Single Assessment Numeric Evaluation Score Research Articles

Poster 127: Repairs of Isolated Supraspinatus Tears: Single vs. Double Row Repairs Effect on Patient-Reported Outcomes Over a 2-Year Episode of Care

Objectives: Rotator cuff tears are the most common cause of shoulder disability, most commonly affecting the middle-aged population. Treatment for rotator cuff tears has changed dramatically over the past few decades, with overall volume of rotator cuff repairs (RCRs) increasing by approximately 1.6% each year. Simultaneously, there has been a shift from open, inpatient RCR to arthroscopic, outpatient procedures. Currently, well over 75% of patients undergo arthroscopic repair. The two most common techniques for rotator cuff fixation include single- or double-row fixation. Cadaveric and biomechanical studies demonstrate more complete reduction of the rotator cuff to its original footprint with double row repair, with a subsequent increase in anatomic restoration and biomechanical advantage. Many studies regarding clinical and functional outcomes, however, have not consistently demonstrated statistically significant differences between the two. The purpose of this study is to determine differences in patient-reported outcomes (PROs) after single- and double-row rotator cuff repairs at one and two years postoperatively. We hypothesize that single-row RCR will have noninferior clinical and patient-reported outcomes when compared to the double-row RCR cohort over the 2-year episode of care. Primary outcomes include baseline, 1-year and 2-year postoperative Single Assessment Numeric Evaluation (SANE) scores. Methods: All patients within a single health system that underwent primary rotator cuff repair between 2016 and 2022 were eligible for inclusion in this study. Exclusion criteria included incomplete baseline PROs, involvement of infraspinatus, subscapularis or teres minor tendons, revision surgeries, and concomitant fractures of the shoulder. Demographic information including age, sex, BMI, ASA score, injury characteristics and medical comorbidities were obtained through review of the patients’ electronic medical record. Surgical characteristics and technique were obtained from operative notes. PROs were collected prospectively and stored in a HIPAA-compliant electronic database until retrospective review for this study. Primary outcomes of interest include SANE score at baseline, 1-year and 2-years postoperatively. Secondary outcomes of interest included American Shoulder and Elbow Surgeons (ASES) scores, Patient-Reported Outcomes Measurement Information System (PROMIS) global 10 health questionnaire scores, rates of symptomatic retear and reoperation. Statistical analysis included descriptive analyses, paired t-tests, chi-squared test of independence and one-way ANOVA as appropriate. Statistical significance was defined as an alpha value of p ≤ 0.05. Results: A total of 237 patients met criteria for inclusion in this study, the majority of which were female (122, 51.5%). The average BMI was 30.0 ± 5.6, and the average age of the study participants was 59.0 ± 9.4 years. The majority of patients underwent double-row RCR (134, 56.5%). There were no significant differences in age, BMI, ASA score, gender, or smoking status between the two groups (Table 1). There was a higher observed frequency of diabetes mellitus than expected in the double-row cohort, however this did not reach statistical significance (p = 0.066). There was no significant difference in symptomatic retear, revision RCR, and other reoperation rates between the two cohorts (Table 2). The cohort that received double-row repair had a higher observed frequency of full-thickness tears than expected (p <0.001), however there was no significant difference in the observed frequencies of chronic and acute tears between the two cohorts. Baseline ASES scores did not differ significantly between the two cohorts (p = 0.505). Both cohorts saw statistically significant increase in ASES scores from baseline to 1-year (Figure 1). The difference between 1-year and 2-year ASES scores was less than a quarter of the improvement seen in the first year postoperatively, however, was still statistically significant in the double-row cohort and neared statistical significance in the single-row cohort (p = 0.048 and p = 0.075, respectively). While both cohorts saw significant improvement in ASES scores over the 2-year period, there was no significant difference in score change between the two cohorts. The baseline SANE scores were 40.7 ± 20.6 and 43.2 ± 21.4 for the double and single-row cohorts respectively. Each cohort saw statistically significant increases in SANE scores at 1 year postoperatively and continued to see significant increase between 1- and 2-years postoperatively (Figure 1). There was no statistically significant difference between the two cohorts regarding 1- and 2-year change in SANE scores. Conclusions: Over a 2-year period of care after RCR, patients saw significant improvement in SANE and ASES scores, with the majority occurring in the first year postoperatively. There were no statistically significant differences in patient-reported outcomes between patients that underwent double- and single-row repairs. Single- and double-row RCRs perform comparably over a 2-year episode of care, with excellent clinical and patient-reported outcomes. [Figure: see text]

Poster 148: Similar Outcomes Despite Differing Costs for Long-head Biceps Brachii Tendon Treatment: Open Tenodesis vs. Arthroscopic Tenodesis vs. Tenotomy

