Publications by authors named "Stephen Aoki"
Background: Improved patient outcomes and decreased patellar instability have been reported after medial patellofemoral ligament (MPFL) reconstruction for recurrent lateral patellar dislocation; however, there is a lack of comparative evidence on functional outcomes associated with different femoral attachment sites for the MPFL graft.
Purpose: To identify differences in MPFL reconstruction graft isometry with femoral tunnel malpositioning, specifically evaluating isometric differences as the femoral position is moved anterior, posterior, proximal, and distal relative to the Schöttle point, the femoral radiographic landmark of the MPFL.
Study Design: Descriptive laboratory study.
Purpose: To investigate the incidence of heterotopic ossification (HO) in patients prescribed prophylactic nonsteroidal anti-inflammatory drugs (NSAIDs), both before and after the introduction of a standardized education protocol.
Methods: A retrospective review was conducted using a database of hip arthroscopy patients treated by a single surgeon at an academic hospital from 2015 to 2023. The inclusion criteria were (1) primary hip arthroscopy for the treatment of femoroacetabular impingement, (2) completion of a 2-week course of prophylactic postoperative NSAIDs (500 mg of naproxen twice daily), and (3) availability of follow-up radiographs at the 6-month postoperative visit.
Article Synopsis
- The study investigates how the acetabular sourcil and bone edges, common radiographic markers, relate to the weightbearing area of the acetabulum, highlighting potential confusion in surgical settings.
- It was hypothesized that the sourcil edge indicates anterolateral coverage while the bone edge shows anterior coverage in the acetabulum.
- Findings revealed that the sourcil edge aligns with the area behind the anterior inferior iliac spine (AIIS), while the bone edge targets a weightbearing region beneath it, with significant implications for hip surgeries.
Article Synopsis
- The study aimed to assess hip capsule thickness using advanced imaging in patients with and without hip dysplasia to see if there are differences between those with borderline and true dysplasia.
- Researchers analyzed data from 80 patients and found that those with dysplasia had significantly thinner hip capsules compared to those without, measuring 2.75 mm vs. 3.52 mm.
- The subanalysis indicated that there were no notable differences in capsular thickness between patients classified as having borderline dysplasia and those with true dysplasia, suggesting further research is needed to explore the implications of these findings on hip stability.
Objective: Patellar height changes after tibial tubercle osteotomy (TTO) have not yet been described. We aimed to evaluate whether TTO ± medial patellofemoral ligament reconstruction (MPFL-R) influences patellar height and tendon length, hypothesizing that TTO would decrease patellar height and tendon length.
Methods: A retrospective review was performed of skeletally mature adolescents (<18 y) receiving primary anteromedialization or medialization TTO ± MPFL-R.
Article Synopsis
- A study investigated the effectiveness of formal physical therapy (FPT) versus a home exercise program (HEP) in patients recovering from hip arthroscopic surgery for femoroacetabular impingement syndrome (FAIS).
- The research was a cohort study involving patients who self-selected either FPT or HEP, tracking their progress through various outcome measures at multiple intervals after surgery.
- Results showed no significant differences in recovery outcomes and patient satisfaction between the FPT and HEP groups after 12 months, indicating that both approaches may be equally effective.
Article Synopsis
- The study examines how repairing the hip capsule affects stability during the initial phase of hip distraction in patients with femoroacetabular impingement (FAI).
- Researchers measured joint space in three different conditions: native capsule, interportal capsulotomy, and capsular repair using fluoroscopic images during hip distraction.
- Results show that both the native and repaired capsule required a median force of 75 lb to distract the hip by 3 mm, while the unrepaired capsulotomy only needed 50 lb, indicating that i) restoration of the capsule improves hip stability.
Article Synopsis
- The study focuses on how accurately a perfect lateral knee X-ray represents the anatomical features of the femoral physis, given that X-rays are 2D images of a 3D structure.
- By analyzing pediatric CT scans, researchers created digitally reconstructed radiographs (DRRs) and measured the differences between the actual physis and its projection on these X-rays.
