Quadriceps tendon has a lower re-rupture rate than hamstring tendon autograft for anterior cruciate ligament reconstruction - A meta-analysis
IMPORTANCE/OBJECTIVE:There have been several recent systematic reviews of quadriceps tendon autografts (QT), which have not shown any significant difference in outcomes between QT and hamstring tendon autograft (HS) for ACL reconstruction (ACLR). However, several recent comparative studies have been published comparing QT to HS for ACLR. AIM/OBJECTIVE:The purpose of this study is to perform a systematic review and meta-analysis of the studies comparing QT to HS for ACLR. EVIDENCE REVIEW/METHODS:Two independent reviewers performed the literature search based on the PRISMA guidelines, with a senior author arbitrating discrepancies. Cohort studies comparing QT with HS were included. FINDINGS/RESULTS:There were 15 studies comparing 611 patients with QT to 543 patients with HS, with a mean of 27.4 months follow-up. QT resulted in a significantly lower rate of graft re-rupture (2.5% vs 8.7%, pÂ =Â 0.01), and donor site morbidity (17.6% vs 26.2%, pÂ =Â 0.02). There was a significant difference in favour of QT for the positive pivot shift test (Grade I/II: 15.8% vs 23.0%, pÂ =Â 0.02), but not in the rate of the positive Lachman test (Grade I/II: 18.3% vs 26.7%, pÂ =Â 0.16). Additionally, there was no difference in the side to side difference in knee stability (1.8Â mm vs 2.0Â mm, pÂ =Â 0.48). Functionally, both grafts had similar functional outcomes in terms of the IKDC score (88.0 vs 87.9, pÂ =Â 0.69), and Lysholm score (89.3 vs 87.6, pÂ =Â 0.15). CONCLUSIONS AND RELEVANCE/CONCLUSIONS:Our study showed that QT has a lower re-rupture rate than HS in ACLR, with lower donor site morbidity. QT appeared to be slightly better for residual pivot shift, but there was no difference in patient-reported outcomes. LEVEL OF EVIDENCE/METHODS:III.
Both Open and Arthroscopic Latarjet Result in Excellent Outcomes and Low Recurrence Rates for Anterior Shoulder Instability
Purpose/UNASSIGNED:The purpose of this study is to evaluate the patient-reported outcomes of open Latarjet (OL) compared to arthroscopic Latarjet (AL) for anterior shoulder instability. Methods/UNASSIGNED:value of < .05 was considered to be statistically significant. Results/UNASSIGNED:Â = .84). Conclusion/UNASSIGNED:In patients with anterior shoulder instability, both the OL and AL are reliable treatment options, with a low rate of recurrent instability, and similar patient-reported outcomes.
ICRS scores worsen between 2-year short term and 5-year mid-term follow-up after transtibial medial meniscus root repair despite maintained functional outcomes
PURPOSE/OBJECTIVE:The purpose of this study was to evaluate the mid-term results of posterior medial meniscal root tear (PMMRT) repair through assessment of functional outcome scores and magnetic resonance imaging (MRI). METHODS:This was a single-center, retrospective study evaluating patients that had undergone a PMMRT. This was a follow-up to a previously published 2-year outcome study (all original patients were invited to participate). Clinical outcomes included pre- and postoperative International Knee Documentation Committee (IKDC) and Lysholm scores. Root healing, meniscal extrusion, and cartilage degeneration via International Cartilage Repair Society Scale (ICRS) grades were assessed on MRI by two musculoskeletal fellowship-trained radiologists. RESULTS:10 of the original study's 18 patients were able to participate. Mean age and BMI was 48.4â€‰Â±â€‰12.0Â years and 29.5â€‰Â±â€‰4.5, respectively, with mean follow-up 65.5â€‰Â±â€‰8.3Â months (range 52.0-75.8) (60% female). The IKDC significantly increased from 43â€‰Â±â€‰13 preoperatively to 75â€‰Â±â€‰16 at 5-year follow-up (pâ€‰<â€‰0.001). There was no significant change in IKDC score between 2-year and 5-year follow-up [75â€‰Â±â€‰16 vs 73â€‰Â±â€‰20, (n.s)]. TheÂ Lysholm also significantly increased between preoperative and 5-year follow-up (49â€‰Â±â€‰7 vs 84â€‰Â±â€‰11, pâ€‰<â€‰0.001). There was no significant change between Lysholm score at 2-year and 5-year follow-up [84.0â€‰Â±â€‰11 vs 82â€‰Â±â€‰13, (n.s)]. Mean extrusion did not significantly change from the preoperative state to 5-year follow-up [4.80Â mmâ€‰Â±â€‰1.9 vs 5.0Â mmâ€‰Â±â€‰2.5, (n.s.)]. Extrusion also did not significantly change between 2-and 5-year follow-up [6.1â€‰Â±â€‰3.2Â mm vs 5.0Â mmâ€‰Â±â€‰2.5, (n.s.)]