Previous Sports Activity Level Research Articles

10-Year Survival and Clinical Improvement of Meniscal Allograft Transplantation in Early to Moderate Knee Osteoarthritis

Background: Meniscal allograft transplantation (MAT) is a viable option for patients experiencing unicompartmental knee pain after total or subtotal meniscectomy. Nonetheless, caution is recommended when suggesting this procedure in the presence of knee osteoarthritis (OA) because of the higher risk of poor survival and outcomes. Purpose/Hypothesis: The purpose was to document the long-term survival of MAT performed as a salvage procedure in patients with knee OA. The hypothesis was that MAT would significantly reduce pain and increase the function of the affected joint at a long-term follow-up compared with the preoperative condition, with a low number of failures and knee replacement surgeries. Study Design: Case series; Level of evidence, 4. Methods: A total of 47 patients (37 men and 10 women) with symptomatic knee OA (Kellgren-Lawrence grades 2 or 3) treated with MAT were evaluated at baseline, 5 years, and a minimum 10-year final follow-up (11.1 ± 1 years) using the Lysholm score, the visual analog scale for pain, the Knee injury and Osteoarthritis Outcome Score subscales, and the Tegner score. A total of 44 patients had undergone previous surgeries. Patient satisfaction, revision surgeries, and failures were also recorded. Results: A statistically significant improvement was observed in all clinical scores from the baseline assessment to the final follow-up. The Lysholm score improved significantly from 46.4 ± 17.2 at the preoperative assessment to 77.7 ± 20.4 at the intermediate follow-up (P < .001), with a significant decrease at the final follow-up (71 ± 23.3; P = .018). A similar trend was reported for the visual analog scale scale for pain, Knee injury and Osteoarthritis Outcome Score, and Tegner score, with no complete recovery to the previous sports activity level. A total of 33 patients required concurrent procedures, such as anterior cruciate ligament reconstructions, osteotomies, and cartilage procedures. Five patients underwent reoperation and were considered surgical failures, while 15 patients presented a clinical condition of <65 of the Lysholm score and were considered clinical failures. Among these, 4 patients were considered both surgical and clinical failures. Conclusion: MAT surgery has proven to be a valid option for improving pain and function even in OA joints (Kellgren-Lawrence grades 2 or 3), yielding satisfactory results despite a worsening clinical outcome in the long-term follow-up. Therefore, based on the data from this study, orthopaedic surgeons may consider recommending MAT as a salvage procedure even in knees affected by early to moderate OA, while advising patients that the need for combined interventions could potentially reduce graft survival.

Operative Repair of Hamstring Injuries From the Jackling Position in Rugby.

The jackling position within rugby has not been previously described as a mechanism for proximal hamstring injuries. Acute surgical repair of proximal hamstring avulsion injuries sustained from the jackling contact position enables a return to a previous level of sporting activity with low risk of recurrence. Case series; Level of evidence, 4. This study included 54 professional rugby players (mean age, 26 ± 4.8 years) who underwent acute primary surgical repair of complete, proximal hamstring avulsion injuries. The mean follow-up time was 17 months (range, 12-24 months). Mean isometric hamstring strength and function testing was performed at 3 months and 1 year after repair. Of the 54 players, 51 (94.4%) returned to their preinjury level of sporting activity. The mean time from surgical repair to full sporting activity was 7 months (range, 4-12 months). No patients had recurrence of the primary injury. At 1 year postoperatively, patients had significantly restored mean isometric hamstring muscle strength when compared with the uninjured leg at 0° (98.4% ± 2.8%), 15° (95.9% ± 2.9%), and 45° (92.9% ± 4.1%); improved Lower Extremity Functional Score (78.0 ± 2.0); and improved Marx activity rating score (14.3 ± 1.5) (P < .001 for all). Acute surgical repair of proximal hamstring avulsion injuries caused by the contact jackling position produced a high return to preinjury level of sporting activity, increased muscle strength, and improved functional outcome scores, with a low risk of recurrence at short-term follow-up.

