Faculty Bibliography

Purpose/UNASSIGNED:To examine finger, thumb, hand, wrist, and forearm fractures in the National Hockey League (NHL) and determine: (1) basic demographic data, (2) return to sport (RTS) rates, (3) performance after RTS, and (4) the difference in RTS between players treated operatively versus conservatively. Methods/UNASSIGNED:NHL players with finger, thumb, hand, wrist, and forearm fractures between the 1995-1996 and 2014-2015 seasons were identified through team injury reports and archives on public record. Player demographics, RTS rate, games played per season, and performance score for each player were recorded and compared between the preinjury season and one season following injury. Results/UNASSIGNED:A total of 247 total NHL players with hand, wrist, and forearm fractures were identified, consisting of 30.8% finger, 38.5% hand, 13.8% thumb, 14.6% wrist, and 2.4% forearm fractures. Defenseman comprised the majority of players (40.1%). The overall RTS rate was 98.0%, with no significant difference between players with surgery or between injury location groups. In total, 52 players (21.1%) underwent surgery with no significant correlation of surgery rates based on fracture location. The mean number of missed games was 13.8 ± 9.9, with players sustaining wrist and forearm fractures missing the largest number of games (21.6 ± 17.7and 22.8 ± 7.5 games missed, respectively). There was no significant change in games played or performance scores 1 year after injury for players with any of the fracture types compared with baseline preoperative games played and performance. Conclusions/UNASSIGNED:NHL players have a high RTS rate following hand, wrist, and forearm fractures. Players were able to return to preinjury performance within 1 year, regardless of treatment or type of fracture. Level of Evidence/UNASSIGNED:Level IV, case series.

Purpose/UNASSIGNED:To evaluate clinical and biomechanical outcomes after knee extensor mechanism reconstruction (KEMR). Methods/UNASSIGNED:Patients who underwent KEMR at our institution from 2011 to 2018 were identified. Patient-reported outcomes (Kujala, Lysholm, Tegner Activity Scale) were compiled at clinical follow-up. Isokinetic testing was conducted using the BioDex system 4 pro dynamometer at slow (60°/s), intermediate (180°/s), and fast (300°/s) speeds in a 9-patient subset. Results/UNASSIGNED: = .038). Conclusions/UNASSIGNED:Patients undergoing KEMR in this study have significantly improved clinical outcomes despite having strength deficits that persist postoperatively. Level of Evidence/UNASSIGNED:Therapeutic Case Series, Level IV.

PURPOSE/OBJECTIVE:The purpose of the current study is to meta-analyze the current evidence in the literature to compare arthroscopic Bankart repair versus conservative management for first-time anterior shoulder dislocation. METHODS:A literature search of MEDLINE, EMBASE and The Cochrane Library, was performed based on the PRISMA guidelines. Prospective studies comparing arthroscopic Bankart repair versus conservative management as treatment for first-time anterior shoulder dislocation were included. Recurrence, further treatment, and return to play were compared, with all statistical analysis performed using Review Manager Version 5.3. A p-value of < 0.05 was considered statistically significant. RESULTS:= 0, p = 0.002). CONCLUSION/CONCLUSIONS:Arthroscopic Bankart repair resulted in a 7-fold lower recurrence rate and a higher rate of return to play compared to conservative management. Thus, arthroscopic Bankart repair may be advisable to perform routinely for first-time dislocators who participate in sports.

Introduction/UNASSIGNED:The traditional nociceptive approach to pain identifies the mind and body as functionally separate. However, the biopsychosocial model accounts for the impact of social, psychological and physical factors on the patient experience. The purpose of this study was to determine the relationship between diagnosis, physical disability, and psychological distress among patients with anterior knee pain-one of the most common complaints in an orthopedic clinic. Methods/UNASSIGNED:This was a single-center, cross-sectional study. Patients presenting for initial evaluation of knee pain completed the Pain Catastrophizing Scale, Kujala Anterior Knee Pain Scale, and SF-12 questionnaires. Statistical analysis was performed using SPSS Version 24. Results/UNASSIGNED:207 patients, 108 (52.2%) females and 99 (47.8%) males, with a mean age 44.5 ± 15.4 years were enrolled. The osteoarthritis cohort had the highest pain catastrophizing score (17 ± 14.5), lowest Kujala score (48.3 ± 18.1), lowest SF-12 PCS (37.5 ± 8.3), and lowest SF-12 MCS (50.8 ± 11.0). Across all diagnoses, there was a statistically significant negative correlation between the total Pain Catastrophizing Score (PCS) and the Kujala, SF-12 Physical, and SF-12 Mental Component Scores. Bivariate and multivariate analysis demonstrated a correlation between PCS and duration of symptoms and African-Americans. The Kujala and SF-12 PCS demonstrated a statistically significant correlation with age, smoking, and the Asian Indian ethnicity. The SF-12 MCS showed a significant relationship with the Asian Indian ethnicity. Bivariate analysis also showed a statistically significant relationship between the SF-12 PCS and the SF-12 MCS. Conclusion/UNASSIGNED:Knee pain patients presenting to an orthopedic sports medicine clinic demonstrate diminished physical quality of life and psychological reserves. This study determined an association between catastrophizing behavior and other patient reported outcomes measuring pain, physical distress, quality of life and mental/emotional well-being. To optimize patient outcomes, psychological domain should be managed contemporaneously to orthopedic pathology.

