Search

Introduction: Adductor-related groin pain involves an injury to the common aponeurosis connecting the rectus abdominus and adductor longus to the pubis. It commonly occurs in sports that require cutting and pivoting and can result in significant loss of playing time. Platelet-Rich Plasma (PRP) is often indicated for treatment of musculoskeletal disorders and may represent an alternative treatment for patients with adductor-related groin pain. The purpose of this case report is to describe the non-surgical management of adductor-related groin pain in a competitive soccer player with a with an ultrasound (US)-guided PRP injection and physical therapy management., Case Description: A 17-year-old male competitive soccer player with right-sided adductor-related groin pain was treated with an US-guided PRP and a multi-phased physical therapy regimen based on tissue healing and individual patient/criteria progression. The patient completed 12 physical therapy sessions over six weeks post PRP injection., Outcomes: At the end of treatment, clinically meaningful improvements were observed in pain intensity, passive range of motion, strength (handheld dynamometry, Biodex), functional tests, psychosocial (OSPRO-YF) and patient-reported outcomes (HAGOS, LEFS). The subject returned to sport at six weeks post injection without limitation and at three months follow up, the subject reported that he had returned to 95% of his previous level of play., Discussion: This case report may offer support for PRP as an alternative treatment in the management of adductor-related groin pain. Incorporation of PRP as an adjunct to physical therapy led to improvements on all outcomes that surpassed the clinical significance change criteria., Level of Evidence: 5., (© The Author(s).)

Background: The need for capsular closure during arthroscopic hip labral repair is debated., Purpose: To compare pain and functional outcomes in patients undergoing arthroscopic hip labral repair with concomitant repair or plication of the capsule versus no closure., Study Design: Cohort study., Methods: Outcomes were compared between patients undergoing arthroscopic hip labral repair with concomitant repair or plication of the capsule versus no closure at up to 2 years postoperatively and with stratification by age and sex. Patients with lateral center-edge angle <20°, a history of instability, a history of prior arthroscopic surgery in the ipsilateral hip, or a history of labral debridement only were excluded. Subanalysis was performed between patients undergoing no capsular closure who were propensity score matched 1:1 with patients undergoing repair or plication based on age, sex, and preoperative Modified Harris Hip Score (MHHS). We compared patients who underwent T-capsulotomy with concomitant capsular closure matched 1:5 with patients who underwent an interportal capsulotomy with concomitant capsular repair based on age, sex, and preoperative MHHS., Results: Patients undergoing capsular closure (n = 1069), compared with the no-closure group (n = 230), were more often female (68.6% vs 53.0%, respectively; P < .001), were younger (36.4 ± 13.3 vs 47.9 ± 14.7 years; P < .001), and had superior MHHS scores at 2 years postoperatively (85.8 ± 14.5 vs 81.8 ± 18.4, respectively; P = .020). In the matched analysis, no difference was found in outcome measures between patients in the capsular closure group (n = 215) and the no-closure group (n = 215) at any follow-up timepoint. No significant difference was seen between the 2 closure techniques at any follow-up timepoint. Patients with closure of the capsule achieved the minimal clinically important difference (MCID) and the patient acceptable symptom state (PASS) for the 1-year MHHS at a similar rate as those without closure (MCID, 50.3% vs 44.9%, P = .288; PASS, 56.8% vs 51.1%, P = .287, respectively). Patients with T-capsulotomy achieved the MCID and the PASS for the 1-year MHHS at a similar rate compared with those with interportal capsulotomy (MCID, 50.1% vs 44.9%, P = .531; PASS, 65.7% vs 61.2%, P = .518, respectively)., Conclusion: When sex, age, and preoperative MHHS were controlled, capsular closure and no capsular closure after arthroscopic hip labral repair were associated with similar pain and functional outcomes for patients up to 2 years postoperatively., Competing Interests: One or more of the authors declared the following potential conflict of interest or source of funding: M.W.M. has received education payments from CGG Medical and Fortis Surgical LLC. K.W.F. has received nonconsulting fees from Arthrex, Arthrosurface Inc, Baudax Bio, and CGG Medical; education payments from CGG Medical and Arthrex; consulting fees from Exactech, Arthrex, and Flexion Therapeutics; and honoraria from Baudax Bio. R.P.R. has received education payments from CGG Medical, Arthrex, and Smith & Nephew and grant payments from Arthrex. K.H. has received consulting fees from LinkBio Corp. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto Ethical approval for this study was obtained from the University of Florida (reference No. 16614)., (© The Author(s) 2024.)