Hip arthroscopy is an effective treatment for high-level female athletes

ObjectivesThis study aimed to assess the outcomes of hip arthroscopic surgery in high-level female athletes diagnosed with femoroacetabular impingement (FAI) compared to those with lower levels of sports activity. Additionally, we investigated the effectiveness of patient-reported outcomes (PROs) and the potential ceiling effect as a lack of sensitivity in detecting clinically statistically significant changes in high-level female athletes due to high baseline scores. MethodsWe conducted a retrospective analysis of prospectively collected data from female patients who underwent hip arthroscopy for FAI between January 2016 and August 2022 with a minimum 1-year follow-up. Patients were categorised into two groups: high-level athletes (group A) and low sports activity level (group B). Various PROs, visual analogue scales for pain, and patient satisfaction were assessed preoperatively and postoperatively. Return to sports (RTS) rates were determined based on the patient's reported ability to return to their previous level of sports activity. The minimally clinically important differences (MCIDs) and the Patient-Acceptable Symptomatic State (PASS) analyses were used to evaluate the clinical impact of the Hip Outcome Score-Sport Subscale (HOS-SSS). ResultsA total of 11 high-level female athletes were included in group A, and 22 were included in the low sports activity level group B. Both groups showed significant improvements in PROs, with no significant differences between them. RTS rates were lower in high-level athletes (63.6%) than in low sports activity patients (85.7%). Visual analogue scales for pain improved significantly in both groups. Patient satisfaction was high in both groups, with a median score of 9. The HOS-SSS showed no ceiling effect, and the MCID and PASS analyses indicated that a high proportion of patients in both groups achieved clinically relevant improvement in HOS-SSS. ConclusionHip arthroscopic surgery is effective for FAI treatment in high-level female athletes, with outcomes similar to those in patients with lower sports activity levels. The absence of a ceiling effect in sports-related outcomes suggests that PROs can detect clinically significant changes in high-level female athletes. Although RTS rates were lower in high-level athletes, this difference was not significant. These findings underscore the value of using PROs to evaluate outcomes in female athletes with different sports-activity levels. Level of evidenceIV.

Primary conservative treatment PCL rupture in athletes

The purpose of this study: to evaluate the results of conservative treatment of isolated grade II and III PCL rupture in athletes.Materials and methods. The study included 36 patients who were athletes at a professional level, with isolated PCL rupture, and have been treated non-operative in the period from 2012 to 2020. The non-operative protocol of isolated lesions of the PCL involve, bracing with posterior leg support, rehabilitation program determined by the symptoms and physical signs.Results. After 2 years from injury, the average score on the Tegner scale was 9 (5–10) (p=0.42). 32 (89%) patients returned to the previous level of sports activity, the average score on the Tegner scale was 9 (7–10). The mean time to return to sports-specific training was 10.6 (4–27) weeks, and the mean time to return to full competitive sport was 16.4 (10–40) weeks. Conclusion. The non-operative management of isolated, Hughston grade II and III PCL injuries gives excellent functional outcomes with a high proportion returning to the same level of sport.

Tibial tubercle avulsion fractures in adolescents: impact on function and quality of life.

The objective of the study was to assess functional outcomes and quality of life of patients treated for tibial tubercle avulsion fractures (TTAFs). Retrospective study of patients under 18 years of age treated from June 2011 to May 2018. Demographic data included age, gender, mechanism of injury, side, fracture classification, associated injuries, predisposing factors, and type of treatment. Clinical results included knee range of motion, pain, return to sports, overall satisfaction, functional outcomes, and complications. At final follow-up, Tegner Lysholm Knee Scoring Scale, and Kidscreen-10 were applied. Ten patients were included, all males, with a median age of 15 years. Mechanism of injury: football (three patients), basketball (two patients), running (two patients), handball (one patient), gymnastics (one patient), and fall (one patient). Nine were treated surgically with reduction and fixation with cannulated screws or Kirschner wires, plus treatment of associated injuries (three patellar tendon avulsions, one contralateral proximal tibia epiphyseal fracture, and two prophylactic fasciotomies). One patient developed mild recurvatum and two presented minor decreased knee flexion. Eight patients returned to their previous level of sports activity. Median Tegner Lysholm Knee Score was 100/100 and Kidscreen-10 was 50/50. With appropriate treatment, nearly 100% of TTAFs have good functional outcomes and low impact on quality of life.

