Publications by authors named "Eoghan T Hurley"

89 Publications

Immobilisation in external rotation after first-time traumatic anterior shoulder instability reduces recurrent instability: a meta-analysis.

J ISAKOS 2021 Jan 23;6(1):22-27. Epub 2020 Dec 23.

Department of Orthopedic Surgery, NYU Langone Health, New York, New York, USA.

Importance: Cadaveric and MRI findings have demonstrated significantly less labral separation and displacement when the shoulder is placed in external rotation as compared with internal rotation.

Objective: The purpose of the current study is to meta-analyse the randomised controlled trials in the literature to compare immobilisation in external versus internal rotation after first-time anterior shoulder dislocation.

Evidence Review: A literature search of MEDLINE, EMBASE and the Cochrane Library was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Randomised controlled trials comparing immobilisation in external rotation versus internal rotation for first-time anterior shoulder dislocation were included.

Findings: Nine randomised controlled trials with 795 patients were included. The mean age of included patients was 29 years, 82.4% were male and the mean follow-up was 25.5 months. As compared with immobilisation in internal rotation, compliance was significantly higher (74.5% vs 67.4%, p=0.01), and the rate of recurrent dislocations was significantly lower (22.2% vs 33.4%, p=0.02) with immobilisation in external rotation. Additionally, in patients 20-40 years old the rate of recurrent dislocations was significantly lower in those treated with immobilisation in external rotation than internal rotation (12.1% vs 31.4%, p=0.006). Immobilisation in external rotation also resulted in a higher rate of return to preinjury level of play (60.1% vs 42.6%, p=0.0001).

Conclusions And Relevance: Immobilisation of the shoulder in external rotation after a traumatic first-time anterior shoulder dislocation results in a higher compliance rate, a lower recurrent dislocation rate and a higher rate of return to play as compared with immobilisation in internal rotation.

Level Of Evidence: Level I.
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http://dx.doi.org/10.1136/jisakos-2020-000511DOI Listing
January 2021

Long-Term Outcomes of Radial Head Arthroplasty for Radial Head Fractures - A Systematic Review at Minimum 8-Year Follow-Up.

J Shoulder Elbow Surg 2021 Mar 31. Epub 2021 Mar 31.

Sports Surgery Clinic, Dublin, Ireland.

Background: The purpose of this study was to systematically review the literature to evaluate the functional outcomes, radiological outcomes and revision rates following radial head arthroplasty (RHA) at a minimum of 8 years follow-up.

Methods: Two independent reviewers performed a literature search using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using PubMed, Embase and Web of Science databases. Only studies reporting on outcomes of RHA with a minimum of mean 8 years' follow-up were considered for inclusion.

Results: Our search found 10 studies including 432 elbows (51% males), with average age of 50 years (15-93) and mean follow-up of 117 months (98-145) met our inclusion criteria. At final follow-up, the mean Mayo Elbow Performance Score (MEPS) and Quick Disabilities of Arm, Shoulder & Hand (QuickDASH) scores 83 (45-100) and 17 (0-63) respectively, and 86% of patients reported having no or minimal pain. The overall dislocation, subluxation, ulnar neuritis and infection rates were 2%, 4%, 3% and 3% respectively. The rates of radiologic loosening, radiolucency, degenerative change and heterotopic ossification were 9%, 46%, 27% and 38% respectively. The overall surgical revision rates were 20%, with 3%, 15% and 5% requiring RHA implant revision, removal of metal/implants and arthrolysis respectively.

Conclusion: Our systematic review established that RHA results in satisfactory clinical outcomes and modest complication and revision rates at long-term follow-up, despite high levels of radiological degenerative changes over the same period.
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http://dx.doi.org/10.1016/j.jse.2021.03.142DOI Listing
March 2021

Use of Extracellular Matrix Cartilage Allograft May Improve Infill of the Defects in Bone Marrow Stimulation for Osteochondral Lesions of the Talus.

Arthroscopy 2021 Mar 23. Epub 2021 Mar 23.

NYU Langone Health, New York, New York, USA. Electronic address:

Purpose: The purpose of this study is to evaluate the effectiveness of Extracellular Matrix Cartilage Allograft (EMCA) as an adjuvant to bone marrow stimulation (BMS) compared to BMS alone in the treatment of osteochondral lesions of the talus (OLT).

Methods: A retrospective cohort study comparing patients treated with BMS with EMCA (BMS-EMCA group) and BMS alone (BMS group) between 2013 and 2019 was undertaken. Clinical outcome was evaluated with the Foot and Ankle Outcome Score (FAOS) pre- and postoperatively. Postoperative MRIs were evaluated using a modified Magnetic Resonance Observation of Cartilage Tissue (MOCART) score. Comparisons between groups were made with the Man-Whitney U test for continuous variables and the χ or Fisher exact test for categorical variables.

Results: Twenty-four patients underwent BMS with EMCA (BMS-EMCA group) and 24 patients underwent BMS alone (BMS group). The mean age was 40.8 years (range, 19 to 60 years) in BMS-EMCA group and 47.8 years (range, 24 to 60 years) in BMS group (p=0.060). The mean follow-up time was 20.0 months (range, 12-36 months) in BMS-EMCA group and 26.9 months (range, 12 to 55 months) in BMS group (p=0.031). Both groups showed significant improvements in all FAOS subscales. No significant differences between groups were found in all postoperative FAOS. The mean MOCART score in BMS-EMCA group was higher (76.3 vs 66.3), but not statistically significant (p=0.176). The MRI analysis showed that 87.5% of BMS-EMCA group had complete infill of the defect with repair tissue, however less than half (46.5%) of BMS group had complete infill (p=0.015).

Conclusion: BMS with EMCA is an effective treatment strategy for the treatment of OLT and provides better cartilage infill in the defect on MRI. However, this did not translate to improved functional outcomes compared with BMS alone in the short-term. Additionally, according to the minimal clinically important difference (MCID) analysis, there was no significant difference in clinical function scoring between either group postoperatively.

Level Of Evidence: Level III retrospective comparative study.
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http://dx.doi.org/10.1016/j.arthro.2021.03.032DOI Listing
March 2021

High rates of return to play and work follow knee extensor tendon ruptures but low rate of return to pre-injury level of play.

Knee Surg Sports Traumatol Arthrosc 2021 Mar 24. Epub 2021 Mar 24.

New York University, New York, NY, USA.

Purpose: Extensor mechanism ruptures (EMR) of the knee are rare but debilitating injuries that always require surgery to restore knee function. The purpose of this study was to systematically review the literature to ascertain the rate of return to play following patellar or quadriceps tendon ruptures.

