Early Outcomes on the Use of an Anterior Plate for complicated Ankle Fusions

Category: Ankle Introduction/Purpose: An ankle fusion is indicated for severe osteoarthritis of the ankle. An anterior ankle fusion plate for tibiotalar fusions provides a rigid and reproducible solution to treat ankle arthritis. With a plate fixation it might be possible to treat more complex deformities and provide additional stability in compromised patients. This study documents the early outcomes on the use of an anterior plate for patients undergoing an ankle arthrodesis. Methods: All ankle fusions using the anterior plate at our center were included and followed. Fifty-one patients (53 ankles) presented to the senior author between September 2014 and February 2017. Patients experienced ongoing ankle pain due to degenerative changes, a previous ankle fusion, post-traumatic arthritis (PTA) or failure of a total ankle arthroplasty (TAA). All patients’ medical and ankle surgical history was documented. This study was conducted in compliance and approved with a local IRB. Outcomes were evaluated pre-operatively and post-operatively with the Veterans Rand Health Survey (VR-12), Ankle Osteoarthritis Scale (AOS) and Visual Analog Scale (VAS) Pain scale. A patient satisfaction survey was distributed to all patients and results were tabulated. Average follow up for outcome scores 16.8 months (range 6 – 38 months). Results: Fifty-one patients(29 females) with the mean age of 56.56 years(26.3–74.8) had a mean follow-up of 16.6months(6– 38months). Diagnoses included 17 primary, 10 revision, 6 TAA failures and 20 PTA. 86.3%(44 patients) were non-diabetic. Non-smokers included 43.1%(22). VR-12 Physical improved from 29.46 to 37.72, and Mental 47.34 to 52.55 pre-operatively to post-operatively, respectively. AOS Pain improved: 462.41 to 252.8; AOS Disability: 567.52 to latest 387.77. Mean VAS improved from pre-operatively of 54.28 to latest of 30.61. Arthrodesis rate was 98%(52/53 ankles). 45 ankles were fused at 3 months by x-rays. Symptomatic patients (with pain) had a CT scan done at a minimum of 3 months (1/8 CT scans showed non-union & 7 were fused). Major complications were 3.8%(2 patients). There were no wound complications. Conclusion: An anterior plate construct is more invasive compared to arthroscopic or other arthrodesis options. However, the stability of the construct allows for a reliable option in complex situations, and the arthrodesis rate appears to be exceptional. In this complex patient population, the arthrodesis rate was 98%, while major complications only 4%. Summary Sentence: Anterior plate construct is more invasive compared to arthroscopic/other arthrodesis options. However, stability of the construct allows for a reliable option and fusion rates seem to be exceptional

Retrospective Chart Review of the Internal Brace Ligament Augmentation Repair in Conjunction with Open Broström Surgery in Ankle patients

Category: Arthroscopy, Sports Introduction/Purpose: The Broström is the most commonly used Lateral ligament repair for chronic instability, but there is growing evidence that a fairly large percentage will stretch out with time, resulting in recurrent instability. Due to the nature of the repair, rehabilitation is fairly slow, so as not to compromise the tissue during the maturation stage. Currently, the Internal Brace Ligament Augmentation Repair is an accepted augmentation method for management of a Broström procedure. However, to our knowledge, no formally collected outcome data on the procedure has been reported. Hypotheses Augmentation of the Broström repair with an Internal Brace would 1)allow accelerated rehabilitation and return to activity, 2)Will aid in long-term stability of the repair without a tendency to stretch out. Methods: Patients with lateral ankle instability repaired with a Broström and Internal Brace Augmentation were prospectively evaluated one-time post-operatively between 6 and 24 months. Patients with concomitant procedures other than debridement were excluded. Outcome measures included demographics; surgical time; AOFAS, FAAM, satisfaction, VAS scores; ROM, Raise Test, and calf strength compared to the contralateral limb; return to sports, and adverse events. Fifty five (55) patients were analyzed from two sites. The cohort includes 20 males and 35 females. 96% of the patients were non-smoking with an average BMI 27.7 ± 5.3 (range 20.6 to 43.8). Median age was 35 years (18 to 62 years). Six of the cases were revisions. Interestingly, 55% of the injuries resulted from severe sprains to the involved ankle from normal activities of daily living (ADL), while 45% were a result of sports injuries. The mean follow up time was 13.5 ± 6.5 months (range 6-27 months). Results: Average surgical time was 36±9 minutes (range 16-60minutes). The average postoperative VAS and Satisfaction scores were 0.9±1.5 and 9.1±2.0, respectively. The mean return to sports was 86 days (range 44-181). Average AOFAS score was 93.9±10.4. Thirty (55%) patients reported an ideal max score of 100. For the FAAM, current level of function in sports activities score was 90+ in 76% of subjects. Forty five (81%) patients were brace free with return to sport. The objective calf strength examination (actual girth measured) proved not significantly different from the contralateral limb; 38.9±4.5 cm and 38.7±4.4 cm (p=0.866). 89% had a negative anterior drawer. Ankle dorsiflexion comparisons were 9.4±2.8 cm (operative side) and 10.6±3.4 cm (contralateral); and ankle plantarflexion comparison (goniometer) 45.7±12.1degrees (operative side) and 45.9±12.7degrees (contralateral). Neither comparison showed a difference. Conclusion: The overall complication rate was < 3% without any reported adverse events. The results of the outcome measures and objective measurements suggest the Internal Brace Augmentation of Broström procedure is safe and efficacious

