Centering the female athlete voice in a sports science research agenda: a modified Delphi survey with Team USA athletes.

Objectives: To co-construct a sports medicine and exercise science research and translational agenda with Team USA elite female athletes serving as the experts on their health, performance and well-being.

Methods: 40 Team USA female athletes across sports disciplines participated in an online, anonymous, modified Delphi survey by ranking topics on a Likert scale (1='strongly disagree' and 5='strongly agree') and providing qualitative justification regarding whether they believed having more information and research on each topic would support their athletic performance, health and well-being. After each Delphi round, quantitative rankings of topics and qualitative justifications were analysed, informing revisions to the list of topics for review in the subsequent round.

High accuracy of intra-articular needle position during anterior landmark guided glenohumeral injections.

Objectives: Image-guided ultrasound or fluoroscopic glenohumeral injections have high accuracy rates but require training, equipment, cost, and radiation exposure (fluoroscopy). In contrast, landmark-guided glenohumeral injections do not require additional subspecialist referrals or equipment. An optimal technique would be safe and accurate and have few barriers to implementation.

Does Operative Time Modify Obesity-related Outcomes in THA?

Background: Most orthopaedic surgeons refuse to perform arthroplasty on patients with morbid obesity, citing the higher rate of postoperative complications. However, that recommendation does not account for the relationship of operative time (which is often longer in patients with obesity) to obesity-related arthroplasty outcomes, such as readmission, reoperation, and postoperative complications. If operative time is associated with these obesity-related outcomes, it should be accounted for and addressed to properly assess the risk of patients with obesity undergoing THA.

A Staged Protocol for Treatment of High-Energy Tongue-Type Calcaneus Fractures: Surgical Technique and Case Series.

Displaced tongue-type calcaneus fractures are frequently associated with severe soft tissue injuries, and urgent relief of the displaced tongue fragment on the posterior soft tissues is essential to preventing soft tissue complications. If there is a complex articular injury, the soft tissue envelope often needs time for swelling to resolve to allow for a safe open anatomic reduction because premature open reduction internal fixation is often associated with increased complications. We have found that in high-energy tongue-type calcaneus fractures with complex articular injuries, a staged protocol consisting of initial percutaneous reduction and fixation with later definitive reconstruction is soft tissue friendly, allows early restoration of calcaneal morphology, and affords extensile approaches for eventual reconstruction.

Impact of Certificate of Need on Lumbar Discectomy Reimbursement and Utilization.

The Certificate of Need (CON) program was established to respond to increasing healthcare costs; however, its impact on spine surgery trends is not well understood. The purpose of this study was to evaluate the impact of CON status on utilization of single-level lumbar discectomy. A combined Medicare and private payer database was used to identify single level lumbar discectomies performed from 2007 to 2015.

Identifying Risk Factors for Complication and Readmission with Same-Day Discharge Arthroplasty.

Background: The COVID-19 pandemic caused a surge of same-day discharge (SDD) for total joint arthroplasty. However, SDD may not be beneficial for all patients. Therefore, continued investigation into the safety of SDD is necessary as well as risk stratification for improved patient outcomes.

Rehabilitation and Return to Sport Following Elbow Injuries.

Elbow injuries are frequently seen in throwing and overhead athletes. This review provides a framework for diagnosis, treatment, and particularly rehabilitation of common elbow pathologies, including ulnar collateral ligament injury, valgus extension overload, and medial and lateral epicondylitis. Advanced rehabilitation facilitates complete return to functional sport-specific activity and is based on objective criteria.

Biomechanical properties of common graft choices for anterior cruciate ligament reconstruction: A systematic review.

Background: This systematic review explores the differences in the intrinsic biomechanical properties of different graft sources used in anterior cruciate ligament (ACL) reconstruction as tested in a laboratory setting.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, two authors conducted a systematic review exploring the biomechanical properties of ACL graft sources (querying PubMed, Cochrane, and Embase databases). Using the keywords "anterior cruciate ligament graft," "biomechanics," and "biomechanical testing," relevant articles of any level of evidence were identified as eligible and included if they reported on the biomechanical properties of skeletally immature or mature ACL grafts solely and if the grafts were studied in vitro, in isolation, and under similar testing conditions.

A Single Injection of Amniotic Suspension Allograft Is Safe and Effective for Treatment of Mild to Moderate Hip Osteoarthritis: A Prospective Study.

Purpose: The purpose of our study was to examine the effects of a commercially available amniotic suspension allograft (ASA) (ReNu, Organogenesis, Canton, MA) in a patient population with moderate osteoarthritis of the hip.

Methods: Ten patients with symptomatic hip osteoarthritis, defined as Tonnis grade 1 or 2 on radiographic examination, were prospectively enrolled. Each patient received a single image-guided injection of ASA into the hip joint.

Medial Column Support in Pilon Fractures Using Percutaneous Intramedullary Large Fragment Fixation.

