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Does Hip Arthroscopy Really Help?

Menge_Image_for_O'Buzz.pngOver the past 15 to 20 years, the use of arthroscopic procedures for hip pathologies has rapidly increased. Leaders in sports medicine have standardized many arthroscopic techniques, including methods of joint distraction, portal location, approaches to labral repair or debridement, and management of cartilage lesions.

Many in the orthopaedic community have wondered whether this expansive  use of  hip arthroscopy is justified by significant improvement in patient function or is simply a first (and perhaps overused) step toward inevitable hip arthroplasty. To help answer that question, in the June 21, 2017 issue of The Journal, Menge et al. document the 10-year outcomes of arthroscopic labral repair or debridement in 145 patients who originally presented with femoroacetabular impingement (FAI).

Whether these patients were treated with debridement or repair, their functional outcomes and improvement in symptoms were excellent over the 10-year time frame, and the median satisfaction score (10) indicates that these patients were very satisfied overall. However, as seen in other similar studies in the peer-reviewed literature, the results in older patients with significant cartilage injury or radiographic joint space narrowing were inferior, and most of the patients with these characteristics ended up with a hip replacement.

The Menge et al. study helps confirm that arthroscopic repair or debridement in well-selected FAI patients yields excellent longer-term outcomes, and it provides concrete criteria for patient selection.

Marc Swiontkowski, MD
JBJS Editor-in-Chief

Sports Medicine Update

What's_New_Sports_Med_Image_for_O'Buzz.pngEvery month, JBJS publishes a Specialty Update—a review of the most pertinent and impactful studies published in the orthopaedic literature during the previous year in 13 subspecialties. Click here for a collection of all OrthoBuzz Specialty Update summaries.

The May 17, 2017 JBJS Specialty Update on Sports Medicine reflects evidence in the field of sports medicine published from September 2015 to August 2016. Although this review is not exhaustive of all research that might be pertinent to sports medicine, it highlights many key articles that contribute to the existing evidence base in the field.

Topics covered include:

  • Prevention of Musculoskeletal Injuries
  • Autograft vs Allograft ACL Reconstruction
  • Anterior Shoulder Stabilization
  • Hip Arthroscopy

High Rates of Return to Play and Patient Satisfaction after ACL Reconstruction

ACL Recon for O'Buzz.jpegThe estimated annual cost of surgical treatment for anterior cruciate ligament (ACL) ruptures in the US is $2 billion. Are ACL surgery patients—and the health care system—getting significant value for all that money spent?

In the May 3, 2017 issue of The Journal of Bone & Joint Surgery, Nwachukwu et al. set out to answer that question by retrospectively analyzing rates of return to play and satisfaction among 231 ACL-surgery patients (mean age of 27 years) who were followed for a mean of 3.7 years. The authors found that:

  • 87% had returned to play at a mean of 10 months after surgery.
  • 89% of the 171 athletes eligible to return to their prior level of competition did so.
  • 85% said they were “very satisfied” with the outcome, and 98% stated they would have the surgery again.

Not surprisingly, patients were more likely to say they were “very satisfied” if they had returned to play.

The authors also found that the use of patellar tendon autograft increased the chance of returning to play, while preoperative participation in soccer or lacrosse decreased the likelihood of returning to play. Those who participated in basketball, football, skiing, and tennis had higher return-to-play rates than those who participated in the two aforementioned sports.

In addition, Nwachukwu et al. found that one-third of those who did not return to sports reported fear of reinjury as the reason. The authors encourage surgeons to understand that “psychological readiness, fear of reinjury, and mental resiliency influence the probability of an athlete returning to play.”

In her commentary, Elizabeth Matzkin, MD cautions readers to interpret the Level IV study’s findings cautiously. She calls for “better prospective, homogeneous studies” to more accurately assess which surgical graft types and specific sports are more or less likely to result in patients returning to play. Nevertheless, the study, she says, “forces us to look at the big picture: What can we do to make ACL [reconstruction] better for our patients?”

