Outcomes Following Fully Threaded Intramedullary Nailing of Metacarpal Fractures.

Purpose: Intramedullary screw fixation has emerged as a popular approach for the treatment of displaced metacarpal fractures. The purpose of this study was to investigate the functional and radiographic outcomes of a newly designed, headless noncompressive fully threaded intramedullary nail (TIMN) for the treatment of metacarpal fractures. Methods: A retrospective chart review was performed on patients who were treated with the INnate TIMN (ExsoMed) at a single academic institution with a minimum of 1-year follow-up. Patient-reported functional outcomes included Quick Disabilities for the Arm, Shoulder, and Hand (QuickDASH) questionnaires, return to work and physical activity time, and overall satisfaction. Radiographs were retrospectively reviewed to determine radiographic union, change in angulation, and metacarpal shortening. Results: A total of 49 patients (58 fractures) with a mean age of 36 years (range: 17-75 years) were included. The mean follow-up time was 2.7 years (range: 1.4-4.3 years). Overall, the mean patient satisfaction rating was 4.9 of 5 (range: 3-5). The mean return to work time was 7.2 weeks (range: 0.14-28 weeks), and the mean return to sport or activity was 8.3 weeks (range: 1-28 weeks). Average QuickDASH scores across all patients were 4 (range: 0-56.9). The median radiographic healing time was 6.1 weeks (range: 4.7-15.4 weeks). Mean postoperative shortening in the fifth metacarpal fracture was 3 mm (range: -4.2 to 8 mm) at the initial postoperative visit and 3.6 mm (range: -3.3 to 7.9 mm) at the final radiographic follow-up. Subgroup analysis showed that postoperative shortening was similar, regardless of the fracture pattern. The following four complications were reported: one case of persistent pain and stiffness, one case of carpal tunnel syndrome, one nonunion, and one fractured intramedullary nail. Conclusions: Our findings suggest that the TIMN allows for a reliable return to work and physical activity, high patient satisfaction, low complication rate, and minimal shortening at the final radiographic follow-up. Type of study/level of evidence: Therapeutic IV.

Resilience of Patients Undergoing Knee and Shoulder Arthroscopy Procedures.

INTRODUCTION: Resilience is a person's capacity to overcome adversity. The purpose was to determine what patient factors correlate with resilience using the Brief Resilience Score. We hypothesize that characteristics of female sex, younger age, Workers' Compensation status, and preoperative opioid use are predictors of a lower preoperative resilience score and that patients with positive psychosocial factors would have higher resilience scores. METHODS: Eight hundred nine patients undergoing knee or shoulder arthroscopy were preoperatively categorized into low, normal, and high-resilience groups. Preoperative patient-reported outcome measures (PROMs) and demographics were assessed. Statistical analyses evaluated differences in demographics and PROMs between resilience groups. RESULTS: Analysis disclosed notable differences between low, normal, and high-resilience groups regarding demographics and PROMs. High resilience was seen in older patients, male patients, and patients with positive psychosocial factors. Low resilience scores were discovered in Workers' Compensation patients and those with a history of preoperative opioid use. No difference in resilience scores was observed between smokers and nonsmokers. DISCUSSION: Preoperative resilience score is associated with age, sex, preoperative opioid use, Workers' Compensation status, and smoking status of patients undergoing knee or shoulder arthroscopy.

Systematic Assessment of the Quality and Comprehensibility of YouTube Content on Ulnar Collateral Ligament Injury and Management.

Background: Ulnar collateral ligament (UCL) reconstruction has received a unique level of attention in the press and social media. There has also been an increasing use of the internet by patients to seek medical information. Concern exists regarding the quality and comprehensibility of online information when used for patient education. Purpose: To evaluate the quality and comprehensibility of the most-viewed YouTube videos related to the diagnosis and management of UCL injuries. Based on our new evidence-based scoring rubrics, we hypothesized that the quality and comprehensibility of these videos would be poor. Study Design: Cross-sectional study. Methods: The YouTube platform was searched on September 7, 2021, with the terms "UCL injury," "ulnar collateral ligament injury," "UCL surgery," "ulnar collateral ligament surgery," and "Tommy John surgery," and the 50 most-viewed videos from each search were compiled, yielding 250 videos. After removal of duplicates and application of exclusion criteria, the 100 most-viewed videos remained. Basic attributes, including duration of video and number of views, were recorded. Each video was then analyzed by 2 independent reviewers and evaluated for 4 key parameters (quality of diagnostic content [QAR-D], quality of treatment content [QAR-T], presence of inaccurate information, and comprehensibility) and graded on a novel scale from 1 to 4 (4 being the most appropriate for patient education). Results: The mean QAR-D was 4.83 ± 3.41 (fair quality), and the mean QAR-T was 2.76 ± 3.26 (poor quality). Physician-led educational videos had both the highest mean QAR-D (6.37) and the highest mean QAR-T (4.34). No correlation was observed between video quality and views/likes. A total of 12 videos included ≥1 inaccuracy. The mean comprehensibility score was 2.66 ± 1.12, with 39 videos falling below the acceptable comprehensibility threshold (score <3). Conclusion: The overall quality of UCL injury-related YouTube content was low. In addition, the absence of correlation between video quality and views/likes suggests that patients are not preferentially utilizing the limited high-quality content that does exist on the YouTube platform. In addition, inaccurate videos were prevalent (12%), and almost half of all videos were deemed inappropriate for patient education in terms of comprehensibility, as defined by our comprehensibility parameter.

