Femoral and tibial bone bruise volume is not correlated with ALL injury or rotational instability in patients with ACL-deficient knee.

PURPOSE: Some researchers have suggested that bone bruises are evidence of rotational instability. The hypothesis was that the extent of lateral bone edema is correlated with the presence of an anterolateral ligament (ALL) injury. The main objective was to determine whether there was a correlation between the presence of an ALL injury the extent of bone bruises. METHODS: A prospective diagnostic study enrolled all the patients who suffered an acute anterior cruciate ligament (ACL) who were operated on within 8 weeks. The extent of bone bruising according to the ICRS classification was measured on preoperative MRIs by two independent blinded raters twice with an interval of 4 weeks. Dynamic ultrasonography (US) to look for ALL injury and the pivot shift test were performed before the ACL surgery. The correlation between ALL injury and bone bruises, and the correlation between an ALL injury and a high-grade pivot shift test were determined. RESULTS: Sixty-one patients were included; 52% of patients had an ALL injury on US. The extent of lateral bone bruise was not related to the presence of an ALL injury, nor related to the presence of a high-grade pivot shift. A grade 2 or 3 pivot shift was significantly correlated with an ALL injury (p < 0.0001). Inter- and intra-rater reliability for the bone bruise rating was excellent. CONCLUSION: The extent of lateral bone bruise is not correlated with ALL injury or a high-grade pivot shift; thus, it is not correlated with rotational instability of the knee. LEVEL OF EVIDENCE: II.

Outpatient total knee arthroplasty: Readmission and complication rates on day 30 in 61 patients.

BACKGROUND: Total knee arthroplasty (TKA) on an outpatient basis is controversial due to concerns about patient safety. In France, only 1.1% of TKAs performed in 2017 were outpatient procedures. Nevertheless, recent advances in the multi-modal and multidisciplinary management of TKA patients combined with optimisation of the various components of perioperative care are increasing the use of outpatient TKA. However, studies on outcomes remain scarce. The primary objective of this work was to compare readmission rates within 30 days after TKA between patients managed as outpatients and as inpatients. The secondary objectives were to compare complication rates and patient satisfaction between the two groups. HYPOTHESIS: After outpatient TKA, the day-30 rates of readmission and complications are similar to those seen after inpatient TKA. MATERIAL AND METHODS: A retrospective single-centre study of consecutive patients who underwent TKA between April 2014 and July 2017 was performed. Readmissions, complications, and patient satisfaction were collected. RESULTS: Of 574 patients, 61 were selected to undergo outpatient TKA and 513 had inpatient TKA. The day-30 readmission rate was 2/61 (3.3%) in the outpatient group and 25/513 (4.9%) in the inpatient group. The overall complication rate was 8% in the outpatients and 7.2% in the inpatients. The satisfaction rate was high in the outpatient group, with 80% very satisfied and 20% satisfied patients. CONCLUSION: When performed in appropriately selected patients, outpatient TKA is not associated with a higher readmission rate compared to inpatient TKA. LEVEL OF EVIDENCE: IV, retrospective comparative study.