OBJECTIVE:To report radiographic features and complications of coracoclavicular ligament reconstruction and the association of radiographic features with symptomatology. MATERIALS AND METHODS/METHODS:Retrospective picture archiving and communication system query (1/2012-8/2018) identified subjects with prior coracoclavicular ligament reconstruction. Post-operative radiographs were reviewed with attention to the following: (1) acromioclavicular alignment, (2) coracoclavicular width, (3) distal clavicular osteolysis, (4) osseous tunnel widening, and (5) hardware complication or fracture. Medical records were reviewed to determine purpose of imaging follow-up (symptomatic versus routine). Statistical analysis determined associations between binary features and outcomes, and inter-reader agreement. RESULT/RESULTS:Review of 55 charts identified 32 subjects (23 male, 9 females; age range 24-64; imaged 1-34 months following surgery) meeting inclusion criteria. Loss of acromioclavicular reduction was the most common imaging finding (n = 25, 78%), with 76% progressing to coracoclavicular interval widening. Distal clavicular osteolysis was seen in 21 cases (66%) and was significantly associated with loss of acromioclavicular joint reduction (p = 0.032). Tunnel widening occurred in 23 patients (82%) with more than one follow-up radiograph. Six (19%) had hardware complication or fracture. No radiographic feature or complication had significant correlation with symptomatology (p values 0.071-0.721). Inter-reader agreement was moderate to substantial for coracoclavicular interval widening and hardware complication, fair to substantial for tunnel widening, and fair to moderate for loss of acromioclavicular reduction and distal clavicular osteolysis. CONCLUSION/CONCLUSIONS:Loss of acromioclavicular joint reduction, coracoclavicular interval widening, distal clavicular osteolysis, and tunnel widening are common radiographic features after coracoclavicular ligament reconstruction; however, they do not necessarily correlate with symptomatology.

BACKGROUND:Given the relatively low incidence of infection, the role of prophylactic antibiotics for infection prevention in arthroscopic surgery is unclear. Without established evidence-based guidelines, it becomes important to understand the trends and common practices in the field. HYPOTHESIS/OBJECTIVE:We hypothesized that a majority of surgeons would use preoperative intravenous antibiotics and that postoperative antibiotics would be rarely used. METHODS:A web-based link containing a questionnaire on perioperative antibiotic use for arthroscopic surgery of the knee and shoulder was sent to sports medicine surgeons at several institutions in the New York tri-state region. The questionnaire addressed antibiotic use both preoperatively and postoperatively and the type of medication used. RESULTS:During the study period, 86 surgeons responded to the knee portion of the survey and 139 surgeons responded to the shoulder portion of the survey. A significant majority (94.24% for knee and 93.02% for shoulder) of the respondents routinely preferred to use preoperative intravenous antibiotics for both shoulder and knee surgery. The antibiotic of choice for a majority of the respondents was cefazolin (98.1% respondents). In patients with penicillin allergies, most preferred to use clindamycin. Most respondents (84.5%) did not routinely use postoperative oral antibiotics. CONCLUSION/CONCLUSIONS:There is significant consensus among orthopedic surgeons performing knee and shoulder arthroscopic surgery regarding use of preoperative antibiotics, with the majority routinely prescribing preoperative intravenous antibiotics for prophylaxis and cefazolin being the most commonly used antibiotic. The majority of surgeons prefer not to use postoperative oral antibiotics. CLINICAL RELEVANCE/CONCLUSIONS:This study describes the current trends in the use of perioperative antibiotics among orthopedic surgeons for routine arthroscopic procedures in the shoulder and knee.

Injuries to the posterolateral corner of the knee are rare but significant injuries that occur most commonly in the context of a multiligamentous knee injury. The structures of the posterolateral corner serve as a primary restraint to varus and external rotation and as a secondary restraint to posterior translation. Contemporary reconstructive techniques focus on anatomic restoration of function of the posterolateral corner and excellent long-term results have been demonstrated.

Meniscus surgery has dramatically changed over the last 20 years. This article reviews the advances and current evidence in meniscus repair.

Bone tunnel-related issues are frequently encountered during revision anterior cruciate ligament reconstruction. Tunnel malposition, widening, and interference pose unique challenges that may complicate surgery and compromise outcomes. Preoperative planning is critical to identify and characterize bone tunnel pathology. Choice of technique, graft, and implant are influenced by numerous patientrelated and technical factors. Despite this complexity, a variety of strategies are available to help manage and navigate common bone tunnel problems. Among these include alternative techniques for reaming, bone grafting, and fixation. This review provides a modern evidence-based and practical guide to equip the orthopedic surgeon with a systematic approach to the evaluation and management of bone tunnel-related issues encountered during revision anterior cruciate ligament reconstruction.