Faculty Bibliography

BACKGROUND:Patient-reported allergies (PRAs) are often stigmatized as a potential nonmodifiable risk factor for increased pain and worse functional outcomes following surgery. However, there is a dearth of literature directly assessing the impact of PRAs on outcomes in sport surgeries such as medial patellofemoral ligament reconstruction (MPFLR). The purpose of our study was to determine whether PRAs were associated with worse outcomes following MPFLR. METHODS:We conducted a retrospective review of patients who underwent MPFLR at our institution from 2011 to 2019. Patients were included if they had at least 12 months of follow-up. PRAs were obtained from preoperative medical assessments and categorized by drug class. Demographic and perioperative data were obtained from electronic medical records. Postoperative outcomes were measured using a telephone survey and included recurrent instability, Visual analog scale (VAS) for pain, VAS for sports, Kujala score, MPFL-Return to Sport after Injury (MPFL-RSI) score, and overall satisfaction score. Multiple linear regression was used to determine association between PRAs and outcome measures, and p-values less than 0.05 were considered significant. RESULTS:The cohort included 141 MPFLR. Most patients were female (98, 70%) with an average age of 25 years (range 12-56 years). Average follow-up time was 47 months. Forty-seven patients (33%) reported at least one PRA. There were no significant differences in postoperative pain, functional outcomes, satisfaction, or return to sport between patients with or without PRAs (all p > 0.05). Absence of antibiotic PRAs was predictive of higher VAS (p < 0.007), but there were no other differences. There were no significant differences in outcomes between patients without PRAs, PRAs without a concomitant psychiatric disorder, or PRAs with a concomitant psychiatric disorder (all p > 0.05). CONCLUSIONS:In conclusion, PRAs with or without concomitant psychiatric diagnoses are not associated with worse postoperative pain, functional outcomes, or satisfaction following MPFLR with allograft, dispelling common misconceptions that increased number of allergies or psychiatric diagnoses lead to inferior surgical outcomes. Presence of antibiotic allergies was associated with lower VAS postoperative pain score. Future research should investigate the relationship between PRAs and other surgeries in the field of sports medicine.

Entrapment neuropathies of the shoulder most commonly involve the suprascapular or axillary nerves, and they primarily affect the younger, athletic patient population. The extremes of shoulder mobility required for competitive overhead athletes, particularly in the position of abduction and external rotation, place this cohort at particular risk. Anatomically, the suprascapular nerve is most prone to entrapment at the level of the suprascapular or spinoglenoid notch; the axillary nerve is most prone to entrapment as it traverses the confines of the quadrilateral space.Radiographs should be ordered as a primary imaging study to evaluate for obvious pathology occurring along the course of the nerves or for pathology predisposing the patient to nerve injury. Magnetic resonance imaging plays a role in not only identifying any mass-compressing lesion along the course of the nerve, but also in identifying muscle signal changes typical for denervation and/or fatty atrophy in the distribution of the involved nerve.

BACKGROUND/UNASSIGNED:Performing open subpectoral biceps tenodesis in overhead athletes with a superior labrum anterior to posterior (SLAP) tear may affect their ability to return to overhead sports. PURPOSE/UNASSIGNED:To investigate clinical outcomes in overhead athletes undergoing biceps tenodesis for the treatment of symptomatic, isolated SLAP tears involving the biceps-labral complex. STUDY DESIGN/UNASSIGNED:Case series; Level of evidence, 4. METHODS/UNASSIGNED:value of <.05 was considered to be statistically significant. RESULTS/UNASSIGNED:The current study included 44 overhead athletes. The mean age was 34.9 years (range, 16-46 years), 79.5% were male, and the mean follow-up was 49.0 months (range, 18-107 months). Overall, 81.8% of patients returned to play their overhead sport after biceps tenodesis, and 59.1% of patients returned to the same or higher level of play. It took patients, on average, 8.7 months to return to play after biceps tenodesis. The mean SLAP-RSI score was 69.4, and 70.5% of patients passed the SLAP-RSI threshold of 56. The mean ASES score, VAS score, SSV, and satisfaction were 92.0, 0.8, 80.6, and 87.9%, respectively. No patients in our cohort required revision surgery. CONCLUSION/UNASSIGNED:This study found that athletes undergoing biceps tenodesis for the treatment of a symptomatic, isolated SLAP tear had a high rate of return to play, good functional outcomes, and a low rate of revision surgery.