. No patients withâ€‰>â€‰3Â mm of extrusion on preoperative MRI hadâ€‰<â€‰3Â mm of extrusion on postoperative MRI. Both medial femoral condyle and medial tibial plateau ICRS grades significantly increased from preoperative to 2-year follow-up (pâ€‰=â€‰0.038, pâ€‰=â€‰0.023, respectively). Medial femoral condyle and medial tibial plateau ICRS grades again significantly increased between 2-year and 5-year follow-up (pâ€‰=â€‰0.014, pâ€‰=â€‰0.034). CONCLUSION/CONCLUSIONS:Patients treated with the transtibial suture pullout technique with two locking cinch sutures had maintenance of clinical outcome improvements at 5-year follow-up. However, extrusion was widely prevalent,Â with worsening progression of femoral and tibial chondral disease. LEVEL OF EVIDENCE/METHODS:Level 4.
Short-term complications of the Latarjet procedure: a systematic review
PURPOSE/OBJECTIVE:The purpose of this study is to evaluate the short-term complication rate following the open and arthroscopic Latarjet procedures and to meta-analyze the studies comparing the 2 approaches. METHODS:PubMed was searched according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to find clinical and biomechanical studies comparing complication rates in open and arthroscopic Latarjet procedures. A literature search of MEDLINE, Embase, and the Cochrane Library was performed based on the PRISMA guidelines. Clinical studies reporting on the complications following the open or arthroscopic Latarjet were included. Meta-analysis was performed for comparative studies using Review Manager, version 5.3. A P value of <.05 was considered statistically significant. RESULTS:Overall, 89 studies (Level of Evidence [LOE] I: 2, LOE II: 2, LOE III: 24, LOE IV: 61) met inclusion criteria, with 7175 shoulders. Following the open Latarjet procedure, the overall complication rate was 6.1%, with a 1.9% occurrence of graft-related complications, 1.1% hardware, 1.1% wound, 0.9% nerve, and 1.2% other complications. Following the arthroscopic Latarjet procedure, the overall complication rate was 6.8%, with a 3.2% occurrence of graft-related complications, 1.9% hardware, 0.5% wound, 0.7% nerve, and 0.5% other complications. Complications were reported in 7 studies comparing 379 patients treated with the open Latarjet and 531 treated with the arthroscopic Latarjet, with no statistically significant difference between the two (P = .81). CONCLUSION/CONCLUSIONS:Our study established that the overall complication rate following the Latarjet procedure was 6%-7%, with the most common complication being graft-related. Furthermore, based on the current evidence, there is no significant difference in the complication rate between the open and arthroscopic Latarjet procedures.
No difference in 90-day complication rate following open versus arthroscopic Latarjet procedure
The purpose of this study was to compare the 90-day complication rate between the open and arthroscopic Latarjet procedure. A retrospective review of patients who underwent an open or arthroscopic Latarjet procedure at NYU Langone Health between 2012 and 2019 was performed. The complications, readmissions, and reoperations within 90 days were assessed. Outcomes were compared between the two approaches, and a p value ofâ€‰<â€‰0.05 was considered to be statistically significant. The study included 150 patients (open: 110; arthroscopic: 40), with no patients lost to follow-up within the first 90Â days. Both cohorts were similar in terms of patient demographics. No intra-operative complications were observed in either group. Overall, there were 4 post-operative complications with the open approach and 2 with the arthroscopic approach (3.6% and 5.0%, respectively; n.s.) during the study period. Three patients required a readmission within the 90-day period; one patient in both groups required a revision Latarjet for graft fracture, and one patient in the open Latarjet required irrigation and debridement for deep infection (n.s.). With the open approach, there were 2 (2.3%) wound complications, 1 graft complication, and 1 (1.1%) nerve injury. With the arthroscopic approach, there was 1 (2.8%) wound complication and 1 (2.8%) hardware complication. The safety, and 90-day complication and readmission profile of arthroscopic Latarjet is similar to open Latarjet procedure. LEVEL OF EVIDENCE: Level III.