Methods: A systematic literature search was conducted based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using the EMBASE, MEDLINE, and Cochrane Library databases. Inclusion criteria consisted of clinical studies reporting on return to play after patellar or quadriceps tendon repair. Statistical analysis was performed with the use of SPSS.

Results: Our review found 48 studies including 1135 cases meeting our inclusion criteria. There were 33 studies including 757 patellar tendon (PT) repairs, and 18 studies including 378 quadriceps tendon (QT) repairs. The overall rate of return to play for PT repairs was 88.9%, with 80.8% returning to the same level of play. The overall rate of return to play for QT repairs was 89.8%, with 70.0% returning to the same level of play. Among professional athletes, the overall rate of return to play after PT repair and QT repair was 76.9% and 70.9%, respectively. Following PT repair, 95.8% were able to return to work, and following QT repair, 95.9% were able to return to work.

Conclusion: The overall rate of return to play was high following both PT and QT repairs. Moreover, a high percentage of those patients were able to return to their pre-operative level of sport with a low risk for re-rupture.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1007/s00167-021-06537-4DOI Listing
March 2021

Arthroscopic Latarjet Procedure: Indications, Techniques, and Outcomes.

JBJS Rev 2021 03 10;9(3). Epub 2021 Mar 10.

Department of Orthopedic Surgery, New York University Langone Health, New York, NY.

»: The proposed advantages of the arthroscopic approach in the Latarjet procedure for shoulder dislocation include improved visualization for accurate positioning of the coracoid graft, the ability to address any associated intra-articular pathologies, and the diminished potential for the formation of postoperative scar tissue and stiffness associated with an open procedure.

»: Young age, the presence of glenoid and/or humeral bone loss, a history of dislocation, a history of failed arthroscopic stabilization surgery, and an active lifestyle are all associated with recurrent dislocation and are relative indications for an osseous augmentation procedure.

»: Both the open and arthroscopic Latarjet procedures result in substantial improvements in patient function, with comparable rates of recurrent instability and complication profiles.
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http://dx.doi.org/10.2106/JBJS.RVW.20.00071DOI Listing
March 2021

Evidence-based Treatment of Failed Primary Osteochondral Lesions of the Talus: A Systematic Review on Clinical Outcomes of Bone Marrow Stimulation.

Cartilage 2021 Feb 22:1947603521996023. Epub 2021 Feb 22.

Department of Orthopaedic Surgery, NYU Langone Health, New York, NY, USA.

Objective: The purpose of this study is to systematically review the literature and to evaluate the outcomes following bone marrow stimulation (BMS) for nonprimary osteochondral lesions of the talus (OLT).

Design: A literature search was performed to identify studies published using PubMed (MEDLINE), EMBASE, CDSR, DARE, and CENTRAL. The review was performed according to the PRISMA guidelines. Two authors separately and independently screened the search results and conducted the quality assessment using the Methodological Index for Non-Randomized Studies (MINORS). Studies were pooled on clinical, sports, work, and imaging outcomes, as well as revision rates and complications. The primary outcome was clinical success rate.

Results: Five studies with 70 patients were included in whom nonprimary OLTs were treated with secondary BMS. The pooled clinical success rate was 61% (95% confidence interval [CI], 50-72). The rate of return to any level of sport was 83% (95% CI, 70-91), while the return to pre-injury level of sport was 55% (95% CI, 34-74). The rate of return to work was 92% (95% CI, 78-97), and the complication rate was assessed to be 10% (95% CI, 4-22). Imaging outcomes were heterogeneous in outcome assessment, though a depressed subchondral bone plate was observed in 91% of the patients. The revision rate was 27% (95% CI, 18-40).

Conclusions: The overall success rate of arthroscopic BMS for nonprimary osteochondral lesions of the talus was 61%, including a revision rate of 27%. Return to sports, work, and complication outcomes yielded fair to good results.
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http://dx.doi.org/10.1177/1947603521996023DOI Listing
February 2021

Return to Play Criteria Among Shoulder Surgeons Following Shoulder Stabilization.

J Shoulder Elbow Surg 2021 Feb 19. Epub 2021 Feb 19.

NYU Langone Health, Department of Orthopaedic Surgery, Division of Sports Medicine.

Purpose: The purpose of this study is to survey the members of North American and European shoulder surgery & sports medicine societies to evaluate their criteria for deciding when an athlete can safely return to play (RTP) following shoulder stabilization surgery.

Methods: A survey was sent to the members of the American Shoulder and Elbow Surgeons (ASES), American Orthopaedic Society for Sports Medicine (AOSSM), European Society for Sports & Knee Arthroscopy (ESSKA), and European Society for Surgery of the Shoulder and the Elbow (SECEC). Surgeons were asked which criteria they used to determine when an athlete can RTP following the arthroscopic Bankart repair and Latarjet procedures, with additional questions on how time from surgery and participation in collision sports affect return.

Results: Overall, 317 surgeons responded to the survey. Following arthroscopic Bankart repair, the most common criteria used were time (98.7%), strength (74.8%), and range of motion (70%). The most commonly-reported time point was 4 months (43.8%), and the majority used an additional time period, most commonly 2 months (38.2%), before allowing a collision athlete to RTP (75.4%). Interestingly, the addition of a Remplissage procedure did not affect decision-making regarding RTP in most cases (92.1%). Following the Latarjet procedure, the most common criteria used were time (98.4%), strength (67.5%), and range of motion (65.9%). Less than half reported using imaging to assess for radiographic union before allowing patients to RTP (47%), and the most common modality was plain radiography (80%). The most common time point was 4 months (33.1%), and the majority reported waiting an additional period of time, most commonly by 2 months (25.9%), before allowing a collision athlete to RTP (59.6%).

Conclusion: Despite the absence of evidence-based guidelines on when athletes can safely return to play following shoulder stabilization surgery, there exists minimal variability in recommendations between North American and European shoulder surgeons. Further research is required to better define criteria for return to play after the arthroscopic Bankart repair and Latarjet procedures.
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http://dx.doi.org/10.1016/j.jse.2021.01.026DOI Listing
February 2021

Return to Play After Arthroscopic Stabilization for Posterior Shoulder Instability-A Systematic Review.

Arthrosc Sports Med Rehabil 2021 Feb 24;3(1):e249-e256. Epub 2020 Dec 24.

Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A.

Purpose: To ascertain the rate and timing of return to play (RTP) and the availability of specific criteria for safe RTP after arthroscopic posterior shoulder stabilization.

Methods: Medline, EMBASE, and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to find studies on arthroscopic posterior shoulder stabilization. Studies were included if they reported RTP data or rehabilitation protocols and excluded if concomitant procedures influenced the rehabilitation protocol. Rate and timing of RTP, along with rehabilitation protocols, were assessed.