Despite multiple advances in techniques for posterior cruciate ligament reconstruction (PCL-R), residual posterior laxity continues to be a commonly reported complication. Multiple studies demonstrated a decreased or flat posterior tibial slope, increases posterior laxity, and forces placed across the native and reconstructed PCL. Anterior opening wedge high tibial osteotomies (aOW-HTO) can be used to increase posterior tibial slope, thereby reducing tibial sag and posterior laxity. Depending on the technique used, anterior opening wedge osteotomies can lead to changes in patellar height, affecting patient pain and satisfaction. The purpose of this article is to describe a technique for an aOW-HTO with a tibial tubercle osteotomy and concomitant PCL-R to increase the posterior tibial slope while minimizing changes to patellar height.

IMPORTANCE/OBJECTIVE:There have been several recent systematic reviews of quadriceps tendon autografts (QT), which have not shown any significant difference in outcomes between QT and hamstring tendon autograft (HS) for ACL reconstruction (ACLR). However, several recent comparative studies have been published comparing QT to HS for ACLR. AIM/OBJECTIVE:The purpose of this study is to perform a systematic review and meta-analysis of the studies comparing QT to HS for ACLR. EVIDENCE REVIEW/METHODS:Two independent reviewers performed the literature search based on the PRISMA guidelines, with a senior author arbitrating discrepancies. Cohort studies comparing QT with HS were included. FINDINGS/RESULTS:There were 15 studies comparing 611 patients with QT to 543 patients with HS, with a mean of 27.4 months follow-up. QT resulted in a significantly lower rate of graft re-rupture (2.5% vs 8.7%, p = 0.01), and donor site morbidity (17.6% vs 26.2%, p = 0.02). There was a significant difference in favour of QT for the positive pivot shift test (Grade I/II: 15.8% vs 23.0%, p = 0.02), but not in the rate of the positive Lachman test (Grade I/II: 18.3% vs 26.7%, p = 0.16). Additionally, there was no difference in the side to side difference in knee stability (1.8 mm vs 2.0 mm, p = 0.48). Functionally, both grafts had similar functional outcomes in terms of the IKDC score (88.0 vs 87.9, p = 0.69), and Lysholm score (89.3 vs 87.6, p = 0.15). CONCLUSIONS AND RELEVANCE/CONCLUSIONS:Our study showed that QT has a lower re-rupture rate than HS in ACLR, with lower donor site morbidity. QT appeared to be slightly better for residual pivot shift, but there was no difference in patient-reported outcomes. LEVEL OF EVIDENCE/METHODS:III.

Anterior cruciate ligament (ACL) injuries are one of the most common and debilitating injuries experienced by athletes. While many patients successfully undergo ACL reconstructions, long-term failure rates have been reported between 2% to 27% resulting in the need for revisions. One of the main causes for the failure of ACL reconstruction is osseous malalignment (coronal versus sagittal). This review discusses the pathology behind osseous malalignment and provides insights into the origins that helped advance our understanding of our treatment, the high tibial osteotomy.

PURPOSE/OBJECTIVE:The purpose of the current study is to compare the outcomes of open subpectoral biceps tenodesis (BT) to arthroscopic repair (AR) for SLAP tears in patients under the age of 30 years. METHODS:A retrospective review of patients under the age of 30 years who underwent either isolated BT or AR for a diagnosis of a SLAP tear between 2011 and 2019 was performed. Patients were included if they were >16 years old at the time of surgery, had an isolated SLAP tear involving instability of the biceps-labral anchor (types II-IV), were skeletally mature, and had a minimum follow-up of 12 months. The American Shoulder & Elbow Surgeons score, visual analog scale, Subjective Shoulder Value, patient satisfaction, willingness to undergo surgery again, revisions, and return to play (RTP) were evaluated. A P value of <.05 was considered statistically significant. RESULTS:Our study included 103 patients in total; 29 patients were treated with BT, and 74 were treated with AR. The mean age was 24.8 years, and the mean follow-up duration was 60 months. At final follow-up, there was no difference between treatment groups in any of the functional outcome measures assessed (P > .05). Overall, there was no significant difference in the total rate of RTP (BT: 76.3%, AR: 85%; P = .53), timing of RTP (BT: 8.8 months, AR: 9.4 months; P = .61), and total rate of RTP among overhead athletes (BT: 84.2%, AR: 83.3%; P > .99). Among those undergoing AR, 9 required a revision procedure (11.5%) compared to none treated with BT (P = .11). CONCLUSIONS:In patients under the age of 30 years with a symptomatic isolated SLAP tear, BT may be a reliable alternative to AR. LEVEL OF EVIDENCE/METHODS:Level III, retrospective comparative study.