A Practical Guide to Lower Extremity Nerve Blocks for the Sports Medicine Surgeon.

BACKGROUND: Peripheral nerve blocks (PNBs) are vital in the administration of surgical analgesia and have grown in popularity for use in lower extremity arthroscopic procedures because of their capacity to safely and effectively control pain. The number and specificity of PNBs, however, have made choosing the best option for a procedure nebulous for orthopaedic surgeons. PURPOSE: To present a narrative literature review of the PNBs available for arthroscopic hip and knee procedures that is adapted to an audience of orthopaedic surgeons. STUDY DESIGN: Narrative literature review. METHODS: A combination of the names of various lower extremity PNBs AND "hip arthroscopy" OR "knee arthroscopy" was used to search the English medical literature including PubMed, Cochrane Library, ScienceDirect, Embase, and Scopus. Placement technique, specificity of blockade, efficacy, and complications were assessed. Searches were performed through May 2, 2021. RESULTS: A total of 157 studies were included in this review of lower extremity PNBs. Femoral nerve, lumbar plexus, sciatic nerve, and fascia iliaca compartment blocks were most commonly used in arthroscopic hip surgery, while femoral nerve, 3-in-1, and adductor canal blocks were preferred for arthroscopic knee surgery. Each block demonstrated a significant benefit (P > .05) in ≥1 of the following outcomes: intraoperative morphine, pain scores, nausea, and/or opioid consumption. Combination blocks including the lateral femoral cutaneous nerve block, obturator nerve block, quadratus lumborum block, and L1 and L2 paravertebral block have also been described. Complication rates ranged from 0% to 4.8% in those administered with ultrasound guidance. The most commonly reported complications included muscular weakness, postoperative falls, neuropathy, intravascular and intraneural injections, and hematomas. CONCLUSION: When administered properly, PNBs were a safe and effective adjuvant method of pain control with a significant potential to limit postoperative narcotic use. While blockade choice varies by surgeon preference and procedure, all PNBs should be administered with ultrasound guidance, and vigilant protocols for the risk of postoperative falls should be exercised in patients who receive them.

Operative Time Less Than 1.5 Hours, Male Sex, Dependent Functional Status, Presence of Dyspnea, and Reoperations Within 30 days Are Independent Risk Factors for Readmission After ACLR.

Purpose: The purposes of this study are to use a large, patient-centered database to describe the 30-day readmission rate and to identify predictive risk factors for readmission after elective isolated ACLR. Methods: The National Surgical Quality Improvement Program Database was retrospectively queried for isolated ACLR procedures between 2011 and 2017. Current Procedural Terminology (CPT) codes were used to identify isolated ACLR patients. Those undergoing additional procedures such as meniscectomy or multi-ligamentous reconstruction were excluded. Readmissions were analyzed against demographic variables with bivariate analysis. Multivariate logistic regression was used to find independent risk factors for 30-day readmissions after ACLR. Results: A total of 11,060 patients (37.2% female) were included with an average age of 32.2 ± 10.6 years and mean body mass index (BMI) of 27.9 ± 6.5 kg/m2 (29.2% were >30). The overall readmission rate was 0.59%. The most reported reason for readmission was infection 0.22 (24 out of 11,060). The following variables were associated with significantly higher readmission rates: male sex (P = .001), history of severe chronic obstructive pulmonary disease (COPD) (P = .025), cardiac comorbidity (P = .034), operative time >1.5 hours (P <.001), partially dependent functional health status (P = .002), high preoperative creatinine (P = .009), normal preoperative albumin (P = .020), hypertension (P = .034), and reoperations (P < .001). Operative time >1.5 hours, male sex, dependent functional status, the presence of dyspnea, and undergoing a reoperation were identified as independent risk factors for 30-day readmissions (P < .05 for all). Conclusions: Isolated ACLR is associated with low 30-day readmission rates. Operative time >1.5 hours, male sex, dependent functional status, the presence of dyspnea, and 30-day reoperations are independent risk factors for readmission that should be considered in patient selection and addressed with preoperative counseling. Level of Evidence: Level III, retrospective cohort study.

