Labral Repair Research Articles

Both Labral Debridement and Labral Repair Result in >90% Total Hip Arthroplasty-free Survival at 5-Year Follow-Up: An Analysis of the German Cartilage Registry (KnorpelRegister DGOU)

To compare clinical outcome parameters between labral debridement and repair by analyzing the dataset of a multinational registry. The data are based on the hip module of the German Cartilage Registry (KnorpelRegister DGOU). The register included patients designated for cartilage or femoroacetabular impingement surgery (up to July 1, 2021; n= 2725). The assessment consisted of the patient's characteristics, the type of labral treatment, the length of labral therapy, the pathology, the grade of cartilage damage, and the type of performed approach. The clinical outcomes were documented by the international hip outcome tool via an online platform. Separated Kaplan-Meier analyses were used for total hip arthroplasty (THA)-free survival rates. The debridement group (n= 673) showed a mean score increase of 21.9 ± 25.3 points. The repair group (n= 963) had a mean improvement of 21.3 ± 24.6 (P > .05). The 60-month THA-free survival rate was 90% to 93% for both groups (P > .05). A multivariance analysis showed that the grade of cartilage damage was the only independent statistically significant factor (P= .002-.001) influencing patients' outcomes and THA-free survival. Labral debridement and repair led to good and reliable results. However, these results should not be interpreted with the conclusion that the cheaper and technically easier labral debridement is the recommended treatment due to comparable results in the present study. The clinical outcome and the THA-free survival seemed to be more influenced by the grade of cartilage damage. Level III, retrospective comparative therapeutic trial.

Arthroscopic Repair of a 360° Labrum and Full-Thickness Rotator Cuff Tear After Shoulder Dislocation

Background: Rotator cuff tears after anterior shoulder instability are more common in patients >40 years of age and rare in younger patients where shoulder instability is most common. Although infrequent, little data exist on the evaluation of combined labral and rotator cuff tears in athletes. Indications: Combined rotator cuff and labral tears in the young patient population have a high risk of recurrent instability and require unique intraoperative and postoperative considerations. This patient is a Division 1 collegiate wrestler who sustained a 360° labral and full-thickness rotator cuff tear after an acute traumatic anterior shoulder dislocation. Technique Description: The lateral decubitus position is utilized and a posterior viewing portal is established along with anterior and accessory lateral portals. The 360° labral tear is first addressed by appropriately preparing the glenoid creating a quality healing surface. Tape sutures are then utilized to perform a knotless anterior labral repair. The superior labrum, anterior to posterior (SLAP) and then posterior labral repair are sequentially performed. The posterior portal is closed with a polydioxanone (PDS) suture to prevent a stress riser in the capsule. The rotator cuff tear is then repaired in a knotless double row configuration after appropriate greater tuberosity preparation. Results: Recent studies evaluating athletes with combined rotator cuff and labral pathology who underwent arthroscopic repair reported 90% good to excellent satisfaction with 77% returning to pre-injury level of athletics. Although few studies have evaluated combined labral and rotator cuff repair and concerns with stiffness exist, the current literature and the authors own experience have found good outcomes following single-stage repair. Discussion/Conclusion: Combined labral and rotator cuff tears after anterior shoulder dislocation in the young athletic population are rare and can be challenging to treat. Although there is limited data on these combined injuries in young athletic populations, the current literature and authors’ experience support single stage surgical treatment of combined labral and rotator cuff tears which typically result in improved patient reported outcomes and return to sport. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Arthroscopic Hip Labral Reconstruction With Fresh Meniscal Allograft

The acetabular labrum is essential to maintaining the functional health of the hip joint through contributions to joint congruity, stability, and the negative pressure suction seal. Injury, overuse, long-standing developmental disorders, or failed primary labral repair can eventually lead to functional labral insufficiency requiring management via labral reconstruction. While numerous graft options exist for hip labral reconstruction, there is no current gold standard. The optimal graft should best mimic the native labrum with regard to geometry, structure, mechanical properties, and durability. This has led to the development of an arthroscopic technique for labral reconstruction with fresh meniscal allograft tissue.

