Mikael Sansone

Stable Surgical Repair With Accelerated Rehabilitation Versus Nonsurgical Treatment for Acute Achilles Tendon Ruptures A Randomized Controlled Study

Background: The optimal treatment for acute Achilles tendon ruptures is still a subject of debate. Early loading of the tendon is a factor that has been shown to be beneficial to recovery and to minimize complications. The main outcome of previous studies has been complications such as reruptures and deep infections, without focusing on the functional outcome relevant to the majority of patients who do not experience these complications. Purpose: To evaluate whether stable surgical repair and early loading of the tendon could improve patient-reported outcome and function after an acute Achilles tendon rupture. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 100 patients (86 men, 14 women; mean age, 40 years) with an acute total Achilles tendon rupture were randomized to either surgical treatment, including an accelerated rehabilitation protocol, or nonsurgical treatment. The primary outcome was the Achilles tendon Total Rupture Score (ATRS). The patients were evaluated at 3, 6, and 12 months for symptoms, physical activity level, and function. Results: There were no significant differences between the groups in terms of symptoms, physical activity level, or quality of life. There was a trend toward improved function in surgically treated patients; the results were significantly superior when assessed by the drop countermovement jump (95% CI, 0.03-0.15; P = .003) and hopping (95% CI, 0.01-0.33; P = .040). No reruptures occurred in the surgical group, while there were 5 in the nonsurgical group (P = .06). There were 6 superficial infections in the surgically treated group; however, these superficial infections had no bearing on the final outcome. Symptoms, reduced quality of life, and functional deficits still existed 12 months after injury on the injured side in both groups. Conclusion: The results of the present study demonstrate that stable surgical repair with accelerated tendon loading could be performed in all (n = 49) patients without reruptures and major soft tissue–related complications. However, this treatment was not significantly superior to nonsurgical treatment in terms of functional results, physical activity, or quality of life.

Total dislocation of the hip joint after arthroscopy and ileopsoas tenotomy

AbstractThe hip is a highly stable joint. Non-traumatic dislocation of the hip is extremely uncommon. In this article, we report two cases of non-traumatic hip dislocations following hip arthroscopy. In both cases, capsulotomy and ileopsoas tenotomy had been performed. These cases raise questions about the importance of the natural stabilisers of the hip. Level of evidence V.

Good Results After Hip Arthroscopy for Femoroacetabular Impingement in Top-Level Athletes

Background: Femoroacetabular impingement (FAI) is a common cause of hip pain and dysfunction among athletes. Although arthroscopic surgery is an established treatment option for FAI, there are few studies reporting detailed outcomes using validated outcome measurements specifically designed for young and active athletes. Purpose: To report outcomes 1 year after arthroscopic treatment of FAI in top-level athletes using validated outcome measurements adapted for a young and active population. Study Design: Case series; Level of evidence, 4. Methods: A total of 85 top-level athletes (68 males, 17 females) with a mean (±SD) age of 25 ± 5 years underwent arthroscopic surgery for FAI. All athletes who reported Hip Sports Activity Scale (HSAS) levels 7 or 8 (range, 0-8) prior to symptom onset were included. The cohort was prospectively evaluated using online web-based validated health-related patient-reported outcomes measures (HR-PROMs), including the short version of the International Hip Outcome Tool (iHOT-12), the Copenhagen Hip and Groin Outcome Score (HAGOS; 6 subscales), the EuroQOL 5 dimensions questionnaire (EQ-5D; 2 subscales), the Hip Sports Activity Scale (HSAS) for physical activity level, and a visual analog scale (VAS) for overall hip function. Furthermore, patients reported their overall satisfaction with treatment. Results: The mean follow-up time was 12.3 ± 0.6 months. Preoperative scores compared with those obtained at the 12-month follow-up revealed statistically and clinically significant improvements (P < .0001) for all measured outcomes: iHOT-12 (42 vs 73), VAS for global hip function (52 vs 77), HSAS (4.3 vs 5.7), EQ-5D index (0.60 vs 0.83), EQ-VAS (68 vs 82), and HAGOS subscales (60 vs 83, 50 vs 73, 66 vs 86, 39 vs 75, 27 vs 70, and 34 vs 67). At the 12-month follow-up, 79 athletes (93%) reported that they were satisfied with the outcome of surgery. At follow-up, 62 athletes (73%) had returned to competitive sports (HSAS levels 5-8) and 44 (52%) to their previous HSAS level of activity (HSAS level 7 or 8). Twenty-three athletes (27%) did not return to competitive sports (HSAS level ≤4). Significantly lower levels of return to sports were seen with longer symptom duration (P < .05). Conclusion: Twelve months after surgery, arthroscopic treatment for FAI in top-level athletes resulted in statistically and clinically significant improvements at the group level in all outcome parameters for pain, symptoms, function, physical activity level, quality of life, and general health. One year after surgery, approximately 3 of 4 top-level athletes had returned to sports.

