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Porcellini G, Ziroglu N, De Santis E, Micheloni GM, Tarallo L, Giorgini A. Midterm Clinical Outcomes After Arthroscopic Rotator Cuff Repair in Olympic Volleyball Players: Return to Sports and Return to Performance. Orthop J Sports Med 2023; 11:23259671231186820. [PMID: 37655246 PMCID: PMC10467408 DOI: 10.1177/23259671231186820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/13/2023] [Indexed: 09/02/2023] Open
Abstract
Background The decision-making process and predicting the time to return to sport (RTS) and return to performance (RTP) after arthroscopic rotator cuff repair (ARCR) in elite volleyball players are difficult issues to address, even among experienced shoulder surgeons. Purpose/Hypothesis The purpose of the study was to evaluate the results in Olympic-level volleyball players treated with arthroscopic supraspinatus repair and to report the RTS and the RTP. It was hypothesized that these athletes had higher RTS and faster RTP. Study Design Case series; Level of evidence, 4. Methods This study included 17 elite volleyball athletes (11 male, 6 female; mean age, 26.2 years) who underwent ARCR for partial- and full-thickness supraspinatus tears that did not improve despite nonoperative treatment. The clinical results were evaluated at 12 months postoperatively. The authors compared the athletes' preoperative, 6-month, and 12-month Kerlan-Jobe Orthopaedic Clinic (KJOC) scores and the visual analog scale (VAS) for pain after competition and conducted 6- and 12-month isometric strength analyses. The athletes' RTS and RTP times were recorded. Results All tears were on the dominant side (15 right, 2 left), and 82% were partial tears (14 partial thickness, 3 full thickness). The mean time from the onset of symptoms to surgery was 11.3 ± 6.7 months. While the mean Kerlan-Jobe Orthopaedic Clinic score was 31 preoperatively, it was 89 after 6 months (P < .001 vs preoperative) and 96 after 12 months (P = .003 vs 6 months). The mean VAS for pain was 7.9 preoperatively, 0.4 at 6 months (P < .001 vs preoperative), and 0.1 at 12 months (P = .02 vs 6 months). All athletes were able to reach their preinjury level, with RTS at a mean of 6.9 months and RTP at a mean of 12.4 months. Conclusion ARCR appears to be an effective option for Olympic-level volleyball players who do not benefit from nonoperative treatment. All athletes returned to their preinjury level of sports. The surgeon and athlete can plan surgical decision-making and timing based on the mean RTS time of 6.9 months and mean RTP time of 12.4 months.
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Affiliation(s)
- Giuseppe Porcellini
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Nezih Ziroglu
- Department of Orthopedics and Traumatology, Acibadem University, Acibadem Atakent Hospital, Kucukcekmece/Istanbul, Turkey
| | | | - Gian Mario Micheloni
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Luigi Tarallo
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
| | - Andrea Giorgini
- Department of Orthopedics and Traumatology, University of Modena Reggio Emilia, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
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2
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Drain NP, Greiner JJ, Simonian LE, Carlos NBT, Hyre ND, Smith C, Hughes JD, Lin A, Lesniak BP. Depressive and Anxiety Disorders Increase Risk for Recurrent Anterior Shoulder Pain Following Arthroscopic Suprapectoral Biceps Tenodesis. Arthrosc Sports Med Rehabil 2023; 5:e739-e749. [PMID: 37388874 PMCID: PMC10300603 DOI: 10.1016/j.asmr.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/05/2023] [Indexed: 07/01/2023] Open
Abstract
Purpose To evaluate factors associated with postoperative anterior shoulder pain following arthroscopic suprapectoral biceps tenodesis (ABT) and to determine the clinical impact of postoperative anterior shoulder pain. Methods A retrospective study of patients that underwent ABT between 2016 and 2020 was conducted. Groups were categorized by the presence (ASP+) or absence (ASP-) of postoperative anterior shoulder pain. Patient-reported outcomes (American Shoulder and Elbow score [ASES], visual analog scale [VAS] for pain, subjective shoulder value [SSV]), strength, range of motion, and complication rates were analyzed. Differences between continuous and categorical variables were tested with two-sample t-tests and chi-squared or Fisher's exact tests, respectively. Variables collected at different postoperative timepoints were analyzed using mixed models with post hoc comparisons when significant interactions were detected. Results A total of 461 (47 ASP+, 414 ASP-) patients were included. A statistically significant lower mean age was observed in the ASP+ group (P < .001). A statistically significant higher prevalence of major depressive disorder (MDD) (P = .03) or any anxiety disorder (P = .002) was observed in the ASP+ group. Prescription medication with psychotropic medications (P = .01) was significantly more prevalent