Information videos posted on Instagram by orthopaedics and sports traumatology surgeons mostly explain surgical technique, and the least mentioned topics are injury prevention and complications.

PURPOSE: Social media has become the new information acquisition platform for all content producers. In the current literature, there are no studies examining the content quality and the strengths and weaknesses of videos on Instagram that explain anterior cruciate ligament (ACL) injuries, which is the most discussed topic of sports surgery. The aim of this study was to evaluate the quality, strengths and weaknesses of information pertaining to ACL surgery that is disseminated on Instagram. METHOD: An Instagram search was conducted from 30 May 2023 to 30 January 2024. The search encompassed six languages (English, Spanish, German, French, Italian and Turkish) and was performed by six different observers. The investigation focused on eight subheadings derived from current literature on the ACL. These subheadings were addressed in Instagram videos, covering ACL biology or biomechanics, injury mechanism, injury prevention, injury evaluation, surgical technique, injury or surgery complications, injury rehabilitation process and return to sport or work. RESULT: The content was assessed of 127 videos from 127 Instagram accounts, spanning six different languages. Across the review of eight subheadings, the average number covered for the entire group was 3 (range, 0-8). Further analysis revealed that surgical technique was the most frequently mentioned subheading for the whole group (68.5%), followed by injury evaluation (54.3%). Prevention (10.2%) and complications (19.6%) were the least mentioned subheadings. The number of followers showed a correlation with video content quality. CONCLUSION: Although the video quality scores were found to be moderate, the content often focused on surgery and evaluation subheadings. The prevalence of incomplete information underscores the importance of developing strategies to ensure more comprehensive and accurate dissemination of medical knowledge. LEVEL OF EVIDENCE: Level V.

Postoperative Activity and Knee Function of Patients after Total Knee Arthroplasty: A Sensor-Based Monitoring Study.

Inertial measurement units (IMUs) are increasingly being used to assess knee function. The aim of the study was to record patients' activity levels and to detect new parameters for knee function in the early postoperative phase after TKA. Twenty patients (n = 20) were prospectively enrolled. Two sensors were attached to the affected leg. The data were recorded from the first day after TKA until discharge. Algorithms were developed for detecting steps, range of motion, horizontal, sitting and standing postures, as well as physical therapy. The mean number of steps increased from day 1 to discharge from 117.4 (SD ± 110.5) to 858.7 (SD ± 320.1), respectively. Patients' percentage of immobilization during daytime (6 a.m. to 8 p.m.) was 91.2% on day one and still 69.9% on the last day. Patients received daily continuous passive motion therapy (CPM) for a mean of 36.4 min (SD ± 8.2). The mean angular velocity at day 1 was 12.2 degrees per second (SD ± 4.4) and increased to 28.7 (SD ± 16.4) at discharge. This study shows that IMUs monitor patients' activity postoperatively well, and a wide range of interindividual motion patterns was observed. These sensors may allow the adjustment of physical exercise programs according to the patient's individual needs.

Assessment of learning in simulator-based arthroscopy training with the diagnostic arthroscopy skill score (DASS) and neurophysiological measures.

PURPOSE: Virtual arthroscopic training has become increasingly popular. However, there is a lack of efficiency-based tracking of the trainee, which may be critical for determining the specifics of training programs and adapting them for the needs of each trainee. This study aims to evaluate and compare the measures obtained with a non-invasive neurophysiological method with The Diagnostic Arthroscopy Skill Score (DASS), a commonly used assessment tool for evaluating arthroscopic skills. METHODS: The study collected simulator performance scores, consisting of "Triangulation Right Hand", "Triangulation Left Hand", "Catch the Stars" and "Three Rings" and DASS scores from 22 participants (11 novices, 11 experts). These scores were obtained while participants underwent a structured program of exercises for the fundamentals of arthroscopic surgery training (FAST) and knee module using a simulator-based arthroscopy device. During the evaluation, data on oxy-hemoglobin and deoxy-hemoglobin levels in the prefrontal cortex were collected using the Functional Near-Infrared Spectroscopy (fNIRS) imaging system. Performance scores, DASS scores, and fNIRS data were subsequently analyzed to determine any correlation between performance and cortex activity. RESULTS: The simulator performance scores and the DASSPart2 scores were significantly higher in the expert group compared to the novice group (200.1 ± 28.5 vs 172.5 ± 48.9, p = 0.04 and 9.4 ± 5.6 vs. 5.4 ± 5.6 p = 0.02). In the expert group, fNIRS data showed a significantly lower prefrontal cortex activation during fundamental tasks in the FAST module, indicating significantly more efficient mental resource use. CONCLUSION: The analysis of cognitive workload changes during simulation-based arthroscopy training revealed a significant correlation between the trainees' DASS scores and fNIRS data. This correlation suggests the potential use of fNIRS data and DASS scores as additional metrics to create adaptive training protocols for each participant. By incorporating these metrics, the training process can be optimized, leading to more efficient arthroscopic training and better preparedness for clinical operations. LEVEL OF EVIDENCE: III.

