Return to Sports After Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament (ACL) tears are one of the most common orthopedic injuries among athletes. Although a small proportion of patients with isolated tears can return to sports after completing a nonsurgical rehabilitation program, ACL reconstruction is frequently recommended for young athletes, especially those with concomitant knee injuries or symptomatic knee instability. Alongside emerging evidence for the effect of prehabilitation, the current standard of care for postoperative ACL physical therapy includes pain control, range of motion, quadriceps strengthening, weight bearing, postoperative bracing, and dynamic limb stabilization and control.

Republication of "Most Readmissions Following Ankle Fracture Surgery Are Unrelated to Surgical Site Issues: An Analysis of 5056 Cases".

Background: Ankle fracture surgeries are generally safe and effective procedures; however, as quality-based reimbursement models are increasingly affected by postoperative readmission, we aimed to determine the causes and risk factors for readmission following ankle fracture surgery.

Methods: Ankle fracture cases were identified from the prospectively collected American College of Surgeons National Surgical Quality Improvement Program from 2013 to 2014. Demographics, comorbidities, and fracture characteristics were collected.

Editorial Commentary: Hip Arthroscopy for Patients With Decreased Center-Edge Angle and Bipolar Cartilage Lesions Is Associated With Early Conversion to Total Hip Arthroplasty.

The utilization of hip arthroscopy to treat femoroacetabular impingement has continued to grow year after year. Clinical studies and cost-effectiveness analyses have repeatedly shown the benefits of hip arthroscopy in improving quality of life, offering much promise to this patient population. Through years of research, a more comprehensive understanding of impingement pathologies has brought improving surgical techniques.

PROMIS Global-10 performs poorly relative to legacy shoulder instruments in patients undergoing total shoulder arthroplasty for glenohumeral arthritis.

Background: The PROMIS Global-10 is a 10-item questionnaire that assesses general health-related quality of life. There is a paucity of research on the utility of the PROMIS Global-10 in the evaluation of orthopedic conditions. The aim of this study is to compare PROMIS Global-10 and legacy shoulder-specific patient-reported outcome measures (PROMs) in patients undergoing total shoulder arthroplasty (TSA) for shoulder arthritis.

Fibular Collateral Ligament Reconstruction Graft Options: Clinical and Radiographic Outcomes of Autograft Versus Allograft.

Purpose: To compare varus knee stability and clinical outcomes between patients who underwent fibular collateral ligament reconstruction (FCLR) or lateral collateral ligament (LCL) reconstruction with autografts versus allografts when undergoing concomitant anterior cruciate ligament reconstruction (ACLR).

Methods: All patients who underwent primary ACLR and concomitant FCLR from 2010 to 2017 performed by a single surgeon (R.F.

The identification and treatment of snapping posterior tendons of the knee improves patient clinical outcomes.

Purpose: To assess the most common presenting symptoms, clinical outcomes, and patient satisfaction following treatment of either snapping medial pes anserinus hamstrings or snapping lateral biceps femoris tendons.

Methods: Consecutive patients with a minimum 2-year follow-up after isolated medial hamstring release for a diagnosis of medial snapping pes anserinus tendons or patients treated with primary biceps repair for lateral snapping biceps femoris tendons were evaluated. Clinical outcome scores of the following domains were collected: SF12, WOMAC score, Lysholm Knee Survey, and a simple numeric patient satisfaction score (0-10).

Online Resources for Rotator Cuff Repair: What are Patients Reading?

Purpose: The purpose of this study was to use a novel scoring system to evaluate the content and grade the quality of websites that patients may use to learn about rotator cuff repair.

Methods: Two search terms ("rotator cuff repair" and "rotator cuff surgery") were entered into 3 Internet search engines (Google, Yahoo, and Bing). We scored the quality of information using a novel scoring system.

Clinical Presentation and Outcomes Associated With Fabellectomy in the Setting of Fabella Syndrome.

Background: Clinical outcomes pertaining to isolated lateral fabellectomy in the setting of fabella syndrome are limited to small case reports at this time.

Purpose: To assess the most common presenting symptoms, clinical outcomes, and satisfaction after fabella excision in the setting of fabella syndrome.

