Faculty Bibliography

BACKGROUND:With the increasing utilization of patient satisfaction as a metric for clinical care, there is growing interest in techniques that can be used to improve satisfaction in patients undergoing surgery. The purpose of this trial was to assess the impact of day-of-surgery video and phone calls on patient satisfaction. METHODS:We enrolled 251 patients undergoing outpatient orthopaedic surgery with 3 participating surgeons. Surgeons were randomized to 1 of 3 patient communication modalities: no contact (standard of care), phone call, or video call. Several hours following discharge on the day of surgery, the surgeons contacted patients according to their assigned treatment group. At the initial postoperative office visit, satisfaction outcomes were assessed using the Consumer Assessment of Healthcare Providers and Systems Surgical Care (S-CAHPS) survey and an additional satisfaction questionnaire. RESULTS:Fifty-nine (97%) of 61 patients in the no-contact group, 118 (99%) of 119 patients in the phone group, and 71 (100%) of 71 patients in the video group completed follow-up assessment. The S-CAHPS top-box response rate in both the video group (0.86 ± 0.14, p < 0.001) and the phone group (0.84 ± 0.17, p < 0.001) was greater than in the no-contact group (0.68 ± 0.26). When asked to rate satisfaction with overall care, a greater proportion of patients in the video group (85.9%) gave the top-box response compared with both the phone group (71.8%, p = 0.040) and the no-contact group (60.7%, p = 0.002). Among the patients in the video group, 62.0% indicated that they would prefer a video call in future encounters with their surgeon compared with 1.8% of patients in the no-contact group (p < 0.001) and 1.7% of patients in the phone group (p < 0.001). CONCLUSIONS:Phone and video calls following discharge are an effective way of enhancing patient satisfaction with the clinical care experience as measured by the S-CAHPS survey. In terms of satisfaction with overall care, video calls may be superior to phone calls. LEVEL OF EVIDENCE/METHODS:Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Background: Literature on glenohumeral dislocations has focused on younger patient populations due to high recurrence rates. However, the spectrum of injuries sustained in younger versus older patient populations is reported to be quite different. Objective: To describe MRI findings and management of anterior shoulder instability in the aging (≥60 years) population. Methods: Shoulder MRIs of anterior glenohumeral dislocators aged ≥40 were subdivided into <60 or ≥60 age groups, and reviewed by two musculoskeletal radiologists for: Hill-Sachs lesion, other fracture, glenoid injury, capsulolabral injury, rotator cuff tear, muscle atrophy, and axillary nerve injury. Fischer exact and logistic regression evaluated for significant differences between cohorts, and inter-reader agreement was assessed. Surgical management was recorded, if available. Results: 104 shoulder MRIs (40-79 years, mean=58.3, 52 females, 52 males) were reviewed (N=54 age <60, N=50 age ≥60). Acute high-grade or full-thickness supraspinatus (64.0% vs. 37.0%, p=0.001), infraspinatus (28.0% vs. 14.8%, p=0.028), and subscapularis tears (22.0% vs. 3.7%, p=0.003) were more common in the ≥60 group. Hill-Sachs lesions were more common in the <60 group (81.5% vs. 62.0%, p=0.046). Greater tuberosity fractures were seen in 15.3% of the overall cohort, coracoid fractures in 4.8%, and axillary nerve injuries in 16.3%. Inter-reader concordance was 88.5-89.4% for rotator cuff tears, and 89.4-97.1% for osseous injury. The <60 group had rotator cuff repair in 11/37 subjects (29.7%), and labral repair in 11/37 (29.7%), while the ≥60 group underwent rotator cuff repair in 17/36 (47.2%), reverse shoulder arthroplasty in 6/36 (16.7%), and labral repair in 6/36 (16.7%). Conclusion: Radiologists should have a high index of suspicion for acute rotator cuff tears in anterior shoulder instability, especially in aging populations. Greater tuberosity or coracoid fractures and axillary nerve injury occur across all ages, while Hill-Sachs injuries are more common in younger patients. Clinical Impact: Acute, high-grade or full-thickness rotator cuff tears are seen with higher frequency in older populations after anterior glenohumeral dislocation in the elderly. Osseous and nerve injuries are important causes of patient morbidity that, if not carefully sought out, may be overlooked by the interpreting radiologist on routine imaging.

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.

BACKGROUND/UNASSIGNED:Shoulder arthroscopy is one of the most commonly performed orthopaedic procedures used to treat a variety of conditions, with >500,000 procedures performed each year. PURPOSE/UNASSIGNED:To systematically review the randomized controlled trials (RCTs) on pain control after shoulder arthroscopy in the acute postoperative setting and to ascertain the best available evidence in managing pain after shoulder arthroscopy to optimize patient outcomes. STUDY DESIGN/UNASSIGNED:Systematic review and meta-analysis. METHODS/UNASSIGNED:A systematic review of the literature was performed based on the PRISMA (Preferred Reporting Items for Systematic Meta-Analyses) guidelines. Studies were included if they were RCTs evaluating interventions to reduce postoperative pain after shoulder arthroscopy: nerve blocks, nerve block adjuncts, subacromial injections, patient-controlled analgesia, oral medications, or other modalities. Meta-analyses and network meta-analyses were performed where appropriate. RESULTS/UNASSIGNED:< .05). No benefit was found in any of the studies evaluating subacromial infusions. CONCLUSION/UNASSIGNED:Continuous interscalene block resulted in the lowest pain levels at most time points, although this was not significantly different when compared with the other nerve blocks. Additionally, nerve block adjuncts may prolong the postoperative block time and improve pain control. There is promising evidence for some oral medications and newer modalities to control pain and reduce opioid use. However, we found no evidence to support the use of subacromial infusions or patient-controlled analgesia.

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.

INTRODUCTION:There has been controversy regarding whether headgear use in women's lacrosse will affect the rate of head and musculoskeletal injuries. The purpose of this study was to investigate the effect of mandated headgear use on the rate of head and musculoskeletal injuries in high school women's lacrosse. METHODS:This was a prospective cohort study of eight high school women's lacrosse teams and their game op-ponents who were mandated to wear F3137 headgear for the 2017 and 2018 seasons. Athletic trainers documented all injuries that occurred as a result of participation on the lacrosse teams. Injury rates in the headgear cohort were compared to a retrospective (control) cohort from the High School Reporting Information Online injury data reports. RESULTS:Over the study period, 17 total injuries were reported in the headgear cohort during 22,397 exposures for an injury rate of 0.76 injuries per 1,000 athlete-exposures. The headgear cohort demonstrated significant decreases in rates of in-game head and face injury (RR 0.141, 95% CI [0.004, 0.798]), in-game concussion (RR 0.152, 95% CI [0.004, 0.860]), and practice trunk and extremity injury (RR 0.239, 95% CI [0.049, 0.703]) when compared to the control cohort. CONCLUSION:Mandated use of headgear was shown to be effective at lowering the rate of head or face injury and concussions in women's lacrosse. Additionally, mandated headgear use was also shown to lower the rate of injury to body locations other than the head or face during practice. To our knowledge, this is the first study to demonstrate a decrease in injury rates associated with ASTM approved headgear in women's lacrosse.

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.