Towards a human centered economy

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Concurrent meniscus and chondral injuries after anterior cruciate ligament injury are more common in elite versus recreational alpine skiers: a systematic review

Background: The anterior cruciate ligament (ACL) has been extensively studied in those with alpine skiing injuries; however, less focus has been given to meniscal/chondral injuries in this population. Objectives: To perform a systematic review investigating the incidence of meniscal/chondral injuries in alpine skiers who have sustained an ACL injury. Data sources: MEDLINE, Scopus, manual journal searches. Study eligibility criteria: Studies reporting rates of meniscal and/or chondral injuries in alpine skiers with an ACL tear were included. Techniques, revisions, non-alpine skiers, and studies lacking an association between skiing and ACL diagnosis were excluded. Participants and interventions: Alpine skiers with a diagnosis of an ACL tear. Study appraisal and synthesis methods: MINORS criteria. Results: Nine hundred fifty-eight studies were identified. Screening, removal of duplicates, and assessment for inclusion/exclusion criteria resulted in 12 level III/IV studies for review. A total of 1185 skiers with ACL injuries were included (209 elite and 976 recreational). Meniscal tears were present in 47.4% of the skiers, with an increased rate seen in elite versus recreational skiers (61.2% vs 43.2%). Elite skiers were more likely to have a combined medial/lateral meniscal injury and a lateral meniscal tear repair (69.8% vs 19.2% for the latter). There were no differences in medial meniscal tear treatment. Chondral injuries presented at a rate of 11.2% and were more common in elite versus recreational skiers (20.3% vs 5.3%). Limitations: Heterogenous nature of study types included; Did not include larger databases and was limited to alpine skiing studies only; demographics were not part of the analysis. Conclusions: Approximately 47% of the alpine skiers with an ACL injury sustained a concomitant meniscal tear, with 11% having an associated chondral injury. Meniscal/chondral injuries are more common in elite skiers, and they are more likely to have their meniscus repaired. Implications of key findings: Careful consideration of the accompanying pathology is warranted in alpine skiers who present with ACL injury. Systematic review registration number: PROSPERO: CRD42022373207

Arthroscopic Hip Capsule Reconstruction for Anterior Hip Capsule Insufficiency in the Revision Setting

Iatrogenic hip instability is increasingly recognized as a cause of persistent pain and disability after hip arthroscopy. Many authors currently advocate capsular repair to reduce postoperative instability. However, anatomic deficiencies in the anterosuperior capsule can prevent a functional capsular repair, particularly in the revision setting. Capsular reconstruction has been shown to restore biomechanical stabilization in cadaveric models and improve short-term patient outcomes in patients with primary hip arthroscopy failure. Arthroscopic hip capsular reconstruction is technically challenging, largely owing to complex suture management and difficulties with graft placement and sizing. This article describes the capsular reconstruction technique, detailing the technical aspects of anterosuperior capsular defect identification; capsular preparation; suture management; and dermal allograft sizing, preparation, and positioning

Magnetic Resonance Imaging and Magnetic Resonance Arthrography Are Both Reliable and Similar When Measuring Hip Capsule Thickness in Patients With Femoroacetabular Impingement Syndrome

Purpose: To propose an accurate method of measuring hip capsular thickness in patients with femoroacetabular impingement syndrome and to compare the reliability of these measurements between magnetic resonance imaging (MRI) and magnetic resonance arthrography (MRA). Methods: A previously established database of patients with femoroacetabular impingement syndrome (FAIS) was used to identify candidates with preoperative MRI or MRA from November 2018 to June 2021. Two reviewers independently examined preoperative imaging for 85 patients. Capsular thickness was measured in 12 standardized locations. Intraclass correlation coefficients (ICCs) were calculated using an absolute-agreement, 2-way random-effects model. Using the same method, 30 patients were randomly selected for repeat measurements by 1 reviewer following a washout period. Ten additional patients with preoperative MRI and MRA of the same hip were identified to compare measurements between modalities using paired samples t test. Results: ICCs for measurements on MRIs and MRAs using these proposed measurements to compare inter-rater reliability were 0.981 and 0.985. ICCs calculated using measurements by a single reviewer following a washout period for intrarater reliability were 0.998 and 0.991. When comparing MRI and MRA measurements in the same patient, t test for all pooled measurements found no difference between modality (P = .283), and breakdown of measurements by quadrant found no difference in measurements (P > .05), with the exception of the inferior aspect of the capsule on coronal sequences (P = .023). Conclusions: In patients with FAIS, both MRI and MRA have excellent reliability for quantifying hip capsular thickness. A difference in capsular thickness was found only when comparing MRI and MRA on inferior coronal aspects of the hip capsule, indicating interchangeability of these imaging modalities when measuring the clinically important aspects of the hip capsule. Level of Evidence: Level IV, diagnostic case series