in the ASP+ group. No significant differences were observed in the proportion of individuals reaching the minimal clinical important difference (MCID) for ASES, VAS, or SSV between groups. Conclusions A pre-existing diagnosis of major depressive disorder or any anxiety disorder, as well as the use of psychotropic medications was associated with postoperative anterior shoulder pain following ABT. Other factors associated with anterior shoulder pain included younger age, participation in physical therapy before surgery, and lower rate of concomitant rotator cuff repair or subacromial decompression. Although the proportion of individuals reaching MCID did not differ between groups, the presence of anterior shoulder pain after ABT resulted in prolonged recovery, inferior PROs, and a higher incidence of repeat surgical procedures. The decision to perform ABT in patients diagnosed with MDD or anxiety should be carefully considered, given the correlation to postoperative anterior shoulder pain and inferior outcomes. Level of Evidence Level III, retrospective case-control study.
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Affiliation(s)
- Nicholas P. Drain
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Justin J. Greiner
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Lauren E. Simonian
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Noel Bien T. Carlos
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Nathan D. Hyre
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, U.S.A
| | - Clair Smith
- Department of Physical Therapy, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
| | - Jonathan D. Hughes
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- Pittsburgh Shoulder Institute, Pittsburgh, Pennsylvania, U.S.A
| | - Albert Lin
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- Pittsburgh Shoulder Institute, Pittsburgh, Pennsylvania, U.S.A
| | - Bryson P. Lesniak
- Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A
- Pittsburgh Shoulder Institute, Pittsburgh, Pennsylvania, U.S.A
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Baumgarten KM. Can the Single Assessment Numeric Evaluation be used as a stand-alone subjective outcome instrument in patients undergoing rotator cuff repair? J Shoulder Elbow Surg 2022; 31:2542-2553. [PMID: 35750155 DOI: 10.1016/j.jse.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND/HYPOTHESIS There is no consensus to which patient-determined shoulder outcome scores should be considered when analyzing patient outcomes. Use of multiple patient-determined outcomes may be redundant and cause increased responder burden. The Single Assessment Numeric (SANE) has not been widely accepted as a stand-alone shoulder-specific outcome measure. The hypothesis was that SANE will correlate with and be comparable in responsiveness to other subjective outcome measures that have been used in a stand-alone fashion in patients undergoing rotator cuff repair (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES], Western Ontario Rotator Cuff Index [WORC], and the Simple Shoulder Test [SST]). In addition, the SANE will be more relevant to each patient compared to the ASES, further supporting its use as a stand-alone shoulder-specific outcomes measure. METHODS A retrospective review of a database of patients undergoing rotator cuff repair was reviewed where the SANE was recorded with the ASES, WORC, and/or SST. Correlations were determined using the Pearson coefficient. Subgroup analysis was performed to determine if correlations differed in (1) preoperative and (2) postoperative outcome determinations. Responsiveness was determined by calculating the standardized response mean (SRM) and the effect size (ES) of all scores. Relevance and precision of the SANE and ASES were examined using 150 consecutive patients to determine the number of questions in each score that were not answered. RESULTS Correlation was excellent for the SANE and the ASES (n = 1838, r = 0.81, P < .0001), the WORC (n = 1793, r = 0.82, P < .0001), and the SST (n = 1836, r = 0.76, P < .0001). Correlation of preoperative scores was moderate and postoperative scores were excellent when comparing the SANE with all 3 scores. All scores were highly responsive, with the SRM of the SANE = 2.1, ASES = 2.2, WORC = 2.4, and the SST = 1.8. The ES of the SANE = 2.4, ASES = 2.7, WORC = 3.0, and the SST = 2.1. One hundred percent of the SANE scores were answered completely compared with 57% (P < .0001) of the ASES, with significant variability found in the answers to the "work" and "score" questions. CONCLUSION In patients undergoing rotator cuff repair, the SANE highly correlated and has equivalent responsiveness with the WORC, ASES, and SST, which have been used as stand-alone shoulder-specific outcomes measures. The SANE may provide the same information as the WORC, ASES, and SST regarding outcome with significant reduction in responder burden. This study supports that the SANE can be used as a subjective, stand-alone instrument for patients undergoing rotator cuff repair.
