Anterior Cruciate Ligament Hybrid Remnant Preservation Reconstruction Demonstrates Equivalent Patient-Reported Outcomes and Complications as Traditional Anterior Cruciate Ligament Reconstruction After 1 Year.

Purpose: To compare the outcomes of anterior cruciate ligament (ACL) Hybrid Remnant Preservation Reconstruction (HRPR) with traditional anterior cruciate ligament reconstruction (ACLR) and determine differences in patient-reported outcomes, range of motion (ROM), and complications after 12 months. Methods: A retrospective cohort study of patients undergoing ACLR by a single surgeon from December 2020 to January 2022 was conducted. Patients undergoing ACL-HRPR were compared with control patients undergoing traditional ACLR with bone-patellar tendon-bone autograft. Preoperative and postoperative Patient-Reported Outcome Measurement Information System scores, International Knee Documentation Committee, and patient acceptable symptom state were recorded over 12 months. Any complications occurring 12 months postoperatively were collected. Results: The final analysis included 104 patients, with 39 undergoing ACL-HRPR compared with 65 ACLR controls. Patients who received HRPR were on average 19.46 ± 5.01 years old, with 51.28% being female, whereas control patients were, on average, 21.92 ± 7.71 years old with 50.77% being female. Total ROM was equivalent between groups, with complete terminal extension at 12 months. No significant differences were found for patient acceptable symptom state; Patient-Reported Outcome Measurement Information System-Physical Function, -Pain Interference, or -Depression; or International Knee Documentation Committee at 6 months and 12 months postoperatively. Total ROM was similar between the HRPR and control groups. No differences were found for timed 6-meter hop test, hop for distance, or KT-1000 side-to-side differences. Over the 12-month period, complication rates were similar between groups (10% vs 12% P = .75) were similar. Conclusions: ACL HRPR is associated with equivalent patient-reported outcomes, full ROM, and no differences in complications rates after 1 year compared with control patients in the present retrospective study. Level of Evidence: Level III, retrospective cohort study.

What Do Patients Encounter When Searching Online About Meniscal Surgery? An Analysis of Internet Trends.

Background: Many patients use the internet to learn about their orthopaedic conditions and find answers to their common questions. However, the sources and quality of information available to patients regarding meniscal surgery have not been fully evaluated. Purpose: To determine the most frequently searched questions associated with meniscal surgery based on question type and topic, as well as to assess the website source type and quality. Study Design: Cross-sectional study. Methods: The following search terms were entered into a web search (www.google.com) using a clean-install browser: "meniscal tear,""meniscus repair,""meniscectomy,""knee scope,""meniscus surgery," and "knee arthroscopy." The Rothwell classification system was used to categorize questions and sort them into 1 of 13 topics relevant to meniscal surgery. Websites were also categorized by source into groups. The Journal of the American Medical Association (JAMA) benchmark criteria (medians and interquartile ranges [IQRs]) were used to measure website quality. Results: A total of 337 unique questions associated with 234 websites were extracted and categorized. The most popular questions were "What is the fastest way to recover from meniscus surgery?" and "What happens if a meniscus tear is left untreated?" Academic websites were associated more commonly with diagnosis questions (41.9%, P < .01). Commercial websites were associated more commonly with cost (71.4%, P = .03) and management (47.6%, P = .02). Government websites addressed a higher proportion of questions regarding timeline of recovery (22.2%, P < .01). Websites associated with medical practices were associated more commonly with risks/complications (43.8%, P = .01) while websites associated with single surgeons were associated more commonly with pain (19.4%, P = .03). Commercial and academic websites had the highest median JAMA benchmark scores (4 [IQR, 3-4] and 3 [IQR, 2-4], respectively) while websites associated with a single surgeon or categorized as "other" had the lowest scores (1 [IQR 1-2] and 1 [IQR 1-1.5], respectively). Conclusion: Our study found that the most common questions regarding meniscal surgery were associated with diagnosis of meniscal injury, followed by activities and restrictions after meniscal surgery. Academic websites were associated significantly with diagnosis questions. The highest quality websites were commercial and academic websites.

Rare Dedifferentiated Periosteal Chondrosarcoma with 11-Year Metastatic Relapse: A Case Report.

A 50-year-old man presented for evaluation of a periscapular mass. Biopsy suggested a low-grade chondrosarcoma; however, the resected specimen revealed a grade 2 chondrosarcoma with a low-grade dedifferentiated mesenchymal component. The mass multiply recurred as chondrosarcoma without a dedifferentiated component before the patient developed lung metastases of chondrosarcoma without a dedifferentiated component 11 years after the initial diagnosis and died of disease. This is one of the first reported cases of a dedifferentiated chondrosarcoma with low-grade dedifferentiated component. While overall prognosis may be better than in typical dedifferentiated chondrosarcoma, this tumor demonstrated numerous local recurrences as well as metastasis.

Indications for Surgery, Activities After Surgery, and Pain Are the Most Commonly Asked Questions in Anterior Cruciate Ligament Injury and Reconstruction.