Study Design: Case series; Level of evidence, 4.

Clinical Characteristics and Outcomes After Anatomic Reconstruction of the Proximal Tibiofibular Joint.

Purpose: To assess the most common presenting symptoms, clinical outcomes, and satisfaction after anatomic reconstruction of the proximal tibiofibular joint (PTFJ) with a free semitendinosus autograft.

Methods: Consecutive patients with minimum 2-year follow-up after isolated anatomic PTFJ reconstruction were retrospectively reviewed. Patients were evaluated with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and Lysholm Knee Survey score along with a simple numeric patient satisfaction score (0-10, with 10 rated as perfect).

Clinical and Imaging Outcomes After Arthroscopic Superior Capsule Reconstruction With Human Dermal Allograft for Irreparable Posterosuperior Rotator Cuff Tears: A Minimum 2-Year Follow-Up.

Purpose: To report the clinical and structural outcomes for non-pseudoparalytic irreparable posterosuperior rotator cuff tears treated with superior capsule reconstruction (SCR) using dermal allograft (DA).

Methods: Patients who underwent SCR using DA with a mean thickness of 3 mm for irreparable posterosuperior rotator cuff tears and underwent surgery at least 2 years earlier were included. Outcomes were assessed prospectively by the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores; patient satisfaction; and visual analog scale for pain.

A Shift in Hip Arthroscopy Use by Patient Age and Surgeon Volume: A New York State-Based Population Analysis 2004 to 2016.

Purpose: To perform a population-level analysis of the shifts in use of hip arthroscopy by different age groups and to describe the proportion of hip arthroscopy procedures performed by high-volume surgeons.

Methods: The Statewide Planning and Research Cooperative System database was combined with New York State census data to calculate changes in annual hip arthroscopy incidence by age and gender (2004-16). Annual (January to January) surgeon volumes were calculated and stratified into 4 thresholds that have been associated with significant differences in revision hip surgery rates to calculate changes in hip arthroscopy rates by surgeon volume over time.

In Patients with Early-Onset Scoliosis, Can Growing Rods Be Removed Without Further Instrumentation? An Evidenced-Based Review.

Early-onset scoliosis (EOS) is defined by the presence of spinal deformity in children 10 years of age or younger. Left untreated, patients with EOS are at high risk for thoracic insufficiency and early demise. This article provides a critical review of a recent prospective cohort study of children with EOS: "Graduation Protocol After Growing-Rod Treatment: Removal of Implants without New Instrumentation Is Not a Realistic Approach," by Kocyigit and colleagues ( 2017;99(18):1554-1564).

Incidence and safety profile of outpatient unicompartmental knee arthroplasty.

Background: Outpatient surgery is an increasingly attractive option for patients undergoing procedures with established, acceptable risk profiles. Benefits of outpatient surgery include cost savings, enhanced patient experience and improved resource allocation at busy hospitals. The purpose of this study was to compare 90-day complication and readmission rates for patients undergoing unicompartmental knee arthroplasty (UKA) in the outpatient as opposed to the inpatient setting.

Comparison of pharmacologic prophylaxis in prevention of venous thromboembolism following total knee arthroplasty.

Background: Anticoagulants are used following total knee arthroplasty (TKA) to prevent venous thromboembolism (VTE). These drugs reduce VTE risk but may lead to bleeding-related complications. Recently, surgeons have advocated using antiplatelet agents including aspirin (ASA).

Comparison of Infection Risk with Corticosteroid or Hyaluronic Acid Injection Prior to Total Knee Arthroplasty.

Background: Recent studies have shown that intra-articular injections ≤3 months before total knee arthroplasty increase the risk of periprosthetic joint infection. We are aware of no previous study that has differentiated the risk of periprosthetic joint infection on the basis of the type of medication injected. In addition, we are aware of no prior study that has evaluated whether hyaluronic acid injections increase the risk of infection after total knee arthroplasty.

Cost Comparison of Femoral Distraction Osteogenesis With External Lengthening Over a Nail Versus Internal Magnetic Lengthening Nail.