Objectives: Rotator Cuff Repair (RCR) is frequently associated with treatment of the long head of the biceps brachii tendon. This is because the biceps tendon is a common pain generator of the shoulder, and it is commonly diseased concurrently with the rotator cuff. Biceps tendinopathy is commonly treated with tenodesis (open or arthroscopic) or tenotomy. Previous studies have shown no differences in complication rates and patient-reported outcomes (PROs) at 2-year follow-up between arthroscopic tenodesis or open tenodesis. Other literature has shown open biceps tenodesis (OBT) to have similar costs and operative time compared to arthroscopic biceps tenodesis (ABT); however, time-driven activity-based costing was not used. The purpose of this study was to evaluate for differences in day of surgery (DOS) costs at one-year for OBT, ABT, and biceps tenotomy in the context of RCR. We hypothesized that cost would be similar between OBT and ABT and would be less for tenotomy. The primary outcome was DOS cost as measured by time-driven activity-based costing. Secondary aims included assessing PROs with the Single Assessment Numeric Evaluation (SANE) score, and the American Shoulder and Elbow Surgeons (ASES) score, as well as operative time, symptomatic retear rate, and reoperation rate at one year. Methods: A prospectively collected PRO database was retrospectively reviewed for patients who underwent surgical treatment of their biceps tendon in the setting of primary RCR between 2018 and 2022. Inclusion criteria consisted of patients who underwent supraspinatus or supraspinatus and infraspinatus tendon repair, as well as biceps tenodesis (arthroscopic or open) or tenotomy and had full PRO data at preoperative baseline and at one-year follow up. Patients were excluded if they were missing PRO data, missing cost and implant data, had a prior history of shoulder surgery, underwent revision rotator cuff repair, or had their subscapularis, teres minor, or isolated infraspinatus tendon repaired. A total of 266 patients met criteria. PROs collected included SANE and ASES scores at baseline and one-year follow-up. Patient demographics, injury and surgical characteristics, operative time, retear and reoperation rates, and day of surgery cost were evaluated. Time-driven activity-based costing was used to determine DOS costs. Statistical analyses conducted included descriptive statistics, Fisher exact tests, and analysis of variance. Results: Of the 266 patients that met criteria, approximately half were female (n = 131, 49.3%). Mean patient age at time of surgery was 60.4 years old and mean body mass index was 30.15. Chronic tears were present in 55.6% of patients. 113 patients underwent OBT, 75 underwent ABT, and 78 underwent biceps tenotomy. The average values for ASES and SANE scores at baseline versus 1-year follow-up were 46.9 versus 84.3 and 40.2 versus 84.0, respectively. The age of patients who underwent tenotomy (64.2 years old) was significantly older than the ABT (58.7 years old) and OBT (58.8 years old) groups (p < 0.001). Additionally, more women underwent biceps tenotomy versus tenodesis compared to men (37.4% of women vs. 21.5% of men). Mean operative time was significantly different between the groups with tenotomy being the fastest (ABT 128.0 minutes, OBT 139.9 minutes, tenotomy 121.6 minutes, p < 0.001). DOS costs as well as biceps tendon fixation costs were highest for OBT compared to ABT and biceps tenotomy (DOS $3,963.64 vs. $3,426.67 vs. $3,095.34, p < 0.001, respectively; Biceps fixation $505.25 vs. $237.94 vs. $5.15, p < 0.001, respectively). Additionally, overall implant costs (including RCR) were highest for OBT, despite the number of anchors used not differing between the groups (p = 0.132). There was no difference in the number of tendons repaired by bicep treatment type (p = 0.203). Changes in 1-year ASES and SANE scores were not different between the group (p = 0.221 and p = 0.159, respectively). There were also no differences between groups in rotator cuff symptomatic retears or reoperations (p = 0.731 and p = 0.391, respectively). Conclusions: This study found DOS costs were lowest for biceps tenotomy and highest for OBT with a difference of more than $850. Operative time from shortest for biceps tenotomy, while OBT was associated with an 18 minute longer operative time. Despite the differences in cost and operative time, there were no differences in PROs, symptomatic rotator cuff retear rates, or reoperation rates at one-year follow-up. These results may indicate that all three treatment types can provide patients with similar outcomes; however, lower operative times and costs can be provided by tenotomy or ABT compared to OBT. Surgeons can use these results to help guide technique selection when treating patients with biceps pathology. [Figure: see text]

Revising Failed Reverse Total Shoulder Arthroplasty: Comprehensive Techniques for Precise Explantation of Well-Fixed Implants.

With the increased utilization of reverse total shoulder arthroplasty (RTSA), there has been a corresponding increase in the incidence of and demand for revision RTSA3. In cases in which the patient has undergone multiple previous surgeries and presents with well-fixed shoulder implants, even the most experienced shoulder surgeon can be overwhelmed and frustrated. Having a simple and reproducible treatment algorithm to plan and execute a successful revision surgery will ease the anxiety of a revision operation and avoid future additional revisions. The extraction techniques described here strive to preserve the humeral and glenoid anatomy, hopefully facilitating the reimplantation steps to follow. The main principles of implant removal include several consistent, simple steps. In order to revise a well-fixed humeral implant, (1) identify the old implants; (2) create a preoperative plan that systematically evaluates the glenoid and humeral deficiencies; (3) prepare consistent surgical tools, such as an oscillating saw, osteotomes, and/or a tamp; (4) follow the deltoid; (5) dissect the soft tissue with a sponge; (6) dissect the bone with use of an osteotome; and (7) remove the humeral stem in rotation. In cases in which there is also a well-fixed glenoid implant, the surgical procedure will require additional steps, including (8) exposure of the anteroinferior glenoid, (9) disengagement of the glenosphere, and (10) removal of the glenoid baseplate in rotation. Alternatives to revision RTSA include nonoperative treatment, implant retention with conversion of modular components, extensile revision surgical techniques, and/or mechanical implant removal. With the advent of modular humeral and glenoid components, surgeons may choose to change the implant components instead of removing the entire humeral and glenoid implants; however, repeat complications may occur if the previous implant or implant position was not completely revised. When confronted with a tough humeral explantation, an extensile surgical approach involves creating a cortical window or humeral osteotomy to expose the humeral implant. This approach can compromise the humeral shaft integrity, leading to alternative and less ideal reconstruction implant choices, the use of cerclage wires, and/or the use of a strut graft, all of which may complicate postoperative mobilization. If glenoid implant removal is necessary, the glenosphere is removed first, followed by the underlying baseplate component(s). If the glenosphere is stuck or if screws are cold-welded, the use of a conventional mechanical extraction technique with a burr or diamond saw may be required; however, this may lead to additional metal debris and intraoperative sparks. Revision RTSA can lead to high complication rates, ranging from 12% to 70%2, which will often require additional revision surgeries4. The first steps to all revision RTSA procedures include careful surgical exposure and component explantation. A simplified approach to expose the humerus and glenoid, coupled with a systematic and atraumatic approach to remove the implants without inadvertent injuries, will prevent surgical complications and the need for re-revision. The proposed comprehensive technique hopefully will allow precise removal of the humeral and glenoid implants while also preserving the remnant humerus or glenoid for future reconstruction. Few studies have evaluated postoperative patient outcomes in revision RTSA. Chalmers et al. performed a meta-analysis and found that patients were able to achieve a mean elevation of 106°, a mean American Shoulder and Elbow Surgeons score of 63, and a mean Single Assessment Numeric Evaluation score of 522. Boileau showed very similar outcomes, with a mean elevation of 107° and a mean adjusted Constant score of 621. These outcomes are slightly inferior to those of primary RTSA, but patients remain satisfied with their improvement from their preoperative function. Preoperative preparation will reduce intraoperative reparation. Know the existing implant and the unique features of its design, understand the patient anatomy including bone defects, and anticipate all of the potential tools that may be needed.Know your anatomy. The anteromedial deltoid edge will help you identify the scarred-in humeral shaft.Da Vinci said that simplicity is the ultimate sophistication. Some of the most common surgical tools and instruments can be more effective than custom-designed ones.The implant should be removed in rotation.There are some company-specific explantation instruments that can be very helpful. Give the appropriate ones a try, but be prepared to consider alternative solutions. RTSA = reverse total shoulder arthroplastyCT = computed tomographyFE = forward elevation.

