Background: The biceps superior labral complex is a known source of shoulder dysfunction in young, high-level athletes. Superior labral anterior-posterior (SLAP) repairs are often unsatisfactory for treating biceps-labral pathology in this demographic group, with high failure rates and poor return to sport (RTS). Minimal data have been published to demonstrate patient-reported outcomes (PROs) and RTS in gymnasts after treatment of SLAP pathologies. Hypothesis: Gymnasts undergoing biceps tenodesis for SLAP pathologies would have satisfactory PROs and satisfactory RTS. Study Design: Case series; Level of evidence, 4. Methods: Gymnasts aged ≤25 years who underwent open subpectoral biceps tenodesis for SLAP tears with or without biceps tendon pathology between August 20, 2014, and August 20, 2019, and who had minimum 2-year follow-up data were included in this study. Tenodesis was performed using a subpectoral technique with bicortical button fixation. The following PROs were included: RTS, postoperative activity level, 10-point visual analog scale for pain (VAS–Pain), American Shoulder and Elbow Surgeons (ASES), and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Results: Of 16 shoulders in 14 gymnasts undergoing biceps tenodesis for SLAP tear during the study period, a follow-up was obtained for 13 of 16 shoulders (81%) at 4.3 ± 1.5 years. The mean age of patients at the time of surgery was 21.8 ± 2.2 years, with 12 (92%) male patients. Biceps tenodesis was performed as the primary procedure for the diagnosis of SLAP tear in 12 patients (92%) and for failed prior SLAP repair in 1 patient (8%). PROs were excellent at the follow-up, with VAS–Pain scores of 1.8 ± 1.7, ASES scores of 89.1 ± 9.1, and DASH scores of 2.4 ± 3.2. After surgery, 8 (62%) patients returned to their prior level of collegiate gymnastics. Three (60%) of 5 patients did not return to collegiate gymnastics because of the end of eligibility, and 2 (40%) patients did not return to collegiate gymnastics because of knee injuries. Significantly higher DASH scores were noted in the group that did not RTS ( P = .04). No patients experienced postoperative complications or reoperation. Conclusion: Biceps tenodesis was an effective primary operation for high-level gymnasts with SLAP tears, with a satisfactory rate of return to the same level of sport and excellent PROs.
Objectives: Patellar dislocation is a common knee injury and up to 35% who dislocate can develop recurrent patellar instability. In the setting of recurrent instability, medial patellofemoral ligament reconstruction (MPFLR) often restores knee stability. There has been recent interest in the evaluation of patient and surgical factors that may influence the outcomes of isolated MPFLR. Much of the previous work has focused on influences of anatomical measures; however, patient and injury characteristics may also impact surgical outcomes. We hypothesize that patients who suffer > 2 patellar dislocations prior to MPFLR will demonstrate poorer patient-reported outcomes (PROs) than those who experience ≤ 2 prior dislocations. Methods: Records were reviewed to identify patients who underwent MPFLR at a single academic institution in the United States between 2008 and 2016. Patients were excluded if they underwent concomitant tibial tubercle osteotomy or fixation of an osteochondral fracture. Patient demographics (age, sex, BMI), number of prior patellar dislocations, and patient anatomical measures (Caton-Deschamps index, tibial tubercle-trochlear groove distance, and trochlear sulcus angle) were collected. PROs were assessed with Norwich Patellar Instability (NPI) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Marx activity score. Outcomes of those with > 2 or ≤ 2 patellar dislocations were compared using linear regression analysis. Results: A total of 160 patients were identified who underwent isolated MPFLR. Ninety-five patients (60%) were available to complete PROs at a mean follow-up of 4.8 years post-operation. Patients with < 2 dislocations were younger (≤ 2 dislocations: 20.7 ± 9.4yrs, > 2 dislocations: 27.4 ± 9.4yrs; p < 0.001), though there were no other differences between groups in terms of demographics or radiographic anatomical measures (Table 1). Controlling for age, sex, BMI, and anatomical factors linear regression analysis found that patients with > 2 dislocations had lower KOOS pain (p = 0.003), ADLs (p = 0.025), Sports/rec (p = 0.009), and knee related QOL (p = 0.008) subscales (Table 2). Conclusions: Patients who suffer > 2 patellar dislocations prior to MPFLR demonstrate poorer PROs at 4.8 years post-operation than those who suffer < 2 dislocations prior to surgery. To our knowledge, no other study has investigated the relationship between the number of pior patellar dislocations and outcomes following MPFLR. Our findings emphasize the role patient and injury factors may play in determining outcomes following MPFLR. [Table: see text][Table: see text]
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