Better Outcomes but No Difference in Joint Space Narrowing at Five Years Among Patients Without Unstable Chondral Lesions Versus Those With Unstable Chondral Lesions (Left In Situ) at the Time of Arthroscopic Partial Meniscectomy.

PURPOSE: To compare 5-year outcomes among patients with and without unstable chondral lesions undergoing arthroscopic partial meniscectomy (APM). METHODS: Using data from the Chondral Lesions And Meniscal Procedures (ChAMP) Trial, we compared outcomes for patients with unstable chondral lesions found at the time of APM and left in situ (CL-noDeb, N = 71) versus patients without unstable chondral lesions (NoCL, N = 47) at 5 years after APM. Outcomes included the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), visual analog pain scale, Short-form Health Survey (SF-36), physical knee measurements, progressive joint space narrowing on radiographs, and the rate of additional knee surgery. Multivariate linear regression was used to obtain mean differences (MDs) with corresponding 95% confidence intervals (CIs) adjusted for age, body mass index, and preoperative score (for postoperative scores). RESULTS: Compared with CL-noDeb, NoCL subjects had significantly greater improvement at 5 years in the KOOS score for function in sport and recreation (MD = 9.9 [95% CI, 0.7-19.1]), SF-36 pain (MD = 13.9 [95% CI, 5.5-22.3]), knee extension (MD = 0.8 [95% CI, 0.1-1.5]), and decreased quadriceps circumference at the mid-portion of the patella (MD = -1.5 [95% CI, -2.7 to -0.3). A greater proportion of patients in the NoCL group achieved the MCID for all outcome scores except for the WOMAC pain score (89% CL-NoDeb vs 87% NoCL) and SF-36 general (29% CL-NoDeb vs 23% NoCL). There were no significant group differences in measures of progressive radiographic joint space narrowing in any compartments of the operative knee and no significant difference in the rate of additional knee surgery within 5 years of the initial APM. CONCLUSIONS: Patients undergoing APM without unstable chondral lesions had statistically significantly better outcomes than patients with unstable chondral lesions at 5 years after surgery; however, there were no group differences in progressive radiographic joint space narrowing. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Observation Versus Debridement of Unstable Chondral Lesions During Partial Meniscectomy: Analysis of Patient Outcomes and Degenerative Joint Disease at 5 Years in the Chondral Lesions And Meniscus Procedures (ChAMP) Randomized Controlled Trial.

BACKGROUND: The purpose of this study was to examine the effect of debridement (CL-Deb) versus observation (CL-noDeb) of unstable chondral lesions on knee pain 5 years after arthroscopic partial meniscectomy (APM) in patients enrolled in the Chondral Lesions And Meniscus Procedures (ChAMP) Trial. Secondarily, other knee symptoms, function, general health, and the rate of additional surgery on the affected knee were examined. METHODS: Patients aged ≥30 years who had an unstable Outerbridge grade-II, III, or IV chondral lesion when undergoing APM were randomly allocated to the CL-Deb (n = 98) or CL-noDeb (n = 92) group; ∼80% in each group completed a 5-year follow-up. Outcomes were measured preoperatively and at 5 years postoperatively, and included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Short Form-36 (SF-36), physical knee measurements, knee radiographs, and rate of additional knee surgery at 5 years. The primary outcome was the 5-year WOMAC pain score. Group comparisons were made using the t test for continuous outcomes and the Fisher exact test for categorical outcomes. RESULTS: There were no significant differences between the groups with respect to the primary outcome, the WOMAC pain score (CL-Deb: 86.0 [95% confidence interval (CI): 82.9 to 89.1]) versus CL-noDeb: 88.3 [95% CI: 85.5 to 91.1]; p = 0.27), or secondary outcomes at 5 years. There were also no differences in radiographic measurements of joint-space narrowing in any compartment (medial or lateral tibiofemoral or medial, central, or lateral patellofemoral) as well as no difference in the rate of additional knee surgery within 5 years after APM between the CL-Deb and CL-noDeb groups. CONCLUSIONS: Outcomes for the CL-Deb and CL-noDeb groups did not differ at 5 years postoperatively, suggesting that there is no long-term benefit of arthroscopic debridement of chondral lesions encountered during APM. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Simple versus horizontal mattress suture configuration in bankart repair.