Poster 182: Pain and Quality of Life Scores Following Hip Arthroscopy for Femoroacetabular Impingement are More Related to Mental Health Than Hip Pathology

Objectives: Symptom severity in patients with femoroacetabular impingement (FAI) has been demonstrated to have a stronger association with mental health status than pathology. However, there is limited data on the relationship between mental health status and postoperative outcomes in FAI patients. This study aims to evaluate the relationship of mental health status and structural hip pathology to pain and quality of life. Methods: This was a retrospective review of patients from a single surgeon’s hip outcomes registry. Mental health status was evaluated using the Patient-Reported Outcomes Measurement Information System (PROMIS)-Anxiety and PROMIS-Depression scores. Pain was evaluated with Single Assessment Numerical Evaluation Score for Activities of Daily Living (SANE ADL) while quality of life (QOL) was evaluated with the International Hip Outcome Tool (iHOT-12). Repeated measures mixed modeling was used to evaluate the association between hip pathology (size of labral tear, grade of chondral damage, preoperative alpha angle), pain, QOL, anxiety, and depression pre- and postoperatively. Results: A total of 337 patients were included in this study. The degree of preoperative alpha angle, intra-operative cartilage damage and size of labral tear did not influence postoperative improvements in pain or QOL (p>0.05). However, higher levels of anxiety and depression were significantly associated with lower SANE-ADL scores (anxiety estimate: -0.608, SE (0.079), p<0.0001), (depression estimate: -0.677, SE (0.086), p<0.0001), and lower iHOT-12 scores (anxiety estimate: -0.709, SE (0.069), p<0.0001), (depression estimate: -0.706, SE (0.077), p<0.0001). These associations were seen both preoperatively and up to 2 years postoperatively. Furthermore, anxiety and depression do not appear to moderate the relationship between hip pathology and patient outcomes. Conclusions: All patients had similar improvements in pain scores and QOL following hip arthroscopy for FAI suggesting this surgery is beneficial for varying degrees of hip pathology. Additionally, preoperative anxiety and depression are associated with greater pain and decreased QOL both pre- and postoperatively regardless of the degree of hip pathology. This may suggest a need for pre- and postoperative psychological interventions in patients with anxiety and depression, and clinicians should prioritize mental health treatment at or above the level of the hip pathology itself.

Anterior cruciate ligament-Return to sport after injury scale brief version after ACL reconstruction: Persian translation, cross-cultural adaptation and validation.

The purpose of this study is to analyze the short anterior cruciate ligament return to sport after injury (ACL-RSI) (Persian) version's cultural adaption and validity. To assess test-retest reliability, 102 participants were filled out the short ACL-RSI(Per) scale 6 months or more after ACLR surgery. Internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficients), construct validity (Pearson's r) and sensitivity (floor/ceiling effect) were determined. In addition, patient completed other relevant measures such as Lysholm scores, the hospital for special surgery ACL satisfaction survey (HSS ACL-SS), the visual analogue scale (VAS) of pain and patient's satisfaction, the Tegner activity score (TAS), the single assessment numeric evaluation (SANE) and the Cincinnati Knee Rating System (CKRS). The short ACL-RSI(Per) scale showed high internal consistency (Cronbach's alpha = 0.91) and test-retest reliability (ICC = 0.923). Significant correlations between short ACL-RSI(Per) and other scales supported validity. There was a statistically significant connection between the short ACL-RSI(Per) and the following outcomes: HSS ACL-SS (r = 0.698, p < 0.001), VAS pain (r = 0.356, p < 0.001), CKRS (r = 0.644, p < 0.001), TAS (r = 0414, p < 0.001), Lysholm score (r = 0.467, p < 0.001) and SANE score (r = 0.536; p < 0.001). In addition to a satisfactory ceiling impact (15%), a sizeable floor effect (16.7%) was also seen. The short ACL-RSI(Per) scale is a reliable and valid tool for assessing psychological readiness for return to sport after ACL reconstruction in Persian. III.

Good clinical outcomes and low recurrence rate in patients undergoing arthroscopic revision Latarjet for failed arthroscopic Bankart repair

BackgroundThe role of arthroscopic Latarjet stabilization after failed arthroscopic Bankart repair has yet to be definitively established and merits further investigation. ObjectiveTo assess clinical and radiological outcomes after arthroscopic Latarjet stabilization as a revision procedure for failed Bankart repair, as well as the return to athletic activity and complication rates. MethodsBetween 2009 and 2020, patients with a previous failed arthroscopic Bankart repair who were treated with an arthroscopic Latarjet were retrospectively evaluated. Clinical outcomes at a minimum of 24 months postoperatively included Rowe score, Western Ontario Shoulder Instability Index (WOSI), Constant-Murley Shoulder Outcome score (CS), and Single Assessment Numeric Evaluation (SANE). Dislocations, subluxations, complications, pre and postoperative level of activity and degree of osteoarthritis were also assessed. ResultsA total of 77 patients, mean age at revision surgery 31.2 ± 9.1 and with either one (n = 59), two (n = 13), or three (n = 4) arthroscopic previous stabilizations underwent revision surgery using arthroscopic Latarjet procedure were studied. Postoperatively, the mean ROWE and CS scores increased from 41.8 ± 16 to 90.7 ± 14.3 (p<0.001) and from 50.5 ± 13.8 to 90.5 ± 10.3 (p<0.001), respectively. WOSI decreased from 1247 ± 367.6 to 548.9 ± 363 at the final follow-up (p<0.001). After a mean follow-up of 39.6 ± 23.1 months, 64 shoulders (83.1%) were subjectively graded as good to excellent using SANE score. Grade 1, 2, and 3 osteoarthritis, according to Ogawa et al were found in 18 (23.4%), 6 (7.8%), and 3 (3.9%) shoulders, respectively. Six dislocations after revision surgery were reported (7.8%). In four failed cases an Eden-Hybinette procedure was conducted and in remaining two patients an arthroscopic extraarticular anterior capsular reinforcement was performed. Significantly decreased level of athletic activity was observed postoperatively (p= 0.01). ConclusionsArthroscopic Latarjet for revision of failed arthroscopic Bankart repair provides satisfactory patient-reported subjective outcomes with low rate of recurrences and complications. However, decreased level of athletic activity is expected.