Distance of the Posterior Interosseous Nerve From the Bicipital (Radial) Tuberosity at Varying Positions of Forearm Rotation: A Magnetic Resonance Imaging Study With Clinical Implications
BACKGROUND:The proximity of the posterior interosseous nerve (PIN) to the bicipital tuberosity is clinically important in the increasingly popular anterior single-incision technique for distal biceps tendon repair. Maximal forearm supination is recommended during tendon reinsertion from the anterior approach to ensure the maximum protective distance of the PIN from the bicipital tuberosity. PURPOSE:To compare the location of the PIN on magnetic resonance imaging (MRI) relative to bicortical drill pin instrumentation for suspensory button fixation via the anterior single-incision approach in varying positions of forearm rotation. STUDY DESIGN:Descriptive laboratory study. METHODS:Axial, non-fat suppressed, T1-weighted MRI scans of the elbow were obtained in positions of maximal supination, neutral, and maximal pronation in 13 skeletally mature individuals. Distances were measured from the PIN to (1) the simulated path of an entering guidewire (GWE-PIN) and (2) the cortical starting point of the guidewire on the bicipital tuberosity (CSP-PIN) achievable from the single-incision approach. To radiographically define the location of the nerve relative to constant landmarks, measurements were also made from the PIN to (3) the prominent-most point on the bicipital tuberosity (BTP-PIN) and (4) a perpendicular plane trajectory from the bicipital tuberosity exiting the opposing radial cortex (PPT-PIN). All measurements were subsequently compared between positions of pronation, neutral, and supination. In supination only, BTP-PIN and PPT-PIN measurements were made and compared at 3 sequential axial levels to evaluate the longitudinal course of the nerve relative to the bicipital tuberosity. RESULTS:< .001). CONCLUSION:This MRI study supports existing evidence that supination protects the PIN from the entering guidewire instrumentation during anterior, single-incision biceps tendon repair using cortical button fixation. The distances between the entering guidewire trajectory and PIN show that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach. CLINICAL RELEVANCE:When a safe technique is used, PIN injuries during anterior repair are likely the result of aberrant retractor placement, and we recommend against the use of retractors deep to the radial neck. Guidewire placement as close as possible to the anatomic footprint of the biceps tendon is safe from the anterior approach. MRI evaluation confirms that ulnar and proximal guidewire trajectory is the safest technique when using single-incision bicortical suspensory button fixation.
Institutional Reductions in Opioid Prescribing Following Hip Arthroscopy Do Not Change Patient Satisfaction Scores
Purpose/UNASSIGNED:To investigate what effect decreased opioid prescribing following hip arthroscopy had on Press-Ganey satisfaction survey scores. Methods/UNASSIGNED:A retrospective review of prospectively collected data was conducted on patients who underwent primary hip arthroscopy for femoroacetabular impingement between October 2014 and October 2019. Inclusion criteria consisted of complete Press-Ganey survey information, no history of trauma, fracture, connective tissue disease, developmental hip dysplasia, autoimmune disease, or previous hip arthroscopy. Groups were separated based on date of surgery relative to implementation of an institutional opioid reduction policy that occurred in October 2018. Prescriptions were converted to milligram morphine equivalents (MME) for direct comparison between different opioids. Results/UNASSIGNED:> .05). Conclusions/UNASSIGNED:A reduction in opioids prescribed after a hip arthroscopy is not associated with any statistically significant difference in patient satisfaction with pain management, as measured by the Press-Ganey survey. Level of Evidence/UNASSIGNED:Level III, retrospective comparative study.
