Web-Based Education Prior to Outpatient Orthopaedic Surgery Enhances Early Patient Satisfaction Scores: A Prospective Randomized Controlled Study.

BACKGROUND: A good patient-surgeon relationship relies on adequate preoperative education and counseling. Several multimedia resources, such as web-based education tools, have become available to enhance aspects of perioperative care. PURPOSE/HYPOTHESIS: The purpose of this study was to evaluate the effect of an interactive web-based education tool on perioperative patient satisfaction scores after outpatient orthopaedic surgery. It was hypothesized that web-based education prior to outpatient orthopaedic surgery enhances patient satisfaction scores. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: All patients undergoing knee arthroscopy with meniscectomy, chondroplasty, or anterior cruciate ligament reconstruction or shoulder arthroscopy with rotator cuff repair were eligible for inclusion and were randomized to the study or control group. The control group received routine education by the surgeon, whereas the study group received additional web-based education. At the first postoperative visit, all patients completed the OAS CAHPS (Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems) survey. Differences in patient satisfaction scores between the study and control groups were determined with an independent t test. RESULTS: A total of 177 patients were included (104 [59%] males; mean age, 42 ± 14 years); 87 (49%) patients were randomized to receive additional web-based education. Total patient satisfaction score was significantly higher in the study group (97 ± 5) as compared with the control group (94 ± 8; P = .019), specifically for the OAS CAHPS core measure "recovery" (92 ± 13 vs 82 ± 23; P = .001). Age, sex, race, workers' compensation status, education level, overall health, emotional health, procedure type and complexity, and addition of a video did not influence patient satisfaction scores. CONCLUSION: Supplemental web-based patient education prior to outpatient orthopaedic surgery enhances patient satisfaction scores.

'Batter's shoulder': can athletes return to play at the same level after operative treatment?

BACKGROUND: Batter's shoulder has been defined as posterior subluxation of the lead shoulder during the baseball swing. However, it is unclear whether or how frequently patients may return to play after treatment of this uncommon condition. QUESTIONS/PURPOSES: We therefore determined the rate of return to play after operative treatment for Batter's shoulder and whether ROM was restored. METHODS: We retrospectively reviewed the records of 14 baseball players diagnosed with Batter's shoulder. Four played professionally, six were in college, and four were in varsity high school. The average age was 20.3 years (range, 16-33 years). All had physical examinations and MRI findings consistent with posterior labral tears involving the lead shoulder. Treatment involved arthroscopic posterior labral repair (n = 10), débridement (n = 2), or rehabilitation (n = 2). The minimum followup was 18 months (average, 2.8 years; range, 18-64 months). RESULTS: Eleven of 12 surgically treated patients returned to their previous level of batting at an average of 5.9 months after surgery. The one patient who was unable to return to play also had an osteochondral lesion of the glenoid identified at surgery. Players typically returned to hitting off a tee at 3 months and to facing live pitching at 6 months postoperatively. All patients regained full internal and external ROM as compared with preoperative data. CONCLUSIONS: Batter's shoulder is an uncommon form of posterior instability in hitters affecting their lead shoulder. Most athletes are able to return to play at the same level after arthroscopic treatment of posterior capsulolabral lesions. LEVEL OF EVIDENCE: Level IV, case series. See Guidelines for Authors for a complete description of levels of evidence.

Revision surgery for failed elbow medial collateral ligament reconstruction.

