Increased Body Mass Index is Associated with Worse Mid- To Long-Term Patient Outcomes after Surgical Repair of Multiligamentous Knee Injuries.

We evaluated the relationship between elevated body mass index (BMI) and mid- to long-term outcomes after surgical treatment of multiligamentous knee injury (MLKI). Records identified patients treated surgically for MLKI at a single institution. Inclusion criteria: minimum 2 years since surgery, complete demographics, surgical data, sustained injuries to two or more ligaments in one or both knees, and available for follow-up. Patients were contacted to complete patient-reported outcomes assessments and were classified according to mechanism of injury. Multivariate logistic regression analysis was used to predict the impact of BMI on outcome scores. A total of 77 patients (72.7% male) were included with a mean age at the time of injury of 29.4 ± 11.0 years and a mean BMI of 30.5 ± 9.4 kg/m2. The mean length of follow-up was 7.4 years. For each 10 kg/m2 increase in BMI, there is a 0.9-point decrease in Tegner activity scale (p = 0.001), a 5-point decrease in Knee Injury and Osteoarthritis Outcome Score (KOOS)-pain (p = 0.007), a 5-point decrease in KOOS-ADL (p = 0.003), a 10-point decrease in KOOS-QOL (p = 0.002), and an 11-point decrease in KOOS-Sport (p = 0.002). There were no significant correlations with BMI and Pain Catastrophizing Scale or Patient Health Questionnaire scores. Increasing BMI has a negative linear relationship with mid- to long-term clinical outcomes including pain, ability to perform activities of daily living, quality of life, and ability to perform more demanding physical activity after MLKI. BMI does not appear to have a significant relationship with knee swelling and mechanical symptoms or patients' mental health.

Arthroscopic Bone Graft Technique for Two-Stage Revision Anterior Cruciate Ligament Reconstruction.

Revision anterior cruciate ligament reconstruction is an increasingly common procedure, with 2-stage surgery often required to address large bone defects and malpositioned tunnels. The arthroscopic bone grafting technique described herein uses morselized allograft bone to provide reproducible fill of asymmetrical bone defects without autograft harvest or additional loss of native bone. The second stage of the anterior cruciate ligament reconstruction can typically proceed 6 months following bone grafting.

Tensioning Ligament and Tendon Repairs to Bone Using a Modified Screw-post Technique.

PURPOSE: The purpose of this study was to demonstrate how to tension tendon and ligament repairs or reconstructions to bone by using an oblique screw-post. A controlled experiment simulating this repair technique is reported, followed by 5 case examples. METHODS: A wood frame model was used to test 5 initial exposed screw lengths (4, 8, 12, 16, 20 mm) and 5 screw angles [90 (perpendicular to wood plane), 75, 60, 45, 30 degrees]. A spring-based force gauge was tied to the exposed 3.5 mm cortical screw with a washer using a #2 nonabsorbable braided suture, and the screw was fully advanced. System lengths were measured before and after advancement using digital calipers. Screw angles were measured with a protractor. Analysis of variance with post hoc paired t tests was performed to compare changes in system length with different initial exposed screw length and screw angle. RESULTS: Greater changes in system length was achieved with decreasing screw angle and increasing initial exposed length (P<0.05). A maximum change in system length of 12.4 mm (SD=0.4 mm) was achieved with a 45-degree screw with 20 mm initial exposed length (P<0.05). Five case examples where a screw-post was used to repair tendons and ligaments in the upper extremity are described. CONCLUSIONS: An oblique screw-post can advance a tendon or ligament repair to bone. This can result in increased tension of the repaired structure, potentially providing a better repair or greater joint stability.

Timing of Physical Therapy Referral in Adolescent Athletes With Acute Spondylolysis: A Retrospective Chart Review.

OBJECTIVES: The purposes of this study were (1) to determine whether the duration of rest before referral to physical therapy (PT) affects the time to make a full return to activity for patients with an acute spondylolysis, (2) to assess the safety of an early referral to PT in patients with an acute spondylolysis. STUDY DESIGN: Retrospective chart review. SETTING: Hospital-based sports medicine clinic. PATIENTS: The medical charts of 196 adolescent athletes (mean age = 14.3 ± 1.8 years) with an acute spondylolytic injury met the inclusion criteria and were reviewed. INDEPENDENT VARIABLE: Patients were subgrouped based on physician referral to PT. PATTERNS: An aggressive referral group (<10 weeks) and a conservative referral group (>10 weeks). MAIN OUTCOME MEASURES: Duration of rest before clearance to a full return to activity and the frequency of adverse reactions during the course of treatment. Safety was assessed by calculating the risk of experiencing an adverse reaction in each group. RESULTS: Median days to a full return to activity for aggressive referral group (115.5 days, interquartile range 98-150 days) and conservative referral group (140.0 days, interquartile range 114.5-168 days) were significantly different (P = 0.002). Eleven patients had adverse reactions during the course of treatment. The risk of adverse reaction was not statistically significant between groups (P = 0.509). CONCLUSIONS: Patients with acute spondylolysis in the aggressive referral group were able to make a full return activity almost 25 days sooner. No differences in the risk of adverse reactions were noted between aggressive and conservative referral groups.