Impingement Syndrome Research Articles

Understanding Scapulohumeral Periarthritis: A Comprehensive Systematic Review

Background: This systematic review examines the clinical presentations and prevalence of scapulohumeral periarthritis (SP) by synthesizing the relevant literature from open-access articles from international databases (Medline, Pedro, and EBSCO). Methods: Keywords guiding the review included ‘scapulohumeral periarthritis’, ‘clinical forms’, ‘incidence’, ‘impingement syndrome, ‘calcifying tendinitis’, ‘bicipital tendonitis’, ‘shoulder bursitis’, ‘adhesive capsulitis or frozen shoulder’, ‘rotator cuff tears’, ‘functional assessment’, and ‘clinical trials’. Eligible studies included randomized controlled trials, nonrandomized controlled trials, cross-sectional studies, and review articles published between 1972 and 2024. Results: Our screening identified 2481 initial articles, of which 621 were further reviewed for eligibility resulting in 107 articles that met the relevance criteria. The findings highlight six distinct clinical forms of SP, such as partial rotator cuff tears and calcific tendinitis, each characterized by specific pathological features and prevalence patterns. Key factors contributing to SP include injuries, scapular instability, acromion deformities, and degenerative rotator cuff changes. Functional assessments, including the Neer, Hawkins, Pain Arc, and Yocum tests, demonstrated diagnostic value in distinguishing SP from other shoulder conditions. Conclusions: By comprehensively analyzing the clinical forms, functional assessment methods, and prevalent lesions of SP, functional testing can improve early diagnosis and guide personalized physiotherapy protocols for optimal rehabilitation in the physiotherapist’s practice.

Intravenous Tranexamic Acid Does Not Improve Visual Field Clarity During Hip Arthroscopy: A Double-Blind, Randomized, Placebo-Controlled Trial.

To determine the effectiveness of administering intravenous (IV) tranexamic acid (TXA) on altering visual field clarity (VFC) during arthroscopic hip preservation surgery for patients with femoroacetabular impingement syndrome (FAIS). This randomized, double-blind, parallel-design trial was conducted over a seven-month period between October 2023 and May 2024 at a single tertiary musculoskeletal hospital. Inclusion criteria included consecutive patients that were diagnosed with FAIS through clinical history, physical exam and advanced imaging and indicated for hip arthroscopy after having failed conservative management. This trial prospectively randomized 78 participants (n = 39 assigned to receive 1000mg of TXA in 100mL/0.9% normal saline (NS) bolus, n=39 assigned to receive 100mL/0.9% NS bolus only). Treatment intervention was administered within 15 minutes of incision. The primary outcome was arthroscopic VFC assessed on a Likert-style numeric rating scale (NRS) and graded by the surgeon at 15 minute intervals (1=poor visibility with active bleeding to the degree that vision was too poor to perform the operation; 2=fair visibility(mild bleeding that interfered with vision, but the surgery could still be performed), and 3=good visibility(clear vision without obvious blood). The percentage of good VFC (percent of surgeon-ratings equal to 3 on the NRS scale throughout the procedure) was quantified for each patient. No minimum follow-up was required as the primary endpoint was intraoperative. Baseline characteristics of the TXA cohort [mean age 37.3, 61.5% male, 76.9% Caucasian] were not significantly different than that of the placebo group ([mean age 33.6, 59% male, 86.8% Caucasian]; p>0.05 all). TXA was not associated with improved VFC compared with placebo at any intraoperative timepoint nor when considering composite overall VFC scores (TXA: 2.51±0.41 vs. placebo: 2.64±0.42;p=0.16). Furthermore, no significant difference was observed in the percentage of good VFC ratings between treatment groups (TXA:56.4%, placebo:66.4%, p=0.17). Multivariate regression analysis adjusted for demographic and intraoperative covariates did not demonstrate an association between TXA and VFC rating (ß =-0.14, p=0.14) nor percentage of good VFC ratings (ß =-11.6, p=0.15). No medical or intraoperative complications related to the treatment intervention were observed in either treatment arm. Among patients with FAIS undergoing arthroscopic hip preservation surgery, administration of TXA did not improve arthroscopic VFC when compared with placebo. Therefore, these results of this randomized trial do not support the routine use of TXA in arthroscopic hip preservation surgery for improvement in arthroscopic visualization. 1, prospective randomized controlled trial.

