Orthopedic surgical scoring in asymptomatic COVID-19 patients

Aim: The purpose of this study is to create a scoring system to decide which patient will take maximum precautions while the covid 19 disease continues. Taking maximum precautions is not always possible in all surgical procedures. Therefore, surgical scoring in asymptomatic patients, selecting patients who need maximum precautions, and taking the necessary precautions for these patients will prevent unnecessary use of the equipment. Material(s) and Method(s): A total of 347 who were surgically treated for emergency or elective procedures between March 11 and November 11, 2020 were included in the study. Of these patients, 277 patients whose data could be accessed were included in the study. A scoring system has been created. Patients were divided into 2 groups: bearing low and high risk. Patients with a score above 10 were identified as having a high surgical risk, and those with a score below 10 were identified as having a low surgical risk. Result(s): There were 132 patients in Group 1 and 145 patients in Group 2. It was observed that 29 of 277 patients became positive within the first month. Two of these patients were in Group 1 and 27 of them were in Group 2. It was observed that COVID-19 antibody or PCR tests gave more positive results in patients in Group 2 in the first month compared to two patients in Group 1. The highest positivity rate in Group 2 was observed in the arthroscopy group. Discussion(s): Advanced precautions should be taken in patients with high surgical risk scores. In patients with low surgical risk scores, less strict precautions can be taken.Copyright © 2023, Derman Medical Publishing. All rights reserved.

Shifting the paradigm: ankylosis arthroplasty for the proximal interphalangeal joint with a novel collateral ligament reconstruction.

Silicone arthroplasty for proximal interphalangeal joint ankylosis is rarely performed, partly due to the potential for lateral joint instability. We present our experience performing proximal interphalangeal joint arthroplasty for joint ankylosis, using a novel reinforcement/reconstruction technique for the proper collateral ligament. Cases were prospectively followed-up (median 13.5 months, range 9-24) and collected data included range of motion, intraoperative collateral ligament status and postoperative clinical joint stability; a seven-item Likert scale (1-5) patient-reported outcomes questionnaire was also completed. Twenty-one ankylosed proximal interphalangeal joints were treated with silicone arthroplasty, and 42 collateral ligament reinforcements undertaken in 12 patients. There was improvement in range of motion from 0° in all joints to a mean of 73° (SD 12.3); lateral joint stability was achieved in 40 out of 42 of collateral ligaments. High median patient satisfaction scores (5/5) suggest that silicone arthroplasty with collateral ligament reinforcement/reconstruction should be considered as a treatment option in selected patients with proximal interphalangeal joint ankylosis.Level of evidence: IV.

When and What to Consider Knee Arthroscopy Surgery in Post-COVID 19 Infected Patients

Coronavirus disease 19 (COVID-19) is the worst pandemic ever recorded in history, as of this day more than 545 million people infected and more than 6 million cumulative deaths. COVID 19 is primarily respiratory disease, however non-respiratory presentations that could be manifested are venous and arterial thromboembolic events. Both pulmonary embolism (PE) and deep vein thrombosis (DVT) are the most frequently thrombotic events in COVID-19. Knee arthroscopy surgery is the one of the most common orthopedic surgical procedures nowadays, with the most common procedures are meniscectomy, meniscal repair and cruciate ligament reconstruction. Although knee arthroscopy is known to be a safe procedure, several complications could be found with the 3 most common complications are DVT, effusion and synovitis, and PE. We reported a case series of four patients with DVT post knee arthroscopy anterior cruciate ligament reconstruction during 2021. The DVT diagnosis was retained on clinical presentation and elevated of D-dimer testing. The patient's mean age was 35,25 years, and all of the patients had no risk factors of DVT, although they had COVID-19 infection within 3 months before surgery. The most common clinical presentation was swelling on the lower leg (around the ankle) with slightly pain and numbness. Only one patient had severe pain around the thigh. All of the patients had elevated D-dimer testing result with mean of D-dimer 1250 (normal value < 500). Only one patient had sonography testing and found proximal DVT. One of the patients had DVT at post operative day (POD) 3, one at POD 4 and the other two at POD 5. Three of the patients improved with oral anticoagulant therapy using rivaroxaban (XARELTO). In one patient the symptom was not improved after two days oral anticoagulant therapy and underwent thrombectomy by vascular surgeon. DVT is the most common complication of knee arthroscopy and also the most common non-respiratory events of COVID-19 infection. Routinely administration of thromboprophylaxis agent was not recommended, pre-operative risk assessment of DVT should be used, especially in post-COVID 19 patients.

