Publications by authors named "Edward C Beck"

80 Publications

Lower Extremity Biomechanics Predicts Major League Baseball Player Performance.

Orthop J Sports Med 2021 Jul 8;9(7):23259671211015237. Epub 2021 Jul 8.

Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA.

Background: Although lower extremity biomechanics has been correlated with traditional metrics among baseball players, its association with advanced statistical metrics has not been evaluated.

Purpose: To establish normative biomechanical parameters during the countermovement jump (CMJ) among Major League Baseball (MLB) players and evaluate the relationship between CMJ-developed algorithms and advanced statistical metrics.

Study Design: Cohort study; Level of evidence, 3.

Methods: MLB players in 2 professional organizations performed the CMJ at the beginning of each baseball season from 2013 to 2017. We collected ground-reaction force data including the eccentric rate of force development ("load"), concentric vertical force ("explode"), and concentric vertical impulse ("drive") as well as the Sparta Score. The advanced statistical metrics from each baseball season (eg, fielding independent pitching [FIP], weighted stolen base runs [wSB], and weighted on-base average) were also gathered for the study participants. The minimal detectable change (MDC) was calculated for each CMJ variable to establish normative parameters. Pearson coefficient analysis and regression trees were used to evaluate associations between CMJ data and advanced statistical metrics for the players.

Results: A total of 151 pitchers and 138 batters were included in the final analysis. The MDC for "load," "explode," "drive," and the Sparta Score was 10.3, 8.1, 8.7, and 4.6, respectively, and all demonstrated good reliability (intraclass correlation coefficient > 0.75). There was a weak but statistically significant correlation between the Sparta Score and wSB ( = 0.23; = .007); however, there were no significant correlations with any other advanced metrics. Regression trees demonstrated superior FIP with higher Sparta Scores in older pitchers compared with younger pitchers.

Conclusion: There was a positive but weak correlation between the Sparta Score and base-stealing performance among professional baseball players. Additionally, older pitchers with a higher Sparta Score had statistically superior FIP compared with younger pitchers with a similar Sparta Score after adjusting for age.
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http://dx.doi.org/10.1177/23259671211015237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8274116PMC
July 2021

Relationship Between Clinical Scapular Assessment and Scapula Resting Position, Shoulder Strength, and Baseball Pitching Kinematics and Kinetics.

Orthop J Sports Med 2021 Mar 18;9(3):2325967121991146. Epub 2021 Mar 18.

Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Background: Scapular assessment is important in examining overhead athletes, but there is inconsistency in scapular clinical assessment and its relation to pathology.

Purpose: To determine the relationship between clinical scapular assessment and biomechanical scapula resting position, shoulder strength, and pitching shoulder kinematics and kinetics.

Study Design: Descriptive laboratory study.

Methods: Two clinicians performed scapular assessments and graded the scapula as presence or absence of scapular dyskinesis. Shoulder external rotation (ER) and internal rotation (IR) strength were collected. The 3-dimensional biomechanics of the scapula resting position (upward/downward rotation, IR/ER, and anterior/posterior tilt) were assessed while participants stood at rest, and pitching kinematics (maximum shoulder ER, shoulder abduction, shoulder horizontal abduction, shoulder rotation velocity) and kinetics (maximum shoulder distraction force) were assessed when participants pitched off the portable pitching mound that was engineered to meet major league specifications.

Results: A total of 33 high school baseball pitchers (age, 16.3 ± 1.2 years; height, 184.0 ± 6.9 cm; weight, 76.8 ± 20.8 kg; hand dominance: left, 9 [27%]; right, 24 [73%]; pitch velocity, 34.7 ± 2.3 m/s) participated in this study. Of them, 15 participants had scapular dyskinesis, and 18 had normal scapulothoracic rhythm. No differences were observed for upward/downward rotation or anterior/posterior tilt, shoulder ER, shoulder abduction, or shoulder distraction force, based on the presence of scapular dyskinesis. Pitchers with scapular dyskinesis demonstrated significantly greater scapular resting IR position (effect size [ES], 0.80; 95% CI, 0.06 to 1.54; = .020), greater nondominant shoulder ER to IR strength ratio (ES, 0.49; 95% CI, -0.02 to 1.00; = .018), and decreased shoulder rotation velocity (ES, 14.66; 95% CI: 12.06 to 17.25; = .016). Pitchers with greater anterior tilt demonstrated greater shoulder rotation velocity ( = -0.48; = .006).

Conclusion: Pitchers with scapular dyskinesis had greater scapular IR, greater nondominant shoulder ER to IR strength ratio, and reduced shoulder rotation velocity.

Clinical Relevance: Scapular assessment may be more influenced by differential IR than upward rotation or anterior tilt. Scapular dyskinesis has no competitive performance advantage among amateur athletes. Greater understanding is needed to decipher the critical threshold between beneficial and maladaptive scapular movement patterns.
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http://dx.doi.org/10.1177/2325967121991146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8239341PMC
March 2021

Endoscopic Approach to Proximal Hamstring Avulsion Repair.

JBJS Essent Surg Tech 2020 Oct-Dec;10(4). Epub 2020 Dec 24.

Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.

Background: Endoscopic repair of a proximal hamstring avulsion promotes precise anatomical repair and lowers the risk of neurovascular injury.

Description: Indications for proximal endoscopic repair of the proximal part of the hamstrings include acute tears of 2 tendons with >2 cm of retraction in young active patients, acute complete tears of 3 tendons with >2 cm of retraction, or failed conservative treatment of tears of ≥2 tendons with ≤2 cm of retraction. Repair of a proximal hamstring avulsion is performed using 2 portals. The medial portal is developed percutaneously under fluoroscopic guidance. The lateral portal is developed under direct visualization. The footprint of the hamstrings is identified from medial to lateral. The sciatic and posterior femoral cutaneous nerves must be carefully identified and protected. The avulsed tendons are fixed with suture anchors with the knee in flexion.

Alternatives: Conservative treatment is commonly used to treat injuries of the musculotendinous junction (type 2), incomplete or complete avulsion with minimal retraction (≤2 cm) (type 3 or 4, respectively), and patients with limited mobility or severe comorbidities. The initial treatments consist of RICE (rest, ice, compression, and elevation), protective ambulation, and then physical therapy. Open repair is used for incomplete or complete avulsion with >2 cm of retraction, or when conservative treatments have failed. Open reconstruction is used for chronic avulsion with tendon retraction of >5 cm.

Rationale: Endoscopic surgery is a minimally invasive procedure that offers excellent visualization of the subgluteal space without gluteus maximus muscle retraction. In open repair, the inferior border of the gluteus maximus muscle is mobilized to access the ischial tuberosity. The mean distance (and standard deviation) from the inferior border of the gluteus maximus muscle to the hamstring origin has been reported to be 6.3 ± 1.3 cm, which is close to the mean distance from the inferior border of the gluteus maximus to the inferior gluteal nerve and artery, which has been reported to be 5.0 ± 0.8 cm. Open repair, which requires gluteus maximus retraction, poses an injury risk to the inferior gluteal nerve and artery. Open repair increases the risk of wound infection because the incision involves the perineum. The feasibility of the endoscopic repair depends on the chronicity and amount of tendon retraction. It is feasible for a symptomatic tear of ≥2 tendons with a retraction of ≤2 cm. Mobilization of the retracted tendon is challenging in endoscopic repair. In acute injuries, the degree of retraction is not critical because the tendon is easily mobilized. Chronic injuries (>2 months) and those with far tendon retraction (>5 cm) are not suitable for endoscopy. In chronic injuries with incomplete or complete avulsion with minimal retraction (≤2 cm) (types 3 and 4) that have failed conservative treatment, endoscopy is suitable since the tendon is not retracted. Endoscopic repair can be converted to an open procedure in difficult endoscopic conditions.
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http://dx.doi.org/10.2106/JBJS.ST.19.00037DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8154397PMC
December 2020

Predicting Patient Satisfaction With Maximal Outcome Improvement After Biceps Tenodesis.