Results: This review found 25 studies, including 895 cases, meeting the study's inclusion criteria. The majority of patients were male (82.7%), with an age range of 14 to 66 years and a follow-up range of 4 to 148.8 months. The overall RTP rate ranged from 62.7% to 100.0%, and 50.0% to 100.0% returned to the same level of play. Among collision athletes, the overall rate of RTP was 80.0% to 100.0%, with 69.2%-100.0% returning to the same level of play. In overhead athletes, the overall rate of RTP was 85.2% to 100.0%, with 55.6% to 100.0% returning to the same level of play. Four studies (128 patients) specifically addressed the timing of RTP, and the range to RTP was 4.3 to 8.6 months. Specific RTP criteria were reported in a majority of studies (60%), with the most reported item being restoration of strength (44%).

Conclusion: There is a high rate of return to sport after arthroscopic posterior shoulder stabilization, ranging from 4.3 to 8.6 months after surgery. Return to preinjury level is higher for collision athletes compared with overhead athletes. However, there is inadequate reporting of RTP criteria in the current literature, with no clear timeline for when it is safe to return to sport.

Level Of Evidence: IV, systematic review of level II to IV studies.
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http://dx.doi.org/10.1016/j.asmr.2020.08.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879176PMC
February 2021

Return-to-Play and Rehabilitation Protocols Following Isolated Meniscal Repair-A Systematic Review.

Arthrosc Sports Med Rehabil 2021 Feb 24;3(1):e241-e247. Epub 2020 Dec 24.

Department of Orthopaedic Surgery, Division of Sports Medicine, NYU Langone Health, New York, New York, U.S.A.

Purpose: To systematically review the literature and assess the reported rehabilitation protocols, return-to-play guidelines, and reported rates of return-to-play after meniscal repair.

Methods: MEDLINE, EMBASE, and the Cochrane Library were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies on meniscal repair. Studies were included if return-to-play data and/or rehabilitation protocols were reported. The rate and timing of return-to-play was assessed. The rehabilitation protocols were documented, in addition to when to start range of motion (ROM), full ROM, partial weight-bearing (WB), and full WB.

Results: Overall, 88 studies met our inclusion criteria. Thirteen studies, including 507 patients, cited a range of 71.2% to 100% of return-to-play, with 53.9% to 92.6% returning to the same/greater level, ranging between 3.3 and 10 months. There was considerable variability in the reported rehabilitation protocols, but the most frequently reported time to begin ROM exercises was within the first week (78.9%) and full ROM at 6 weeks (33.3%). Partial WB was typically begun during the first week (61.0%), and full WB between the fourth and sixth week (65.6%) postoperatively. Following surgery, time elapsed was the most commonly cited criteria for return-to-play (97.0%), with 6 months being the most common time point applied (46.9%). No study advised against returning to competitive or contact sports after meniscal repair.

Conclusions: In conclusion, there was a high rate of return-to-play following meniscal repair, with 60% of patients returning to the same level of play. However, there was considerable diversity in the reported rehabilitation protocols and insufficient reporting on return-to-play criteria in the literature. This demonstrates the need for further research and formulation of an evidence-based consensus statement for this patient population.

Level Of Evidence: Level IV, systematic review of Level I to IV studies.
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http://dx.doi.org/10.1016/j.asmr.2020.07.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879171PMC
February 2021

Short Term Complications of the Latarjet Procedure - A Systematic Review.

J Shoulder Elbow Surg 2021 Feb 16. Epub 2021 Feb 16.

NYU Langone Health, Department of Orthopaedic Surgery, Division of Sports Medicine, New York, NY, USA.

Purpose: The purpose of this study is to evaluate the short-term complication rate following the open and arthroscopic Latarjet procedures, and to meta-analyze the studies comparing the two approaches METHODS: PUBMED was searched according to PRIMSA guidelines to find clinical and biomechanical studies comparing complication rates in open and arthroscopic Latarjet procedures.

Results: Overall, 89 studies (LOE I: 2, LOE II: 2, LOE III: 24, LOE IV: 61) met inclusion criteria, with 7,175 shoulders. Following the open Latarjet procedure, the overall complication rate was 6.1%, with a 1.9% occurrence of graft-related complications, 1.1% hardware, 1.1% wound, 0.9% nerve, and 1.2% other complications. Following the arthroscopic Latarjet procedure, the overall complication rate was 6.8%, with a 3.2% occurrence of graft-related complications, 1.9% hardware, 0.5% wound, 0.7% nerve, and 0.5% other complications. Complications were reported in 7 studies comparing 379 patients treated with the open Latarjet and 531 treated with the arthroscopic Latarjet, with no statistically significant difference between the two (p = 0.81).

Conclusion: Our study established that the overall complication rate following the Latarjet procedure was 6-7% with the most common complication being graft-related. Furthermore, based on the current evidence, there is no significant difference in the complication rate between the open and arthroscopic Latarjet procedures.

Level Of Evidence: Level IV; Systematic Review.
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http://dx.doi.org/10.1016/j.jse.2021.01.024DOI Listing
February 2021

Distal posterolateral corner injury in the setting of multiligament knee injury increases risk of common peroneal palsy.

Knee Surg Sports Traumatol Arthrosc 2021 Feb 9. Epub 2021 Feb 9.

New York University Langone Orthopedic Hospital, 333 East 38th Street, New York, NY, 10016, USA.

Purpose: The purpose of this study was to identify if the location of posterolateral corner (PLC) injury was predictive of clinical common peroneal nerve (CPN) palsy.

Methods: A retrospective chart review was conducted of patients presenting to our institution with operative PLC injuries. Assessment of concomitant injuries and presence of neurologic injury was completed via chart review and magnetic resonance imaging (MRI) review. A fellowship-trained musculoskeletal radiologist reviewed the PLC injury and categorized it into distal, middle and proximal injuries with or without a biceps femoral avulsion. The CPN was evaluated for signs of displacement or neuritis.

Results: Forty-seven operatively managed patients between 2014 and 2019 (mean age-at-injury 29.5 ± 10.7 years) were included in this study. Eleven (23.4%) total patients presented with a clinical CPN palsy. Distal PLC injuries were significantly associated with CPN palsy [9 (81.8%) patients, (P = 0.041)]. Nine of 11 (81.8%) patients with CPN palsy had biceps femoral avulsion (P = 0.041). Of the patients presenting with CPN palsy, only four (36.4%) patients experienced complete neurologic recovery. Three of 7 patients (43%) with an intact CPN had full resolution of their clinically complete CPN palsy at the time of follow-up (482 ± 357 days). All patients presenting with a CPN palsy also had a complete anterior cruciate ligament (ACL) rupture in addition to a PLC injury (P = 0.009), with or without a posterior cruciate ligament (PCL) injury. No patient presenting with an isolated pattern of PCL-PLC injury (those without ACL tears) had a clinical CPN palsy.

