- Email: [email protected]
Return to Sports After Chronic Anterior Exertional Compartment Syndrome of the Leg: Conservative Treatment Versus Surgery
2017 ISAKOS ABSTRACTS
injuries were recorded. 62/136 (45%) of injuries were sustained during preseason. 62/136 (45%) of injuries were sustained by either wide receivers or defensive backs. Ankle sprains (39/65) were the most common type of ligamentous injury while hamstring strains (35/71) were the most common type of ligamentous injury. 100 injuries that had complete GPS and clinical data were included in the analysis. Injuries were associated with significantly greater increases in player workload during the week of injury over workloads during the prior month when compared to uninjured controls (193.6, 95% CI 104.6282.5 versus 101.2, 95% CI 27.7-174.8, p ¼ .0038). This effect was especially pronounced during preseason training in myotendinous injuries as these injuries were associated with significantly greater increases in training compared to uninjured controls (617.0, 95% CI 318.4915.6 versus 384.1 95% CI 137.5-630.8, p ¼ .0095). This effect was not observed in ligamentous injuries. Discussion and conclusion: These results demonstrate that injuries in professional football players are associated with sudden increases in training load over the course of a month. This effect seems to be especially pronounced during the preseason when player workloads are generally higher and in myotendinous injuries which are more susceptible to fatigue and overuse. These results suggest a gradual increase of training intensity is a potential method to reduce the risk of soft tissue injury. Preseason versus postseason specific training programs monitored with wearable technology may assist team athletic training and medical staff with developing programs to optimize player performance. Category: Sports Medicine - Muscle/Tendons Paper #146: Return to Sports After Chronic Anterior Exertional Compartment Syndrome of the Leg: Conservative Treatment Versus Surgery RAN THEIN, MD, ISRAEL ELEONOR SVANTESSON, M.SC., SWEDEN YUICHI HOSHINO, MD, PHD, JAPAN KRISTIAN SAMUELSSON, ASSOCIATE PROFESSOR, MD, PHD, MSC, SWEDEN STEFANO ZAFFAGNINI, MD, PROF., ITALY RYOSUKE KURODA, MD, PHD, JAPAN JON KARLSSON, PROF., SWEDEN Sheba Medical Center, Tel-Hashomer, ISRAEL
SUMMARY This study supports surgery as the treatment of choice for anterior chronic anterior exertional compartment syndrome of the leg with differential benefit for fasciotomy in terms of pain and return to pre-diagnosis athletic activity. ABSTRACT DATA Background: Chronic anterior exertional compartment syndrome (CECS) of the lower leg usually results from repetitive physical activity, especially in young people and amongst athletes and causes a reduction in athletic frequency and intensity. It is classically diagnosed on
e103
history and examination with recording of raised compartmental pressures following exercise. The aim of the study is to evaluate if surgical treatment for CECS of the lower leg will lead to full athletic activity recovery compare to conservative treatment. Methods: Patients with anterior CECS of the leg were followed, assessing both groups for pain, functional status and the Tegner sports activity score with comparisons at diagnosis and following treatment. Results: Forty three patients were treated for CECS (31; 72.1% with surgery and 12; 27.9% conservatively) with a mean follow-up of 28.15 (4.16-54.09) months. Reported pain improved at follow-up by 1.59 (0-6) points and by 4.27 (0-10) points in the conservatively and the surgically treated patient groups, respectively (P¼0.014) with a mean change in the Tegner score of 0.09 (-5-5) and 3.22 (-4-7), respectively (P¼0.009). Three patients in the conservatively treated group (25% of 12) and 24 patients in the operated group (77.4% of 31) reported full resumption of their pre-diagnosis activity level (P¼0.001). Conclusion: This study supports surgery as the treatment of choice for anterior CECS of the leg with differential benefit for fasciotomy in terms of pain and return to pre-diagnosis athletic activity. Category: Hip - Impingement Paper #147: Defining the Learning Curve for Hip Arthroscopy: A Threshold Analysis of the Volume-Outcomes Relationship STEPHEN L. LYMAN, PHD, UNITED STATES DAOHONG ZHAO, MD, CHINA JUN ZHANG, MD, CHINA QI HUI DUAN, MD, CHINA Hospital for Special Surgery, New York, NY, UNITED STATES SUMMARY Stratum specific likelihood ratio analysis of 8,041 hip arthroscopies defined 4 strata of surgeon career volume associated with significantly different risks of subsequent surgery after primary hip arthroscopy. Cases performed by surgeons with career volumes over 519 had significantly lower risk of subsequent hip surgery than those performed by lower-volume surgeons. ABSTRACT DATA Introduction/Objective: Hip arthroscopy has emerged as an effective procedure for the treatment of femoroacetabular impingement and related hip disorders. However, the procedure is technically challenging and is widely believed to have a steep learning curve, which is not well defined. We aimed to define the learning curve through which surgeons become proficient at hip arthroscopy, demonstrated by decreased subsequent hip surgeries after the primary procedure. Methods: Using the New York State SPARCS database, we identified hip arthroscopy procedures performed by individual surgeons between 2003-2012 and followed these cases for subsequent hip surgery (revision hip arthroscopy, total hip arthroplasty, or hip resurfacing)
