Outcomes Following the Use of Extracellular Matrix Cartilage Allograft for the Management of Osteochondral Lesions of the Talus: A Systematic Review.

Extracellular matrix cartilage allograft (EMCA) is a novel biological strategy utilized to augment the repair of osteochondral lesions of the talus (OLTs). However, there is no consensus on the precise role and outcomes following its use in the treatment of OLTs. The purpose of this systematic review was to evaluate the clinical and radiological outcomes following the use of EMCA for the treatment of OLT. During July 2023, the PubMed, Embase, and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following EMCA for the management of OLTs. In total, 162 patients (162 ankles) across five studies received EMCA as part of their surgical procedure at a weighted mean follow-up time of 23.8±4.2 months. Across all five studies, there were improvements in subjective clinical outcomes following the use of EMCA, regardless of the clinical scoring tool utilized. Two studies demonstrated superior postoperative magnetic resonance observation of cartilage repair tissue (MOCART) scores in the EMCA cohort compared to the bone marrow stimulation (BMS) cohort alone. In the EMCA-BMS cohort, there were seven complications (9%) and three failures (4.1%). In the autologous osteochondral transplantation (AOT) cohort, there were 10 complications (38.5%), zero failures, and six secondary surgical procedures (23.1%). In the EMCA alone cohort, there were zero complications and three failures (4.3%), all of which underwent an unspecified revision procedure. This current systematic review demonstrated improvements in both clinical and radiological outcomes following the use of EMCA for the treatment of OLTs. Further prospective comparative studies with longer follow-up times are warranted to determine the precise role of EMCA in the management of OLT.

Closure of the Quadriceps Tendon Autograft Harvest Site for Anterior Cruciate Ligament Reconstruction: A Systematic Review.

BACKGROUND: The quadriceps tendon (QT) autograft is a commonly used and effective graft option for anterior cruciate ligament reconstruction (ACLR). Surgical techniques vary, and there is no current standard of care for management of the QT autograft harvest site. PURPOSE: To examine the literature on patient-reported outcomes and complications after ACLR with a QT autograft and to further clarify the frequency with which the harvest site is closed and potential biomechanical implications. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed using multiple medical databases. Level 1 to 4 studies on patients undergoing ACLR with a QT autograft were included. There were 2 independent reviewers who analyzed all studies. Study quality was analyzed using the methodological index for non-randomized studies checklist. RESULTS: Overall, 13 studies with a total of 650 patients were included. The mean patient age for all studies was 31 years (range, 14-59 years) with a mean follow-up of 21.2 months (range, 6-84 months). Of the 13 studies, 12 studies (92%) documented patient sex, comprising 331 female patients (55%) and 274 male patients (45%). There were 8 studies (62%) that reported the use of a bony QT autograft in 273 patients, and 5 studies (38%) reported the use of a soft tissue QT autograft in 377 patients. The graft length harvested was most commonly 7 to 8 cm, while the tendon width harvested was 10 mm. Moreover, 5 studies (38%) did not discuss closure of the harvest site, while 2 studies (15%) only closed the harvest site if a capsular rent was present. The surgical technique for harvest-site closure varied when reported in 7 studies (54%). Good to excellent clinical outcomes were reported in 80% of patients when the harvest site was closed. CONCLUSION: Based on the results of this study, there is no consensus on whether the QT defect should be closed after harvesting the graft for ACLR. It has been reported that closure of the harvest site is performed if there is a capsular rent present. Several techniques are utilized to close the QT autograft harvest site; however, it is unclear if there is a difference in outcomes based on the technique used. Future studies should further clarify whether there are any biomechanical and clinical advantages to closing the QT autograft harvest site.

Is Prior Hip Arthroscopy Associated With Higher Complication Rates or Prolonged Opioid Claims After Total Hip Arthroplasty? A Matched Cohort Study.

