Faculty Bibliography

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.

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.

Anterior cruciate ligament (ACL) injuries in children and adolescents are increasing every year. This patient population has unique risk factors and treatment considerations depending on specific patient factors and the level of bone maturity. This review summarizes the current data regarding pertinent features of the history and physical exam, indications for nonoperative management, assessment of skeletal maturity, and the surgical management of patients based on their unique physeal considerations. To prevent physeal injury, the surgical considerations differ from the adult population with respect to graft choice, location of fixation, reconstruction technique, and postoperative protocol. Orthopedic surgeons should be familiar with the various surgical techniques, graft selection choices, postoperative rehabilitation programs, controversies, and outcomes associated with the management of ACL injuries in the pediatric population.

BACKGROUND/UNASSIGNED:The gold-standard method for collecting patient-reported outcomes (PROs) is the prospective assessment of preoperative to postoperative change. However, this method is not always feasible because of unforeseen cases or emergencies, logistical and infrastructure barriers, and cost issues. In such cases, a retrospective approach serves as a potential alternative, but there are conflicting conclusions regarding the reliability of the recalled preoperative PROs after orthopaedic procedures. PURPOSE/UNASSIGNED:To assess the agreement between prospectively and retrospectively collected PROs for a common, low-risk procedure. STUDY DESIGN/UNASSIGNED:Cohort study (Diagnosis); Level of evidence, 3. METHODS/UNASSIGNED:Patients who underwent arthroscopic rotator cuff repair between May 2012 and September 2017 at the study institution were identified. All of the patients completed the American Shoulder and Elbow Surgeons (ASES) Standard Shoulder Assessment Form preoperatively at their preassessment appointment. Patients were then contacted in the postoperative period and asked to recall their preoperative condition while completing another ASES form. RESULTS/UNASSIGNED:= .068). Greater age at the time of recall, a shorter symptomatic period before surgery, and less severe preoperative shoulder dysfunction were associated with a greater difference between preoperative ASES and recall ASES. CONCLUSION/UNASSIGNED:Retrospectively reported PROs are subject to significant recall bias. Recalled PROs were almost always lower than their prospectively recorded counterparts. Recalled PROs are more likely to be accurate when reported by younger patients, those with a longer duration of symptoms, and those with more severe preoperative conditions.

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.

Orthobiologics continue to be one of the most discussed and trending topics in orthopaedic surgery today. Pathology of tendons, ligaments, bone, cartilage, and meniscal tissue are all theoretically treatable with biologics. Ultimately, the hope for biologics is to provide symptom relief and improve tissue healing with the potential to treat some conditions without the need for surgery. It is important to review the current state of biologic therapies available for musculoskeletal disease, discuss government regulations and barriers to use, and, finally, examine current research in biologics and what the future may hold.

PURPOSE/OBJECTIVE:The purpose of this study is to present one institution's experience managing chronic exertional compartment syndrome (CECS) and to identify patient and surgical characteristics associated with better outcomes following open surgical management of CECS with specific emphasis on return to sports. METHODS:Fifteen patients (10 male, 5 female) who underwent open fasciotomy for CECS with a minimum of 1-year follow-up were included. Chart review was performed to obtain patient demographics, medical and surgical history, presenting symptomatology, and surgical details of fasciotomy. Outcomes were assessed using follow-up questionnaires that consisted of Tegner Activity Scale, EuroQol-5D (EQ5D) index score, EQ-5D rating scale, symptom resolution, patient satisfaction, and return to sports. RESULTS:The mean patient age at the time of surgery was 28.1 years (range: 17 to 49 years). At mean follow-up of 2.7 years (range: 1.0 to 5.1 years), five patients reported complete resolution of symptoms, eight reported improvement (but not resolution) of symptoms, one reported no change in symptoms, and one reported worsening of symptoms. The mean Tegner Activity Score was 6.7 (range: 1 to 9) prior to injury and 4.7 (range: 1 to 9) postoperatively. Patients with any preoperative symptoms at rest had significantly lower Tegner before score (4.0 vs. 7.1, p = 0.036) and EQ5D rating (50.0 vs. 83.5, p = 0.04) compared to those that only experienced symptoms with activity. Patients that had prior surgery, including fasciotomy, had significantly lower EQ-5D rating than patients with no history of prior lower extremity surgery (56.7 vs. 84.6, p = 0.045). Although 10 (66%) patients were able to return to sports, only four (27%) of them were able to return to their prior level of sport. The overall satisfaction rate was 87%. CONCLUSION/CONCLUSIONS:Although open surgical fasciotomy for treatment of chronic exertional compartment syndrome leads to high rates of symptom improvement or resolution, fewer patients are able to return to their prior level of sports. Presence of symptoms at rest, presence of bilateral symptoms, and history of prior lower extremity surgery all portend worse outcomes.