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Affiliation(s)
- Keith M Baumgarten
- Orthopedic Institute, Sioux Falls, SD, USA; University of South Dakota Sanford School of Medicine, Sioux Falls, SD, USA.
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Zhou ZY, Ying H, Wang ZM. Transtendon Repair Under Switching-Scope Technique for Articular Partial-Thickness Rotator Cuff Tears. Arthrosc Tech 2022; 11:e1973-e1979. [PMID: 36457393 PMCID: PMC9705721 DOI: 10.1016/j.eats.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 07/25/2022] [Indexed: 11/07/2022] Open
Abstract
Partial-thickness rotator cuff tears are common diseases causing pain and disability. Among the different surgical methods, the transtendon repair technique is recommended due to its biomechanically superiority. However, this technique has a high learning curve and is time-consuming. In this Technical Note, we introduce a safer and more effective modified transtendon repair technique. Our switching-scope technique sets a switching stick into the glenohumeral joint through the posterior portal and is used as a guide for switching the arthroscope between the subacromial and articular spaces. This technique can reduce surgical time and overcome the disadvantage of vision limitation in articular-sided transtendon repair.
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Affiliation(s)
- Zhi-you Zhou
- First Affiliated Hospital of Navy Medical University
| | - Hua Ying
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zi-min Wang
- Shanghai Key Laboratory of Orthopaedic Implant, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China,Address correspondence to Zi-min Wang, Ph.D., Shanghai Ninth People’s Hospital, No. 639 Zhizaoju Rd., Huangpu District, Shanghai, China.
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5
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Li Z, Hu G, Zhu Y, Xu F, Ye J, Guan J, Guan H. Factors Associated with Shoulder Range of Motion After Arthroscopic Rotator Cuff Repair: A Hospital‐Based Prospective Study. Orthop Surg 2022; 14:1309-1316. [PMID: 35603551 PMCID: PMC9251286 DOI: 10.1111/os.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 02/09/2022] [Accepted: 02/18/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the factors associated with outcomes of arthroscopic surgical repair of rotator cuff tears (RCTs). Method This prospective study recruited patients, at least 18 years old, who underwent arthroscopic rotator cuff repair for full‐thickness RCTs at the First People's Hospital of Hangzhou Xiaoshan between July 2019 and October 2020. Patient demographics, lifestyle habits, and medical histories were collected preoperatively; RCT sizes and affected tendons were determined intraoperatively. Outcomes were assessed by shoulder range of motion (ROM) determinations 1.5 and 3 months postoperatively. The factors associated with ROM were determined using a binary logistic regression analysis, and the results were expressed as adjusted relative risks (RRs) and 95% confidence intervals (CIs). Results A total of 132 patients with RCTs underwent arthroscopic surgery. Five were lost to follow‐up, leaving 127 patients (mean age, 59 years; 58.3% women) who were included in the study analysis. The majority of the patients (54.5%) had RCTs that were classified as large or massive, and approximately 20% had tears involving multiple tendons; 80.3% of the patients had tears involving only a single tendon. Moreover, 29.9% of the patients had hypertension and 11.0% had diabetes. Among the patients, 23.0% were smokers and 34.6% drank alcohol. According to the multivariate analysis, none of the assessed factors were associated with shoulder ROM at the 1.5‐month follow‐up. At the 3‐month follow‐up, RCTs involving a single tendon demonstrated 3‐fold better abduction (RR = 4.00; 95% CI, 1.30–12.33; P = 0.016) and 3.15‐fold better internal rotation (RR = 3.15; 95% CI, 1.19–8.36; P = 0.021) than did RCTs involving multiple tendons. Patients who did not drink alcohol demonstrated 6.08‐fold better anteflexion (RR = 7.08; 95% CI, 2.11–23.73; P = 0.002) and nearly 4‐fold better abduction (RR = 4.97; 95% CI, 1.62–15.23; P = 0.005) than patients who drank alcohol. Conclusion To improve outcomes, the results indicate that more targeted measures should be directed toward patients with multiple‐tendon RCTs and that preoperative alcohol abstinence education is needed for patients with RCTs.
