Faculty Bibliography

Purpose/UNASSIGNED:To determine whether an association exists between the presence of cervical spine pathology and postoperative patient-reported outcomes (PROs) in patients undergoing open subpectoral biceps tenodesis (BT). Methods/UNASSIGNED:text, Fisher exact test, or analysis of variance. Results/UNASSIGNED: = .046). There were no significant differences between groups' ASES, baseline VAS, overall satisfaction scores, and willingness to undergo the same operation again. No significant differences were found in postoperative rate of return to sport, time to return, and return to preoperative competitiveness. Conclusions/UNASSIGNED:Patients with SLAP tears undergoing isolated BT in the presence of cervical spinal stenosis may have inferior Subjective Shoulder Value, Shoulder Instability-Return to Sport after Injury, and VAS during sport scores as compared with controls, although many PROs were similar at follow-up. Athletes undergoing BT, particularly with concomitant cervical spine pathology, should be counseled appropriately before surgery. Level of Evidence/UNASSIGNED:Level III, case-control study.

PURPOSE/OBJECTIVE:The purpose of this study was to assess the prognostic effect of lumbar spinal stenosis on clinical outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAI). METHODS:Patients undergoing hip arthroscopy between September 2009 to December 2015 for FAI with concomitant lumbar spinal stenosis (central/neuroforaminal) and a 2-year follow-up were identified (hip-spine). A 1:1 case-matching query using pre-operative modified Harris Hip Score (mHHS) within 3 points, body mass index (BMI) within 3 points, age within 5 years, and gender identified a control cohort without spinal pathology. Follow-up patient reported outcomes and clinical failure rates to revision procedure were compared using analysis of variance (ANOVA) and Kaplan-Meier survival analysis. RESULTS:, P=0.61; baseline mHHS: 44.27±2.82, P=0.98). ANOVA analysis demonstrated that all PROs improved from baseline to 2-year outcomes (P<0.001). The hip-spine versus control had lower 1-year (mHHS: 65.97±5.64 versus 85.04±3.09, P=0.006; nonarthritic hip score (NAHS): 70.26±5.71 versus 87.89±2.65, P=0.010) and 2-year (mHHS: 69.72±4.92 versus 84.71±2.56, P=0.007; NAHS: 72.23±5.18 versus 87.14±2.23, P=0.008) outcomes. While there was no difference in Patient Acceptable Symptomatic State (PASS) and Minimal Clinically Important Difference (MCID) rates at 1-year follow-up, the hip-spine group demonstrated lower PASS (42% versus 81%, P =0.004) and MCID (58% versus 88%, P=0.027) rates at 2 years. Although susceptible to type II error, there was no difference in clinical failure rates to revision procedure (P=0.13). CONCLUSION/CONCLUSIONS:While net PROs from baseline improve after hip arthroscopy for FAI, the presence of concomitant lumbar spinal stenosis negatively affects post-operative PROs. FAI patients with spinal stenosis should be counseled accordingly. LEVEL OF EVIDENCE/METHODS:III, case-control study.

Purpose/UNASSIGNED:To correlate patient-reported outcomes (PROs) and minimal clinically important difference (MCID) achievement rates after hip arthroscopy for femoroacetabular impingement syndrome (FAI). Methods/UNASSIGNED:linically diagnosed FAI who underwent primary hip arthroscopy from September 2012 to March 2014 with a minimum of 5-year outcomes were identified. Patients undergoing labral debridement, microfracture, bilateral procedures, with evidence of dysplasia, Tönnis grade >1, and joint space <2 mm were excluded. Analysis of variance was used to compare PROs. Survival rates were determined using Kaplan-Meier analysis. Regression analysis identified associations with modified Harris Hip Scores (mHHS), minimal clinically important difference (MCID) rates, and Nonarthritic Hip Scores (NAHS). Results/UNASSIGNED: = .010) with 5-year outcomes. Conclusions/UNASSIGNED:There is a decline in MCID at 5-year follow-up after hip arthroscopy for FAI. Lower BMI, younger age, and cam resection are associated with positive outcomes. There is excellent index procedure survivability and excellent total hip arthroplasty prevention rate. Level of Evidence/UNASSIGNED:Level IV.

BACKGROUND/UNASSIGNED:Limited evidence exists concerning the effect of age on hip arthroscopy outcomes for femoroacetabular impingement (FAI). PURPOSE/HYPOTHESIS/UNASSIGNED:The purpose was to investigate patient-reported outcomes (PROs) and clinical failure rates across various age groups in patients undergoing hip arthroscopy for FAI. We hypothesized that older patients would experience lower improvements in PROs and higher clinical failure rates. STUDY DESIGN/UNASSIGNED:Cohort study; Level of evidence, 3. METHODS/UNASSIGNED:A total of 109 of 130 eligible consecutive patients underwent hip arthroscopy for FAI with a minimum 5-year follow-up. Patients were stratified into 3 groups for comparison (ages 15-34, 35-50, and 51-75 years). Clinical survival rates to revision surgery or total hip arthroplasty (THA) were determined by Kaplan-Meier analysis, and PROs were assessed using analysis of variance. Regression analysis was used to determine factors associated with clinical failure and ΔPROs from baseline to 5 years. RESULTS/UNASSIGNED:= .030) groups from 6-month to 5-year outcomes. CONCLUSION/UNASSIGNED:Although hip arthroscopy for FAI yielded improvements in PROs regardless of age, middle-aged and older patients experienced greater declines in clinical outcomes over time than younger patients. Older patients remain good candidates for arthroscopy despite a greater risk for conversion to THA.