Orthopedics 2021 May-Jun;44(3):e359-e366. Epub 2021 May 1.

The goal of this study was to determine the threshold for achieving maximal outcome improvement (MOI) on the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation (SANE), and Constant-Murley (CM) questionnaires that predict satisfaction after isolated biceps tenodesis without concomitant rotator cuff repair. A retrospective analysis of prospectively collected data was performed for patients undergoing isolated biceps tenodesis from 2014 to 2017 at a single institution with minimum 6-month follow-up. Receiver operating characteristic curve analysis was used to determine thresholds for MOI for the ASES, SANE, and CM questionnaires. Stepwise multivariate logistical regression analysis was performed to identify predictors for achieving the threshold for MOI. A total of 123 patients were included in the final analysis. Receiver operating characteristic analysis determined that achieving 43.1%, 62.1%, and 61.4% MOI was the threshold for satisfaction for the ASES, SANE, and CM questionnaires, respectively. Regression analysis showed that concomitant superior labrum anterior-posterior (SLAP) repair was predictive of achieving MOI on the ASES and SANE questionnaires, whereas partial rotator cuff tear was predictive of achieving MOI on the CM questionnaire (<.05 for both). Further, workers' compensation status, diabetes, history of ipsilateral shoulder surgery, and hypertension were negative predictors of achieving MOI on the SANE and CM questionnaires (<.05 for all). Achieving MOI of 43.1%, 62.1%, and 61.4% is the threshold for satisfaction after biceps tenodesis for the ASES, SANE, and CM questionnaires, respectively. Concomitant SLAP repair was positively predictive of achieving MOI, whereas workers' compensation status, diabetes, history of ipsilateral shoulder surgery, and hypertension were negative predictors. [. 2021;44(3):e359-e366.].
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http://dx.doi.org/10.3928/01477447-20210414-07DOI Listing
July 2021

Particulated Juvenile Articular Cartilage Allograft for Treatment of Chondral Defects of the Knee: Short-Term Survivorship with Functional Outcomes.

J Surg Orthop Adv 2021 ;30(1):10-13

Hopkins County Memorial Hospital, Sulphur Springs, Texas.

While basic science research confirms the robust biological profile of juvenile chondrocytes, the clinical outcomes after particulated juvenile cartilage allograft transplantation are not well established. A retrospective analysis of active duty servicemembers undergoing surgical treatment with particulated juvenile articular cartilage allograft transplantation for chondral defects of the knee from two military treatment facilities was completed. Demographic variables, operative details, activity limitations, and medical discharges were obtained. A total of 29 patients with 36 treated chondral defects were isolated at an average follow-up of 16.2 months. The cohort was comprised of male service members in the Army with mean age of 33.1 years. Location of chondral lesion included the patellofemoral articulation (patella 39%, trochlea 31%, bipolar lesions 8%) and condyles (31%). Offloading or realignment osteotomy procedures were performed in 7 patients (23%). Of all patients, 14 servicemembers (48%) underwent knee-related medical discharge, and one patient underwent conversion to total knee arthroplasty. In this small patient cohort, particulated juvenile cartilage allograft transplantation for chondral defects of the knee did not reliably restore military servicemembers to full military function. At least one in two patients had persisting knee pain after chondral restoration procedure. (Journal of Surgical Orthopaedic Advances 30(1):010-013, 2021).
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April 2021

Hypermobile Disorders and Their Effects on the Hip Joint.

Front Surg 2021 25;8:596971. Epub 2021 Mar 25.

Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, United States.

Hypermobility, or joint hyperlaxity, can result from inherited connective tissue disorders or from micro- or macrotrauma to a joint. The supraphysiologic motion of the hip joint results in capsuloligamentous damage, and these patients have a propensity to develop femoroacetabular impingement syndrome (FAIS) and labral injury. In this review, the recent literature evaluating the definitions, history, incidence, genetics, and histology of hypermobile disorders is investigated. We then review the clinical evaluation, natural history, and resulting instability for patients presenting with a hypermobile hip. Lastly, treatment options and outcomes will be highlighted.
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http://dx.doi.org/10.3389/fsurg.2021.596971DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8027473PMC
March 2021

The effect of smoking on achieving meaningful clinical outcomes 1-year after lumbar tubular microdecompression: A matched-pair cohort analysis.

Spine J 2021 Mar 25. Epub 2021 Mar 25.

Department of Orthopedic Surgery, Wake Forest Baptist Health, Medical Center Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA; Department of Neurosurgery , Wake Forest Baptist Health, Medical Center Boulevard, 4th Floor Comprehensive Cancer Center, Winston-Salem, NC 27157, USA.

Background Context: There has been a shift in the spine literature in reporting meaningful outcomes, including meaningful clinically important difference (MCID), after surgery. The evidence on the effect of tobacco smoking at the time of lumbar tubular microdecompression (LTMD) on meaningful outcomes is limited.

Purpose: To compare differences in 1-year functional outcomes and rates of achieving MCID between current smokers and non-smokers who underwent LTMD for lumbar spinal stenosis (LSS).

Study Design: A nested case control study to compare the difference in patient reported outcomes (PROs) between smokers and non-smokers 1-year after undergoing LTMD.

Patient Sample: This study included patients that underwent single level LTMD by a single surgeon between January 2014 through August 2019.

Outcome Measures: Preoperative and postoperative PROs were recorded using the questionnaires EQ-5D, Oswestry Disability Index (ODI), and the visual analog scale (VAS) for back pain and leg pain. The MCID was also used.

Methods: Current tobacco smokers at the time of surgery were matched 1:2 to non-smokers by age (+/- 1year). Preoperative and postoperative functional scores were compared between the two groups using independent t-tests. Additionally, thresholds for achieving MCID were calculated for each individual functional score, and were compared using Fisher's exact test.

Results: Of the 183 patients with 1-year follow-up who met inclusion criteria, 35 patients were identified as smokers and were matched to 70 non-smokers. No statistical differences were identified between age, BMI, or gender. Comparison of preoperative PROs showed no statistically significant differences between smokers and non-smokers (p>0.05 for all), while smokers had statistically lower EQ-5D (p<0.001) and higher ODI (p=0.05), VAS back (p=0.033), and VAS leg (p=0.03) score averages at a minimum of one year follow-up. Evaluation of meaningful outcomes demonstrated non-smokers had higher rates of achieving MCID on at least 1 threshold score as compared to smokers (98.5% vs. 91.1%; p=0.043).

Conclusions: Current smokers at the time of surgery have inferior postoperative EQ-5D scores, increased pain and disability, and lower odds of achieving the MCID at 1-year after undergoing LTMD when compared to patients without any smoking history.
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http://dx.doi.org/10.1016/j.spinee.2021.03.020DOI Listing
March 2021

Gender and Age-Specific Differences Observed in Rates of Achieving Meaningful Clinical Outcomes 5-Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Arthroscopy 2021 Mar 5. Epub 2021 Mar 5.

Division of Sports Medicine Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.

Purpose: To compare the impact of age and gender on achieving meaningful outcomes among minimum patients 5 years after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS).