Lesão SLAP Tipo II Isolada em Desportistas – Reparação Labral ou Tenodese da Longa Porção do Bicípite. Análise de Resultados e Taxa de Return to Play

Introduction: SLAP injuries are common in young athletes and in the military men. In the failure of conservative treatment, surgical treatment is indicated. Objectives: To compare clinical results in two groups of sportsmen and military men with SLAP type II injuries who underwent two surgical techniques. Material and methods: Retrospective study, in sportsmen and military personnel submitted to surgical treatment between 2010 and 2018. Each group was submitted to the same technique by the same surgical team. Clinical evaluation was performed with a Constant (SC) score, complications were recorded, surgical re-interventions, rate of return to sports activity and rate of return to the previous level of activity. Results: We analyzed 25 patients, 12 who underwent labral repair (RL) and 13 who underwent bicipital tendon tenodesis (TLPB). The mean follow-up was 4.5 years, the mean age was 25.7 years for the RL group and 31 years for the TLPB group. There was an improvement in SC in both groups. In the RL, there were 4 cases of post-operative stiffness with two re-interventions, whereas with the TLPB there was a failure with tenodesis rupture. The rate of return to sports activity was 100% in both groups, but in the RL group the rate of return to the previous level was 42% and in the TLPB group 70%. Conclusions: Both techniques have good clinical results in the medium and long term. In our series, the results are superior for TLPB and without re-interventions. In the RL group, the rate of complications was higher and the rate of return to the previous level of sports activity was lower.

Operative Results of Plantar Plating for Fifth Metatarsal Stress Fracture.

The treatment of fifth metatarsal stress fractures can be challenging. Various operative fixation methods have been reported for fracture management. Among them, intramedullary screw fixation has become increasingly popular. However, recent reports have described failures after screw fixation in athletes. The aim of this study was to determine the rates of clinical and radiographic healing, time to return to sport, and complications of elite athletes with proximal fifth metatarsal fractures treated with plantar plating. Thirty-eight athletes with fifth metatarsal stress fractures treated using a plantar plating technique in 3 hospitals from 2013 to 2018 were evaluated retrospectively. Demographic data, radiographic evaluation, and the time until union and return to sports activities were collected and analyzed. A total of 38 patients underwent the plantar plating for a fifth metatarsal stress fracture with a mean follow-up of 23 (range, 12-49) months. The mean time to the radiologic union, as determined by plain radiography, was 9.3 (range, 8-16) weeks. Although there were no nonunions or delayed unions during follow-up, 4 refractures developed (10.5%). All but 1 patient were able to return to their previous levels of sporting activity at 22.2 ± 4.5 (range, 12-40) weeks. With a minimum of 1-year follow-up, the described plantar plating technique could be an alternative method for the operative treatment of fifth metatarsal stress fractures without nonunion problems. Level IV, case series.

Surgical Results of Plantar Plating for Fifth Metatarsal Stress Fracture

Category:Midfoot/Forefoot, Sports, TraumaIntroduction/Purpose:The treatment of 5th metatarsal stress fractures of the can be challenging and at times can result in significant disability. Intramedullary screw fixation has become a popular surgical method for management. However, many recent reports have described failures after screw fixation in athletes. The aim of this study was to determine rates of clinical and radiographic fracture healing, return to sport, and complications of elite athletes with proximal fifth metatarsal fracture treated with plantar plating.Methods:Thirty-eight patients with fifth metatarsal stress fractures treated using the plantar plating technique in four hospitals from 2013 to 2018 were evaluated retrospectively. All of the patients were elite athletes. Demographic data, radiographic evaluation, and the time until union and return to unrestricted sporting competition were collected and analyzed.Results:A total of 38 patients underwent the plantar plating for 5th metatarsal stress fracture with a mean follow-up of 23 months (range, 12-49 months). The mean time to radiologic union as determined by CT was 9.3 weeks (range, 8-16 weeks). However, during follow-up, there were 4 refractures but no union problems. One patient experienced temporary sensory disturbance that resolved within 3 months. There was one patient with temporary wound complication, two cases with hardware prominence. All but one patients were able to return to their previous levels of sporting activity at 21 ± 4 (range, 18 to 40) weeks.Conclusion:With minimum 1-year follow-up, the described plantar plating technique is a good alternative method for the surgical treatment of fifth metatarsal stress fractures with less complications.