The covid-19 pandemic did not affect rehabilitation following acl reconstruction / La pandemia de covid-19 no afectó a la rehabilitación tras la reconstrucción del lca / A pandemia de covid-19 não afetou a reabilitação depois de reconstrução do lca

ABSTRACT Objective: To assess postoperative rehabilitation patterns in patients who underwent Anterior Cruciate Ligament Reconstruction (ACLR) during the COVID-19 pandemic. Methods: A retrospective study of patients who underwent primary isolated ACLR between February 2019 and July 2020. Two different periods were evaluated. The "COVID group" represents the period from February 1st to July 1st of 2020 and the "non-COVID group" represents the equivalent period in 2019. Rehabilitation features and the effect of the COVID-19 pandemic on rehabilitation habits were assessed. Patient outcome scores were assessed using the Lysholm, Tegner, and International Knee Documentation Committee (IKDC) questionnaires. Subjective satisfaction, post-operative complications, and subsequent surgeries were recorded. Results: The groups did not differ significantly in demographics, functional outcome scores, or subjective satisfaction. There was no significant difference in rehabilitation patterns between the groups. In the COVID group, only one patient (4%) reported participation in online physiotherapy. Conclusions: There were no differences in the post-operative rehabilitation patterns, including duration, length, and environment of the training, between patients who underwent primary isolated ACLR during the COVID-19 pandemic and those who underwent the treatment in the preceding non-COVID year. Patient outcome scores, subjective satisfaction, and subsequent surgery rates did not differ between the groups. Level of evidence IV; Therapeutic studies - investigation of treatment results.

RESUMEN Objetivo: Evaluar los patrones de rehabilitación postoperatoria en pacientes sometidos a una reconstrucción del ligamento cruzado anterior (RLCA) durante la pandemia de COVID-19. Métodos: Se realizó un estudio retrospectivo de pacientes sometidos a RLCA aislada primaria entre febrero de 2019 y julio de 2020 evaluados en dos períodos distintos. El "grupo COVID" representa el período comprendido entre el 1de febrero y el 1 de julio de 2020 y el "grupo pre-COVID" representa el período equivalente en 2019. Se evaluaron los recursos de rehabilitación y el efecto de la pandemia de COVID-19 en los patrones de rehabilitación. Las puntuaciones de los resultados de los pacientes se evaluaron mediante los cuestionarios de Lysholm, Tegner y del International Knee Documentation Committee (IKDC). Se informaron datos de satisfacción subjetiva, complicaciones postoperatorias y cirugías posteriores. Resultados: En ambos grupos no se identificaron diferencias significativas en los datos demográficos, las puntuaciones funcionales y la satisfacción subjetiva, así como en los patrones de rehabilitación. En el "grupo COVID", sólo un paciente (4%) declaró haber participado en fisioterapia "online". Conclusiones: Los pacientes sometidos a RLCA aislada primaria durante la pandemia de COVID-19 no presentaron diferencias en los patrones de rehabilitación postoperatoria, incluida la duración, el alcance y el entorno del entrenamiento en comparación con los pacientes del grupo pre-COVID. Las puntuaciones de los resultados de los pacientes, la satisfacción subjetiva y las tasas de cirugía posterior no difirieron entre los grupos. Nivel de Evidencia IV; Estudios terapéuticos - Investigación de los resultados del tratamiento.

RESUMO Objetivos: Avaliar os padrões de reabilitação pós-operatória em pacientes submetidos à reconstrução do ligamento cruzado anterior (RLCA) durante a pandemia de COVID-19. Métodos: Foi realizado um estudo retrospectivo dos pacientes submetidos a RLCA isolada primária no período de fevereiro de 2019 a julho de 2020 avaliados em dois períodos distintos. O "grupo COVID" representa o período de 1 de fevereiro a 1 de julho 2020, e o "grupo pré-COVID" representa o período equivalente em 2019. Os recursos de reabilitação e o efeito da pandemia de COVID-19 sobre os padrões de reabilitação foram avaliados. Os escores dos resultados dos pacientes foram avaliados com os questionários Lysholm, Tegnes e pelo International Knee Documentation Committee (IKDC). Foram relatados os dados de satisfação subjetiva, complicações pós-operatórias e cirurgias subsequentes. Resultados: Em ambos os grupos não foram identificadas diferenças significativas nos dados demográficos, escores funcionais e na satisfação subjetiva, assim como nos padrões de reabilitação. No "grupo COVID", somente um paciente (4%) reportou participação em fisioterapia "on-line". Conclusões: Os pacientes submetidos à RLCA isolada primária durante a pandemia COVID-19 não apresentaram diferença nos padrões de reabilitação pós-operatória, incluindo duração, extensão e ambiente de treinamento em comparação com pacientes do grupo pré-COVID no ano anterior. Os escores dos resultados dos pacientes, a satisfação subjetiva e as taxas de cirurgia subsequentes não diferiram entre os grupos. Nível de Evidência IV; Estudos terapêuticos - Investigação dos resultados do tratamento.

Is anterior knee pain following anterior cruciate ligament reconstruction a consideration for graft choice, and the influence of COVID: a qualitative analysis in recreational athletes.