Poster 297: Clinical Outcomes and Return to Sports After Revision ACL Reconstruction With Lateral Extraarticular Tenodesis: Comparison to A Control Group of ACL Reconstruction Only at a Minimum 2-Year Follow-Up

Objectives: Lateral extraarticular tenodesis (LET) has been shown to decrease failure rate in settings of revision anterior cruciate ligament (ACL) reconstruction in young, high-demand patients. However, there is a paucity of literature comparing clinical outcomes and return to sports after patients who undergo revision ACL reconstruction LET compared to those without LET (control group). Methods: All patients who underwent revision ACL reconstruction with and without LET between January 2018 and February 2020 were queried at our institutional registry. The LET group was compared to the control group (revision ACL reconstruction without LET) were followed for a minimum of 24 months postsurgery to evaluate patients reported outcome measures, satisfaction, return to sports, rate of reoperation, and psychological readiness for return to sports (using the ACL-Return to Sport After Injury Scale, ACL-RSI). Results: A total of 81 patients with a mean follow-up of 2.75 years were included. The LET group contained 37 patients (76% female) with a mean age of 26.6 years and body mass index (BMI) of 23.5 kg/m^2 compared to 44 patients (80% female) with mean age of 28.2 years and BMI of 26.9 kg/m^2. There were no significant differences between the LET and control groups with respect to mean postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference (47.7 vs 48.3, p = 0.46) and PROMIS Mobility scales (53.3 vs 52.9, p = 0.97). In addition, there were no differences in postoperative International Knee Documentation Committee (78.9 vs 78.3, p=0.45), Marx (7.9 vs 7.2, p = 0.64), or Single Assessment Numeric Evaluation (73.1 vs 74.2, p = 0.38) scores. The same held true with regards to postoperative ACL-RSI scores between the groups (43.3 vs 50.1, p = 0.38). Return to play rates after revision ACL were similar in the LET group compared to the control group (55% vs 45%, p = 0.40) with similar confidence to play their pre-injury sport (scale out of 100, 58.2 vs 56.2, p = 0.82). Lastly, overall reoperation rates were similar between the groups with the LET group having a rate of 21.2% compared to 19.4% for the control group. When isolated for revision due to graft tear, the LET group had a re-revision rate of 13.5% compared to 6.8% in the control group (p = 0.31). Conclusions: Satisfaction and patient reported outcome scores after revision ACL reconstruction are good with or without LET. While both groups have similar rates of return to play and reoperation at greater than 2- year follow-up, these results suggest the addition of LET may provide similar outcomes in high-risk patients when compared to isolated revision ACL reconstruction.

Internal rotation-based activities of daily living show limitations following reverse shoulder arthroplasty versus anatomic shoulder arthroplasty

BackgroundOne of the more common limitations after reverse total shoulder arthroplasty (rTSA) is limited internal rotation (IR). Outcomes after rTSA are commonly reported as patient-reported outcome measures (PROMs) but are rarely assessed by specific activities of daily living (ADLs). Analyzing ADLs evaluates for specific motions from PROMs. The purpose of this study is to investigate the deficit in IR following rTSA through ADLs. MethodsA retrospective case-control study was conducted using institutional medical records. Patients who underwent total shoulder arthroplasty between 2009 and 2020 were reviewed for demographic and clinical variables (type of arthroplasty, indication, range of motion and strength). PROMs were taken by phone at 2-year minimum follow-up. Statistics were calculated as two-tailed using Chi-square or simple t-tests as appropriate. ResultsAmong 208 patients, 114 aTSA, and 94 rTSA were identified and included in this study. Both groups reported significant increases in range of motion and strength postoperatively. PROMs were mostly similar between aTSA and rTSA (Single Assessment Numeric Evaluation 83.4 ± 17.1 vs. 82.3 ± 18.4, P = .643; visual analog scale Pain 2.2 ± 2.8 vs. 1.8 ± 2.4, P = .247), while Simple Shoulder Test did show a difference (9.2 ± 2.8 vs. 7.8 ± 3.2, P = .001) with higher scores in the aTSA cohort. The ADLs which showed significant disparity between aTSA and rTSA were toileting (P = .001), donning a coat (P = .017), reaching one’s back (P = .017), as well as throwing overhand (0.013) with rTSA patients reporting more difficulty in all these ADLs. ConclusionBoth aTSA and rTSA are safe and efficacious options for shoulder replacement, as evidenced by high Single Assessment Numeric Evaluation and low visual analog scale pain scores and should be used according to their established indications. Surgeons may counsel rTSA patients about potential increased deficits in ADLs reliant on IR such as managing toileting and dressing compared to aTSA recipients.

Poster 382: Predictors of Clinical Outcomes and Quality of Life after Sternoclavicular Joint Reconstruction with Hamstring Tendon Autograft

Objectives: Instability of the sternoclavicular joint (SCJ) is a rare but potentially devastating pathologic condition, particularly when it occurs in young or active patients. SCJ reconstruction using hamstring tendon autograft is a commonly used treatment option, yet results are limited to small case series, to date. To date, studies on baseline preoperative demographic factors and their association with postoperative outcome are limited. The objective was to assess the clinical and sport specific outcomes and survivorship after SCJ reconstruction using hamstring tendon autograft in patients suffering from SCJ instability and to determine whether baseline demographic factors were associated with postoperative outcomes or patient satisfaction. Methods: Patients who underwent SCJ reconstruction with a hamstring tendon autograft for SCJ instability between October 2005 and October 2020 were enrolled in this retrospective, monocentric study. At a minimum of 2-years postoperatively, clinical outcomes were collected, including the following patient reported outcomes (PROs): the 12-Item Short Form Survey (SF-12) physical component summary (PCS) and mental component summary (MCS) scores, American Shoulder and Elbow Surgeons (ASES) score, Quick Disabilities of the Arm, Shoulder and Hand (DASH) score, Single Assessment Numeric Evaluation (SANE) score, VAS pain score, VAS pain at worst and subjective postoperative satisfaction with the procedure (0 = very unsatisfied to 10 = very satisfied). Sport specific parameters were investigated via questionnaire. The predictive role of patient demographic factors, including age, sex, and injury in dominant arm, on postoperative PROs and satisfaction at short term follow-up was evaluated using bivariate analysis. According to their respective distribution, continuous variables were compared employing a parametric unpaired t test or the non-parametric Mann–Whitney U test. Categorical variables were compared performing the binary Fisher’s exact test or the Chi-square test. The non-parametric Wilcoxon test for two related samples was used to compare pre- and postoperative values of each outcome parameter. Spearman rank correlations coefficients were calculated in the predictive factor analysis. Results: A total of 49 patients (age: 29.6 ± 16.2 years, range 13.8-67.1, 27 females) were included in the final analysis. Surgery was performed on the dominant shoulder in 26 (63.4%) of the cases. At a mean follow-up of 3.9 ± 2.1 years, all PROs had significantly improved. These included the SF12 PCS (40.4 ± 6.8 to 52.6 ± 6.9, p&lt;0.001), ASES (54.9 ± 20.4 to 91.0 ± 11.3, p&lt;0.001), QuickDASH (41.2 ± 18.5 to 10.2 ± 9.1, p&lt;0.001); SANE (50.2 ± 21.1 to 88.3 ± 8.8, p&lt;0.001), VAS pain (4.4 ± 2.6 to 0.8 ± 1.4, p&lt;0.001) and VAS pain at its worst (7.4 ± 2.5 to 3.3 ± 2.6, p&lt;0.001). The median postoperative satisfaction score was 9 (1-10). Revision-free survivorship was 95.9%. Of those, all patients returned to athletic activity. However only 45% of the overhead athletes returned to their preinjury level. Male patients had a significantly lower VAS pain at worst compared to female patients (2.6 ± 2.6 vs. 4.1 ± 2.4; p=0.045), higher age was significantly correlated with a worse Quick-DASH score (correlation coefficient: 0.314*; p=0.036) and overhead athletes had a significantly lower propensity to return to sports compared to non-overhead athletes (p=0.043). Conclusions: The significant improvements in clinical and sports specific outcomes and high patient satisfaction after SCJ reconstruction with a hamstring autograft demonstrate the success of this procedure in treating SCJ instability. Male sex and younger patient age are associated with superior outcomes, while overhead athletes have to be counseled about difficulties of returning to preinjury level of sport, postoperatively.