Return-To-Sport at 5-Year Follow-Up after Non-Operative Treatment of Acute Achilles Tendon Rupture

Category:SportsIntroduction/Purpose:There is a controversy if non-operative or operative treatment for acute Achilles tendon rupture is superior. It is unknown, if young and active patients with acute Achilles tendon rupture, return to previous sports activity level after treatment with standardized non-operative immediate full weight-bearing protocol. The purpose of this was to assess (1) the return-to-sport rate and subjective satisfaction in patients with different activity levels before the rupture, at 1-year, and at 5-year follow-up, (2) the clinical outcome at 1-year follow-up, and (3) re-ruptures and complications.Methods:Out of 171 consecutive patients that were treated nonoperatively, 114 patients were available for 1-year follow-up. Eighty-nine patients responded to questionnaires for sports activity. Non-operative treatment consisted of a combination of an equinus cast and rehabilitation boot, that enables immediate full weight-bearing and early functional rehabilitation. Clinical 1-year follow-up and follow-up with questionnaires at 1-year and 5-year follow-up were evaluated to calculate Tegner Activity Scale (TAS), and Activity Rating Scale (ARS) and were compared to the status before the rupture. Based on the TAS before the rupture, patients were divided into a low-level activity (<5) and high-level activity (>5) group and the return-to-sport rate was compared between those two groups.Clinical assessment at minimum 1-year follow-up included testing of plantarflexion strength and endurance, calf circumference, and subjective parameters to calculate a modified Thermann score. Mean clinical follow-up was 34 ± 23 months (range 12-88 months).Results:(1) A significantly higher proportion (91%) of the patients in the low-level activity group returned to their previous TA at 5-year follow-up compared to patients (67%) in the high-level activity group (p=0.029). A higher proportion (91%) of the patients in the low-level activity group returned to their previous ARS Score at 5-year follow-up compared to patients (82%) in the high- level activity group (p=0,115). (2) The mean Thermann score was not significantly different between the two activity groups at minimum 1-year follow-up: 84 ±12 (range, 41-100) and 82 ±12 (range, 44 -100). (3) There were a total of 17 complications. There were 9,6% reruptures (8 with and 3 without an adequate trauma), 5 deep venous thromboses, 1 complex regional pain syndrome at 1 year follow-up.Conclusion:After 17 years of prospective evaluation, our non-operative treatment protocol for acute rupture of the Achilles tendon leads to good functional outcome, high patient satisfaction and high return-to-sport rate. Most patients return to their previous sports activity level after a standardized nonoperative early full-weightbearing treatment protocol for acute Achilles tendon rupture. Even for patients with a high activity level return to pre-rupture sports level activity was possible in two third of the patients. The re-rupture rate with immediate weight bearing is low and comparable to other non-operative treatment methods.

Clinical outcomes and return to sport after repeat-revision ACL reconstruction: 2-year minimum follow-up

ObjectivesAnterior cruciate ligament reconstruction (ACLR) is one of the most common procedures performed by orthopaedic surgeons to date. As the number of ACL reconstructions continues to increase, revision and multiple revision scenarios will become more frequent. The purpose of our study was to retrospectively analyze functional outcomes, return-to-sports and concomitant procedures in a series of patients who had undergone repeat revision surgery.MethodsWe retrospectively evaluated a consecutive series of patients operated between 2011 and 2016 with a minimum follow-up of 2 years. Surgical procedure, type of graft and fixation were recorded. IKDC evaluation, Lysholm score, KOOS score, Tegner scale, return-to-sports and a radiographic evaluation were performed.ResultsSeven patients were included for analysis with an average age at the second revision of 34 years (range 22-49). The contralateral knee was intact in 5 cases while in the remaining 2 an ACLR had been performed. The average follow-up was 35 months (SD 17; median 27 [IQR 24-39 months]).The graft used for ACLR was: 1 ipsilateral BTB autograft and 6 allografts. In three cases, an associated lateral extra-articular procedure was performed. Three (43%) patients had a meniscal tear; two required partial meniscectomy and 1 was sutured. Three (43%) patients had grade III chondral lesion and we performed microfracture.All patients had a side-to-side difference of less than 5 mm in the arthrometric evaluation and none had residual rotational laxity.The median pre and postoperative IKDC score was 60 (IQR 45-68) and 89 (IQR, 65-94) respectively (p 0.021). The median pre and postoperative Lysholm score was 69 (IQR, 55-80) and 91 (IQR, 86-100) respectively (p 0.S007). The median postoperative KOOS score was: Pain 93, Symptoms 94, ADL 100, Sports 90, QOL 56. Three (43%) patients returned to their previous sports activity level at final follow-up. Three switched to a less demanding activity, whereas 1 discontinued contact sports.No significant osteoarthritic changes were observed. The mean posterior tibial slope was 8° (SD 2.7; median 7 [IQR 10-6]).ConclusionRepeat revision ACLR was effective in restoring knee stability and improving functional outcomes in our patients when compared to their preoperative state. However, only 43% returned to their pre-injury level of sports activity.