Conclusion: Distal PLC injuries have a strong association with clinical CPN palsy, with suboptimal resolution in the initial post-operative period. Specifically, the presence of a biceps femoris avulsion injury was highly associated with a clinical CPN palsy. Additionally, CPN palsy in the context of PLC injury has a strong association with concomitant ACL injury. Furthermore, the relative rates of involvement of the ACL vs. PCL suggest that specific injury mechanism may have an important role in CPN palsy.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-021-06469-zDOI Listing
February 2021

Tranexamic Acid Has No Effect on Postoperative Hemarthrosis or Pain Control After Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft: A Double-Blind, Randomized, Controlled Trial.

Arthroscopy 2021 Jan 30. Epub 2021 Jan 30.

Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A.. Electronic address:

Purpose: The purpose of this double-blind, randomized, controlled trial was to evaluate the use of intravenous (IV) tranexamic acid (TXA) in patients undergoing primary bone-patellar tendon-bone (BPTB) anterior cruciate ligament reconstruction (ACLR) regarding postoperative hemarthrosis, pain, opioid consumption, and quadriceps atrophy and activation.

Methods: A controlled, randomized, double-blind trial was conducted in 110 patients who underwent ACLR with BPTB autograft. Patients were equally randomized to the control and experimental groups. The experimental group received two 1-g boluses of IV TXA, one prior to tourniquet inflation and one prior to wound closure; the control group did not receive TXA. If a clinically significant hemarthrosis was evident, the knee was aspirated and the volume of blood (in milliliters) was recorded. Additionally, we recorded perioperative blood loss (in milliliters); visual analog scale scores on postoperative days 1, 4, and 7 and at postoperative weeks 1, 6, and 12; postoperative opioid consumption on postoperative days 1, 4, and 7; range of motion (ROM) and ability to perform a straight leg raise at postoperative weeks 1, 6, and 12; and preoperative and postoperative thigh circumference ratio.

Results: There was no significant difference in perioperative blood loss between the TXA and control groups (32.5 mL vs 35.6 mL, P = .47). In the TXA group, 23 knees were aspirated; in the control group, 26 knees were aspirated (P = .56). No significant difference in postoperative hemarthrosis volume was seen in patients who received IV TXA versus those who did not (26.7 mL vs 37.3 mL, P = .12). There was no significant difference in visual analog scale scores between the 2 groups (P = .15); in addition, there was no difference in postoperative opioid consumption (P = .33). No significant difference in ROM, ability to perform a straight leg raise, or postoperative thigh circumference ratio was observed (P > .05 for all).

Conclusions: IV TXA in patients who undergo ACLR with BPTB autograft does not significantly impact perioperative blood loss, postoperative hemarthrosis, or postoperative pain levels. Additionally, no significant differences were seen in early postoperative recovery regarding ROM or quadriceps reactivation.

Level Of Evidence: Level I, randomized controlled trial.
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http://dx.doi.org/10.1016/j.arthro.2021.01.037DOI Listing
January 2021

Current management strategies for osteochondral lesions of the talus.

Bone Joint J 2021 Feb;103-B(2):207-212

Imperial College London, London, UK.

The management of symptomatic osteochondral lesions of the talus (OLTs) can be challenging. The number of ways of treating these lesions has increased considerably during the last decade, with published studies often providing conflicting, low-level evidence. This paper aims to present an up-to-date concise overview of the best evidence for the surgical treatment of OLTs. Management options are reviewed based on the size of the lesion and include bone marrow stimulation, bone grafting options, drilling techniques, biological preparations, and resurfacing. Although many of these techniques have shown promising results, there remains little high level evidence, and further large scale prospective studies and systematic reviews will be required to identify the optimal form of treatment for these lesions. Cite this article: 2021;103-B(2):207-212.
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http://dx.doi.org/10.1302/0301-620X.103B2.BJJ-2020-1167.R1DOI Listing
February 2021

Pain Management Strategies After Anterior Cruciate Ligament Reconstruction: A Systematic Review With Network Meta-analysis.

Arthroscopy 2021 04 28;37(4):1290-1300.e6. Epub 2021 Jan 28.

Sports Medicine Division, Orthopaedic Surgery Department, NYU Langone Health, New York, New York, U.S.A.

Purpose: To systematically review randomized controlled trials (RCTs) evaluating various pain control interventions after anterior cruciate ligament reconstruction (ACLR) to determine the best-available evidence in managing postoperative pain and to optimize patient outcomes.

Methods: A systematic review of the literature was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. A study was included if it was an RCT evaluating an intervention to reduce postoperative pain acutely after ACLR in one of the following areas: (1) nerve blocks, (2) nerve block adjuncts, (3) intra-articular injections, (4) oral medications, (5) intravenous medications, (6) tranexamic acid, and (7) compressive stockings and cryotherapy. Quantitative and qualitative statistics were carried out, and network meta-analysis was performed where applicable.

Results: Overall, 74 RCTs were included. Across 34 studies, nerve blocks were found to significantly reduce postoperative pain and opioid use, but there was no significant difference among the various nerve blocks in the network meta-analysis. Intra-articular injections consisting of bupivacaine and an adjunct were found to reduce reported postoperative pain scores up to 12 hours after ACLR, with significantly lower postoperative opioid use.

Conclusions: Nerve blocks and regional anesthesia are the mainstay treatment of postoperative pain after ACLR, with the commonly used nerve blocks being equally efficacious. Intra-articular injections consisting of bupivacaine and an adjunct were found to reduce reported postoperative pain scores up to 12 hours after ACLR, with significantly lower postoperative opioid use. There was promising evidence for the use of some oral and intravenous medications, tranexamic acid, and nerve block adjuncts, as well as cryotherapy, to control pain and reduce postoperative opioid use.

Level Of Evidence: Level II, systematic review and meta-analysis of RCTs.
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http://dx.doi.org/10.1016/j.arthro.2021.01.023DOI Listing
April 2021

The majority of athletes fail to return to play following anterior cruciate ligament reconstruction due to reasons other than the operated knee.

Knee Surg Sports Traumatol Arthrosc 2021 Jan 28. Epub 2021 Jan 28.

Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, Ireland.

Purpose: The purpose of this study is to evaluate the reasons why athletes do not return to play (RTP) following anterior cruciate ligament (ACL) reconstruction from a large single-centre database.

Methods: The institutional ACL registry was screened for patients that had undergone a primary ACLR and had RTP status reported at 24-month follow-up. The reasons that patients were unable to RTP at 24 months were evaluated. The ACL-Return to Sport Index (ACL-RSI) was evaluated at baseline and 24-month follow-up to evaluate psychological ability to RTP.