Electric scooter-associated orthopedic injuries cause long absence from work, regret and are emerging as a major cause of hip fractures in young individuals: a comprehensive study from a regional trauma center in a densely populated urban setting.

PURPOSE: This study aimed to give a full spectrum of orthopedic injuries associated with electric scooter (e-scooter) use and analyze related factors, report on follow-up data from the patient's perspective and make a comparative etiological analysis of young adult hip fractures. METHODS: A total of 851 consecutive patients were admitted to the Emergency Department following e-scooter injuries between January 2021 and July 2022, of whom 188 had 214 orthopedic injuries. The demographics, injury, and incident characteristics of these patients were collected. All fractures were classified as per the AO/OTA classification. Two groups were created as operatively or conservatively treated patients and data were comparatively analyzed. Follow-up examination incorporated a survey using binary questions on patients' perspectives. An etiological comparative analysis of hip fractures in young adults admitted to the same center between 2016 and 2022 was conducted. RESULTS: The median patient age was 25. Inexperienced drivers constituted 32% of the injured. The protective gear use rate was at 3%. Higher speed (p = 0.014) and age (p = 0.011) were significantly associated with operative treatment. A total of 39% of the operated patients could not return to preinjury physical function, while 74% regretted using an e-scooter. The most common etiological factor for traumatic young hip fractures was fall from a height between 2016 and 2020, whereas it became e-scooter accidents in 2021-2022. CONCLUSION: The rate of e-scooter-related operative treatment is high and leaves the patient in regret (84%) and a physically limited condition (39%). A speed limit of ≤ 15 km/h could decrease the rate of operative injuries. The e-scooter was identified as the top etiological factor in the last 2 years for traumatic young hip fractures. LEVEL OF EVIDENCE: II, Diagnostic cohort study.

A More Conservative Approach in the Surgical Management of Pediatric Physeal Ankle Fractures Should be Preferred: Mid to Long-term Functional Outcomes of Three Different Surgical Techniques for Salter-Harris Type II and Triplane Distal Tibial Fractures.

BACKGROUND: Pediatric physeal ankle fractures carry a high risk of complications. This study aimed to (1) investigate the effect of anatomic reduction of the physis on mid to long-term functional outcomes in Salter-Harris type II and triplane distal tibial physeal fractures (DTPFs) and (2) compare the outcomes of 3 different surgical techniques applied in these fractures. METHODS: The database of a single level-I trauma center was retrospectively reviewed for DTPFs between 2012 and 2022. A total of 39 eligible patients with operative Salter-Harris type II and triplane fractures between 2012 and 2022 were included. Surgical treatment methods were closed reduction-percutaneous fixation (CR-PF), open reduction-screw fixation, or open reduction-plate fixation. Patients were further divided into subgroups for fractures reduced anatomically (<1 mm) or nonanatomically (1 to 3 mm). The primary outcome measures were the American Orthopaedic Foot and Ankle Society Score, ankle range of motion, presence of premature physeal closure and angular deformities, and Takakura ankle osteoarthritis grade. RESULTS: A total of 39 patients were included, with an average age of 12.9 ± 2.2 years. The mean follow-up time was 68.9±38.0 months. The CR-PF group had higher postoperative fracture displacement ( P = 0.011). American Orthopaedic Foot and Ankle Society scores were excellent in all groups, statistically similar between surgical techniques, and similar between anatomic and nonanatomic reduction groups. The CR-PF group ( P =0.030) and nonanatomic reduction ( P = 0.030) provided a significantly lower ankle osteoarthritis rate. All 4 patients with premature physeal closure were observed in patients treated with open techniques. CONCLUSIONS: CR-PF for the treatment of DTPFs should be preferred in suitable cases as it is less invasive and provides satisfactory mid to long-term functional outcomes without increasing complications compared with anatomic reduction and open techniques. LEVEL OF EVIDENCE: Level III.

The Comparison of Dynamic Condylar Screw Plate to Proximal Femoral Nail in Reverse Oblique and Transverse Intertrochanteric Fractures: A Retrospective Study on 61 Patients.