Long-Term, Latarjet Beats Bankart for Anterior Shoulder Instability

Barkart vs Latarjet_12_7_16.gifIn a retrospective case-cohort analysis of 364 shoulders that had primary repair of recurrent anterior instability, Zimmermann et al. conclude in the December 7, 2016 issue of JBJS that arthroscopic Bankart repairs were inferior to the open Latarjet procedure, at a mean follow-up of 10 years.

Specific 10-year outcome comparisons included:

  • Redislocations in 13% of the Bankart shoulders vs 1% of the Latarjet shoulders
  • Apprehension (fear of the shoulder dislocating with the arm in abduction and external rotation) in 29% of the Bankart patients vs 9% of the Latarjet patients
  • Cumulative revision rate for recurrent instability of 21% in the Bankart group vs 1% in the Latarjet group
  • Not-satisfied rating from 13.2% of patients in the Bankart group vs 3.2% in the Latarjet group

Overall, there were few early and almost no late failures after the Latarjet procedure, while the arthroscopic Bankart repair was associated with an increasing failure rate over time. The authors say that this study’s longer-term analysis confirms “the contention that arthroscopic Bankart reconstructions fail progressively” and supports “the observation that restoration of stability with the Latarjet procedure is stable over time.”

New Key Knee Content from JBJS

Knee Spotlight Image.pngThe recently launched JBJS Knee Spotlight offers highly relevant and potentially practice-changing knee content from the most trusted source of orthopaedic information.

Here are the five JBJS articles to which you will have full-text access through the Knee Spotlight during the month of November 2016:

  • Comparative Survivorship of Different Tibial Designs in Primary Total Knee Arthroplasty
  • All-Polyethylene Versus Metal-Backed Tibial Components
  • Repair of Intraoperative Injury to the Medial Collateral Ligament During Primary Total Knee Arthroplasty
  • Risk of Total Knee Arthroplasty After Operatively Treated Tibial Plateau Fracture
  • Long-Term Clinical Outcomes and Survivorship of Press-Fit Condylar Sigma Fixed-Bearing and Mobile-Bearing Total Knee Prostheses in the Same Patients

Knee studies offered on the JBJS Knee Spotlight will be updated monthly, so check the site often.

Visit the JBJS Knee Spotlight website today.

Read Key Knee Content from JBJS

knee_for_microsite_obuzz_2016-10-06_1212

The recently launched JBJS Knee Spotlight offers highly relevant and potentially practice-changing knee content from the most trusted source of orthopaedic information.

Here are the five JBJS articles to which you will have full-text access through the Knee Spotlight during the month of October 2016.

  • What’s New in Adult Reconstructive Knee Surgery
  • The Effect of Timing of Manipulation Under Anesthesia to Improve Range of Motion and Functional Outcomes Following Total Knee Arthroplasty
  • Nonsurgical or Surgical Treatment of ACL Injuries: Knee Function, Sports Participation, and Knee Reinjury
  • Topical Intra-Articular Compared with Intravenous Tranexamic Acid to Reduce Blood Loss in Primary Total Knee Replacement
  • Total Knee Replacement in Young, Active Patients: Long-Term Follow-up and Functional Outcome

Knee studies offered on the JBJS Knee Spotlight will be updated monthly, so check the site often.

Visit the JBJS Knee Spotlight website today.

Soccer Players Benefit from Ankle-Injury Prevention Programs

6580f_sports-medicine-devices-marketA Level-I meta-analysis by Grimm et al. in the September 7, 2016 issue of The Journal of Bone & Joint Surgery found a significant reduction in the risk of ankle injury among soccer athletes who participated in ankle-injury prevention programs. Researchers reviewed data from 10 randomized controlled trials of such prevention programs involving more than 4,000 female and male soccer players, applying random-effects statistical models to determine pooled risk differences. Not surprisingly, the authors found substantial heterogeneity among the included studies, but there was no evidence of publication bias.

Despite the overall finding of a protective effect from prevention programs, the authors were “unable to comment on the role of individual elements of injury prevention programs,” saying that further research is needed to evaluate the effectiveness of specific exercises and the optimal timing and age for implementing these programs.