Results: At 2 years, 1140 patients returned to play, and 222 had not returned to play. The most common reasons athletes were unable to return was fear of reinjury (27.5%), lack of confidence in performance on return (19.4%) and external life factors (16.6%), i.e. work commitments and family reasons. Other reasons for athletes not returning to play were residual knee pain (10%) and subsequent injury (5%). The ACL-RSI score was significantly lower at diagnosis (40.3 vs. 49.3; p = 0.003) and 2 years (41.8 vs. 78.7; p < 0.0001) in athletes who did not return to play vs. those that did RTP.

Conclusion: The majority of patients that report they have not returned to play do so due to external life and psychological factors associated with their injury, including fear of reinjury and lack of confidence in performance. A small minority of patients were unable to return due to residual knee symptoms or reinjury. Pre-operative psychological assessment and intervention may identify those less likely to RTP and provide an opportunity for targeted interventions to further improve RTP outcomes.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-020-06407-5DOI Listing
January 2021

There are differences in knee stability based on lateral extra-articular augmentation technique alongside anterior cruciate ligament reconstruction.

Knee Surg Sports Traumatol Arthrosc 2021 Jan 23. Epub 2021 Jan 23.

New York University Langone Health, New York, NY, USA.

Purpose: The purpose of the current study is to systematically review and network meta-analyze the current evidence in the literature to ascertain if there is a superior lateral extra-articular augmentation technique in conjunction with anterior cruciate ligament (ACL) reconstruction (ACL.R) with respect to knee stability, re-rupture rates and functional outcomes.

Methods: The literature search was performed based on the PRISMA guidelines. Cohort studies comparing ACL.R to ACL.R + lateral extra-articular augmentation were included. Lateral extra-articular techniques included were anterolateral ligament reconstruction (ALL.R), Cocker-Arnold, Lemaire, Losee, Maraccaci, and McIntosh. Clinical outcomes were compared between ACL.R alone and the different lateral extra-articular augmentation techniques using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-Score.

Results: Twenty-eight studies with a total of 2990 patients were included. ACL.R + Cocker-Arnold technique had the highest P-Score for ACL re-ruptures and residual pivot-shift. ACL.R + Cocker-Arnold, Lemaire, and ALL.R all significantly reduced the rate of ACL re-rupture, and residual pivot-shift, compared to ACL.R alone. There was no significant difference between any of the lateral extra-articular augmentation techniques and ACL.R alone. ALL.R had the highest P-Score for return to play, and return to play at pre-injury level.

Conclusion: This study established that ACL.R + Cocker-Arnold, Lemaire and ALL.R resulted in significantly lower ipsilateral ACL re-ruptures, as well as reduced pivot-shift, compared to ACL.R alone. Whereas, the other lateral extra-articular augmentation techniques did not reduce pivot-shift and re-rupture. Additionally, functional outcomes and return to play were comparable between those who underwent ACL.R and lateral extra-articular augmentation and ACL.R alone.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-020-06416-4DOI Listing
January 2021

Patients unable to return to play following medial patellofemoral ligament reconstructions demonstrate poor psychological readiness.

Knee Surg Sports Traumatol Arthrosc 2021 Jan 20. Epub 2021 Jan 20.

Department of Orthopedic Surgery, New York University Langone Health, 333 E 38th Street, New York, NY, USA.

Purpose: Medial patellofemoral ligament reconstruction (MPFLR) is often indicated in athletes with lateral patellar instability to prevent recurrence and allow for a successful return to play. In this patient population, the ability to return to play is one of the most important clinical outcomes. The purpose of the current study was to analyze the characteristics of patients who were unable return to play following MPFL reconstruction.

Methods: A retrospective review of patients who underwent MPFL reconstruction and subsequently did not return to play after a minimum of 12-months of follow-up was performed. Patients were evaluated for their psychological readiness to return to sport using the MPFL-Return to Sport after Injury (MPFL-RSI) score, which is a modification of the ACL-RSI score. A MPFL-RSI score > 56 is considered a passing score for being psychologically ready to return to play. Additionally, reasons for not returning to play including Visual Analog Scale for pain (VAS), Kujala score, satisfaction, and recurrent instability (including dislocations and subluxations) were evaluated.

Results: The study included a total of 35 patients who were unable to return to play out of a total cohort of 131 patients who underwent MPFL reconstruction as treatment for patellar instability. Overall, 60% were female with a mean age of 24.5, and a mean follow-up of 38 months. Nine patients (25.7%) passed the MPFL-RSI benchmark of 56 with a mean overall score of 44.2 ± 21.8. The most common primary reasons for not returning to play were 14 were afraid of re-injury, 9 cited other lifestyle factors, 5 did not return due to continued knee pain, 5 were not confident in their ability to perform, and 2 did not return due to a feeling of instability. The mean VAS score was 1.9 ± 2.3, the mean Kujala score was 82.5 ± 14.6, and the mean satisfaction was 76.9%. Three patients (8.7%) reported experiencing a patellar subluxation event post-operatively. No patient sustained a post-operative patellar dislocation.

Conclusion: Following MPFL reconstruction, patients that do not return to play exhibit poor psychological readiness with the most common reason being fear of re-injury.

Level Of Evidence: IV.
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http://dx.doi.org/10.1007/s00167-021-06440-yDOI Listing
January 2021

Management of Meniscal Pathology: From Partial Meniscectomy to Transplantation.

Instr Course Lect 2021 ;70:309-318

Meniscal pathology is one of the most common structural knee issues seen and managed by the orthopaedic surgeon. An ever-evolving armamentarium of management options exists that are geared toward the elimination of symptoms and restoration of normal knee function. A common theme among these management options is to preserve meniscal tissue whenever possible through repair or minimization of meniscal excision, as the literature has shown that the loss of meniscal tissue can significantly alter the distribution of forces and contact stresses on knee articular cartilage, thus predisposing the joint to degenerative osteoarthritis. In the setting of meniscal injuries or insufficiency, various advances in repair techniques, use of meniscal allografts, and use of biologic adjuvants have been reported to help preserve and/or attempt to restore the native kinematic properties of the knee. It is important to explore meniscal function, its associated pathologies, and currently available treatment options that are supported by short-term and long-term clinical data.
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January 2021

Long-term outcomes of total elbow arthroplasty: a systematic review of studies at 10-year follow-up.

J Shoulder Elbow Surg 2021 Jan 5. Epub 2021 Jan 5.

Sports Surgery Clinic, Dublin, Ireland.

Background: The purpose of this study was to systematically review the literature to evaluate the functional outcomes, dislocation, and revision rates following total elbow arthroplasty (TEA) at a minimum 10 years' mean follow-up.

