Faculty Bibliography

BACKGROUND:The number of total shoulder arthroplasties (TSAs) performed is increasing annually, with a continued effort to improve outcomes using new techniques and materials. In anatomic TSAs, the main options for glenoid fixation currently involve keeled or pegged components. The aim of this review was to determine which fixation option provides optimal long-term functional outcomes with decreased rates of revision surgery and radiolucency. METHODS:The MEDLINE, Embase, PubMed, and Cochrane databases were searched from 2007 to July 10, 2017, for all articles that examined TSAs using either pegged or keeled glenoid fixations. All studies were screened in duplicate for eligibility. Two separate analyses were completed examining noncomparative and comparative studies independently. RESULTS: = .30). CONCLUSION/CONCLUSIONS:Pegged glenoid fixation may result in a decreased risk of revision TSAs, but no significant differences in patient-reported outcomes have been identified to date.

BACKGROUND:Injury to the ulnar collateral ligament of the elbow is relatively common among baseball pitchers. Ulnar collateral ligament reconstruction (UCLR) has revolutionized the management of this injury, allowing a greater proportion of pitchers to return to play. PURPOSE:To assess the return to play and in-game performance specific to baseball pitchers who have undergone primary UCLR. STUDY DESIGN:Systematic review. METHODS:This review was conducted according to the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The electronic databases MEDLINE, EMBASE, and PubMed were searched for relevant studies, and pertinent data were abstracted. Only studies reporting in-game performance statistics (earned run average [ERA], pitching velocity, innings pitched per season, etc) of pitchers after UCLR were included. The methodological index for nonrandomized studies (MINORS) was used to assess study quality. RESULTS:A total of 14 studies and 1520 pitchers were included in this systematic review. All studies were of level 3 or 4 evidence, and the mean ± SD MINORS score was 14.4 ± 3.0, which indicates fair quality of evidence for nonrandomized studies. The rates of return to any level of pitching after UCLR ranged from 79% to 100%. Subgroup analysis revealed that 79% to 87% of Major League Baseball (MLB) pitchers returned to preinjury levels of pitching. The mean time to return to play was 19.8 ± 13.5 months, and the mean time to return to competition for MLB pitchers was 17.3 ± 2.4 months. Of the 5 studies reporting ERA, 2 cited a significant increase after UCLR, and 1 indicated a significant decrease. Of the 4 studies reporting fastball velocity, 3 cited decreased pitching velocities after UCLR. All studies found that pitchers pitched, on average, fewer innings per game or season after UCLR. CONCLUSION:There was a high rate of return to pitching after UCLR. However, most studies showed that UCLR was associated with a prolonged recovery and significant decline in pitching performance as objectively measured by in-game statistics. The strength of these conclusions is limited by the quality of the available literature and inconsistencies in the reporting of outcomes.

CONTEXT/BACKGROUND:Hip pain from femoroacetabular impingement (FAI) can impair health-related quality of life (HRQL) but can be treated via hip arthroscopy techniques. OBJECTIVE:To systematically assess the HRQL outcomes after arthroscopic management of FAI. DATE SOURCES/METHODS:Three online databases (EMBASE, PubMed, and Ovid [MEDLINE]) were searched for relevant literature from database inception until June 2018 and screened by 2 reviewers independently and in duplicate. STUDY SELECTION/METHODS:Level I to IV English studies that investigated HRQL outcomes after hip arthroscopy were included. Data for generic and hip-specific HRQL outcomes were collected. Mean differences were plotted in a forest plot when possible. STUDY DESIGN/METHODS:Systematic review. LEVEL OF EVIDENCE/METHODS:Level 4. RESULTS:= 44%), for studies with follow-up between 12 and 24 months. CONCLUSION/CONCLUSIONS:Hip arthroscopy can lead to significant improvement in generic and hip-specific HRQL outcomes at 12 to 24 months postoperatively in patients with FAI who do not have advanced hip osteoarthritis. Confirmatory, high-quality, prospective studies are warranted to compare this observed improvement with other treatment modalities for FAI and to determine long-term outcomes.

OBJECTIVE/PURPOSE:The aim of the study was to assess the options of treatment and their related outcomes for chondral injuries in the hip based on the available evidence whilst highlighting new and innovative techniques. METHODS:A systematic review of the literature from PubMed (Medline), EMBASE, Google Scholar, British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Allied and Complementary Medicine Database (AMED) was undertaken from their inception to March 2017 using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical outcome studies, prospective/retrospective case series and case reports that described the outcome of cartilage repair technique for the chondral injury in the hip were included. Studies on total hip replacement, animal studies, basic studies, trial protocols and review articles were excluded. RESULTS:The systematic review found 21 relevant papers with 596 hips. Over 80% of the included studies were published in or after 2010. Most studies were case series or case reports (18 studies, 85.7%). Arthroscopy was used in 11 studies (52.4%). The minimum follow-up period was six months. Mean age of the participants was 37.2 years; 93.5% of patients had cartilage injuries of the acetabulum and 6.5% of them had injuries of the femoral head. Amongst the 11 techniques described in the systematic review, autologous matrix-induced chondrogenesis, osteochondral autograft transplantation and microfracture were the three frequently reported techniques. CONCLUSION:Over ten different techniques are available for cartilage repair in the hip, and most of them have good short- to medium-term outcomes. However, there are no robust comparative studies to assess superiority of one technique over another, and further research is required in this arena.

