The impact of the 30 most cited articles on hip arthroscopy: what is the subject matter?

The purpose of this study was to identify the 30 most cited articles on hip arthroscopy and discuss their influence on recent surgical treatment. Due to advancements in hip arthroscopy, there is a widening spectrum of diagnostic and treatment indications. The purpose of this study was to identify the 30 most cited articles on hip arthroscopy and discuss their influence on contemporary surgical treatment. The Thomson Reuters Web of Science was used to identify the 30 most cited studies on hip arthroscopy between 1900 and 2018. These 30 articles generated 6152 citations with an average of 205.07 citations per item. Number of citations ranged from 146 to 461. Twenty-five out of the 30 papers were clinical cohort studies with a level of evidence between III and IV, encompassing 4348 patients. Four studies were reviewed (one including a technical note) and one a case report. We were able to identify the 30 most cited articles in the field of hip arthroscopy. Most articles were reported in high-impact journals, but reported small sample sizes in a retrospective setting. Prospective multi-arm cohort trials or randomized clinical trials represent opportunities for future studies.

Quantitative and Qualitative Assessment of the Relative Arterial Contributions to the Calcaneus.

BACKGROUND: The purpose of this study was to quantitatively and qualitatively assess relative arterial contributions to the calcaneus. METHOD: Fourteen cadaveric ankle pairs were used. In each specimen, the posterior tibial artery, peroneal artery, and anterior tibial artery were cannulated and used for contrast-enhanced magnetic resonance imaging (MRI) and computed tomography (CT). Quantitative MRI analysis of the pre- and postcontrast MRI scans facilitated assessment of relative arterial contributions. In addition, postcontrast MRIs were used to measure all perfused arterial entry points and scaled to a 3-dimensional calcaneus model. Contrast-enhanced CT imaging was assessed to further delineate the extraosseous arterial course. Two pairs underwent infusion of diluted BaSO4 through a constant-pressure pump using extended infusion duration. RESULTS: Quantitative MRI findings indicated the peroneal artery provided 52.6% of the calcaneal arterial supply, 31.6% from the posterior tibial artery, and 15.8% from the anterior tibial artery. The cortical entry points were found in fairly consistent patterns along calcaneal cortical surfaces. All specimens demonstrated intraosseous anastomoses between lateral and medial entry points at common locations. CONCLUSIONS: The peroneal artery was found to provide the largest calcaneal arterial contribution, followed by the posterior tibial artery and anterior tibial artery. A rich anastomotic arterial network was found supplying the calcaneus. CLINICAL RELEVANCE: This study provides quantitative and qualitative findings of the relative arterial contribution of the calcaneus. This knowledge can help expand our understanding of calcaneal vascularization, demonstrate the vascular impact of calcaneal fracture and surgery, and facilitate future research on the arterial anatomy of the calcaneal soft tissue envelope.

Do clinical outcomes correlate with bone density after open reduction and internal fixation of tibial plateau fractures.

INTRODUCTION: The operative management of tibial plateau fractures in elderly patients has historically led to inconsistent results, and these clinical outcomes were thought to be associated with poor bone quality often in elderly patients. The goal of this study was to investigate the relationship between bone density and subjective clinical outcome scores after open reduction and internal fixation of tibial plateau fractures. MATERIALS AND METHODS: This is a retrospective cohort study from a single-surgeon conducted at an Academic, Level 1 Trauma Center. A preoperative computed tomography (CT) scan was obtained for all patients. Bone density of the distal femur was quantified with Hounsfield units (HU) as measured on axial CT scans. Inter-rater reliability of HU measurements was assessed using interclass correlation coefficients. Regression models controlling for age were used to identify relationships between bone density (HU) and the following variables: articular subsidence and 1-year subjective clinical outcomes scores [Knee Outcome Survey Activities of Daily Living Scale (KOS-ADLS), and Short-Form-36 (SF-36) physical and mental component scores (PCS, MCS)]. RESULTS: Sixty-one patients with a mean age of 59.3 years (range 27-85 years) and a minimum of 12 months of clinical follow-up were included in the study. The majority of the fractures (32 of 61) were classified as Schatzker II tibial plateau fractures, and there were 13 Schatzker V fractures, 11 Schatzker VI fractures, 2 Schatzker IV fractures and 1 Schatzker 1 fracture. HU measurements demonstrated an almost perfect inter-observer reliability (ICC = 0.97). Age was negatively correlated with HU measurements (r = -0.51, p < 0.001), and using a geriatric cut-off of 65 years of age, the geriatric group had a lower mean HU compared to the non-geriatric group (78.2 versus 114.8, p = 0.018). There was no significant relationship between bone quality, as assessed by distal femoral HU, and any subjective clinical outcome score. CONCLUSIONS: Inferior bone mineral density alone does not appear to affect clinical outcomes 1 year postoperatively when bone grafting is used to restore osseous voids. Poor bone quality should not be used as an indication for non-operative management of tibial plateau fractures.

Multiplanar Fixation for Patella Fractures Using a Low-Profile Mesh Plate.