Takedown of Ankle Fusions and Conversion to Total Ankle Replacements

Category: Ankle Introduction/Purpose: With ankle replacements gaining credibility there is a small subset of patients that might benefit from a conversion of an ankle fusion to a replacement. There is not much in the literature about conversions and we began this study without having any specific data regarding success and expectations we could provide to the patients. Our hypothesis was that for the correct indication a conversion of an ankle fusion to a total ankle replacement might do as well as a primary total ankle replacement. Methods: Twenty five patients presented to the senior author with either ongoing ankle pain after a fusion, or increasing pain after a period of relative comfort after an ankle fusion. All patients came specifically with the desire to discuss a conversion to an ankle replacement. Exclusion criteria included a history of Diabetes, peripheral neuropathy, excision of either malleoli at the time of fusion, pantalar fusion and neurovascular compromise. This study was conducted in compliance and approved with a local IRB. Outcomes were evaluated pre-operatively and post-operatively with the Veterans Rand Health Survey (VR-12), Ankle Osteoarthritis Scale (AOS), Visual Analog Scale (VAS) Pain scale and the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score forms. A patient satisfaction survey was distributed to all patients and results were tabulated. Average follow up for outcome scores 23.77 months (range 4 – 74.78 months). Results: All ankle fusion conversions done at our center were included; no patients were lost to follow-up. Twenty-five patients(19 females) with the mean age of 63.7 months(36.55-75.83) were followed with a mean follow-up of 22.19 months(4–74.78 months). The mean AOFAS improved pre-operatively 26.25(8.0-56.0) to the latest follow-up of 78(77-100). VR-12 Mental improved from 52.24(34.81-72.46) to 56.13(28.4–72.31), and Physical 21.88(13.34-35.79) to 36.49(19.82-50.39) pre-operatively to post-operatively, respectively. The AOS Pain improved: 533.33(243-898) to the latest follow-up 215.86(15 -641); AOS Disability: 628.67(306-900) to the latest follow-up 221.64(2-612). Given patients have minimal to no dorsiflexion(DF) and plantarflexion(PF) with an ankle fusion, the range of motion increased with the affected ankle. Patients have a DF of 9.47degrees(2-15) and PF of 21.53degrees(12-35). Overall patients were satisfied with their results: 76.81/100. Conclusion: This is a small study with reasonable short follow-up, but the evidence show very satisfactory functional outcomes after a conversion of an ankle fusion to a total ankle replacement. Patient selection is extremely important. Long-term follow-up will show whether the longevity of these replacements compare to primary replacements

Treatment of osteochondral lesions in the ankle with a particulated juvenile cartilage allograft