A Single-Center, Observational Study Assessing Functional Outcomes After Arthroscopic Anterior Cruciate Ligament Reconstruction Using Suspensory Tibial Fixation With a Polyether Ether Ketone (PEEK) Button.

Background Anterior cruciate ligament reconstruction (ACLR) is a crucial procedure in orthopedic surgery. This study evaluates the efficacy and safety of ACLR employing suspensory tibial fixation with a polyether ether ketone (PEEK) button. Methodology This retrospective observational study conducted at Sai Shree Hospital, Pune, India, between November 2023 and December 2023 enrolled 47 subjects aged 18-60 years who underwent arthroscopic ACLR utilizing the T-Button-A Adjustable Loop Ultra-High-Molecular-Weight Polyethylene Suture PEEK button. The functional outcomes and patient-reported outcomes were assessed using the International Knee Documentation Committee (IKDC) score, the Modified Cincinnati Rating System Questionnaire (MCRS), the Single Assessment Numeric Evaluation (SANE) score, the Tegner Activity Level (TAL) Scale, and Knee Injury and Osteoarthritis Outcome Score (KOOS) quality of life subscale. Results Femoral fixation utilized 27 (57.4%) Proloop Ultra Adjustable Loop Button 60 mm, 19 (40.4%) Infiloop Fixed Loop Button 20 mm, and 1 (2.1%) Infiloop Fixed Loop Button 30 mm. Tibial fixation solely relied on T-Button A (PEEK Tibial Button With Adjustable Loop 90 mm). Postoperative evaluations revealed favorable IKDC (79.49 ± 12.67), MCRS (81.32 ± 11.57), SANE (77.83 ± 11.11), TAL Scale (3.87 ± 0.99) and KOOS quality of life subscale (83.81 ± 13.07) scores. Conclusions The findings affirm the efficacy and safety of arthroscopic ACLR utilizing suspensory tibial fixation with the PEEK button, supporting its use for improved patient outcomes.

Ulnohumeral Cross-Pinning in the Management of Traumatic Elbow Instability

Traumatic elbow instability (subluxation and dislocation) represents a challenging clinical entity that can be complicated by persistent intraoperative instability after attempted stabilization or recurrent postoperative instability. Both static and dynamic supplemental stabilization procedures have been described for cases where fracture fixation and ligament repair fail to restore stability. There is a paucity of prior studies involving ulnohumeral cross-pinning (UCP), which is a type of static supplemental stabilization. Our purpose was to assess complications and outcomes after UCP. We reviewed all surgical cases involving primary and revision UCP for traumatic elbow instability at a single center from 2017-2023. Baseline demographics were recorded. Outcomes including radiographs, range of motion, patient-reported outcome measures, and surgical complications were analyzed. Fourteen patients undergoing UCP were included with a mean follow-up of 27 months. Five cross-pinnings (36%) were performed during revision procedures. Mean visual analog scale (VAS) pain, Disabilities of the Arm, Shoulder, and Hand (QuickDASH), and the Single Assessment Numeric Evaluation (SANE) scores were 2.4, 34, and 69, respectively. The mean flexion-extension and pronation-supination arcs were 114° and 140°, with 85% achieving at least a 100° arc for flexion and forearm rotation. Five patients (36%) had complications, all of which required reoperation. Two complications involved postoperative instability: one radial head subluxation and one radial head dislocation. Both occurred in revision UCP cases indicated for recurrent postoperative instability. Ulnohumeral cross-pinning for persistent and recurrent elbow instability results in maintained ulnohumeral joint alignment, functional arcs of elbow range of motion, and acceptable patient-reported outcome measures, particularly in the setting of a primary procedure indicated for persistent intraoperative instability. Ulnohumeral cross-pinning is a reasonable supplemental stabilization procedure for complex elbow instability. Therapeutic IV.

Anterior Cruciate Ligament Repair With Suture Tape Augmentation of Proximal Tears and Early Anterior Cruciate Ligament Reconstruction With Suture Tape Augmentation Result in Comparable Clinical Outcomes With Anterior Cruciate Ligament Reconstruction at 2-Year Follow-Up

To compare the postoperative side-to-side laxity and short-term clinical outcomes of patients who received primary anterior cruciate ligament (ACL) repair with suture tape augmentation, acute anterior cruciate ligament reconstruction (ACLR) with suture tape augmentation performed within 8 weeks of injury (ACLRacute), or ACLR beyond 8 weeks of injury. After institutional review board approval was obtained, 100 patients were enrolled in this prospective trial: 34 primary ACL repair with suture tape augmentation, 33 ACLRs performed within 8 weeks of injury (ACLRacute), and 33 ACLRs. Patients were allocated to ACL repair if a proximal avulsion was present with good tissue quality (Sherman type 1), confirmed by intraoperative diagnostic arthroscopy. Preoperative side-to-side anteroposterior knee laxity was assessed with KT-1000 arthrometer, and patient-reported outcomes (PROs) including the visual analog scale, Marx activity scale, Veterans RAND 12-item health survey (VR-12 physical & mental), Single Assessment Numeric Evaluation, Knee Injury and Osteoarthritis Outcome Score survey subscales, and range of motion were collected. These objective and subjective measures were repeated at regular intervals postoperatively through 2 years. Minimal clinically important difference calculations were performed assessing postoperative PRO changes at 2 years compared with preoperative. The average time from injury to surgery was 5.03 ± 1.2 weeks for the ACL repair group, 5.09 ± 0.74 weeks for the ACLRacute, and 43.22 ± 33.5 weeks for the ACLR group. Postoperatively, the KT-1000 side-to-side laxity difference for 30 lbs was determined to be 0.1 ± 0.37 (95% confidence interval [CI] -0.7 to 0.8) for ACL repair versus ACLR (P < .0001), -0.8 ± 0.35 (95% CI -1.5 to -0.1) for ACLRacute versus ACLR (P < .0001), and 0.8 ± 0.40 (95% CI 0.0-1.6) for ACL repair versus ACLRacute (P < .0001). The data reveal ACL repair and ACLRacute are noninferior to ACLR at 2-year follow-up. The postoperative difference from baseline for all PROs demonstrated improvement for all PROs. Magnetic resonance imaging at 1 year revealed tissue healing for the 3 ACL injury treatment groups. Patients who underwent ACL repair of proximal tears with suture tape augmentation or ACL reconstruction within 8 weeks from injury resulted in noninferior side-to-side knee laxity, comparable PROs, and similar range of motion at 2-year follow-up compared with ACLR. Level II, prospective comparative study.

