The known and unknown reality of knee dislocations: A systematic review.

BACKGROUND: Knee dislocations (KD) are limb threatening injuries known to cause significant dysfunction and disability. This review aims to summarize KD knowledge and uncover areas where more research is needed. METHODS: The published literature was queried according to PRISMA guidelines. Studies eligible for inclusion were clinical studies of knee dislocations. Studies published before 1990, or that focused on patellofemoral dislocation were excluded. RESULTS: A total of 132 studies involving 43,869 knee dislocations were analyzed. The majority of patients were young adult males, with high-velocity trauma, particularly motor vehicle accidents, being the most common cause. Substance use and alcohol involvement were commonly reported. The predominant KD types were KD III (54.8 %) and KD IV (20.5 %). Meniscal tears were observed in over 50 % of cases, while cartilage injuries were present in 26.7 %. Neurovascular complications were significant, with popliteal artery injuries in 7.8 % and peroneal nerve injuries in 15.3 % of patients. Acute ligament repairs (64.2 %) were more common than delayed repairs (35.8 %), although the average time to repair was 56.1 days. Complications included amputations (2.3 %), fatalities (1.9 %), compartment syndrome (2.7 %), deep infection (5.3 %), and heterotopic ossification (21.6 %). Despite these severe injuries, a substantial loss to follow-up (19 %) and underreporting of functional outcomes were noted, limiting the comprehensive assessment of long-term recovery. A notable percentage of patients did not return to work or sports, with many requiring a change in profession due to their injuries, but these outcomes were only reported in 10 or fewer studies. CONCLUSION: This study highlights the significant gaps in understanding the treatment strategies, financial burden, and long-term outcomes of knee dislocations. The incomplete data, particularly the high loss to follow-up rates and underreported functional outcomes, hinders the ability to make comprehensive assessments. Available results should thusly be interpreted with an understanding of the gaps in data, however return to sport and prior employment is often not achieved. Additionally, the potential influence of socioeconomic factors and substance abuse on treatment decisions and outcomes remains inadequately explored. Future research should focus on these areas to improve the management and prognosis of patients with knee dislocations, ensuring more accurate and thorough evaluations of long-term recovery and quality of life.

Electrical Stimulation: Enhancing Axonal Growth following Peripheral Nerve Injury.

Electrical stimulation has been integrated in recent decades into rehabilitation protocols following neuromuscular injuries. Existing literature supports the utilisation of prolonged or continuous stimulation generated by implantable or transcutaneous devices for chronic pain subsidence and muscle trophism maintenance, which improve outcomes following microsurgical interventions. Newer uses include brief electrical stimulation for peripheral nerve injury. Brief electrical stimulation has shown promise in expediting regeneration of both torn and crushed nerve axons in the murine model and has been incorporated into a limited number of clinical studies. Augmentation of the natural response of an injured peripheral nerve by electrical stimulation has the potential to accelerate regeneration, presumably leading to improved function and clinical outcomes. We review the existing literature on intraoperative utilisation of electrical stimulation to enhance regeneration, such as neural mechanisms of action and their microscopic effect in animal models, as well as results from initial human studies. Level of Evidence: Level V (Therapeutic).

Orthopaedic Surgery Training and Education During COVID-19: A Systematic Review.

COVID-19 forced surgical resident training programs to adapt to meet educational requirements within the constraints of various guidelines. Some of the changes implemented during the pandemic have imparted a lasting effect on orthopaedic education. As such, the purpose of this article was to review how orthopaedic training and education were affected during the COVID-19 pandemic. Methods: The published literature was queried using search strategies devised by a medical librarian, according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Studies eligible for inclusion were studies related to COVID-19, orthopaedic surgical training, and medical education. Studies were excluded if they (1) were abstracts, conference proceedings, letters, perspective pieces, reviews, or editorials; (2) evaluated medical student education; (3) included other specialties; or (4) were unrelated to COVID-19 and/or orthopaedic training. Results: Eighty-three (n = 83) studies were included. Five themes emerged including (I) Fellowship Application, Interview, and Match Processes; (II) Social Media and Websites for Program Information; (III) Changes in Trainee Surgical Volume; (IV) Trainee Mental Health and Well-being; and (V) Innovations in Education. The pandemic decreased opportunities for medical students to gain exposure to orthopaedic surgery. Social media use, particularly Instagram, among orthopaedic residencies increased during the pandemic. Between the cancellation of away rotations and in-person interviews, applicants saved over $6,000; however, both residency applicants and interviewers preferred in-person interviews. The pandemic led to decreased surgical volume and in-person didactics for trainees, thus relying more on virtual learning. Orthopaedic trainees had mixed feelings regarding online virtual education. Although some respondents reported that they preferred the convenience of online learning, others expressed dissatisfaction with the quality of virtual education. Conclusions: The shift to virtual learning affected how applicants learned about residency programs, with many relying on virtual away rotations and social media to compare different programs. The pandemic also highlighted issues of diversity and accessibility within orthopaedic surgery, with cost savings from virtual interviews and canceled away rotations potentially benefiting applicants from lower socioeconomic backgrounds. Although some innovative approaches and adaptations to orthopaedic education and training have shown promise and may continue to be used in the future after the COVID-19 pandemic, the role of others, such as virtual interviews, is less clear.

Demographic, behavioral, dietary, and clinical predictors of high-sensitivity C-reactive protein: The National Health and Nutrition Examination Surveys (NHANES).

Aims: High-sensitivity C-reactive protein (hs-CRP), a marker of inflammation, is associated with atherosclerosis, and recent studies indicate that therapies targeting inflammation are associated with reductions in cardiovascular risk. However, factors predictive of elevated hs-CRP in the general population have not been elucidated. Methods: In this cross-sectional study, multivariable logistic regression analysis was used to identify independent predictors of elevated hs-CRP (≥3 mg/L) utilizing the National Health and Nutrition Examination Survey (NHANES) 2015-2016 cycle. The model was verified using the independent NHANES 2017-2018 cycle. Candidate variables comprised demographic, behavioral, dietary, and clinical factors. The study included 5412 adults from the 2015-2016 cohort and 5856 adults from the 2017-2018 cohort. Results: Significant independent predictors of elevated hs-CRP included: older age (OR 1.09 per decade; 95 % CI 1.03-1.14; P = 0.024), female sex (OR 1.57; 95 % CI 1.36-1.80; P = 0.003), Black vs White race (OR 1.31; 95 % CI 1.10-1.56; P = 0.037), increased BMI (OR 1.12 per kg/m2; 95 % CI 1.10-1.14; P < 0.001), elevated white blood cell count (OR 1.21 per 1000 white blood cells/µL; 95 % CI 1.15-1.28; P = 0.002), and self-reported poor vs excellent health (OR 1.73; 95 % CI 1.04-2.22; P = 0.012). The model had excellent discrimination with a c-statistic of 0.77 in the 2015-2016 cycle and 0.76 in the 2017-2018 cycle. Conclusion: Older age, female sex, Black race, increased BMI, higher white blood cell count, and self-reported poor health were independent predictors of elevated hs-CRP levels. Additional studies are needed to determine if behavioral modifications can lower hs-CRP and whether this translates to reduced risk for cardiovascular disease and other conditions associated with chronic inflammation.