Methods: Consecutive patients undergoing hip arthroscopy for FAIS by a single fellowship-trained surgeon between January 2012 and October 2014 were analyzed. Study inclusion criteria included any patient undergoing primary hip arthroscopy for FAIS, with 5 years follow-up. Preoperative and 5-year postoperative functional scores were collected, including the Hip Outcome Score Activities of Daily Living Subscale (HOS-ADL), HOS-Sport Subscale (HOS-SS), modified Harris hip score (mHHS), and Visual Analog Scale for satisfaction. Patients were matched 1:1 by gender and age to compare outcomes between these 2 demographics. Minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) were calculated for each functional measure and compared by gender and age.

Results: Of the 340 patients (70.5%) with 5 years' follow up, 150 were matched by gender and age into one of the following groups: female patients <30 years, female patients 30 to 45 years, female patients >45 years, male patients <30 years, male patients 30 to 45 years, and male patients >45 years of age. At minimum 5-year follow-up, all 6 groups demonstrated statistically significant improvement in the functional outcome score averages and pain (P < .001 for all). Both within gender and within age category analysis of postoperative functional scores did not demonstrate any statistical differences (P > .05). Analysis of achieving MCID and PASS demonstrated that females had higher rates of reaching the HOS-SS and mHHS threshold for achieving MCID as compared to their male counterparts (P < .05). Furthermore, patients <30 years old had higher rates of reaching the HOS-ADL and mHHS for achieving PASS when compared to patients >45 years old (P < .05).

Conclusion: The majority of patients achieve clinically significant outcome improvement at 5-year follow-up after arthroscopic FAIS surgery. Females reach the mHHS threshold for achieving MCID at significantly higher rates than males. Patients <30 years of age achieved PASS on the HOS-ADL and mHHS threshold scores at higher rates than those >45 years old.

Level Of Evidence: Level III, case-control study.
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http://dx.doi.org/10.1016/j.arthro.2021.02.033DOI Listing
March 2021

Return to sport and weightlifting analysis following distal biceps tendon repair.

J Shoulder Elbow Surg 2021 Mar 3. Epub 2021 Mar 3.

Rush University Medical Center, Chicago, IL, USA. Electronic address:

Background: Rupture of the distal biceps tendon is an increasingly frequent injury sustained predominantly by middle-aged men. Despite the prevalence of sport in this age group, little is known regarding return to sport outcomes following surgery.

Methods: Patients undergoing distal biceps tendon repair (DBR) between January 2015 and January 2017 were contacted electronically via e-mail and via telephone to administer a previously validated and standard return to sport survey. Patients self-reported preinjury and current level of sport and activity as well as preinjury and current level of select weightlifts.

Results: A total of 77 of 124 patients were available for follow-up (62.1%). Of these patients, 61 endorsed preoperative sport and were included for analysis. Average follow-up was 38.7 ± 6.7 months. The mean age at surgery was 47.5 ± 8.8 years, and the mean body mass index was 30.3 ± 5.1. The dominant side was affected in 25 of 61 cases. Of the 61 included patients, 57 (93.4%) were able to return to sport at any level (lower, same, or higher intensity than preinjury activity level). Forty of the patients (65.6%) were able to return to sport at same or higher intensity. Mean time to return to sport was 6.0 ± 2.8 months. Days from injury to surgery (odds ratio [OR] 0.999, 95% confidence interval [CI] 0.998-0.999), suture anchor fixation in comparison to suture button (OR 0.602, 95% CI 0.427-0.850), and dominant-side surgery (OR 0.749, 95% CI 0.582-0.963) were associated with a decreased likelihood to return to sport at same or higher level of duty. Single-sided incision in comparison to double (OR 5.209, 95% CI 1.239-20.903) and dominant-side surgery (OR 6.370, 95% CI 1.639-24.762) were associated with increased duration to return to sport.

Conclusion: Distal biceps tendon rupture is a significant injury; however, patients can expect high levels of return to sport following DBR with some residual impairment compared with baseline. It is important to counsel patients on their expectations while taking into account the results of this study: that there will be a small but appreciable decrease in strength compared with preinjury levels.
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http://dx.doi.org/10.1016/j.jse.2021.01.034DOI Listing
March 2021

Complete Capsular Closure Provides Higher Rates of Clinically Significant Outcome Improvement and Higher Survivorship Versus Partial Closure After Hip Arthroscopy at Minimum 5-Year Follow-Up.

Arthroscopy 2021 06 30;37(6):1833-1842. Epub 2021 Jan 30.

Division of Sports Medicine Surgery, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.

Purpose: To (1) compare the rates of reaching threshold hip-specific outcome scores for achieving the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) in patients who underwent partial versus complete T-capsulotomy repair and (2) identify the failure rates in each group 5 years after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS).

Methods: Data from consecutive patients who underwent hip arthroscopy for FAIS performed by a single fellowship-trained surgeon from January 2011 to March 2013 were collected and analyzed. Baseline data, hip-specific outcomes, and clinical failure rates were recorded at a minimum of 5 years postoperatively. Patients with partial T-capsulotomy repair were matched 1:3 by age, body mass index, and sex to patients with complete T-capsulotomy repair. Threshold scores for achieving the MCID and PASS were calculated and compared between the 2 groups. Additionally, rates of revision and conversion to total hip arthroplasty (THA) were compared between the groups.

Results: A total of 379 patients were available for analysis (39 partial and 340 complete repairs), with 100 patients included in the matching process (25 in the partial-repair group and 75 in the complete-repair group). Comparison of radiographic parameters, including the Tönnis grade, alpha angle, and lateral center-edge angle, between the 2 groups showed no statistically significant difference (P > .05 for all). Comparison of postoperative score averages between the partial- and complete-closure groups showed a significant difference in the Hip Outcome Score-Activities of Daily Living Subscale (85.4 ± 17.7 vs 94.6 ± 7.8, P < .001), Hip Outcome Score-Sports Subscale (76.6 ± 26.2 vs 89.3 ± 16.8, P = .034), modified Harris Hip Score (83.2 ± 19.7 vs 90.5 ± 11.2, P = .035), and visual analog scale pain score (24.5 ± 30.8 vs 13.4 ± 15.8, P = .035). A total of 65 complete-repair patients (95.6%) achieved the MCID for at least 1 outcome measure versus 18 patients with partial repair (78.3%) (P = .04). A total of 69 complete-repair patients (92%) achieved the PASS for at least 1 outcome measure versus 18 partial-repair patients (72%) (P = .017). Of the 39 partial-repair patients, 35.9% (n = 14) underwent revision or conversion to THA, as compared with 2.9% (n = 10) in the overall cohort.

Conclusions: At a minimum 5-year follow-up, patients with complete capsular closure after hip arthroscopy for FAIS show superior long-term outcomes and achieve higher rates of meaningful clinical success when compared with patients with partial capsular closure. Furthermore, patients with partial capsular repair undergo revision or conversion to THA at high rates.

Level Of Evidence: Level III, retrospective comparative study.
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http://dx.doi.org/10.1016/j.arthro.2021.01.035DOI Listing
June 2021

Hip Arthroscopy for Femoroacetabular Impingement Syndrome in Adolescents Provides Clinically Significant Outcome Benefit at Minimum 5-Year Follow-Up.

Arthroscopy 2021 05 24;37(5):1467-1473.e2. Epub 2020 Dec 24.

Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois.

Purpose: To report the rates of achieving clinically significant outcomes as defined by the minimal clinically important difference (MCID), patient acceptable symptomatic state (PASS), or substantial clinical benefit (SCB) in adolescent patients and the rates of clinical failure 5 years after undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS).

Methods: Data from consecutive adolescent patients (defined by the American Academy of Pediatrics as age 11 to 21 years) who underwent primary hip arthroscopy with routine capsular closure for the treatment of FAIS between January 2012 and January 2015 by a single, fellowship-trained surgeon was collected. Baseline data, clinical outcomes including Hip Outcome Score (HOS)-Activities of Daily Living, HOS-Sports Subscale, modified Harris hip score, international Hip Outcome Tool, and clinical failure rates were recorded at 5 years after operative. Clinical failure was defined by revision hip arthroscopy or conversion to total hip arthroplasty. Clinically significant outcomes was defined as achieving MCID, PASS, or SCB on at least 1 hip-specific outcome measure.