Patella fractures are challenging orthopaedic injuries. Many commonly used fixation techniques can be ineffective and lead to poor clinical outcomes even with satisfactory reductions and fracture healing. In this investigation, we present the technique of cage plate fixation of patella fractures and the clinical outcomes of 9 initial patients surgically treated at our institution. This technique allows direct visualization of the articular reduction, provides multiplanar fixation, effectively stabilizes inferior pole comminution, and reduces the risk of patella vascular disruption. Using this technique, we have achieved excellent functional and radiographic outcomes.

Standard perioperative imaging modalities are unreliable in assessing articular congruity of ankle fractures.

OBJECTIVES: To determine the sensitivity, specificity, and interobserver and intraobserver reliabilities of intraoperative fluoroscopy and postoperative plain radiographs (XR) in the assessment of articular congruency after open reduction and internal fixation (ORIF) of ankle fractures involving the tibial plafond. DESIGN: Retrospective cohort. SETTING: Academic level 1 trauma center. PATIENTS/PARTICIPANTS: One hundred five patients treated surgically for rotational ankle fractures. INTERVENTION: ORIF. MAIN OUTCOME MEASUREMENTS: Sensitivity, specificity, and interobserver and intraobserver reliabilities of fluoroscopy and plain radiographs when compared with computed tomography imaging. RESULTS: The sensitivities of fluoroscopy and XR were 21% and 36%, respectively. Specificities were 95% (fluoroscopy) and 89% (XR). Fluoroscopy interobserver reliability was κ = 0.15, and mean intraobserver reliability was κ = 0.32. XR interobserver and mean intraobserver reliabilities were κ = 0.30 and κ = 0.59. CONCLUSIONS: Although results show acceptable specificity, the reliability and sensitivity of both intraoperative fluoroscopy and postoperative XR in the assessment of ankle articular congruency are low. This calls into question available literature correlating clinical results with articular reduction. During ORIF of an intra-articular ankle fracture, surgeons should be highly critical of fluoroscopic imaging that seems adequately reduced and direct visualization of the articular surface should be used as a reduction aid if possible. Furthermore, in the postoperative period, axial imaging may be warranted in patients who have poor clinical outcomes despite apparent anatomic articular reduction to evaluate for occult joint incongruence.

Performance-based tests and self-reported questionnaires provide distinct information for the preoperative evaluation of total hip arthroplasty patients.

Our objectives were to assess relationships between self-reported questionnaires and 2-minute walk test (2MWT) and timed get-up-and-go test (TUG) in preoperative total hip arthroplasty patients. A total of 162 patients completed the Western Ontario and McMaster Universities Osteoarthritis Index and Short Form 36 and performed 2MWT and TUG. Correlations between self-reported questionnaires and 2MWT and TUG were mild to moderate, indicating that the 2MWT and TUG capture additional dimensions of preoperative total hip arthroplasty function not measured by the Western Ontario and McMaster Universities Osteoarthritis Index and Short Form 36. Use of walking aids, female sex, and presence of other painful joints were significantly associated with 2MWT, whereas older age and additional painful joints were significantly associated with TUG. These 2 tests are easy to perform in clinical practice and contribute to a comprehensive assessment of preoperative status.

Reduced cortical bone compositional heterogeneity with bisphosphonate treatment in postmenopausal women with intertrochanteric and subtrochanteric fractures.

Reduction of bone turnover with bisphosphonate treatment alters bone mineral and matrix properties. Our objective was to investigate the effect of bisphosphonate treatment on bone tissue properties near fragility fracture sites in the proximal femur in postmenopausal women with osteoporosis. The mineral and collagen properties of corticocancellous biopsies from the proximal femur were compared in bisphosphonate-naive (-BIS, n = 20) and bisphosphonate-treated (+BIS, n = 20, duration 7 ± 5 years) patients with intertrochanteric (IT) and subtrochanteric (ST) fractures using Fourier transform infrared imaging (FTIRI). The mean values of the FTIRI parameter distributions were similar across groups, but the widths of the parameter distributions tended to be reduced in the +BIS group relative to the -BIS group. Specifically, the widths of the cortical collagen maturity and crystallinity were reduced in the +BIS group relative to those of the -BIS group by 28% (+BIS 0.45 ± 0.18 versus -BIS 0.63 ± 0.28, p = 0.03) and 17% (+BIS 0.087 ± 0.012 versus -BIS 0.104 ± 0.036, p = 0.05), respectively. When the tissue properties were examined as a function of fracture morphology within the +BIS group, the FTIR parameters were generally similar regardless of fracture morphology. However, the cortical mineral:matrix ratio was 8% greater in tissue from patients with atypical ST fractures (n = 6) than that of patients with typical (IT or spiral ST) fractures (n = 14) (Atypical 5.6 ± 0.3 versus Typical 5.2 ± 0.5, p = 0.03). Thus, although the mean values of the FTIR properties were similar in both groups, the tissue in bisphosphonate-treated patients had a more uniform composition than that of bisphosphonate-naive patients. The observed reductions in mineral and matrix heterogeneity may diminish tissue-level toughening mechanisms.