Poster 131: Loop 'N' Tack Tenodesis: A Multi-Center Retrospective Case Series of Clinical and Patient Reported Outcomes of a Novel Suture Technique for Proximal Biceps Tenodesis

Objectives: Tenodesis and tenotomy of the long head of the biceps are treatment options for a wide range of pathologies without clear superior technique or site of fixation. Tenotomy may result in a cosmetic “Popeye” deformity and fatigue pain. The Loop ‘N’ Tack technique is a quick, simple, and knotless technique for tenodesis of the long head of the biceps that can be completed entirely arthroscopically. The tensionless repair allows the biceps to scar within the biceps groove, thereby reducing subsidence and formation of a “Popeye" deformity and fatigue pain in the biceps seen with tenotomy alone while eliminating the ability to overtension. The primary objective will be to retrospectively report the clinical outcomes and associated complications of patients undergoing biceps tenodesis utilizing the Loop ‘N’ Tack technique at multiple institutions from 1/1/2015 – 7/25/2021. Methods: CPT procedure codes (29827,29823, 29826) were used to identify participants in the EHR (i.e., Epic) who underwent the Loop ‘N’ Tack biceps tenodesis technique by each author at 9 separate institutions. Patient reported outcomes (PRO) including Visual Analog Scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numeric Evaluation (SANE), UCLA Shoulder Rating Scale (UCLA), and Simple Shoulder Test (SST) were recorded at multiple time points throughout the patient’s preoperative and postoperative course. Scores were compared to the established minimal clinically important difference (MCID) for each PRO to assess the viability of this tenodesis technique. Additional metrics including bicipital groove pain, Popeye deformity, and need for revision surgery were also recorded. Results: 1,473 patients were initially screened who underwent the Loop ‘N’ Tack biceps tenodesis technique. 82 patients were excluded secondary to limited follow up or lack of PRO data within the EHR. The average patient age was 64.7 years old with average follow up of 8.11 months. Mean preoperative PRO scores were 5.64 (2.13), 43.31 (20.38), 15.14 (3.52), 5.81 (1.92), and 49.24 (15.06) for the VAS, SANE, UCLA, SST, and ASES scores, respectively. Postoperative PRO scores at most recent follow up respectively measured 1.05 (1.66), 89.56 (17.06), 31.50 (4.01), 10.69 (1.92), and 89.48 (13.81). MCID was reached for each PRO at the 1-2 month mark postoperatively. 36 patients (2.6%) underwent revision surgery for biceps related pathology, while 40 patients (2.9%) required revision shoulder surgery for a separate pathology. Postoperative Popeye deformity was noted in 15 patients (1.08%). Conclusions: The Loop ‘N’ Tack technique results in high rates of patient satisfaction with improvement in shoulder related patient reported outcomes, low incidence of postoperative pain, and low rates of Popeye deformity. This case series establishes the Loop ‘N’ Tack technique as a viable tenodesis approach during shoulder arthroscopy for biceps related pathology.

Poster 153: Decreased Coracoid Index in Patients with Recurrent Instability after an Arthroscopic Bankart Procedure: A Retrospective Analysis with a Mean Follow-Up of 12.9 Years

Objectives: Traumatic anterior shoulder instability is a common sports medicine pathology, disproportionally affecting competitive, contact athletic and military populations. Currently, arthroscopic Bankart repair is the gold standard for managing patients with anterior instability and associated labral injury with subcritical bone loss. However, recurrent instability remains common after the index operation, with rates between 5% and 20% reported in the literature. Multiple prognostic calculators and scoring indices have been developed in attempts to proactively determine which cohorts may benefit from a bony (Latarjet or free bone graft) or soft tissue (Remplissage) augmentation procedure to further stabilize the joint and decrease the risk of recurrence. Importantly, there has been a growing appreciation for the effects of coracoid process morphology on shoulder pathology, including subcoracoid impingement and subscapularis tears. However, there is a paucity of literature exploring the effect of coracoid morphology on anterior shoulder instability. Therefore, the purpose of this study was to compare known osseous risk factors for recurrent instability, as well as the coracoid index, between patients with and without recurrent instability after an arthroscopic Bankart repair, and to compare long-term outcomes between the 2 cohorts. Methods: Following institutional review board approval, a retrospective cohort comparison of patients with anterior glenohumeral instability treated at a single academic military medical facility was performed. After identifying the initial cohort, patients were invited to complete Western Ontario Shoulder Instability Index (WOSI) and Single Assessment Numeric Evaluation (SANE) surveys. Inclusion criteria included symptomatic anterior shoulder instability, surgical treatment with arthroscopic Bankart repair, and survey completion. Preoperative MRIs were obtained, and glenoid bone loss, Hill-Sachs interval, and coracoid index were quantified. Patients with recurrent instability at last follow up were age-matched in a 1:2 ratio for comparison with those without recurrent instability. Subsequently, unpaired two-tailed t tests were used to compare anatomic morphologies and patient-reported outcome measures (PROMs) between the 2 cohorts. Finally, linear regression was used to evaluate the relationship between the anatomic measurements and PROMs. Results: At a mean of 12.9 years follow-up, 12 patients were confirmed to have recurrent shoulder instability by survey and chart review and were age-matched to 24 patients without recurrent instability (n = 36; mean age 26.0 ± 5.2 years). Patients with recurrent instability after arthroscopic Bankart repair had lower coracoid indices (by 3.28 ± 1.55 mm; p = .0412), greater glenoid bone loss (by 6.67 ± 1.62%; p = .0002), and larger Hill-Sachs Intervals (by 5.88 ± 2.30 mm; p = .0153) on preoperative MRI. The cohort with recurrent instability had lower SANE scores (by 38.0 ± 9.1; p = .0002), and higher WOSI scores (by 692 ± 174; p = .0003) at final follow-up. Coracoid index, glenoid bone loss and Hill-Sachs interval were not correlated with PROMs at latest follow-up (p &gt; 0.05). Conclusions: To our knowledge, this is the first study to assess coracoid morphology in a cohort of patients with symptomatic shoulder instability. The current study findings suggest that a more laterally-projecting coracoid may be protective against recurrent shoulder instability after an arthroscopic Bankart repair. In accordance with recent literature, the recurrent instability cohort had greater glenoid bone loss and larger Hill-Sachs lesions on their index pre-operative MRI and had worse subjective outcomes at latest follow-up. As the shoulder is a complex joint with static and dynamic stabilizers, it is important to understand the effects of anatomic variation on pathoanatomy, as well as patient symptomatology. These preliminary findings highlight the need for further large cohort studies investigating the role of coracoid morphology on shoulder stability. A clearer understanding of the anatomic risk factors for recurrent instability will improve surgical planning and decision making, as well as minimizing time missed from athletic activities or military service.