OBJECTIVE: Reverse oblique (RO) and transverse intertrochanteric fracture patterns constitute a challenge for the operating surgeon. Currently, no gold standard fixation method exists. This study aimed to retrospectively compare proximal femoral nail (PFN) to dynamic condylar screw (DCS) plating in the treatment of RO and transverse intertrochanteric fractures. METHODS: A total of 61 patients fixated by PFN or DCS were included. Of these, 36 were treated with PFN (21 females and 15 males; mean age: 65.52 years), and 25 were treated with DCS (12 females and 13 males; mean age: 59.36 years). The mean follow-up time was 33.8 and 42.6 months (range: 24-108). Radiological evaluation included the quality of fracture reduction, neck-shaft angle change, posteromedial support presence, and bone union time. Complications such as mechanical failure, nonunion, and infection were noted. RESULTS: The only significant differences between the fixation methods were the superiority of DCS over PFN in earlier fracture union time (mean values: 8.9 versus 14.1 weeks) and the superiority (p=0.007) of PFN in shorter hospital stay (3.4 days versus 5.1 days). No significant difference was observed in radiological parameters. While similar mechanical complication rates were found, a significantly higher nonunion rate was detected with the DCS. CONCLUSION: The most crucial disadvantage of DCS was the high rate of nonunion. Closed fracture reduction in PFN seems to be the most critical parameter to prevent severe complications. The open reduction using DCS showed no advantages over closed reduction and PFN fixation in providing a more anatomical alignment in AO/Orthopaedic Trauma Association (OTA) 31-A3 fractures. However, we recommend PFN application in this type of fracture, since nonunion is more common in DCS.

Effects of physiotherapy interventions for home-based rehabilitation on physical function after primary total knee arthroplasty: a systematic review protocol.

OBJECTIVE: The objective of this review is to provide a systematic and transparent overview of the effects of common physiotherapy techniques and exercises for the rehabilitation of patients following total knee arthroplasty. INTRODUCTION: Many protocols exist for the rehabilitation of patients after total knee arthroplasty, but there is a lack of systematic evidence on rehabilitation components, including precise exercise descriptions and their parameters. This review will fill in some of the gaps in reporting on scientific rehabilitation protocol components and the evaluation of their effectiveness. INCLUSION CRITERIA: We will include randomized controlled trials investigating active and passive physiotherapy techniques and exercises employed after primary total knee arthroplasty, and which report concrete parameters, such as dosage, duration, frequency, intensity, and function-related measurements. We will exclude other study types and randomized controlled trials reporting on techniques and exercises without precise descriptions. METHODS: This review will aim to find both published and unpublished studies. The key information sources to be searched are MEDLINE (PubMed), Embase (Ovid), CINAHL (EBSCO), PEDro, Cochrane CENTRAL, ClinicalTrials.gov, and WHO International Clinical Trials Registry Platform. Two independent reviewers will screen titles, abstracts, and full texts; assess the methodological quality; and extract the data. We will perform narrative synthesis, followed by meta-analyses for pooled studies, where possible. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42022309185.

Prone-positioned knee arthroscopy for isolated retropatellar cartilage defects with gel-type autologous chondrocyte implantation.

OBJECTIVE: Treatment of isolated retropatellar cartilage defects using current gel-type regenerative methods requires settlement of the gel to the underlying subchondral bone under gravity; thus, prone positioned arthroscopy is used. INDICATIONS: Isolated retropatellar contained cartilage defect size >2.5 cm2. Age <40 years, epiphyseal closure, cartilage defect grade 3/4 (International Cartilage Repair Society). CONTRAINDICATIONS: Cartilage defects at medial or lateral femorotibial compartments, at the trochlea, with degenerative genesis, rheumatoid arthritis, local infection, patellar malalignment, patellofemoral dysplasia, knee instability, knee malalignment >3°, kissing lesions. SURGICAL TECHNIQUE: Two-stage procedure: At initial arthroscopy, chondrocytes were harvested. At the second stage, the patient was positioned prone and the leg with a thigh tourniquet was fixed in a leg holder. Removal of table extension below the knee and support of foot in sling to prevent knee hyperextension. Placement of 2 lateral portals. Lesion visualized and debrided, followed by aspiration of intra-articular fluid. A loop, placed posterior to the patellar ligament using a lasso, was used to suspend a weight to expand the patellofemoral space. The lesion was then dried using a sponge. NOVOCART® Inject (TETEC, Reutlingen, Germany) administered onto the defect. Gel was allowed to solidify for 15 min and operation was completed. POSTOPERATIVE MANAGEMENT: Knee locked in extension using a brace for 6 weeks. Continuous passive motion applied and incrementally increased until full range of motion (ROM) at week 6. Weight-bearing as tolerated was allowed with the knee in extension. Routine clinical follow-up after 3, 6 and 12 months. RESULTS: Mean age of the 5 patients was 23 ± 6 (range 14-30) years; mean follow-up time after surgery 28 ± 7 (range 20-40) months. All patients returned to full activity without residual knee ROM restriction. Clinical examination at the latest follow-up revealed a Kujala score of 90 ± 12 points and Lysholm score of 95 ± 5 points. MRI showed filled cartilage defects in all patients. Mocart score was 63 ± 7 points. Cartilage was inhomogeneous and hyperintense at the repaired site. Quantitative measurement of the patella mobility of the operated knee under a translating force of 10 N showed medial and lateral displacements of 21 ± 5 and 15 ± 2 mm and on the healthy side 22 ± 5 and 19 ± 3 mm, respectively.