Clinical outcomes and return to play in softball players following SLAP repair or biceps tenodesis.

Shoulder pain due to labral tears and biceps tendonitis is commonly found in softball players. Surgical options include labral repair and biceps tenodesis. Although past studies are limited by heterogeneous study groups from multiple sports, this is the first study that assesses clinical outcomes and return to play rates for fast-pitch softball players. The purpose of this study was to evaluate the clinical outcomes and return to play for fast-pitch softball players treated for a superior labrum anterior posterior (SLAP) tear and recalcitrant biceps tendonitis with a biceps tenodesis compared with a traditional SLAP repair. We hypothesized that the biceps tenodesis would have comparable outcomes with a faster return to play compared with SLAP repair. We performed a retrospective analysis on fast-pitch softball players treated surgically for SLAP tear, recalcitrant biceps tendonitis, or a combination between 2001 and 2019 at our institution. Inclusion criteria were fast-pitch softball players who underwent biceps tenodesis or a SLAP repair with greater than 2-year follow-up. Exclusion criteria involved slow-pitch softball players, patients with less than 2-year follow-up, and patients who had undergone concomitant procedures on the ipsilateral shoulder at the time of SLAP repair or biceps tenodesis. Follow-up was either self-reported through OBERD, a patient-reported outcomes (PRO)-managing software, or achieved over the phone. Follow-up data included American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Andrews Carson Score, Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score, Numeric Rating Scale for Pain, and our institution-specific return-to-play questionnaire. We statistically compared players who underwent biceps tenodesis or a SLAP repair, and compared pitchers with position players using Student t tests and Fisher exact test with statistical significance determined to be P<.05. From 60 eligible patients identified, follow-up outcome data were successfully captured for 47 (78%). Of the 18 SLAP repair patients, 17 (94%) returned to full competition at an average of 7.9 months. Of the 29 patients who underwent biceps tenodesis, 27 (93%) returned to full competition at an average of 7.1 months. Statistical analysis of PRO scores for each group found no significant differences between any of the measures used to evaluate patient outcomes, including no statistical difference in pitchers compared with position players. In conclusion, this study demonstrated comparable outcomes between SLAP repairs and biceps tenodesis procedures among our study group of fast-pitch softball players. There was no significant difference between RTP times between the 2 groups.

Results of Endoscopic Labral Repair With Concomitant Gluteus Medius and/or Minimus Repair Compared With Outcomes of Labral Repair Alone: A Matched Comparative Cohort Analysis at Minimum 2-Year Follow-up

Background: There is a paucity of information available to clinicians on outcomes of patients undergoing endoscopic surgery for labral repairs and femoroacetabular impingement syndrome with simultaneous repair of the gluteus medius and/or minimus muscles. Purpose: To determine whether patients with labral tears and concomitant gluteal pathology who undergo simultaneous endoscopic labral and gluteus medius and/or minimus repair experience similar outcomes to patients with isolated labral tears who undergo endoscopic labral repair alone. Study Design: Cohort study; Level of evidence, 3. Methods: A matched retrospective comparative cohort study was performed. Patients who underwent gluteus medius and/or minimus repair with concomitant labral repair between January 2012 and November 2019 were identified. These patients were matched in a 1:3 ratio by sex, age, and body mass index (BMI) to patients who underwent labral repair alone. Preoperative radiographs were assessed. Patient-reported outcomes (PROs) were assessed preoperatively and 2 years postoperatively. PRO measures included the Hip Outcome Score Activities of Daily Living and Sports subscales, modified Harris Hip Score, 12-Item International Hip Outcome Tool, and visual analog scales for pain and satisfaction. Published labral repair minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) thresholds were utilized for these measures. Results: A total of 31 patients who underwent gluteus medius and/or minimus repair with concomitant labral repair (27 female, 4 male; age, 50.8 ± 7.3 years; BMI, 27.9 ± 5.2) were matched with 93 patients who underwent labral repair alone (81 female, 12 male; age, 50.9 ± 8.1 years; BMI, 28.5 ± 6.2). There were no significant differences in sex (P > .99), age (P = .869), or BMI (P = .592); preoperative radiographic measurements; or preoperative or 2-year postoperative PRO scores (P≥ .081). Changes between preoperative and 2-year postoperative PRO scores were significantly different for both groups for all PROs assessed (P < .001 for all). There were no significant differences in MCID or PASS achievement rates (P≥ .123), with low PASS achievement rates of 40% to 60% found in both groups. Conclusion: Patients who were treated with endoscopic gluteus medius and/or minimus repair with concomitant labral repair demonstrated comparable outcomes with those who were treated with endoscopic labral repair alone.