Materials And Methods: Two independent reviewers performed a literature search using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using PubMed, Embase, and Cochrane Library databases. Studies were only included if they focused on outcomes post-TEA at a minimum 10 years' mean follow-up.

Results: Our search found 23 studies including 1429 elbows (60.4% linked TEA) that met our inclusion criteria. There were 1276 patients (79.0% female), with an average age of 64.7 years (19-93) and a mean follow-up of 137.2 months (120-216). At final follow-up, the mean Mayo Elbow Performance Score, Oxford Elbow Score, and Quick Disabilities of the Arm, Shoulder, and Hand scores were 89.1 (35-100), 64.4 (16-48), and 39.2 (3-93), respectively, and 63.3% of patients reported having no pain. The rates of aseptic loosening, infection, implant dislocation, and nerve injury were 12.9%, 3.3%, 4.2%, and 2.1%, respectively. The overall complication and revision rates were 16.3% and 14.6%, respectively.

Discussion And Conclusion: Our systematic review established that TEA offers patients satisfactory clinical outcomes at long-term follow-up, with relatively stable revision and complication rates compared to short and medium term.
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http://dx.doi.org/10.1016/j.jse.2020.11.014DOI Listing
January 2021

Type V superior labral anterior-posterior tears results in lower rates of return to play.

Knee Surg Sports Traumatol Arthrosc 2021 Jan 1. Epub 2021 Jan 1.

Sports Surgery Clinic, Northwood Avenue, Santry, Santry Demesne, Dublin 9, IE, Ireland.

Purpose: The purpose of this study was to evaluate the rate of return to play (RTP) in patients who underwent Type V superior labrum anterior-posterior (SLAP) repair compared to patients who underwent isolated Bankart repair in the setting of traumatic anterior shoulder instability.

Methods: A retrospective review of patients who underwent arthroscopic Bankart repair and SLAP repair by a single surgeon between 2012 and 2017 was performed. Additionally, these were pair-matched in a 1:2 ratio for age, sex, sport and level of pre-operative play, with those undergoing isolated arthroscopic Bankart repair alone as a control group. RTP, level of RTP and the timing of RTP were assessed.

Results: The study included a total of 96 patients, with 32 in the study group and 64 in the control group, and a mean follow-up of 59 months. Overall, there was no significant difference in the overall rate of return to play (26/32 (81.3%) vs 56/64 (87.5%), n.s), but there was a significantly higher rate of RTP at the same/higher level in the control group (14/32 (43.6%) vs 43/64 (67.2%), p = 0.0463). There was no significant difference in timing of RTP between the groups (n.s). There was no significant difference in recurrent instability (6/32 (18.8%) vs 5/64 (7.8%), n.s) but there was a significant difference in revision rates (5/32 (15.6%) vs. 2/64 (3.1%), p = 0.0392) between the Type V SLAP repair group and the control group.

Conclusion: Following arthroscopic repair, patients with Type V SLAP tears had a similar overall rate of RTP when compared directly to a control group of patients who underwent arthroscopic Bankart repair alone. However, those who underwent Type V SLAP repair reported significantly lower rates of RTP at the same or higher level compared to the control group.

Level Of Evidence: III.
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http://dx.doi.org/10.1007/s00167-020-06388-5DOI Listing
January 2021

The Effect of Platelet-Rich Plasma Leukocyte Concentration on Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of Randomized Controlled Trials.

Am J Sports Med 2020 Dec 17:363546520975435. Epub 2020 Dec 17.

New York University Langone Health, New York, New York, USA.

Background: It is unclear whether leukocyte-poor (LP) or leukocyte-rich (LR) varieties of platelet-rich plasma (PRP) as an adjuvant to arthroscopic rotator cuff repair (ARCR) result in improved tendon healing rates.

Purpose: To perform a network meta-analysis of the randomized controlled trials in the literature to ascertain whether there is evidence to support the use of LP- or LR-PRP as an adjunct to ARCR.

Methods: The literature search was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Randomized controlled trials comparing LP- or LR-PRP with a control alongside ARCR were included. Clinical outcomes, including retears and functional outcomes, were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-score.

Results: There were 13 studies (868 patients) included, with 9 studies comparing LP-PRP with a control and 4 studies comparing LR-PRP with a control. LP-PRP was found to significantly reduce the rate of retear and/or incomplete tendon healing after fixation, even among medium-large tears; it also improved outcomes on the visual analog scale for pain, Constant score, and University of California Los Angeles score. LP-PRP had the highest P-score for all treatment groups. LR-PRP did not result in any significant improvements over the control group, except for visual analog scale score for pain. However, post hoc analysis revealed that LP-PRP did not lead to significant improvements over LR-PRP in any category.

Conclusion: The current study demonstrates that LP-PRP reduces the rate of retear and/or incomplete tendon healing after ARCR and improves patient-reported outcomes as compared with a control. However, it is still unclear whether LP-PRP improves the tendon healing rate when compared with LR-PRP.
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http://dx.doi.org/10.1177/0363546520975435DOI Listing
December 2020

Pain Control After Shoulder Arthroscopy: A Systematic Review of Randomized Controlled Trials With a Network Meta-analysis.

Am J Sports Med 2020 Dec 15:363546520971757. Epub 2020 Dec 15.

New York University Langone Health, New York, New York, USA.

Background: Shoulder arthroscopy is one of the most commonly performed orthopaedic procedures used to treat a variety of conditions, with >500,000 procedures performed each year.

Purpose: To systematically review the randomized controlled trials (RCTs) on pain control after shoulder arthroscopy in the acute postoperative setting and to ascertain the best available evidence in managing pain after shoulder arthroscopy to optimize patient outcomes.

Study Design: Systematic review and meta-analysis.

Methods: A systematic review of the literature was performed based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Studies were included if they were RCTs evaluating interventions to reduce postoperative pain after shoulder arthroscopy: nerve blocks, nerve block adjuncts, subacromial injections, patient-controlled analgesia, oral medications, or other modalities. Meta-analyses and network meta-analyses were performed where appropriate.

Results: Our study included 83 RCTs. Across 40 studies, peripheral nerve blocks were found to significantly reduce postoperative pain and opioid use, but there was no significant difference among the variable nerve blocks in the network meta-analysis. However, continuous interscalene block did have the highest P-score at most time points. Nerve block adjuncts were consistently shown across 18 studies to prolong the nerve block time and reduce pain. Preoperative administration was shown to significantly reduce postoperative pain scores ( < .05). No benefit was found in any of the studies evaluating subacromial infusions.