Level of osteotomy is relevant to obtain better union and clinical results in patients with severe hip dysplasia operated on with total hip arthroplasty and shortening osteotomy using a cementless, rectangular femoral component.

INTRODUCTION AND OBJECTIVE: Total hip arthroplasty with rectangular femoral component and transverse osteotomy for patients with Crowe type 3 or 4 dysplasia yields successful results with varying radiological findings. This study aims to investigate the surgery and patient related factors associated with successful clinical and radiological results. PATIENTS AND METHODS: Fifty hips of 41 patients were retrospectively examined. Length and percentage of the stem passing the osteotomy level and canal fill ratio were measured. Radiological findings such as radiolucent lines (RL) around the stem, hypertrophic callus or an identifiable osteotomy line on X-ray images were assessed. All clinical and radiological results were analyzed for any significant association. RESULTS: Mean stem length and percentage passing the osteotomy level were 6.4 cm (± 0.7) and 51% (± 6). Presence of an identifiable osteotomy line was positively associated with the increasing length of the stem passing the osteotomy level and with a lower HHS (p < 0.05). RL around the stem were associated with a lesser reduction in VAS score (p < 0.05). CONCLUSION: Rectangular femoral stem conveniently accommodate the proximal femur in severely dysplastic hips. An upper limit for the femoral stem exists to obtain better bony union and higher HHS. RL around the stem are clinically relevant and is associated with a worse VAS score at the latest follow-up.

Clinical and Radiological Results of Crowe Type 3 or 4 Dysplasia Patients Operated on With Total Hip Arthroplasty Using a Cementless Rectangular Femoral Component Without Fixating or Grafting the Transverse Osteotomy Site.

BACKGROUND: Total hip arthroplasty (THA) involving shortening osteotomy for patients with Crowe type 3 or 4 dysplasia is a challenging surgical procedure. This study aims to demonstrate that rectangular femoral component use in anatomical reconstructions with THA and transverse shortening osteotomy yields successful results without the use of bone graft or any fixation material at the osteotomy site. METHODS: Fifty hips from 41 patients were identified retrospectively as per study objectives. All patients were evaluated using the Harris Hip Score and Visual Analog Scale for pain. Complications were reported. Radiological evaluation criteria were then evaluated, including leg length discrepancy, degree of trochanter caudalization and stem subsidence, radiolucent and radiodense lines for both components and bone atrophy or hypertrophy around the stem according to Gruen zones, and the canal fill ratio of the stem. RESULTS: Postoperative Harris Hip Score was excellent for 68% of patients. No patient had poor results. Complication rate was 32%. One patient had nonunion (2%). The mean postoperative leg length discrepancy was 0.8(±0.6) cm. No patient had a subsidence of more than 5 mm. Radiolucent and radiodense lines were present in up to 34% of patients, and bone atrophy was present in the proximal femur in up to 96% of patients. No patient had osteolysis or loosening in neither component. CONCLUSION: Successful clinical and radiological results can be obtained from Crowe type 3 and 4 dysplastic hips operated on with THA using a rectangular femoral component and transverse shortening osteotomy technique. The use of graft or any fixation material at the osteotomy site is not mandatory.

Validation of a Novel Device for the Knee Monitoring of Orthopaedic Patients.

