Arthroscopic surgery for isolated capitellar osteochondritis dissecans in adolescent baseball players: minimum three-year follow-up

BACKGROUND: Osteochondritis dissecans of the capitellum of the humerus usually occurs in adolescence and is caused by the valgus forces associated with excessive throwing. HYPOTHESIS: Arthroscopic surgery is an appropriate procedure for this condition. STUDY DESIGN: Retrospective cohort study. METHODS: Arthroscopic surgery was performed on 10 baseball players (average age, 13.8 years) with osteochondritis dissecans whose symptoms had been apparent for an average of 9 months before the operation. Follow-up at an average of 3.9 years included use of a standard rating scale, radiographs, and a questionnaire regarding return to sport. RESULTS: There were two grade I, one grade II, two grade IV, and five grade V lesions. Symptoms and objective findings correlated poorly with the grade of the lesion. The postoperative score averaged 195, reflecting excellent results. Radiographically, the primary lesion was still apparent in one patient, secondary degenerative changes were evident in one patient, and, in one patient, the lesion was still evident and degenerative changes had occurred. Only four athletes returned to organized baseball. CONCLUSIONS: Arthroscopic surgery for symptomatic osteochondritis dissecans of the capitellum in adolescent baseball players can provide excellent rating scores with intermediate follow-up but does not assure return to baseball.     

Arthroscopic labral repair concomitantly performed with curved periacetabular osteotomy

A 23-year-old female presented with pain in the left hip. Radiological examination showed developmental dysplasia of the hip (DDH) combined with acetabular retroversion and posterior wall deficiency. Findings in the physical examination were coincident with femoroacetabular impingement. At surgery, we performed curved periacetabular osteotomy concomitant with arthroscopic labral repair and osteochondroplasty, simultaneously addressing dysplastic acetabulum and femoroacetabular impingement. The final follow-up examination at 18 months showed satisfactory outcome with the D’Aubigne and Postel hip score of 17/18. In addition to accurate diagnosis, the arthroscopic procedure for associated intra- and peri-articular problems seems to help improve the surgical outcome of periacetabular osteotomy performed for patients with DDH. Level of evidence IV.     

Modest mid-term outcomes after isolated arthroscopic debridement of acetabular labral tears

Purpose

Currently, there is a paucity of literature regarding outcomes after isolated labral debridement. The purpose of this study was to (1) report the reoperation rate following isolated labral debridement, (2) report clinical and functional outcomes after labral debridement with a minimum 2-year follow-up and (3) identify risk factors for worse clinical and functional outcomes. It was hypothesized that inferior outcomes are associated with an increasing Tönnis grade and those with untreated femoral acetabular impingement (FAI).

Methods

The records of patients undergoing hip arthroscopy between 1998 and 2005 were reviewed. Patients with labral tears who underwent isolated arthroscopic labral debridement were identified. Kaplan–Meier estimate of failure (defined as subsequent surgery) was performed for all patients. Patients with minimum 2-year follow-up were assessed with Modified Harris Hip Score (MHHS) and Hip Outcome Score (HOS). Univariate analysis was then performed to assess which factors were associated with worse clinical and functional outcomes.

Results

Fifty-nine hips in 57 patients met our inclusion criteria (39 females, 18 males) with a mean age of 46 ± 14 years and mean follow-up of 5 (range 2–14) years. Overall, 45 % of the hips failed for repeat surgery (20 %) or rating for hip function as abnormal or severely abnormal (25 %). Twelve hips (20 %) required subsequent surgical intervention at a mean 23 (range 6–60) months (7 total hip arthroplasties, 2 open revisions, 3 arthroscopic revisions). Of the remaining hips, mean MHHS was 83.4 ± 19.7, mean HOS ADL score was 83.8 ± 21.3 and mean HOS sport score was 70.6 ± 32.9, with 33 of 41 (75 %) reporting normal or nearly normal current level of function. Univariate analysis revealed that hips with untreated bony impingement (p = 0.01) or requiring concomitant chondroplasty (p = 0.03) had inferior clinical outcome scores.

Conclusions

Isolated arthroscopic labral debridement for hip labral tears had 45 % combined poor results when strictly defining failure as repeat surgery or abnormal hip rating. Untreated FAI and concomitant chondroplasty were risk factors for inferior outcome. We recommend concomitant treatment for bony impingement lesions and preservation of the labrum whenever possible.

Level of evidence

Retrospective case series, Level IV.     

Arthroscopic debridement of the isolated Ligamentum Teres rupture

Purpose

Most tears of the Ligamentum Teres (LT) are diagnosed when treating other hip pathologies. The purpose of this study was to evaluate the outcome of arthroscopic surgery for a unique group of patients with symptomatic isolated Ligamentum Teres rupture of the hip.