Conclusion: Continuous interscalene block resulted in the lowest pain levels at most time points, although this was not significantly different when compared with the other nerve blocks. Additionally, nerve block adjuncts may prolong the postoperative block time and improve pain control. There is promising evidence for some oral medications and newer modalities to control pain and reduce opioid use. However, we found no evidence to support the use of subacromial infusions or patient-controlled analgesia.
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http://dx.doi.org/10.1177/0363546520971757DOI Listing
December 2020

Knotted Versus Knotless Anchors for Labral Repair in the Shoulder: A Systematic Review.

Arthroscopy 2021 04 9;37(4):1314-1321. Epub 2020 Dec 9.

Department of Orthopaedic Surgery, New York University Langone Health, New York, New York, U.S.A.

Purpose: To compare biomechanical and clinical outcomes between knotless and knotted anchors in arthroscopic labral repair, specifically in (1) Bankart repair, (2) SLAP repair, (3) posterior labral repair, and (4) remplissage augmentation of Bankart repair.

Methods: MEDLINE, EMBASE, and the Cochrane Library were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to find biomechanical and clinical studies comparing knotted and knotless anchors using the search term "knotless anchor."

Results: Overall, 17 studies met inclusion criteria. There were 7 studies evaluating the biomechanical outcomes, of which 5 found mixed results between knotted and knotless anchors for arthroscopic Bankart repair, 1 demonstrated a difference for SLAP repair favoring knotless anchors, and 2 showed no significant difference for Remplissage in terms of ultimate load-to-failure. Four studies evaluated knotless labral anchors compared with knotted anchors in patients undergoing arthroscopic Bankart repair with no significant differences in outcomes reported between the 2 anchor types, except in one study that found an improved visual analog scale score and a lower recurrence and revision rate with knotted anchors. Five studies evaluated knotless anchors compared with knotted anchors in patients undergoing SLAP repair, and none of the included studies found any significant differences in the patient reported outcome measures or revision rates. Of the 5 studies comparing operative time, 4 found a reduced time with knotless anchors.

Conclusions: The clinical results show no significant differences in outcomes between knotless and knotted anchors for labral repair in the shoulder, including Bankart repair, SLAP repair, and posterior labral repair. However, there was conflicting evidence supporting knotless or knotted anchors in the biomechanical studies. However, operative times may be reduced with the use of knotless anchors.

Level Of Evidence: III, A Systematic Review of Level II and III studies.
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http://dx.doi.org/10.1016/j.arthro.2020.11.056DOI Listing
April 2021

Distal biceps femoris avulsions: Associated injuries and neurological sequelae.

Knee 2020 Dec 15;27(6):1874-1880. Epub 2020 Nov 15.

NYU Langone Health, United States of America.

Background: The aim of this study was to describe associated injuries in cases of distal biceps femoris avulsions (DBFA) as well as the incidence of neurological injury and radiographic abnormalities of the common peroneal nerve (CPN).

Methods: A retrospective chart review was conducted of patients presenting to our office or trauma center with DBFA injuries. Demographic data was obtained as well as mechanism of injury. Assessment of concomitant injuries and presence of neurologic injury was completed via chart review and magnetic resonance imaging (MRI) review. The CPN was evaluated for signs of displacement or neuritis.

Results: Sixteen patients were identified (mean age-at-injury 28.6 years, 87.5% male) with DBFA. Three patients (18.8%) sustained their injuries secondary to high energy trauma while 13 (81.3%) had injuries secondary to lower energy trauma. Nine patients (56.3%) initially presented with CPN palsy. All patients presenting with CPN palsy of any kind were found to have a displaced CPN on MRI and no patient with a normal nerve course had a CPN palsy.

Conclusions: This case series demonstrates a strong association between DBFA and CPN palsy as well as multi-ligamentous knee injury (MLKI). These injuries have a higher rate of CPN palsy than that typically reported for MLKI. Furthermore, these findings suggest that CPN displacement on MRI may be a clinically significant indicator of nerve injury. LOE: IV.
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http://dx.doi.org/10.1016/j.knee.2020.07.085DOI Listing
December 2020

Arthroscopic Suture-Button Versus Hook-Plate Fixation for Acromioclavicular Joint Injuries-A Systematic Review of Comparative Studies.

Arthrosc Sports Med Rehabil 2020 Oct 22;2(5):e671-e676. Epub 2020 Sep 22.

Sports Surgery Clinic, Santry, Dublin, Ireland.

Purpose: To systematically review the comparative studies in the literature to compare joint stability, clinical outcomes, and complications of acromioclavicular joint fixation using a hook plate versus arthroscopic suture-button (SB) fixation.

Methods: A literature search was performed in accordance with the PRISMA guidelines to identify clinical studies comparing the hook plate and arthroscopic SB techniques for acromioclavicular joint injuries. Qualitative statistical analysis was performed using SPSS, and a value of ≤.05 was considered to be statistically significant.

Results: Six clinical studies including 285 patients were included in the systematic review. In 3 of the studies, there was a significant difference in favor of SB for Constant score. Patients treated with the SB technique had a lower visual analog scale score at final follow-up in 2 of the 4 studies that measured this outcome. In addition, there were no significant difference in the rate of complications, revisions, or joint malreduction in any of the included studies.

Conclusions: The arthroscopic SB procedure resulted in lower postoperative pain scores, and improved postoperative functional outcomes, although this was not a clinically significant difference. In addition, there were no significant differences in the rate of complications, revisions, or joint malreduction.

Level Of Evidence: Level III, systematic review of Level I, II, and III studies.
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http://dx.doi.org/10.1016/j.asmr.2020.07.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588637PMC
October 2020

Return to Play after Arthroscopic Bankart Repair Combined with Open Subpectoral Biceps Tenodesis.

Arthrosc Sports Med Rehabil 2020 Oct 24;2(5):e499-e503. Epub 2020 Oct 24.

Sports Surgery Clinic, Dublin, Ireland.

Purpose: To evaluate the clinical outcomes and rate of return to play (RTP) in patients who underwent arthroscopic Bankart repair and open subpectoral biceps tenodesis.

Methods: A retrospective review of patients who underwent combined arthroscopic Bankart repair and open subpectoral biceps tenodesis by a single surgeon between 2012 and 2016 was performed. RTP, the level of return, and the timing of return were assessed. Visual analog scale for pain, Rowe score, Shoulder Instability-Return to Sport after Injury score, and Subjective Shoulder Value were evaluated.

Results: The study included 14 patients, with a mean follow-up of 34.2 ± 12.1 months. Of the 14 patients, 13 (92.9%) returned to sport at a mean of 4.8 ± 1.2 months and 9 (64.3%) returned to the same or higher level of sport. At final follow-up, the mean Rowe was 80.0 ± 16.3, the mean Subjective Shoulder Value was 81.0 ± 15.1, the mean Shoulder Instability-Return to Sport after Injury was 57.3 ± 25.6, and the mean visual analog scale score was 2.6 ± 1.5. One patient had a recurrent dislocation, whereas no patients underwent a further operation on the ipsilateral shoulder.