Podium Presentation Title: NHL Player Workload and Performance Following Arthroscopic Shoulder Labral Repair

Podium Presentation Title: NHL Player Workload and Performance Following Arthroscopic Shoulder Labral Repair

Valeur prédictive du test d’hyperabduction de Gagey pour identifier les lésions du ligament glénohuméral inférieur

IntroductionClinical tests that can identify inferior glenohumeral ligament (IGHL) complex injuries are indispensable for the diagnosis of shoulder instability. Gagey's hyperabduction test has been developed to diagnose IGHL hyperlaxity, however, it is unclear whether the test is able to accurately diagnose an IGHL lesion. The aim of this study was to (1) determine the diagnostic performance of the Gagey test in identifying an IGHL lesion and (2) determine if a positive Gagey test is more predictive for an anterior or posterior IGHL lesion thanks to the heatmapping of the lesions. It was hypothesized that a Gagey test can accurately predict IGHL lesions, but would not be able to distinguish between anterior and inferior IGHL lesions. MethodsA retrospective diagnostic accuracy study was conducted including all consecutive patients who underwent glenoid labral repair between January 2005 and September 2021 with a documented Gagey test prior to surgery. Using arthroscopic findings as a reference standard, the diagnostic performance characteristics of the Gagey test for each type of IGHL lesion (anterior, posterior and combined) were calculated and labral heatmapping was used to depict its localisation. ResultsA total of 167 patients were included, with a mean age of 29±10 years. The sensitivity, specificity and accuracy of the Gagey test on determining an IGHL lesion were 46%, 38% and 46%, respectively. The positive and negative predictive values were 88% and 7%, respectively. Heatmapping of the labral lesions demonstrated that a positive Gagey test was most predictive of anterior IGHL and axillary pouch tears and non-predictive of posterior IGHL lesions. DiscussionThe Gagey test demonstrated a low sensitivity and specificity to identify an IGHL lesion and therefore the hypothesis could not be confirmed. However, the Gagey test has a high positive predictive value to diagnose anterior IGHL lesions. Further prospective research with a more evenly distribution of lesions is needed to investigate the clinical value of the Gagey test to identify these lesions. Based on this data, the Gagey test seems especially important to support the results of other clinical tests such as the apprehension, relocation and surprise tests. Level of evidenceIII, retrospective case-control study.

SLAP lesion type IX: case series and a review of literature.

A type IX SLAP (superior labrum anterior to posterior) lesion involves 360° of the glenohumeral labrum. Only rare reports have been published analyzing the risk factors of this lesion and the success of its arthroscopic management. The aim of our study is to evaluate predisposing factors that lead to SLAP IX and to assess the clinical outcome after arthroscopic treatment. Our treatment algorithm is also presented. We report on a series of six patients treated in our institution between January 2014 and January 2019 who underwent shoulder arthroscopy and were intraoperatively found to have a SLAP lesion type IX. Arthroscopic labral repair and biceps tenodesis were indicated in all patients. American Shoulder and Elbow Surgeons (ASES) Shoulder Score, Rowe Score and Constant Murley Shoulder Score (CS) were used for clinical evaluation. Patients were evaluated preoperatively and at 12weeks, 1year and 2years postoperatively. We analyzed six patients of which 83% were males (5/6 patients). The average age at the time of surgery was 37.16 (range 30-42years). The dominant arm was affected in 50% of patients (3/6 patients). A significant postoperative improvement was seen in all six patients. 83% (5/6) of patients returned to their pre-injury activity level. Average values of all three measured scores show a significant increase comparing preoperative to postoperative period (P-value < 0.05). All patients were able to return to work. The final diagnosis was established intraoperatively as 83% (5/6) of radiology reports differed from subsequent arthroscopic findings. The mechanism of injury in all our cases was high energy trauma with traction, arm in abduction or anteflexion. We observed great success with arthroscopic treatment as high percentage of our patients returned back to work and sports.