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Affiliation(s)
- Zhennan Li
- The Second Clinical Medicine College Zhejiang Chinese Medical University Hangzhou China
| | - Gangfeng Hu
- Department of Orthopaedics The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Yuan Zhu
- Department of Orthopaedics The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Fangqi Xu
- Department of Orthopaedics The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Jiakuan Ye
- Department of Orthopaedics The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Jie Guan
- Department of Orthopaedics The First People's Hospital of Xiaoshan District, Hangzhou, Zhejiang, China
| | - Hong Guan
- The Second Clinical Medicine College Zhejiang Chinese Medical University Hangzhou China
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Franciozi CE, Minami FK, Ambra LF, Galvão PHSAF, Schumacher FC, Kubota MS. Remnant preserving ACL reconstruction with a functional remnant is related to improved laxity but not to improved clinical outcomes in comparison to a nonfunctional remnant. Knee Surg Sports Traumatol Arthrosc 2022; 30:1543-1551. [PMID: 33893826 DOI: 10.1007/s00167-021-06572-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 04/06/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE The Anterior cruciate ligament (ACL) remnant has been pointed out as a ligamentization enhancer. Nonetheless, the remaining tissue can be functional if it still provides some stability or nonfunctional. This study intends to compare the clinical results and knee stability of functional vs. nonfunctional remnant preservation ACL reconstruction (ACLR). METHODS One hundred and seventy-five patients with ACL injuries were included and underwent remnant preservation ACLR. They were divided into two groups accordingly to remnant tissue functionality: functional (Group F) and nonfunctional (Group NF). Primary outcome was defined as patient reported outcomes measured with Lysholm, IKDC and Tegner continuous scales and improvements. Secondary outcomes comprised of Lachman test, anterior drawer test, pivot shift test, extension and flexion deficit, graft coverage by remnant preserved tissue and failure rate (persistent instability or new ACL lesion). Menisci lesions, cartilage lesions and time to surgery were also recorded for each group. RESULTS One hundred and forty-four patients were available at a mean of 30.2 ± 10.1 months: 69 Functional and 75 Nonfunctional. Lysholm, IKDC and Tegner functional outcomes demonstrated no difference between the groups, Functional compared to Nonfunctional: 88.4 ± 10.5 vs. 92.2 ± 4.9, n.s. and 83.2 ± 11.3 vs. 87 ± 5.3, n.s. and 6 (5-10) vs. 6 (5-9), n.s., respectively. Lysholm and IKDC functional outcomes improvements demonstrated differences between the groups: Functional compared to Nonfunctional (39.3 ± 9.4 vs. 42.3 ± 7.4, p = 0.014 and 37.7 ± 10 vs. 41.0 ± 6.6, p = 0.032); however, they were not clinically significant. Functional group showed more stability on physical examination pre- and post-operatively (p < 0.001, p < 0.001). There was no difference regarding extension deficit (n.s.); however, functional group had more flexion deficit (p = 0.02). Nonfunctional group had better graft coverage (p = 0.001). There was no difference regarding failure rate: 4% vs. 9%, (n.s.). CONCLUSION Both remnant preservation ACLR techniques were able to achieve satisfactory functional outcomes. A functional remnant was not related to improved functional outcomes in comparison to a nonfunctional remnant; however, it was related to less laxity pre and postoperatively and inferior graft coverage. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Carlos Eduardo Franciozi
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil.,Knee Institute - Heart Hospital (Hospital do Coração - Hcor), São Paulo, Brazil.,Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Flávio Kazuo Minami
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil.