Changes in physical impairments in femoroacetabular impingement syndrome following arthroscopic surgery: a systematic review and meta-analysis

Abstract Femoroacetabular impingement syndrome (FAIS) is a motion-related condition causing hip pain in young active adults. Physical impairment measures of body function include objective and reproducible measures of hip mobility, muscle power, and movement coordination. Limited data on physical impairments and the effects of arthroscopic surgery exist. The aim of this systematic review was to investigate changes in physical impairments in those with FAIS, pre- and post-arthroscopic surgery. Six databases were searched for English-language studies reporting on pre- and postoperative physical impairments using physical outcome measures. Reporting quality was assessed using the Grading of Recommendations Assessment, Development and Evaluations (GRADE) framework, the Cochrane Risk of Bias tools and Methodological Index for Non-Randomized Studies (MINORS); for pooled data [standardized mean difference (SMD), and 95% confidence intervals (CI)]. Seventeen studies were included (two randomized controlled trials; fifteen pre/postintervention studies), varying from low-critical risk of bias, low-moderate on the MINORS, and very low reporting quality using the GRADE tool. Postoperatively, participants with FAIS walked with a higher peak hip flexion moment [SMD 0.5, 95% CI (0.12–0.88); heterogeneity I2 = 0%, P = .82] and reduced external rotation range [SMD −0.68, 95% CI (−1.34 to −0.01); heterogeneity I2 = 61%, P = .05]. Surgery increased participant hip flexion moment and impulse, hip strength and faster gluteus maximus contraction time. Patients demonstrated reduced hip extension, abduction and adduction angles during walking gait, and peak hip extension moments during gait and squatting. While this review found some physical impairments changed postoperatively, further research into specific subgroups of FAIS would enhance understanding and inform rehabilitation programs and optimize patient outcomes. Level of Evidence: IV (systematic review of III and IV evidence).

A meta-analysis of the effectiveness and side effects of hip arthroscopy and open surgical dislocation in the management of femoroacetabular impingement

BackgroundThe influence of femoroacetabular (FA) impingement has been implied in early hip osteoarthritis, particularly in young patients who enjoy athletics. The purpose of this meta-analysis is to assess the effectiveness and safety of hip arthroscopy compared to open surgical dislocation for the treatment of femoroacetabular impingement (FAI), based on clinical trials that have been published.MethodsA comprehensive literature search was conducted through PUBMED, EMBASE, and the Cochrane Central Register of Controlled Trials for studies evaluating coxoscopy and open surgical dislocation as treatment modalities for femoroacetabular impingement syndrome (FAI).ResultsUltimately 9 studies were added in this meta-analysis. 9 studies reported the Improvement of alpha angle of the Hip Arthroscopy treatment group and the surgical treatment group, which was no remarkable statistical significance(SMD: -5.54; 95% Cl: -12.45,1.38; P = 0.117) compared to the surgical treatment group, Modified Harris Hip Score (mHHS) after 12 months of follow-up(SMD: 0.94; 95% Cl: -2.87,4.75; P = 0.629), Nonarthritic Hip Score (NAHS) after 12 months of follow-up (SMD:6.31; 95% Cl: 0.53,12.09; P = 0.032), rate of recurrence (OR: 0.48; 95% Cl: 0.29,0.82; P < 0.01), and rate of Complication (OR: 0.66; 95% Cl: 0.26,1.65; P = 0.372).ConclusionAlpha angle improvement, mHHS, NAHS after 12 months of follow-up, rate of recurrence, and rate of Complication are some of the indicators of the study’s results point to the possibility that hip arthroscopy may be effective for patients with FA impingement; hence, these conclusions required to be corroborated by additional superior-quality studies.

Sex-Based Differences in the Arthroscopic Treatment of Femoroacetabular Impingement Syndrome: 10-Year Outcomes With a Nested Propensity-Matched Comparison.