Arthroscopic Repair of the Acetabular Labrum Using an Anchor-First Modified Toggle Suture Technique

The goal of acetabular labral repair is to restore stable contact between the labrum and acetabular rim while maintaining the anatomic suction seal. One of the challenges of labral repair is achieving proper in-round repair, so that the labrum contacts the femoral head in the native position. This technique article presents a repair method that allows for enhanced inversion of the labrum to assist with anatomic repair. Our modified toggle suture technique utilizes an anchor-first method and has various distinct technical advantages. We present an efficient and vendor-agnostic technique that allows for straight or curved guides. Similarly, the anchors may be all-suture or hard-anchor designs that accommodate suture sliding. This technique also utilizes a self-retaining hand-tied knot construct to facilitate preventing knots from migrating toward the femoral head or joint space.

Harvest and Application of Bone Marrow Aspirate Concentrate to Address Acetabular Chondral Damage During Hip Arthroscopy.

Harvest and Application of Bone Marrow Aspirate Concentrate to Address Acetabular Chondral Damage During Hip Arthroscopy.

High Return to Play Rate and Diminished Career Longevity are Seen Following Arthroscopic Shoulder Labral Repair in Major League Baseball Players

High Return to Play Rate and Diminished Career Longevity are Seen Following Arthroscopic Shoulder Labral Repair in Major League Baseball Players

The Longitude-Latitude-Loop Used for Complex Bankart Lesion Repair: An All-Arthroscopic Technique

The most frequent operation for anterior shoulder instability is the arthroscopic Bankart repair, which has a positive outcome and a low rate of complications. A variety of restoration procedures have been reported to reconstruct labral height and reproduce a dynamic concavity–compression reaction. The longitude–latitude loop is a knotless high-strength suture method that simultaneously tightens the joint capsule in the warp and weft direction and resists tearing. The suture method is safe and reproducible. This study aimed to present a longitude–latitude loop suture for joint capsule labral complex repair during Bankart arthroscopy surgery.

Hypermobile Patients With Femoroacetabular Impingement Syndrome Can Be Effectively Treated Utilizing Hip Arthroscopy With Periportal Capsulotomy Closure: A Matched Cohort Analysis Compared to Patients Without Joint Hypermobility

To assess the 2-year outcomes of arthroscopic treatment with periportal capsulotomy closure for femoroacetabular impingement syndrome (FAIS) in patients with generalized ligamentous laxity (GLL). A retrospective analysis was performed from a prospectively collected database of FAIS patients undergoing hip arthroscopy. FAIS patients with GLL were identified as having Beighton score ≥4. FAIS patients with GLL were treated with arthroscopic labral repair, osteochondroplasty, via periportal capsulotomy with subsequent capsular closure. These patients were matched by age, sex, and body mass index (BMI) with a cohort of FAIS patients without GLL who underwent the same procedure via periportal capsulotomy without capsular closure. Preoperatively, and 2 years postoperatively, patients completed patient-reported outcomes (PRO) scores, including the Hip Disability and Osteoarthritis Outcome Score (HOOS), 12-item Short-Form survey (SF-12) and the visual analog scale (VAS). Forty patients (5 male, 35 female) with FAIS and GLL were included (age: 29.7 ± 9.0; BMI: 23.3 ± 4.1). FAIS patients with GLL demonstrated similar significant PRO score improvements compared to a matched cohort of FAIS patients without GLL at 2 years after surgery (VAS Pain: (-)2.5 ± 3.0, (-)2.7 ± 2.7; SF-12 PCS: 17.7 ± 14.2, 16.7 ± 15.0; HOOS-Symptoms: 26.3 ± 24.0, 20.6 ± 18.1; HOOS-Pain: 29.8 ± 20.4, 24.4 ± 9.0; HOOS-ADL: 24.9 ± 18.4, 22.0 ± 19.9; HOOS-Sports: 43.6 ± 26.1, 33.1 ± 29.8; and HOOS-QOL: 44.2 ± 27.6, 41.7 ± 27.1, respectively). Both cohorts achieved minimal clinically important differences (MCID) for each HOOS subscore at equivalent high rates (70-88%). Patients with GLL in the setting of FAIS can be effectively treated with arthroscopy via periportal capsulotomy and capsular closure. These patients demonstrate significant improvements in PRO scores at 2 years, similar to normal laxity FAIS patients undergoing arthroscopic treatment via periportal capsulotomy without capsular closure. Level III, retrospective comparative therapeutic trial.