injuries were recorded. 62/136 (45%) of injuries were sustained during preseason. 62/136 (45%) of injuries were sustained by either wide receivers or defensive backs. Ankle sprains (39/65) were the most common type of ligamentous injury while hamstring strains (35/71) were the most common type of ligamentous injury. 100 injuries that had complete GPS and clinical data were included in the analysis. Injuries were associated with significantly greater increases in player workload during the week of injury over workloads during the prior month when compared to uninjured controls (193.6, 95% CI 104.6282.5 versus 101.2, 95% CI 27.7-174.8, p ¼ .0038). This effect was especially pronounced during preseason training in myotendinous injuries as these injuries were associated with significantly greater increases in training compared to uninjured controls (617.0, 95% CI 318.4915.6 versus 384.1 95% CI 137.5-630.8, p ¼ .0095). This effect was not observed in ligamentous injuries. Discussion and conclusion: These results demonstrate that injuries in professional football players are associated with sudden increases in training load over the course of a month. This effect seems to be especially pronounced during the preseason when player workloads are generally higher and in myotendinous injuries which are more susceptible to fatigue and overuse. These results suggest a gradual increase of training intensity is a potential method to reduce the risk of soft tissue injury. Preseason versus postseason specific training programs monitored with wearable technology may assist team athletic training and medical staff with developing programs to optimize player performance. Category: Sports Medicine - Muscle/Tendons Paper #146: Return to Sports After Chronic Anterior Exertional Compartment Syndrome of the Leg: Conservative Treatment Versus Surgery RAN THEIN, MD, ISRAEL ELEONOR SVANTESSON, M.SC., SWEDEN YUICHI HOSHINO, MD, PHD, JAPAN KRISTIAN SAMUELSSON, ASSOCIATE PROFESSOR, MD, PHD, MSC, SWEDEN STEFANO ZAFFAGNINI, MD, PROF., ITALY RYOSUKE KURODA, MD, PHD, JAPAN JON KARLSSON, PROF., SWEDEN Sheba Medical Center, Tel-Hashomer, ISRAEL
SUMMARY This study supports surgery as the treatment of choice for anterior chronic anterior exertional compartment syndrome of the leg with differential benefit for fasciotomy in terms of pain and return to pre-diagnosis athletic activity. ABSTRACT DATA Background: Chronic anterior exertional compartment syndrome (CECS) of the lower leg usually results from repetitive physical activity, especially in young people and amongst athletes and causes a reduction in athletic frequency and intensity. It is classically diagnosed on
e103
history and examination with recording of raised compartmental pressures following exercise. The aim of the study is to evaluate if surgical treatment for CECS of the lower leg will lead to full athletic activity recovery compare to conservative treatment. Methods: Patients with anterior CECS of the leg were followed, assessing both groups for pain, functional status and the Tegner sports activity score with comparisons at diagnosis and following treatment. Results: Forty three patients were treated for CECS (31; 72.1% with surgery and 12; 27.9% conservatively) with a mean follow-up of 28.15 (4.16-54.09) months. Reported pain improved at follow-up by 1.59 (0-6) points and by 4.27 (0-10) points in the conservatively and the surgically treated patient groups, respectively (P¼0.014) with a mean change in the Tegner score of 0.09 (-5-5) and 3.22 (-4-7), respectively (P¼0.009). Three patients in the conservatively treated group (25% of 12) and 24 patients in the operated group (77.4% of 31) reported full resumption of their pre-diagnosis activity level (P¼0.001). Conclusion: This study supports surgery as the treatment of choice for anterior CECS of the leg with differential benefit for fasciotomy in terms of pain and return to pre-diagnosis athletic activity. Category: Hip - Impingement Paper #147: Defining the Learning Curve for Hip Arthroscopy: A Threshold Analysis of the Volume-Outcomes Relationship STEPHEN L. LYMAN, PHD, UNITED STATES DAOHONG ZHAO, MD, CHINA JUN ZHANG, MD, CHINA QI HUI DUAN, MD, CHINA Hospital for Special Surgery, New York, NY, UNITED STATES SUMMARY Stratum specific likelihood ratio analysis of 8,041 hip arthroscopies defined 4 strata of surgeon career volume associated with significantly different risks of subsequent surgery after primary hip arthroscopy. Cases performed by surgeons with career volumes over 519 had significantly lower risk of subsequent hip surgery than those performed by lower-volume surgeons. ABSTRACT DATA Introduction/Objective: Hip arthroscopy has emerged as an effective procedure for the treatment of femoroacetabular impingement and related hip disorders. However, the procedure is technically challenging and is widely believed to have a steep learning curve, which is not well defined. We aimed to define the learning curve through which surgeons become proficient at hip arthroscopy, demonstrated by decreased subsequent hip surgeries after the primary procedure. Methods: Using the New York State SPARCS database, we identified hip arthroscopy procedures performed by individual surgeons between 2003-2012 and followed these cases for subsequent hip surgery (revision hip arthroscopy, total hip arthroplasty, or hip resurfacing)