal migration of the femoral button were seen in more than half of our patients. However, these findings had no detrimental effects on clinical outcome measures or remaining skeletal growth.

Systematic Review of Patient Outcomes and Associated Predictors After Microfracture in the Patellofemoral Joint.

We summarized the clinical outcomes and predictors of clinical outcomes after microfracture for chondral lesions in the patellofemoral joint (PFJ). METHODS: Embase, PubMed, CENTRAL, BIOSIS, and CINAHL databases were searched between January 1, 1980, and January 1, 2019, to identify all articles that examined outcomes or predictors of outcomes of microfracture in patients with patellofemoral chondral lesions. Studies of full-thickness chondral lesions in the PFJ were included, whereas those involving adolescents, partial-thickness chondral lesions, and underlying patellar instability were excluded. RESULTS: We found a total of 257 articles, of which 8 articles (174 patients) met our inclusion criteria. All studies found improvement in clinical outcomes after microfracture in the PFJ. Younger patients showed greater improvement in clinical outcomes than older patients. However, the effect of size, severity (grade), or location of chondral lesions on clinical outcomes after microfracture is unclear. CONCLUSION: We found improvement in clinical outcomes after microfracture in the PFJ at midterm follow-up. Age may be a predictor of successful outcomes and longevity of the repair; however, there is insufficient evidence regarding the influence of defect size, severity, and location on clinical outcomes.

Decreased Lean Psoas Cross-Sectional Area Is Associated With Increased 1-Year All-Cause Mortality in Male Elderly Orthopaedic Trauma Patients.

OBJECTIVES: To investigate the association between lean psoas cross-sectional area (CSA) and 1-year all-cause mortality in elderly patients sustaining pelvic and long bone fractures. DESIGN: Retrospective cohort. SETTING: Level I trauma center. PATIENTS: Elderly trauma patients admitted from 2007 to 2014. METHODS: We reviewed demographic and clinical data, injury mechanism, fracture OTA/AO classification, and mortality. Axial computed tomography images were used to measure lean psoas CSA at the L3-L4 disk space. Cox proportional hazard regression analysis was used to estimate 1-year mortality association with psoas CSA in crude and adjusted for age, body mass index, Injury Severity Score, medical comorbidities, and discharge destination in total population and stratified by sex. MAIN OUTCOME MEASUREMENT: One-year all-cause mortality defined as death within 12 months from date of hospitalization. RESULTS: Five hundred fifty-eight patients (54% female, 46% male) were analyzed. The pelvis was most commonly fractured (37.81%). A statistically significant association was observed between decreased lean psoas CSA and 1-year mortality in total population {hazard ratio [HR] = 0.93 [95% confidence interval (CI) = 0.90-0.96], P < 0.0001}. Stratification by gender revealed a statistically significant mortality HR in male patients [HR = 0.89 (95% CI = 0.84-0.96), P = 0.002]. We did not find a statistically significant mortality HR in female patients [HR = 0.95 (95% CI = 0.89-1.01), P = 0.103]. CONCLUSIONS: In this cohort of elderly orthopaedic trauma patients, decreased lean psoas CSA was associated with increased 1-year all-cause mortality in total population and males. Further investigation of the association of sarcopenia with mortality in the elderly is warranted. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.