Postoperative Outcomes of Patients Undergoing Fasciotomy for Exercise Induced Compartment Syndrome: A Case Series.

Exercise induced compartment syndrome (EICS) is a rare source of pain in athletes that can significantly limit their ability to compete and train. We evaluated a series of patients undergoing open fasciotomy for EICS of the leg in our institution. Twenty-five patients were followed for an average of 3.2 ± 1.5 years postoperatively. Sixteen patients underwent bilateral fasciotomies (64%), with four patients (16%) receiving two compartment and 21 (84%) receiving four compartment release. A significant reduction in intra-compartmental pressure, measured intraoperatively by hand-held manometry, was observed in all treated compartments. Surgical success, defined as the absence of revision surgery within the study time-period, was achieved in 19 patients (76.0%). Postoperative wound complications occurred in six patients (24.0%). Twenty-four of 25 patients (96.0%) achieved confirmed return to function within the study period. Our case series confirms the efficacy of open fasciotomy for the treatment of EICS. Patients should be followed closely after fasciotomy, and further research is necessary to improve surgical techniques and rehabilitation to decrease postoperative complications. (Journal of Surgical Orthopaedic Advances 30(3):170-172, 2021).

Mid-term outcomes of anterior cruciate ligament reconstruction across age groups: A national database study.

BACKGROUND: The purpose of this study was to examine the impact of age on complication risk after anterior cruciate ligament reconstruction. METHODS: The TriNetX research database was retrospectively queried for patients undergoing primary arthroscopic ACL reconstruction. Univariate logistic regression was performed to evaluate the risk of complication by age group. RESULTS: A total of 21,449 patients were included in the study. Patients ≥61 years old demonstrated significantly higher rates of repeat reconstruction. Rates of postoperative opioid related disorders and surgical site infection varied by age. CONCLUSION: For patients undergoing ACL reconstruction, increasing age is associated with increased risk of developing opioid related disorders, and repeat reconstruction.

Recommendations for return to sports following cervical spine injuries.

The decision of return to play following cervical spine injuries can be one of the most challenging with a wide variation in opinion as far as management. The onus is on the physician to consider the risks of continued play for patients who have experienced a cervical spine injury and who are reluctant to give up their sport of choice. In general, the literature shows agreement for the basic necessities for return to collision sports to include: normal strength, painless range of motion, a stable vertebral column and adequate space for the neurological elements. In addition, return to play in an unsafe environment is contraindicated. Playing with defective equipment or with improper technique has been associated with catastrophic injuries and should be avoided. This particularly includes: spear tackling, diving in unknown or shallow water, diving while intoxicated, checking from behind in hockey or using a trampoline without spotting equipment. However, there is a lack of consensus on returning to play with the following: stenosis, spear tackler's spine, loss of normal lordosis or range of motion, surgically corrected instability, ligamentous instability less than that defined by White/Panjabi, transient quadriparesis, healed disc herniation and congenital fusion. More informed decisions can be made by physician and patient using a basic knowledge of: (i) previous clinical experience, including that outlined in published epidemiological studies and guidelines; (ii) biomechanical data defined in the laboratory; and (iii) the priorities of the patient.

Saphenous neuritis: a poorly understood cause of medial knee pain.

Saphenous neuritis is a painful condition caused by either irritation or compression at the adductor canal or elsewhere along the course of the saphenous nerve. The condition also may be associated with surgical or nonsurgical trauma to the nerve, especially at the medial or anterior aspect of the knee. Saphenous neuritis can imitate other pathology around the knee, particularly a medial meniscal tear or osteoarthritis. Unrecognized saphenous neuritis can confuse the patient's clinical picture, complicate treatment, and compromise results. As an isolated entity, saphenous neuritis may appear in conjunction with other common problems, such as osteoarthritis and patellofemoral pain syndrome, and it can have an indolent and protracted course. Its clinical appearance is characterized by allodynia along the course of the saphenous nerve. The diagnosis is confirmed by relief of symptoms after injection of the affected area with local anesthetic. Initial treatment can include non-surgical symptomatic care, treatment of associated pathology, and diagnostic or therapeutic injections of local anesthetic. In recalcitrant cases, surgical decompression and neurectomy are potential options. The key to treatment is prompt recognition; palpation of the saphenous nerve should be part of every routine examination of the knee.