High Altitude is an Independent Risk Factor for Postoperative Venous Thromboembolism Following Primary Total Knee Arthroplasty: A Large Database Study.

Introduction: Venous thromboembolism (VTE) is a relatively uncommon but potentially fatal complication following total knee arthroplasty (TKA). High altitude may induce physiological changes that can predispose patients to VTE. The purpose of this study was to determine if high altitude is an independent risk factor for postoperative VTE following TKA.

The outpatient experience in unicompartmental knee arthroplasty: How to perform safely in the ambulatory surgery center.

The number of outpatient unicompartmental knee arthroplasty (UKA) procedures has increased substantially over the last decade. The ambulatory surgery center (ASC) and hospital outpatient department provide a safe, cost-effective alternative with significant cost savings to the healthcare system. Advancements in technology and perioperative management strategies have expanded the number of eligible patients to optimize outcomes with a focus on safety.

Return to Sports After Unicompartmental Knee Arthroplasty.

Knee osteoarthritis (OA) is a widespread and potentially debilitating condition that can interfere with the growing demand for a healthy and active lifestyle. In people under the age of 55 years, the prevalence of OA is expected to increase substantially in the coming decades. High tibial osteotomy and cartilage repair operations have been used to treat OA in young, active individuals; however, these procedures require lengthy rehabilitation periods and result in poor return to preoperative levels of activity that make them unsuitable for the young, active patient.

Fixed-bearing medial unicompartmental knee arthroplasty: New indications in the anterior cruciate ligament-deficient knee.

The anterior cruciate ligament (ACL)-deficient osteoarthritic knee presents a challenging disease entity, which requires careful thought to restore function and enable return to activities. Advancements in technology and surgical techniques have expanded indications for unicompartmental knee arthroplasty (UKA), to inlcude ACL-deficiency in appropriately-selected patients. An improved understanding of the ACL-deficient osteoarthritic knee can aid in clinical and surgeon decision-making to restore knee function.

Arthroscopic Management of Moderate-to-Severe Osteoarthritis of the Knee: A Systematic Review.

Background: Total knee arthroplasty (TKA) is the procedure of choice for osteoarthritis of the knee (OAK) when conservative treatment fails; however, high rates of dissatisfaction and poor implant longevity dissuade younger patients from TKA. There is a paucity of evidence that report outcomes and clinical effectiveness of arthroscopic knee procedures in patients with end-stage (grade 3-4) OAK. The purpose of this systematic review was to evaluate the efficacy of arthroscopic treatment for patients with moderate-to-severe (grade 3-4) OAK.

Editorial Commentary: Biologics Injections for Partial-Thickness Rotator Cuff Tears Show Promise.

Partial-thickness rotator cuff tears (PTRCTs) are difficult to treat. Conservative treatment typically includes physical therapy, nonsteroidal anti-inflammatory drugs, and injectables (e.g.

Unicompartmental knee arthroplasty improves mental health in patients with single compartment knee osteoarthritis.

Purpose: The purpose of this study was to determine if preoperative mental health status improves following unicompartmental knee arthroplasty (UKA) in patients with single compartment knee osteoarthritis (OA).

Methods: A total of 163 patients underwent UKA [115 (71%) medial, 48 (29%) lateral] (mean age = 65 ± 11) completed preoperative and minimum 2-year postoperative veterans RAND 12 item health survey (VR-12) mental component score (MCS). VR-12 MCS was the primary outcome measure.

Arthroscopic Labral Reconstruction With a Modified Inferior Capsular Shift Allows Return to Sport and Excellent Outcomes in Contact and Noncontact Athletes With Anterior Shoulder Instability at Minimum 5-Year Follow-Up.

Purpose: To compare return to sport, functional outcomes, recurrence of instability, and osteoarthritis (OA) between collision/contact and limited/noncontact athletes following arthroscopic labral reconstruction with a modified inferior capsular shift for anterior shoulder instability.

Methods: Athletes underwent an arthroscopic labral reconstruction with a modified inferior capsular shift by the senior author between 1999 and 2018. Inclusion criteria were labral stripping from 12 (just beyond the biceps anchor) to 6 o'clock, less than 20% glenoid bone loss, active sports participation, and no previous surgery.

The Role of Severe Lateral Facet Patellar Osteoarthritis in Patient Selection for Success of a Medial Unicompartmental Knee Arthroplasty: Mean Follow-Up of 10 Years.