Arthroscopic Latarjet Procedure: Indications, Techniques, and Outcomes
Â»:The proposed advantages of the arthroscopic approach in the Latarjet procedure for shoulder dislocation include improved visualization for accurate positioning of the coracoid graft, the ability to address any associated intra-articular pathologies, and the diminished potential for the formation of postoperative scar tissue and stiffness associated with an open procedure. Â»:Young age, the presence of glenoid and/or humeral bone loss, a history of dislocation, a history of failed arthroscopic stabilization surgery, and an active lifestyle are all associated with recurrent dislocation and are relative indications for an osseous augmentation procedure. Â»:Both the open and arthroscopic Latarjet procedures result in substantial improvements in patient function, with comparable rates of recurrent instability and complication profiles.
Decreased Hip Labral Width Measured via Preoperative MRI is Associated with Inferior Outcomes for Arthroscopic Labral Repair for Femoroacetabular Impingement
PURPOSE/OBJECTIVE:To determine the association between labral width as measured on preoperative MRI with hip-specific validated patient self-reported outcomes at a minimum of 2 years follow-up. METHODS:An IRB-approved retrospective review of prospectively gathered hip arthroscopy patients from 2010 to 2017 was performed. Inclusion criteria was defined as patients >18 years old with radiographic evidence of femoroacetabular impingement who underwent a primary labral repair and had a minimum of 2 years clinical follow-up. Exclusion criteria was defined as inadequate preoperative imaging, prior hip surgery, Tonnis grade â‰¥2 or lateral central edge angle <25 degrees. An a-priori power analysis was performed. MRI measurements of labral width were conducted by two blinded, musculoskeletal fellowship-trained radiologists at standardized "clockface" locations using a previously validated technique. Outcomes were assessed using the Harris Hip Score (HHS), Modified HHS (mHSS), and NonArthritic Hip Score (NAHS). For mHHS, a minimal clinically important difference (MCID) and Patient Acceptable Symptomatic State (PASS) of 8 and 74 were used, respectively. Patients were divided into groups by labral width of < (hypoplastic) and â‰¥ 1 standard deviation below the mean. Statistical analysis was performed using linear and polynomial regression, Mann-Whitney U, chi-square, Fischer exact, and interclass-correlation coefficients (ICC) testing. RESULTS:=0.26, p<0.001). CONCLUSION/CONCLUSIONS:Hip labral width < 1 standard deviation below the mean measured via preoperative MRI was associated with significantly worse functional outcomes following arthroscopic labral repair and treatment of FAI. The negative relationship between labral width and outcomes may be non-linear.
MRI of superior capsular reconstruction graft and associated short-term clinical outcomes in patients with massive irreparable rotator cuff tears
OBJECTIVE:To assess MRI appearance of the dermal allograft and its correlation with clinical outcome following superior capsular reconstruction (SCR). MATERIALS AND METHODS/METHODS:This is a retrospective study of patients who underwent SCR between 2015 and 2018. Patients with postoperative MRI and clinical follow-up were included. Exclusion criteria were preoperative shoulder instability, advanced glenohumeral arthritis, and lack of postoperative MRI or clinical follow-up. Radiographs and MRIs were evaluated for graft integrity and position, acromiohumeral interval, superior subluxation distance (SSD), and glenohumeral cartilage loss. Correlation between imaging and clinical outcome measures were assessed. RESULTS:24 shoulders (23 patients) met the inclusion criteria at a mean clinical and MRI follow-up of 9.1Â months. There were 12 intact grafts (50%) and 12 torn grafts (50%), most commonly at the glenoid attachment (8/12). Patients with graft tear had greater SSD (mean 10.5Â Â±Â 6.1Â mm) than those without tear (mean 6.1Â Â±Â 3.8Â mm) (pÂ =Â 0.028). SSDÂ >Â 7.9Â mm had a 79% sensitivity and 91% specificity for graft tear. The intact grafts were more commonly covering the superior humeral head (91.7%) compared with the torn grafts (41.7%) (pÂ =Â 0.027). There was improvement of clinical outcome measures including American Shoulder and Elbow Surgeons score (pÂ =Â 0.005) and forward elevation (pÂ =Â 0.021) although there was no correlation between clinical outcome and integrity of the graft. CONCLUSION/CONCLUSIONS:SCR results in significant short-term clinical improvement even in the presence of graft tear on postoperative MRIs on current study. Gap between graft and the anchors, non-superior position of the graft, and humeral head superior subluxation can be associated with tear.