Background: Hip arthroscopy (HA) procedures have increased exponentially in recent years. Their effect on outcomes after subsequent total hip arthroplasty (THA) remains unclear. Purpose: To compare rates of complications and opioid claims after elective THA among patients with prior HA versus controls. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent THA were identified in the PearlDiver database. Arthroplasty performed for hip fractures and hip avascular necrosis were excluded. Within this population, patients with HA before arthroplasty (n = 3156) were propensity score matched 1:1 with controls on age, sex, US region, and several comorbidities. Rates of medical complications within 90 days and prosthesis-related complications within 2 years were queried. The number of patients with an opioid claim within 0 to 30 days and subsequent opioid claim(s) during the 90-day global period were obtained to assess rates of prolonged opioid use after arthroplasty. Rates of postoperative complications and opioid claims were compared using logistic regression. Results: Patients with prior HA exhibited significantly lower rates of readmission (5.6% vs 7.3%; odds ratio [OR], 0.72), pulmonary embolism (0.2% vs 0.6%; OR, 0.45), urinary tract infection (3.1% vs 4.0%; OR, 0.75), and blood transfusion (3.6% vs 6.1%; OR, 0.55). The prior HA cohort also exhibited a significantly lower rate of prosthetic joint infection at 1 year postoperatively (0.6% vs 1.3%; OR, 0.50). Rates of dislocation, periprosthetic fracture, mechanical complications, and aseptic revision arthroplasty were statistically comparable between the cohorts within 2 years. The prior HA cohort was significantly less likely to file persistent opioid claims after 30 days postoperatively, including between 31 and 60 days (27.2% vs 33.1%; OR, 0.74) and 61 to 90 days (16.2% vs 20.9%; OR, 0.71). Conclusion: After elective THA, patients with prior HA exhibited significantly lower rates of medical complications and prolonged opioid claims within 90 days and prosthetic joint infection at 1 year. Rates of all other prosthesis-related complications within 2 years were statistically comparable.

The Top 50 Articles on Knee Posterolateral Corner Injuries.

Purpose: To identify and characterize the most cited publications in orthopaedic research related to posterolateral corner (PLC) injuries of the knee. Methods: The Science Citation Index Expanded was queried for PLC injury articles. The 50 most-cited studies from 1976 to 2021 were selected. Article characteristics, including number of citations, citation density, year of publication, source journal, country of origin, article type, article subtype, and level of evidence, were analyzed. Results: The number of citations for individual articles ranged from 47 to 205. The 50 most cited articles were published in 16 journals. Eleven of the 50 articles (22%) were published in Arthroscopy-The Journal of Arthroscopic and Related Surgery. The largest proportion of the articles (n = 22, 44%) were classified as clinical, with the rest classified as reviews (n = 15, 30%), and basic science research (n = 13, 26%). The most common level of evidence for clinical articles was IV (14/22, 63.6%). Nine countries contributed to the top 50 articles, with the majority published in the United States (n = 35, 70%). Conclusions: In the last 20 years, papers published on the diagnosis and surgical management of PLC injuries have a high citation frequency. Future high-quality research is needed to establish best-practice guidelines for the management of PLC injuries due to the low overall level of evidence of existing clinical studies. Clinical Relevance: This research provides a comprehensive list for practitioners and may help educators identify articles to include in the curriculum for residents and fellows.

Patients Report A Positive Experience on Social Media After Bankart Repair.

