Evaluation of Graft Tensioning Effects in Anterior Cruciate Ligament Reconstruction between Hamstring and Bone-Patellar Tendon Bone Autografts.

This article investigates the clinical, functional, and radiographic outcomes in anterior cruciate ligament (ACL) reconstruction patients over 7 years to determine the effects of initial graft tension on outcomes when using patellar tendon (bone-tendon-bone [BTB]) and hamstring tendon (HS) autografts. Ninety patients, reconstructed with BTB or HS, were randomized using two initial graft tension protocols: (1) normal anteroposterior (AP) laxity ("low-tension"; n = 46) and (2) AP laxity overconstrained by 2 mm ("high-tension"; n = 44). Seventy-two patients had data available at 7 years, with 9 excluded for graft failure. Outcomes included the Knee Injury and Osteoarthritis Outcome Score, Short-Form-36 (SF-36), and Tegner activity scale. Clinical outcomes included KT-1000S and International Knee Documentation Committee examination score; and functional outcomes included 1-leg hop distance and peak knee extensor torque. Imaging outcomes included medial joint space width, Osteoarthritis Research Society International radiographic score, and Whole-Organ Magnetic Resonance Score. There were significantly improved outcomes in the high-tension compared with the low-tension HS group for SF-36 subset scores for bodily pain (p = 0.012), social functioning (p = 0.004), and mental health (p = 0.014) 84 months postsurgery. No significant differences in any outcome were found within the BTB groups. Tegner activity scores were also significantly higher for the high-tension HS group compared with the low-tension (6.0 vs. 3.8, p = 0.016). Patients with HS autografts placed in high tension had better outcomes relative to low tension for Tegner activity score and SF-36 subset scores for bodily pain, social functioning, and mental health. For this reason, we recommend that graft fixation be performed with the knee at 30-degree flexion ("high-tension" condition) when reconstructing the ACL with HS autograft.

Diagnosis and Management of Hip Abductor Insufficiency.

Greater Trochanteric Pain Syndrome (GTPS) is a common cause of lateral hip pain, with an incidence of 1.8 per 1000 patients, most commonly occurring between the fourth and sixth decades of life. When GTPS fails to improve with conservative management, hip abductor insufficiency should be suspected. The diagnosis of hip abductor insufficiency is made by a combination of physical exam findings and imaging studies, with Magnetic Resonance Imaging (MRI) being the diagnostic study of choice. Initial conservative management consists of activity modification, physical therapy, non-steroidal anti-inflam- matories and corticosteroid injections. If conservative management fails, this may be suggestive of a hip abductor tear. Surgical intervention has been shown to provide excellent outcomes, and may be necessary if a tear is present. The purpose of this paper is to review and raise awareness of hip abductor insufficiency as an under- diagnosed and under-treated condition that can limit patient mobility and quality of life.

A Comparison of Three C-Arm Draping Techniques to Minimize Contamination of the Surgical Field.

The use of intraoperative fluoroscopy has become a routine and useful adjunct within orthopaedic surgery. However, the fluoroscopy machine may become an additional source of contamination in the operating room, particularly when maneuvering from the anterior-posterior position to the lateral position. Consequently, draping techniques were developed to maintain sterility of the operative field and surgeon. Despite a variety of methods, no studies exist to compare the sterility of these techniques specifically when the fluoroscopy machine is in the lateral imaging position. We evaluated the sterility of 3 c-arm draping techniques in a simulated operative environment. The 3 techniques consisted of a traditional 3-quarter sterile sheet attached to the side of the operative table, a modified clip-drape method, and a commercially available sterile pouch. Our study demonstrated that the traditional method poses a high risk for sterile field contamination, whereas the modified clip-drape method and commercially available sterile pouch kept floor contamination furthest from the surgical field. With the current data, we urge surgeons to use modified techniques rather than the traditional draping method.

Complications in pediatric deep neck space abscesses.

OBJECTIVES: To determine the incidence and demographic profile of children who develop complications from deep neck space abscess. STUDY DESIGN: Case series. SETTING: Tertiary children's hospital. SUBJECTS AND METHODS: One hundred thirty-eight patients admitted for deep neck space abscesses between 1998 and 2008. Inclusion criteria were age younger than 18 years and computed tomography scan demonstrating an abscess in the retropharyngeal, parapharyngeal, or peritonsillar spaces. Children were diagnosed with abscess if purulence was encountered on operative incision and drainage. RESULTS: In the first 5 years of the study, 45 children met the inclusion criteria, whereas in the latter 5 years, 93 children were treated for abscesses. There were no differences between these cohorts in terms of age (P = .70), gender (P = .08), abscess site (P = .23), or rate of surgical intervention (P = .83). The total major complication rate was 9.4% (n = 13) with mediastinitis being the most frequent (n = 9) complication. The number of complications between the first (n = 3) and second (n = 10) groups was not significantly different (P = .55). The factors that predisposed patients to develop complications were younger age at presentation and retropharyngeal abscess location. Children with complications were more likely to have Staphylococcus aureus identified as the causative organism (P = .007). Only 1 of 4 children with methicillin-resistant S aureus had a complicated clinical course. CONCLUSIONS: Deep neck space abscesses continue to cause significant morbidity in children. Factors that predict complications include young age, retropharyngeal location, and S aureus. Providers must maintain a high index of suspicion to promptly diagnose and treat these complications.

Screening, diagnosing and prevention of fetal alcohol syndrome: is this syndrome treatable?

Prenatal alcohol exposure can lead to a wide range of adverse effects on a developing fetus. As a whole, these teratogenic outcomes are generally known as fetal alcohol spectrum disorders, the most severe of which is fetal alcohol syndrome (FAS). Clinically, children diagnosed with FAS vary greatly in their presentation of symptoms, likely due to the amount of alcohol and timing of exposure, as well as maternal and genetic influences. All these factors play a role in determining the mechanisms through which alcohol damages a developing brain, the details of which are still largely unknown. However, continuing research and recent developments have provided promising results that may lead to screening mechanisms and treatment therapies for children with FAS. Here we review the teratogenic effects of alcohol, strategies for detecting maternal alcohol consumption, identification of fetal biological markers, and prevention methods for FAS.