Recall Bias in the Retrospective Collection of Common Patient-Reported Outcome Scores in Hip Arthroscopy.

BACKGROUND: The use of patient-reported outcomes (PROs) is common practice in the treatment of patients undergoing hip arthroscopy. While the prospective collection of PROs is preferred, retrospective collection involving patient recall is not uncommon and may be subject to bias. PURPOSE: To assess the presence of recall bias between prospectively and retrospectively collected PRO scores in hip arthroscopy. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Patients who underwent hip arthroscopy between 2015 and 2021 and provided preoperative baseline responses for the International Hip Outcome Tool-12 (iHOT-12), the Hip disability and Osteoarthritis Outcome Score-Physical Shortform (HOOS-PS), and the modified Harris Hip Score (mHHS) were eligible for recruitment. After surgery, participants were asked to complete a study-specific survey and the same preoperative PROs retrospectively. Agreements between the prospective and retrospective scores were assessed, and associations between score discrepancies and patient characteristics were identified. RESULTS: A total of 94 patients (43.3% participation rate) completed study requirements and were included for analysis. The mean ± standard deviation duration of symptoms before surgery was 25.3 ± 32.8 months, and the mean duration to recall (from the day of surgery) for the PROs was 29.6 ± 22.2 months. The iHOT-12 (intraclass correlation coefficient [ICC], 0.409; P < .001) and HOOS-PS (ICC, 0.415; P < .001) scores had low agreement between prospectively and retrospectively collected scores. The mHHS showed moderate agreement (ICC, 0.598; P < .001). The mean scores for the iHOT-12 (41.4 ± 22.6 vs 34.6 ± 16.3; P < .01), HOOS-PS (29.7 ± 18.5 vs 40.9 ± 17.1; P < .001), and mHHS (62.7 ± 16.5 vs 54.5 ± 14.8; P < .001) were all significantly different prospectively versus retrospectively. The average changes in score for the iHOT-12, HOOS-PS, and mHHS were -6.8, 11.2, and -8.2, respectively. Duration to recall and female sex were predictors of the difference between prospectively and retrospectively collected iHOT-12 data, while no predictors were significant for the HOOS-PS or mHHS. CONCLUSION: The retrospective collection of PROs for hip arthroscopy procedures is subject to bias. On average, retrospective (recalled) PROs reflected worse pain/function than their prospectively recorded counterpoints; therefore, retrospective patient recall is an unreliable source of clinical data, and the prospective collection of iHOT-12, mHHS, and HOOS-PS data should be prioritized.

Open Versus Arthroscopic Surgical Management for Recalcitrant Trochanteric Bursitis: A Systematic Review.

Background: While excision of the trochanteric bursae to treat lateral hip pain has increased in popularity, no comparison exists between the surgical outcomes and complications of the open and arthroscopic techniques involving trochanteric bursectomy. The purpose of this study was to determine the efficacies and complication rates of arthroscopic and open techniques for procedures involving trochanteric bursectomy. Methods: The terms "trochanteric," "bursectomy," "arthroscopic," "open," "outcomes," and "hip" were searched in five electronic databases. Fifteen studies from 120 initial results were included. Patient-reported outcomes (PRO), pain, satisfaction, and complications were included for analysis. Results: Five hundred-two hips in 474 total patients (77.7% female) were included in this study. The average age was 54. The fourteen distinct PRO scores that were reported by the included studies improved significantly from baseline to final mean follow-up (12-70.8 months for open; 12-42 months for arthroscopic) for both approaches, demonstrating statistically significant patient benefit in a variety of hip arthroscopy settings (P > 0.05). The complication rates of all procedures ranged from 0%-33% and failure to improve pain ranged from 0%-8%. Patient satisfaction with surgery was high at 95% and 82% reported a willingness to undergo the same surgery again. No significant mean differences were found between the open and arthroscopic techniques. Conclusion: The open and arthroscopic approaches for trochanteric bursectomy are both safe and effective procedures in treating refractory lateral hip pain. No significant differences in PROs, pain, total complications, severity of complications, and total failures were seen between technique outcomes.Level of Evidence: IV.