A Swedish hip arthroscopy registry: demographics and development

AbstractPurpose Hip arthroscopy is a rapidly expanding field in orthopaedics. Indications and surgical procedures are increasing. Although several studies report favourable clinical outcomes, further scientific evidence is needed for every aspect of this area. Accordingly, a registry for hip arthroscopy was developed. The purpose of this study is to describe the development of the registry and present its baseline data.MethodsA Scandinavian expert group agreed to use a set of functional outcome scores for the evaluation of hip arthroscopy patients. They were the international hip outcome tool-12, hip and groin outcome score, EQ-5D, hip-specific activity level scale and visual analogue scale for overall hip function. These scores were validated and culturally adapted to Swedish. A database was created for web-based, self-administered questionnaires. Perioperative data were also collected.ResultsThe process leading to the registry is reported. Baseline data from the first 606 patients collected during a 14-month period are presented. The preferred surgical technique is presented. The mean operation time was 69 (SD 14) minutes. In 333 procedures, mixed cam and pincer pathology were addressed, compared with 223 procedures with the treatment of isolated cam pathology. Outpatient surgery was performed in all patients.ConclusionThe baseline data in this study can be used as reference values for future scientific work from this registry. Knowledge of the process leading to the development of the registry could be useful to other researchers planning similar work.Level of evidenceIV.

Outcome after hip arthroscopy for femoroacetabular impingement in 289 patients with minimum 2‐year follow‐up

Femoroacetabular impingement (FAI) is a common cause of hip pain and dysfunction. The purpose of this study was to report outcome 2 years after the arthroscopic treatment of FAI using validated outcome measurements. Two hundred and eighty‐nine patients (males = 190, females = 99) with a mean age of 37 years underwent arthroscopic surgery for FAI. Patients were included consecutively in a hip arthroscopy registry. The cohort was evaluated using online web‐based validated health‐related patient‐reported outcomes measurements, including the iHOT‐12, HAGOS, EQ‐5D, HSAS for physical activity level, VAS for overall hip function and overall satisfaction. The mean follow‐up time was 25.4 months. Pre‐operative scores compared with those obtained at follow‐up revealed statistically and clinically significant improvements (P < 0.05) for all measured outcomes; iHOT‐12 (43 vs 66), VAS for global hip function (50 vs 71), HSAS (2.9 vs 3.6), EQ‐5D index (0.58 vs 0.75), EQ‐VAS (67 vs 75) and HAGOS different subscales (56 vs 76, 51 vs 69, 60 vs 78, 40 vs 65, 29 vs 57, 33 vs 58). At the 2‐year follow‐up, 236 patients (82%) reported they were satisfied with the outcome of surgery. We conclude that arthroscopic treatment for FAI resulted in statistically and clinically significant improvements in outcome parameters.

Outcome of hip arthroscopy in patients with mild to moderate osteoarthritis—A prospective study

Osteoarthritis (OA) of the hip is a common cause of hip pain. The arthroscopic management of patients with femoro-acetabular impingement (FAI) has been reported to yield good outcomes. The purpose of this study was to report on outcome following the arthroscopic treatment of patients with FAI in the presence of mild to moderate OA. Seventy-five patients undergoing arthroscopic surgery for FAI, all with preoperative radiological signs of mild to moderate OA were prospectively included in this study. A 2-year follow-up, using web-based patient-reported outcome measures, including the International Hip Outcome Tool (iHOT-12), Copenhagen Hip and Groin Outcome (HAGOS), EQ-5D, Hip Sports Activity Scale (HSAS) for physical activity level and a visual analogue scale (VAS) for overall hip function, was performed, complemented by a radiographic evaluation. At follow-up (mean 26 months, SD 5), five patients (7%) had undergone total hip arthroplasty, leaving 70 patients for the analysis. Preoperative scores compared with those obtained at the 2-year follow-up revealed significant improvements (P < 0.0001) for all measured outcomes; the iHOT-12 (42 versus 65), VAS for global hip function (48 versus 68), HSAS (2.5 versus 3), EQ5D index (0.62 versus 0.76), EQ VAS (69 versus 75) and different HAGOS subscales (54 versus 72, 47 versus 67, 56 versus 75, 40 versus 61, 33 versus 56, 31 versus 55). At follow-up, 56 (82%) patients reported that they was satisfied with the outcome of surgery. Arthroscopic treatment for patients with FAI in the presence of mild to moderate OA resulted in statistically significant and clinically relevant improvements in outcome measures related to pain, symptoms, function, physical activity level and quality of life in the majority of patients.