Results: Of the 139 eligible patients, a total of 85 (60.4%) patients (85 hips) were included in the final analysis, with an age and body mass index average of 17.6 ± 2.5 years (range 13-21) and 22.3 ± 3.1 kg/m, respectively. The majority of the patients were female (80.6%) and participated in sports (76.2%). There was statistically significant difference between preoperative and postoperative score averages across every reported outcome (P < .001). At 5 years, 88.4%, 67.6%, and 64.9% reached at least 1 threshold for achieving MCID, PASS, and SCB, respectively, whereas 89.2% achieved at least one of the meaningful outcome thresholds. Last, 2 patients (2.4%) failed clinically, with both undergoing revision (2.4%) because of continued pain. There were no conversions to total hip arthroplasty.

Conclusion: This study demonstrated that a large majority (89.2%) of adolescent patients undergoing primary arthroscopic treatment for symptomatic FAIS achieved meaningful clinically significant outcomes. Furthermore, only 2.4% of patients failed clinically, requiring revision hip arthroscopy because of continued pain.

Level Of Evidence: IV, Retrospective Case Series.
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http://dx.doi.org/10.1016/j.arthro.2020.12.188DOI Listing
May 2021

THE RELATIONSHIP OF RANGE OF MOTION, HIP SHOULDER SEPARATION, AND PITCHING KINEMATICS.

Int J Sports Phys Ther 2020 Dec;15(6):1119-1128

Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Background: When pitching a baseball, pelvic and trunk pitching kinematics play an integral role in momentum transfer from the lower extremity to the upper extremity. However, it is unknown how hip and trunk ROM and hip shoulder separation interplay with pelvic and trunk pitching kinematics.

Hypothesis/purpose: To determine the relationship between clinical trunk and hip range of motion (ROM) and pitching biomechanical pelvis and trunk kinematics, and kinematic sequencing.

Study Design: Controlled biomechanical study.

Methods: High school pitchers were assessed for trunk rotation via motion capture and hip ROM via a goniometer prior to pitching. Trunk rotation was designated as dominant and non-dominant sides, and hips as stance and lead limbs. Pitchers threw four fastballs during three dimensional biomechanical assessment. Spearman's Rho correlations were performed between trunk and hip ROM, and trunk and hip biomechanical kinematics, and kinematic pitching sequence.

Results: Thirty-two pitchers (mean age: 16.3 ± 1.2 years, height = 184.0 ± 6.9 cm, mass = 76.8 ± 20.8 kg) were included in this study. Their mean pitch velocity was 34.7 ± 2.3 m/s, peak pelvis rotation velocity: 669.1 ± 95.5 deg/s, and peak trunk rotation velocity: 1084.7 ± 93.0 deg/s. There were no differences between dominant and non-dominant side trunk rotation, or between stance and lead hip ROM. There were no significant relationships between trunk or hip ROM and pitching kinematics. There was a significant relationship between hip shoulder separation and peak trunk rotation velocity (r = 0.390, p=0.027). There was a significant relationship between pitch velocity and peak trunk rotation velocity (r = 0.478, p = 0.006). There were no other significant relationships between pitching kinematics or kinematic sequencing.

Conclusion: Hip shoulder separation is related to trunk rotation velocity, and ultimately pitch velocity. These ROM measurements can be used as normative values for hip shoulder separation in high school pitchers.

Level Of Evidence: 3.
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http://dx.doi.org/10.26603/ijspt20201119DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7727427PMC
December 2020

Cortical Button Fixation for Proximal Tibiofibular Instability: A Technical Report.

Arthrosc Tech 2020 Sep 2;9(9):e1415-e1421. Epub 2020 Sep 2.

Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, U.S.A.

Instability of the proximal tibiofibular joint (PTFJ) is a rare injury pattern than can affect high-demand athletes involved in twisting or pivoting movements on a flexed knee. Instability may produce painful subluxations during provocative activity and occasional neuritic symptoms from tethering of the common peroneal nerve at the fibular neck. There are several reports of reconstruction for symptomatic PTFJ instability; however, no optimal treatment has been elucidated in the literature. Use of a cortical button suspensory device for fixation of the PTFJ offers the advantage of stabilizing the joint without need for free graft harvest or rigid screw fixation. The present technical report illustrates the operative technique and the advantages, disadvantages, pearls, and pitfalls associated with this operation.
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http://dx.doi.org/10.1016/j.eats.2020.05.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528657PMC
September 2020

The relationship between pitch velocity and shoulder distraction force and elbow valgus torque in collegiate and high school pitchers.

J Shoulder Elbow Surg 2020 Dec 9;29(12):2661-2667. Epub 2020 Jun 9.

Department of Orthopaedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, UK; Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.

Background: The relationship between pitch velocity, shoulder distraction force, and elbow valgus torque is not well understood. The purpose of this study was to (1) determine the association between baseball pitch velocity and shoulder distraction force and (2) determine the association between baseball pitch velocity and elbow valgus torque. A subpurpose was to determine these same associations within subgroups of college baseball and high school baseball pitchers.

Methods: Collegiate and high school baseball pitchers were biomechanically analyzed; variables extracted from the pitching reports included fastball pitch velocity, shoulder distraction force, and elbow valgus torque. Linear regression was performed to analyze the relationship between fastball velocity and shoulder and elbow kinetics. Subgroup analyses were then performed for college and high school pitches. Coefficients and 95% confidence intervals (95% CI) were calculated, with R squared (r) used to assess model fit.

Results: A total of 70 pitchers (college: n = 23; high school: n = 47) were included in this study. There was a positive weak linear relationship between pitch velocity and shoulder distraction force (3.24 %body weight [BW] [95% CI: 2.07, 4.40], r = 0.32, P < .001) and elbow valgus torque (0.16 %body weight × height [BW × H] [95% CI: 0.11, 0.20], r = 0.44, P < .001). College pitchers did not exhibit a relationship between pitch velocity and shoulder distraction force (1.44 %BW [95% CI: -2.50, 5.38], r = 0.02, P < .001), whereas high school pitchers did exhibit a weak positive linear relationship between pitch velocity and shoulder distraction force (3.69 %BW [95% CI: 2.25, 5.14], r = 0.36, P < .001). Both college and high school pitchers exhibited a weak positive relationship between pitch velocity and elbow valgus torque (college: 0.15 %BW × H [95% CI: 0.05, 0.25], r = 0.29, P < .001; high school: 0.16 %BW × H [95% CI: 0.09, 0.22], r = 0.36, P < .001).

Discussion: Pitching velocity exhibited a weak positive linear relationship with both shoulder distraction force and elbow valgus torque. However, only high school pitchers were observed to have a weak positive linear relationship between pitch velocity and shoulder distraction force, whereas both college and high school pitchers exhibited a weak positive relationship between pitch velocity and elbow valgus torque. These findings suggest that older pitchers may attenuate shoulder forces with increased pitch velocity due to physical maturity or increased pitching mechanical skill in comparison with younger pitchers.
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http://dx.doi.org/10.1016/j.jse.2020.04.046DOI Listing
December 2020

Hip internal and external rotation range of motion reliability in youth baseball players.

J Sports Med Phys Fitness 2021 Jan 23;61(1):75-79. Epub 2020 Jul 23.

Department of Orthopedic Surgery, Wake Forest School of Medicine, Winston-Salem, NC, USA.

