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Background: The timing of return to work (RTW) after anterior cruciate ligament (ACL) reconstruction (ACLR) is a less studied milestone compared with return to sports. Purpose: To systematically review the rate and postoperative timing of RTW after ACLR. Study Design: Systematic review; Level of evidence, 4. Methods: This study was conducted in accordance with the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A literature search was performed in PubMed, Embase, Cochrane, and Ovid databases for clinical studies reporting RTW after ACLR, and 806 studies were identified in August 2022. A quality assessment was performed using the Methodological Index of Nonrandomized Studies (MINORS) grading system. The following data were extracted from studies: study characteristics, cohort demographics, ACLR technique, concomitant meniscal and/or cartilage procedures, preoperative patient-reported outcomes, rates of RTW, and days required for RTW after ACLR. Results: A total of 13 studies met inclusion criteria, totaling 1791 patients (86.4% male). Wide variability was observed in the methodological quality of the assessed studies (MINORS score range, 8-17). Hamstring tendon (HT) autograft was used in 76.8% (n = 1377; mean age, 30.5 years old), allograft in 17.1% (n = 308; mean age, 33.1 years old), the ligament advanced reinforcement system in 2.5% (n = 46; mean age, 33.2 years old), bone-patellar tendon-bone autograft in 2% (n = 36; mean age, 28.5 years old), and quadriceps tendon autograft in 1.3% (n = 24; mean age, 24.1 years old). Among the included patients, 99.1% (n = 1781) reported successful RTW after surgery. The mean time to RTW was 84.2 days (range, 31.4-107.1 days) for HT and 69.5 days (range, 49-56.6 days) for allograft. Conclusion: While data regarding work intensity before and after ACL injury were absent, our study results suggested that patients most often RTW within 90 days of surgery. Patients with allograft ACLR may RTW earlier than patients undergoing ACLR with HT autograft.
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Purpose Management of ulnar-sided wrist pain is difficult due to the complexity of the anatomy and the similarity of the signs and symptoms of possible diagnoses. The study's main purpose is to examine the effect of arthroscopic triangular fibrocartilage (TFC) repair on untreated extensor carpi ulnaris (ECU) tendinitis and synovitis. Methods Thirteen patients who underwent arthroscopic TFC repair in our clinic and preoperatively demonstrated ECU tendon pathology with magnetic resonance imaging (MRI) were included in the retrospective study. Pre- and postoperative visual analog scale (VAS), pre- and postoperative tendinitis and synovitis, postoperative Mayo and patient-rated wrist evaluation score, postoperative grip strength of the operated and control sides, short and long diameters of the ECU tendon in ultrasonography were recorded. Results The mean age of 13 patients (9 females and 4 males) was 39.54 ± 13.54, and the mean follow-up period was 26 ± 7.25 months. While there was no significant difference between pre- and postoperative tendinitis or synovitis levels, VAS decreased significantly (8.46 ± 1.33 vs. 3.00 ± 2.31, p = 0.0016). While the grip strength was 21.78 ± 7.83 on the control side, it was 18.28 ± 7.51 on the surgery side, being significantly lower ( p = 0.0252). Ulnar variance did not affect tendinitis or synovitis. Short and long diameters of ECU were similar for the operated and control sides. While the short diameter did not affect the synovitis-tendinitis score, the bigger the long diameter, the higher the synovitis score (rho = 0.5162). Conclusion In the presence of ECU, tendon pathologies accompanying TFC lesions, additional surgical interventions are mandatory as arthroscopic TFC repair has no significant effect on the healing of ECU. Level of evidence : 4.
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OBJECTIVES: This study aims to compare the clinical, radiological, and functional outcomes of the late-presenting ulnar carpometacarpal (CMC) joint injuries treated conservatively with plaster cast versus treated surgically with open reduction internal fixation (ORIF). PATIENTS AND METHODS: Between May 2019 - October 2021, a total of 28 patients (26 males, 2 females; mean age: 32.2±10.3 years; range, 20 to 59 years) who were treated conservatively or surgically were retrospectively analyzed. Fourteen patients operated with ORIF were included in the first group (surgery group), and 14 patients followed conservatively with a plaster cast were included in the second group (conservative group). The patients were classified according to Cain's classification and the AO Foundation and Orthopedic Trauma Association (AO/OTA) classification. The patients were evaluated in terms of pulp palm distance (PPD), Visual Analog Scale (VAS), Disabilities of the Arm, Shoulder and Hand (DASH) score, grip strength, time to return to work, follow-up time, and presence of complications. RESULTS: No significant difference was found in terms of the pain and functional scores. In the conservative group, the grip strength of the injured side was significantly lower than the healthy side (p=0.0093). The patients with and without metacarpal fracture subluxation/dislocation were evaluated separately, and the grip strength of the fractured side in the subluxation/dislocation group was found to be significantly higher in the surgery group than the conservative group (p=0.0237). In the group with subluxation/dislocation, the recovery time increased, as the time to treatment increased. In three patients in the conservative group, the PPD values were 2, 3, and 4 mm, respectively while it was 0 mm for all in the surgery group. CONCLUSION: The non-bridging dorsal buttress plate technique with or without a Kirschner wire is effective in patients with delayed ulnar CMC fracture-dislocations. Although surgery is associated with longer time to return to work, long-term results obtained with anatomical reduction of the joint are satisfactory for manual workers.