Background: Studies to date comparing biceps tenodesis methods in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes., Purpose: To compare biceps tenodesis constructs, locations, and techniques in patients who underwent RCR using a large multicenter database., Study Design: Cohort study; Level of evidence, 3., Methods: A global outcome database was queried for patients with medium- and large-sized tears who underwent biceps tenodesis with RCR between 2015 and 2021. Patients ≥18 years of age with a minimum follow-up of 1 year were included. The American Shoulder and Elbow Surgeons, Single Assessment Numeric Evaluation, visual analog scale for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores were compared at 1 and 2 years of follow-up based on construct (anchor, screw, or suture), location (subpectoral, suprapectoral, or top of groove), and technique (inlay or onlay). Nonparametric hypothesis testing was used to compare continuous outcomes at each time point. The proportion of patients achieving the minimal clinically important difference (MCID) at the 1- and 2-year follow-ups were compared between groups using chi-square tests., Results: A total of 1903 unique shoulder entries were analyzed. Improvement in VR-12 Mental score favored anchor and suture fixations at 1 year of follow-up ( P = .042) and the onlay tenodesis technique at 2 years of follow-up ( P = .029). No additional tenodesis comparisons demonstrated statistical significance. The proportion of patients with improvement exceeding the MCID did not differ based on tenodesis methods for any outcome score assessed at the 1- or 2-year follow-up., Conclusion: Biceps tenodesis with concomitant RCR led to improved outcomes regardless of tenodesis fixation construct, location, or technique. A clear optimal tenodesis method with RCR remains to be determined. Surgeon preference and experience with various tenodesis methods as well as patient clinical presentation should continue to guide surgical decision-making., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: J.J.K. has received consulting fees from Exactech and LinkBio. R.C.S. has received education payments from Medinc of Texas, consulting fees and nonconsulting fees from Acumed, and hospitality payments from Exactech and Integra LifeSciences. T.W.W. has received consulting fees and royalties from Exactech. M.W.M. has received education payments from Fortis Surgical. K.W.F. has received education payments from Arthrex and CCG Medical; consulting fees from Exactech, Pacira Therapeutics and Arthrex; nonconsulting fees from Arthrex, Baudex, CCG Medical, and Arthrosurface; and honoraria from Baudex. J.O.W. has received education payments from Pinnacle and hospitality payments from Acumed, Stryker, and Zimmer Biomet. R.P.R. has received grant support from Arthrex and education payments from Arthrex and Smith & Nephew. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2023.)