OBJECTIVES/OBJECTIVE:An isolated medial patellofemoral ligament (MPFL) reconstruction (MPFLR) has been demonstrated to be an effective treatment option in the prevention of patellar instability, but there is growing support for performing a tibial tubercle osteotomy (TTO) in patients with an elevated tibial tubercle-trochlear groove distance. The purpose of this study was to evaluate the impact of adding a TTO to MPFLR on patient-reported outcomes. METHODS:A retrospective review of patients who underwent MPFLR with or without TTO with a minimum of 12-month follow-up was performed. Patients in both groups were matched based on age, gender, and follow-up time. Recurrent instability (including redislocation and subluxation), visual analogue scale (VAS) score, Kujala score, and satisfaction were evaluated. RESULTS:There were 59 patients who underwent MPFLR with concomitant TTO performed at our institution and met our inclusion and exclusion criteria. These patients were then matched to patients undergoing isolated MPFLR based on demographics and follow-up time. The mean age was 25.0 years, 76.3% were female, and the mean follow-up time was 49 months. There was a significant difference in mean tibial tubercle-trochlear groove distance (19.8 ± 3.9 vs. 14.1 ± 2.8) between groups. There was no significant difference in VAS (1.48 ± 2.0 vs. 1.49 ± 2.1, p = 0.972), satisfaction (86.1% ± 24.2% vs. 81.2% ± 27.9, p = 0.311) or revision surgeries (10.2% vs. 10.2%) between groups. CONCLUSION/CONCLUSIONS:Matched patients undergoing MPFLR with TTO compared with isolated MPFLR demonstrate no statistically significant difference in patient-reported outcomes, levels of pain, and satisfaction postoperatively. Furthermore, the addition of a TTO does not increase the risk of further surgery or complications. LEVEL OF EVIDENCE/METHODS:III, retrospective comparative study.

BACKGROUND/UNASSIGNED:As platelet-rich plasma injection for knee osteoarthritis (OA) has increased in popularity, it has become more important to assess its effectiveness and satisfaction with its use in the context of its high cost. The purpose of this study was to determine satisfaction, commercial appeal, and effectiveness of platelet-rich plasma (PRP) for the treatment of knee OA. METHODS/UNASSIGNED:A retrospective review of patients who underwent PRP injection in the knee from 2016 to 2019 was performed. Satisfaction with the PRP injection (out of 100), whether the patient would want to undergo PRP injection again, whether they would recommend the injection and whether they felt that the injection was worth the cost was collected. VAS pain scores were collected and measured out of 100. RESULTS/UNASSIGNED:Overall, 114 patients were included. The mean pre-injection pain score was 70.4, and the mean pain level decreased after injection to 36.8. Patients rated their satisfaction on average at 49.2, 50.9% stated that they would get the PRP injection again, 60.5% would recommend to a friend, and 50.9% felt the injection was worth the cost. Younger age and improved post-injection pain correlated with increasing likelihood of desiring further PRP injection. CONCLUSIONS/UNASSIGNED:Patients on average rated satisfaction slightly below average, indicating net indifference skewing towards dissatisfaction with their injection, and only half indicated that it was worth the cost and that they would receive it again. Younger age and pain relief increased desire for further injection, but efficacy did not correlate with patients saying that the injection was worth the cost.

»:A high tibial osteotomy (HTO) is a joint-preserving procedure that can be used to treat symptomatic unicompartmental cartilage disorders in the presence of limb malalignment. »:Appropriate patient selection and careful preoperative planning are vital for optimizing outcomes. »:Based on past literature, correction of varus malalignment to 3° to 8° of valgus appears to lead to favorable results. Recently, there has been growing awareness that it is important to consider soft-tissue laxity during preoperative planning. »:Although there has been a recent trend toward performing opening-wedge rather than closing-wedge or dome HTOs for unicompartmental osteoarthritis, current data suggest that all 3 are acceptable techniques with varying complication profiles. »:Based on current evidence, an HTO provides pain relief, functional improvement, and a high rate of return to sport, with reported survivorship ranging from 74.7% to 97.6% and 66.0% to 90.4% at 10 and 15 years, respectively.