Purpose: To leverage Google's search algorithms to summarize the most commonly asked questions regarding anterior cruciate ligament (ACL) injuries and surgery. Methods: Six terms related to ACL tear and/or surgery were searched on a clean-installed Google Chrome browser. The list of questions and their associated websites on the Google search page were extracted after multiple search iterations performed in January of 2022. Questions and websites were categorized according to Rothwell's criteria. The Journal of the American Medical Association (JAMA) Benchmark criteria were used to grade website quality and transparency. Descriptive statistics were provided. χ2 and Student t-tests identified for categorical differences and differences in JAMA score, respectively (significance set at P < .05). Results: A total of 273 unique questions associated with 204 websites were identified. The most frequently asked questions involved Indications/Management (20.2%), Specific Activities (15.8%), and Pain (10.3%). The most common websites were Medical Practice (27.9%), Academic (23.5%), and Commercial (19.5%). In Academic websites, questions regarding Specific Activities were seldom included (4.7%) whereas questions regarding Pain were frequently addressed (39.3%, P = .027). Although average JAMA score was relatively high for Academic websites, the average combined score for medical and governmental websites was lower (P < .001) than nonmedical websites. Conclusions: The most searched questions on Google regarding ACL tears or surgery related to indications for surgery, pain, and activities postoperatively. Health information resources stemmed from Medical Practice (27.9%) followed by Academic (23.5%) and Commercial (19.5%) websites. Medical websites had lower JAMA quality scores compared with nonmedical websites. Clinical Relevance: These findings presented may assist physicians in addressing the most frequently searched questions while also guiding their patients to greater-quality resources regarding ACL injuries and surgery.

Survey of blood flow restriction therapy for rehabilitation in Sports Medicine patients.

Background: Blood flow restriction (BFR) therapy has demonstrated benefits across a spectrum of musculoskeletal injuries, including improved strength, endurance, function, and reduction in pain perception. There is, however, no standardized application of BFR therapy among orthopaedic surgeons within the United States (US). Hypothesis: The indication and protocol for BFR therapy vary significantly across providers in the US. Methods: An online survey of 21 multiple-choice questions was sent to 3,281 surgeons listed on a large orthopaedic registry. A cross-sectional study was performed on all surgeons who successfully completed the questionnaire. Surgeons were queried on current or planned use of BFR, indications, contraindications, and peri-operative and non-operative management of sports-related injuries. Results: Overall, 250 physicians completed the survey, with 149 (59.8%) reporting current BFR use and 75.2% initiating use in the last 1-5 years. Most protocols (78.8%) utilize the modality 2-3 times per week while 15.9% use it only once weekly. Anterior cruciate ligament reconstruction (ACLR) rehabilitation was the most reported indication for initiating BFR therapy (95.7%) along with medial patellofemoral ligament reconstruction (70.2%), multiligamentous knee reconstruction (68.8%), meniscus repair (62.4%), collateral ligament reconstruction (50.4%), Achilles tendon repairs (30.5%), and meniscectomy (27%). Only 36.5% reported using BFR after upper extremity procedures, such as distal biceps repair (19.7%), ulnar collateral ligament elbow reconstruction (17%), rotator cuff (16.8%), and shoulder labrum repair (15.3%). For non-operative injuries, 65.8% of surgeons utilized BFR. Of those not currently using BFR therapy, 33.3% intended to implement its use in the future. Conclusion: BFR therapy has increased in popularity with most physicians implementing its use in the last 5 years. BFR was commonly utilized after ACLR. Clinical relevance: BFR allows light-load resistance to simulate high-intensity resistance training. This study describes US orthopaedic surgeons' common practice patterns and patient populations that utilize BFR therapy.

3D-Printed Cutting Guides for Resection of Long Bone Sarcoma and Intercalary Allograft Reconstruction.

The use of 3-dimensional (3D)-printed cutting guides for resection of long bone sarcoma is a novel technique. These 3D-printed guides provide a potential benefit over navigational or freehand osteotomy. We evaluated whether the use of 3D-printed cutting guides in the resection of long bone sarcoma affects margin status and rates of union compared with historical controls. In this study, we performed a retrospective review of a prospectively maintained surgical database and reviewed 6 patients who underwent limb salvage for long bone sarcoma. We collected and analyzed clinicopathologic and surgical data. Six (100%) cases recorded negative margins, with mean postoperative follow-up of 108 weeks (range, 8-211 weeks). Time (mean±SD) to bony union was 20.5±10.5 weeks. Nine of 12 (75%) cumulative (proximal and distal) osteotomy sites went on to achieve union, with a nonunion rate of 25% per osteotomy. One (33%) nonunion occurred after adjuvant radiation therapy. Long-term complications were limited to 2 (33.3%) patients overall who had implant failure according to the Henderson classification system, and there were zero local recurrences at the conclusion of the study. Our institution has successfully performed limb salvage surgery with patient-specific 3D-printed technology. We show high rates of negative margin resection and junctional union that align with and improve on earlier findings. [Orthopedics. 2022;45(1):e35-e41.].