Sport-specific Outcomes Research Articles

Arthroscopic Suture Anchor Fixation of Bony Bankart Lesions: Clinical Outcome, Magnetic Resonance Imaging Results, and Return to Sports

The purpose of this study was to evaluate the outcome, return to sporting activity, and postoperative articular cartilage and bony morphology of shoulders that underwent arthroscopic suture anchor repair of bony Bankart lesions. The inclusion criteria for this retrospective study were anterior glenoid rim fractures after traumatic shoulder instability that were treated with arthroscopic suture anchor repair. Patients were surveyed by a questionnaire including sport-specific outcome, Rowe score, Western Ontario Shoulder Instability Index, and Oxford Instability Score. Three-tesla magnetic resonance imaging could be performed in 30 patients to assess osseous integration, glenoid reconstruction, and signs of osteoarthritis. From November 1999 to April 2010, 81 patients underwent an anterior bony Bankart repair in our department (50 arthroscopic suture anchor repairs, 5 arthroscopic screw fixations, and 26 open repairs). The 55 arthroscopic repairs comprised a consecutive cohort of patients treated by a single surgeon. Of the 50 patients in the suture anchor group, 45 (90%) were available for evaluation. At 82 ± 31 months postoperatively, the mean Rowe score was 85.9 ± 20.5 points, the mean Western Ontario Shoulder Instability Index score was 89.4% ± 14.7%, and the mean Oxford Instability Score was 13.6 ± 5.4 points. Compared with the contralateral shoulder, all scores showed a significantly reduced outcome (P < .001, P < .001, and P < .001, respectively). A redislocation occurred in 3 patients (6.6%). Regarding satisfaction, 35 patients (78%) were very satisfied, 9 (20%) were satisfied, and 1 was partly satisfied. Overall, 95% of patients returned to any sporting activity after surgery. The number of sports disciplines (P < .001), duration (P= .005), level (P= .02), and risk category (P= .013) showed a significant reduction compared with the pretrauma condition. However, only 19% of patients reported that shoulder complaints were the reason for the reduction in activity. Nonunion occurred in 16.6%, with a higher frequency in patients with chronic lesions (P= .031). Anatomic reduction was achieved in 72%, the medial step-off in patients with nonanatomic reduction averaged 1.8 ± 0.9 mm, and the remaining glenoid defect size averaged 6.8% ± 7.3%. Full-thickness cartilage defects of the anterior glenoid were detected in 70% of patients. Arthroscopic suture anchor repair may enable an anatomic reduction of bony Bankart lesions with no or only minimal articular steps and provides successful midterm outcomes concerning clinical scores, recurrence, and patient satisfaction. The return to activity is limited for various, mostly non-shoulder-related causes. Chronic lesions may have an inferior healing potential; therefore early surgical stabilization of acute Bankart fragments is suggested to avoid possible nonunion. Level IV, therapeutic case series.

Improved Outcomes After Hip Arthroscopic Surgery in Patients Undergoing T-Capsulotomy With Complete Repair Versus Partial Repair for Femoroacetabular Impingement

Background: Hip capsular management after hip arthroscopic surgery for femoroacetabular impingement (FAI) is controversial. Purpose/Hypothesis: To compare the clinical outcomes of patients undergoing hip arthroscopic surgery for FAI with T-capsulotomy with partial capsular repair (PR; closed vertical incision, open interportal incision) versus complete capsular repair (CR; full closure of both incisions). The hypothesis was that there would be improved clinical outcomes in patients undergoing CR compared with those undergoing PR. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients undergoing hip arthroscopic surgery for FAI by a single fellowship-trained surgeon from January 2011 to January 2012 were prospectively collected and analyzed. Inclusion criteria included all patients between ages 16 and 65 years with physical examination and radiographic findings consistent with symptomatic FAI, with a minimum 2-year follow-up. For analysis, patients were matched according to sex and age ±2 years. Primary clinical outcomes were measured via the Hip Outcome Score Activities of Daily Living (HOS-ADL) and Sport-Specific (HOS-SS) subscales, the modified Harris Hip Score (mHHS), patient satisfaction (measured on a visual analog scale), and clinical improvement at baseline, 6 months, 1 year, and 2 years. Statistical analysis was performed utilizing Student paired and unpaired t tests, with P < .05 considered significant. Results: A total of 64 patients were included in the study, with 32 patients (12 male, 20 female) in each group. The average follow-up was 29.9 ± 2.6 months. There were no significant demographic differences between the groups. The CR group demonstrated significantly superior outcomes in the HOS-SS at 6 months (PR: 63.8 ± 31.1 vs CR: 72.2 ± 16.1; P = .039), 1 year (PR: 72.7 ± 14.7 vs CR: 82.5 ± 10.7; P = .006), and 2.5 years (PR: 83.6 ± 9.6 vs CR: 87.3 ± 8.3; P < .0001) after surgery. Patient satisfaction at final follow-up was significantly better in the CR group (PR: 8.4 ± 1.0 vs CR: 8.6 ± 1.1; P = .025). Both groups demonstrated significant improvements in the HOS-ADL (PR: 64.6 ± 17.0 to 90.7 ± 8.4 [P < .0001]; CR: 66.1 ± 15.7 to 92.1 ± 7.9 [P < .0001]) and HOS-SS (PR: 39.4 ± 23.9 to 83.6 ± 9.6 [P < .0001]; CR: 39.1 ± 24.2 to 87.3 ± 8.3 [P < .0001]) at final follow-up. There were no significant differences between the groups in the HOS-ADL at any time point. There were no significant differences in the mHHS between the groups at final follow-up (PR: 82.5 ± 5.0 vs CR: 83.0 ± 4.4; P = .364). The overall revision rate was 6.25%; all patients (n = 4) who required revision arthroscopic surgery were in the PR group (13% of 32 patients), while no patients in the CR group required revision surgery. Conclusion: While significant improvements were seen at 6 months, 1 year, and 2.5 years of follow-up regardless of the closure technique, patients who underwent CR of the hip capsule demonstrated superior sport-specific outcomes compared with those undergoing PR. There was a 13% revision rate in the PR group, but no patients in the CR group required revision surgery. While longer term outcome studies are needed to determine if these results are maintained over time, these data suggest improved outcomes after CR compared with PR at 2.5 years after hip arthroscopic surgery for FAI.

