Outcomes, Complications, and Reoperations After Meniscal Allograft Transplantation.

Background: Outcomes following meniscal allograft transplantation (MAT) are an evolving topic. Purpose: To review clinical outcomes in younger, previously active patients who underwent an isolated MAT or MAT plus any osteotomy. Concurrent surgeries, complications, and graft survivorship are presented. Study Design: Case series; Level of evidence, 4. Methods: Inclusion criteria included having undergone MAT with a minimum of 1 year of follow-up with at least 1 of the following patient-reported outcome (PRO) measures collected pre- and postoperatively: visual analog scale for pain, Knee injury and Osteoarthritis Outcome Score (KOOS), the Western Ontario and McMaster Universities Arthritis Index, the 36-Item Short Form Health Survey, and overall satisfaction. From patient records, we recorded descriptive data, side (medial/lateral), previous or concurrent procedures, perioperative complications, revisions, and conversion to arthroplasty. Two-factor analysis of variance (ANOVA) was used to test for differences in age and body mass index (BMI). A 2 × 2 chi-square test was used to determine if the spectrum of procedures performed on our study's patient group was representative of the entire population. PRO results were analyzed using a multivariate ANOVA. Results: From a total of 91 eligible patients, 61 (63 knees) met our inclusion criteria. Mean presurgery age was 25.5 ± 9.2 years, and mean BMI was 26.7 (range, 18.5-38.4). At follow-up (mean, 4.8 years; range, 1.0-13.6 years) overall PROs were statistically and clinically improved at final follow-up (P ≤ .003); effect sizes were moderate and large. KOOS Pain and KOOS Activities of Daily Living showed some main or interaction effects that were trivial or small. Patient satisfaction with the treatment was ≥7 out of 10 in 85% of patients. A minimum of 1 subsequent surgery for various concerns was necessary in 23% of the 93 knees. Graft survival in the included patients was 100%. Conclusion: Complications (conditions requiring at least 1 subsequent surgery) affected about one-quarter of the patients who underwent MAT. Nevertheless, MAT seemed to provide our patients with adequate pain relief and improved function.

Superior Capsular Reconstruction With Autologous Fascia Lata Using a Single Lateral-Row Technique Is an Effective Option in Massive Irreparable Rotator Cuff Tears: Minimum 2-Year Follow-Up.

PURPOSE: The purpose of this study was to evaluate clinical and radiologic outcomes of arthroscopic superior capsular reconstruction (ASCR) with fascia lata autograft in patients with irreparable rotator cuff tears (IRCTs) performed using a single lateral-row fixation technique. METHODS: We studied a retrospective case series of patients with large or massive IRCTs for ASCR with fascia lata autograft. Clinical outcomes were evaluated using the Visual Analog Scale (VAS) and the Constant score. Healing of the graft was assessed by magntic resonance imaging or ultrasound. Acromiohumeral distance was evaluated by radiographs. RESULTS: Thirty-one patients with an average age of 61 years and an average follow-up of 35 months (24-51 months) underwent ASCR with fascia lata autograft. There was a significant improvement in VAS (7.7-0.7), Constant score (36.0-78.7), forward elevation (115°-171°), external rotation (33°-50°), strength (0.3 kg-2.3 kg), and acromiohumeral distance (6.1 mm-8.6 mm) (P < 0.001). Graft failure was present in 13.8% of patients, as shown by magnetic resonance imaging (26 patients) or ultrasound (3 patients). Patients with failed ASCR showed worse Constant scores (68.5.8 vs 80.2, P = 0.007), worse VAS (2.5 vs 0.4, P = 0.00002), worse external rotation (20° vs 54°, P = 0.004), lower acromiohumeral distance (5mm vs 9mm, P = 0.007), and a high association with the presence of os acromiale (χ2P = 0.003). No revision or subsequent surgical procedures were required. CONCLUSIONS: ASCR, with autologous fascia lata and single lateral row configuration, is an effective option in irreparable rotator cuff tears and results in clinical and radiologic improvement. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Anterior Cruciate Ligament Reconstruction: A Comparative Clinical Study Between Adjustable and Fixed Length Suspension Devices.

Background: Adjustable-length cortical suspension devices provide technical advantages over fixed-length devices for femoral graft fixation during anterior cruciate ligament (ACL) reconstruction but have shown increased lengthening during cyclic loading in biomechanical studies. The purpose of this study was to prospectively measure graft elongation in vivo along with patient reported outcomes. Methods: Thirty-seven skeletally mature patients diagnosed with anterior cruciate insufficiency who underwent ACL reconstruction using autogenous hamstring graft were included in this study. Thirteen patients received an ACL reconstruction using a fixed loop device (FL) and twenty-four patients were treated with an adjustable-length device (AL) based on surgeon preference. Bilateral knee laxity was measured with a KT1000 Arthrometer before surgery and immediately after surgery with the patient under anesthesia, and at the 6-week, 3-month, and 6-month clinical follow-up appointments. All measurements were made by the same operator with maximum force testing. Differences between the affected knee and the contralateral knee were measured. Patient reported outcomes were collected at 6 and 24 months post-operatively. Results: No difference was found between the FL and AL groups in either knee laxity or patient reported outcomes. Average side-to-side difference at 6 months was 1.8 ± 2.6 mm for the FL group and 1.7 ± 2.4 mm for the AL group (p=.874). One patient in the FL group (7.7%) and two in the AL group (9.5%) had a side to side difference in laxity greater 5 mm. Patient reported outcomes did not differ between groups and no patients underwent revision surgery. Conclusions: The adjustable-length cortical suspension device (AL) did not demonstrate increased laxity as compared to fixed-length devices. There was no difference in patient reported outcomes between the groups.Level of Evidence: IV.

