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Much is known about the biomechanical performance of various types of suture anchors commonly used for labral fixation in the shoulder; however, similar studies in the hip are less common. We sought to compare all-suture and polyether ether ketone small-diameter anchors in the setting of labral repair during hip arthroscopy, with and without acetabuloplasty. We hypothesized that the biomechanical properties of the all-suture group when compared to polyether ether ketone anchors would be similar amongst native acetabula and significantly less following acetabuloplasty and that pullout forces would be reduced in the anterior and inferior regions of the acetabulum compared to the superior region. Bone density was measured in nine matched pairs of fresh-frozen cadaveric acetabula in the superior, anterosuperior, and anterior regions. Acetabuloplasty was performed in all three regions, while the contralateral acetabulum was left in situ as a control. Suture anchors were placed such that one each of two different types was placed within each region. Specimens were tested in cyclic fatigue and loaded to failure. The all-suture group had significantly higher cyclic displacement compared to the polyether ether ketone, but there was no significant difference in ultimate load, regardless of acetabuloplasty. Amongst all non-resected specimens, the lowest bone density was observed consistently in the inferior region. Our results indicate that, with or without acetabuloplasty, a small-diameter polyether ether ketone anchor appears to be more stable than an all-suture anchor, which needs to be set first.

Background: A rectus abdominis–adductor longus (RA-AL) aponeurotic plate injury, commonly associated with athletic pubalgia, sports hernia, or a core muscle injury, causes significant dysfunction in athletes. Increased recognition of this specific injury distinct from inguinal hernia abnormalities has led to better management of this debilitating condition. Hypothesis: Surgical repair of RA-AL aponeurotic plate injuries will result in decreased symptoms and high rates of return to play. Study Design: Case series; Level of evidence, 4. Methods: Using our billing and clinical database, patients who underwent RA-AL aponeurotic plate repair by a single surgeon at a single institution were contacted for Hip Outcome Score (HOS) and return-to-play data. Patients with a confirmed diagnosis by history, physical examination, and magnetic resonance imaging who failed 6 to 12 weeks of appropriate conservative treatment were indicated for surgery. Surgical repair involved adductor longus fractional lengthening, limited adductor longus tenotomy, and a turn-up flap of the released adductor tendon and aponeurosis onto the rectus abdominis for imbrication reinforcement. Results: Of 100 patients who met the inclusion criteria, 85 (85%) were contacted. A total of 82 (96%) patients were able to return to play at a mean of 4.1 months after repair. Hip function was rated as 98% of normal and sports function as 92% of normal. Factors associated with negative outcomes were multiple procedures, prior inguinal hernia repair, and female sex. Negative outcomes were demonstrated by decreased HOS scores and decreased sports function. The overall complication rate was 7%. Conclusion: RA-AL aponeurotic plate repair by the method of an adductor-to–rectus abdominis turn-up flap is a safe procedure with high return-to-play success. Patients who had previously undergone inguinal hernia repair or other hip/pelvic-related surgery and female patients had worse outcomes.

Femoroacetabular impingement syndrome (FAIS) causes pain and functional limitations. Little is known regarding walking characteristics, volume, and intensity evaluated in laboratory and free-living conditions and whether these measures differ between those with FAIS and uninjured individuals. To examine the differences in laboratory gait measures and free-living step-based metrics between individuals with FAIS and uninjured control participants. Comparative, cross-sectional study. We enrolled 25 participants with FAIS and 14 uninjured controls. We evaluated laboratory spatiotemporal gait measures (cadence, velocity, step length, stride length) during self-selected and fast walking speeds using an instrumented walkway. Participants then wore an accelerometer around the waist during waking hours for 7 consecutive days. Free-living step-based metrics included average daily steps, peak 1- and 30-minute cadence, and average daily time spent in walking cadence bands. We compared laboratory gait measures and step-based metrics between groups. The groups did not differ in laboratory spatiotemporal gait measures during both speeds (all P > .05). The FAIS group took fewer daily steps (5346 ± 2141 versus 7338 ± 2787 steps/d; P = .030) and had lower peak 1-minute (92.9 ± 23.9 versus 119.6 ± 16.3 steps/min; P < .001) and 30-minute cadences (60.9 ± 27.1 versus 86.8 ± 22.4 steps/min; P = .003) compared with uninjured controls, respectively. The FAIS group also spent less time in slow (6.0 ± 3.6 versus 10.3 ± 3.4 min/d; P = .001), medium (4.5 ± 4.2 versus 8.9 ± 4.4 min/d; P = .005), and brisk/moderate (4.5 ± 6.2 versus 12.2 ± 10.3; P = .020) cadence bands compared with uninjured controls. Clinical/laboratory gait measures alone may not be representative of real-world walking-related physical activity behavior in individuals with FAIS.