| | - Luiz Felipe Ambra
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
| | - Pedro Henrique Schmidt Alves Ferreira Galvão
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
| | - Felipe Conrado Schumacher
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
| | - Marcelo Seiji Kubota
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Universidade Federal de São Paulo, Napoleão de Barros Street, 715, 5th Fl, Vila Clementino, São Paulo, Brazil
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7
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Ernat JJ, Rakowski DR, Casp AJ, Horan MP, Millett PJ. Results of arthroscopic rotator cuff repair for calcific tendonitis: a comparative analysis. J Shoulder Elbow Surg 2022; 31:616-622. [PMID: 34481052 DOI: 10.1016/j.jse.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/28/2021] [Accepted: 08/03/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Outcomes following arthroscopic excision of calcific tendonitis and arthroscopic rotator cuff repair (CT-ARCR) are relatively limited without comparison analysis to standard arthroscopic rotator cuff repair (ARCR). The purpose of this study was to evaluate patient-reported outcomes (PROs) after CT-ARCR compared against a matched cohort who received standard ARCR. METHODS An institutional review board-approved retrospective review was performed for patients aged 18-80 years receiving CT-ARCR by a single surgeon from 2006-2018. These were matched 1:3 with patients receiving ARCR. Patients with concurrent labral repair, subscapularis repair, or glenohumeral joint arthritis procedures; refusal to participate; deceased; inadequate contact information; or those with inadequate records were excluded. PROs included Short Form-12 Physical Component Summary (SF-12 PCS) score; American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES); Single Assessment Numeric Evaluation (SANE); Quick Disabilities of the Arm, Shoulder, and Hand questionnaire (QuickDASH); patient satisfaction; activity level/symptoms; and sport participation scores. RESULTS 21 CT-ARCR patients (mean age 50 years, range 36-62) and 54 ARCR patients (mean age 52 years, range 19-77) were included. Minimum 2-year follow-up was obtained in 18 of 21 (86%) CT-ARCR (mean 5.9 years) and 45 of 54 (83%) ARCR patients (mean 5.6 years). CT-ARCR patients improved pre- to postoperation in mean SF-12 PCS (41.1 to 50.0), ASES (54.2 to 94.0), and QuickDASH (54.2 to 94.0). SANE score improvements (57.6 to 82.8) were not significant. ARCR controls improved pre- to postoperation in mean SF-12 PCS (41.4 to 49.0), ASES (59.4 to 88.0), QuickDASH (35.1 to 13.8), and SANE scores (52.6 to 80.8). Pre- to postoperative pain during recreation and sport participation similarly improved in both groups. The only postoperative difference observed between CT-ARCR and ARCR was better patient satisfaction with CT-ARCR (9.7 vs. 8.3). CONCLUSION CT-ARCR results in excellent PROs, activity symptoms, and sports participation at final follow-up. CT-ARCR results were comparable to patients who received conventional ARCR for similar-sized rotator cuff tears that did not have calcific tendonitis.
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Affiliation(s)
- Justin J Ernat
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | | | - Aaron J Casp
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA
| | | | - Peter J Millett
- Steadman Philippon Research Institute, Vail, CO, USA; The Steadman Clinic, Vail, CO, USA.