Clinical Outcomes and Recurrence Rates After Arthroscopic Stabilization Procedures in Young Patients With a Glenoid Bone Erosion: A Comparative Study Between Glenoid Erosion More and Less Than 20%

To evaluate the clinical outcomes and recurrence rates of arthroscopic stabilization procedures in young patients who had recurrent anterior shoulder instability with a glenoid bone erosion more than 20%, and to compare with those in patients with a glenoid bone erosion less than 20%. A total of 161 patients who underwent an arthroscopic stabilization procedure for recurrent anterior shoulder instability with anterior glenoid bone erosions and at least 2years of follow-up were included. Patients were divided into 2 groups based on the glenoid defect size (group I [32 patients]: erosion >20%, group II [129 patients]: erosion <20%). The clinical outcomes were compared using the American Shoulder Elbow Surgeons (ASES) score, Rowe score, and sports/recreation activity level between the 2 groups. Postoperative complications including instability recurrence were documented. The mean glenoid defect size was 22.1 ± 2.1% in group I, and 12.2 ± 3.7% in group II. In group I, clinical outcomes were significantly improved after operation (ASES score: 57.9 ± 14.3 at initial, 88.9 ± 6.2 at the last visit, P= .001; Rowe score: 42.1 ± 15.6 at initial, 87.4 ± 7.6 at the last visit, P= .001). These results were inferior to the clinical outcomes of patients in group II (ASES score: 91.5 ± 12.7, P < .001; Rowe score: 89.3 ± 12.4, P=.01). Postoperative recurrences occurred in 5 patients (15.6%) in group I, whereas patients in group II showed 5.4% of recurrence rate (P= .05). Competent recoveries to sports/recreation activity were achieved in 84.4% of patients in group I. Arthroscopic stabilization procedures for recurrent anterior shoulder instability in young patients with glenoid bone erosions more than 20% showed satisfactory clinical outcomes and recurrence rate, although these results were inferior to those of patients with glenoid erosions less than 20%. Arthroscopic stabilization procedures can be applied as the primary treatment of recurrent anterior shoulder instability with a large glenoid bone erosion for functional restoration and return to previous sports activity level. Level III, retrospective comparative study.

Refractory patellar tendinopathy treated by arthroscopic decortication of the inferior patellar pole in athletes: Mid-term outcomes

BackgroundThis study aimed to evaluate the clinical outcomes of arthroscopic decortication of the inferior patellar pole in athletes with refractory chronic patellar tendinopathy. MethodsThirty-seven athletes in whom conservative management for at least six months failed underwent arthroscopic patellar tendon debridement and decortication of the inferior pole of the patella. Clinical outcomes were evaluated using subjective knee scores and isokinetic muscle strength tests. The average duration taken and sports participation level were also assessed. ResultsThe mean follow-up period was 51.3 ± 14.8 months. At the last follow-up, all improvements in subjective knee scores including Lysholm score, International Knee Documentation Committee (IKDC) subjective score, Victorian Institute of Sport Assessment -Patella (VISA-P) score, and Kujala score were statistically significant (p<.001). Tegner activity scale improved from 6.5±1.0 to 8.9±0.8 (p<.001). Limb symmetry index for extensor peak torque improved from 71.4±19.6% to 92.7±21.7% (p<.001). Thirty-two (86.5 %) athletes were able to return to full sports activities in a mean 3.5±1.7months, and 27 (73%) athletes maintained their previous sports activity level at the last follow-up. Symptoms recurred in two (5.2%). ConclusionsArthroscopic decortication of the inferior pole of the patella showed satisfactory clinical results and high rates of return to sports at mid-term follow-up in professional athletes with refractory chronic patellar tendinopathy. This technique could be an invasive, safe, and effective treatment for chronic patellar tendinopathy in professional athletes who want a faster return to sports. Level of evidenceLevel IV, case series.