Background: Recent innovative techniques have led to renewed interest in ulnar collateral ligament (UCL) repair. Although early outcome data regarding the clinical outcome of overhead athletes undergoing UCL repair with augmentation have been encouraging, long-term data are still needed to evaluate both the appropriate indications and success rate for this procedure. Purpose: To describe and evaluate the acute complications seen in a large cohort of patients who underwent UCL repair with internal brace augmentation at a single institution. Study Design: Case series; Level of evidence, 4. Methods: We performed a retrospective chart review of a prospectively collected database, consisting of all patients who underwent UCL repair with internal brace augmentation utilizing a collagen-dipped FiberTape at our institution from August 2013 to January 2020. Patient characteristics, injury setting, side of surgery, and concomitant ulnar nerve transposition procedures were recorded. Early complications of UCL repair (within 6 months of the procedure) were evaluated and characterized as either minor or major, depending on whether the patient required a return to the operating room. Results: Of the 353 patients who underwent UCL repair at our institution with a minimum of 6-month follow-up, 84.7% (299/353) reported no complications, 11.9% (42/353) reported minor complications—including ulnar nerve paresthesia, postoperative medial elbow pain, and postoperative superficial wound complications—and 3.4% (12/353) required a return to the operating room because of a major complication requiring ulnar nerve exploration/debridement, primary ulnar nerve transposition, or heterotopic ossification excision. Conclusion: The low major complication rate identified in this study further validates the efficacy of the UCL repair with the internal bracing augmentation technique. Longer term follow-up data are needed to more adequately assess the outcomes and durability of this procedure.

Objectives: Athletic Pubalgia, also known as sports hernia or core muscle injury, causes significant dysfunction in athletes. Increased recognition of this specific injury distinct from inguinal hernia pathology has led to better management of this debilitating condition. We hypothesize that patients who undergo our technique of athletic pubalgia repair will recover and return to high-level athletics. Methods: Using our billing and clinical database, patients who underwent sports hernia repair by single surgeon at a single institution were contacted for Harris hip score, functional outcome, and return to play data. Results: Of 101 patients who met criteria, 43 were contacted. 93% of patients were able to return to play at an average of 4.38 mo. Normal activities were rated at 95.5% and athletic function was rated at 88.9%. Negative predictors were female sex, multiple operations, and prior inguinal hernia repair. Overall complication rate was 4.6%, and reoperation rate was 4.6%. Conclusion: Our method of adductor to rectus abdominis turn up flap is a safe procedure with high return to play success. Patients who had previously undergone inguinal hernia repair or other hip/pelvic related surgery had a worse outcome.

Background: The use of all-suture anchors for rotator cuff repair is increasing. Potential benefits include decreased bone loss and decreased damage to the chondral surface. Minimal evidence exists comparing outcomes among medial-row anchor fixation methods in double-row suture bridge rotator cuff repair. Purpose: To compare the clinical outcomes between all-suture and solid medial-row anchors in double-row suture bridge rotator cuff repair. Study Design: Case series; Level of evidence, 4. Methods: A total of 352 patients (mean age at surgery, 60.3 years) underwent double-row suture bridge rotator cuff repair at our institution. Patients were separated into 2 groups based on whether they underwent all-suture (n = 280) or solid (n = 72) anchor fixation for the medial row. Outcomes data were collected via an ongoing longitudinal data repository or through telephone calls (minimum follow-up time, 2.0 years; mean follow-up time, 3.0 years). Outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) standardized shoulder assessment form and the visual analog scale (VAS). The same rehabilitation protocol was administered to all patients. The proportions of patients meeting previously published Patient Acceptable Symptom State (PASS) thresholds were calculated for the outcome measures, and outcome scores and the proportions of patients meeting PASS thresholds between groups were compared using linear and logistic regression, respectively. Results: The groups did not differ in terms of age at surgery, sex distribution, rotator cuff tear size, or number of medial-row anchors used. The solid anchor group had a longer follow-up time compared with the all-suture anchor group (3.6 ± 0.7 vs 2.8 ± 0.8 years, respectively; P < .01). After controlling for follow-up time, the solid and all-suture anchor groups did not differ in ASES scores (89.6 ± 17.8 vs 88.8 ± 16.7, respectively; P = .44) or VAS scores (1.1 ± 2.1 vs 1.2 ± 2.1, respectively; P = .37). Similarly, after controlling for follow-up time, the solid and all-suture anchor groups did not differ in the proportions of patients meeting PASS cutoffs for the ASES (84.7% vs 80.7%, respectively; P = .44) or the VAS (80.6% vs 75.0%, respectively; P = .83). Conclusion: Double-row suture bridge rotator cuff repair using all-suture anchors for medial-row fixation demonstrated similar excellent clinical outcomes to rotator cuff repair using solid medial-row anchors.