Background: Impaired hip range of motion has been related to increased injury risk in baseball players. However, no hip rotation range of motion (ROM) reliability studies have been performed in youth, which cannot be assumed to be comparable to adults. This study aimed to: 1) assess the inter- and intra-rater reliability of hip rotation passive ROM in youth baseball players; 2) calculate the standard error of measurement (SEM) and minimum clinically important difference (MCID).

Methods: Hip external (ER) and internal (IR) rotation were measured. Inter and intra-rater reliability were assessed through intraclass correlation coefficients (ICC) and 95% Confidence interval (95% CI), with SEM and MCID. Bland-Altman plots were used to assess overall measurement bias.

Results: Nineteen youth baseball players participated. Hip ER intra-rater ICC was excellent (tester one: 0.983 (0.965, 0.993); tester two: 0.952 (0.903, 0.980) and hip IR was excellent (tester one: 0.965 (0.927, 0.985); tester two: 0.965 (95%CI: 0.928, 0.985). Hip ER SEM was 3.2 degrees, and hip IR was 2.2 degrees. Hip ER MCID was 7.5 degrees, and hip IR was 5.1 degrees. Bland-Altman plots for hip ER and IR did not detect any bias.

Conclusions: Hip ROM inter-rater and intra-rater reliability was excellent for use in youth baseball players, with no rater bias. Sports medicine professionals can reliably assess supine hip rotation ROM in youth baseball players. This ROM methodology can be easily administered within the clinic or pitch-side, and interpret the results, increasing its real-world applicability.
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http://dx.doi.org/10.23736/S0022-4707.20.11126-5DOI Listing
January 2021

Patient-Reported Outcomes Measurement Information System Physical Function Has a Lower Effect Size and is Less Responsive Than Legacy Hip Specific Patient Reported Outcome Measures Following Arthroscopic Hip Surgery.

Arthroscopy 2020 12 14;36(12):2992-2997. Epub 2020 Jul 14.

Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A.

Purpose: To compare the use and responsiveness of Patient Reported Outcomes Measurement Information System (PROMIS) to legacy patient-reported outcome measures (PROMs) in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) at 6-month follow-up.

Methods: Data from patients who underwent primary hip arthroscopy with routine capsular closure between August 2018 and January 2019 for the treatment of FAIS were analyzed. Preoperative outcomes, 6-month postoperative outcomes, and demographics were recorded. Primary outcome measures included PROMIS Physical Function (PROMIS-PF), PROMIS Pain Interference (PROMIS-PI), and PROMIS Depression. The legacy PROMs included Hip Outcome Score Activities of Daily Living (HOS-ADL), Hip Outcome Score Sport Subscale (HOS-SS), and the international hip outcome tool 12 questions (iHOT-12). Floor and ceiling effects along with the responsiveness and Cohen's d effect size of each PROM tool were calculated.

Results: Ninety-six patients with an average age and body mass index of 32.4 ± 11.9 years and 25.9 ± 6.1 kg/m, respectively, were included in the final analysis. All outcomes were significantly higher at 6 months compared with the preoperative level (P < .001) except for PROMIS Depression (P = .873). PROMIS-PF demonstrated excellent correlation with HOS-SS (r = 0.81; P < .001), very good correlation with HOS-ADL (r = 0.73; P < .001), and good correlation with iHOT-12 (r = 0.68; P < .001). No floor was observed for any measure. The effect size was large for all outcomes, except PROMIS Depression (d = 0.04), but largest for iHOT12 (d = 1.87) followed by HOS-ADL (d = 1.29). The iHOT-12 was more responsive than PROMIS-PI (relative efficiency [RE] = 3.95), PROMIS-PF (RE = 4.13), HOS-ADL (RE = 2.26), and HOS-SS (RE = 3.84). HOS-SS was similarly responsive to PROMIS-PI (RE=1.03) and PROMIS-PF (RE=1.08). However, PROMIS-PF was overall the least responsive.

Conclusions: In patients at 6 months postoperatively from hip arthroscopy for FAIS, iHOT-12 was the most responsive and had the largest effect size. In contrast, PROMIS-PF had a lower effect size compared with legacy hip-specific PROMs. Additionally, PROMIS-PF did not correlate as well with iHOT-12 compared with HOS-SS.

Level Of Evidence: Level IV, case series.
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http://dx.doi.org/10.1016/j.arthro.2020.07.008DOI Listing
December 2020

Comparison of Suction Seal and Contact Pressures Between 270° Labral Reconstruction, Labral Repair, and the Intact Labrum.

Arthroscopy 2020 09 3;36(9):2433-2442. Epub 2020 Jun 3.

Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.

Purpose: To biomechanically compare the suction seal, contact area, contact pressures, and peak forces of the intact native labrum, torn labrum, 12- to 3-o'clock labral repair, and 270° labral reconstruction in the hip.

Methods: A cadaveric study was performed using 8 fresh-frozen hemipelvises with intact labra and without osteoarthritis. Intra-articular pressure maps were produced for each specimen using an electromechanical testing system under the following conditions: (1) intact labrum, (2) labral tear, (3) labral repair between the 12- and 3-o'clock positions, and (4) 270° labral reconstruction using iliotibial band allograft. Specimens were examined in neutral position, 20° of extension, and 60° of flexion. In each condition, contact pressure, contact area, and peak force were obtained. Repeated-measures analysis of variance was used to identify differences in biomechanical parameters among the 3 conditions. Qualitative differences in suction seal were compared between labral repair and labral reconstruction using the Fisher exact test.

Results: Repeated-measures analysis of variance for contact area in neutral position, extension, and flexion showed statistically significant differences between the normalized study states (P < .05). Post hoc analysis showed significantly larger contact areas measured in labral repair specimens than in labral reconstruction specimens in the extension and flexion positions. Region-of-interest analysis for the normalized contact area in the extension and flexion positions, as well as normalized contact pressures in neutral position, showed statistically significant differences between the labral states (P < .05). Finally, 8 labral repairs (100%) versus only 1 labral reconstruction (12.5%) retained the manually tested suction seal (P < .001).

Conclusions: In this in vitro biomechanical model, 270° labral reconstruction resulted in decreased intra-articular contact area and loss of suction seal when compared with labral repair. Clinically, labral reconstruction may not restore the biomechanical characteristics of the native labrum as compared with labral repair.

Clinical Relevance: Labral reconstruction may result in lower intra-articular hip contact area and loss of suction seal, affecting the native biomechanical function of the acetabular labrum. Further biomechanical studies and clinical studies are necessary to determine whether there are any long-term consequences of 270° labral reconstruction.
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http://dx.doi.org/10.1016/j.arthro.2020.05.024DOI Listing
September 2020

A Cadaveric Study of Cam-Type Femoroacetabular Impingement: Biomechanical Comparison of Contact Pressures Between Cam Morphology, Partial Femoral Osteoplasty, and Complete Femoral Osteoplasty.

Arthroscopy 2020 09 24;36(9):2425-2432. Epub 2020 May 24.

Section of Young Adult Hip Surgery, Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.

Purpose: To compare the biomechanical properties of the hip joint with an intact femoral cam lesion, partial cam resection, and complete cam resection.

Methods: A cadaveric study was performed using 8 hemipelvises with cam-type morphology (alpha angle > 55°) and intact labra. Intra-articular pressure maps were produced for each specimen under the following conditions: (1) native cam morphology (intact), (2) cam morphology with incomplete resection (partial), and (3) cam morphology with complete resection (complete). By use of an open technique, resection of the superior portion of the cam morphology was performed with a 5.5-mm burr to create the partial resection, followed by the inferior portion to create the complete resection. In each condition, 3 biomechanical parameters were obtained: contact pressure, contact area, and peak force within a region of interest. Measurements were performed 3 times in each condition, and the average value was used for statistical analysis. Analysis of variance was used to compare biomechanical parameters between conditions.