- Results showed that the actual position of the physis on the medial cortex was significantly higher than what was seen in the X-ray, indicating a consistent discrepancy in visualization across all measured areas.
An aspherical hip can mechanically damage the joint and lead to chondrolabral injury, functional pain, and potentially arthritis. Hip arthroscopy to address femoroacetabular impingement (FAI) and make the hip spherical, with treatment of concomitant labral pathology, can result in excellent outcomes in patients with this pathology. The goal is complete cam resection.
View Article and Find Full Text PDFPurpose: Abnormal patellar height has been identified as a source of aberrant mechanical functioning within the patellofemoral joint. The purpose of this study is to examine the statistical agreement among three commonly used classification methods: Blackburne-Peel (BPI), Caton-Deschamps (CDI) and Insall-Salvati (ISR), by evaluating (1) the rates of patella alta identification and (2) the ability for one index to predict another.
Methods: One hundred lateral knee radiographs were evaluated using BPI, CDI and ISR to classify each knee as patella normal, patella alta or patella baja.
Article Synopsis
- Thinner anterior hip capsules are linked to hip laxity and potential instability after hip arthroscopic surgery, but the relationship specifically regarding capsular thickness and surgical outcomes remains unclear.
- This study examined patients who underwent revision hip arthroscopy due to instability and compared them to a control group, finding that those with instability had significantly thinner hip capsules (average 1.9 mm) compared to those without instability (average 3.4 mm).
- The results suggest that decreased capsular thickness is notably associated with hip instability after surgery, indicating that preoperative MRI assessments of capsular thickness could be crucial for predicting surgical outcomes.
Article Synopsis
- The study aims to find a reliable way to measure hip capsular thickness in patients with femoroacetabular impingement syndrome, comparing measurements obtained through MRI and MRA techniques.
- Two independent reviewers analyzed preoperative imaging of 85 patients to measure capsular thickness at various points, achieving high reliability scores (ICCs) for both MRI (0.981) and MRA (0.985).
- The findings suggest that while both imaging methods are generally interchangeable, a significant difference was noted only in the inferior aspect of the capsule, indicating some variation in measurements specific to the imaging technique.
Background: An elevated posterior tibial slope (PTS) is associated with an increased risk for anterior cruciate ligament and meniscal injury. Recent evidence suggests that the PTS is elevated in patients with Osgood-Schlatter disease.
Purpose: To determine whether there is an association between objective measures of anterior tibial tubercle growth and PTS.
Article Synopsis
- The study aimed to analyze the femoral deformity after fixing the hip in patients with a slipped capital femoral epiphysis (SCFE) and its connection to skeletal immaturity.
- Researchers reviewed data from 27 patients with unilateral SCFE who underwent a specific treatment and followed them for at least three years.
- Findings revealed that greater overgrowth in the trochanter was linked to wider triradiate cartilage and an open TRC, indicating that more caution is needed when performing prophylactic hip fixation.
Article Synopsis
- Patients undergoing hip arthroscopy with perineal post distraction have a higher risk of postoperative numbness compared to those using postless distraction methods.
- In a study of 195 patients, 30.9% in the postless group experienced numbness, while 44.6% in the post distraction group reported the same, with significant differences in groin numbness rates (1.1% vs. 18.8%).
- Multivariate analysis indicated that post distraction methods and traction time significantly increase the chances of groin numbness post-surgery.
Acetabular Labral Reconstruction: Review of Techniques and Outcomes.
Curr Rev Musculoskelet Med
October 2023
Purpose Of Review: To analyze advances in labral reconstruction, and to discuss the literature relating to efficacy, outcomes, and technical considerations of labral reconstruction.
Recent Findings: The available evidence suggests that labral reconstruction is a safe and effective procedure that can improve pain and function in patients with severe and/or complex labral tears. The superiority of labral reconstruction over labral repair is uncertain, and it remains unclear what graft type and technique should be used in labral reconstructions.
Article Synopsis
- The study aimed to analyze how venting the hip joint affects the traction force needed for arthroscopic procedures in the hip's central compartment.