Pilon fractures are complex injuries to the tibial plafond requiring stable fixation in the setting of effective soft tissue management, particularly in high-energy injuries, open fractures, or in geriatric individuals. Medial column support of the distal tibial metaphysis is often an essential component when applying balanced fixation. However, the biologic implications of multiple surgical approaches in the setting of damaged tissue, devitalized bone, or significant bone loss may contribute to increased complications.

Metaphyseal callus formation in pilon fractures is associated with loss of alignment: Is stiffer better?

Objective: To assess the relationship between metaphyseal callus formation and preservation of distal tibial alignment in pilon fractures treated with internal plate fixation.

Design: Retrospective Review SETTING: Academic Level I Trauma Center PATIENTS: Forty-two patients with AO/OTA type C2 or C3 pilon fractures treated with plate fixation.

Intervention: Internal fixation with anterolateral plating, medial plating, or both.

White-Light Body Scanning Captures Three-Dimensional Shoulder Deformity After Displaced Diaphyseal Clavicle Fracture.

Objective: We sought to determine if white-light three-dimensional (3D) body scanning can identify clinically relevant shoulder girdle deformity after displaced diaphyseal clavicle fracture (DCF).

Methods: Adult patients with DCF (OTA/AO 15A) were prospectively enrolled. Four subcutaneous osseous landmarks were used to measure shoulder girdle morphology of the injured and uninjured shoulder.

Patient Willingness to Pay for Faster Return to Work or Smaller Incisions.

Value-based health care models such as bundled payments and accountable care organizations can penalize health systems and physicians for excess costs leading to low-value care. Health systems can minimize these extra costs by constraining diagnostic (eg, magnetic resonance imaging utilization) or treatment options with debatable necessity in the setting of clinical equipoise. Instead of restricting more expensive treatments, it is plausible that health systems could instead recoup the extra costs of these treatments by charging patients supplementary out-of-pocket charges (cost sharing).

Tensile and Torsional Structural Properties of the Native Scapholunate Ligament.

Purpose: The ideal material for reconstruction of the scapholunate interosseous ligament (SLIL) should replicate the mechanical properties of the native SLIL to recreate normal kinematics and prevent posttraumatic arthritis. The purpose of our study was to evaluate the cyclic torsional and tensile properties of the native SLIL and load to failure tensile properties of the dorsal SLIL.

Methods: The SLIL bone complex was resected from 10 fresh-frozen cadavers.

Comprehensive Operative Note Templates for Primary and Revision Total Hip and Knee Arthroplasty.

Background: Adequate preoperative planning is the first and most crucial step in the successful completion of a revision total joint arthroplasty. The purpose of this study was to evaluate the availability, adequacy and accuracy of operative notes of primary surgeries in patients requiring subsequent revision and to construct comprehensive templates of minimum necessary information required in the operative notes to further simplify re-operations, if they should become necessary.

Methods: The operative notes of 144 patients (80 revision THA's and 64 revision TKA's) who underwent revision total joint arthroplasty at Stanford Hospital and Clinics in the year 2013 were reviewed.

What is the level of evidence substantiating the Medicare local coverage determinations?

Total joint arthroplasty (TJA) accounts for large expenditures of Medicare resources. Recovery audit contractors (RACs) utilize Local Coverage Determinations (LCDs) documents to retrospectively assess the medical necessity of performed procedures. The Florida LCD requires 3 months of documented unsuccessful nonoperative care prior to TJA.

Neurosarcoidosis presenting as mononeuritis multiplex.

Sarcoidosis is a multisystem granulomatous disease of unknown etiology, with prevalence ranging from 1 to 50 per 100,000. Neurologic involvement occurs in up to 5% of patients but can be the initial presentation of sarcoidosis in 50% of those affected by neurosarcoidosis. The authors report a case of mononeuritis multiplex of the ulnar and then the radial nerve that subsequently led to a diagnosis of sarcoidosis in a patient 8 mos after initial presentation.

Restoration of knee volume using selected arthroscopic releases.

Background: Inflammation and subsequent fibrosis, adhesions, or plicae may limit normal capsular compliance and decrease volume capacity of the knee.

Hypothesis: Patients with fibrosis, anterior interval scarring, adhesions, or palpable painful plicae will have decreased knee volumes when compared to controls, and selective arthroscopic releases will restore volume to normal levels.

Study Design: Descriptive laboratory study and cohort study; Level of evidence, 2.

Lumbar tumor resections and management.

More than one-third of patients with cancer have vertebral metastases found at autopsy. Primary and metastatic tumors to the spinal column can lead to pain, instability, and neurologic deficit. Symptomatic lesions are most prevalent in the thoracic spine (70%), followed by the lumbar spine (20%) and cervical spine (10%).

Disorders of the suprapatellar pouch of the knee.

Proper recognition and treatment of pathological conditions of the suprapatellar pouch of the knee is dependent on the knowledge of normal pouch anatomy and of the various conditions which affect this area of the knee and contribute to knee pain. This article includes a comprehensive review of the surgical anatomy of the pouch, current surgical techniques and review of the common conditions that have a predilection for this often overlooked area of the knee.