Objectives: Despite a dramatic increase in the numbers of primary and revision hip arthroscopy cases that are performed, there is limited literature focusing on the younger population of patients who undergo revision hip arthroscopy. Pathophysiology and post-procedural outcomes of pediatric patients has been demonstrated to differ from adults in many common sports related injuries, including those to the shoulder and knee. The purpose of this study was to describe the indications for and outcomes following revision hip arthroscopy in patients 18 years and younger. Our hypothesis was that these patients would present to revision surgery with different pathology and demonstrate significant improvement in outcomes and return to activity. Methods: A prospective data registry was queried for all patients 18 years and younger who underwent revision hip arthroscopy with a minimum of 2-year follow-up. Data included detailed surgical data and outcome scores (modified Harris hip (mHHS), Tegner activity scale, and patient satisfaction with outcome) at minimum 2 year follow-up. This study was IRB approved. Results: Thirty hips were included in 29 patients. 24 of the patients were female. Average age at revision was 16.6 (range 15-18). 21 of the patients had one prior surgery, 6 had 2 prior surgeries and 2 had 3 prior surgeries. Mean time from most recent surgery to revision surgery was 18.7 months (range 4.7 to 74 months). Surgeries prior to presentation included 13 with labral debridement, 11 with labral repair, 7 had both cam and pincer addressed, 4 had cam only, 1 had pincer only. 18 patients did not have femoroacetabular impingement (FAI) addressed. 5 patients had iliopsoas releases. At revision, lysis of adhesions was performed on all patients. 12 had labral reconstruction, including 9 of the initial labral debridement patients. 18 underwent cam and pincer resection, including 13 of those without FAI addressed initially. 8 patients had labral repair. 3 patients had iliopsoas release and 1 had iliotibial band release. One patient underwent a periacetabular osteotomy without further arthroscopy. At an average follow-up of 37 months (range 24 to 52 months), the mHHS improved from 57 (25 to 96) to 82 (45 to 96). Mean improvement was 22 points (p<0.001). The median satisfaction was 7 (1 to 10), median Tegner was 5 (1 to 9), SF12 PCS was 50.8 (37.2 to 58.3) and the SF12 MCS was 52.8 (45. to 63.6) Conclusion: Revision hip arthroscopy in patients under the age of 18 resulted in good outcomes scores. The majority of these patients were satisfied and all returned to activity. Failure to address FAI and the failure of labral debridement were the most common pathologies precipitating revision hip arthroscopy. This challenging population should be further studied to prevent revision surgery and possible additional irreparable damage.
Purpose: Meniscus loss leads to decreased clinical function and activity levels and increases rate of knee degeneration, thus leading to additional surgeries or even knee replacement, especially in chronic patients. Chronic patients are more focused on preserving their knees and avoiding additional surgeries. The purpose of this study was to determine if replacement of lost or irreparable meniscus tissue with the Collagen Meniscus Implant (CMI) decreased the need for additional surgeries in multiply operated chronic knee patients compared to meniscectomy only. We hypothesized that patients who gained meniscus tissue with the CMI would require fewer surgeries than meniscectomy only controls through five years. Methods: In this prospective randomized multicenter clinical trial (Level of Evidence I), patients 18 to 60 years old who had undergone one to three prior partial medial meniscectomies (PMM) and currently had clinical symptoms of meniscus pathology were randomized either to receive the CMI or have an additional PMM (control). Eighty-five CMI were implanted, but one was removed at 3 weeks after an incision wound infection, and two patients died. The remaining 82 CMI patients were compared to 66 controls over 5 years to determine survivorship. Survivorship was defined as not having an additional unplanned surgery outside the experimental protocol on the study knee. Results: Follow-up rate at 5 years was 96%. Eight CMI patients (9.5%) and 15 control patients (22.7%) required reoperation through 5 years. Survivorship at one year was 90% for control and 95% for CMI patients, 86% for control and 95% for CMI patients at 2 years, 83% and 92% at 3 years, 79% for control patients and 91% for CMI patients at 4 years, and 74% for control patients and 89% for CMI patients at 5 years. CMI patients had a significantly higher survivorship compared to controls (p=0.04). The risk (odds) of reoperation was 2.7 times greater for controls compared to CMI patients at 5 years (95% CI=1.2 to 6.7). Furthermore, the majority of control patient reoperations occurred prior to 24 months, but only four CMI reoperations occurred during the first 24 months. Conclusion: This study confirms that chronic patients who received the CMI required fewer additional surgeries in their multiply operated knees than PMM only controls through 5 years. The additional tissue regeneration supported by the CMI may decrease progression of degenerative changes and reduce necessity and frequency for additional surgeries. This study further confirms the importance of preserving as much meniscus tissue as possible at time of meniscus surgery, and clearly it supports potential positive benefits of regrowing or regenerating lost meniscus tissue. Our hypothesis was affirmed.