Surgical Dislocation of the Hip Versus Arthroscopic Treatment of Femoro-acetabular Impingment

Objectives:Femoroacetabular impingement (FAI) can be treated by arthroscopy or by surgical dislocation of the hip. Advocates of each have suggested advantages of each technique. To date, there have been no studies that directly compare these two treatment modalities, using patient-reported outcomes (PRO), in a single surgeon design. The purpose of this study was to prospectively compare outcomes of patients receiving surgical hip dislocation to arthroscopic treatment for FAI, using a matched-pair analysis. Our hypothesis is the arthroscopic group will demonstrate improved clinical outcomes when compared to patients receiving open surgical dislocation.Methods:During the study period between January 2008 and August 2011, data was prospectively collected on all patients <30 years of age treated for FAI. Patients were given the choice of open dislocation versus arthroscopic treatment. Patients with developmental dysplasia of the hip, Legg-Calve-Perthes disease, Tonnis grade >1, and previous hip surgery were excluded. The patients in the surgical dislocation cohort were pair-matched in a 1:2 ratio to patients treated arthroscopically, based on age within 2 years, gender, workers’ compensation status and diagnosis of FAI. PRO tools, including the modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score – Sport Specific Subscale (HOS - SSS) and Hip Outcome Score - Activity of Daily Living (HOS - ADL), were obtained in all patients pre-operatively and post-operatively at 3 months, 1 year, and 2 years, and at latest follow up. Alpha angles were measured pre and post- surgery for both groups. Revision surgery and complications were recorded for each group.Results:Ten patients were included in the surgical dislocation group, and 20 pair-matched patients were included in the arthroscopic group. 100% patient follow-up was obtained at mean 24.8 months in the open group and 25.5 months in the arthroscopic group. Preoperative mHHS, NAHS, HOS-ADL and HOS-SSS were similar between the two groups. Both the arthroscopic group and the surgical dislocation group had significant postoperative improvement at 3 months, 1 year and final follow-up for all scores. In comparing the two groups, the ΔHOS-SSS was significantly higher in the arthroscopic group at final follow-up, improving 42.8 points versus 23.5 in the surgical dislocation (p=0.047). The arthroscopic group also had significantly better NAHS at 3 months (88.1 vs. 75.3, p=0.016) and at final follow-up. (94.2 vs. 85.7, p=0.01). Nine out of 10 patients in the dislocation group had good/excellent results, and 19 out of 20 patients in the arthroscopic group had good/excellent results. Patient satisfaction for the open group was 8.1, and 9.2 in the arthroscopic group (p=0.07). Both groups showed a significant decrease in the alpha angle postoperatively, from 58° to 40° in the dislocation group, and 57° to 40° in the arthroscopic group, with no difference between the groups (p=0.775). The dislocation group had 8 patients undergo hardware removal, and two required hip arthroscopy for continued pain.Conclusion:This is the first study to directly compare surgical dislocation to arthroscopic management of FAI in single surgeon design. Favorable results were shown with both approaches, with significant improvement in all PRO measures and high patient satisfaction ratings. However, arthroscopic treatment of FAI showed greater improvement in the HOS-SSS and a higher absolute NAHS score at 2 year follow-up.

Surgical Repair of Multiple Pulley Injuries—Evaluation of a New Combined Pulley Repair

We report on a combined repair of multiple annular pulley tears using 1 continuous palmaris longus tendon graft to restore strength and function. We treated 6 rock climbers with grade 4 pulley injuries (multiple pulley injuries) using the combined repair technique and re-evaluated them after a mean of 28 months. All patients had excellent Buck-Gramcko scores; the functional outcome was good in 4, satisfactory in 1, and fair in 1. The sport-specific outcome was excellent in 5 and satisfactory in 1. Proximal interphalangeal joint flexion deficit slightly increased in 1 patient and remained the same in the other 5. Climbing level after the injury was the same as before in 4 and decreased slightly in 2 climbers. The technique is effective with good results and has since become our standard treatment. Nevertheless, it is limited in patients with flexion contracture of the proximal interphalangeal joint. Therapeutic III.