Category: Ankle Introduction/Purpose: Numerous treatment modalities are in use today to treat symptomatic osteochondral lesions in the ankle; however, there are ongoing challenges with the treatment of certain types of lesions and concern regarding the long-term effectiveness of current common techniques. Methods: The purpose of this study was to collect mid and long-term clinical outcomes of pain, function, and activity level (VAS, SF-12, FAAM ADL, FAAM sports) Single-arm, multi-center study collected outcomes prospectively in standard clinic patients who would be undergoing or who had previously undergone treatment with DeNovo NT. The main exclusion criteria were high surgical risk, clinically diagnosed autoimmune diseases, or an active joint infection; all other patients receiving DeNovo NT could be approached for the study. The outcome analysis for this abstract focused on enrolled subjects’ final follow-up to date. Results: Clinical outcomes have been prospectively collected for 24 subjects with a total of 48 months follow-up. Twenty four of the treated lesions were located on the talus, none on the tibia. Out of the 24 patients, 23 had a single lesion and 1 had more than one. The average lesion size was 108.1 mm +/- 60.0 [23]. The Hepple classification was used to categorize each lesion. Interestingly, 19/24 were classified as 3 or higher. Cartilage ICRS was also used for classification. Out of the subjects, 23/24 were ICRS grade 3 or 4. There was also a concomitant procedure for 22/24 patients. Pre and post op VAS scores of 47.5 (+/- 23.1) and 12.2 +/- 17.8. SF-12 scores pre and post of 38.0 +/- 8.5 and 50.1 +/- 8.2. FAAM ADL’s pre and post 60.4 +/- 16.3 and 90.4 +/-11.8. FAAM sport scale scores pre and post 28.8 +/- 16.7 and 74.5 +/- 22.4. all outcome measures were statistically significant. Conclusion: Four year complete data is a challenge in this particular clinical population. This data set encompasses symptomatic osteochondral lesions of the talus treated with particulated juvenile cartilage allograft. The outcomes reflect an improvement in symptoms and patient satisfaction when treated with this technique. Based on these final outcome measures (V AS, SF-12, FAAM ADL’s, FAAM sport scale score) and satisfaction, it can be concluded that this is a viable option to get patients back to their pre-injury state

Impact of Ethnicity on Tibial Morphometrics Relevant to Total Ankle Replacement

Category: Ankle Introduction/Purpose: Total ankle replacement (TAR) success has improved since first-generation implants, but patient satisfaction continues to be less than knee and hip replacements. Little is known about variations in distal tibia anatomy between genders and across ethnicities; therefore it is unclear the extent to which current TAR prostheses accommodate variability in patient size and shape. This study quantified distal tibia morphometrics relevant to TAR design, and assessed differences between ethnicities and genders. The hypotheses were: (1) The anterior-posterior (AP) location of the dwell point of the tibia is centralized; (2) The sagittal radius of curvature of the tibial articulation increases with bone size; (3) Differences in dwell point location or sagittal radii between genders and ethnicities can be attributed to size differences between those populations. Methods: Tibial CT scans were obtained from cadavers or individuals of various ethnicities (Table 1). Landmarks were defined on digital models created from the scans, including medial and lateral edges of the distal tibial articulation (Figure 1a), and sagittal contours of the articulation (Figure 1b). The articulation center was defined as the average center point of all contours (Figure 1c). The AP center and AP length at the level of a distal tibial resection for TAR were determined, and the AP offset of the articulation center was calculated (Figure 1c). Differences in metrics for each ethnic and gender group were determined using a one-way Anova (P< .05) with Tukey’s method for differentiating groups. Regression fits of AP offset, average medial radius, and average lateral radius were determined. Utilizing AP length as a covariate, ANCOVA was utilized to assess differences in AP offset and sagittal radii between gender and ethnic groups (P< .05). Results: Descriptive statistics for AP length, AP offset, and medial/lateral radii are shown in Table 1, with Tukey groupings assigned. The relationship between medial and lateral radius was not consistent across all groups. AP length was a significant covariate for medial and lateral radii, but not AP offset. The relationship between lateral radius and AP length was significantly impacted by ethnicity (P< .001), but not by gender (P=.067) (Figure 2a). Medial radius versus AP length was significantly impacted by both ethnicity (P=.01) and gender (P< .03) (Figure 2b). Conclusion: This study illustrates for the first time the complexity of anatomical variation of the distal tibia across ethnic groups and between genders. The location of the articulation center is invariant to tibia size across each ethnicity. Medial and lateral sagittal radii generally increase with bone size, but the relative radii of the medial and lateral compartments are not consistent across ethnicities. These results highlight the need for increased anatomic understanding of the distal tibia, and implications on TAR design and technique