BACKGROUND/UNASSIGNED:Limited evidence exists comparing short- and long-term patient-reported outcomes (PROs) and overall survival rates after hip arthroscopy for femoroacetabular impingement syndrome (FAIS). HYPOTHESIS/UNASSIGNED:Patients with high improvement (HI) versus low improvement (LI) at 1 year postoperatively would achieve higher PROs and better index procedure survival rates at 5-year follow-up. STUDY DESIGN/UNASSIGNED:Cohort study; Level of evidence, 3. METHODS/UNASSIGNED:Patients who underwent primary hip arthroscopy for FAIS between September 2012 and March 2014 with minimum 5-year outcome data were identified. Using the median 1-year change in modified Harris Hip Score (mHHS) as a threshold, HI and LI subcohorts were determined. Analysis of variance was used to compare PROs. Failure rates were determined using Kaplan-Meier and Cox proportional hazards model analyses. Regression analysis was used to identify factors associated with increasing 5-year change in mHHS and Nonarthritic Hip Score (NAHS). RESULTS/UNASSIGNED:= .023) were associated with higher 5-year ΔPROs. CONCLUSION/UNASSIGNED:Patients with FAIS and significant improvement in the first year after hip arthroscopy had superior 5-year outcomes versus patients with persistent symptom severity. Survival rates and PROs were significantly better in patients who achieved high early outcomes at the 1-year mark.

Purpose/UNASSIGNED:To evaluate clinical and biomechanical outcomes after knee extensor mechanism reconstruction (KEMR). Methods/UNASSIGNED:Patients who underwent KEMR at our institution from 2011 to 2018 were identified. Patient-reported outcomes (Kujala, Lysholm, Tegner Activity Scale) were compiled at clinical follow-up. Isokinetic testing was conducted using the BioDex system 4 pro dynamometer at slow (60°/s), intermediate (180°/s), and fast (300°/s) speeds in a 9-patient subset. Results/UNASSIGNED: = .038). Conclusions/UNASSIGNED:Patients undergoing KEMR in this study have significantly improved clinical outcomes despite having strength deficits that persist postoperatively. Level of Evidence/UNASSIGNED:Therapeutic Case Series, Level IV.

BACKGROUND:Some studies have suggested that altered tibiofemoral cartilage contact behavior (arthrokinematics) may contribute to long-term cartilage degeneration, potentially leading to tibiofemoral osteoarthritis. However, few studies have assessed normal tibiofemoral arthrokinematics during dynamic activities. PURPOSE/OBJECTIVE:To characterize tibiofemoral arthrokinematics during the impact phase of level walking and downhill running. STUDY DESIGN/METHODS:Descriptive laboratory study. METHODS:Arthrokinematic data were collected on uninjured knees of 44 participants (mean age, 20.7 ± 6.6 years). Using a dynamic stereoradiographic imaging system with superimposed 3-dimensional bone models from computed tomography and magnetic resonance imaging of participant-specific tibiofemoral joints, arthrokinematics were assessed during the first 15% of the gait cycle during level walking and the first 10% of the gait cycle during downhill running. RESULTS:During level walking and downhill running, the medial compartment had a greater cartilage contact area versus the lateral compartment. Both compartments had a significantly less cartilage contact area during running versus walking (medial compartment gait cycle affected: 8%-10%; lateral compartment gait cycle affected: 5%-10%). Further, medial and lateral compartment tibiofemoral contact paths were significantly more posterior and longer during downhill running. CONCLUSION/CONCLUSIONS:There was a decreased tibiofemoral cartilage contact area during downhill running compared with level walking, suggesting that underlying bone morphology may play a key role in determining the size of cartilage contact regions. CLINICAL RELEVANCE/CONCLUSIONS:This study provides the first data characterizing tibiofemoral cartilage contact patterns during level walking and downhill running. These results provide evidence in support of performing biomechanical assessments during both level walking and downhill running to obtain a comprehensive picture of tibiofemoral cartilage behavior after clinical interventions.

BACKGROUND:Limited in vivo kinematic information exists on managing meniscal injury during anterior cruciate ligament reconstruction (ACLR). HYPOTHESIS:Isolated anatomic ACLR restores knee kinematics, whereas ACLR in the presence of medial meniscal injury is associated with altered long-term knee kinematics. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:From March 2011 to December 2012, 49 of 57 participants in a clinical trial underwent anatomic ACLR with successful kinematic testing at 24 months after ACLR. Twenty-five patients had associated meniscal tears: medial (n = 11), lateral (n = 9), or bilateral (n = 5). With a dynamic stereo radiography system with superimposed high-resolution computed tomography scans of patient knees, kinematics were measured during downhill running. The initial single-support phase of the gait cycle (0%-10%) was analyzed. RESULTS:Anterior tibial translation (ATT) was the only kinematic outcome between patients' ACLR and contralateral knees that had significant interactions among meniscal groups ( P = .007). There was significant difference in ATT between patients with intact menisci and medial tears ( P = .036) and with medial tears and lateral tears ( P = .025). Patients with intact menisci had no difference in ATT, with a negligible effect size between the ACLR and contralateral knees (mean ± SEM: 13.1 ± 0.7 mm vs 12.6 ± 0.5 mm, P = .24, Cohen d = 0.15, n = 24), while patients with medial meniscal tears had an increase in ATT, with a medium effect size between the ACLR and contralateral knees (15.4 ± 1.0 mm vs 13.2 ± 1.0 mm, P = .024, Cohen d = 0.66, n = 11). CONCLUSION:Associated medial meniscal injury in the setting of ACLR leads to increased ATT at 24-month follow-up. Furthermore, isolated anatomic ACLR in the absence of meniscal injury demonstrated no significant difference from native knee kinematics at 24-month follow-up during rigorous "high demand" knee activity with the current sample size. Patients undergoing anatomic ACLR in the presence of medial meniscal injury remained at a higher likelihood of sustaining altered long-term knee kinematics.