An adolescent female patient presented with atraumatic left knee pain and limited flexion. MRI demonstrated evidence of a soft tissue lesion abutting the posterior cruciate ligament. Differential diagnosis included pigmented villonodular synovitis (PVNS) and fibroma of the tendon sheath (FTS). Following arthroscopic biopsy, histopathological evaluation confirmed FTS. The tumour was then excised via an arthroscopic approach. This case report provides a unique example of FTS abutting the cruciate ligaments in an uncommonly young female patient. It highlights the importance of including benign processes, such as FTS, in the differential with more aggressive-type diagnoses like PVNS. Furthermore, this case exemplifies an appropriate surgical indication for FTS. Finally, it emphasises the importance of communication and collaboration among orthopaedic subspecialists in providing safe and effective arthroscopic treatment of this unique tumour presentation., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Studies to date evaluating biceps tenotomy versus tenodesis in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes., Hypothesis: It was hypothesized that a significant difference could be demonstrated for pain and functional outcome scores comparing biceps tenotomy versus tenodesis in the setting of RCR if the study was adequately powered., Study Design: Cohort study; Level of evidence, 3., Methods: The Arthrex Surgical Outcomes System database was queried for patients who underwent arthroscopic biceps tenotomy or tenodesis and concomitant RCR between 2013 and 2021; included patients had a minimum of 2 years of follow-up. Outcomes between treatment types were assessed using the American Shoulder and Elbow Surgeons Shoulder (ASES), Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Results were stratified by age at surgery (3 groups: <55, 55-65, >65 years) and sex., Results: Overall, 1936 primary RCRs were included for analysis (1537 biceps tenodesis and 399 biceps tenotomy patients). Patients who underwent tenotomy were older and more likely to be female. A greater proportion of female patients aged <55 years and 55 to 65 years received a biceps tenotomy compared with tenodesis ( P = .012 and .026, respectively). All scores were comparable between the treatment types preoperatively and at 3 months, 6 months, and 1 year postoperatively. At 2-year follow-up, patients who received a biceps tenodesis had statistically more favorable ASES, SANE, VAS pain, and VR-12 scores ( P ≤ .031); however, the differences did not exceed the minimal clinically important difference (MCID) for these measures., Conclusion: Our findings indicate that surgeons are more likely to perform a biceps tenotomy in female and older patients. Biceps tenodesis provided improved pain and functional scores compared with tenotomy at 2-year follow-up; however, the benefit did not exceed previously reported MCID for the outcome scores. Both procedures provided improvement in outcomes; thus, the choice of procedure should be a shared decision between the surgeon and patient., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: R.C.S. has received education payments from MedInc, speaking fees from Acumed, and hospitality payments from Integra LifeSciences. T.W.W. has received consulting fees and royalties from Exactech. K.W.F. has received education payments from Exactech; consulting fees from Arthrex, Exactech, and Flexion Therapeutics; speaking fees from Arthrex, Arthrosurface, and CGG Medical; honoraria from Arthrosurface and Baudax Bio; and hospitality payments from Rotation Medical. J.O.W. has received education payments from Pinnacle and hospitality payments from Acumed and Zimmer Biomet. R.P.R. has received grant support from Arthrex and education payments from Arthrex and Smith & Nephew. M.W.M. has received education payments from Fortis Surgical and speaking fees from Arthrex. M.C.F. has received hospitality payments from Arthrex. J.J.K. has received consulting fees from Exactech and hospitality payments from Integra LifeSciences. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2022.)

Background: Ligamentum teres (LT) reconstruction is an appropriate alternative in select cases of LT full-thickness tears, resulting in hip micro- or macroinstability. Graft fixation at the acetabular fossa is critical to achieving the best functional results., Purpose: The purpose of this study is to compare the pullout strength of 2 graft fixation methods used for LT reconstruction of the hip., Study Design: Controlled laboratory study., Methods: In 7 cadaveric specimens, the acetabular socket was prepared after the native LT was transected and the femoral head was removed. Seven separate tibialis anterior grafts were then prepared by suturing a running-locking No. 2 suture on each tail of the graft. Three specimens had fixation of the graft to the acetabulum using an adjustable cortical suspension suture button; the remaining 4 were fixed to the acetabulum using a knotless suture anchor. Specimens were then mounted onto a custom jig within a mechanical test frame to allow for the in-line pull of the graft fixation construct. After a preload of 5 N, each specimen was loaded to failure at 0.5 mm/s. Stiffness and load to failure were measured for each specimen construct., Results: Suture button fixation had a higher mean load to failure when compared with the knotless anchor fixation method (mean ± SD, 438.1 ± 114.3 vs 195.9 ± 50.0 N; P = .01). There was no significant difference in mean stiffness between the methods of fixation (24.5 ± 1.4 vs 26.5 ± 5.8 N/mm; P = .6)., Conclusion: In this cadaveric study, the suture button fixation demonstrated greater load to failure than the knotless anchor fixation., Clinical Relevance: Results of this study can guide surgical decision making when selecting an acetabular fixation method for LT reconstruction., Competing Interests: One or more of the authors has declared the following potential conflict of interest or source of funding: This study was sponsored by Arthrex in the form of direct funding as well as in kind donations of cadaveric specimens and surgical products used in the completion of the study aims. A.C.L. has received research support from Arthrex, Stryker, and Medacta; education payments from Arthrex, Medwest, and Smith & Nephew; consulting fees from Arthrex and Graymont Medical; and hospitality payments from Zimmer Biomet. M.K.R. has received research support from Arthrex, education payments from Smith & Nephew, and hospitality payments from Prime Surgical. R.P.R. has received research support from Arthrex and education payments from Arthrex and Smith & Nephew. P.J.R. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. D.R.M. has received hospitality payments from Arthrex, Stryker, and Smith & Nephew. B.A.E. has received consulting fees, nonconsulting fees, and royalties from Arthrex. B.G.D. has received research support from Arthrex, ATI, Stryker, and Pacira Pharmaceuticals; education payments from Arthrex, Breg, and Medwest; consulting fees from Adventist Hinsdale Hospital, Arthrex, MAKO Surgical, Medacta, Pacira Pharmaceuticals, and Stryker; speaking fees from Arthrex and Pacira Pharmaceuticals; honoraria from Medacta; and royalties from Amplitude, Arthrex, DJO Global, MAKO Surgical, Medacta, Stryker, and Orthomerica. B.G.D has also had ownership interests in Hinsdale Orthopaedics, the American Hip Institute, SCD#3, North Shore Surgical Suites, and Munster Specialty Surgery Center. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto., (© The Author(s) 2021.)

