Purpose Of Review: Treatment of meniscus injuries can have a substantial effect on the intra-articular biomechanics and long-term function of the knee. Meniscus repair has become a more favorable treatment option as prior studies have demonstrated a strong correlation between meniscal preservation and restoration of intra-articular contact pressure and decreased progression of arthritis. The goal of meniscus repair is to provide a stable load bearing construct to allow for meniscal healing.
View Article and Find Full Text PDFIntroduction: Letters of recommendation are considered an important factor in the holistic ranking of orthopaedic residency applications. The standardized letter of recommendation (SLOR) was introduced in 2017 in response to the inherent bias and limited comparative value of traditional LORs. It includes standardized questions about an applicant's orthopaedic qualifications, designed to enable fair comparisons among candidates.
View Article and Find Full Text PDFBackground: Pediatric patients with isolated femoral diaphyseal fractures are difficult to assess for nonaccidental trauma (NAT). The purpose of this study was to determine (1) if there are any demographic features of isolated femoral diaphyseal fractures associated with suspected NAT and (2) if there are clinical signs associated with isolated femoral diaphyseal fractures associated with suspected NAT.
Methods: All patients with femoral diaphyseal fractures from January 2010 to June 2018 were reviewed.
Introduction: Although hip arthroscopy continues to be one of the most used arthroscopic procedures, no focused, comprehensive evaluation of reimbursement trends has been conducted. The purpose of this study was to analyze the temporal Medicare reimbursement trends for hip arthroscopy procedures.
Methods: From 2011 to 2021, the Medicare Physician Fee Schedule Look-Up Tool was queried for Current Procedural Terminology (CPT) codes related to hip arthroscopy (29860 to 29863, 29914 to 29916).
J Am Acad Orthop Surg Glob Res Rev
April 2024
Introduction: No specific study has investigated the characteristics and outcomes of anterior shoulder dislocations in morbidly obese individuals. The purpose of this study was to describe shoulder dislocations in patients with body mass index (BMI) greater than 40.
Methods: A retrospective review was conducted to identify patients aged 18 years and older with a BMI ≥40 who presented with a shoulder dislocation in a single institution from 2000 to 2020.
» Reverse total shoulder arthroplasty was designed to function in the rotator cuff deficient shoulder by adjusting the glenohumeral center of rotation (COR) to maximize deltoid function.» Adjustments in the COR ultimately lead to changes in resting tension of the deltoid and remaining rotator cuff, which can affect implant stability and risk of stress fracture.» Soft-tissue balance and complication profiles can be affected by humeral component (version, neck shaft angle, and inlay vs.
View Article and Find Full Text PDFObjective: To determine if immediate plate fixation of open tibial plafond fractures has a negative effect on soft tissue complications and increases the risk of deep infection.
Design: This was a single-institution retrospective cohort study performed at level-1 trauma center. All patients with open OTA/AO 43C plafond fractures treated over 20-year period with follow-up until fracture union or development of deep infection.
Background: Studies demonstrate an increase incidence of intertrochanteric fractures within the United States. Matched studies evaluating intertrochanteric fractures managed with either sliding hip screw (SHS) or intramedullary nail (IMN) within the Medicare population are limited. The purpose of this study was to investigate: 1) annual utilization trends; 2) patient demographics; and 3) complications including mortality.
View Article and Find Full Text PDFBackground: On August 31, 2017, Ohio passed legislation that regulates how opioids can be prescribed postoperatively. Studies have shown that such legislation is successful in reducing the morphine milligram equivalents (MMEs) prescribed after certain orthopaedic procedures.
Purpose: (1) To determine if the opioid prescription-limiting legislation in Ohio reduced the cumulative MMEs prescribed after hip arthroscopy without significantly affecting the rates of emergency department (ED) visits, hospital readmissions, and reoperations within 90 days postoperatively, and (2) to assess risk factors associated with increased postoperative opioid dosing.
J Am Acad Orthop Surg Glob Res Rev
May 2023
Emphysematous osteomyelitis (EO) is a rare condition identified through the presence of intraosseous gas. It is frequently fatal even with prompt recognition and management. We report a case of EO presenting with a necrotizing soft tissue infection of the thigh in the setting of prior pelvic radiation.
View Article and Find Full Text PDFPurpose: The purpose of this study was to evaluate the effect of bioabsorbable interference screw diameter on the pullout strength and failure mode for femoral tunnel fixation in primary anterior cruciate ligament reconstruction (ACLR) at time zero fixation using bone-patellar tendon-bone (BTB) autograft in a cadaveric model.