Introduction: Femoral lengthening is performed by distraction osteogenesis via lengthening over a nail (LON) or by using a magnetic lengthening nail (MLN). MLN avoids the complications of external fixation while providing accurate and easily controlled lengthening. However, the increased cost of implants has led many to question whether MLN is cost-effective compared with LON.

The national burden of periprosthetic hip fractures in the US: costs and risk factors for hospital readmission.

Introduction: Periprosthetic hip fractures (PPFX) are serious complications that result in increased morbidity, mortality and healthcare costs. Decreasing hospital readmissions has been a recent healthcare focus, but little is known about the overall costs associated with PPFX or the risk factors associated with readmissions. We investigated patient demographics, treatment types, 30- and 90-day readmission rates, direct costs, and patient risk factors associated with PPFX readmission.

The Quality of Online Resources Available to Patients Interested in Knee Biologic Therapies Is Poor.

Background: As the use of biologic therapies for the management of knee pathology continues to expand, it is more likely that patients will turn to the Internet to gather information on this topic. Given the lack of scientific consensus on the use of biologics, care providers must understand what information is available online.

Questions/purposes: The purpose of this study was to evaluate the quality of websites that patients may use to educate themselves on knee biologics.

Race and Insurance Status Are Associated With Surgical Management of Isolated Meniscus Tears.

Purpose: The purpose of this study was to perform a population-level analysis to evaluate the effect of socioeconomic markers on the use of meniscus surgery in patients with meniscus tears.

Methods: We queried all hospital-based clinic visits from 2011 to 2014 in the Statewide Planning and Research Cooperative System database, which also contains all New York inpatient/outpatient visits. Patients with known prior knee surgery, meniscus tear before 2011, or other ligament injuries were excluded.

Type of Anticoagulant Used After Total Knee Arthroplasty Affects the Rate of Knee Manipulation for Postoperative Stiffness.

Background: The aim of this study was to perform a population-level analysis on the effect of different types of anticoagulation on postoperative stiffness after total knee replacement, requiring manipulation under anesthesia. We hypothesized that patients receiving warfarin would have a higher rate of manipulation under anesthesia compared with patients receiving low-molecular-weight heparin. We also hypothesized that aspirin, direct factor Xa inhibitors, and fondaparinux would have no effect on the rate of manipulation under anesthesia.

Time Required to Achieve Minimal Clinically Important Difference and Substantial Clinical Benefit After Arthroscopic Treatment of Femoroacetabular Impingement.

Background: Minimal clinically important difference (MCID) defines the minimum degree of quantifiable outcome improvement that a patient perceives as the result of an intervention or in the process of healing. Substantial clinical benefit (SCB) defines the amount of quantifiable outcome improvement that is needed for a patient to feel substantially better. Little is known about when clinically significant outcome improvement is achieved.

Discharge to inpatient facilities after lumbar fusion surgery is associated with increased postoperative venous thromboembolism and readmissions.

Background Context: Postdischarge care is a significant source of cost variability after posterior lumbar fusion surgery. However, there remains limited evidence associating postdischarge inpatient services and improved postoperative outcomes, despite the high cost of these services.

Purpose: To determine the association between posthospital discharge to inpatient care facilities and postoperative complications.

Revision Total Shoulder Arthroplasty is Associated with Increased Thirty-Day Postoperative Complications and Wound Infections Relative to Primary Total Shoulder Arthroplasty.

Background: With an increasing volume of primary total shoulder arthroplasties (TSA), the number of revision TSA cases is expected to increase as well. However, the postoperative medical morbidity of revision TSA has not been clearly described.

Questions/purposes: The purpose of this study was to determine the rate of postoperative complications following revision TSA, relative to primary TSA.

Ankle Arthroscopy for Diagnosis of Full-thickness Talar Cartilage Lesions in the Setting of Acute Ankle Fractures.

Purpose: To delineate the prevalence of chondral lesions, in particular full-thickness talar dome lesions, with concurrent arthroscopy in acute ankle fracture open reduction-internal fixation (ORIF) and evaluate the impact on clinical outcomes.

Methods: We conducted a retrospective chart review of prospectively collected registry data at our institution from 2012 to 2016. Consecutive patients who underwent acute ankle fracture ORIF with concurrent arthroscopy were identified.