Step Activity After Surgical Treatment of Ankle Arthritis

Category: Ankle Arthritis Introduction/Purpose: We used step counts as objective measures of activity as a compliment to patient self-reported outcomes in treatment of ankle arthritis to validate success or failure of treatment. Methods: 234 patients who were treated with ankle arthrodesis or ankle replacement wore step activity monitors before treatment and after treatment at 6 months, 12 months, 24 months and 36 months. Total steps taken as well as low, medium and high activity, sustained activity, and an activity index were measured in each group. In addition, step activity was compared with the subjects’ self-reported outcome using the MFA and SF-36. We measured change from baseline and compared treatment type. Linear mixed-effects regression analysis was used to test for improvement in step activity (the dependent variables) across follow-up (the fixed effect, modeled as 4 dummy variables representing differences from pre-op at 6, 12, 24 and 36 months), with fixed covariates age, sex, body mass index (BMI) and surgical treatment. Results: Both treatment groups improved significantly. Objective and PROM were not parallel. While PROM plateaued at 6 months, steps continued to increase at 36 months. Step counts increases did correlate with improving PROM however. Patients undergoing arthrodesis had slower improvement than arthroplasty patients with greater differences in the early stages of recovery (i.e., 6 and 12-month post-op) than at 36 months where improvements were similar across groups. (See table 2 for data). The trajectory of recovery was different but there were no significant differences in improvement by surgery procedure. Conclusion: Patients increase the number and the intensity of steps after treatment. Improvement after arthrodesis and ankle replacement follow different trajectories. For step totals, high intensity steps and the sustained activity metrics, arthroplasty patients showed more improvement than arthrodesis patients early in recovery. Step data are consistent with patient reported outcomes but do not parallel them. Unlike PROM which improve dramatically in the first six months then plateau, step activity demonstrated mild or no improvement at 6 months but later had improvement that increased gradually across follow-up out to three years. Objective outcome measures add value to measurement of treatment outcomes

Comparison of treatment outcomes of Arthrodesis and Two Generations of Ankle Replacement Implants

Category: Ankle, Ankle Arthritis, Arthroscopy, Trauma Introduction/Purpose: We tested clinical equipoise in ankle arthrodesis and ankle arthroplasty during a time of transition from older to newer generation implants using a prospective cohort. Methods: We performed a prospective cohort study comparing outcomes in 273 consecutive patients treated for ankle arthritis by arthrodesis or ankle arthroplasty between 2005 and 2011. Adult Patients with end-stage ankle arthritis, who were ambulatory and willing and able to respond to surveys were included. Patients were excluded from the study if they had another significant lower limb problem that might affect ambulation. At baseline and at 6, 12, 24, and 36 months follow up visit, participants completed a pain and satisfaction survey, a Musculoskeletal Function Assessment (MFA), and a Short Form-36 (SF-36) survey. Surgery was performed by surgeons trained in both foot and ankle reconstruction and hip and knee arthroplasty. The participants were primarily enrolled from a tertiary teaching hospital but also at three sites in different states that included both teaching hospitals and private practice settings. Results: Linear mixed effects regression adjusted for baseline differences (age, BMI, and surgery type.) There were no significant baseline differences in MFA or SF-36 by surgery type. There was significant mean improvement after surgery regardless of procedure (p<0.001). The greatest improvement occurred at 6 month follow-up; Mean ± SE, (%) improvement was 12.6±0.7, (32%) for MFA, 22.0±1.4, (58%) for Physical Function (PF); 32.4±1.6, (96%) for Bodily Pain (BP), 4.0±0.2, (60%) for pain score. Average improvement was significantly better with arthroplasty in MFA (3.6 ± 1.6, p=0.023) and in PF (7.5 ± 2.9, p=0.0098). The difference between arthrodesis and arthroplasty was greater for patients receiving the newer Salto Talaris implant; average improvement for MFA (3.9±1.4, p=0.031), PF (8.8±3.3, p=0.0074), BP (7.3±3.6, p=0.045), and pain score (0.8±0.4, p=0.038). Conclusion: Conclusions Both ankle replacement and ankle arthrodesis are highly effective treatments for ESAA. When treated by surgeons with expertise in both foot reconstruction and hip and knee arthroplasty, patients reported improved comfort and function with both treatments. Average improvement was significantly better in those with arthroplasty in MFA and in SF-36 PF scale (7.5 ± 2.9, p=0.0098). That difference was greater when earlier generation implants were removed from the analysis. Younger patients had greater functional improvements than older patients. Patients with low BMI had better improvement that those with high BMI