Objective: Lysholm and Tegner scores have been validated to assess outcomes of meniscus surgery. We prospectively determined Lysholm scores for function and calculated Tegner index to determine percentage of pre-injury activity level regained by patients six years after partial meniscectomy alone versus placement of collagen meniscus implants (CMI, MenaflexTM). We hypothesized that in this prospective randomized multicenter clinical trial, patients who received collagen meniscus implant would have better function and would have regained more of their lost activity than patients with meniscectomy alone. Methods: Patients 18 to 60 years old who had undergone 1 to 3 prior partial medial meniscectomies (thus deemed “chronic”) and remained symptomatic randomly received either a CMI (n=76) or another partial medial meniscectomy (control) (n=69). Lysholm and Tegner data were collected prospectively. Tegner index was calculated by subtracting preoperative Tegner scores from the longest follow-up scores and then dividing that difference by the difference of pre-injury less preoperative scores. The quotient multiplied by 100 yields a percentage that represents amount of lost activity regained as a result of therapeutic intervention. The findings were then compared to earlier analyses of the same patients. Results: Average follow-up for both groups was 72 months (range for CMI, 24 to 88; for controls, 24 to 92). For both groups, Lysholm scores improved significantly (p=0.0001) from preoperative to 6 years postoperative, but there was no difference between treatments. Average Tegner index for CMI patients was 0.47; thus, 6 years after receiving CMI they had regained 47% of activity lost due to the inciting injury. Average Tegner index for controls was 0.22; thus, they regained 22% of lost activity. This difference was clinically and statistically significant (p=0.028). The Lysholm scores for both groups were unchanged from 2-year findings; however, Tegner index for CMI patients improved from 0.42 to 0.47, but Tegner index decreased for controls from 0.29 earlier to 0.22 at 6 years. Conclusion: CMI (Menaflex) and partial meniscectomy both allowed chronic patients to regain function equally 6 years after index surgery. However, patients treated with CMI had significantly higher Tegner index at 6 years compared to controls, thus chronic CMI patients regained more of the activity they had lost as a result of their inciting injury. Noteworthy, CMI patients continued to gain activity from 2 to 6 years while meniscectomy only controls lost activity. These findings suggest that control patients reduced their activity levels in an attempt to maintain their function.
Lateral unicompartmental knee arthroplasty (UKA) is an excellent option to alleviate disability and restore function in patients with lateral compartment knee osteoarthritis (OA). The purpose of the present study was to determine the survivorship and long-term outcomes in both younger/middle-aged and older patients with lateral compartment OA following non-robotically-assisted, fixed-bearing lateral UKA and to determine if an acceptable symptom state can be achieved.All patients were managed with fixed-bearing lateral UKA by a single surgeon utilizing a lateral parapatellar approach without robotic assistance. The primary outcome variables were the Knee injury and Osteoarthritis Outcome Score (KOOS) Activities of Daily Living (ADL) and Sport subscale scores. In addition, the other KOOS subscores, the Lysholm score, the achievement of the Patient Acceptable Symptom State (PASS), and the Veterans RAND (VR-12) Physical Component Summary score (PCS) and Mental Component Summary score (MCS) were collected. Failure was defined as conversion to total knee arthroplasty (TKA). Patients were divided into 2 cohorts: younger/middle-aged patients (<60 years of age) and older patients (≥60 years of age).A cohort of 256 patients underwent medial (n = 193) or lateral (n = 63) UKA. Sixty-one patients met the inclusion criteria. At mean of 10 years (range, 4 to 17 years) of follow-up, there were no significant differences between the groups in terms of any patient-reported outcome measures (p > 0.05). The percentage of patients in whom PASS was achieved on the KOOS ADL and Sport subscores was 82% and 88%, respectively, in the younger cohort and 80% and 80%, respectively, in the older cohort. The mean survival estimate of the prothesis was 15.3 years (95% confidence interval [CI], 14.5 to 16.2 years) for the entire cohort. The estimated rate of implant survival in the younger cohort was 100% at 5 and 10 years, and the estimated rate of implant survival in the older cohort was 98% at 5 years and 96% at 10 years.Lateral fixed-bearing, non-robotic UKA for the treatment of isolated lateral compartment OA resulted in >80% of patients reaching an acceptable symptom state in terms of both activities of daily living and sporting activities. UKA provides an excellent option that provides longevity with high PASS rates and return to activities with a low risk of complications and failure.Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
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