Return-to-Sport Outcomes After Primary Ulnar Collateral Ligament Reconstruction With Palmaris Versus Hamstring Tendon Grafts: A Systematic Review.

BACKGROUND: Ulnar collateral ligament (UCL) reconstruction is the current gold standard of treatment for overhead athletes with a symptomatic, deficient UCL of the elbow who have failed nonoperative treatment and wish to return to sport (RTS) at a high level. The palmaris longus and hamstring tendons are common graft choices, but no study has analyzed the existing literature to assess whether one graft is superior to the other. PURPOSE: To systematically report on the outcomes of UCL reconstruction using palmaris and hamstring autografts. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A combination of the terms "ulnar collateral ligament," "valgus instability," "Tommy John surgery," "hamstring," and "palmaris longus" were searched in PubMed, Embase, and the Cochrane Library. RTS and return-to-same-level (RSL) rates, patient-reported outcomes, and complications were included for analysis. We used the modified Coleman Methodology Score and risk-of-bias tool for nonrandomized studies to assess the quality of the included studies. RESULTS: This review included 6 studies (combined total of 2154 elbows) that directly compared palmaris and hamstring graft use in UCL reconstruction. Follow-up ranged from 24 to 80.4 months, and the mean patient age across all studies was 21.8 years. The mean RSL across all studies and grafts was 79.0%, and the mean RTS was 84.1%, consistent with results previously reported in the literature. The mean RTS and RSL rates for the palmaris graft group were 84.6% and 82%, respectively; the hamstring graft group showed mean RTS and RSL rates of 80.8% and 80.8%. Meta-analysis revealed no significant difference in RSL between the 2 graft groups (odds ratio, 1.06; 95% CI, 0.77-1.46). The combined complication rate of the included studies was 18.2%, with failure rates ranging from 0% to 7.1%. CONCLUSION: Results of this review indicated that both palmaris and hamstring tendon grafts are viable options for primary UCL reconstruction. Graft choice should be determined by a combination of patient and surgeon preference.

Resident Involvement in Hip Arthroscopy Procedures Does Not Affect Short-Term Surgical Outcomes.

PURPOSE: To evaluate whether the presence of residents in hip arthroscopy (HA) procedures affects short-term surgical outcomes. METHODS: The American College of Surgeons National Surgical Quality Improvement Program Database was used to identify patients who underwent HA from 2006 to 2012. Demographic and 30-day outcome variables were compared between cohorts of patients with and without residents. Multivariate logistic regression was used to identify whether resident involvement was an independent risk factor for adverse outcomes. Propensity score matching was performed to control for all demographic and intraoperative variables. RESULTS: A total of 869 patients (59.7% female) were included in this study, 626 of which reported data on resident involvement. Patients were mostly White (73.4% of cases without a resident, 51.8% with a resident, P < .05). Those with residents were younger (P = .016), had lower modified 5-item frailty index (mFI-5) scores (P = .028), and had fewer cardiac comorbidities (P = .008). There was no difference in diabetic status, dyspnea symptoms, history of chronic obstructive pulmonary disease, renal comorbidity, neurologic comorbidity, cumulative comorbidities, history of bleeding disorders, inpatient vs. outpatient treatment, preoperative functional status, smoking history, and steroid use for chronic conditions. There was no difference in all complications, operative time, length of stay, reoperation, readmission, wound complication, venous thromboembolism, blood transfusions, or sepsis. Propensity score match for demographic and intraoperative differences found no association between resident involvement and increased complications. Resident involvement was not an independent risk factor for all complications studied. CONCLUSION: Resident involvement in HA procedures was not a risk factor for 30-day complications between 2006 and 2012. Resident involvement did not increase the risk of adverse outcomes, readmission, reoperation, or length of stay, nor did it significantly increase operative times.

Intraoperative Scrub Nurse Handoffs Are Associated with Increased Operative Times for Lower Extremity Orthopaedic Sports Procedures.

