Stiffness and Instability After MPFL Reconstruction Using a Fluoroscopic Versus Open Technique to Localize the Femoral Attachment Site: A Systematic Review and Meta-analysis.

Background: Open and fluoroscopic techniques have been described for localization of the femoral attachment site in medial patellofemoral ligament (MPFL) reconstruction. No study to date has evaluated if one technique is superior to another in terms of complications. Purpose: To review the literature comparing clinical outcomes of MPFL reconstruction using the fluoroscopic versus open technique to localize the site of femoral graft placement. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic literature review was performed via PubMed, Embase, and CINAHL to identify articles published between the inception of these databases and March 1, 2022, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This search yielded 4183 publications for initial review. Studies with at least a 2-year follow-up and complete reporting of patient-reported outcomes, range of motion, recurrent instability, and/or complications (ie, stiffness, infection, persistent pain) were included. We excluded studies of patients with collagen disorders; revision surgeries; surgeries with concomitant procedures; synthetic MPFL reconstruction; MPFL repairs; combined open and radiographic technique; and case series that included <10 patients. A proportional meta-analysis was performed by calculating the pooled estimate of incidence with 95% CIs using a fixed-effects model with double arcsine transformation (Freeman-Tukey) for each type of surgical technique (fluoroscopic or open). Results: A total of 29 studies met our inclusion criteria, of which 15 studies (566 patients) used the open technique and 14 studies (620 patients) used fluoroscopy. There were no significant differences between the open and fluoroscopic techniques in the incidence of postoperative apprehension (P = .4826), postoperative subjective instability (P = .1095), postoperative objective instability (P = .5583), reoperations (P = .7981), recurrent dislocation (P = .6690), or arthrofibrosis (P = .8118). Conclusion: Both open and radiographic localization of the femoral graft position in MPFL reconstruction offer similar outcomes and rates of complications.

Survivorship of the Hip Joint After Acetabulum Fracture.

PURPOSE: The purposes of this study were to determine the rate of failure of the hip joint after acetabulum fracture and to identify risk factors. METHODS: Acetabulum fractures treated over 17 years at a level-1 trauma center were reviewed. Patient, injury, and treatment factors were assessed regarding possible association with failure of the hip joint: end-stage arthrosis and/or total hip arthroplasty (THA). RESULTS: Seventy percent were treated with primary open reduction and internal fixation (ORIF). Seventy-two (12.5%) of 575 fractures underwent THA; 64 were after initial ORIF. The mean follow-up was 80 months, and the median time to THA was 14 months (range 10-200 months). Age, body mass index, fracture type, marginal impaction, and hip dislocations were independent predictors of hip joint failure. The mean injured age of THA patients was 53 versus 43 (P < 0.001). T-type fractures were most likely to fail (21% within 2 years, 45% within 10 years, P = 0.001). Other injury features: marginal impaction and posterior hip dislocation were associated with failure with odds ratios 2.79 and 1.73, respectively (P < 0.001). CONCLUSION: Eighty-five percent of native hips survived; the median time to THA was 14 months. Most who had THA had initial posterior fracture-dislocations. Older age, elevated body mass index, T-type pattern, marginal impaction, and hip dislocation increase the likelihood of hip joint failure.

Diagnosis and Management Strategies for Distal Biceps Rupture.

Rupture of the distal biceps tendon most commonly is secondary to mechanical overload during eccentric muscle contraction. Due to deficits of strength and endurance, surgical repair usually is recommended. Although both single- and double-incision approaches have been described, double-incision techniques have been shown to better re-create the native anatomic insertion. However, excellent and comparable clinical outcomes have been demonstrated with both techniques. Fixation with a cortical button and interference screw has been shown to be the strongest construct biomechanically; however, several modern constructs provide adequate strength. Surgical technique should focus on restoration of anatomy, early range of motion, and prevention of complications. [Orthopedics. 2019; 42(6):e492-e501.].

Chronic Morbidity of a Pilot Hole Burr Technique for Anterior Iliac Crest Autograft in Cervical Fusion.

Anterior cervical decompression and fusion is a commonly performed procedure for cervical pathology. Graft choices include autograft, allograft, xenograft, synthetic, or a combination. Autograft has been shown to increase fusion rate compared with allograft, yet high morbidity at the harvest site has been reported. Few studies have evaluated chronic graft site pain, and to the authors' knowledge, no study has evaluated morbidity of a pilot hole burr technique for anterior iliac crest harvest. The objective of this study was to evaluate chronic morbidity of anterior iliac crest harvest in anterior cervical decompression and fusion using a pilot hole burr technique. A phone survey was used to identify chronic morbidity. Number of levels fused, age, sex, and acute graft site complications were explored to evaluate impact of patient characteristics on chronic graft site pain. A total of 140 patients met inclusion criteria; 106 patients (76%) completed the phone survey. Mean follow-up was 38.9 months. Two patients (1.9%) reported current and constant graft site pain. Nine patients (8.5%) reported intermittent pain. Average numeric pain rating scale score for survey participants was 0.25 of 10. No patients were taking narcotics for graft site pain. Two patients (1.9%) reported functional impairment secondary to the graft site pain. There was no impact of number of levels fused, age, sex, or acute graft site complications on chronic graft site pain. The pilot hole burr technique resulted in low long-term morbidity and may offer an alternative to traditional methods for those wishing to use autologous graft in anterior cervical decompression and fusion. [Orthopedics. 2019; 42(1):e68-e73.].