Achievement of the patient acceptable symptom state following total shoulder arthroplasty with nonspherical humeral head and inlay glenoid

Background Total shoulder arthroplasty (TSA) with a nonspherical humeral head component and inlay glenoid is a bone preserving treatment for glenohumeral arthritis. This study aims to describe minimum two year patient reported outcomes, patient acceptable symptomatic state (PASS) achievement, and complications following TSA with this prosthesis. Methods A retrospective review of patients undergoing TSA with nonspherical humeral head and inlay glenoid was performed. Outcomes included Single Assessment Numeric Evaluation (SANE) scores, American Shoulder and Elbow Surgeons (ASES) scores, and complications. SANE and ASES scores were compared to established PASS threshold values to determine PASS achievement. Results 56 TSA in 53 patients were identified. The mean age was 64.5 years, 64% were male, and mean follow-up was 29.2 ± 4.9 months (24.0–42.8). Two complications (3.6%) were observed: one subscapularis tear requiring revision to reverse TSA and one traumatic minimally displaced greater tuberosity fracture successfully treated nonoperatively. The mean SANE score was 84.3 ± 16.9 (40–100) and 77% of patients surpassed the PASS threshold of 75.5. The mean ASES score was 85.3 ± 15.7 (40–100) and 77% of patients surpassed the PASS threshold of 76. Discussion Patients undergoing TSA with a nonspherical humeral head and inlay glenoid demonstrated high PASS achievement rates and few complications at short-term follow-up.

Quadriceps Tendon Anterior Cruciate Ligament Reconstruction in Skeletally Immature Patients: 3-Year Clinical and Patient-Reported Outcomes.

The rate of anterior cruciate ligament (ACL) rupture in active, skeletally immature patients is increasing. Although hamstring tendon autograft (HTA) was previously deemed the gold standard, recent studies have shown HTA to have a high failure rate in this high-risk population of young competitive athletes, and quadriceps tendon autograft (QTA) has yielded excellent preliminary outcomes in some studies examining this population. To evaluate 3-year clinical and patient-reported functional outcomes of primary ACL reconstruction (ACLR) with soft tissue QTA in skeletally immature patients. Case series; Level of evidence, 4. Skeletally immature patients who underwent ACLR with a full-thickness soft tissue QTA were included. Preoperative patient and surgical data were collected. The ACLR technique was selected predicated upon skeletal age and included all-epiphyseal and complete transphyseal techniques. Patients were followed for a minimum of 2 years with successive clinical visits or were contacted via telephone. Patients who did not have minimum 2-year follow-up after 3 contact attempts via telephone were excluded. Information regarding return to sports (RTS) and concomitant or subsequent surgical procedures was collected. Pediatric International Knee Documentation Committee (Pedi-IKDC), Hospital for Special Surgery Functional Activity Brief Scale (HSS Pedi-FABS), and Single Assessment Numeric Evaluation (SANE) scores were collected. Of 85 adolescent patients aged 11.1 to 17.6 years (mean age, 14.1 ± 1.2 years), 2 patients were determined to be lost to follow-up after 3 failed contact attempts. Of the patients included in this study (N = 83), 26 patients (31%) underwent all-epiphyseal and 57 patients (69%) underwent complete transphyseal ACLR. Additionally, 48 patients (58%) underwent concomitant lateral extra-articular tenodesis using the iliotibial band with a modified Lemaire technique. The mean follow-up time was 3.7 ± 1.2 years (range, 2-7 years). Twenty (24%) patients had subsequent surgical procedures, of which 3 (4%) were due to graft failures. At a mean 3-year follow-up, the mean Pedi-IKDC, HSS Pedi-FABS, and SANE scores were 90, 23, and 94 respectively; the RTS rate was 100%; and the rate of RTS at the previous level of performance was 93%. Use of a soft tissue QTA for ALCR in a high-risk skeletally immature population of athletes resulted in excellent postoperative outcomes with low rates of graft failure and high return to sport rates.

Short-term Outcomes After Hip Arthroscopic Surgery in Patients Participating in Formal Physical Therapy Versus a Home Exercise Program: A Prospectively Enrolled Cohort Analysis

Background: Physical therapy is frequently utilized in the postoperative care of femoroacetabular impingement syndrome (FAIS). There has been limited research into the efficacy of a structured home exercise program (HEP) compared with formal physical therapy (FPT) in this patient population. Purpose/Hypothesis: The purpose was to evaluate the short-term outcomes of patients utilizing FPT versus an HEP after hip arthroscopic surgery for FAIS. It was hypothesized that both groups would show similar improvements regarding outcome scores, which would improve significantly compared with their preoperative scores. Study Design: Cohort study; Level of evidence, 2. Methods: Patients undergoing hip arthroscopic surgery for FAIS at a single center between October 2020 and October 2021 were prospectively enrolled. Patients were allowed to self-select FPT or an HEP and were administered a survey preoperatively and at 1 month, 3 months, 6 months, and 12 months postoperatively. The survey included the Single Assessment Numeric Evaluation, visual analog scale for pain, 12-item International Hip Outcome Tool, Patient-Reported Outcomes Measurement Information System Physical Function, and patient satisfaction with physical therapy and overall care. Statistical analysis was conducted between the 2 groups and within groups to compare preoperative and postoperative scores. Results: The patients’ mean age was 32.6 ± 10.4 years, with 47.2% being female and 57.4% choosing the HEP. At 12 months postoperatively, no significant differences were reported between the FPT and HEP groups regarding the Single Assessment Numeric Evaluation score (P = .795), visual analog scale for pain score (P > .05), Patient-Reported Outcomes Measurement Information System Physical Function T-score (P = .699), 12-item International Hip Outcome Tool score (P = .582), and patient satisfaction (P > .05). Outcome scores at 12 months postoperatively were significantly improved from the preoperative scores across all measures in both groups (P < .001). Conclusion: There were no significant differences regarding patient outcomes between FPT and the HEP at 1-year follow-up after hip arthroscopic surgery for FAIS when patients selected their own treatment, with both groups demonstrating significant improvements in their outcome scores from their preoperative values. These findings suggest that a structured HEP may be a viable alternative to FPT after hip arthroscopic surgery in patients who prefer a self-directed rehabilitation program.