Sex has been associated with different pathologic characteristics in painful hips undergoing hip arthroscopic surgery. To compare minimum 10-year patient-reported outcomes (PROs) and survivorship in patients who underwent primary hip arthroscopic surgery for femoroacetabular impingement syndrome and labral tears according to sex. Cohort study; Level of evidence, 3. Data from patients who underwent primary hip arthroscopic surgery between March 2009 and May 2011 were reviewed. Patients with minimum 10-year PROs for the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports-Specific Subscale (HOS-SSS), and visual analog scale (VAS) for pain were eligible. Exclusion criteria included previous ipsilateral hip conditions or surgical procedures, Tönnis grade >1, or dysplasia (lateral center-edge angle <25°). In the subanalysis, female patients were matched to male patients using a 1:1 ratio by age, sex, and body mass index. A total of 375 hips had a minimum 10-year follow-up. There were 249 female (mean age, 36.8 ± 13.1 years) and 126 male (mean age, 38.9 ± 13.1 years) hips. Survivorship was defined as no conversion to total hip arthroplasty. Female and male hips exhibited similarly high rates of survivorship (80.3% vs 72.2%, respectively; P = .076). Female hips underwent secondary arthroscopic surgery at a statistically higher rate of 14.5% (P = .021) and had higher rates of capsular repair and iliopsoas fractional lengthening (P < .0001 and P < .001, respectively). Male hips had a significantly higher rate of acetabular labrum articular disruption/Outerbridge grade 3 and 4 damage at 54.0% compared with female hips (both P < .001) and underwent femoroplasty and acetabular microfracture at significantly higher rates of 88.1% versus 51.0%, respectively, and 16.7% versus 4.8%, respectively (both P < .001). In the subanalysis, both groups showed significant improvements in all PROs from baseline (all P < .001). Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher self-reported mean satisfaction score of 9.0 compared with 8.4 (P = .003) and a greater magnitude of improvement in 10-year PROs (ΔmHHS: 29.3 ± 17.5 vs 23.1 ± 19.8, respectively [P = .036]; ΔNAHS: 33.2 ± 21.3 vs 25.1 ± 19.5, respectively [P = .012]; ΔHOS-SSS: 47.0 ± 32.0 vs 32.7 ± 31.9, respectively [P = .008]; and ΔVAS: -4.6 ± 2.7 vs -3.5 ± 2.0, respectively [P = .009]). However, all PROs at a minimum 10-year follow-up were similar between the groups. After undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome, both female and male patients reported significant improvements in all PROs at a minimum 10-year follow-up and high patient satisfaction, with similar final functional scores. Even though female patients demonstrated a higher rate of secondary arthroscopic surgery, they had a higher satisfaction score and a greater magnitude of improvement in PROs postoperatively.

Association of Preoperative Walking Speed With 1-Year Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Previous studies have identified demographic, radiographic, and intraoperative predictors of outcomes after hip arthroscopy for femoroacetabular impingement syndrome, yet few studies have identified whether preoperative gait metrics can predict outcomes. Increased preoperative step count, walking speed, step length, and gait symmetry will be associated with better outcomes after surgery. Retrospective cohort study. Level 4. Patients who underwent hip arthroscopy between 2019 and 2022 and downloaded the smartphone app rHip, allowing for retroactive access of gait metric data, were identified. Preoperative gait metrics, age, sex, body mass index (BMI), and exercise participation were analyzed via multivariate stepwise linear regression for a relationship with 1-year postoperative patient-reported outcomes (PROs), including Hip Outcome Scale-Activities of Daily Living (HOS-ADL); HOS-Sports Subscale (HOS-SS), and 12-item international Hip Outcome Tool (iHOT-12). Thresholds for preoperative gait metrics were analyzed via receiver operator characteristic curve. A subgroup analysis was performed to compare those who did and did not reach this threshold. A total of 43 patients (86% female; age, 33.1 ± 13.7 years; BMI, 23.9 ± 4.4 kg/m2) met inclusion criteria. Multivariate regression found that preoperative walking speed was significantly associated with postoperative HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .01). A preoperative walking speed threshold of 1.065 m/s was predictive of outcome achievement. Those who failed to achieve this threshold were significantly older, of greater BMI, and less active (P ≤ .04). They also showed significantly worse 1-year postoperative scores (P ≤ .02) and lower PASS achievement for HOS-ADL, HOS-SS, and iHOT-12 (P ≤ .04). Preoperative walking speed is significantly associated with 1-year outcomes after hip arthroscopy. Patients who averaged <1.065 m/s show significantly worse outcomes after surgery. Assessment of preoperative walking speed may allow physicians to better counsel patients regarding expected outcomes after hip arthroscopy.