Improved Mental Health Status and Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement

Background: Femoroacetabular impingement (FAI) is often a chronic problem, which can lead to a decrease in mental well-being. Purpose/Hypothesis: The purpose of this study was to determine patient mental health improvement after hip arthroscopy and if this improvement correlated with improved outcomes. It was hypothesized that patients with low mental health (LMH) status would improve after hip arthroscopy for FAI and that their patient-reported outcomes (PROs) would significantly improve after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent hip arthroscopy with labral repair between 2008 and 2015 were included. The minimum follow-up was 2 years. PROs included the modified Harris Hip Score (mHHS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), HOS–Sports (HOS-Sports), and 12-Item Short Form Health Survey (SF-12). The minimal clinically important difference and Patient Acceptable Symptom State (PASS) were determined for HOS-ADL, HOS-Sports, and the mHHS based on previously published studies. Patients who scored <46.5 on the SF-12 Mental Component Summary (MCS) were in the LMH group, and those who scored ≥46.5 were in the high mental health (HMH) group. Results: In total, 120 (21%) of the 566 patients were in the LMH group and 446 (79%) patients were in the HMH group preoperatively. There was no difference in age or sex between groups. Patients in the LMH group had lower mHHS, HOS-ADL, and HOS-Sports at the mean 4-year follow-up and were less likely to reach PASS for the scores. Postoperatively, 84% (478/566) of the entire group was in the HMH group. A total of 88 (73%) of the LMH group improved to HMH. A multiple linear regression model for change in MCS identified independent predictors of changes in preoperative MCS to be LMH group preoperatively, change in HOS-Sports, and change in mHHS (r2 = 0.4; P < .001). Conclusion: HMH was achieved in 84% of the patients after hip arthroscopy for FAI. Improvement in MCS was correlated with function and activity, as indicated by a significant correlation with HOS-ADL and HOS-Sports. A small percentage of patients did see a decline in their MCS score. This study showed that patients with LMH scores before hip arthroscopy for FAI can improve to normal/high mental health, and this correlated with higher PROs.

The Effects of Arthroscopic Labral Repair on Patient-Reported Outcomes in the Setting of Periacetabular Osteotomy