The purpose of this article was to compare the anatomy and biomechanics of different suture repair configurations for arthroscopic Bankart lesion repair. The horizontal mattress technique improves the restoration of labral height and decreases capsular strain in comparison to simple suture repairs. Further research examining the clinical outcomes of horizontal mattress suture technique is required for comparison with simple suture arthroscopic Bankart repairs.

All-inside ACL reconstruction: How does it compare to standard ACL reconstruction techniques?

The all-inside ACL reconstruction technique is a relatively new development in ACL surgery. Some features of this technique include closed-socket tunnels, dual suspensory graft fixation, decreased bone removal, and smaller skin incisions. The purpose of this review was to compare the unique features of the all-inside ACL versus standard ACL techniques using biomechanical and clinical studies. The all-inside ACL appears to have similar overall results on subjective and objective outcomes studies compared to standard ACL techniques and may be associated with decreased post-operative pain. There is also a concern for a higher graft failure rate with the all-inside ACL.

The Current State of Head and Neck Injuries in Extreme Sports.

BACKGROUND: Since their conception during the mid-1970s, international participation in extreme sports has grown rapidly. The recent death of extreme snowmobiler Caleb Moore at the 2013 Winter X Games has demonstrated the serious risks associated with these sports. PURPOSE: To examine the incidence and prevalence of head and neck injuries (HNIs) in extreme sports. STUDY DESIGN: Descriptive epidemiological study. METHODS: The National Electronic Injury Surveillance System (NEISS) was used to acquire data from 7 sports (2000-2011) that were included in the Winter and Summer X Games. Data from the NEISS database were collected for each individual sport per year and type of HNI. Cumulative data for overall incidence and injuries over the entire 11-year period were calculated. National estimates were determined using NEISS-weighted calculations. Incidence rates were calculated for extreme sports using data from Outdoor Foundation Participation Reports. RESULTS: Over 4 million injuries were reported between 2000 and 2011, of which 11.3% were HNIs. Of all HNIs, 83% were head injuries and 17% neck injuries. The 4 sports with the highest total incidence of HNI were skateboarding (129,600), snowboarding (97,527), skiing (83,313), and motocross (78,236). Severe HNI (cervical or skull fracture) accounted for 2.5% of extreme sports HNIs. Of these, skateboarding had the highest percentage of severe HNIs. CONCLUSION: The number of serious injuries suffered in extreme sports has increased as participation in the sports continues to grow. A greater awareness of the dangers associated with these sports offers an opportunity for sports medicine and orthopaedic physicians to advocate for safer equipment, improved on-site medical care, and further research regarding extreme sports injuries.

Biofilm Disrupting Technology for Orthopedic Implants: What's on the Horizon?

The use of orthopedic implants in joints has revolutionized the treatment of patients with many debilitating chronic musculoskeletal diseases such as osteoarthritis. However, the introduction of foreign material into the human body predisposes the body to infection. The treatment of these infections has become very complicated since the orthopedic implants serve as a surface for multiple species of bacteria to grow at a time into a resistant biofilm layer. This biofilm layer serves as a protectant for the bacterial colonies on the implant making them more resistant and difficult to eradicate when using standard antibiotic treatment. In some cases, the use of antibiotics alone has even made the bacteria more resistant to treatment. Thus, there has been surge in the creation of non-antibiotic anti-biofilm agents to help disrupt the biofilms on the orthopedic implants to help eliminate the infections. In this study, we discuss infections of orthopedic implants in the shoulder then we review the main categories of anti-biofilm agents that have been used for the treatment of infections on orthopedic implants. Then, we introduce some of the newer biofilm disrupting technology that has been studied in the past few years that may advance the treatment options for orthopedic implants in the future.