Wrist arthroscopic Wafer surgery combined with triangular fibrocartilage complex insertion point reconstruction in treatment of Palmer type ⅡC combined with type ⅠB ulnar impingement syndrome

To investigate the effectivess of arthroscopic Wafer surgery combined with triangular fibrocartilage complex (TFCC) insertion point reconstruction in the treatment of Palmer type ⅡC combined with typeⅠB ulnar impingement syndrome. The clinical data of 14 patients with Parlmer type ⅡC combined with type ⅠB ulnar impingement syndrome who met the selection criteria between July 2021 and April 2024 were retrospectively analyzed. There were 7 males and 7 females with an average age of 43 years ranging from 16 to 59 years. The causes of injury were fall in 8 cases and sprain in 6 cases. The time from injury to operation ranged from 1 to 6 months, with an average of 2.3 months. Distal radioulnar joint instability was found in all cases. Arthroscopic Wafer surgery combined with TFCC insertion point reconstruction was used. The effectiveness was evaluated by comparing the wrist flexion-dorsiflexion range of motion, wrist ulnar deviation-radial deflection range of motion, forearm pronation-supination range of motion, visual analogue scale (VAS) score, and modified Mayo wrist score before and after operation. All patients were followed up 6-12 months, with an average of 9.1 months. The positive variation of ulna was (3.2±0.7) mm before operation, and the negative variation of ulna was (2.2±0.6) mm after operation. There was a significant difference in ulna variation between pre- and post-operation ( t=23.851, P<0.001). The pain symptoms and forearm rotation function of the patients after operation significantly improved. At last follow-up, the wrist flexion-dorsiflexion range of motion, wrist ulnar deviation-radial deflection range of motion, forearm pronation-supination range of motion, VAS score, and modified Mayo wrist score significantly improved when compared with those before operation ( P<0.05). Arthroscopic Wafer surgery combined with TFCC insertion point reconstruction can effectively relieve wrist pain, enhance the stability of the distal radioulnar joint, and restore the function of the wrist in patients with Palmer type ⅡC combined with type ⅠB ulnar impingement syndrome.

Detection of Acromion Types in Shoulder Magnetic Resonance Image Examination with Developed Convolutional Neural Network and Textural-Based Content-Based Image Retrieval System.

Background: The morphological type of the acromion may play a role in the etiopathogenesis of various pathologies, such as shoulder impingement syndrome and rotator cuff disorders. Therefore, it is important to determine the acromion's morphological types accurately and quickly. In this study, it was aimed to detect the acromion shape, which is one of the etiological causes of chronic shoulder disorders that may cause a decrease in work capacity and quality of life, on shoulder MR images by developing a new model for image retrieval in Content-Based Image Retrieval (CBIR) systems. Methods: Image retrieval was performed in CBIR systems using Convolutional Neural Network (CNN) architectures and textural-based methods as the basis. Feature maps of the images were extracted to measure image similarities in the developed CBIR system. For feature map extraction, feature extraction was performed with Histogram of Gradient (HOG), Local Binary Pattern (LBP), Darknet53, and Densenet201 architectures, and the Minimum Redundancy Maximum Relevance (mRMR) feature selection method was used for feature selection. The feature maps obtained after the dimensionality reduction process were combined. The Euclidean distance and Peak Signal-to-Noise Ratio (PSNR) were used as similarity measurement methods. Image retrieval was performed using features obtained from CNN architectures and textural-based models to compare the performance of the proposed method. Results: The highest Average Precision (AP) value was reached in the PSNR similarity measurement method with 0.76 in the proposed model. Conclusions: The proposed model is promising for accurately and rapidly determining morphological types of the acromion, thus aiding in the diagnosis and understanding of chronic shoulder disorders.

The Continuous Fragility Index of Statistically Significant Findings in Studies Based on High Levels of Evidence Comparing Interventions for Femoroacetabular Impingement Syndrome.