Background: It is currently unknown whether the addition of arthroscopic labral repair in the setting of periacetabular osteotomy (PAO) provides any clinical benefit. Purpose/Hypothesis: The purpose of this study was to compare outcomes of patients who underwent arthroscopic labral repair concomitantly with PAO versus patients who underwent PAO alone. We hypothesized that there would be no difference in patient-reported outcome measures (PROMs) between the cohorts. Study Design: Cohort study; Level of evidence, 3. Methods: Patients undergoing PAO from a single-center prospective hip preservation registry were eligible for this study if they completed pre- and postoperative PROMs (minimum, 1 year). PROMs were collected at 1 year, 2 years, and latest follow-up at 6.05 years for PAO group and 4.2 years for scope/PAO group. The study group consisted of 53 patients who underwent arthroscopic labral repair at the time of their PAO, and the comparison group consisted of 170 patients who underwent PAO alone. A subset of the PAO group who had radiologic evidence of a detached labral tear (n = 33) was also compared with the rest of the PAO-alone group. PROMs were compared at every time point for both groups as well as the subset of patients who underwent PAO alone despite a labral tear. Results: The mean follow-up of all patients was 2 years (range, 1-6 years). Overall, 85.2% of the PAO group and 85.7% of the scope/PAO group met the minimal clinically important difference for either the modified Harris Hip Score (mHHS) or the International Hip Outcome Tool (iHOT-33) at the most recent follow-up. There was no difference in improvement between groups (mHHS, P = .670; iHOT-33, P = .944). Patients who had a radiologically diagnosed detached labral tear and underwent PAO alone had no difference in outcomes when compared with the rest of the PAO cohort (mHHS, P = .981; iHOT-33, P = .909). Conclusion: There was no significant benefit measured by PROMs at follow-up for concomitant arthroscopic labral repair in the setting of PAO.

Survey of blood flow restriction therapy for rehabilitation in Sports Medicine patients

Blood flow restriction (BFR) therapy has demonstrated benefits across a spectrum of musculoskeletal injuries, including improved strength, endurance, function, and reduction in pain perception. There is, however, no standardized application of BFR therapy among orthopaedic surgeons within the United States (US). The indication and protocol for BFR therapy vary significantly across providers in the US. An online survey of 21 multiple-choice questions was sent to 3,281 surgeons listed on a large orthopaedic registry. A cross-sectional study was performed on all surgeons who successfully completed the questionnaire. Surgeons were queried on current or planned use of BFR, indications, contraindications, and peri-operative and non-operative management of sports-related injuries. Overall, 250 physicians completed the survey, with 149 (59.8%) reporting current BFR use and 75.2% initiating use in the last 1-5 years. Most protocols (78.8%) utilize the modality 2-3 times per week while 15.9% use it only once weekly. Anterior cruciate ligament reconstruction (ACLR) rehabilitation was the most reported indication for initiating BFR therapy (95.7%) along with medial patellofemoral ligament reconstruction (70.2%), multiligamentous knee reconstruction (68.8%), meniscus repair (62.4%), collateral ligament reconstruction (50.4%), Achilles tendon repairs (30.5%), and meniscectomy (27%). Only 36.5% reported using BFR after upper extremity procedures, such as distal biceps repair (19.7%), ulnar collateral ligament elbow reconstruction (17%), rotator cuff (16.8%), and shoulder labrum repair (15.3%). For non-operative injuries, 65.8% of surgeons utilized BFR. Of those not currently using BFR therapy, 33.3% intended to implement its use in the future. BFR therapy has increased in popularity with most physicians implementing its use in the last 5 years. BFR was commonly utilized after ACLR. BFR allows light-load resistance to simulate high-intensity resistance training. This study describes US orthopaedic surgeons' common practice patterns and patient populations that utilize BFR therapy.

Paper 16: The Use of Intravenous Tranexamic Acid Does Not Improve Arthroscopic Visualization in Shoulder Surgery: A Randomized Controlled Trial