Results: A statistically significant difference was found between the pre- and post-resection alpha angles (62.2° ± 3.9° vs 40.9° ± 1.4°, P < .001). Repeated-measures analysis of variance showed that the normalized average pressure values of hips with complete resection of cam lesions were significantly lower than those of hips with incomplete femoral cam lesions and hips with intact cam morphology (100% vs 93.6% ± 8.3% and 82.6% ± 16.2%, respectively; P < .0001). The percentage reduction of contact pressure in the complete and partial groups was 17.4% and 6.4%, respectively, compared with the intact group. Contact area and peak force showed no statistically significant differences across the 3 conditions (P > .05).

Conclusions: Complete cam resection results in significantly lower intra-articular hip contact pressures than incomplete cam resection and native cam morphology in a cadaveric hip model. These observations underscore the importance of ensuring complete resection of femoral cam lesions in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome.

Clinical Relevance: Previous studies have shown that the most common reason for revision hip arthroscopy in patients with femoroacetabular impingement syndrome is incomplete femoral cam resection during the index operation. This study shows biomechanical differences associated with partial cam resection compared with the complete cam resection state that may translate to persistent symptoms.
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http://dx.doi.org/10.1016/j.arthro.2020.05.021DOI Listing
September 2020

Patients With Borderline Hip Dysplasia Achieve Clinically Significant Improvement After Arthroscopic Femoroacetabular Impingement Surgery: A Case-Control Study With a Minimum 5-Year Follow-up.

Am J Sports Med 2020 06 14;48(7):1616-1624. Epub 2020 May 14.

Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.

Background: Hip arthroscopy for the treatment of femoroacetabular impingement syndrome (FAIS) in patients with borderline hip dysplasia (BHD) is becoming a more common practice. However, the literature on achieving meaningful outcomes at midterm follow-up, as well as predictors of these outcomes, is limited.

Purpose: To (1) compare the rates of achieving meaningful clinical outcomes between patients with and without BHD and (2) identify the predictors for achieving clinical success among patients with BHD 5 years after undergoing hip arthroscopic surgery for FAIS.

Study Design: Cohort study; Level of evidence, 3.

Methods: Data from consecutive patients who underwent primary hip arthroscopic surgery with routine capsular closure for the treatment of FAIS between January 2012 and August 2014 were collected and retrospectively analyzed. Patients with BHD (lateral center-edge angle [LCEA] 20°-25°) were matched 1:2 by age (±1 year) and body mass index (BMI; ±5 kg/m) to control patients with normal acetabular coverage (LCEA 25°-40°). Data collected included baseline and 5-year postoperative patient-reported outcomes. The minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were calculated for each patient-reported outcome measure and compared between the 2 groups. A binary logistic regression analysis was used to identify significant predictors of achieving the MCID and PASS in the BHD group.

Results: The MCID in the BHD group was defined as 9.6, 14.1, and 9.5 for the Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sports Subscale, and modified Harris Hip Score, respectively. Threshold scores for achieving the PASS in both groups were 90.9, 76.6, and 81.9, respectively. A total of 88 patients were identified with having BHD and were matched to 176 controls. No statistical differences were identified for age, BMI, or sex. Both the BHD and the non-BHD groups had statistically significant increases in patient-reported outcome scores over the 5-year period, but the difference in both groups was not statistically significant ( > .05 for all). There was no statistical difference in the frequency of patients in the BHD and non-BHD groups achieving the MCID (86.6% vs 85.2%, respectively; = .804) or PASS (76.0% vs 73.7%, respectively; = .675) on at least 1 outcome measure. The logistic regression model demonstrated that being physically active (odds ratio [OR], 27.59; = .005) and being female (OR, 14.64; = .025) were independent predictors of achieving the MCID, while running (OR, 11.1; = .002), being female (OR, 7.6; = .011), and a larger preoperative LCEA (OR, 2.3; = .001) were independent preoperative predictors of achieving the PASS.

Conclusion: The rates of achieving clinical success 5 years after undergoing arthroscopic treatment with capsular closure for FAIS were not significantly different between patients with BHD and those with normal acetabular coverage. Being physically active, running for exercise, female sex, and a larger LCEA were preoperative predictors of achieving clinical success at 5 years in patients with BHD.
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http://dx.doi.org/10.1177/0363546520916473DOI Listing
June 2020

Preoperative Hip Extension Strength Is an Independent Predictor of Achieving Clinically Significant Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome.

Sports Health 2020 Jul/Aug;12(4):361-372. Epub 2020 May 11.

Division of Sports Medicine, Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois.

Background: The effect of preoperative hip strength on outcomes after hip arthroscopy for femoroacetabular impingement syndrome (FAIS) is unclear. The purpose of this study was to determine whether preoperative isometric hip strength is associated with outcome scores at 6 months as well as achieving the minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) in patients undergoing hip arthroscopy for FAIS.

Hypothesis: Increased preoperative isometric strength will be correlated with short-term postoperative outcomes and will be predictive of achieving higher functional status.

Study Design: Case series.

Level Of Evidence: Level 4.

Methods: Data from 92 consecutive patients undergoing primary hip arthroscopy for treatment of FAIS from March through August 2018 were analyzed. All patients included in the analysis had preoperative measures of isometric hip strength on both affected and unaffected limbs, as well as preoperative and 6-month patient-reported outcome (PRO) scores. Analysis was performed to determine correlations between normalized isometric hip strength measurements and PROs and whether strength measurements were predictive of achieving MCID or PASS.

Results: A total of 74 (80.4%) patients had 6-month PROs and were included in the final analysis. Hip extension strength on both sides was correlated with all postoperative PROs (all > 0.05). Abduction strength on both sides was correlated with postoperative Hip Outcome Score-Activities of Daily Living subscale score, achieving MCID on at least 1 score threshold, and reaching the international Hip Outcome Tool-12 threshold score for achieving PASS (all < 0.05). Regression analysis showed that extension strength on the affected side was the only strength measurement predictor of achieving PASS (1.043; = 0.049).

Conclusion: Preoperative isometric hip extension and abduction strength are correlated with 6-month postoperative PRO scores. Furthermore, hip extension strength is a predictor of achieving clinically meaningful outcomes.

Clinical Relevance: This study highlights the possible importance of preoperative optimization of hip function to maximize outcomes in patients undergoing hip arthroscopy for FAIS.
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http://dx.doi.org/10.1177/1941738120910134DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787575PMC
July 2020

Squat and gait biomechanics 6 months following hip arthroscopy for femoroacetabular impingement syndrome.

J Hip Preserv Surg 2020 Jan 18;7(1):27-37. Epub 2020 Feb 18.

Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison St, Suite 300, Chicago, IL 60612, USA.

The purpose of this study was to (i) assess whether squat and gait biomechanical measures improve in patients with femoroacetabular impingement syndrome (FAIS) 6 months after surgery compared to pre-operative measures and (ii) compare biomechanical properties to controls without FAIS. In this prospective study, biomechanical data during a double leg squat task and gait for 15 FAIS patients and 9 controls were collected using three-dimensional motion analysis. Data were collected in the FAIS group at two-time points, pre-operatively and 6-month post-operatively following arthroscopic hip surgery, and at a single time point for the healthy controls. Independent sample's -test were used to compare the FAIS group to the controls, and paired samples -test were used to determine within-group differences before and after hip arthroscopy in the FAIS group. The results indicated that there were significant within-group increases for sagittal plane moment rate during the double leg squat task ( = 0.009) between the pre-operative and post-operative time points for the FAIS group. Between-group differences showed that FAIS patients pre-operatively exhibit slower squat velocities during the descent ( = 0.005) and ascent phase ( = 0.012) of a double leg squat when compared healthy controls. Reduced hip external rotation moments during gait ( = 0.02) were also found between FAIS patients pre-operatively and controls. In conclusion, alterations in hip biomechanics are present before surgery for FAIS when compared to healthy controls, and joint mechanics change 6 months after surgery. However, the biomechanical differences during a double leg squat and gait were minimal.
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http://dx.doi.org/10.1093/jhps/hnaa004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195932PMC
January 2020

Assessment of Hip Translation In Vivo in Patients With Femoracetabular Impingement Syndrome Using 3-Dimensional Computed Tomography.