Critical analysis of studies with high level of evidence has relied on the significance set by the reported P values. However, this strategy steers readers toward categorical interpretation of the data; therefore, a more comprehensive approach of data analysis is warranted. The continuous fragility index (CFI) allows for frailty interpretation of any given study's continuous outcome results. To calculate the CFI of high-level quality studies reporting significant continuous outcomes on comparison of treatment modalities for management of femoroacetabular impingement syndrome. Meta-analysis; Level of evidence, 2. Three databases (PubMed, Embase, Cochrane) were queried from inception to February 2024 utilizing Boolean operators to combine variations of the following search terms: "femoroacetabular impingement, randomized controlled trials or prospective cohort." Studies were included if level of evidence 1 or 2, and a statistically significant outcome was reported for any continuous outcome. CFI calculation was performed for all significant outcomes to obtain a study-specific mean CFI and also for the primary outcome of each study. Mean CFI was also calculated for outcomes reported to be significant in >3 studies. Additionally, multivariable linear regression was utilized for assessment of variables associated with achievement of a higher CFI. Thirteen studies totaling 1316 patients were included for analysis: 11 level of evidence 1 and 2 level of evidence 2 studies. A total of 48 outcomes reaching significance were extracted, with 8 representing primary outcomes. Study-specific mean (SD) CFI was 8 (9.3), whereas primary outcome mean CFI was 12.5 (12). In 4 of the 13 studies, the number of hips lost to follow-up was greater than the study CFI. Outcome-specific mean CFI was obtained for 5 outcomes reported in >3 studies. Multivariable linear regression revealed that larger sample size and greater journal impact factor had a significant positive association with a higher overall CFI value (P < .05). The mean (SD) number of patient outcome events needed to reverse the significance of a continuous outcome (ie, CFI) was 8.0 (9.3). Nearly one-third of studies had a CFI less than the reported loss to follow-up, reflecting the need for better patient compliance to attain less fragile statistical results. Larger sample size and greater journal impact factor were both predictive of a higher CFI.

Analysis of the therapeutic efficacy of arthroscopic repair of the subscapularis tendon combined with coracoplasty

The aim of this study was to analyze the outcomes of arthroscopic subscapularis tendon repair combined with coracoplasty in the treatment. The study involved 80 patients (46 males, 34 females; aged 33 to 73 years), who underwent arthroscopic repair for subscapularis tears (type I, II, and III) presenting symptoms of anterior shoulder pain and tenderness. Subcoracoid impingement was defined as a coracohumeral distance of less than 6 mm on preoperative magnetic resonance imaging, with a follow-up of was at least two years. The patients were divided into two groups: Group A underwent coracoplasty, while Group B did not. The postoperative functional outcomes of the two groups were compared and analyzed using an independent sample t-test. The patients’ prognosis was assessed pre- and postoperatively using the University of California Los Angeles (UCLA) shoulder score, American Shoulder and Elbow Surgeons (ASES) shoulder score, and Visual Analog Scale (VAS)pain score. Postoperatively, primary wound healing was successful in all patients, with no systemic or localized shoulder joint infections or brachial plexus nerve injuries. Both groups showed improvements in overall functional outcomes after surgical intervention. At the 24-month follow-up, all evaluated parameters in both groups demonstrated improvements compared to preoperative values (P < 0.05). The functional scores significantly increased in both groups post-surgery compared to preoperative values (p < 0.01). When comparing the two groups using an independent sample t-test, the p-values for all indicators, except forward flexion range of motion, were below 0.01. The statistical analysis indicated that patients in Group A had better recovery outcomes than those in Group B, except for forward flexion. The results suggested that subcoracoid impingement syndrome could potentially be a significant precursor to subscapularis tendon injuries. It is noteworthy noting that the combined approach of subscapularis tendon repair and coracoplasty showed superior therapeutic efficacy compared to isolated subscapularis tendon repair when subscapularis tendon injuries were associated with subcoracoid impingement.

Efficacy of modified posterior shoulder stretching exercises on shoulder function in subacromial impingement syndrome: A comprehensive meta-analysis.

Subacromial impingement syndrome (SIS) is a common cause of shoulder pain and dysfunction. Modified posterior shoulder stretching exercises have been proposed as a treatment method aimed at improving shoulder function and reducing pain in patients with SIS. However, the efficacy of these exercises remains controversial, necessitating a systematic meta-analysis to comprehensively evaluate their effectiveness. A systematic search was conducted across PubMed, Cochrane Library, Embase, and Web of Science databases to identify randomized controlled trials (RCTs) and observational studies evaluating the efficacy of modified posterior shoulder stretching exercises in patients with SIS. Inclusion criteria required that participants be diagnosed with SIS, the intervention be modified posterior shoulder stretching exercises, and key outcomes such as shoulder function improvement and pain relief be reported. Meta-analysis was performed using RevMan 5.3 software, calculating standardized mean differences (SMD) with 95% confidence intervals (CI), and heterogeneity and bias risk were assessed. A total of 10 RCTs with 628 patients were included. The modified posterior shoulder stretching exercises demonstrated significant effects in reducing pain at rest (SMD = -1.00, 95% CI: -1.85 to -0.15, P = .02) and during activity (SMD = -1.45, 95% CI: -2.49 to -0.41, P = .006). Additionally, the exercises showed positive effects in improving internal rotation (SMD = 0.49, 95% CI: 0.22-0.75, P = .0003) and external rotation range of motion (SMD = 0.29, 95% CI: 0.00-0.58, P = .05), as well as enhancing shoulder function (CMS score: SMD = 0.95, 95% CI: 0.64-1.25, P < .00001) and reducing disability (quick DASH score: SMD = -0.85, 95% CI: -1.12 to -0.58, P < .00001). Sensitivity analysis indicated high robustness of the results, and Egger test did not reveal significant publication bias (P > .05). Modified posterior shoulder stretching exercises are significantly effective in improving shoulder function and reducing pain in patients with SIS, with the study results showing high robustness and low risk of bias. However, further high-quality research is needed to validate these findings.