Objectives: Adequate visual clarity is paramount to performing arthroscopic shoulder surgery safely, efficiently, and effectively. The addition of epinephrine in irrigation fluid, and the intravenous or local administration of tranexamic acid (TXA) have independently been reported to decrease bleeding thereby improving the surgeon’s visualization during arthroscopic shoulder procedures. No study has compared the effect of systemic administered TXA, epinephrine added in the irrigation fluid or the combination of both TXA and epinephrine on visual clarity during shoulder arthroscopy with a placebo group. The purpose of this study is to determine if intravenous TXA is an effective alternative to epinephrine delivered by a pressure-controlled pump in improving arthroscopic shoulder visualization during arthroscopic procedures and whether using both TXA and epinephrine together has an additive effect in improving visualization. Methods: The design of the study was a double-blinded, randomized controlled trial with four 1:1:1:1 parallel groups conducted at one center. Patients aged ≥18 years undergoing arthroscopic shoulder procedures including rotator cuff repair, arthroscopic biceps tenotomy/tenodesis, distal clavicle excision, subacromial decompression and labral repair by five fellowship-trained upper extremity surgeons were randomized into one of four arms: Pressure pump-controlled regular saline irrigation fluid (control), epinephrine (1ml of 1:1000) mixed in irrigation fluid (EPI), 1g intravenous TXA (TXA), and epinephrine and TXA (EPI/TXA). Visualization was rated on a 4-point Likert scale every 15 minutes with 0 indicating ‘poor’ quality and 3 indicating ‘excellent’ quality. The primary outcome measure was the unweighted mean of these ratings. Secondary outcomes included mean arterial blood pressure (MAP), surgery duration, surgery complexity, and adverse events within the first postoperative week. Unweighted means (SD) were calculated for visualization and mean arterial pressure (MAP) for each patient. Study group allocation was represented with epinephrine and tranexamic acid being coded in dichotomous variables (used or not used) for each patient. A step-wise linear regression was performed using visualization as the dependent variable and a series of independent variables considered for inclusion: epinephrine, tranexamic acid, surgery duration, complexity, mean arterial pressure, increase in pump pressure, and volume of irrigation fluid. All statistical tests were considered significant if p&lt;0.05. Results: One-hundred and twenty-eight participants with a mean age (± SD) of 56 (± 11) years were randomized. Figure 1 presents the patient flow through the study. Mean visualization quality for the control, TXA, EPI, and EPI/TXA groups were 2.1 (±0.40), 2.1 (±0.52), 2.6 (±0.37), 2.6 (±0.35), respectively. In a regression model with visual quality as the dependent variable, the presence/absence of EPI was the most significant predictor of visualization quality (R=0.525; p&lt;0.001). TXA presence/absence had no effect, and there was no interaction between TXA and EPI. The addition of MAP and surgery duration strengthened the model (R=0.529; p&lt;0.001). Increased MAP and surgery duration were both associated with decreased visualization quality. When surgery duration was controlled, surgery complexity was not a significant predictor of visualization quality. No adverse events were recorded in any of the groups. Conclusions: Intravenous administration of TXA is not an effective alternative to epinephrine in the irrigation fluid to improve visualization during routine arthroscopic shoulder surgeries although its application is safe. There is no additional improvement in visualization when TXA is used in combination with epinephrine beyond the effect of epinephrine alone. [Figure: see text]

Paper 09: Revision rate following primary hip arthroscopy in patients given prophylactic oral losartan for the prevention of post-surgical fibrosis versus no losartan

Objectives: To evaluate whether postoperative treatment with Losartan decreased the revision rate in patients undergoing primary hip arthroscopy. Methods: Patients underwent primary hip arthroscopy with labral repair and CAM osteoplasty and rim trimming between 2012 and 2017. Patients who underwent microfracture, labral debridement or reconstruction, core decompression, ligamentous teres repair or reconstruction, or capsular reconstruction were excluded. Losartan was added to all patients’ post-operative protocol in December 2015. Patients who underwent hip arthroscopy prior to November 2015 were included in the no-Losartan group (NOLOS) and patients who had arthroscopy between December 2015 and Dec 2017 were included in the losartan group (LOS). Results: Of the 964 cases, follow-up was obtained on 673 patients (70%). There were 405 patients in the NOLOS group and 268 in the LOS group. There was no difference in gender distribution (P=0.128) between groups. The LOS group was significantly older (36.6 ±13 years) compared to the NOLOS group (34.1±11)(p=0.012). Average follow-up in the NOLOS group was 5.8±2 years and was 4.1±1 years in the LOS group. Revision hip arthroscopy was required in 35 (8.6%) patients in the NOLOS group and 6 (2.2%) patients in the LOS group(p=0.001). There was no difference in age between those patients who required revision (32±11 years) and those who did not(35±12 years)(p=0.137). Conclusions: The prevalence of revision hip arthroscopy was significantly lower (2.2%) in patients who took Losartan as part of their post-operative protocol compared to those who did not (8.6%). Reduction in the need for revision hip arthroscopy can improve patient outcomes and reduce healthcare dollars spent.