Purpose: The purpose of this cross-sectional study was to analyze publicly available posts on Instagram and Twitter to gain an understanding of patients' perspectives regarding Bankart injuries and repair. Methods: Public posts on Instagram and Twitter were queried from June 1, 2019, to June 1, 2020, with the following hashtags: #Bankart #Bankartrepair #Bankartlesion #labrumrepair #labralrepair #shoulderdislocation. Posts that did not contain those hashtags were excluded. In addition, posts that included that hashtag but displayed content unrelated to Bankart repair were excluded. A binary categorical system was used for media format (picture or video), perspective (patient, family or friend, physician, hospital or physical therapy group, professional organization, news media, or industry), timing (preoperative, postoperative, nonoperative), tone (positive, negative, or neutral), content (surgical site, hospital or surgeon, imaging, rehabilitation, activities of daily living [ADLs], return to work, surgical instruments, or education), post popularity (number of likes), and geographic location. Results: 1,154 Instagram posts were identified. 722/1,154 posts (62.6%) were made by patients. 600 (52.0%) of the post tones were positive, 407 (35.3%) were neutral, and 667 (57.8%) were postoperative. The most common content included in Instagram posts were ADLs (577; 50.0%), education (233; 20.2%), and rehabilitation (226; 19.6%). Overall, posts had an average of 117 likes and had geotags from 49 different countries. 155 tweets were identified, 92 of which (59.4%) were made by physicians, 113 (72.9%) were neutral, 127 (81.9%) were nonoperative, and the most common type of content posted was education (130; 83.9%). Overall, posts on Twitter had an average of 3.2 likes and had geotags from 4 different countries. Conclusions: Instagram posts were made mostly by patients postoperatively and focused on ADLs. The tone of the Instagram posts indicates that a majority of patients have a positive experience with Bankart repair. The majority of tweets were made by physicians and provided educational information with a neutral tone. Clinical Relevance: Exploring patient's experiences with Bankart repair on social media provides insight into their overall experience with the surgery. The majority of patients reported a positive experience.

Preoperative Optimization and Tips to Avoiding Surgical Complications Before the Incision.

In preparation for surgery, it is important for surgeons to have a detailed discussion with patients about the risks, benefits, and alternatives to surgery. Patient optimization, ensuring the patient is in the best medical condition before surgery, is also an important aspect of patient care that the surgeon must consider. Although complications cannot be eliminated, there are often opportunities to optimize patients, so these risks can be minimized based on current evidence-based medicine. To minimize the risk of complications, the surgeon should take an active role in each step of the patient's care beginning with the history and physical examination, obtaining the correct preoperative labs, and continuing through positioning, draping, and prepping before making an incision.

Social Media and Its Use in Orthopaedic Surgery Resident Education and Training.

¼: The use of social media by health-care professionals and medical educators has been increasing over the past decade. ¼: Online social networks, professional networks, blogs, microblogs, forums, podcasts, and video-sharing platforms can be used effectively to communicate and engage with, as well as learn from, other residents and attending physicians worldwide. ¼: Social media platforms and other web-based applications can serve as powerful educational tools to enhance orthopaedic resident learning, collaboration, teaching, and case discussion.

Pectoralis Major Injuries: Presentation, Diagnosis, and Management.

¼: In the past 20 years, there has been a substantial increase in the prevalence of pectoralis major injuries, largely related to the rising popularity of weight-lifting and participation in contact sports. ¼: Treatment options are influenced by the severity of the injury, patient age, and the amount and type of physical activity. ¼: Although there is no consensus as to which treatment method is most effective, previous studies have demonstrated increased satisfaction among patients who undergo operative treatment. ¼: The average length of time from surgery to return to activity ranges from 6 to 24 months.

Epidemiology, Diagnosis, and Management of Tibial Tubercle Avulsion Fractures in Adolescents.

Although rare, tibial tubercle avulsion fracture must be considered in the differential diagnosis for the pediatric patient presenting with acute knee pain. In the adolescent population, tibial tubercle avulsion fracture is a rare injury that is typically seen in boys who engage in sporting activities that involve jumping or sprinting. The proximal tibial physis closes distally in the posteromedial to anterolateral direction, creating an environment that predisposes the tubercle to a potential avulsion injury. Historically, the Ogden classification has guided nonoperative and operative management of this condition. Multiple fracture fixation methods have been described with the overall goal of restoring the extensor mechanism and the joint surface.