BACKGROUND: Although excellent results can be achieved in up to 90% of primary elbow medial ulnar collateral ligament reconstructions, retears of the ligament have been reported. As the number of primary reconstructions continues to increase, one could expect a commensurate increase in the number of revision medial collateral ligament reconstructions performed. HYPOTHESIS: Given the difficulty associated with revision procedures, the complication rate relative to primary reconstructions would increase while the percentage of athletes returning to their previous level of play would decrease. STUDY DESIGN: Case series; Level of evidence. 4. METHODS: This was a retrospective review of 15 patients who underwent revision surgery for retear of a reconstructed elbow medial collateral ligament. All patients had undergone previous elbow medial collateral ligament reconstruction and had new history and physical examination findings consistent with medial collateral ligament injury. Twelve subjects were professional baseball players and 3 were college-level players at the time of their revision procedure. Patients were evaluated at a minimum of 2 years after revision surgery. Outcomes were classified using the Conway scale. RESULTS: Average time to revision was 36 months. The technique used in the revision was the Jobe technique in 11 cases, DANE TJ in 3, and primary repair in 1. Thirty-three percent (5/15 excellent) returned to their previous level of play for at least 1 season. Additionally, there were 4 good, 2 fair, and 4 poor results. The ligament repair had a good outcome. Forty percent (6/15) of patients had complications, 1 of whom required a subsequent surgery (lysis of adhesions). One subject experienced a retear of the medial collateral ligament. CONCLUSION: The rate of return to play after revision medial collateral ligament surgery is much lower than after primary reconstruction. As was expected, the complication rate of revision surgery is higher as well. This study should help physicians when counseling baseball players who suffer retears of their medial collateral ligament.

Arthroscopic treatment of posterolateral elbow impingement from lateral synovial plicae in throwing athletes and golfers.

BACKGROUND: Although elbow pain is common in throwing athletes and golfers, posterolateral impingement from a hypertrophic synovial plica is a rare but possibly underdiagnosed condition. PURPOSE: To evaluate the clinical results of arthroscopic treatment of symptomatic lateral elbow plicae in this athletic population. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Twelve patients, 9 male and 3 female, whose mean age was 21.6 years (range, 17-33 years), were reviewed. There were 7 baseball pitchers, 2 softball players, and 3 golfers. All patients had diagnosed isolated lateral elbow plica; none had lateral epicondylitis, instability, osteochondritis dissecans, arthritis, loose bodies, or nerve conditions. The mean time from onset of symptoms to treatment was 9.25 months (range, 3-24.5 months). At a mean follow-up of 33.8 months (range, 24-65.5 months), patients were evaluated with a questionnaire and examination, based on the American Shoulder and Elbow Surgeons standardized elbow assessment and previously reported elbow outcome score. RESULTS: Posterolateral elbow pain was present in all patients. Fifty-eight percent (7 of 12 patients) complained of clicking or catching, whereas only 25% (3 of 12) experienced swelling or effusion. At elbow arthroscopy, a thickened synovial lateral plica was debrided in all cases. Ninety-two percent (11 of 12 patients) reported an excellent outcome with a mean elbow score of 92.5 points (maximum, 100 points). Return to competitive play averaged 4.8 months (range, 3-9.5 months). One patient with a fair outcome developed medial elbow instability that later required reconstructive surgery. CONCLUSION: Posterolateral elbow impingement from hypertrophic synovial plicae can cause significant pain and disability in throwing athletes and golfers. With careful diagnosis and exclusion of other elbow problems, treatment with arthroscopic debridement and focused rehabilitation is highly successful and allows these athletes to return to their previous level of play.

Treatment options for osteoarthritis.

Osteoarthritis is the most common form of arthritis and can be a major source of disability. Many older patients continue to be active in sports-related activities. Therefore, treating an active patient with osteoarthritis is becoming more common. Physical therapy and weight loss continue to play a central role in the treatment of patients with osteoarthritis. Nonsteroidal anti-inflammatory drugs decrease inflammation and swelling, which makes physical therapy more effective. Intra-articular corticosteroids have been used for the treatment of osteoarthritis. However, no guidelines exist for the administration of corticosteroids and they can be associated with increased risk of tendon rupture and infection. Viscosupplementation has gained popularity in the treatment of osteoarthritis of the knee. Intra-articular injections of hyaluronic acid have been shown to decrease pain and improve functional outcomes.

Use of injections for osteoarthritis in joints and sports activity.

Osteoarthritis is the most common form of arthritis, and can be a major source of disability. Many older patients continue to be active in sports-related activities; therefore, the treatment of the active patient with osteoarthritis is becoming more common. Intraarticular corticosteroids have been widely used for the treatment of osteoarthritis. There are no guidelines for the administration of corticosteroids, and they can be associated with increased risk of tendon rupture and infection. Viscosupplementation has gained popularity in the treatment of osteoarthritis of the knee. Intraarticular injections of hyaluronic acid have shown to decrease pain and improve functional outcomes.