Acetabular labrum reconstruction with fresh meniscus allograft transplantation : validation in a preclinical canine model

"Acetabular labrum pathology is frequently diagnosed in young, active individuals. Methods of hip preservation emphasize recapitulation of labrum structure and function to re-establish joint health and mitigate the development of hip osteoarthritis (OA). Labrum reconstruction utilizing fresh, frozen tendon allograft has become a popular option based on good short-term outcomes, however, failure rates are ~24%. Meniscus allograft has demonstrated early success as an alternative due to similarities in geometry, tissue composition, and metabolic profile when compared to acetabular labrum tissue. Healing of the fresh (viable) meniscus allografts transplantation (MAT) has not been well characterized."--Introduction

Multicenter Outcomes After Hip Arthroscopy: Comparative Analysis of Patients Undergoing Concomitant Labral Repair and Ligamentum Teres Debridement Versus Isolated Labral Repair

Background: Increased attention has been directed toward the ligamentum teres (LT) and its association with acetabular coverage, labral pathology, and hip microinstability; however, few studies have evaluated whether LT pathology influences the rate of clinically significant outcome improvement after hip arthroscopy. Purpose: To determine if patients with femoroacetabular impingement syndrome (FAIS) undergoing labral repair and concomitant LT debridement achieve outcomes similar to patients without LT pathology undergoing labral repair. Study Design: Cohort study; Level of evidence, 3. Methods: We conducted a retrospective review of a prospectively maintained multicenter database for hip arthroscopy. Included were patients with FAIS who underwent primary labral repair and who had preoperative and minimum 2-year postoperative outcome scores. Patients diagnosed with concomitant partial LT tear were identified and matched 1:3 according to age, sex, and body mass index (BMI) to patients without LT pathology. The following clinical outcomes were compared between groups: modified Harris Hip Score, Hip Outcome Score-Activities of Daily Living, Hip Outcome Score-Sport Subscale, International Hip Outcome Tool, and visual analog scale for pain and satisfaction. Achievement of the minimal clinically important difference and patient acceptable symptomatic state was also compared between groups. Results: This study included 124 patients with FAIS with labral tear and concomitant partial LT tear and 372 patients with labral tear and no LT pathology. The age, BMI, and sex of the matched cohort were 38.0 ± 12.0 years (mean ± SD), 24.3 ± 3.6 kg/m, and 62.0% female, respectively. No significant difference in age, BMI, sex, workers\u27 compensation status, or duration of pain was observed at baseline. Analysis of radiographic parameters indicated that patients who underwent isolated labral repair had a lower preoperative Tönnis angle (4.8° ± 4.4° vs 6.3° ± 5.4°; = .006). There were no significant differences between groups on any pre- or postoperative outcome measure, and there were no significant differences in the proportion of patients who achieved the minimal clinically important difference or patient acceptable symptomatic state on any outcome measure. Conclusion: Patients with labral tear and concomitant partial LT tear experienced similar preoperative scores and achieved similar outcomes as patients with isolated labral tears after hip arthroscopy

Descriptive Characteristics and Outcomes of Patients Undergoing Revision Anterior Cruciate Ligament Reconstruction With and Without Tunnel Bone Grafting

BackgroundLytic or malpositioned tunnels may require bone grafting during revision anterior cruciate ligament reconstruction (rACLR) surgery. Patient characteristics and effects of grafting on outcomes after rACLR are not well described.PurposeTo describe preoperative characteristics, intraoperative findings, and 2-year outcomes for patients with rACLR undergoing bone grafting procedures compared with patients with rACLR without grafting.Study designCohort study; Level of evidence, 3.MethodsA total of 1234 patients who underwent rACLR were prospectively enrolled between 2006 and 2011. Baseline revision and 2-year characteristics, surgical technique, pathology, treatment, and patient-reported outcome instruments (International Knee Documentation Committee [IKDC], Knee injury and Osteoarthritis Outcome Score [KOOS], Western Ontario and McMaster Universities Osteoarthritis Index, and Marx Activity Rating Scale [Marx]) were collected, as well as subsequent surgery information, if applicable. The chi-square and analysis of variance tests were used to compare group characteristics.ResultsA total of 159 patients (13%) underwent tunnel grafting-64 (5%) patients underwent 1-stage and 95 (8%) underwent 2-stage grafting. Grafting was isolated to the femur in 31 (2.5%) patients, the tibia in 40 (3%) patients, and combined in 88 patients (7%). Baseline KOOS Quality of Life (QoL) and Marx activity scores were significantly lower in the 2-stage group compared with the no bone grafting group (P≤ .001). Patients who required 2-stage grafting had more previous ACLRs (P < .001) and were less likely to have received a bone-patellar tendon-bone or a soft tissue autograft at primary ACLR procedure (P≤ .021) compared with the no bone grafting group. For current rACLR, patients undergoing either 1-stage or 2-stage bone grafting were more likely to receive a bone-patellar tendon-bone allograft (P≤ .008) and less likely to receive a soft tissue autograft (P≤ .003) compared with the no bone grafting group. At 2-year follow-up of 1052 (85%) patients, we found inferior outcomes in the 2-stage bone grafting group (IKDC score = 68; KOOS QoL score = 44; KOOS Sport/Recreation score = 65; and Marx activity score = 3) compared with the no bone grafting group (IKDC score = 77; KOOS QoL score = 63; KOOS Sport/Recreation score = 75; and Marx activity score = 7) (P≤ .01). The 1-stage bone graft group did not significantly differ compared with the no bone grafting group.ConclusionTunnel bone grafting was performed in 13% of our rACLR cohort, with 8% undergoing 2-stage surgery. Patients treated with 2-stage grafting had inferior baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting. Patients treated with 1-stage grafting had similar baseline and 2-year patient-reported outcomes and activity levels compared with patients not undergoing bone grafting