Background: The purpose of this study is to present surgical outcomes after humeral head allograft augmentation and glenoid-based procedures in patients with active, uncontrolled seizure activity and anterior shoulder instability., Methods: A retrospective review of a surgical database for patients with active seizure disorder and with recurrent shoulder instability managed with humeral head augmentation was performed. All patients underwent surgical intervention. Postoperative outcomes including Shoulder Pain and Disability Index, Simple Shoulder Test, American Shoulder and Elbow Surgeons questionnaire, and the Short Form Health Survey (SF-12) were recorded at a minimum of 2 years. We hypothesized that appropriate management of the bony defects in these bipolar injuries would result in low recurrence and satisfactory outcomes., Results: Ten patients including 8 males and 2 females (15 shoulders) with active seizure-related shoulder instability underwent surgical intervention including allograft bone grafting of the Hill-Sachs lesion for anterior shoulder instability. The average age was 27 years. All patients reported recurrent seizures postoperatively, but only one sustained a shoulder dislocation after surgery that was unrelated to seizure activity.Self-reported satisfaction was "much better" or "better" in 92% of shoulders. Average outcome scores were as follows: American Shoulder and Elbow Surgeons score = 67 (33-100), Shoulder Pain and Disability Index = 32.5 (0-83), Simple Shoulder Test = 9.4 (5-12), SF-12 PCS = 44.1 (21-65), and SF-12 MCS = 50.6 (21-61). The average follow-up was 4.8 years., Conclusion: Management of bipolar shoulder injuries with humeral head allograft augmentation and glenoid based surgery leads to low recurrence rates and good clinical outcomes in patients with uncontrolled, seizure-related shoulder instability., (© 2021 The Authors.)

This is a case report of a 48-year-old man with multiple transient ischemic attacks and a known hypoplastic right vertebral artery (VA) who presented after a syncopal event while turning his head to the left. The objective of this study is to demonstrate the necessity of proper diagnosis and management of cerebrovascular pathology including imaging and surgical intervention in patients with known anatomical anomalies. This study was conducted at Massachusetts, United States of America. Our patient's history was significant for a hypoplastic right VA and a stenotic segment of the right VA at the C3-C4 junction. There was also degeneration of the C3-C4 facet on the left, with osteophyte formation compressing the VA, and a fusion of the C2-C3 segment. Imaging demonstrated obliteration of the left VA flow with head rotation to the left and subsequent reconstitution of flow in the neutral position. After consultation, the patient decided to proceed with surgical management with an anterior cervical discectomy and fusion at the level of C3-C4. Symptoms of vertebrobasilar insufficiency including syncopal episodes resolved after treatment. VA anomalies, although uncommon, are important to understand. Our patient presented with an anomalous right VA, as well as severe degenerative changes to the C2/C3 vertebrae that contributed to the development of Bow Hunter's syndrome. It is essential that proper monitoring and follow-up has to be carried out in patients with abnormal cerebral vasculature to minimize the occurrence of Bow Hunter's syndrome., Competing Interests: There are no conflicts of interest.