Patient-Reported Outcomes of Surgically Treated Lisfranc Injuries with Isolated Longitudinal Instability

Category: Midfoot/Forefoot; Other Introduction/Purpose: A longitudinal Lisfranc variant injury occurs from a longitudinal force on the midfoot directed through the first ray and medial cuneiform. This is unique in that other Lisfranc injury patterns typically result from an axial-directed force or a rotational force that externally rotates the midfoot. More common Lisfranc injury patterns can have instability longitudinally, but usually it is accompanied by coronal instability and even axial instability. To date, there has been no study with a cohort of Lisfranc injuries with isolated longitudinal instability. The purpose of this study was to report patient-reported outcome measures (PROMs) for those undergoing surgical treatment for longitudinal Lisfranc injuries. Methods: Retrospective chart review was completed to identify patients with surgically treated longitudinal Lisfranc injuries by a single surgeon between April 2018 and February 2022. Intraoperative fluoroscopy was used to confirm Lisfranc injuries positive for only longitudinal instability and negative for coronal and axial instability. Surgical technique consisted of open reduction internal fixation (ORIF) with a compression screw from the medial to middle cuneiform and a “homerun” compression screw from the medial cuneiform to the base of the second metatarsal. PROMs, collected preoperatively and postoperatively, included the Foot and Ankle Ability Measure (FAAM), Veterans RAND 12-Item Health Survey (VR-12), and visual analog scale (VAS) pain scale. Patient satisfaction was assessed through a survey consisting of a 0-100 rating scale with “least satisfied” being 0 and “most satisfied” being 100. Statistical analyses to determine significance were completed through sample t-tests assuming unequal variance with significance set at P<.05. Results: Fourteen patients (14 feet) with an average age of 25.2±15.7 years sustained longitudinal Lisfranc injuries. Eleven of 14 patients competed in competitive sports when injured with football (n=5) being the most prevalent sport. Eleven patients underwent hardware removal an average of 3.6 months following their primary surgery. There were three cases of broken hardware, and one revision in which ORIF was converted to fusion. The average latest follow-up time for PROMs were 25.9 (range, 12-44) months. Results demonstrate a significant improvement in FAAM Total, FAAM ADL, and FAAM Sports scores at latest follow-up (Figure 1). There was also improvement in VR-12 Mental, VR-12 Physical, and VAS scores, though not statistically significant. Mean patient satisfaction at latest follow-up was 99/100. Conclusion: This study is the first to present data from a cohort of isolated longitudinal Lisfranc injuries. There is significant debate about surgical management of Lisfranc injuries. The improvement in PROMs at latest follow-up and high patient satisfaction suggests that ORIF may be an optimal surgical approach for management of longitudinal Lisfranc injuries

Comparison of Acute vs Chronic Lisfranc Injury Patient-Reported Outcomes in Surgically Treated Patients

Category: Midfoot/Forefoot; Other Introduction/Purpose: Lisfranc injury presentations can vary from a mild sports-related midfoot sprain to severe midfoot deformity caused by a motor vehicle accident. Despite this, Lisfranc injuries are not highly prevalent. Lisfranc injuries are often difficult to diagnose, making it possible that the prevalence of these injuries is underreported. It is widely accepted that surgery to correct a Lisfranc injury should be performed as soon as possible since chronic injuries are associated with higher rates of midfoot degenerative changes. Chronic Lisfranc injuries are more commonly treated with primary arthrodesis (PA) “salvage” procedures rather than open reduction internal fixations (ORIF). The purpose of this study was to compare the patient-reported outcome measures (PROMs) after surgery for patients with acute Lisfranc injuries to patients with chronic Lisfranc injuries. Methods: Retrospective chart review was completed to identify patients with surgically treated Lisfranc injuries by a single surgeon between May 2012 and February 2022. Acute versus chronic injury distinction was based on the amount of time between the date of injury and the date of surgery with the cutoff set at six weeks. Ambiguous injury timelines determined through clinical and surgical documentation were excluded. The acute and chronic cohorts were age-gender matched. PROMs, collected preoperatively and postoperatively, included the Foot and Ankle Ability Measure (FAAM), Veterans RAND 12-Item Health Survey (VR-12), and visual analog scale (VAS) pain scale. Patient satisfaction was assessed through a survey consisting of a 0-100 rating scale with “least satisfied” being 0 and “most satisfied” being 100. Latest follow-up PROMs < 12 months were excluded from analysis. Statistical analyses to determine significance were completed through sample t-tests assuming unequal variance with significance set at P<.05. Results: Acute and chronic injury cohorts consisted of 42 patients (42 feet) each, and the average age of both cohorts were 36.58±16.89 years and 36.70±16.65 years, respectively. In the acute cohort, 24 ORIFs and 18 PAs were performed compared to 16 ORIFs and 26 PAs in the chronic cohort. The average latest follow-up time for PROMs for acute and chronic cohorts were 36.02 (range, 12-78) months and 27.72 (range, 12-48) months, respectively. The acute cohort demonstrated significantly lower FAAM scores preoperatively, but no significant preoperative VAS differences were found. Both acute and chronic cohorts individually had significant improvement in the FAAM from preoperative to latest follow-up, but there were no significant differences found between the PROMs at latest follow-up of both cohorts (Table 1). Conclusion: This study directly comparing acute versus chronic Lisfranc injury PROMs after surgery is the first of its kind. The results concluded there were no significant differences found between the latest follow-up PROMs. These findings are despite a higher proportion of PAs to ORIFs in the chronic cohort, which some published studies have concluded to be the superior surgical technique. This study supports the notion to treat surgically indicated Lisfranc injuries acutely