Methods

The study included 29 patients who suffered from an isolated Ligamentum Teres rupture of the hip and were treated with an arthroscopic debridement from 2003 to 2008. Patients with femoroacetabular impingement or other hip pathologies except Ligamentum Teres tear were excluded. Clinical results were measured preoperatively and postoperatively with the modified Harris Hip Score (MHHS) and Non-Arthritic Hip Score (NAHS). The mean age was 25?years (SD?±?11) with a mean follow-up time of 2.5?years (SD?±?1.5).

Results

At the last follow-up, the mean MHHS improved from 70 to 86 [mean difference?=?16 (95% CI 4?C27)] and the mean NAHS improved from 64 to 86 [mean difference?=?22 (95% CI 10?C33)]. Five patients have had a second arthroscopic debridement due to symptomatic recurrent tears.

Conclusion

Arthroscopic debridement alone of the isolated Ligamentum Teres rupture has a short-term beneficial result in more than 80% of cases.     

Red blood cell profile of elite olympic distance triathletes. A three-year follow-up

The purpose of this study was to monitor general and individual changes in hematological variables during long-term endurance training, detraining and altitude training in elite Olympic distance triathletes. Over a period of three years, a total of 102 blood samples were collected in eleven (7-male and 4 female) elite Olympic distance triathletes (mean +/- SD; age = 26.4 +/- 5.1 yr; VO(2) max = 67.9 +/- 6.6 ml/min/kg) for determination of hemoglobin (Hb), hematocrit (Hct), red blood cell count (RBC), Mean corpuscular hemoglobin (MCH), Mean corpuscular hemoglobin content (MCHC), Mean corpuscular volume (MCV) and plasma ferritin. The data were pooled and divided into three periods; off-season, training season and race season. Blood samples obtained before and after altitude training were analyzed separately. Of all measured variables only RBC showed a significant decrease (p < 0.05) during the race season compared to the training season. Hematological values below the lower limit of the normal range were found in 46 % of the athletes during the off-season. This percentage increased from 55 % during the training season to 72 % of the athletes during the race season. Hemoglobin and ferritin values were most frequently below the normal range. There was a weak correlation between Hb levels and VO(2) max obtained during maximal cycling (r = 0.084) and running (r = 0.137) tests. Unlike training at 1500 m and 1850 m, training at an altitude of 2600 m for three weeks showed significant increases in Hb (+ 10 %; p < 0.05), Hct (+ 11 %; p < 0.05) and MCV (+ 5 %; p < 0.05). Long-term endurance training does not largely alter hematological status. However, regular screening of hematological variables is desirable as many athletes have values near or below the lower limit of the normal range. The data obtained from altitude training suggest that a minimum altitude (>2000 m) is necessary to alter hematological status.     

Superior labral strain during the throwing motion. A cadaveric study

We studied the strain on the superior labrum of 10 fresh-frozen cadaveric shoulders with the arm in simulated positions of a pitching motion. We used linear transducers to measure the strain in both the anterior and posterior superior labrum with the arm in various planes and rotations simulating the motions of pitching: early cocking, late cocking, acceleration, deceleration, and follow-through. Predetermined loads, according to the percent of maximum voluntary contraction of the biceps muscle during each phase of pitching, were calculated and applied to the long head of the biceps tendon using a spring device. Only during the late cocking phase, when the arm was in maximal external rotation, was the increase in strain statistically significant for the anterior and posterior portions and the strain on the posterior portion significantly greater than that on the anterior portion of the labrum. The increased strain in the posterior portion may be due to the anatomic orientation of the long head of the biceps tendon at the superior labrum. The increased strain in the late cocking phase may contribute to the detachment of the labrum with the eccentric contraction of the biceps muscle that occurs with rapid extension of the elbow.     

Arthroscopic debridement of theacromioclavicular joint and distal clavicle resection

Painful disorders of the acromioclavicular joint that have not responded to extensive nonoperative management are well treated by arthroscopic resection of the distal clavicle. When the acromioclavicular and coracoclavicular ligaments are intact and the joint is stable, excellent pain relief and function may be achieved, and bone removal is comparable with that obtained with open techniques. When acromioclavicular disease is isolated, a direct (superior) approach to the acromioclavicular joint is preferred. When a sub-acromial procedure (usually acromioplasty) is also planned, a bursal approach is used.     

Arthroscopic meniscectomy: a follow-up report

Eighty patients who underwent arthroscopic meniscectomy were interviewed and examined 12 to 24 months postoperatively. Twenty-seven (34%) of the patients rated their knees as normal, and 46 (58%) of the patients rated their knees as improved. Seventy-nine percent of the patients were pain free at the time of followup. Patients with poor results were likely to have significant degenerative disease or instability. Sixty-five percent of the patients returned to their original sport. Factors limiting patients' return to sports after meniscectomy included instability, patellofemoral disease, and degenerative arthritis.     