Association Between Preoperative Patient Resilience and Patient-Reported Outcomes After Rotator Cuff Repair.

Mental and emotional health can affect outcomes after orthopaedic surgery, and patient resilience has been found to be significantly related to postoperative functional outcomes. To evaluate the relationship between preoperative patient resilience and 2-year postoperative patient-reported outcomes after rotator cuff repair (RCR). It was hypothesized that patients with low preoperative resilience will have worse patient-reported outcomes at 2 years after RCR versus those with high resilience. Cohort study; Level of evidence, 3. Patients who underwent primary arthroscopic RCR in 2020 at a single institution and completed the Brief Resilience Scale (BRS) preoperatively were identified. Other inclusion criteria were American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores at the 2-year follow-up. Outcomes were compared in patients as divided into low resilience (BRS score >1 SD below the mean), normal resilience (BRS score ≤1 SD of the mean), and high resilience (BRS score >1 SD above the mean) groups. Overall, 100 patients (52 male, 48 female; mean age, 60 ± 9 years) were included in this study. Mean BRS scores did not change significantly from preoperative to 2-year follow-up (3.8 ± 0.7 vs 3.9 ± 0.8, P = .404). All patients had preoperative ASES scores. Low-resilience patients (n = 17) had significantly lower preoperative ASES scores compared with normal (n = 64) and high resilience (n = 19) patients (35 vs 42 vs 54, respectively; P = .022). There were no significant group differences in postoperative outcomes (revision rate, ASES score, ASES score improvement from preoperative to 2-year follow-up, or SANE score). Multivariate analysis indicated that preoperative resilience was not significantly associated with ASES score improvement (β estimate = -5.64, P = .150), while resilience at 2-year follow-up was significantly related to ASES score improvement (β estimate = 6.41, P = .031). Patient-reported outcomes at 2-year follow-up did not differ based on preoperative patient resilience for arthroscopic RCR patients. Multivariate analysis also showed that preoperative resilience was not associated with improvement in ASES scores; however, resilience at 2-year follow-up was associated with ASES score improvement.

Outpatient versus inpatient shoulder arthroplasty outcomes using an updated patient-selection algorithm: minimum two-year follow-up

BackgroundPrevious studies have demonstrated the safety and cost-effectiveness of outpatient total shoulder arthroplasty (TSA), with the majority of studies focusing on 90-day outcomes and complications. Patient selection algorithms have helped appropriately choose patients for an outpatient TSA setting. This study aimed to determine the outcomes of TSA between outpatient and inpatient cohorts with at least a 2-year follow-up. MethodsA retrospective review identified patients older than 18 years who underwent a TSA with a minimum of 2-year follow-up in either an inpatient or outpatient setting. Using a previously published outpatient TSA patient-selection algorithm, patients were allocated into three groups: outpatient, inpatient due to insurance requirements, and inpatient due to not meeting algorithm criteria. Outcomes evaluated included visual analog scale (VAS) pain, American Shoulder and Elbow Surgeons (ASES) score, Single Assessment Numeric Evaluation (SANE) score, range of motion (ROM), strength, complications, re-admissions, and re-operations. Analysis was performed between the outpatient and inpatient groups to demonstrate the safety and efficacy of outpatient TSA with midterm follow-up. ResultsA total of 779 TSA were included in this study, allocated into the outpatient (N = 108), inpatient due to insurance (N = 349), and inpatient due to algorithm (N = 322). The average age between these groups was significantly different (59.4 ± 7.4, 66.5 ± 7.5, and 72.5 ± 8.7, respectively; P < 0.0001). All patient groups demonstrated significant improvements in preoperative to final patient-outcomes scores, ROM, and strength. Analysis between cohorts showed similar final follow-up outcome scores, ROM, and strength, with few significant differences that are likely not clinically different, regardless of surgical location, insurance status, or meeting patient-selection algorithm. Complications, reoperations, and readmissions between all three groups were not significantly different. ConclusionThis study reaffirms prior short-term follow-up literature. Transitioning appropriate patients to outpatient TSA results in similar outcomes and complications compared to inpatient cohorts with mid-term follow-up.

Association Between Symptoms of Anxiety and Depression, Hip Pathology, and Patient-Reported Outcomes After Hip Arthroscopy for Femoroacetabular Impingement

Background: In patients with femoroacetabular impingement (FAI), mental health has been implicated in both symptom severity and postoperative outcomes. However, there are limited data regarding the independent influences of baseline mental health and hip pathology on patient-reported outcomes over time after hip arthroscopy. Purpose: To evaluate the association between mental health and structural hip pathology with pain, hip function, and quality of life (QOL). Study Design: Cohort study; Level of evidence, 3. Methods: Patient records from a single surgeon’s hip outcomes registry were retrospectively reviewed. Mental health was evaluated using the Patient-Reported Outcomes Measurement Information System Anxiety and Depression scores. Pain was evaluated with the Single Assessment Numeric Evaluation score for Activities of Daily Living (SANE-ADL), while hip-related QOL was evaluated with the 12-item International Hip Outcome Tool (iHOT-12). Hip function was assessed with the Hip Outcome Score (HOS) Sport-Specific (SS) and ADL subscales. Separate mixed models were used to predict pain, QOL, and hip function, including hip pathology measures (size of labral tear, grade of chondral damage, preoperative alpha angle), anxiety, depression, and time as fixed effects and individuals as a random effect. Results: A total of 312 patients were included in this study. The preoperative alpha angle, degree of intraoperative cartilage damage, and size of the labral tear were not associated with pain or QOL (P > .05 for all). However, higher levels of anxiety and depression were significantly associated with lower SANE-ADL scores (estimate ± SE) (anxiety: –0.59 ± 0.07, P < .0001; depression: –0.64 ± 0.08, P < .0001), iHOT-12 scores (anxiety: –0.72 ± 0.07, P < .0001; depression: –0.72 ± 0.08, P < .0001), HOS-SS scores (anxiety: –0.68 ± 0.09, P < .0001; depression: –0.57 ± 0.10, P < .0001), and HOS-ADL scores (anxiety: –0.43 ± 0.05, P < .0001; depression: –0.43 ± 0.06, P < .0001). Conclusion: Patients had similar improvements in pain scores, QOL, and hip function after hip arthroscopy for FAI irrespective of their degree of hip pathology. Additionally, preoperative symptoms of anxiety and depression symptoms were associated with greater pain, decreased QOL, and worse hip function both pre- and postoperatively, independent of the degree of hip pathology. This suggests that efforts to directly address symptoms of anxiety and depression may improve outcomes after hip arthroscopy.