Return to Activity After Arthroscopically Assisted Triangular Fibrocartilage Complex Repair: A Systematic Review.

OBJECTIVE: To evaluate patients' ability to return to preinjury activity level after arthroscopically assisted triangular fibrocartilage complex (TFCC) repair. DATA SOURCES: The PubMed electronic library was systematically searched from inception to August 2021 for any eligible articles using a combination of the phrases "TFCC," "return to sport," "return to work," and "athlete." RESULTS: Studies that evaluated patients who had undergone arthroscopic repair of isolated TFCC injury and reported objective or patient-reported outcome measures were included. Fifteen studies representing 478 patients fulfilled the inclusion criteria. An average of 84% of patients were able to fully return to their previous work or sport activities. Most studies reported that range of motion (ROM) and grip strength (GS) both returned to >90% of the contralateral side, and every study that evaluated pain levels found a significant reduction in pain postoperatively. Mayo Modified Wrist Score was reported as excellent or good in 83% of patients, and the average Disabilities of the Arm, Shoulder, and Hand score was 13.8 postoperatively. CONCLUSION: Patients were able to return to their previous work or sport activities at a high rate after TFCC repair, even those participating in more strenuous activities. Measurable functional outcomes of ROM and GS were also reliably restored to near preinjury levels. Patient-reported outcomes of pain and disability were similarly improved after TFCC repair. Current literature has established the long-term success of TFCC repair but is lacking in evaluation of the time points at which patients can expect functional status to be restored.

YouTube as a Source of Patient Information for Cubital Tunnel Syndrome: An Analysis of Video Reliability, Quality, and Content.

BACKGROUND: This study seeks to examine the reliability, quality, and content of YouTube videos on cubital tunnel syndrome, on which there is presently a paucity of information. METHODS: The top 50 unique YouTube videos by relevance resulting from the Boolean search term "cubital tunnel + cubital tunnel syndrome" were identified, with video properties for analysis including source, upload date, duration, views, and comments. Content was assessed using the Journal of American Medical Association (JAMA) criteria, the Global Quality Score (GQS), and a "Cubital Tunnel-Specific Score" (CTSS). RESULTS: The average video saw 72 108 ± 199 362 views, with videos produced by allied (nonphysician) health professionals demonstrating the highest mean views (111 789 ± 294 471 views). Videos demonstrated low mean JAMA scores (2.4/4 ± 0.7), GQS (2.8/5 ± 1.3), and CTSS (7.5/21 ± 4.3), with academic and nonacademic physician videos demonstrating significantly greater mean GQS and CTSS scores when compared with videos by allied health professionals. Positive independent predictors for GQS included academic sources (ß = 1.871), nonacademic physician sources (ß = 1.651), and video duration (ß = 0.102), which were likewise positive predictors for CTSS (ß = 4.553, 4.639, 0.374). Content relating to surgical techniques or approaches for cubital tunnel decompression had the greatest CTSS scores (11.2 [4.2]). CONCLUSIONS: YouTube is a source of highly accessible information on cubital tunnel syndrome, although the average video presents generally poor and inadequate information. Directing patients toward higher quality video resources can be a meaningful component of patient education.

Trends in the surgical treatment of meniscal tears in patients with and without concurrent anterior cruciate ligament tears.

Objectives: Meniscal and anterior cruciate ligament (ACL) tears are common injuries. The purpose of this study was to determine trends in meniscal repair and meniscectomy both in the presence and absence of ACL reconstruction (ACLR).Methods: The PearlDiver database (www.pearldiverinc.com, Fort Wayne, IN) was queried for surgical management of patients who underwent arthroscopic meniscectomy (Current Procedural Terminology [CPT] codes 29880, 29881), meniscus repair (29882, 29883), and ACLR (29888) from 2010 to 2015. Patient groups included meniscectomy alone, meniscus repair alone, meniscus repair followed by meniscectomy, ACLR with meniscus repair, and ACLR with meniscus repair followed by meniscectomy. Linear regression was performed to determine the significance of yearly trend across each procedure. Statistical analysis was performed with RStudio, Version 1.1.442 (RStudio Inc. Boston, MA) for α value of .05.Results: The incidence of isolated meniscectomies decreased from 32.5/10,000 to 28.3/10,000 across the study period (p = 0.0230), whereas the incidence of isolated meniscus repairs and all meniscus repairs remained unchanged (p = 0.3000, p = 0.1260). For patients undergoing concomitant meniscal repair and ACLR, the highest proportion of patients was in the age range 15-24 years old with 45.7% of patients being 15-19. Of the ACLR, 18.6% involved a concomitant meniscus repair, and 54.0% involved a concomitant meniscectomy. The risk of subsequent meniscectomy was less in patients undergoing meniscal repair with ACLR than in patients undergoing isolated meniscal repair (10.8% versus 12.4%; aOR = 0.71, 95% CI 0.53-0.95, p = 0.0226).Conclusions: The highest rates of concurrent meniscal repair with ACLR are in the 15-24-year-old population. From 2010 to 2015, the rate of meniscectomy declined while that of isolated meniscal repairs, as well as meniscal repair with ACLR, remained stable. Patients undergoing meniscal repair with ACLR had lower rates of subsequent meniscectomy compared to patients undergoing isolated meniscal repair in the absence of ACL tear.Level of evidence: Level III.

Acute occlusion of an abdominal aortic aneurysm complicated by bilateral lower extremity venous thrombosis: A case report.

Acute occlusion of an abdominal aortic aneurysm is a rare phenomenon. Its possible complications include distal spasm followed by arterial thrombosis, ischemia of the distal limbs, distal embolization, acidosis, hyperkalemia, and the development of venous thrombosis of the lower limbs. Surgical correction is often complicated by cardiac decompensation, renal failure, fatal pulmonary embolism, and metabolic derangements related to toxins released from the revascularized limb. Unless contraindicated, immediate systemic heparinization must be undertaken when the diagnosis is first suspected. We present a case of sudden occlusion of an abdominal aortic aneurysm complicated by venous thrombosis involving both lower extremities. After undergoing surgical revascularization, the patient sustained massive fatal pulmonary emboli. Prophylactic interruption of the inferior vena cava may be indicated in patients who present with this complication of abdominal aortic aneurysm.