Predictors of outcome at 2-year follow-up after arthroscopic treatment of femoro-acetabular impingement

Abstract Femoro-acetabular impingement (FAI) is a common cause of hip pain and dysfunction in the young and active population. Despite reports of good short-term outcomes following treatment for FAI, less is known about the possible preoperative predictors of treatment outcome. The purpose of this study was to identify predictors of treatment outcome, using a patient-reported outcome measurement score (PROM) validated for use in a young and active population undergoing arthroscopic surgery for FAI. Patients were prospectively enrolled and analysed using the PROM International Hip Outcome Tool (iHOT-12) preoperatively and at a 2-year follow-up. Predictors of treatment outcome chosen for analysis were age, gender, duration of symptoms until surgery, level of cartilage damage, preoperative score and FAI type. A total of 198 patients, 122 males and 76 females (M: 61.6%, F: 38.4%), with a mean age of 41 ± 12.1 years, were analysed. The preoperative iHOT-12 score correlated with the postoperative iHOT-12 score at the 2-year follow-up. For one iHOT-12 point positive difference preoperatively, an additional 0.65 points were gained postoperatively at the 2-year follow-up (P ≤ 0.001). Age, gender, symptom duration until surgery, level of cartilage damage and FAI type did not have a statistically significant correlation to the postoperative score. Preoperative hip function as measured by the iHOT-12 is a potential predictor of outcome following FAI surgery relative to other factors.

The morphologic characteristics and range of motion in the hips of athletes and non-athletes

The cam deformity may cause impingement and probably leads to osteoarthritis of the hip. The aetiology of the cam deformity is incompletely understood. Vigorous training during skeletal growth can lead to the development of cam and symptoms of femoro-acetabular impingement and subsequent osteoarthritis of the hip. The purpose of this study was to compare the radiographic characteristics and range of motion between a group of athletes and a non-athletic control group. Thirty-two male athletes (17 soccer players and 15 ice-hockey players) and thirty non-athletes, used as a control group, were examined clinically and radiographically. Hip range of motion was measured and the FADIR and FABER tests were performed. Standard radiographs of both hips were taken. The centre-edge angle, alpha angle, caput-collum-diaphysis angle, head-neck offset and Tönnis grade were registered. The athletes had a higher Tönnis grade (right P =  0.009, left P =  0.004), more pain on the FADIR test (right P =  0.006, left P =  0.001) and lower ROM in internal (right P =  0.003, left P =  0.025) and external rotation (P < 0.001). A superiorly placed cam deformity (seen on an AP pelvis view) was correlated with reduced external rotation (right P =  0.001, left P =  0.004) and mild osteoarthritis (Tönnis grade 1), (P =  0.015, left P =  0.020), while a more anteriorly placed cam deformity (seen on a modified Lauenstein view) was correlated with reduced internal rotation (right P =  0.029, left P =  0.013). A lower range of motion, more osteoarthritic changes and more pain were found in the athletes than the controls. The control group had more cam deformities than previously reported.

Femoro-acetabular impingement clinical research: is a composite outcome the answer?

Abstract Femoro-acetabular impingement (FAI) is increasingly recognized as an important cause of hip pain in the young adult. However, the methods of evaluating the efficacy of surgical intervention are often not validated and/or inconsistently reported. Important clinical, gait, radiographic and biomarker outcomes are discussed. This article (1) presents the rationale for considering a composite outcome for FAI patients; (2) examines a variety of important end points currently used to evaluate FAI surgery; (3) discusses a strategy to generate a composite outcome by combining these end points; and (4) highlights the challenges and current areas of controversy that such an approach to evaluating symptomatic FAI patients may present.

Bilateral femoroacetabular impingement syndrome managed with different approaches: a case report

Purpose The purpose of this case report is to present the successful management of symptomatic bilateral femoroacetabular impingement (FAI) syndrome in a patient who underwent surgical treatment on one side and non-surgical treatment on the other side. Methods We evaluated the treatment outcome of a young female presenting with bilateral FAI syndrome of cam morphology. A follow-up was performed at 5 years following surgical treatment on the right hip and 2 years following non-surgical treatment on the left hip. The evaluation included a clinical examination, patient-reported outcome measurements (PROM), plain radiographs, and magnetic resonance imaging (MRI). Results The patient experienced subjective improvements bilaterally. The clinical examination revealed differences in range of motion between the surgically treated and the non-surgically treated sides, with internal rotation differing the most (20° vs almost 0°). Flexion was, however, the same on both sides (125°). The PROM results were satisfactory on both sides, with slightly better results for the surgically treated side (the short version of the International Hip Outcome Tool [iHOT-12]: 96.9 vs 90, the Copenhagen Hip and Groin Outcome Score [HAGOS]: 90–100 vs 65–100). On the surgically treated side, the alpha angle decreased by 19° postoperatively. An MRI did not reveal any injury to the cartilage or labrum on either side. Conclusion This patient with bilateral FAI syndrome treated with arthroscopic surgery on one side and physiotherapy together with reduced physical activity on the other side, presented with good results bilaterally at follow-up.