Background: Lateral facet patellar osteoarthritis (LFPOA) has been reported as a contraindication for medial unicompartmental (UKA). The purpose of this paper was to determine if severe LFPOA was related to lower survivorship and patient-reported outcomes following medial UKA.

Methods: A total of 170 medial UKAs were performed.

Return to Sport in Middle-aged and Older Athletes After Unicompartmental Knee Arthroplasty at a Mean 10-Year Follow-up: Radiographic and Clinical Outcomes.

Background: Return to sport is essential information when an athlete contemplates surgical intervention. Young athletes, <30 years of age, may undergo complex cartilage procedures or femoral/tibial osteotomies to successfully treat single-compartment knee osteoarthritis. Unicompartmental knee arthroplasty (UKA) may offer an attractive alternative option to middle-aged/older athletes with timely return to the same sport without a lengthy rehabilitation.

Pre-Arthritic/Kinematic Alignment in Fixed-Bearing Medial Unicompartmental Knee Arthroplasty Results in Return to Activity at Mean 10-Year Follow-up.

Background: The optimal alignment strategy in unicompartmental knee arthroplasty (UKA) is debated. Recent studies have suggested that kinematic alignment may lead to improved biomechanics and outcomes. The aim of the present study was to determine if pre-arthritic/kinematic alignment of knees would result in sustained long-term restoration of function, without conversion to total knee arthroplasty (TKA), following non-robotically assisted, fixed-bearing medial UKA.

Isolated Lateral Tibiofemoral Compartment Osteoarthritis: Survivorship and Patient Acceptable Symptom State After Lateral Fixed-Bearing Unicompartmental Knee Arthroplasty at Mean 10-Year Follow-up.

Background: Lateral unicompartmental knee arthroplasty (UKA) is an excellent option to alleviate disability and restore function in patients with lateral compartment knee osteoarthritis (OA). The purpose of the present study was to determine the survivorship and long-term outcomes in both younger/middle-aged and older patients with lateral compartment OA following non-robotically-assisted, fixed-bearing lateral UKA and to determine if an acceptable symptom state can be achieved.

Methods: All patients were managed with fixed-bearing lateral UKA by a single surgeon utilizing a lateral parapatellar approach without robotic assistance.

Reliability and Validity of the Knee Injury and Osteoarthritis Outcome Score in Patients Undergoing Unicompartmental Knee Arthroplasty.

Background: The Knee Injury and Osteoarthritis Outcome Score (KOOS) was developed to document outcomes from knee injury, including the impact of osteoarthritis on knee function. The purpose of this study is to determine the reliability and validity of the KOOS subscales for evaluating outcomes following unicompartmental knee arthroplasty (UKA).

Methods: KOOS Pain, Activities of Daily Living (ADL), Sport, Symptoms, and Quality of Life (QoL) scores collected from 172 patients who underwent UKA were used in the analysis.

An algorithm for successfully managing anterior shoulder instability.

The most common form of shoulder instability involves the anterior glenohumeral joint. Often it is associated with labral and bony injuries with subsequent recurrent instability. To determine optimal management, clinicians should perform a detailed history and physical examination, including appropriate diagnostic imaging to assess for concomitant humeral and glenoid bony deficiencies and other soft-tissue pathologies.

The Lawrence D. Dorr Surgical Techniques & Technologies Award: Patient Acceptable Symptom State (PASS) in Medial and Lateral Unicompartmental Knee Arthroplasty: Does the Status of the ACL Impact Outcomes?

Background: The aim of this study is to determine if there is a difference in the percentage of patients who reach Patient Acceptable Symptom State (PASS) when comparing anterior cruciate ligament (ACL)-deficient and ACL-intact knees following fixed-bearing medial and lateral unicompartmental knee arthroplasty (UKA).

Methods: A consecutive series of 215 knees that underwent UKA (medial = 158, lateral = 57) were included in the study. The Knee Osteoarthritis Outcome Score functional score [KOOS activities of daily living (ADL)] and KOOS Sport were used as the primary outcome variables.

Diagnosis and Management of Partial Thickness Rotator Cuff Tears: A Comprehensive Review.