CONTEXT:/UNASSIGNED:Knee osteoarthritis affects 9.3 million adults over age 45 years in the United States. There is significant disability associated with this condition. Given the potential complications and the significant cost to the health care system with the dramatic increase in total knee arthroplasties performed for this condition, assessment of the efficacy of nonoperative modalities, such as offloading knee braces, is essential as part of optimizing nonoperative treatment for this condition. OBJECTIVE:/UNASSIGNED:To determine the effectiveness of valgus offloader braces in improving clinical outcomes for patients with medial compartment knee osteoarthritis. DATA SOURCES:/UNASSIGNED:Three databases (PubMed, MEDLINE, and EMBASE) were searched from database inception through July 28, 2017. STUDY SELECTION:/UNASSIGNED:Studies reporting outcomes of valgus offloader knee braces in the treatment of medial compartment knee osteoarthritis were included. STUDY DESIGN:/UNASSIGNED:Systematic review. LEVEL OF EVIDENCE:/UNASSIGNED:Level 4. DATA EXTRACTION:/UNASSIGNED:Data pertaining to demographics, descriptive statistics, and clinical outcomes were extracted from the included studies. The methodological quality of included studies was evaluated. RESULTS:/UNASSIGNED:A total of 31 studies were included, with a total of 619 patients. The majority of studies reported improved pain outcomes using valgus offloader braces. However, variable results were reported as to whether valgus offloader braces significantly improved functional outcomes and stiffness. Offloader bracing was more effective at reducing pain when compared with neutral braces or neoprene sleeves. CONCLUSION:/UNASSIGNED:Valgus offloader bracing is an effective treatment for improving pain secondary to medial compartment knee osteoarthritis. The literature remains unclear on the effectiveness of valgus offloader braces with regard to functional outcomes and stiffness. Larger prospective randomized trials with consistent outcome assessment tools and consideration of patient compliance would be beneficial to more accurately determine treatment effects of valgus offloader bracing.

PURPOSE/OBJECTIVE:To compare recurrence rates between prospectively collected and retrospectively collected data on primary anterior shoulder dislocations, as this could influence the timing of surgical decision making. METHODS:A comprehensive literature search of Medline, Embase, CINAHL, and hand searches was performed. Recurrence rates of anterior shoulder dislocations were collected from relevant articles, along with follow-up length, age, and gender. An independent sample t test was conducted to evaluate our hypothesis. A multiple linear regression model was used to examine the variance in recurrence rates while controlling for covariates. RESULTS:A total of 1,379 articles were identified, of which 25 were relevant to our study-16 prospective and 9 retrospective. The average rate of recurrence of anterior shoulder dislocations in retrospective studies (mean [M] = 45.2, standard deviation [SD] = 31.67) was not significantly different from that in prospective studies (M = 56.7, SD = 22.55). The 95% confidence interval for the difference of the means ranged from -34.05 to 10.91. After controlling for covariates with the multiple linear regression, only 1.9% of the variance in recurrence rates was due to study type and was not significant (P = .42). The t test performed to evaluate our hypothesis was also not significant t(23) = -1.07, P = .298. CONCLUSIONS:When comparing prospective and retrospective studies, there was no significant difference in recurrence rates of primary anterior shoulder dislocations treated nonoperatively. The average redislocation rate was 56.7% in prospective studies and 45.2% in retrospective studies. Furthermore, the majority of this difference was accounted for by varying rates between age groups. Further research is needed to determine the risk of redislocation in specific age groups, to guide treatment decisions based on varying risk. LEVEL OF EVIDENCE/METHODS:Systematic review of Level II and III studies.

The optimal entry point for antegrade intramedullary nailing of femoral shaft fractures remains controversial. The purpose of this systematic review was to determine whether there is a difference in operative parameters, healing, and functional outcome when comparing the greater trochanter (GT) and piriformis fossa (PF) entry points. A systematic search of multiple databases and 3 major orthopedic meetings (American Academy of Orthopaedic Surgeons, Canadian Orthopaedic Association, and Orthopaedic Trauma Association) was conducted. Four studies (570 patients) met the inclusion criteria. Mean patient age was 34.5 years, and 60.4% were male. The GT entry point was associated with significantly shorter operative (mean difference [MD], -20.05 minutes [95% confidence interval (CI), -23.09 to -17.02]; P<.00001) and fluoroscopy times (MD, -24.55 seconds [95% CI, -43.23 to -5.86]; P=.01). There was no significant difference in nonunion (risk ratio [RR], 0.74 [95% CI, 0.35 to 1.58]; P=.44) and delayed union rates (RR, 0.94 [95% CI, 0.41 to 2.14]; P=.88) between the 2 entry points. Heterogeneity in outcome measures reported prevented pooled analysis of functional outcomes. This review supports the use of the GT entry point during antegrade nailing of femoral shaft fractures over the PF entry point, with regard to shorter operative and fluoroscopy times. Healing and complication rates were not related to the entry point. Further study is required to determine the effect of each entry point on the surrounding soft tissue structures and ultimately its impact on postoperative function.