Methods: Twenty-four fresh-frozen cadaveric knees were obtained from 17 different donors. Specimens were allocated to three different treatment groups (n = 8 per group) based on interference screw diameter: 6 mm, 7 mm, or 8 mm biocomposite interference screw.
Background: Most outcome studies of total ankle arthroplasty (TAA) do not discriminate by arthritis etiology. The primary purpose of this study was to compare the complications of TAA between posttraumatic fracture osteoarthritis (fracture PTOA) and primary osteoarthritis (POA).
Methods: Ninety-nine patients who underwent TAA were retrospectively evaluated with a mean follow-up of 3.
Objectives: To determine if patients suffering simple, posterior hip dislocations are more likely to display dysplastic characteristics of their acetabulum as compared with those suffering fracture dislocations.
Design: Retrospective cohort study.
Setting: Level 1 trauma center.
Patellar dislocation is a relatively common pediatric injury, which often results in recurrent patellofemoral instability. An increased tibial tubercle-trochlear groove distance predisposes to patellofemoral instability and can be corrected with a distal realignment procedure. Soft-tissue distal realignment procedures must be used in the pediatric population to avoid the risks of premature physeal closure associated with tibial tubercle osteotomies.
View Article and Find Full Text PDFCombined hip arthroscopy and periacetabular osteotomy are used for the treatment of concomitant intra-articular hip pathology and acetabular dysplasia or instability. Traditionally, the procedure has been achieved with the use of a traction table or table attachment for the arthroscopic portion and then subsequent transfer of the patient to a fully radiolucent flat bed. In this article, we highlight the technique of a combined hip arthroscopy and periacetabular osteotomy procedure using a single bed attachment system.
View Article and Find Full Text PDFIntrathecal morphine (IM) is a popular adjunct for pain management in spinal deformity surgery for idiopathic scoliosis. It has not been studied in patients with early onset scoliosis (EOS). We retrospectively reviewed EOS patients undergoing growth-friendly surgery who received IM or did not receive IM (non-IM).
View Article and Find Full Text PDFBackground: Successful management of massive rotator cuff (RC) tendon tears represents a treatment challenge because of the limited intrinsic healing capacity of native tendons and the risk of repair failure. Biologic augmentation of massive RC tears utilizing scaffolds-capable of regenerating bulk tendon tissue to achieve a mechanically functional repair-represents an area of increasing clinical interest.
Purpose: To investigate the histological and biomechanical outcomes after the use of a novel biologic scaffold fabricated from woven electrochemically aligned collagen (ELAC) threads as a suture-holding, fully load-bearing, defect-bridging scaffold with or without mesenchymal stem cells (MSCs) compared with direct repair in the treatment of critically sized RC defects using a rabbit model.
Background: Structural cortical bone allografts are a reasonable treatment option for patients with large cortical bone defects caused by trauma, tumors, or complications of arthroplasty. Although structural cortical bone allografts provide the benefit of an osteoconductive material, they are susceptible to fatigue failure (fracture) and carry a risk of disease transmission. Radiation-sterilization at the recommended dose of 25 kGy decreases the risk of disease transmission.
View Article and Find Full Text PDFBackground: This investigation's purpose was to perform a systematic review of the literature examining the biomechanics of the ligaments comprising the distal tibiofibular syndesmosis with specific attention to their resistance to translational and rotational forces. Although current syndesmosis repair techniques can achieve an anatomic reduction, they may not reapproximate native ankle biomechanics, resulting in loss of reduction, joint overconstraint, or lack of external rotation resistance. Armed with a contemporary understanding of individual ligament biomechanics, future operative strategies can target key stabilizing structure(s), translating to a repair better equipped to resist anatomic displacing forces.
View Article and Find Full Text PDFThe coracoclavicular joint (CCJ) is an anomalous articulation between the surfaces of the inferior clavicle and superior coracoid and its etiology is controversial. Reportedly, symptomatic patients demonstrate significant functional limitations including shoulder abduction loss and potential for brachial plexus compression and impingement. To determine the prevalence of CCJ across age, gender and ethnicity, and to identify clinically useful morphological characteristics.
View Article and Find Full Text PDF»: Femoroacetabular impingement (FAI) is one of the most common causes of early hip articular cartilage wear and labral damage, and subsequently leads to the onset of hip osteoarthritis.
»: Cam-type FAI impingement lesions can be best identified with a 90° Dunn lateral radiograph and a cross-table lateral radiograph with 15° of internal rotation; the alpha angle and the femoral head-neck offset are the most used predictive radiographic markers.
»: FAI lesions with pincer impingement are associated with acetabular retroversion and are more difficult to identify on traditional radiographic imaging; however, the presence of a crossover sign, an ischial spine sign, and/or a posterior wall sign can be useful radiographic markers.