Faculty Bibliography

PURPOSE/OBJECTIVE:The purpose of the current study is to systematically review the current evidence in the literature to ascertain rates of return to play following ACLR with extra-articular augmentation (EA). METHODS:A literature search was performed based on the PRISMA guidelines. Studies were included if they evaluated and reported on return to play following ACLR + EA, case studies and review articles were excluded. The outcomes measured focused on 1) return to play, 2) return to play at the same or higher level, and 3) timing of return to play. Qualitative analysis and quantitative analysis were performed using SPSS. RESULTS:Overall, 19 studies met our inclusion criteria. Among those undergoing primary ACLR, 82.8%-100% were able to return to play, with 64%-100% able to return at the same/higher level of play. All professional athletes were able to return to play and 85.7%-100% able to return to the same level of pre-operative play. The mean time to return was 5-11 months in those undergoing primary ACLR + EA. Among those undergoing revision ACLR, 50-88.4% were able to return to play, with 41.5%-77.8% able to return at the same/higher level of play. None of the included 5 studies comparing rate of return to play between ACLR + EA or ACLR found a significant difference between them. However, among the 6 studies comparing rate of return to play at the same level ACLR + EA or ACLR, 2 studies found a significant difference in rate of return to play at the same/higher level in those undergoing ACLR + EA. CONCLUSION/CONCLUSIONS:ACLR + EA resulted in high levels of return to play in those undergoing either primary or revision ACLR. Additionally, comparative studies of patients undergoing primary ACLR with or without EA reported similar high rates of return to play.

Meniscal pathology is one of the most common structural knee issues seen and managed by the orthopaedic surgeon. An ever-evolving armamentarium of management options exists that are geared toward the elimination of symptoms and restoration of normal knee function. A common theme among these management options is to preserve meniscal tissue whenever possible through repair or minimization of meniscal excision, as the literature has shown that the loss of meniscal tissue can significantly alter the distribution of forces and contact stresses on knee articular cartilage, thus predisposing the joint to degenerative osteoarthritis. In the setting of meniscal injuries or insufficiency, various advances in repair techniques, use of meniscal allografts, and use of biologic adjuvants have been reported to help preserve and/or attempt to restore the native kinematic properties of the knee. It is important to explore meniscal function, its associated pathologies, and currently available treatment options that are supported by short-term and long-term clinical data.

BACKGROUND/UNASSIGNED:It is unclear whether leukocyte-poor (LP) or leukocyte-rich (LR) varieties of platelet-rich plasma (PRP) as an adjuvant to arthroscopic rotator cuff repair (ARCR) result in improved tendon healing rates. PURPOSE/UNASSIGNED:To perform a network meta-analysis of the randomized controlled trials in the literature to ascertain whether there is evidence to support the use of LP- or LR-PRP as an adjunct to ARCR. METHODS/UNASSIGNED:The literature search was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Randomized controlled trials comparing LP- or LR-PRP with a control alongside ARCR were included. Clinical outcomes, including retears and functional outcomes, were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-score. RESULTS/UNASSIGNED:There were 13 studies (868 patients) included, with 9 studies comparing LP-PRP with a control and 4 studies comparing LR-PRP with a control. LP-PRP was found to significantly reduce the rate of retear and/or incomplete tendon healing after fixation, even among medium-large tears; it also improved outcomes on the visual analog scale for pain, Constant score, and University of California Los Angeles score. LP-PRP had the highest P-score for all treatment groups. LR-PRP did not result in any significant improvements over the control group, except for visual analog scale score for pain. However, post hoc analysis revealed that LP-PRP did not lead to significant improvements over LR-PRP in any category. CONCLUSION/UNASSIGNED:The current study demonstrates that LP-PRP reduces the rate of retear and/or incomplete tendon healing after ARCR and improves patient-reported outcomes as compared with a control. However, it is still unclear whether LP-PRP improves the tendon healing rate when compared with LR-PRP.

BACKGROUND:The aim of this study was to describe associated injuries in cases of distal biceps femoris avulsions (DBFA) as well as the incidence of neurological injury and radiographic abnormalities of the common peroneal nerve (CPN). METHODS:A retrospective chart review was conducted of patients presenting to our office or trauma center with DBFA injuries. Demographic data was obtained as well as mechanism of injury. Assessment of concomitant injuries and presence of neurologic injury was completed via chart review and magnetic resonance imaging (MRI) review. The CPN was evaluated for signs of displacement or neuritis. RESULTS:Sixteen patients were identified (mean age-at-injury 28.6 years, 87.5% male) with DBFA. Three patients (18.8%) sustained their injuries secondary to high energy trauma while 13 (81.3%) had injuries secondary to lower energy trauma. Nine patients (56.3%) initially presented with CPN palsy. All patients presenting with CPN palsy of any kind were found to have a displaced CPN on MRI and no patient with a normal nerve course had a CPN palsy. CONCLUSIONS:This case series demonstrates a strong association between DBFA and CPN palsy as well as multi-ligamentous knee injury (MLKI). These injuries have a higher rate of CPN palsy than that typically reported for MLKI. Furthermore, these findings suggest that CPN displacement on MRI may be a clinically significant indicator of nerve injury. LOE: IV.