Fast-track surgery is becoming increasingly popular, whereas the monitoring of postoperative rehabilitation remains a matter of considerable debate. The aim of this study was to validate a newly developed wearable system intended to monitor knee function and mobility. A sensor system with a nine-degree-of-freedom (DOF) inertial measurement unit (IMU) was developed. Thirteen healthy volunteers performed five 10-meter walking trials with simultaneous sensor and motion capture data collection. The obtained kinematic waveforms were analysed using root mean square error (RMSE) and correlation coefficient (CC) calculations. The Bland-Altman method was used for the agreement of discrete parameters consisting of peak knee angles between systems. To test the reliability, 10 other subjects with sensors walked a track of 10 metres on two consecutive days. The Pearson CC was excellent for the walking data set between both systems (r = 0.96) and very good (r = 0.95) within the sensor system. The RMSE during walking was 5.17° between systems and 6.82° within sensor measurements. No significant differences were detected between the mean values observed, except for the extension angle during the stance phase (E1). Similar results were obtained for the repeatability test. Intra-class correlation coefficients (ICCs) between systems were excellent for the flexion angle during the swing phase (F1); good for the flexion angle during the stance phase (F2) and the re-extension angle, which was calculated by subtracting the extension angle at swing phase (E2) from F2; and moderate for the extension angle during the stance phase (E1), E2 and the range of motion (ROM). ICCs within the sensor measurements were good for the ROM, F2 and re-extension, and moderate for F1, E1 and E2. The study shows that the novel sensor system can record sagittal knee kinematics during walking in healthy subjects comparable to those of a motion capture system.

Translation and Validation of the German New Knee Society Scoring System.

BACKGROUND: In 2011 the Knee Society Score (KSS) was revised to include patient expectations, satisfaction, and physical activities as patient-reported outcomes. Since the new KSS has become a widely used method to evaluate patient status after TKA, we sought to translate and validate it for German-speaking populations. QUESTIONS/PURPOSES: After translation of the new KSS into German using established guidelines, we sought to test the new German version for (1) validity; (2) responsiveness; and (3) reliability. METHODS: The new KSS form was translated and adapted according to the available guidelines. The final version was used to validate the German version of the new KSS (GNKSS) in 133 patients undergoing TKA, of which 100 patients were included in the study as per inclusion criteria. Patients completed the GNKSS form along with the German WOMAC and the German SF-36 scores preoperatively and at the 2-year postoperative followup. Construct validity was tested by comparing domain scores of the GNKSS with domain scores of the German WOMAC and the SF-36. Responsiveness was evaluated by comparing pre- and postoperative scores in all questionnaires in all patients using standardized response means. To evaluate reliability, every second patient (n = 50) in the whole group was asked to complete the GNKSS form a second time 1 week after their 2-year followup; 39 patients responded. This sample group was considered representative after testing the difference among age, sex, body mass index, operation side, preoperative or postoperative GNKSS, and WOMAC scores with the original group. Intraclass correlation coefficients (ICCs) were used to assess reliability and Cronbach's α was an indicator of internal consistency of each domain score. RESULTS: Construct validity was excellent pre- and postoperatively between the GNKSS and the WOMAC for domains including symptoms, satisfaction, total functional score, and total score and activity subdomains, except the expectation domain and advanced and discretionary subdomains of the GNKSS and the stiffness domain of WOMAC. The expectation domain showed either no significant correlation or only weak correlations with the domains of WOMAC pre- as well as postoperatively (r ranging between -0.19 and -0.34). Correlation of the function section of the GNKSS as well as the physical function and role-physical domains of the SF-36 pre- and postoperatively were moderate to strong, respectively, with statistically significant (p < 0.001) r values of 0.49 and 0.48 preoperatively and 0.73 and 0.65 postoperatively. Correlation of the symptom section of the GNKSS and bodily pain domain of the SF-36 was also strong pre- and postoperatively. Regarding responsiveness, all domains of the GNKSS showed large changes except the expectation domain. The symptom and functional sections of the GNKSS showed higher responsiveness than the corresponding pain and function domains of the WOMAC and bodily pain and physical function domains of the SF-36. Also, the total score changes were larger for the GNKSS compared with the WOMAC. No floor or ceiling effect was observed. Reliability was excellent with ICCs of 0.83 to 0.97 as an indicator of test-retest reliability and Cronbach's α values of 0.78 to 0.85 preoperatively and 0.92 to 0.94 postoperatively as an indicator of internal consistency for all domains and subdomains. CONCLUSIONS: The GNKSS is a valid, responsive, reliable, and consistent outcome measurement tool that may be used to evaluate the outcome of TKA. LEVEL OF EVIDENCE: Level II, diagnostic study.