Assessing Long-Term Outcomes in Individuals Undergoing Fasciotomy for Chronic Exertional Compartment Syndrome of the Lower Leg

This study was a case series of 46 patients (mean age 30 years (SD ± 13.0) who underwent fasciotomy for treatment of chronic exertional compartment syndrome (CECS). We prospectively collected long-term patient-reported functional outcome using the Lower Extremity Functional Scale (LEFS) and used existing pre-operative intracompartmental pressure testing data prior to and following exercise to determine the association between the LEFS and pre-operative pressure measurements At the time of follow-up, patients completed one LEFS questionnaire to assess their current health status, another to query their status at the time of best outcome, as well as a return-to-sport/satisfaction questionnaire. In our sample of individuals who underwent fasciotomy for treatment of CECS, the immediate post-exercise pressure, 20 minute post-exercise pressure, and the number of months symptomatic prior to surgery were most predictive of functional outcome. However, our model should be validated through confirmatory analysis before being adopted into clinical practice

Diagnostic Validity of the Physical Examination Maneuvers for Hip Pathology: A Systematic Review

Background: There is a number of physical examination maneuvers used to diagnose hip pathology but the diagnostic validity of these maneuvers is unclear. We conducted a systematic review to evaluate current knowledge regarding the diagnostic validity of the physical examination maneuvers for hip pathology. Methods: We conducted a literature search of the electronic databases MEDLINE, CINAHL, EMBASE, Cochrane, and SPORTDiscus. The methodological quality of each eligible study was assessed and classified according to Sackett and Haynes’ phases of diagnostic research, whereby Phase I and II studies represent proof of concept and Phase III studies are applicable to a clinical setting. Results: Eight studies were classified as phase III diagnostic studies, four of which were methodologically rigorous. In diagnosing labral tears of the hip, neither the impingement test (sensitivity=0.51-0.78, specificity=0.10-0.89) nor FABER test (sensitivity=0.60, specificity=0.75) demonstrated evidence to support the use of these tests clinically. In diagnosing gluteal tendon pathology the Trendelenburg test demonstrated some evidence for use in a clinical setting (sensitivity=0.23-0.73, specificity=0.77-0.94). Conclusion: The diagnostic validity of clinical tests to diagnose the presence or absence of hip pathology remains uncertain. The majority of studies supporting validity of these tests lacked methodological rigor, and thus cannot provide evidence to support the use of a test in clinical practice

Biomechanical evaluation of a hybrid suture and anchor-based hip capsular repair

© 2020 Elsevier Ltd Background: Hip capsulotomies, performed routinely during hip arthroscopy, can contribute to adverse joint kinematics. Direct repair is not always feasible. Therefore, the aim of this study was to evaluate the biomechanics of a conventional all-suture repair versus a hybrid suture and anchor-based capsular repair. Methods: Nine paired (n = 18) hips were tested on a joint-motion simulator, utilizing optical trackers to capture kinematic data. Pairs were randomly allocated to capsular repair type and tested as (1) intact, (2) after T-capsulotomy, and (3) repair each at 0°, 45°, and 90° flexion. Internal and external rotation torques and abduction/adduction torques of 3 N·m were applied and rotational range of motion and joint translations recorded. Findings: At 0°, following repair there were no significant differences in joint rotation or translations between repairs (p \u3e 0.134). At 45°, both repair types restored motion to near intact values, with no significant differences between groups. Similarly, there were no significant differences in joint translations between repairs. At 90°, both types of capsular repair failed to restore rotational range of motion, with persistent increases in motion (47.0 ± 16.7°) compared to the intact condition (44.1 ± 15.8°, p = 0.006); however, there were no significant differences between repair groups. There were no significant differences in joint translations between repairs. Interpretation: Use of a hybrid repair produced comparable joint rotation and translation under all testing conditions as an all-suture repair. As such, this technique represents a viable option for capsular repair where proximal capsular tissue is deficient