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Background: Prior reports of hip arthroscopy using a perineal post have established the risks of groin soft tissue injury, sexual dysfunction, and altered lower extremity neurovascular function. These parameters have not been investigated for hip arthroscopy without the use of a perineal post. Purpose: To evaluate the effects of postless hip arthroscopy on lower extremity venous blood flow, nerve conduction, muscle tissue damage, and perineal injury. Study Design: Case series; Level of evidence, 4. Methods: Patients between the ages of 18 and 50 years undergoing an elective unilateral or simultaneous bilateral hip arthroscopy were enrolled. Creatine phosphokinase (CPK)–MM levels and D-dimer levels were obtained preoperatively, immediately postoperatively, and 7 to 12 days postoperatively. Bilateral Doppler ultrasonography of the common femoral vein (CFV) and popliteal vein were conducted intraoperatively. Somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (TcMEPs) were measured intraoperatively for the lower limbs. Perineal injury was assessed at 7 to 12 days postoperatively. Results: 35 patients underwent a total of 40 hip arthroscopies. No significant differences were found in venous blood flow between the operative and nonoperative legs for either the CFV or popliteal vein. SSEP monitoring of the peroneal nerve showed no significant reduction when traction was applied to the operative leg, 90.8%, compared with final measurement just before it was removed, 72.4% ( P = .09). For TcMEPs measured in the muscles outside of the traction boots, no significant changes were seen in the percentage of cases with abnormal measurements throughout the procedure. CPK-MM levels preoperatively, immediately postoperatively, and 7 to 12 days after surgery were on average 112, 190, and 102 IU/L, respectively (normal, Conclusion: Postless hip arthroscopy is safe, without a notable reduction of venous blood flow or alteration of nerve function in the operative leg. Muscle tissue damage is subclinical, transient, and reduced compared with distraction with a post. No cases of perineal injury were observed during the study period.

Orthopedic surgeons are among the highest prescribers of narcotic pills, and no guidelines currently exist for appropriate management of postoperative pain within this field. The purpose of this study was to gain understanding of the current pain management strategies used perioperatively and postoperatively among orthopedic shoulder surgeons.Members of the American Shoulder and Elbow Surgeons were e-mailed an online survey regarding methods for managing pain in the perioperative and postoperative setting for total shoulder arthroplasty, labral and capsular stabilization procedures, and rotator cuff repair. Postoperative narcotic prescribing amounts were converted into oral morphine equivalents.The survey response rate was 25.8% (170/658), with90% of surgeons reporting use of a standard pain management regimen in the perioperative and postoperative periods. A regional nerve block was used on the operative day by 80% of surgeons for all 3 procedures. Short-acting narcotics are prescribed for postoperative pain control by 85% of surgeons, with long-acting narcotics provided by 14%. More than 400 oral morphine equivalents of short-acting narcotic are prescribed by shoulder surgeons. Referral to a pain specialist or primary care physician is made after 12 weeks by 92.3% of surgeons if patients continue to require narcotic painkillers.The majority of shoulder surgeons use a standard pain management protocol in perioperative and postoperative settings. Regimens frequently include a regional nerve block, nonsteroidal anti-inflammatory drugs, and short-acting oral narcotics. Findings from this study provide guidelines on standard pain management strategies for common shoulder operations based on expert opinion.

Symbol Technical errors such as nonanatomic tunnel placement are some of the most common causes of graft failure after primary anterior cruciate ligament reconstruction (ACLR).Symbol When considering a revision ACLR in a patient with ACL graft failure, it is crucial to perform preoperative imaging