Arthrosc Sports Med Rehabil 2020 Apr 9;2(2):e113-e120. Epub 2020 Jan 9.

Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.

Purpose: To determine the 3-dimensional (3D) in vivo hip translation in patients with symptomatic femoroacetabular impingement syndrome (FAIS) using 3D computed tomography (CT) models with the hip in neutral and FABER (flexion, abduction, and the external rotation) positions and to identify patient predictors associated with the degree of hip translation.

Methods: Seventy-eight patients with FAIS and cam lesions underwent CT scans in neutral and FABER positions. Demographics including age, sex, and body mass index (BMI) were recorded for each patient. The cam deformity was characterized both in plain x-ray film and 3D. Translation between both positions was calculated using a validated high-precision 3D-3D registration technique. Univariate and multivariate regression analyses sought factors correlated with translation.

Results: The mean age of the patients included in the analysis was 36.3 ± 9.2 years, with 51% of the study group being female. The mean 3D femoral head center translation was 0.84 ± 0.37 mm, decomposed into vectors on standard anatomical directions as 0.13 ± 0.58 mm medial, 0.10 ± 0.54 mm posterior, and 0.08 ± 0.46 mm inferior. Multivariate analysis demonstrated that total translation was associated with larger alpha angles (β = 0.014; 95% confidence interval [CI] 0.003-0.024;  = .013), and greater BMI (β = 0.033; 95% CI 0.001-0.065;  = .042). Furthermore, posterior-inferior translation was associated with BMI (β = 0.032; 95% CI 0.003-0.061;  = .031), whereas medial-lateral translation is associated with the female sex (β = 0.388; 95% CI 0.124-0.634;  = .002), and smaller head radius (β = -0.068; 95% CI -0.128 to -0.007;  = .029).

Conclusions: As a provocative maneuver, FABER positioning in patients with FAIS resulted in an average measurable translation of the femoral head center in the posterior, medial, and inferior direction. Factors including sex, BMI, and alpha angle predicted the degree of translation.

Clinical Relevance: The current study demonstrates that there is measurable hip translation between the neutral and FABER positions in patients with symptomatic FAIS, which may cause hip microinstability. Furthermore, the study found an association between hip translation and both modifiable and nonmodifiable factors. This may indicate the need for more comprehensive preoperative surgical planning, intraoperative dynamic examination of the hip, and consideration of capsular plication in certain patients.
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http://dx.doi.org/10.1016/j.asmr.2019.12.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190544PMC
April 2020

What is the Role of Kinesiophobia and Pain Catastrophizing in Outcomes After Hip Arthroscopy for Femoroacetabular Impingement Syndrome?

Arthrosc Sports Med Rehabil 2020 Apr 8;2(2):e97-e104. Epub 2020 Jan 8.

Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.

Purpose: To (1) investigate trends in kinesiophobia and pain catastrophizing after hip arthroscopy for femoroacetabular impingement syndrome (FAIS), and (2) determine whether kinesiophobia and pain catastrophizing scores are associated with achieving minimal clinically important difference (MCID) for any of the hip-specific patient-reported outcome questionnaires.

Methods: Patients undergoing primary hip arthroscopy for treatment of FAIS between December 2016 and March 2017 were prospectively enrolled. Patients received the Tampa Scale of Kinesiophoibia-11 (TSK-11) and Pain Catastrophizing Scale (PCS) questionnaires preoperatively, 6 months, and 1 year postoperatively. They also received the hip-specific patient-reported outcome questionnaires (Hip Outcome Score Activities of Daily Living and Sport-Specific subscales, modified Harris Hip Score, and International Hip Outcome Tool-12), as well as visual analog scale for satisfaction and pain preoperatively and 1-year postoperatively. The threshold for achieving MCID was determined for each hip outcome tool, and patients achieving MCID were compared with those who did not.

Results: A total of 85 (80.2%) patients (mean age: 33.7 ± 12.4 years; female: 75.3%) were included in the final analysis. At 1-year follow-up, there was a significant reduction in TSK-11 scores (26.22 ± 5.99 to 18.70 ± 6.49; < .001) and PCS scores (17.81 ± 10.13 to 4.77 ± 7.57; < .001) when compared with preoperative scores. 1-year PCS scores were significantly lower in patients achieving MCID compared with patients failing to achieve MCID (3.2 ± 4.4 vs 10.8 ± 15.2;  = .006). There were no significant differences in TSK-11 scores between those achieving and not achieving MCID.

Conclusions: Patient kinesiophobia and pain catastrophizing both show significant improvements 1 year after undergoing hip arthroscopy for FAIS. However, pain catastrophizing scores at 1 year are significantly greater in patients not achieving MCID, whereas no association was identified between kinesiophobia and likelihood for MCID achievement. This suggests PCS may be a more useful tool than TSK-11 during postoperative rehabilitation for identifying patients at risk for not achieving MCID.

Level Of Evidence: Level II, prospective case series.
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http://dx.doi.org/10.1016/j.asmr.2019.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190542PMC
April 2020

Evaluation of Statistical Shape Modeling in Quantifying Femoral Morphologic Differences Between Symptomatic and Nonsymptomatic Hips in Patients with Unilateral Femoroacetabular Impingement Syndrome.

Arthrosc Sports Med Rehabil 2020 Apr 5;2(2):e91-e95. Epub 2020 Feb 5.

Department of Orthopedic Surgery, University of Maryland, Baltimore, Maryland, U.S.A.

Purpose: To determine whether statistical shape modeling can detect subtle morphologic differences in the shape of the proximal femur that correlate with clinical findings of unilateral femoroacetabular impingement syndrome.

Methods: Patients who had diagnoses of unilateral femoroacetabular impingement syndrome and who had existing computed tomography scans of their pelvises were included. Three-dimensional shape models in the form of triangle meshes were generated from the computed tomography images. Statistical shapes of cam-type and normal hips were compared to identify structural differences.

Results: The study included 33 hips in 17 subjects. Of the subjects, 7 (41.1%) were male, and 10 (58.9%) were female. The subjects ranged in age from 17-60 years of age (mean 36.3 ± 11.0 years old). The statistical shape modeling found mean shapes and modes after optimizing the groupwise correspondence. Symptomatic hips demonstrated 1 mm of thickening as compared to the femoral necks of asymptomatic hips, corresponding to cam lesions.

Conclusions: Symptomatic cam deformities were an average of 1 mm more prominent in the femoral neck region as compared to the asymptomatic hips when using statistical shape modeling. The present study provides a proof of the concept that statistical shape modeling can be used to examine and help define cam morphology and that subtle morphologic differences may account for developing femoroacetabular impingement syndrome.

Clinical Relevance: Using the methods presented in this study, it would be possible to define cam and pincer morphologies by creating statistical shape models, and this work could potentially lead to the development of a new classification system for femoroacetabular impingement syndrome lesions.
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http://dx.doi.org/10.1016/j.asmr.2019.11.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190539PMC
April 2020

A Staged Arthroscopic Approach to Fixation of Unstable Osteochondritis Dissecans in the Medial Femoral Condyle of the Knee Using Nonabsorbable Fixation Screws.