Conclusion: Patients undergoing arthroscopic Bankart repair combined with open subpectoral biceps tenodesis had a high rate of RTP with a low rate of recurrent instability.

Level Of Evidence: IV, Therapeutic Case Series.
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http://dx.doi.org/10.1016/j.asmr.2020.05.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7588640PMC
October 2020

90-Day Complication Rate After the Latarjet Procedure in a High-Volume Center.

Am J Sports Med 2020 12 30;48(14):3467-3471. Epub 2020 Oct 30.

Sports Surgery Clinic, Dublin, Ireland.

Background: The Latarjet procedure is indicated for patients with recurrent anterior shoulder instability, previous failed soft tissue stabilization, glenoid bone loss, or high-risk factors for recurrence, although there is still a concern with the surgical complication rates associated with the Latarjet procedure.

Purpose: To evaluate the 90-day complication rate after the open Latarjet procedure in a high-volume center.

Study Design: Case series; Level of evidence, 4.

Methods: A retrospective review was performed of patients who underwent an open Latarjet procedure at our institution over a 5-year period between January 2015 and December 2019. The complications, readmissions, and reoperations within 90 days were evaluated.

Results: A total of 441 patients with a mean age of 23.0 ± 5.7 years was included; 97.5% of the patients were male. There were 2 intraoperative complications (0.5%): 1 coracoid fracture and 1 anaphylactic reaction to vancomycin. Overall, there were 19 postoperative complications (4.3%) in 18 patients, with 4 (0.9%) readmissions for revision surgery. Hematomas were the most common complication, occurring in 12 patients (2.7%), with 9 (2.0%) requiring a return to the operating theater during their stay for an evacuation. In those who required a readmission for a reoperation, 1 was for a hematoma requiring a washout, 2 were for irrigation and debridement of a surgical site infection, and the third was for a biceps tenodesis in a patient with severe bicipital pain. No patients had recurrence or any postoperative graft complications; additionally, there were no neurovascular complications.

Conclusion: We found that in a high-volume center, the open Latarjet procedure has a low 90-day complication rate with a low revision rate. Hematomas were the most common complication experienced by patients who underwent the Latarjet procedure, while there was no recurrent instability or neurological or hardware complications reported among the 441 patients included in this study.
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http://dx.doi.org/10.1177/0363546520964488DOI Listing
December 2020

Clinical Outcomes of Patients With Anterior Shoulder Instability and Glenolabral Articular Disruption Lesions: A Retrospective Comparative Study.

Am J Sports Med 2020 12 26;48(14):3472-3477. Epub 2020 Oct 26.

Sports Surgery Clinic, Dublin, Ireland.

Background: Anterior shoulder instability is a common clinical condition that often requires surgical stabilization. Glenoid labral tears are often associated with instability, with glenolabral articular disruption (GLAD) lesions occasionally being identified arthroscopically during repair, particularly in collision athletes.

Purpose: To evaluate the clinical outcomes and recurrence rates in patients who had GLAD lesions and underwent arthroscopic Bankart repair (ABR) and compare them with a control group without GLAD lesions.

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

Methods: A retrospective review of patients who underwent ABR with GLAD lesions, by a single surgeon between July 2012 and March 2017, was performed. Additionally, these were pair matched in a 2:1 ratio for age, sex, sport, and level of play with a control group who underwent ABR without GLAD lesions. Return to sport, the level of return, and the timing of return were assessed. The visual analog scale (VAS) for pain score, Rowe score, Shoulder Instability-Return to Sport after Injury (SIRSI) score, and Subjective Shoulder Value (SSV) were evaluated.

Results: The study included a total of 66 patients (22 and 44 patients for the GLAD and control groups, respectively), with a mean age of 25.8 years and a mean follow-up of 66 months. Overall, there was no significant difference in any of the clinical outcome scores (VAS, Rowe, SIRSI, and SSV) utilized for the GLAD and control groups ( > .05 for all). Similarly, there was no significant difference in the total rate of return to play (90.9% vs 88.6%; > .99) or return at the same/higher level (68.2% vs 72.7%; = .78). There was no significant difference in timing of return to play (6.3 ± 6.6 months vs 6.4 ± 2.5 months; = .98). There were 3 cases (13.6%) requiring further surgery (1 revision stabilization, 1 arthroscopic release, and 1 rotator cuff repair) in the GLAD group and 2 cases (4.5%) requiring further surgery (both revision stabilization) in the control group; the difference was not statistically significant ( = .32).

Conclusion: After arthroscopic repair, patients with GLAD lesions had similar midterm outcomes when compared with a control group without GLAD lesions.
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http://dx.doi.org/10.1177/0363546520964479DOI Listing
December 2020

Early Failures of Polyvinyl Alcohol Hydrogel Implant for the Treatment of Hallux Rigidus.

Foot Ankle Int 2021 Mar 10;42(3):340-346. Epub 2020 Oct 10.

Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA.

Background: The purpose of this study was to evaluate the clinical and radiological outcomes following a polyvinyl alcohol hydrogel implant in the treatment of hallux rigidus.

Methods: A retrospective cohort study investigating patients treated with a polyvinyl alcohol hydrogel implant for hallux rigidus was performed. Clinical outcomes were evaluated with the Foot and Ankle Outcomes Score (FAOS) and visual analog scale (VAS) score at the final follow-up. Plain radiographs were assessed postoperatively. Eleven patients (11 feet) with a mean follow-up of 20.9 months (range, 14-27 months) were included. The mean age was 60.3 years.

Results: All FAOS subscales showed pre- to postoperative improvements, but there was no statistical significance in all subscales. The mean VAS score showed improvement from 4.1 to 3.0 ( = .012). On postoperative plain radiographs, implant subsidence was observed 60% (6/10) at 4 weeks after surgery and 90% (9/10) at the final follow-up. Fifty percent (5/10) showed radiologic lucency around the implant. Forty percent (4/10) had erosion of the proximal phalanx of the great toe. Four patients (36%) reported no improvement following surgery at the final follow-up, which were considered as failures. Three patients required additional surgery related to the implants. An additional patient is waiting to revise the implant.

Conclusion: Our current cohort study demonstrated a high failure rate with the polyvinyl alcohol hydrogel implant in patients with hallux rigidus. Significant radiologic subsidence with lysis around the implant, erosion of the proximal phalanx countersurface, and implant wear are harbingers for concern in the long term.

Level Of Evidence: Level IV, case series.
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http://dx.doi.org/10.1177/1071100720962482DOI Listing
March 2021