Root avulsion and para-root tear of the posterolateral meniscus: repair versus untreated

Background: This study aimed to assess the outcomes of repairing posterolateral meniscal (PLM) root avulsion and para-root tear in association with anterior cruciate ligament (ACL) reconstruction and compare with those whose PLM tear was left untreated. Methods: Patients with PLM root avulsion or para-root tear accompanying ACL tear were evaluated for eligibility. Group A was composed of patients whose ACL tears were reconstructed without any lateral meniscal repair (33 patients) from 2006-2009. From 2009-2012, patients had ACL reconstruction and additional PLM repair (group B: 40 patients). Both groups were evaluated for knee stability (Lachman test), return to previous level of sports activity, subjective International Knee Documentation Committee form (S-IKDC) and Lysholm knee scores (LKS). Results: Functional results (IKDS and LKS) at 12 and 24-month follow-up were similar between the two groups (all P&gt;0.05). Eight patients (24%) in group A, and two patients (5%) in group B were unable to achieve the previous sports activity level (P=0.036). Return to previous sports activity level was significantly better in group B. Short-term (34.5 mo) and mid-term (73.5 mo) functional results of group A patients were compared, and it was demonstrated that IKDC (84.5±4) and LKS (87.7±3) scores were decreased significantly (P&lt;0.0001). Conclusions: Functional outcomes of repairing PLM root avulsion and para-root tear with those whose PLM tear was left untreated are similar in short-term follow-up; however, as the time passes, the sports activity level and mid-term subjective outcomes may worsen in patients whose PLM tear was left untreated.

Long-term follow-up on recovery, return to use and sporting activity: a retrospective study of 236 operated colic horses in Finland (2006\u20132012)

BackgroundSurgical treatment of colic is expensive and complications may occur. Information on the prognosis and the use of the horse after surgery for colic is important for surgeons and owners. Current literature on return to athletic function after celiotomy is limited. The present study reviewed surgical cases of the Veterinary Teaching Hospital, Helsinki, Finland for 2006–2012. The aim was to follow the population of horses of different breeds for surgical findings, postsurgical complications, long-term recovery and prognosis. The findings and their influence on survival, return to previous or intended use and performance were assessed.ResultsMost of the operated horses (82.6%; 195/236) recovered from anesthesia and 74.9% (146/195) were discharged. The total follow-up time was 8 years and 10 months and the median survival time 79.2 months. Age of the horse, location of the abdominal lesion (small vs. large intestine), incidence of postoperative colic, surgical site infection, incisional hernia or convalescence time after surgery, did not significantly affect the probability of performing in the previous or intended discipline after the surgery. A majority of the discharged horses (83.7%) was able to perform in the previous or intended discipline and 78.5% regained their former or higher level of performance. Operated horses had 0.18 colic episodes per horse-year during the long-term follow-up. The incidence of colic was 20.0% within the first year after surgery. Horses operated for large intestinal colic were 3.3-fold more prone to suffer postoperative colic than horses operated for small intestinal colic. The majority of the owners (96.3%) were satisfied with the veterinary care and nearly all (98.5%) evaluated the recovery after the colic surgery to be satisfactory or above.ConclusionsIf the horse survives to discharge, prognosis for long-term survival and return to previous level of sporting activity and performance was good after colic surgery in a population of horses of different breeds. None of the factors studied were found to decrease the probability of performing in the same or intended discipline after surgery. The majority of horses were able to return to their previous activity and perform satisfactorily for several years after surgery.

Mini open versus open repair techniques in Achilles tendon rupture: clinical and isokinetic evaluation.