Arthrosc Tech 2020 Apr 10;9(4):e477-e481. Epub 2020 Mar 10.

Division of Sports Medicine, Department of Orthopedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina, U.S.A.

Osteochondritis dissecans is a focal lesion of articular cartilage that can result in fragment instability with progression of early osteoarthritis. Regarding the knee joint, salvage of an unstable lesion can be achieved using arthroscopic-assisted reduction and fixation via a 2-stage process. The first involves arthroscopic fixation of the fragment using nonbioabsorbable screws, whereas the second stage performed 12 weeks later involves removal of the screws and confirmation of successful healing of the lesion. Previous studies have demonstrated excellent outcomes in patients undergoing fixation for unstable chondral lesions not amenable to conservative treatment. A critical component of successful treatment is understanding the importance of hardware placement and technique. The purpose of the Technical Note is to describe a method performing this 2-stage arthroscopic repair of an unstable chondral lesion located on the medial femoral condyle of the knee.
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http://dx.doi.org/10.1016/j.eats.2019.11.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189124PMC
April 2020

Effect of prior ipsilateral lower extremity surgery on 2-year outcomes following hip arthroscopy for femoroacetabular impingement syndrome.

J Hip Preserv Surg 2019 Aug 20;6(3):241-248. Epub 2019 Jul 20.

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.

The purpose of this study was to determine the influence of prior lower extremity surgery on patient reported outcomes following hip arthroscopy for femoroacetabular impingement syndrome (FAIS). Consecutive patients who underwent hip arthroscopy for FAIS and a prior history of ipsilateral lower extremity surgery were identified and matched 2:1 by age, gender, and body mass index (BMI) to controls without a history of lower extremity surgery. The minimal clinically important difference (MCID) and patient acceptable symptomatic state (PASS) were calculated for HOS-ADL, HOS-SS, and mHHS. Preoperative and 2-year postoperative patient reported outcomes of both groups were compared, and logistic regression was performed to determine whether lower extremity surgery influenced achieving MCID and PASS. A total of 102 patients (24.94%) with prior history of ipsilateral lower extremity surgery were identified. Ipsilateral orthopaedic knee surgery accounted for more than half (53.92%) of all prior surgeries. Patients with a history of ipsilateral lower extremity surgery had significant lower 2-year PROs, satisfaction, and greater pain when compared to patients without lower extremity surgery ( < 0.001 all). A history of ipsilateral lower extremity surgery was a negative predictor of achieving MCID for HOS-ADL and HOS-SS, as well as PASS for HOS-ADL, HOS-SS, and mHHS ( < 0.001 all). In conclusion, patients with prior lower extremity surgery were found to have inferior outcome scores and a lower likelihood of achieving clinically significant outcome improvement compared to patients without a history of lower extremity surgery at two years postoperatively.
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http://dx.doi.org/10.1093/jhps/hnz031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7171797PMC
August 2019

Mirror Image Modeling of Acetabular Rim Thickness Differences in Patients With Unilateral Femoroacetabular Impingement Syndrome.

Arthrosc Sports Med Rehabil 2019 Nov 6;1(1):e1-e6. Epub 2019 Aug 6.

Division of Sports Medicine, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A.

Purpose: To use mirror imaging to identify the location and magnitude of difference in acetabular rim morphology between the symptomatic and unaffected acetabula in patients with symptomatic unilateral pincer-type or mixed femoroacetabular impingement syndrome (FAIS) using 1-dimensional models created with computed tomography (CT).

Methods: CT scans of bilateral hips in 33 patients diagnosed with unilateral pincer-type or mixed FAIS were obtained. Three-dimensional bilateral hip models were constructed, and the unaffected hemipelvis was superimposed onto the symptomatic side to compare acetabular thickness. Protrusion of the symptomatic side was recorded, and rim morphology was divided into clock face quadrants to analyze the location of greatest magnitude of difference between affected and unaffected acetabula. Analysis of the quadrants was performed using analysis of variance with post hoc Bonferroni correction.

Results: The study group consisted of more females (51.6%) than males, with an average age of 35.72 ± 7.8 years and an average body mass index of 24.3 ± 4.1 kg/m. Of the 33 hips included, 14 were isolated pincer-type FAIS and 19 were mixed. The average preoperative symptomatic side lateral center edge angle was 37.5° ± 7.2° compared with 29° ± 5.1° on the asymptomatic side ( = .001). The symptomatic acetabular rim was on average 0.43 ± 0.18 mm thicker than the corresponding location on the unaffected rim. When the acetabulum was divided into clock face quadrants, the 12 to 3 o'clock position showed the greatest difference between symptomatic and unaffected sides (0.55 ± 0.18 mm) compared with the 3 to 6 o'clock position (0.4 ± 0.28 mm;  = .006), 6 to 9 o'clock (0.34 ± 0.07 mm; < .001), and 9 to 12 o'clock (0.38 ± 0.03;  = .001).

Conclusions: Patients with unilateral, symptomatic pincer-type or mixed FAIS show statistical differences in rim thickness between the affected and unaffected acetabula. Small changes in acetabular rim morphology on the order of ≤0.5 mm may be the difference between symptomatic FAIS and the unaffected hip.

Level Of Evidence: IV, case series.
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http://dx.doi.org/10.1016/j.asmr.2019.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120855PMC
November 2019

Travel Distance Does Not Affect Outcomes in Hip Preservation Surgery: A Case for Centers of Excellence.

Orthop J Sports Med 2020 Mar 20;8(3):2325967120908821. Epub 2020 Mar 20.

Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.

Background: Previous studies have evaluated the effect of distance to high-volume centers on outcomes after joint replacement. However, there is limited evidence on whether this distance has an effect on outcomes after undergoing hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS).

Purpose: To determine whether increased distance from a patient's home to his or her primary orthopaedic clinic has an influence on the ability to achieve the minimal clinically important difference (MCID) on outcome measures after surgery for FAIS.

Study Design: Cohort study; Level of evidence, 3.

Methods: A retrospective cohort analysis was performed on patients undergoing surgery for FAIS by a single surgeon from January 2012 through January 2017. A total of 692 patients were identified and split into 2 groups: driving distance of <50 miles from our institution (referral group) and driving distance of <50 miles from our institution (local group). Preoperative and 2-year postoperative scores on patient-reported outcome measures (PROMs), including the Hip Outcome Score Activities of Daily Living and Sport-Specific subscales, International Hip Outcome Tool-12, and modified Harris Hip Score, were assessed. Patients achieving the MCID on any included PROM were analyzed using a chi-square analysis. Logistic regression was performed to determine whether driving distance and other demographic variables of interest had an effect on achieving the MCID. Study data were analyzed using PatientIQ, a cloud-based research and analytics platform for health care.

Results: There were 647 patients who completed 2-year follow-up and were included in the analysis. Of these patients, 116 (17.9%) were identified as being ≥50 miles from their orthopaedic provider, and 531 (82.1%) were identified as having a driving distance of <50 miles. A total of 100 patients (86.2%) in the referral group reached the MCID, and 476 patients (89.6%) in the local group reached the MCID. There was no statistically significant difference in reaching the MCID on any of the included PROMs between the 2 groups ( = .364). The same result held when controlling for a number of factors including age, body mass index, and adjusted gross income with logistic regression.

Conclusion: When controlling for a number of factors including age, body mass index, and adjusted gross income, distance to a high-volume hip arthroscopic surgery center did not have an effect on postoperative outcome scores or achieving the MCID 2 years after undergoing surgery for FAIS.
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http://dx.doi.org/10.1177/2325967120908821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7092385PMC
March 2020
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