Background: There is a paucity of outcomes data on surgical reconstruction for multiligament knee injury (MLKI) in the orthopaedic literature. Purpose: To examine functional and return-to-sports (RTS) outcomes and revision rates after single-stage reconstruction for MLKIs in a cohort containing a large proportion of competitive athletes over a 20-year period. Study Design: Case series; Level of evidence, 4. Methods: We identified all patients at our institution who underwent surgical reconstruction for an anterior cruciate ligament (ACL) or bicruciate (ACL-posterior cruciate ligament) MLKI between 2001 and 2020 and had ≥2 years of postoperative outcome data. Patient-reported outcomes were evaluated using the International Knee Documentation Committee (IKDC) form, a surgical satisfaction survey, and questions about subsequent knee surgery and RTS administered via telephone. Summary statistics for all outcomes data were calculated, and predictors of IKDC scores at follow-up were examined using univariable linear regression. Results: Out of 151 patients eligible for this study, outcomes data were collected in 119 patients (79%). The mean follow-up time was 8.3 ± 4.4 years, and the mean IKDC score at follow-up was 79 ± 17. A total of 83 competitive athletes were included; 62 of these athletes attempted to return to preinjury sport. Among the 62 who attempted RTS, 50 (81%) were successful, and 12 were unable to return due to limitations from their surgery. At follow-up, 112 of the overall cohort of 119 patients (94%) were either satisfied or very satisfied with their surgical outcome, and 91% stated the surgery met or exceeded their expectations. In addition, 24% had subsequent ipsilateral knee operations after their index multiligament knee reconstruction. Older age at surgery and female sex were associated with worse IKDC scores at follow-up. Conclusion: Despite the severity of the injuries in our cohort, we found high levels of patient-reported function and a high rate of successful RTS in the competitive athletes. Older age and female sex were associated with worse patient-reported knee function at follow-up.

Background: Few studies have examined the short-term clinical outcomes of rotator cuff repair (RCR) with all-suture anchors for medial row anchor fixation. Purpose: To evaluate clinical outcomes of double-row suture bridge RCR using a novel all-suture medial row anchor. Study Design: Case series; Level of evidence, 4. Methods: We enrolled 179 patients before double-row suture bridge RCR (mean age at surgery, 60.0 years; 63% male patients) at a single institution. All patients underwent RCR with all-suture anchor fixation for the medial row and solid anchor fixation for the lateral row. Preoperative (baseline) and follow-up (minimum follow-up time of 2 years; mean, 2.5 years) clinical outcomes were compared using the American Shoulder and Elbow Surgeons (ASES) score and a 10-point numeric pain rating scale (NPRS). We calculated the proportions of patients meeting previously published Patient Acceptable Symptom State (PASS) thresholds for the ASES (≥78.0) and NPRS (≤1.7). We further compared baseline and follow-up outcome scores and the proportions of patients meeting PASS thresholds using paired t tests and McNemar tests, respectively, and calculated effect size to quantify the magnitude of change from baseline to follow-up. Results: Values significantly improved from baseline to follow-up for ASES (from 45.3 ± 19.8 to 87.3 ± 17.1) and NPRS (from 5.2 ± 2.5 to 1.4 ± 2.1). The proportion of patients meeting PASS thresholds also significantly improved for the ASES (from 6% to 77%) and the NPRS (from 7% to 72%). The magnitude of baseline to follow-up change for all measures was large (all effect sizes ≥1.5). Conclusion: Our study demonstrated excellent short-term clinical outcomes and substantial improvements for patients undergoing double-row suture bridge RCR with all-suture anchors for medial row fixation.