Arthroscopic debridement and biological resurfacing of the glenoid in glenohumeral arthritis

The purpose of this study was to analyse the intermediate-term results of an arthroscopic procedure to debride and resurface the arthritic glenoid, in a middle-aged population, using an acellular human dermal scaffold. Between 2003 and 2005, thirty-two consecutive patients underwent an arthroscopic debridement and biological glenoid resurfacing for glenohumeral arthritis. The diagnoses included primary osteoarthrosis (28 patients), arthritis after arthroscopic reconstruction for anterior instability (1 patient) and inflammatory arthritis (3 patients). All shoulders were assessed clinically using the Constant and Murley score, and results graded according to Neer’s criteria. Statistical analysis was performed to determine significant parameters and associations. A significant improvement (P < 0.0001) in each parameter of the subjective evaluation component (severity of pain, limitation in daily living and recreational activities) of the Constant score was observed. The Constant and Murley score increased significantly (P < 0.0001) from a median of 40 points (range 26–63) pre-operatively to 64.5 (range 19–84) at the final assessment. Overall, the procedure was considered as “successful outcome” in 23 patients (72%) and as a “failure” in 9 patients (28%). According to Neer’s criteria, the result was categorized as excellent in 9 (28%), satisfactory in 14 (44%) and unsatisfactory in 9 (28%). Within the unsatisfactory group, there were five conversions to prosthetic arthroplasty. A standard magnetic resonance imaging was performed on 22 patients in the successful outcome group; glenoid cartilage was identified in 12 (thick in 5, intermediate in 1, thin in 6) and could not be identified in 10 patients (complete/incomplete loss in 5, technical difficulties in 5). Overall, five complications included transient axillary nerve paresis, foreign-body reaction to biological material, inter-layer dissociation, mild chronic non-specific synovitis and post-traumatic contusion. Dominance of affected extremity and generalized disease (diabetes, rheumatoid arthritis, generalized osteoarthritis) was associated with an unsatisfactory outcome (P < 0.05). Arthroscopic debridement and biological resurfacing of the glenoid is a minimally invasive therapeutic option for pain relief, functional improvement and patient satisfaction, in glenohumeral osteoarthritis, in the intermediate-term.     

Correlation of Short Form-36 and disability status with outcomes of arthroscopic acetabular labral debridement

BACKGROUND: Arthroscopic debridement is the standard of care for the treatment of acetabular labral tears. The Short Form-36 has not been used to measure hip arthroscopy outcomes, and the impact of disability status on hip arthroscopy outcomes has not been reported. HYPOTHESIS: Short Form-36 subscale scores will demonstrate good correlation with the modified Harris hip score, but patients undergoing disability evaluation will have significantly worse outcome scores. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: The records of active-duty soldiers who underwent hip arthroscopy at the authors' institution were retrospectively reviewed. Forty consecutive patients who underwent hip arthroscopy for the primary indication of labral tear formed the basis of the study group. Patients completed the modified Harris hip score, the Short Form-36 general health survey, and a subjective overall satisfaction questionnaire. RESULTS: Thirty-three patients, with a mean age of 34.6 years, were available for follow-up at a mean of 25.7 months postoperatively. Fourteen (43%) patients were undergoing medical evaluation boards (military equivalent of workers' compensation or disability claim). Pearson correlation coefficients for comparing the Short Form-36 Bodily Pain, Physical Function, and Physical Component subscale scores to the modified Harris hip score were 0.73, 0.71, and 0.85, respectively (P < .001). The mean modified Harris hip score was significantly lower in patients on disability status than in those who were not (92.4 vs 61.1; P < .0001). The Short Form-36 subscale scores were significantly lower in disability patients (P < .02). Patient-reported satisfaction rates (70% overall) were 50% for those undergoing disability evaluations and 84% for those who were not (P < .04). There was no significant difference in outcomes based on patient age, surgically proven chondromalacia, or gender for military evaluation board status. CONCLUSION: The Short Form-36 demonstrated good correlation with the modified Harris hip score for measuring outcomes after arthroscopic partial limbectomy. Arthroscopic debridement yielded a high percentage of good results when patients undergoing disability evaluations were excluded. Disability status may be a negative predictor of success after hip arthroscopy.     