Cadaveric Study Evaluating the Potential for Hindfoot Endoscopy and Flexor Hallucis Longus Tendoscopy Using a 1.9-mm Diameter Needle Arthroscope.

Hindfoot endoscopy is an effective treatment for posterior ankle impingement syndrome (PAIS) and flexor hallucis longus (FHL) tendon disorders. However, FHL tendoscopy, especially from the posteromedial portal, carries a risk of tibial nerve damage. A needle-arthroscopic system with a 1.9-mm-diameter arthroscope, a semirigid frame, and a 0-degree direction of view has been introduced. This study aimed to evaluate the efficacy and safety of this system in visualizing and reaching significant structures in hindfoot endoscopy and FHL tendoscopy through the posteromedial and posterolateral portals using a cadaveric model. The 1.9-mm-diameter arthroscopic system (NanoScope, Arthrex) was used to perform hindfoot endoscopy in 6 human donor ankles (3 pairs). The arthroscope tube is 9.5 cm long, semirigid, and has an outer diameter of 1.9 mm, a 0-degree direction of view, and a 120-degree field of view. Posteromedial and posterolateral portals were established. Visualization and operative reach were recorded, including the posterolateral talar process, posterior talofibular ligament, intermalleolar ligament, subtalar joint, and FHL tendon. The neurovascular bundle and FHL tendon were examined for kinks or damage. All significant structures were successfully visualized in all specimens. The wide 120-degree field of view facilitated adequate visualization of all structures. In all specimens, the FHL tendon was visualized from the ankle joint to the knot of Henry (zones 1 and 2), and the flexor digitorum longus tendon was observed via both portals. There were no signs of neurovascular damage from either the posterolateral or posteromedial portals. In this cadaver experiment without known pathology, use of a 1.9-mm-diameter needle-arthroscopy with a 0-degree direction of view provided effective visualization of all significant structures in treating PAIS and FHL tendon disorders. It appears that FHL tendoscopy can be performed from the level of the ankle joint to the knot of Henry via both the posterolateral and posteromedial portals.

Correlation between Shoulder Pain, Disability and Axial Thoracolumbar Vertebral Rotation in Subacromial Impingement Syndrome

Correlation between Shoulder Pain, Disability and Axial Thoracolumbar Vertebral Rotation in Subacromial Impingement Syndrome

Declining postoperative ninety-day opioid prescriptions from 2010 to 2021 following hip arthroscopy for femoroacetabular impingement syndrome

Declining postoperative ninety-day opioid prescriptions from 2010 to 2021 following hip arthroscopy for femoroacetabular impingement syndrome

Borderline Dysplastic Hips with Femoroacetabular Impingement Syndrome Demonstrate Increased Axial Distraction Distance on an Intraoperative Traction Exam

Borderline Dysplastic Hips with Femoroacetabular Impingement Syndrome Demonstrate Increased Axial Distraction Distance on an Intraoperative Traction Exam

Evaluation of Outcomes Following Arthroscopic Treatment of Femoroacetabular Impingement Syndrome Across Different Surgeons, Surgical Techniques, and Postoperative Protocols: A Multi-institutional Study.

