Christian Smith

Purpose: To investigate changes in sexual function and activity after arthroscopic hip surgery for femoroacetabular impingement using the United Kingdom Non‐Arthroplasty Hip Registry dataset. Subanalyses were performed between males and females, and patients over 40 and under 40 years old. Methods: Patients who had arthroscopic hip surgery between January 1, 2012, and October 31, 2020, were aged over 16, and completed the relevant patient‐reported outcome measures were included. Question 9 of the International Hip Outcome Tool‐12 (sexual activity question [SAQ]) refers to problems with sexual activity, and responses to this were compared before surgery and at 6 and 12 months after surgery. Subanalyses were also performed, including SAQ scores by patients’ sex or age. SAQ scores were correlated with Euroqol‐5 dimension‐5 level self‐reporting tool (EQ‐5D‐5L) scores using Spearman’s rank coefficient. Results: SAQ was answered by 2,547 patients before and at 6 months after surgery (62.3% female, median age = 36.2, interquartile range [IQR] = 29‐44 years) and by 2,314 at 12 months (61.9% female, median age = 36.2, IQR = 29‐44 years). Scores for sexual activity increased from 35.0 before surgery to 70.0 at 6 months ( P < .001) and were maintained at 12 months ( P < .001). Female patients demonstrated a significantly greater improvement in their scores for sexual function from before surgery (median = 30.0, IQR = 14‐50) to 6 months (median = 60, IQR = 28‐86, P < .001) and 12 months (median = 62.0, IQR = 29‐90, P < .001), compared to male patients (preoperative median = 50.0, IQR 25‐84; 6‐month median = 80, IQR = 45‐97; 12‐month median = 80, IQR = 41‐98). The effect of age on improvements in sexual function did not demonstrate a significant difference. A significant positive correlation was found between improvements in sexual function and quality of life, as measured by the EQ‐5D‐5L, at 6 and 12 months ( P < .001). Conclusions: Hip arthroscopy for symptomatic femoroacetabular impingement produces an improvement in sexual function and activity. Scores for sexual function improved regardless of patient age or sex; however, female patients experienced a greater improvement in sexual function than males. Level of Evidence: Level III, Retrospective cohort study.

Subtalar arthroereisis has a controversial history and has previously been associated with high failure rates and excessive complications. A database search for outcomes of arthroereisis for the treatment of symptomatic paediatric flexible pes planus provided 24 articles which were included in this review, with a total of 2550 feet operated on. Post-operative patient-reported outcome measures recorded marked improvement. Patient satisfaction was reported as excellent in 79.9%, and poor in 5.3%. All radiological measurements demonstrated improvement towards the normal range following arthroereisis, as did hindfoot valgus, supination, dorsiflexion and Viladot grade. Complications were reported in 7.1% of cases, with a reoperation rate of 3.1%. Arthroereisis as a treatment for symptomatic paediatric flexible pes planus produces favourable outcomes and high patient satisfaction rates with a reasonable risk profile. There is still a great deal of negativity and literature highlighting the complications and failures of arthroereisis, especially for older implants. The biggest flaws in the collective literature are the lack of high-quality prospective studies, a paucity of long-term data and the heterogeneity of utilized outcome measures between studies. Cite this article: EFORT Open Rev 2021;6:118-129. DOI: 10.1302/2058-5241.6.200076

OBJECTIVE. The objectives of our study were to assess the evidence for the diagnostic efficacy of 3-T MRI for meniscal and anterior cruciate ligament (ACL) injuries in the knee using arthroscopy as the reference standard and to compare these results with the results of a previous meta-analysis assessing 1.5-T MRI. MATERIALS AND METHODS. The online Cochrane Library, MEDLINE, and PubMed databases were searched using the following terms: MRI AND ((3 OR three) AND (Tesla OR T)) AND knee AND arthroscopy AND (menisc* OR ligament). Patient demographics, patient characteristics, MRI scanning details, and diagnostic results were investigated. The methodologic quality of the included studies was assessed using the revised Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. A meta-analysis of studies using 3-T MRI was performed, and the results were compared with a previous meta-analysis of studies using 1.5-T MRI. RESULTS. One hundred one studies were identified by the search strategy, and 13 studies...