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:This study systematically reviewed the literature for outcomes following revision surgery for a failed prior Latarjet procedure. METHODS:Two independent reviewers performed the literature search based on PRISMA guidelines using the EMBASE, MEDLINE, and The Cochrane Library databases. Studies in which the Latarjet procedure was performed as a revision procedure following failed prior shoulder instability surgery were included. Clinical outcomes analyzed were: 1. functional outcomes, 2. recurrent instability, 3. range of motion, and 4. COMPLICATIONS/RESULTS:Statistical analysis was performed using IBM SPSS. RESULTS:There were seven studies with 161 patients (162 shoulders) included. Four studies used a bone-block procedure, three used arthroscopic soft-tissue stabilization, and the mean follow-up was 49.8 months. The most commonly reported functional outcome measure was the Rowe score, with a weighted mean average of 79.7, with 82.9% of patients having good to excellent outcomes. Return to play was possible for 73.8% of patients, with 64.2% of those returning to at least the same level of competition. The overall recurrence rate was 9.5%, with 3.6% and 5.9% experiencing recurrent dislocations and subluxations, respectively. The overall revision rate was 4.2%, with all patients undergoing revisions due to recurrence. There were no reported neurovascular complications. Instability arthropathy was reported in 43.3% of patients. CONCLUSION/CONCLUSIONS:Surgical management following a failed Latarjet procedure results in moderate rates of recurrent instability and has a low intraoperative and postoperative complication rate. Additionally, the results across all techniques appear similar, with no procedure being identified as the gold-standard in the literature. However, there was a concerning rate of instability arthropathy, which may be related to the failure of a bony procedure.

BACKGROUND/UNASSIGNED:Medial patellofemoral ligament (MPFL) reconstruction is being performed more frequently in athletes experiencing recurrent patellar instability. PURPOSE/HYPOTHESIS/UNASSIGNED:The purpose was to systematically review the evidence in the orthopaedic sports medicine literature to determine both the rate and timing of return to play after MPFL reconstruction and the rate of further patellar instability. Our hypothesis was that there would be a high rate of return to play after MPFL reconstruction. STUDY DESIGN/UNASSIGNED:Systematic review. METHODS/UNASSIGNED:A systematic literature search was performed based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, which utilized EMBASE, MEDLINE, and the Cochrane Library databases. Inclusion criteria for literature included clinical studies reporting on return to play after MPFL reconstruction. Rate of return to play, level of return, timing of return, rate of recurrent instability, and patient-reported outcomes were evaluated. Statistical analysis was performed using SPSS. RESULTS/UNASSIGNED:Our review found 27 studies including 1278 patients meeting our inclusion criteria. The majority of patients were women (58%), and the total group had a mean age of 22.0 years and a mean follow-up of 39.3 months. The overall rate of return to play was 85.1%, with 68.3% returning to the same level of play. The average time to return to play was 7.0 months postoperatively. The rate of recurrent instability events following reconstruction was 5.4%. There was an improvement in both mean visual analog scale, pain scores (preoperative: 4.3, postoperative: 1.6) and Tegner activity scores (preoperative: 4.8, postoperative: 5.5). CONCLUSION/UNASSIGNED:The overall rate of return to play was high after MPFL reconstruction for the treatment of recurrent patellar instability. However, a relatively high percentage of those patients were unable to return to their preoperative level of sport. Additionally, there was a moderate time taken to return to play, at approximately 7 months after the procedure.

BACKGROUND/UNASSIGNED:Female athletes have a higher rate of anterior cruciate ligament (ACL) injuries than male athletes; however, the role of age in mediating this injury risk has not been explored. The purpose of this study was to characterize the relationship between age and sex in predicting ACL injury in the pediatric population. HYPOTHESIS/UNASSIGNED:Prepubescent boys are more likely to sustain an ACL injury than prepubescent girls. STUDY DESIGN/UNASSIGNED:Descriptive epidemiological study. LEVEL OF EVIDENCE/UNASSIGNED:Level 4. METHODS/UNASSIGNED:< 0.05. RESULTS/UNASSIGNED:< 0.0001). CONCLUSION/UNASSIGNED:Prepubescent boys (aged <12 years) are more likely to sustain an ACL injury than same-aged female peers. CLINICAL RELEVANCE/UNASSIGNED:This study demonstrates that the risk of ACL injury varies with age and sex throughout childhood and adolescence, further guiding treatment and prevention for these pediatric athletes.