- Researchers measured joint space before and after venting during surgeries on 50 hips, finding significant increases in joint space with venting.
- The results showed that venting the hip allows for at least a 50% reduction in necessary traction force for better visualization and access during arthroscopy.
Background: Magnetic resonance imaging (MRI) scans and radiographs are often utilized in assessing for preoperative osteoarthritis in patients undergoing hip preservation surgery.
Purpose: To determine if MRI scans improve inter- or intrarater reliabilities over radiographs for findings of hip arthritis.
Study Design: Cohort study (Diagnosis); Level of evidence, 3.
Article Synopsis
- Collegiate female gymnasts are susceptible to Achilles tendon injuries, which can hinder their ability to compete effectively after recovery.
- A survey conducted among NCAA women's gymnastics teams revealed that most Achilles tendon ruptures occur during the floor exercise, especially during the take-off phase of tumbling skills.
- Despite the high rate of injuries, around 61% of gymnasts managed to return to competition, with a slight majority maintaining their previous level of performance after the injury.
Postoperative Pain Medication Utilization in Pediatric Patients Undergoing Sports Orthopaedic Surgery: Characterizing Patient Usage Patterns and Opioid Retention.
J Am Acad Orthop Surg Glob Res Rev
October 2022
Article Synopsis
- Opioid overprescribing in pediatric orthopaedic surgeries leads to leftover medication, prompting a study on opioid usage and disposal among young patients.
- The study involved 114 patients who were surveyed post-surgery, revealing that they were prescribed, on average, 12 opioid pills but only used about 4, indicating significant overprescribing.
- The findings suggest that orthopaedic surgeons could potentially reduce the amount of opioids prescribed, as a majority of patients reported having unused medication after their procedures.
Background: The presence of pre-existing osteoarthritis (OA) has been associated with poor results after hip arthroscopic surgery. There is limited evidence validating the currently available grading systems of hip OA in patients undergoing hip preservation.
Purpose/hypothesis: Our purpose was to evaluate the interobserver and intraobserver reliabilities of 2 grading systems in a group of patients undergoing hip preservation: the Tönnis grading system and a simple 4-choice Likert scale.
Femoroacetabular impingement syndrome (FAIS) is a motion-related pathology of the hip characterized by pain, morphological abnormalities of the proximal femur, and an elevated risk of joint deterioration and hip osteoarthritis. Activities that require deep flexion are understood to induce impingement in cam FAIS patients, however, less demanding activities such as walking and pivoting may induce pain as well as alterations in kinematics and joint stability. Still, the paucity of quantitative descriptions of cam FAIS has hindered understanding underlying hip joint mechanics during such activities.
View Article and Find Full Text PDFPurpose: To determine the incidence of screw impingement on dynamic exam during hip arthroscopy in patients undergoing treatment for femoroacetabular impingement after previous slipped capital femoral epiphysis fixation and to evaluate screw characteristics with hardware impingement.
Methods: A retrospective review from 2008 to 2020 was performed of slipped capital femoral epiphysis (SCFE) patients that underwent arthroscopy for symptoms of hip impingement. Patients underwent a dynamic exam under direct arthroscopic visualization to assess for sources of impingement, including bony anatomy and fixation hardware.
Medial Patellofemoral Ligament Reconstruction in the Pediatric Population: Skeletal Immaturity Does Not Affect Functional Outcomes but Demonstrates Increased Rate of Subsequent Knee Injury.
Arthrosc Sports Med Rehabil
October 2022
Purpose: To evaluate short- to mid-term-outcomes, including instability rates, following medial patellofemoral ligament (MPFL) reconstruction in skeletally immature versus mature pediatric patients.
Methods: Patients younger than age 18 with recurrent patellar instability who underwent primary allograft MPFL reconstruction by a single surgeon from 2013 to 2019 were identified. Skeletally immature patients underwent all-epiphyseal drilling and mature patients underwent metaphyseal drilling at the Schöttle's point.