To compare the diagnostic accuracy of magnetic resonance imaging (MRI), 2-dimensional magnetic resonance arthrogram (MRA) and 3-dimensional isotropic MRA in the diagnosis of rotator cuff tears when performed exclusively at 3-T. A systematic review was undertaken of the Cochrane, MEDLINE and PubMed databases in accordance with the PRISMA guidelines. Studies comparing 3-T MRI or 3-T MRA (index tests) to arthroscopic surgical findings (reference test) were included. Methodological appraisal was performed using QUADAS 2. Pooled sensitivity and specificity were calculated and summary receiver-operating curves generated. Kappa coefficients quantified inter-observer reliability. Fourteen studies comprising 1332 patients were identified for inclusion. Twelve studies were retrospective and there were concerns regarding index test bias and applicability in nine and six studies respectively. Reference test bias was a concern in all studies. Both 3-T MRI and 3-T MRA showed similar excellent diagnostic accuracy for full-thickness supraspinatus tears. Concerning partial-thickness supraspinatus tears, 3-T 2D MRA was significantly more sensitive (86.6 vs. 80.5 %, p = 0.014) but significantly less specific (95.2 vs. 100 %, p < 0.001). There was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA showed similar accuracy to 3-T conventional 2D MRA. Three-Tesla MRI appeared equivalent to 3-T MRA in the diagnosis of full- and partial-thickness tears, although there was a trend towards greater accuracy in the diagnosis of subscapularis tears with 3-T MRA. Three-Tesla 3D isotropic MRA appears equivalent to 3-T 2D MRA for all types of tears.

Purpose: To systematically review and assess the use of the Ligament Advanced Reinforcement System (LARS; Surgical Implants and Devices, Arc‐sur‐Tille, France) for posterior cruciate ligament (PCL) reconstruction. Methods: A search of multiple databases was conducted using the following terms: (LARS[All Fields] AND posterior[All Fields]) OR (LARS[All Fields] AND PCL[All Fields]). The methodologic quality of each article was assessed by use of abridged Downs and Black criteria. Results: Fifty‐four studies were found from the database search, of which 5 were included in the final review (4 case series and 1 case‐control study). One hundred twenty‐nine PCL reconstructions with LARS were performed. The mean patient age was 32.2 years, with 89 male and 40 female patients included. The mean follow‐up time ranged from 10.5 to 44 months. Lysholm scores improved from a mean of 64.8 preoperatively to 89.8 postoperatively. No patients had International Knee Documentation Committee grade 1 or 2 preoperatively, with 93.0% achieving this postoperatively. Only 1 case of synovitis and 1 case of graft rupture were reported. Conclusions: There is little evidence on the effectiveness of PCL reconstructions using LARS ligaments. What data there are show great promise, with short‐ and medium‐term outcome data appearing favorable to autograft reconstruction. Complication rates are encouragingly low. Clinical Relevance: LARS has great potential for PCL reconstruction. Further studies are needed regarding the use of LARS ligaments during PCL reconstruction, including longer follow‐up periods and investigation into the optimal timing for reconstruction. This may be best achieved by way of a multicenter study.

Knee osteoarthritis after anterior cruciate ligament (ACL) injury has previously been reported. However, there has been no meta-analysis reporting the development and progression of osteoarthritis. We present the first meta-analysis reporting on the development and progression of osteoarthritis after ACL injury at a minimum mean follow-up of 10 years, using a single and widely accepted radiologic classification, the Kellgren & Lawrence classification. Meta-analysis. Articles were included for systematic review if they reported radiologic findings of ACL-injured knees and controls using the Kellgren & Lawrence classification at a minimum mean follow-up period of 10 years. Appropriate studies were then included for meta-analysis. Nine studies were included for systematic review, of which 6 studies were further included for meta-analysis. One hundred twenty-one of 596 (20.3%) ACL-injured knees had moderate or severe radiologic changes (Kellgren & Lawrence grade III or IV) compared with 23 of 465 (4.9%) uninjured ACL-intact contralateral knees. After ACL injury, irrespective of whether the patients were treated operatively or nonoperatively, the relative risk (RR) of developing even minimal osteoarthritis was 3.89 (P < .00001), while the RR of developing moderate to severe osteoarthritis (grade III and IV) was 3.84 (P < .0004). Nonoperatively treated ACL-injured knees had significantly higher RR (RR, 4.98; P < .00001) of developing any grade of osteoarthritis compared with those treated with reconstructive surgery (RR, 3.62; P < .00001). Investigation of progression to moderate or severe osteoarthritis (grade III or IV only) after 10 years showed that ACL-reconstructed knees had a significantly higher RR (RR, 4.71; P < .00001) compared with nonoperative management (RR, 2.41; P = .54). It was not possible to stratify for return to sports among the patients undergoing ACL reconstruction. Results support the proposition that ACL injury predisposes knees to osteoarthritis, while ACL reconstruction surgery has a role in reducing the risk of developing degenerative changes at 10 years. However, returning to sports activities after ligament reconstruction may exacerbate the development of arthritis.