Femoroacetabular impingement syndrome (FAIS) is frequently treated arthroscopically with osteoplasty and labral repair. Surgical preferences vary in terms of equipment, technique, and postoperative protocol. Patient-reported outcome measures (PROMs) are valuable tools to assess outcomes across different institutions. To compare PROMs after FAIS arthroscopy and evaluate the impact on postoperative outcomes with independent surgeons utilizing different surgical techniques and postoperative protocols. Cohort study; Level of evidence, 2. Prospective data were collected from patients with a 2-year follow-up after arthroscopic FAIS treatment by 2 orthopaedic surgeons from different states, each attending different sports medicine fellowships. Patients were matched according to age, sex, and body mass index. Data included patient characteristics, surgical findings, and the Hip disability and Osteoarthritis Outcome Score (HOOS) preoperatively and 2 years postoperatively. Patients with revision surgery, concomitant procedures, or incomplete pre- and postoperative data were excluded. Surgeon A utilized interportal capsulotomy, capsular repair, all-suture anchors, and a postoperative hip brace. Surgeon B employed periportal capsulotomy without repair, polyether ether ketone suture anchors, and no brace. The 2 high-volume arthroscopists (>100 hips/year) performed osteoplasty and labral repair and used a large perineal post. Cohorts were analyzed with appropriate t tests, with significance set at P < .05. The percentage of patients achieving minimal clinically important difference (MCID) was calculated using Pearson chi-square tests. A total of 176 hips (100 women, 76 men) were included, with 88 matched patients from each institution. The mean age was 33.7 years and the body mass index was 26.3 kg/m2. Both cohorts significantly improved in all 5 HOOS subscales 2 years after surgery. When comparing the mean change in PROMs and the percentage of patients achieving the MCID, differences were only observed in the HOOS-Sports subscale (cohort A: 25.3 ± 29.7 vs cohort B: 34.3 ± 29.7; P = .048; MCID achieved in 57% of patients vs 76%; P = .01). This prospective cohort study on arthroscopic FAIS treatment indicates that matched patient cohorts from different institutions show similarly improved PROMs at 2 years. This study suggests consistent patient outcomes across sites despite geography, surgeon, training, surgical technique, implants, and postoperative protocol.

The impact of central sensitization-related symptoms on subacromial steroid injection outcomes in patients with subacromial impingement syndrome: an observational study.

Evidence indicates that central sensitization (CS) plays a role in subacromial impingement syndrome (SIS). Reduced treatment response has been associated with pretreatment pain sensitization features, such as CS-related symptoms. Patients who received subacromial steroid injection were evaluated before the injection, at the first and third months. CS-related symptoms were investigated through the central sensitization inventory (CSI), and pain hypersensitivity was investigated by pressure pain threshold (PPT). Patients were evaluated using the visual analog scale (VAS), Quick Disabilities of the Arm, Shoulder, and Hand, Hospital Anxiety and Depression Scale, and Short Form-36. With the injection, all participants had a significant reduction in shoulder pain (P < 0.05). In all follow-ups, VAS values did not differ significantly between the groups, and patients with CSI ≥ 40 had higher levels of disability, anxiety, depression, and worse quality of life before treatment (P < 0.05). Post-injection disability decreased significantly in the CS group and reached similar levels in both groups at the third month (P > 0.05). Although both groups' PPT values were comparable pre-treatment and at the third month, the CS group's affected shoulder showed a notable PPT decline at the first month (P < 0.05). Pre-treatment CS-related symptoms had no effect on SIS patients' responsiveness to steroid injections.

Six-month rehabilitation following surgical hip dislocation for femoroacetabular impingement restores the preoperative strength of most hip muscles, except for external rotators

Abstract The aim of this study was to evaluate the bilateral changes in hip muscle strength after a 6-month rehabilitation period for patients undergoing surgical hip dislocation (SHD) to treat femoroacetabular impingement syndrome (FAIS). We conducted a retrospective analysis on a cohort of 22 patients (mean ± SD age: 26 ± 7, 68% male) who underwent SHD for FAIS between March 2020 and January 2023 at La Tour Hospital. Bilateral isometric strength of eight hip muscle groups (abductors, adductors, hamstrings, quadriceps, extensors, flexors, internal, and external rotators) was assessed using a handheld dynamometer before surgery, and at 3 and 6 months postoperatively. After 6 months of rehabilitation, only the external rotators were weaker compared to preoperative levels (−13% ± 23%, P = .021). Strength levels were similar to preoperative levelsfor adductors (−2% ± 21%, P = .309), internal rotators (0% ± 25%, P = .444), quadriceps (0%± 23%, P = .501), hamstrings (7%± 20%, P = .232), extensors (7%± 19%, P = .336), flexors (8%± 34%, P = .781), and abductors (8% ± 25%, P = .266). At 6 months, 59% (abductors) to 82% (adductors) of patients did not achieve a clinically relevant strength improvement (&amp;gt;15%) compared to their preoperative status for aforementioned muscles. Additionally, 50% of the cohort experienced a clinically relevant loss of strength in the external rotators at 6 months post-surgery. To conclude, after SHD, most FAIS patients regained their preoperative strength for all muscle groups except the external rotators with a 6-month rehabilitation program. However, the effectiveness of the rehabilitation protocol varies on an individual level.