Partial thickness rotator cuff tears (PRCTs) are a challenging disease entity. Optimal management of PRCTs continues to be controversial. Although advances in magnetic resonance imaging and ultrasonography have aided in early diagnosis, arthroscopic evaluation remains the benchmark for diagnosis.

Relevance of the Tibial Slope on Functional Outcomes in ACL-Deficient and ACL Intact Fixed-Bearing Medial Unicompartmental Knee Arthroplasty.

Background: Excessive posterior tibial slope in medial unicompartmental knee arthroplasty (UKA) has been implicated in early failure. The purpose of this study was to evaluate the relationship between preoperative posterior tibial slope and postoperative slope of the implant (PSI) on outcomes in patients with anterior cruciate ligament (ACL) intact and ACL-deficient knees after fixed-bearing medial UKA.

Methods: Patients who underwent a medial UKA between 2002 and 2017 with a minimum 3-year follow-up were included.

Endoscopic/arthroscopic decompression of the suprascapular nerve at the spinoglenoid notch: indications and surgical technique.

Suprascapular nerve compression at the spinoglenoid notch can lead to posterior shoulder pain, muscle weakness, and longstanding muscle atrophy of the infraspinatus. Although rare, it is most commonly seen in overhead athletes and laborers who perform repetitive overhead activities. Early diagnosis requires a thorough history and physical examination including imaging, diagnostic injections, and electromyography to avoid a missed diagnosis.

Thumb Carpometacarpal Suspension Arthroplasty With Flexor Carpi Radialis Ligament Reconstruction and Tendon Interposition Using An Absorbable Interference Screw: A Volar Approach Technique.

The goal of operative intervention for pantrapezial arthritis is to relieve pain, maintain or improve motion, stability, and strength, and restore function. The purpose of this article is to present a volar approach to thumb carpometacarpal suspension arthroplasty using an absorbable interference screw for flexor carpi radialis ligament reconstruction and tendon interposition in the treatment of pantrapezial arthritis. This technique allows for visualization of the volar beak and avoidance of the radial artery and the branches of the superficial radial nerve while allowing optimal surgical manipulation for suspensionplasty with interference screw fixation and tendon interposition at the carpometacarpal joint.

The Accessory Medial Portal for Anterior Cruciate Ligament Reconstruction: A Safe Zone to Avoid Neurovascular Complications.

Background: The accessory medial portal (AMP) used for anatomic anterior cruciate ligament reconstruction (ACLR) is gaining popularity. This portal is routinely created at 60° of knee flexion, placing the infrapatellar branch of the saphenous nerve (IBSN) and, less commonly, the descending and superior medial genicular arteries at risk.

Purpose/hypothesis: The purpose of this study was to identify a safe zone for AMP placement in ACLR to minimize the risk of injury to the IBSN.

The Shoulder Trans-pectoralis Arthroscopic Portal Is a Safe Approach to the Arthroscopic Latarjet Procedure: A Cadaveric Analysis.

Purpose: To assess the proximity of neurovascular structures in a layered approach during medial portal placement and determine standardized measurements for establishing a portal medial to the coracoid used in arthroscopic Latarjet-type procedures.

Methods: Twelve shoulders (6 right and 6 left) in 6 fresh frozen cadaveric torsos were mounted in the modified beach-chair position. A standard posterior portal and 3 anterior portals-central, lateral, and medial-were used.

DVT and Pulmonary Embolism Following Knee Arthroscopy: The Role of Genetic Predisposition and Autoimmune Antibodies: A Report of 3 Cases.

Deep vein thrombosis (DVT) after arthroscopy has been considered a rare event; however, recent studies using ultrasound and venography have shown that the incidence of DVTs is underestimated. CASES:: This report describes 3 patients with DVT and/or PE after knee arthroscopy who were attributed to a genetic predisposition of hypercoagulability unknown to the patient and surgeon. CONCLUSIONS:: Genetic predisposition and autoimmune antibodies may play a role in the development of DVT after knee arthroscopy.

The Changing Face of Orthopaedic Education: Searching for the New Reality After COVID-19.

The COVID-19 pandemic has had immediate impact on the practice of medicine and on orthopaedic education. As the practice of social distancing has been put into place to help slow the spread of disease as well as to conserve medical supplies and equipment, elective surgery has come to a grinding halt. This dramatic change has forced our leaders to evaluate critically the delivery of education and skills training for our residents, fellows and all orthopaedic surgeons.