The aim of the study was to compare the mini-open to the classic open repair techniques for Achilles tendon ruptures. We retrospectively evaluated at a minimum of 2 years follow-up 32 subcutaneous Achilles tendon ruptures; 17 underwent mini-open surgery (Group A) and 15 the open technique (Group B). No difference in Achilles Tendon Total Rupture Score and in modified Leppillahti score was observed. With respect to the contralateral side the width of the operated Achilles tendon was 4.07 mm thicker in Group A and 7.67 mm in Group B (p<.05); the calf circumference reduction was respectively 10 mm and 23.75 mm (p<.05). Iso-kinetic peak force measurement of the calf muscle strength showed a loss of 8.21% in Group A versus 17.25% in Group B (p <.05). The mean Patient Satisfaction Score was 96.76 in Group A and 88.67 in Group B (p<.01); respectively 82.3% vs 66.7% of patients were able to return to previous levels of sporting activity. There were two post-operative complications in Group B and one in Group A. Mini-open technique minimizes the risk of complications, leads to an improved tendon healing process and functional recovery with higher patient satisfaction. IV.

Microfracture and Osteochondral Autograft Transplantation Are Cost-effective Treatments for Articular Cartilage Lesions of the Distal Femur

Background: Multiple techniques have been suggested for the treatment of isolated knee articular cartilage injuries. For smaller lesions (<2-5 cm2), microfracture and osteochondral autograft transplantation (OAT) are commonly used options. With an increasing focus on health care efficiency, analyzing the cost-effectiveness of treatment modalities has become increasingly important. Purpose/Hypothesis: The purpose of this study was to analyze the costs and outcomes of microfracture and OAT to compare their cost-effectiveness. The hypothesis was that microfracture would be more cost-effective. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: A literature search was performed to identify studies comparing microfracture and OAT for the treatment of articular cartilage lesions of the distal femur in an adult population. Data from these studies including surgical time, failure rates, revision surgeries, outcome scores, and return to athletics were then incorporated into a constructed cost model using standard accounting methodology. The model was based on actual 2013 cost figures (in US dollars) for all procedure, operating room, and instrumentation costs. Results: Three studies, with a mean follow-up of 8.7 years, met the inclusion criteria of having evidence level 1 or 2 comparing microfracture and OAT. There was a cumulative 28.6% reoperation rate among patients undergoing microfracture compared with 12.5% among patients undergoing OAT. While both groups demonstrated significant improvements compared with preoperative levels, the only significant differences in any outcome score reported between the 2 procedures were the International Cartilage Repair Society (ICRS) score and patient-reported return to their previous sports activity level. While microfracture had a lower initial cost ($3100), these savings lessened over 1 year ($1843) and 10 years ($996). Microfracture was more cost-effective when comparing Lysholm and Hospital for Special Surgery scores, whereas OAT was more cost-effective when comparing Tegner and ICRS scores. There was a significantly lower cost for return to play in athletes after OAT versus microfracture at 1 year ($11,428 vs $16,953, respectively), 3 years ($12,856 vs $38,000, respectively), and 10 years ($32,141 vs $60,799, respectively). Conclusion: Published level 1 and 2 clinical studies with a 10-year follow-up demonstrated that the net cost and cost-effectiveness of microfracture and OAT are comparable for the treatment of isolated articular cartilage lesions of the distal femur. Clinical Relevance: Given similar clinical outcomes, microfracture and OAT are both viable, cost-effective first-line treatment options for these injuries.

Dynamic Intraligamentary Stabilization (DIS) for treatment of acute anterior cruciate ligament ruptures: case series experience of the first three years.