BACKGROUND:Despite advances in technology, graft rupture rates reported in the literature following anterior cruciate ligament (ACL) surgery range from 1.8% to 18%. Recent anatomical studies have identified a lateral structure, the anterolateral ligament (ALL), as a potential source of residual pivoting following ACL reconstruction. The purpose of this report is to review the history surrounding the ALL and recent anatomic studies, identify its biomechanical and clinical implications, and develop a practical approach to utilizing it during ACL reconstruction. METHODS:An extensive review of the historical and current literature surrounding the identification of the ALL, its biomechanical function, reconstruction, and outcomes of ALL reconstruction was performed. DISCUSSION/CONCLUSIONS:After the storm of media coverage surrounding the "new ligament" known as the ALL, much attention was focused on cadaveric dissection, biomechanical analysis, and reconstruction of this structure. Several techniques have been described, and currently studies are being performed both retrospectively and prospectively to evaluate the added benefit of ALL reconstruction to the rotational stability of the knee and outcomes after ACL reconstruction. CONCLUSION/CONCLUSIONS:The ALL is a lateral-based structure that provides rotational stability to the knee in the presence of ACL deficiency. Reconstruction of this ligament may provide added benefit to stability and outcomes following ACL reconstruction in certain patient populations. Further randomized controlled trials are needed to elucidate the true benefit of ALL reconstruction and those patients who should undergo this added procedure.

PURPOSE/OBJECTIVE:The purpose of this study is to present one institution's experience managing chronic exertional compartment syndrome (CECS) and to identify patient and surgical characteristics associated with better outcomes following open surgical management of CECS with specific emphasis on return to sports. METHODS:Fifteen patients (10 male, 5 female) who underwent open fasciotomy for CECS with a minimum of 1-year follow-up were included. Chart review was performed to obtain patient demographics, medical and surgical history, presenting symptomatology, and surgical details of fasciotomy. Outcomes were assessed using follow-up questionnaires that consisted of Tegner Activity Scale, EuroQol-5D (EQ5D) index score, EQ-5D rating scale, symptom resolution, patient satisfaction, and return to sports. RESULTS:The mean patient age at the time of surgery was 28.1 years (range: 17 to 49 years). At mean follow-up of 2.7 years (range: 1.0 to 5.1 years), five patients reported complete resolution of symptoms, eight reported improvement (but not resolution) of symptoms, one reported no change in symptoms, and one reported worsening of symptoms. The mean Tegner Activity Score was 6.7 (range: 1 to 9) prior to injury and 4.7 (range: 1 to 9) postoperatively. Patients with any preoperative symptoms at rest had significantly lower Tegner before score (4.0 vs. 7.1, p = 0.036) and EQ5D rating (50.0 vs. 83.5, p = 0.04) compared to those that only experienced symptoms with activity. Patients that had prior surgery, including fasciotomy, had significantly lower EQ-5D rating than patients with no history of prior lower extremity surgery (56.7 vs. 84.6, p = 0.045). Although 10 (66%) patients were able to return to sports, only four (27%) of them were able to return to their prior level of sport. The overall satisfaction rate was 87%. CONCLUSION/CONCLUSIONS:Although open surgical fasciotomy for treatment of chronic exertional compartment syndrome leads to high rates of symptom improvement or resolution, fewer patients are able to return to their prior level of sports. Presence of symptoms at rest, presence of bilateral symptoms, and history of prior lower extremity surgery all portend worse outcomes.