Ishimoto, Alyssa

Abstract Background Some studies have reported more severe chondral pathology and less successful hip arthroscopic outcomes in patients with acetabular subchondral cysts. Purpose The purpose of this study is to report multicenter arthroscopic outcomes of patients with and without acetabular bone cysts. Methods A multicenter matched-pair study was performed with data from a large prospectively collected database. Inclusion criteria were adult patients that had undergone primary unilateral hip arthroscopy for femoroacetabular impingement syndrome (FAIS). The study group was defined by the presence of a superolateral acetabular subchondral cyst on preoperative imaging with > 2mm minimum joint width. 1:1 matching on age, gender, Body Mass Index (BMI), lateral center-edge angle (LCEA), Alpha angle, and rendered arthroscopic treatments of femoroplasty, acetabuloplasty, and labral treatment (i.e., repair, reconstruction, or debridement). Beck chondral grade and minimum 2-year outcomes utilizing VAS for pain, iHOT-12, MCID, SBC, and PASS scores were compared. Results There were 82 patients. The study group had a mean age of 42.16 ± 11.26 years with 48.78% women and a mean BMI of 26.51 ± 4.31 kg/m2. Mean Beck chondral grade was 2.59 ± 1.27 in the study group and 2.70 ± 0.95 in the matched control group (p=0.72). Two-year mean postoperative iHOT-12 scores for the study and control groups were 69.49 ± 24.51 and 73.24 ± 25.16 (p=0.38), while mean postoperative pain VAS were 18.84 ± 18.17 and 20.74 ± 21.39 (p=0.70) The study group reached MCID in 82.93%, SBC in 58.54%, and PASS in 65.85%. The control group reached MCID in 78.05%, SBC in 65.85%, and PASS in 73.17%, with no significant difference between the cohorts (p=0.57, p=0.49, p=0.47, respectively). Discussion/Conclusion Acetabular subchondral cysts are not associated with more chondral pathology than strictly matched controls and may not be a contraindication to hip arthroscopy in patients with FAIS that would otherwise be indicated for this surgery. This finding has pragmatic value in that a significant subset of patients that would otherwise have been denied elective hip arthroscopy may now be potential arthroscopic candidates.

Background: The aim of this study was to evaluate the prevalence and perceived efficacy of cannabidiol (CBD) products in patients presenting to an orthopedic hand and upper extremity clinic. Materials and Methods: New patients seen for an initial surgical consultation between July and December 2022 were surveyed regarding CBD use, pain, and function. Pain was measured with the Numeric Pain Rating Scale (NPRS, 0–10) and function with the Single Assessment Numeric Evaluation (SANE, 0–100). Demographic and clinical factors were collected via chart review. Results: A total of 918 patients completed the survey (53% female; mean age 63 years, range 18–97). Joints involved included elbows (106), wrists (335), and hands/fingers (667). Common diagnoses included arthritis (199), tendinopathy (273), and nerve-related conditions (160). Overall, 15% (135/918) reported prior CBD use, and 39% (53/135) perceived pain relief. CBD users were more likely to be female (65% vs 51%; P =0.003), to present with wrist pathology (44% vs 35%; P =0.038), and to have arthritis (36% vs 19%; P <0.001). Compared to non-users, CBD users reported higher pain scores (mean NPRS 6.2 vs 5.1; P <0.001) and lower contralateral function (mean SANE 77.3 vs 87.4; P <0.001). Conclusions In this cohort, CBD use was uncommon, and only a minority of users reported subjective benefit. CBD users tended to report higher pain and worse function, particularly in the setting of wrist arthritis. CBD products did not appear to provide measurable objective improvement in pain or function. Further studies are needed to clarify optimal dosing, administration, and potential role in upper extremity care.