Background: In recent years, innovation in arthroscopic glenoid labral repair techniques has included the development of all-suture anchors. There are multiple potential advantages of all-suture anchors, including decreased bone removal, anchor migration, synovitis/chondral injury, and bone reaction. Despite these potential advantages, few studies have examined clinical outcomes of glenoid labral repair with all-suture anchors. Purpose: To evaluate patient-reported and return-to-sport outcomes of arthroscopic glenoid labral repairs using all-suture anchors. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent arthroscopic glenoid labral repair using all-suture anchors at our institution over a 6-year period were identified. As a part of a longitudinal data repository, we collected baseline (presurgical) and follow-up patient-reported outcome data, with a minimum follow-up time of 2 years, using the American Shoulder and Elbow Surgeons (ASES) score and the Western Ontario Shoulder Instability Index (WOSI) score. For athletes, we also collected data on return to preinjury level of sport and relevant contextual factors. We compared baseline and follow-up ASES and WOSI scores and examined the association between demographic, injury, and surgery variables and ASES/WOSI scores at follow-up. Results: Of 529 eligible patients, follow-up data were collected for 372 (70%). Of those, 51 underwent any type of subsequent ipsilateral shoulder surgery (14% of those with follow-up data [51/372]). In the remaining 321 patients (mean age at surgery, 23.9 years; 83% male), we collected both presurgical and follow-up outcome data (mean follow-up time, 3.3 years). Across all labral repair types, mean values significantly improved from baseline to follow-up for both the ASES (baseline, 62.1; follow-up, 92.7) and the WOSI (baseline, 47.5; follow-up, 85.4). Younger age, being a competitive athlete, and having a labral tear in the inferior location (vs not) were associated with higher ASES and WOSI scores at follow-up. Those with concomitant biceps tenodesis demonstrated lower ASES and WOSI scores at follow-up compared with those without tenodesis. Within competitive athletes (n = 201), 95% of athletes who attempted to return to preinjury level of sport were able to do so. Conclusion: Among patients with follow-up data, 14% underwent subsequent ipsilateral shoulder procedures. Those who didn't undergo subsequent procedures demonstrated excellent patient-reported outcomes, including large and meaningful improvements in ASES and WOSI scores and a high level of return-to-sport in athletes, after arthroscopic all-suture anchor glenoid labral repair at a mean follow-up of 3.3 years.

Background: Posterior glenoid labral injuries are more common in football players than in the general population. Arthroscopic repair with all-suture anchors has proven to be an effective technique to address other abnormalities, allowing for low-profile constructs that minimize damage to surrounding tissue. Few studies have examined the outcomes of posterior labral repair with all-suture anchors in football players. Hypothesis: It was hypothesized that after labral repair with all-suture anchors, functional outcomes would improve, revision rates would be low, return-to-sport rates would be high, and clinical outcomes would be comparable with those seen after arthroscopic repair performed with traditional solid anchors among football players. Study Design: Case series; Level of evidence, 4. Methods: The authors identified patients in the institution’s ongoing data repository who were football players when they underwent arthroscopic posterior glenoid labral repair using all-suture anchors. The authors collected baseline (preoperative) and follow-up demographic, clinical, surgical, and functional outcome data, with a minimum follow-up time of 2 years. Patient-reported outcome measures included the American Shoulder and Elbow Surgeons (ASES) score and the Western Ontario Shoulder Instability Index (WOSI). Results: The authors identified 52 male football athletes (mean age at surgery, 18.5 years) with both baseline and follow-up data (mean follow-up time, 3.8 years), with all competing at either the high school (n = 41 [79%]) or collegiate (n = 11 [21%]) level. Mean outcome scores improved significantly from baseline to follow-up for both the ASES score (baseline: 63.2; follow-up: 97.1) and the WOSI (baseline: 48.1; follow-up: 94.0). Overall, 37 of 52 (71%) returned to football at their preinjury level after surgery. However, only 38 of 52 athletes attempted to return to sport. Among athletes who attempted to return to sport, 97% (37/38) were able to return. There were no significant differences in follow-up ASES or WOSI scores between high school and collegiate athletes, between blocking and nonblocking positions, or between isolated posterior labral repair and combined labral repair. Conclusion: The results demonstrated excellent outcomes, including large and significant improvements in ASES and WOSI scores, in football players. While 29% did not return to football, 97% of those who attempted to return to play did so at their preinjury level. This study shows encouraging results for the use of all-suture anchors for posterior labral repair in this population of athletes.