Suture-Staple Fixation of Os Acetabuli: Description of a Novel Fixation Technique Using Linked Knotless Suture Anchors

Background: An os acetabuli is a bone fragment of the acetabular rim. Several stabilization techniques have been described in the literature including the use of canulated headless compression screws, sutures placed over screws, and knotted suture anchors; however, the use of screws near the joint could either lead to irritation or increased joint surface wear if placed improperly. Indications: Fixation of an os acetabuli is indicated when removal of the os would result in under-coverage of the femoral head which would in turn lead to a rapid onset of arthritis. Technique Description: This novel technique for os acetabuli fixation uses knotless suture anchors to create a “suture-staple” construct. Following the debridement of fibrous tissue and labral repair, reduction of the acetabular os is accomplished and confirmed on intraoperative fluoroscopy. Knottless FiberTak™ Suture Anchors are placed in the anterior and the posterior aspects of the os, and the anchor suture of one anchor is passed through the pass suture of the second anchor to create a “suture-staple” configuration. Results: Maintenance of reduction and pain-free motion of the hip was confirmed at 3-month clinic follow-up. The x-rays obtained at this time revealed no evidence of arthritis and appropriate coverage of the hip joint. Discussion/Conclusion: Outcomes of other methods of os fixation are largely lacking; however, outcomes using a knotted suture anchor technique in 3 patients with 1-year follow-up seem to indicate fully healed os fragments in all patients with improvement in patient-reported outcomes scores. Longer-term follow-up will be needed to ensure this similar technique produces similar outcomes. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Revision Arthroscopic Labral Repair Using All-Suture Anchors in Patients With Subcritical Glenoid Bone Loss After Failed Bankart Repair: Clinical Outcomes at 2-Year Follow-up.

All-suture anchors have been used for primary arthroscopic Bankart repair because of their ability to minimize initial bone loss. To evaluate the clinical efficacy of using all-suture anchors in revision arthroscopic labral repair after failed Bankart repair. Case series; Level of evidence, 4. Enrolled in this study were 28 patients who underwent revision arthroscopic labral repair with all-suture anchors after a failed primary arthroscopic Bankart repair. Revision surgery was determined for patients who had a frank redislocation history with subcritical glenoid bone loss (<15%), nonengaged Hill-Sachs lesion, or off-track lesion. Minimum 2-year postoperative outcomes were evaluated using shoulder range of motion (ROM), the Rowe score, the American Shoulder and Elbow Surgeons (ASES) score, apprehension, and the redislocation rate. Postoperative shoulder anteroposterior radiographs were assessed to evaluate arthritic changes in the glenohumeral joint. The mean patient age was 28.1 ± 6.5 years, and the mean time between primary Bankart repair and revision surgery was 5.4 ± 4.1 years. Compared with the number of suture anchors used in the primary operation, significantly more all-suture anchors were inserted in the revision surgery (3.1 ± 0.5 vs 5.8 ± 1.3, P < .001). During the mean follow-up period of 31.8 ± 10.1 months, 3 patients (10.7%) required reoperation because of traumatic redislocation and symptomatic instability. Of patients with symptoms that did not require reoperation, 2 patients (7.1%) had subjective instability with apprehension depending on the arm position. There was no significant change between preoperative and postoperative ROM. However, ASES (preoperative: 61.2 ± 13.3 to postoperative: 81.4 ± 10.4, P < .01) and Rowe (preoperative: 48.7 ± 9.3 to postoperative: 81.7 ± 13.2, P < .01) scores were significantly improved after revision surgery. Eight patients (28.6%) showed arthritic changes in the glenohumeral joint on final plain anteroposterior radiographs. Revision arthroscopic labral repair using all-suture anchors demonstrated satisfactory 2-year clinical outcomes in terms of functional improvement. Postoperative stability was obtained in 82% of patients without recurrent shoulder instability after failed arthroscopic Bankart repair.