Outcomes after Surgical Repair of Medial Meniscal Root Tears: A Review.

At the present time, there is a paucity of literature regarding medial meniscal posterior root repair and outcomes. This review seeks to examine the currently available data to further elucidate the clinical risks and benefits and any associated risks of medial meniscal posterior root repair. A systematic literature search was performed up to July 2018 in the databases of Medline via PubMed, EBSCOhost, and EMBASE. The results were reviewed independently by two authors and appropriate articles were reviewed and eligibility determined based on established criteria. The best-evidence synthesis was subsequently used. Thirteen studies (324 patients) were included in this review with a mean patient age of 54 years. There were no control studies with nonoperative treatment of medial meniscal posterior root tears. All studies included a minimum of 10 patients in a case series or case-control manner. Of patients treated with medial meniscal posterior root repair, 62.43% demonstrated complete healing on follow-up magnetic resonance imaging (MRI) or second-look arthroscopy. Among them, 32.60% demonstrated incomplete healing, loosening of the construct, or excessive scar tissues formation. Also, 4.97% demonstrated complete failure or retearing of the construction. At a mean follow-up period of 33 months, patients demonstrated a mean improvement in Lysholm's score of 30.5 (p < 0.00001), International Knee Documentation Committee (IKDC) score of 31.9 (p < 0.00001), and HSS Knee Score of 38.3 (p < .00001). Surgical repair of medial meniscus posterior root tears appears to result in highly satisfying subjective outcomes. Patients included in this review meet criteria for both statistically and clinically significant improvement, based on published guidelines for minimal clinically important difference. Despite this, however, postoperative MRI and second-look arthroscopy demonstrate a relatively high rate of incomplete healing (32.60%) or retearing and failure of the construct (4.97%). More highly powered studies are required to confirm these findings.

Innate Arthroscopic & Laparoscopic Surgical Skills: A Systematic Review of Predictive Performance Indicators Within Novice Surgical Trainees.

OBJECTIVE: To query the literature for predictive factors for performance on arthroscopic and laparoscopic surgical simulators in novice surgical trainees. These predictive factors may prove a valuable tool in identifying certain innate potential to becoming a future skilled surgeon that could benefit both surgical residency candidates and program directors alike, while also improving patient care. DESIGN: Systematic Review. RESULTS: The initial searches yielded 249 articles. After screening titles/abstracts and implementing inclusion and exclusion criteria, 36 studies were included in the final systematic review. CONCLUSIONS: Current literature suggests that video game experience/frequency, psychomotor and visuospatial aptitude, and perceptual ability are among the most promising predictive indicators of baseline simulator performance. Study limitations include utilization of different standards for characterizing predictive factors. Future studies should aim to utilize standard guidelines for accurate quantification of innate predictive factors. Future research should also focus on utilizing standardized simulator platforms and aptitude tests to allow for more accurate cross-study comparisons and meta-analyses with larger sample sizes.

Predictors of Performance on the Arthrobox Arthroscopy Simulator for Medical Students.

PURPOSE: The purpose of this study was to analyze the effects of past participation in athletics, the playing of musical instruments and video games and other variables on medical students' performance on an arthroscopic simulator task as well as other assessments of visuospatial ability. METHODS: We assessed 50 medical students by using previously validated tests of manual dexterity and spatial reasoning as well as performance on an arthroscopic surgical simulator. Inclusion criteria were to be 18 years of age or older and to be a student studying in the M.D. program at a single public state university. Exclusion criteria were previous use of an arthroscopic surgery training device or active participation in an actual arthroscopic surgery, defined as participating as a surgeon, resident trainee, physician's assistant, or other similarly credentialed professional. Students were also assessed by the use of a high-fidelity ultrasound simulator as a marker of visuospatial capacity. Students were then surveyed about lifestyle characteristics and personal attributes hypothesized to predict surgical skill, such as playing sports, instruments or video games. RESULTS: A total of 49 participants were included in this study. High levels of athletic experience were significantly associated with improved performance on the arthroscopic surgical simulator (P = .008). Participants with higher levels of athletic experience were more likely to achieve competence on the arthroscopic surgical simulator (P = .006). Scores on the arthroscopic simulator task were significantly correlated with both ultrasound simulator shape-identification task scores and masked mirror-tracing task scores, as independent measures of visuospatial ability (P = .015 and P = .013, respectively). CONCLUSIONS: This study provides evidence of a statistically significant correlation between increased experience in athletics and single-use test performance on an arthroscopic surgical simulator. Subjects who reported higher levels of experience in athletics were significantly more likely to achieve competence in the arthroscopic surgical simulator task. Finally, statistically significant correlations were found between subjects' performance scores on tasks assessed by the surgical simulator, masked mirror-trace assessment and ultrasound simulator. CLINICAL RELEVANCE: Simulator-based training and education allow for the development of arthroscopic skills prior to operating on a live patient in a clinical situation. This is an area of great interest in orthopaedic education. Our study evaluates parameters in a trainee that may relate to a higher performance level in technical skills on an arthroscopic surgical simulator.

Regional Interdependence and the Role of the Lower Body in Elbow Injury in Baseball Players: A Systematic Review.

BACKGROUND: Elbow injuries are exceedingly common in baseball players. Previous studies have identified that upper extremity strength and range of motion deficits pose a risk for these injuries, but few studies have examined the effect of lower extremity deficits. Given the role of the lower extremity in the kinetic chain of the baseball throwing motion, lower body deficits may affect the kinematics of the upper extremity and play a role in the elbow injury of baseball players. PURPOSE: To systematically review the current literature investigating the association of trunk and lower extremity deficits with elbow pain or injury in baseball players. STUDY DESIGN: Systematic review. METHODS: A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines to identify and analyze all previous studies focused on the association of elbow pain and/or injury with functional deficits of the trunk and lower extremities. RESULTS: A total of 14 studies met inclusion criteria, examining a range of baseball players extending from youth to professional athletes. One of the 14 studies examined other types of overhead throwing athletes alongside baseball players. Lower extremity-related risk factors for elbow pain and injury in these athletes were found and stratified per level of play. Factors included specific hip range of motion, lower extremity injury or pain, balance, and foot arch posture. Associations were also found with lower extremity injury and noncompliance with primary prevention programs. CONCLUSION: Specific lower extremity deficits were found to be independent risk factors for elbow pain and injury in throwing athletes at certain levels of play. Additionally, prevention programs designed to correct deficits in identified risk factors were effective in reducing the incidence of elbow injury in youth athletes. These results highlight the potential of screening and subsequent intervention to reduce the incidence of elbow injury in certain subsets of baseball players.