Arthroscopic partial meniscectomy: 5-year follow-up

The purpose of this study was to determine the influence of preexisting chondromalacia at time of surgery on the results at a minimum of 5 years follow-up of arthroscopic partial menisceetomy. The patients were divided into two groups: group 1 (87 patients, average age 29.8 years) with no intraoperative findings of chrondromalacia at the time of surgery, and group II (234 patients, average age 39.2 years) with chondromalacia at the time of surgery. The follow-up period was 70–86 months, with the eriterion of a minimum of 5 years in each patient. Postoperative changes were evaluated according to Fairbank's classification and preoperative X-rays were compared to follow-up X-rays. For statistical analysis the Mann-Whitney test was used. In both groups arthroscopic partial lateral meniscectomy led to worse results in respect of the development of osteoarthritis. Following partial medial meniscectomy preexisting chondromalacia had a negative influence on the radiological outcome. An increase of osteoarthritis was also proven in our patient population which was statistically significantly related to age and female sex (P=0.002).     

Arthroscopic subacromial decompression. An anatomical study

Anterior acromioplasty as described by Neer has been an effective procedure for shoulder impingement syndrome. Recent presentations by Ellman suggest that an effective acromioplasty may be performed arthroscopically. These clinical reports have not been supported by any laboratory experience. The purpose of our study was to examine the feasibility and attempt to quantitate the results of arthroscopic subacromial decompressions. Six acromioplasties were performed according to the recommended technique of Dr. Neer to create a standard for comparison. Fourteen fresh postmortem specimens were studied. In seven shoulders a standard acromioplasty was performed with an osteotome. In seven shoulders an acromioplasty was performed using standard arthroscopic approaches and motorized instruments. In five shoulders an isolated division of the coracoacromial ligament was performed arthroscopically. The coracoacromial ligament was completely divided in all five cases. In the osteotome group adequate bone was resected in 75% (21/28) measured locations. In the arthroscopic group adequate bone was removed at 86% (24/28) location. This difference is not statistically significant. In the cadaver, anterior acromioplasty was performed effectively and predictably with arthroscopic instruments. This compared favorably to a conventional osteotome acromioplasty. It was concluded that coracoacromial ligament division can be accomplished.     

Arthroscopic lavage reduced the recurrence rate following primary anterior shoulder dislocation A randomised multicentre study with 1-year follow-up

Young individuals have a high recurrence rate following non-operative treatment of traumatic primary anterior shoulder dislocation. The present multicentre study was undertaken to find out whether the results could be improved by using arthroscopic lavage as treatment. Sixty patients aged 16-30 years, with traumatic primary anterior shoulder dislocation were randomised into two groups. One group was treated with arthroscopic lavage within 10 days, while the other group was treated non-operatively. Rehabilitation was otherwise identical. At 1-year follow-up, 4 of 30 patients (13%) in the lavage group had had redislocation compared with 13 of 30 (43%) in the group treated non-operatively (P = 0.01).The difference in recurrence rate was more pronounced in younger patients. The functional outcome according to the Rowe shoulder score was better in the lavage group (P = 0.003), as was the anterior stability according to the apprehension test (P = 0.008). We conclude that arthroscopic lavage reduced the recurrence rate and produced a better functional outcome at 1-year follow-up than the non-operative treatment in young individuals.     

A three-year epidemiological study of injuries affecting young female gymnasts

Objectives. The purpose of this study was to determine the rate and distribution of injuries affecting beginning- and advanced-level competitive female gymnasts over a three-year period. Of particular interest, was the comparison of risk and severity of injury among these groups during training and competition.Design. Prospective cohort.Setting. Regional university and community-based gymnastics club in the Pacific Northwest.Participants. Seventy nine female artistic gymnasts, ages 7–18 years, representing USA Gymnastics competitive levels 4–10.Main outcome measures. Injury incidence. A log-linear model was used to estimate the relative risk (RR) of injury in competition versus training and among beginning versus advanced level gymnasts. Chi square analysis using Fisher's exact test was used to compare the distribution of injuries by event, anatomical location, type and time loss.Results. During the study, 60 of 79 gymnasts sustained 192 injuries while 19 gymnasts remained injury-free. The overall injury rate was 2.5 injuries/1000 h. The RR of injury during competition relative to practice was 2.69 (95% CI: 1.53, 4.75; p≤0.001). This was mostly driven by the advanced group; when stratified by competition level and compared to all practice injuries, the RR of injury during competition was 0.47 (95% CI: 0.07, 3.42) for the beginning group, and 4.34 (95% CI: 2.39, 7.88; p=0.035) for the advanced group.Chi square analyses showed a variant injury distribution for injury location, event, and time loss depending on competitive group and whether injury occurred during practice or competition. Notably, a greater proportion of severe injuries, as measured by time loss, affected advanced- than beginning-level gymnasts (Fisher's exact p-value=0.003) and occurred in competition relative to practice (Fisher's exact p-value=0.007).Conclusions. The findings of this study suggest that advanced-level competitive female gymnasts experience a higher risk and severity of injury compared to their beginning-level counterparts, especially during competition.