Return-to-sport following Operative Management of Lisfranc Injuries in Competitive Athletes

Category: Sports; Midfoot/Forefoot Introduction/Purpose: The relative incidence of Lisfranc injuries amongst competitive athletes is higher than the incidence in the general population. Lisfranc injuries can be particularly devastating to competitive athletes. They can dramatically hinder athletic performance, cause severe midfoot pain, and are difficult to diagnose. It is well documented that many Lisfranc injuries are initially misdiagnosed. To date, there is limited literature surrounding return-to-sport timelines and outcomes following operatively managed Lisfranc injuries in competitive athletes. The purpose of this study is to present an average return-to-sport timeline and patient-reported outcomes of surgically treated Lisfranc injuries in competitive athletes. Methods: Patients with surgically treated Lisfranc injuries by a single surgeon between May 2012 and February 2022 were identified through retrospective chart review. Competitive athletes and their levels of athletic competition were identified through clinical and surgical documentation. Patients with surgically treated Lisfranc injuries that were not active competitive athletes at the time of injury were excluded. Data from a novel Lisfranc return-to-sport survey was prospectively collected. Patient-reported outcome measures (PROMs) analyzed included the visual analog scale (VAS) pain scale, Veterans RAND 12-Item Health Survey (VR-12), and the Foot and Ankle Ability Measure (FAAM). PROMs with latest follow-up less than 12 months from the date of surgery were excluded from analysis. The differences between mean preoperative and mean latest follow-up outcome measures were analyzed using simple t tests with significance set at P<.05. Results: Forty-six competitive athletes were surgically treated for Lisfranc injuries. All PROMs demonstrated statistically significant improvement upon latest follow-up except for the VR-12 Mental (Table 1). Nine patients (9/46) were lost to follow-up. Thirty- two patients (86.5%, 32/37) completed the Lisfranc return-to-sport survey at a mean follow-up time of 52.17 (range, 7.33-125.26) months after surgery. Twenty-eight patients (28/32) desired to return to play, and four did not (4/32). Twenty-seven patients (96.4%, 27/28) successfully returned to sport after an average of 5.5 (range, 3-12) months. Twenty-two patients (22/28) eventually returned to pre-injury levels of play, and six (6/28) did not. Average pain levels when returning to play were 26.2/100. Twenty- three patients (23/28) were eventually able to play pain free. Overall average patient satisfaction level was 95.6/100. Conclusion: This study is one of the largest known cohorts (n=46) of competitive athletes with operatively managed Lisfranc injuries to have return-to-sport time and PROMs analyzed. Overall, the return-to-sport rate, PROMs, and patient satisfaction levels were excellent for this cohort. Of the athletes who desired to return-to-sport, the return-to-sport rate was 96.4% with a mean return-to-sport time of 5.5 (range, 3-12) months after surgery. All PROMs (VAS, VR-12 Physical, FAAM) except for the VR- 12 Mental demonstrated statistically significant improvement at latest follow-up