BACKGROUND The aims of this study were to describe a novel minimally invasive, interlocking periacetabular osteotomy (PAO) for the treatment of hip dysplasia that was developed at our institution and to report on its safety, complications, and early clinical outcomes. METHODS This was a prospective longitudinal study of the first 200 consecutive hips that underwent the CU (University of Colorado) PAO, an interlocking osteotomy combining the benefits of the Birmingham interlocking pelvic osteotomy (BIPO) and the Ganz PAO. The technique provides direct visualization of the sciatic nerve during the ischial osteotomy and allows for immediate weight-bearing postoperatively. Demographic characteristics, intraoperative and perioperative parameters, and functional outcomes were documented. All patients underwent hip arthroscopy 3 to 10 days prior to the PAO to address concomitant intra-articular pathology. Mechanical deep venous thrombosis (DVT) prophylaxis was used for 2 weeks postoperatively. Results were stratified to compare the first 100 and the second 100 cases. RESULTS A total of 161 patients (200 hips) underwent primary PAO; mean follow-up was 20 months (range, 3 to 33 months). The mean patient age at the time of surgery was 29.4 years (range, 13 to 55 years). Females accounted for 89% of the patients included in this study. The average length of stay was 4 days. A concomitant proximal femoral derotational osteotomy was performed in 19 hips. The lateral center-edge angle (LCEA) improved from a mean of 18.8° preoperatively to 31.5° postoperatively (p < 0.001). The mean Non-Arthritic Hip Score (NAHS) improved from 56.0 preoperatively to 89.4 at the 24-month follow-up (p < 0.0001). Paresthesias in the distribution of the lateral femoral cutaneous nerve were common (65% at 2 weeks postoperatively) but resolved in 85% of the patients within the first 6 months. There were no sciatic nerve-related complications, deep infections, or DVTs. CONCLUSIONS The CU PAO enables corrective realignment of symptomatic acetabular dysplasia with direct visualization of the sciatic nerve, early weight-bearing, cosmetic incisions, and good short-term outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The direction and nature of incisions can impact the healing and appearance of a surgical scar. This can be attributed mainly due to skin tension and direction of force. The aim of this study was to identify differences in healing rates and scar esthetics between transverse and longitudinal portals used for hip arthroscopy. A total of 75 patients underwent bilateral hip arthroscopy for femoroacetabular impingement. All patients received a portal perpendicular to the long axis of the body on the left side (transverse portal) and parallel with the long axis of the body on the right side (longitudinal portal) for the standard anterolateral viewing portal. Postoperatively, patients were reviewed at 2 weeks, 6 weeks, 3 months and 6 months and the portal scars were assessed, photographed and measured. No patients were lost to follow-up. The transverse scars, although slightly longer, were found to be narrower at 6 weeks (3.8 mm versus 2.7 mm, P

Strains of the adductor muscle are common among athletes, but avulsion at its insertion is rare. Likewise, the diagnosis and management of distal ruptures of the adductors are infrequently reported in the literature. Presented here are the common presenting clinical findings of chronic distal adductor longus tendon ruptures and a description of how these can be successfully treated with a previously undescribed surgical technique. Preoperative and postoperative magnetic resonance imaging can be compared for verification of successful surgical repair. Also reviewed are common sports and mechanisms that elicit this injury pattern, adductor longus muscle function, relevant surgical anatomy, and treatment strategies.

Superior labral anterior and posterior lesions and long head biceps injury are 2 common sources of shoulder pain. The presenting complaints and physical examination findings for these etiologies are often nonspecific, making diagnosis challenging. Further complicating their diagnoses, these 2 pathologies often cooccur together or with other shoulder pathologies such as subacromial bursitis, rotator cuff tear, and shoulder instability. However, with advancement in magnetic resonance imaging and shoulder arthroscopy techniques the ability to diagnose and treat these pathologies has vastly improved over the past 30 years. This review provides a case-based description of the correlation between magnetic resonance imaging and arthroscopic findings in common superior labral anterior and posterior and long head biceps injury, accompanied with current management strategies.

Arthroscopic treatment of hip disorders is an area of growing interest in the United States, with increasing numbers of operations being performed and an increasing presence of fellowship programs for training in hip preservation1-3. Femoroacetabular impingement has been implicated as one of the most common causes of osteoarthritis of the nondysplastic hip when abnormal contact mechanics result in degeneration of chondrolabral soft tissues in the hip joint4-9. Structural deformities include loss of femoral head-neck offset and/or sphericity (cam-type …

The purpose of this study is to demonstrate that the percentage of obese individuals initially presenting to total joint arthroplasty clinics in a public, tertiary hospital is greater than the proportion of obese individuals in the general population. In a retrospective, comparative study of patients seen in total joint replacement clinics at a public, tertiary hospital with an ICD-9 diagnosis of hip or knee osteoarthritis and documented body mass index, the proportion of obese individuals was compared with recent obesity data for the general population from the Centers for Disease Control and Prevention. Patients who had previously undergone hip or knee replacement surgery were excluded. Comorbid conditions, functional comorbidity index (FCI) scores, and Charlson comorbidity index scores were compared between obese and nonobese cohorts. The study included 499 patients aged 20 to 92 years (mean, 64.3 years), 58.9% of whom were female. Fifty-five percent of patients were obese, a significantly greater percentage than in the national (34.9%; P P P P P Orthopedics. 2016; 39(1):e127–e133.]