Evidence-based approach to the shoulder examination for subacromial bursitis and rotator cuff tears: a systematic review and meta-analysis

IntroductionShoulder pain represents a common patient complaint evaluated in a primary care setting. Approximately two thirds of these patients have rotator cuff injuries, with rotator cuff tears (RCTs) and subacromial impingement syndrome (SIS) accounting for a majority of causes. An accurate and efficient diagnostic strategy focused on physical examination findings may lead to improved outcomes and less functional disability.ObjectiveTo identify the most accurate physical examination tests for the diagnosis of RCT and SIS, we performed a systematic review and meta-analysis.MethodsThe database for our systematic review was compiled by using keywords and common indexing strategies to search PubMed, Ovid MEDLINE, Embase and the Cochrane Library from January 1, 1980, to March 15, 2024. Included studies evaluated a physical examination being performed prior to a reference standard diagnostic test for either RCT or SIS. Data was extracted in dual fashion and meta-analyses were performed regarding physical examination tests identified in our included studies.ResultsA total of twenty studies, which include 3,438 patients, met our inclusion criteria and had data extracted for statistical analysis. Data was adequate to perform meta-analyses on ten physical examination tests for RCT and five physical examination tests for SIS. There were six physical examination tests which had significant diagnostic odds ratios (DORs) when used in the diagnostic evaluation of suspected RCT, with the External Rotation Lag Sign at 90 Degrees having the highest magnitude of significance (DOR, 12.70; 95% CI, 3.68 – 43.86; P < .0001). Four physical examination tests had significant DORs for physical examination tests when used in the diagnostic evaluation of SIS, with the Yergason’s Test having the highest magnitude of significance (DOR, 4.71; 95% CI; 2.16 – 10.32; P = .0001).ConclusionWe present a large body of low-quality evidence for the diagnostic accuracies of physical examination tests for the identification of both RCT and SIS. We have identified novel data for the accuracy of the External Rotation Lag Sign at 90 Degrees and the Internal Rotation Lag Sign that have high to moderate diagnostic accuracy for ruling in tears of the rotator cuff.

Postoperative femoral head cartilage injury after hip arthroscopic treatment for femoroacetabular impingement syndrome and labral tear

BackgroundPostoperative femoral head cartilage injury (FHCI) is a rare condition that can be observed in a certain proportion of patients undergoing hip arthroscopy. However, the prevalence and associated factors of FHCI, and the effect of this condition on clinical outcomes still remain unknown.Patients and methodsConsecutive patients who were diagnosed with femoroacetabular impingement syndrome (FAIS) and labral tear and underwent hip arthroscopic treatment in our institute between July 2020 and July 2021 were retrospectively evaluated. Supine anteroposterior hip radiographs, cross-table lateral radiographs, magnetic resonance imaging (MRI), and computed tomography (CT) were obtained preoperatively. Postoperative MRI, at least 6 months after arthroscopy, was performed. Postoperative FHCI was evaluated by two surgeons through MRI. Preoperative patient-reported outcomes (PROs) including visual analog scale (VAS) for pain, and modified Harris Hip Score (mHHS) before surgery and at final followup were obtained.ResultsA total of 196 patients were included. Postoperative FHCI was identified in 21 (10.7%) patients. The intraobserver reliability of the observer A and B for detecting postoperative FHCI using 3.0-T MRI was high (k = 0.929, and k = 0.947, respectively). The interobserver reliability between the two observers for detecting FHCI using 3.0-T MRI was high (k = 0.919). There was no significant difference in preoperative and postoperative mHHS, VAS, and percentage of patients who surpassed minimal clinically important difference (MCID) and achieved patient acceptable symptom state (PASS) between patients with and without postoperative FHCI (P > 0.05).ConclusionAlthough postoperative FHCI was observed in 10.7% of patients, which was associated with larger labrum, this condition did not result in inferior clinical outcomes.Level of evidence IV, retrospective case series.Trial registration The Chinese Clinical Trial Registry approved the registration (ChiCTR2200061166). The date of registration is 2022-06-15.