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Ahrend MD, Eisenmann T, Herbst M, Gueorguiev B, Keller G, Schmidutz F, Döbele S, Schröter S, Ihle C. Increased tibial tubercle-trochlear groove and patellar height indicate a higher risk of recurrent patellar dislocation following medial reefing. Knee Surg Sports Traumatol Arthrosc 2022; 30:1404-1413. [PMID: 34032867 PMCID: PMC9007812 DOI: 10.1007/s00167-021-06581-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/13/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Identifying anatomical risk factors on recurrent dislocation after medial reefing is important for deciding surgical treatment. The present study aimed to retrospectively analyze the preoperative magnetic resonance imaging (MRI)-based parameters of patients treated with medial reefing and whether these parameters lead to a higher risk of recurrent dislocation. METHODS Fifty-five patients (18.6 ± 6.6 years) who underwent medial reefing after primary traumatic patellar dislocation (84% with medial patellofemoral ligament [MPFL] rupture) were included. Patients were followed up for at least 24 months postoperatively (3.8 ± 1.2 years) to assess the incidence of recurrent patellar dislocation. In patients without recurrent dislocation, the Kujala and subjective IKDC scores were assessed. Moreover, the tibial tubercle-trochlear groove (TT-TG), sulcus angle, patellar tilt, patellar shift, and lateral trochlea index (LTI) were measured. The patellar height was measured using the Caton-Dechamps (CDI), Blackburne-Peel (BPI), and Insall-Salvati index (ISI). The cohort was subclassified into two groups with and without recurrent dislocation. Differences between groups were analyzed with respect to the MRI parameters. RESULTS Forty percent had a pathological sulcus angle of > 145°, 7.2% had an LTI of < 11°, 47.3% had a patellar tilt of > 20°, and 36.4% had a TT-TG of ≥ 16 mm. Increased patellar height was observed in 34.5, 65.5, and 34.5% of the patients as per CDI, BPI, and ISI, respectively. Nineteen (34.5%) patients suffered from recurrent dislocation. Compared with patients without recurrent dislocation, those with recurrent dislocation had a significantly lower LTI (p = 0.0467). All other parameters were not significantly different between the groups. Risk factor analysis showed higher odds ratios (OR > 2), although not statistically significant, for MPFL rupture (OR 2.05 [95% confidence interval 0.38-11.03], LTI (6.6 [0.6-68.1]), TT-TG (2.9 [0.9-9.2]), and patellar height according to ISI (2.3 [0.7-7.5]) and CDI (2.3 [0.7-7.5])). Patients without recurrent dislocation had a Kujala score of 93.7 ± 12.1 (42-100) points and an IKDC score of 90.6 ± 11.7 (55.2-100) points. CONCLUSION Anatomical, MRI-based parameters should be considered before indicating medial reefing. A ruptured MPFL, an LTI < 11°, a TT-TG ≥ 16 mm, a patellar tilt > 20 mm, and an increased patellar height according to ISI and CDI were found to be associated, although not significantly, with a higher risk (OR > 2) of recurrent patellar dislocation after medial reefing. Thorough preoperative analysis is crucial to reduce the risk of recurrent dislocation in young patient cohorts. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Marc-Daniel Ahrend
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany ,grid.418048.10000 0004 0618 0495AO Research Institute Davos, Davos, Switzerland
| | - Tobias Eisenmann
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Moritz Herbst
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany.
| | - Boyko Gueorguiev
- grid.418048.10000 0004 0618 0495AO Research Institute Davos, Davos, Switzerland
| | - Gabriel Keller
- grid.411544.10000 0001 0196 8249Department of Diagnostic and Interventional Radiology, University Hospital Tuebingen, Tübingen, Germany
| | - Florian Schmidutz
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Stefan Döbele
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Steffen Schröter
- grid.491771.dDepartment of Traumatology and Reconstructive Surgery, Diakonie Klinikum GmbH Jung-Stilling-Krankenhaus, Siegen, Germany
| | - Christoph Ihle
- grid.10392.390000 0001 2190 1447Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
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