PURPOSE: The purpose of this study was to evaluate the effect of intraoperative scrub nurse handoffs on surgical times for arthroscopically-assisted anterior cruciate ligament (ACL) reconstructions and hip arthroscopies. METHODS: A retrospective chart review was done at a major, urban academic medical center for all patients who underwent arthroscopically-assisted ACL reconstructions and hip arthroscopies for femoroacetabular impingement syndrome between May 2014 and May 2020. All ACL reconstructions were performed by 1 of 6 sports medicine fellowship-trained surgeons, and all hip arthroscopies were performed by a single surgeon. Operative times, number of scrub nurse handoffs, surgeon, patient demographics, and procedure-specific information were recorded. The association between patient characteristics and the number of handoffs, as well as the association between patient characteristics and operative times, stratified by scrub nurse handoffs, were calculated. A multivariable linear regression was performed to assess the association between intra-operative handoffs and operative times. RESULTS: Eight hundred twenty ACL reconstructions and 269 hip arthroscopies were identified. Multivariable linear regression demonstrated increasing intraoperative scrub nurse handoffs were associated with increased operative times for all patients. For ACL reconstructions, when including all possible covariates, 1 scrub nurse handoff increased operative times by 21.1 minutes (95% confidence interval [CI]: 15.36 to 26.89; P < .001), and 2+ handoffs increased operative times by 34.2 minutes (95% CI: 26.28 to 42.15; P < .001). For hip arthroscopies, 1 scrub nurse handoff increased operative times by 7.0 minutes (95% CI: 0.31 to 13.74; P = .04). CONCLUSION: Although a causal link cannot be made, intraoperative scrub nurse handoffs were associated with statistically significant increase in operative times for both ACL reconstructions and hip arthroscopies. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

A Systematic Assessment of YouTube Content on Femoroacetabular Impingement: An Updated Review.

BACKGROUND: Online video-sharing platforms such as YouTube have become popular sources of medical information for patients. However, concern exists regarding the quality of such non-peer reviewed content. In fact, a previous investigation found the majority of YouTube information related to femoroacetabular impingement (FAI) to be of poor quality. PURPOSE: To provide an updated assessment of the quality of FAI-related videos available on YouTube. STUDY DESIGN: Cross-sectional study. METHODS: The terms FAI, femoroacetabular impingement, and hip impingement were searched on YouTube, and exclusion criteria were applied to the first 100 results for each term. The diagnostic and treatment content of each video was graded and assigned a quality assessment rating based on a previously used rubric. Video characteristics (e.g. duration, views, "likes") were compared using both quality assessment rating and video source. RESULTS: A total of 142 videos were included in the final analysis. The most common video source was educational (48.6%), followed by physician-sponsored (30.3%). The majority of videos were graded as "somewhat useful" for both diagnostic and treatment content (59.4% and 61.6%, respectively); however, treatment content was rated "not useful" more often than diagnostic information (20.3% vs. 8.7%, respectively). Videos rated as "somewhat useful" received the most views per day on average, while educational videos were the most viewed by source (views and views per day). Educational videos had more views and likes on average than physician-sponsored videos (P < .05), but all other comparisons of video characteristics by source were not significant. Video duration was the only characteristic found to vary significantly by quality assessment rating (P < .001 for both diagnostic and treatment analyses), with higher-quality videos tending to be longer. Videos rated as "excellent" and "very useful" had mean durations >30 minutes but were viewed the least. CONCLUSION: The overall quality of FAI-related content on YouTube remains low. Clinicians should be familiar with medical information available to patients on the internet, as it can influence patients' perspectives and shared decision-making processes. This review substantiates the need for more publicly available, high-quality video content regarding the diagnosis and treatment of FAI.

An Analysis of In Vivo Hip Kinematics in Elite Baseball Batters Using a Markerless Motion-Capture System.

PURPOSE: The aim of this study was to investigate the kinematics of the asymptomatic baseball batter's hips by comparing passive range of motion (PROM) and real-time active hip range of motion (AROM) and determine whether differences in ROM exist between lead and trail hips. METHODS: Parameters of passive hip ROM were obtained using a goniometer and physical examination standards. Active hip ROM during batting swings was captured with the Dynamic Athletic Research Institute's markerless motion-capture system. RESULTS: Twenty-nine elite-level baseball players were recruited for participation. Comparison of lead and trail hips showed no significant differences in PROM. Statistically significant differences in AROM were found between lead and trail legs with large effect sizes for flexion (mean difference [MD°], 11.22), extension (MD°, 30.30), abduction (MD°, 6.24), adduction (MD°, 18.63), external rotation (MD°, 14.87) and total arc of rotation (MD°, 17.17) (P < .001 for all). External rotation in the lead hip approached maximum passive endpoint during early phases of the swing, whereas trail hip extension reached maximum passive endpoint during follow-through. CONCLUSION: There is a significant difference in the AROM of the lead and trail hips during the batting swing, with active extension in the trail hip, active external rotation of the lead hip, and total arc of rotation of the lead hip nearing their respective passive endpoints and suggesting a potential for bony interaction in the hips of baseball batters. LEVEL OF EVIDENCE: Level 3, Cross-Sectional Study.