Background: As participation in high school athletics increases, so does the number of adolescents experiencing sports-related injury. Understanding injury patterns is an important component to developing and evaluating prevention and rehabilitation programs. Purpose: To analyze recurrent injury rates and patterns among high school athletes, to compare recurrent injuries with new injuries, and to evaluate injury trends over time. Study Design: Descriptive epidemiology study. Methods: High school sports injury data on 24 sports were collected from 2005-2006 through 2015-2016 via the High School RIO (Reporting Information Online) surveillance system. Injury rates were calculated as number of injuries per 10,000 athletic exposures (AEs). Injury rate ratios and injury proportion ratios (IPRs) were calculated to compare differences among subgroups. Results: Overall, 78,005 injuries were sustained during 40,195,806 AEs, for an injury rate of 19.41 per 10,000 AEs. Of these, 69,821 (89.5%) were new injuries, and 8184 (10.5%) were recurrent. The ankle was the most commonly injured body part among recurrent injuries, while the head/face was the most common body part that sustained new injuries. Ligament sprains were more often recurrent, while concussions were more commonly diagnosed as new, although concussions represented 16.7% of recurrent injuries. Trends for recurrent injuries over time were relatively stable. The proportion of athletes who had >3 weeks of time loss or medical disqualification (15.8% vs 13.3%; IPR, 1.19; 95% CI, 1.13-1.26) or who voluntarily withdrew from sport (2.5% vs 1.1%; IPR, 2.33; 95% CI, 2.00-2.73) was significantly greater for recurrent injuries than new injuries. Furthermore, a greater proportion of recurrent injuries resulted in surgery (8.1% vs 6.0%; IPR, 1.34; 95% CI, 1.24-1.46). Conclusion: Although only 10.5% of all injuries were recurrent, they more frequently resulted in missing >3 weeks of playing time and were more often managed surgically when compared with new injuries. The rate of recurrent injuries has not increased over the past decade.

Background: Lacrosse and ice hockey are quickly growing in popularity, while football remains the most popular sport among high school student-athletes. Injuries remain a concern, given the physical nature of these contact sports. Purpose: To describe the rates and patterns of injuries sustained as a result of intentional player contact in United States high school boys’ football, ice hockey, and lacrosse. Study Design: Descriptive epidemiology study. Methods: We conducted a secondary analysis of High School RIO (Reporting Information Online) data, including exposure and injury data collected from a large sample of high schools in the United States from 2005-2006 through 2015-2016. Data were analyzed to calculate rates, assess patterns, and evaluate potential risk factors for player-to-player contact injuries. Results: A total of 34,532 injuries in boys’ football, ice hockey, and lacrosse occurred during 9,078,902 athlete-exposures (AEs), for a rate of 3.80 injuries per 1000 AEs in the 3 contact sports of interest. The risk of injuries was found to be greater in competition compared with practice for all 3 sports, with the largest difference in ice hockey (rate ratio, 8.28) and the smallest difference in lacrosse (rate ratio, 3.72). In all 3 contact sports, the most commonly injured body site in competition and practice caused by both tackling/checking and being tackled/checked was the head/face. However, a significantly greater proportion of concussions sustained in football were the result of tackling compared with being tackled (28.2% vs 24.1%, respectively). In addition, a significantly greater proportion of concussions were sustained in competition compared with practice for all 3 sports. Conclusion: This study is the first to collectively compare injury rates and injury patterns sustained from intentional player-to-player contact in boys’ high school football, ice hockey, and lacrosse. Notably, there was a relatively high risk of injuries and concussions during football practices.

The study aim was to understand patient impressions of reimbursement to orthopedic spine surgeons. Our findings revealed that the majority of patients significantly overestimate the amount surgeons are reimbursed per procedure. Despite this, most feel that surgeons are appropriately compensated. Additionally, many patients are unaware of the global billing period.