Knee, Shoulder, and Fundamentals of Arthroscopic Surgery Training: Validation of a Virtual Arthroscopy Simulator.

PURPOSE: To validate the knee, shoulder, and virtual Fundamentals of Arthroscopic Training (FAST) modules on a virtual arthroscopy simulator via correlations with arthroscopy case experience and postgraduate year. METHODS: Orthopaedic residents and faculty from one institution performed a standardized sequence of knee, shoulder, and FAST modules to evaluate baseline arthroscopy skills. Total operation time, camera path length, and composite total score (metric derived from multiple simulator measurements) were compared with case experience and postgraduate level. Values reported are Pearson r; alpha = 0.05. RESULTS: 35 orthopaedic residents (6 per postgraduate year), 2 fellows, and 3 faculty members (2 sports, 1 foot and ankle), including 30 male and 5 female residents, were voluntarily enrolled March to June 2015. Knee: training year correlated significantly with year-averaged knee composite score, r = 0.92, P = .004, 95% confidence interval (CI) = 0.84, 0.96; operation time, r = -0.92, P = .004, 95% CI = -0.96, -0.84; and camera path length, r = -0.97, P = .0004, 95% CI = -0.98, -0.93. Knee arthroscopy case experience correlated significantly with composite score, r = 0.58, P = .0008, 95% CI = 0.27, 0.77; operation time, r = -0.54, P = .002, 95% CI = -0.75, -0.22; and camera path length, r = -0.62, P = .0003, 95% CI = -0.8, -0.33. Shoulder: training year correlated strongly with average shoulder composite score, r = 0.90, P = .006, 95% CI = 0.81, 0.95; operation time, r = -0.94, P = .001, 95% CI = -0.97, -0.89; and camera path length, r = -0.89, P = .007, 95% CI = -0.95, -0.80. Shoulder arthroscopy case experience correlated significantly with average composite score, r = 0.52, P = .003, 95% CI = 0.2, 0.74; strongly with operation time, r = -0.62, P = .0002, 95% CI = -0.8, -0.33; and camera path length, r = -0.37, P = .044, 95% CI = -0.64, -0.01, by training year. FAST: training year correlated significantly with 3 combined FAST activity average composite scores, r = 0.81, P = .0279, 95% CI = 0.65, 0.90; operation times, r = -0.86, P = .012, 95% CI = -0.93, -0.74; and camera path lengths, r = -0.85, P = .015, 95% CI = -0.92, -0.72. Total arthroscopy cases performed did not correlate significantly with overall FAST performance. CONCLUSIONS: We found significant correlations between both training year and knee and shoulder arthroscopy experience when compared with performance as measured by composite score, camera path length, and operation time during a simulated diagnostic knee and shoulder arthroscopy, respectively. Three FAST activities demonstrated significant correlations with training year but not arthroscopy case experience as measured by composite score, camera path length, and operation time. CLINICAL RELEVANCE: We attempt to validate an arthroscopy simulator that could be used to supplement arthroscopy skills training for orthopaedic residents.

Distal interphalangeal joint arthrodesis for degenerative osteoarthritis with compression screw: results in 102 digits.

PURPOSE: To assess objective and subjective outcomes of distal interphalangeal joint arthrodesis with a headless compression screw for degenerative osteoarthritis. METHODS: We retrospectively analyzed 102 cases of distal interphalangeal joint arthrodesis performed with headless compression screws on 59 patients. We included only primary cases of degenerative osteoarthritis with a minimum follow-up of 7 months. We identified appropriate bone coaptation and hardware positioning on postoperative radiographs in all digits. The mean follow-up period was 26 months (range, 7-67 mo). RESULTS: In 89 of 102 cases, patients were fully satisfied; in 9 cases, they were satisfied. Four complications occurred: 2 cases of prominent hardware, 1 complex regional pain syndrome type 1, and 1 symptomatic bony callus on the fused joint. Secondary surgery was required in each of these 4 cases. No nonunion, malunion, nail dystrophy, pseudarthrosis, or infection occurred. All arthrodeses healed. CONCLUSIONS: Distal interphalangeal joint arthrodesis with headless compression screws was shown to be safe and effective in cases of degenerative osteoarthritis, with a low complication rate.