BackgroundIn recent years, the scientific discussion has focused on new strategies to enable a torn anterior cruciate ligament (ACL) to heal into mechanically stable scar tissue. Dynamic intraligamentary stabilization (DIS) was first performed in a pilot study of 10 patients. The purpose of the current study was to evaluate whether DIS would lead to similarly sufficient stability and good clinical function in a larger case series.MethodsAcute ACL ruptures were treated by using an internal stabilizer, combined with anatomical repositioning of torn bundles and microfracturing to promote self-healing. Clinical assessment (Tegner, Lysholm, IKDC, and visual analogue scale [VAS] for patient satisfaction scores) and assessment of knee laxity was performed at 3, 6, 12, and 24 months. A one-sample design with a non-inferiority margin was chosen to compare the preoperative and postoperative IKDS and Lysholm scores.Results278 patients with a 6:4 male to female ratio were included. Average patient age was 31 years. Preoperative mean IKDC, Lysholm, and Tegner scores were 98.8, 99.3, and 5.1 points, respectively. The mean anteroposterior (AP) translation difference from the healthy contralateral knee was 4.7 mm preoperatively. After DIS treatment, the mean 12-month IKDC, Lysholm, and Tegner scores were 93.6, 96.2, and 4.9 points, respectively, and the mean AP translation difference was 2.3 mm. All these outcomes were significantly non-inferior to the preoperative or healthy contralateral values (p < 0.0001). Mean patient satisfaction was 8.8 (VAS 0–10). Eight ACL reruptures occurred and 3 patients reported insufficient subjective stability of the knee at the end of the study period.ConclusionsAnatomical repositioning, along with DIS and microfracturing, leads to clinically stable healing of the torn ACL in the large majority of patients. Most patients exhibited almost normal knee function, reported excellent satisfaction, and were able to return to their previous levels of sporting activity. Moreover, this strategy resulted in stable healing of all sutured menisci, which could lower the rate of osteoarthritic changes in future. The present findings support the discussion of a new paradigm in ACL treatment based on preservation and self-healing of the torn ligament.

Endoscopy-Assisted Percutaneous Repair of Acute Achilles Tendon Tears

We developed a technique for endoscopy-assisted percutaneous repair of acute Achilles tendon tears. Nineteen patients with acute Achilles tendon tears were prospectively recruited into the study. All patients (18 male, 1 female) had sports-related injuries. Preoperative diagnosis was made from patient history, physical examination, and sonography. The average patient age was 38.7 years, and follow-up averaged 24 months. All patients received endoscopy-assisted percutaneous Achilles tendon repair with modified Bunnell sutures passed by bird beak and No. 5 Ethibond under direct visualization using 4.0-mm arthroscopy. Results were evaluated by physical examination, sonography, and magnetic resonance imaging (MRI). All 19 patients achieved tendon healing. All patients were evaluated by sonography, and the tendons of 16 patients were imaged using MRI to evaluate the extent of healing. Final dorsiflexion was 16 degrees and plantar flexion 26 degrees, and 95% of the patients (18/19) returned to their previous level of sporting activity. One patient developed a superficial infection, and 2 patients had postoperative sural nerve injury with numbness for 1 month. There were no other major complications. Endoscopy-assisted percutaneous repair of the Achilles tendon allowed good tendon healing and return to sports at 6 months. Sural nerve injury during surgery was a potential complication of this procedure. Level IV, retrospective case series.

Nonoperative Management of a Partial Patellar Tendon Rupture after Bone-Patellar Tendon-Bone Graft Harvest for ACL Reconstruction

This is a case report of a young athlete who sustained a partial tear of the patellar tendon after anterior cruciate ligament (ACL) reconstruction with a bone-patellar tendon-bone (BPTB) autograft. The injury, diagnostic workup, and decision-making process that lead to the choice of nonsurgical treatment are described. Furthermore, the rehabilitation process is described in detail. The patient returned to his previous level of sports activity and had a good clinical outcome as measured by range of motion, isokinetic quadriceps muscle strength testing, single leg hop testing, and the modified Noyes survey. In the absence of extensor mechanism incompetence or radiographic evidence of significant patella alta, partial ruptures of the patella tendon after ACL reconstruction using a BPTB autograft may be treated nonoperatively.

Chondral fragment of the lateral femoral trochlea of the knee in adolescents

Most injuries to the osteochondral region in adolescents have generally been believed to occur as osteochondral fractures. However, we report three cases of pure chondral fragments of the knee in adolescents. The patients were injured during sports activities and as a result had acute limitation of ROM of the knee joint. Only one case out of three could be diagnosed by MRI, and arthroscopic examinations were needed to make a final diagnosis in the remaining two cases. Re-fixation of the fragments was performed using bio-absorbable pins. All the patients were eventually able to return to their previous level of sports activity. Two years after the operation they experienced no symptoms and MRI showed that the re-fixed fragments were continuous to the bed without any abnormal intervening signal area, suggesting successful healing. Moreover, the arthroscopic integration between the re-fixed fragment and the surrounding articular cartilage was acceptable. Chondral fragment of the lateral femoral trochlea in active adolescents should be recognized as a clear entity that can be successfully treated by re-fixation.