BACKGROUND: We set out to investigate whether anterior knee pain following anterior cruciate ligament reconstruction has a significant effect on patients, and whether it should influence graft choice. METHODS: This was a qualitative analysis of a set of recreational athletes treated at a university hospital at about 1 year following anterior cruciate ligament reconstruction surgery. Participants were interviewed by an orthopaedic fellow and resident using structured, open-ended questions. Inductive theme analysis was used to code the data. RESULTS: There were 4 major themes: (1) Our hypothesis was that patients would be given adequate information to make an appropriate graft choice. This hypothesis was rejected. Discussion took place, but with little details or rationale for the graft choice. The predominant theme was that the surgeon made the decision, and there was a lack of reliable information for the patient to make a choice. (2) The overall theme was that most patients had no anterior knee pain, and it did not interfere with activities of daily living. (3) One theme was that patients were able to resume all sports without restriction, but in some, the anterior knee pain interfered with the more demanding activities such as impact, cutting, and pivoting. A separate theme was that fear was a major impediment to return to sports and was not related to the anterior knee pain. (4) The overriding theme was that the generalized closures associated with the COVID-19 pandemic slowed the rehabilitation process. Although virtual care was available in general, it was not particularly satisfactory. Patients indicated that they had not been able to return to the gym or to their sporting activities as a result. CONCLUSIONS: Amongst non-competitive athletes, anterior knee pain post-anterior cruciate ligament reconstruction surgery does not significantly affect activities of daily living. Although there is a minor effect on sporting activities, the inability to return to sports is related to factors such as the COVID-19 pandemic, fear, or insufficient rehabilitation, rather than anterior knee pain. Overall, anterior knee pain is not a significant factor that plays a role in determining graft choice.

Evaluation of a smartphone application for self-rehabilitation after anterior cruciate ligament reconstruction during a COVID-19 lockdown

Introduction: La rééducation après une intervention chirurgicale est essentielle et conditionne le résultat fonctionnel final. Une application destinée aux patients présentant une lésion du ligament croisé antérieur (LCA) propose un programme d'auto-rééducation (Doct'up, Healing sas, Lyon, France). La pandémie COVID-19 au printemps 2020 a contraint les patients à suspendre leur rééducation postopératoire chez le kinésithérapeute pendant la période de confinement en France. Hypothèse: Une application d'auto-rééducation permet de limiter les conséquences de l'absence de rééducation chez le kinésithérapeute. Matériels et méthodes: Il s'agit d'une étude cas-témoin à partir de l'analyse rétrospective de données collectées de façon prospective incluant deux groupes de patients opérés d'une ligamentoplastie du LCA. Les patients du premier groupe (« App ») étaient opérés juste avant la période de confinement en mars 2020 en France durant la pandémie de COVID-19 et utilisaient uniquement l'application comme moyen de rééducation pendant le confinement. Un groupe de patient témoin apparié opéré 1 an plus tôt (« Standard ») bénéficiaient d'une kinésithérapie traditionnelle. Les 2 groupes bénéficiaient de la même technique de ligamentoplastie. Le critère de jugement principal était l'apparition d'un flexum à 6 semaines. Les critères de jugement secondaires étaient : le flexum du genou à 3 semaines et 6 mois, le réveil du muscle quadriceps et le verrouillage de l'extension du genou à 3 et 6 semaines et le taux de reprise chirurgicale pour syndrome du cyclope à 6 mois. Résultats: Trente-deux patients ont été inclus dans le groupe « App » et 101 patients dans le groupe « Standard ». Après auto-rééducation avec l'application seule, il n'existait pas de différence significative dans les 2 groupes concernant l'apparition d'un flexum à 6 semaines : 9,4% [28/32] vs 4,6% [87/101] p = 0,39. Il existait un meilleur réveil quadricipital (94% [30/32] vs 73% [74/101], p = 0,015) et un meilleur contrôle de l'extension avec cannes (78,1% [25/32] vs 40,6% [41/101], p = 0,0002) à 3 semaines. Il n'y a pas de différence entre les 2 groupes pour les autres critères étudiés (flexum à 3 semaines : 12,5% [4/32] vs 13,8% [14/101];flexum à 6 mois : 3,2% [1/32] vs 1% [1/101], réveil quadricipital à 6 semaines : 97% [31/32] vs 99% [100/101];verrouillage de l'extension avec cannes à 6 semaines : 96,9% [31/32] vs 93,1% [94/101], verrouillage de l'extension sans cannes à 3 semaines : 53,2% [17/32] vs 47,5% [48/101];verrouillage de l'extension sans cannes à 6 semaines : 93,7% [30/32] vs 82,2% [83/101], taux de syndrome du cyclope : 3,1% [1/32] vs 1% [1/101]). Discussion: Une application d'auto-rééducation après chirurgie du LCA utilisée dans le contexte de confinement imposée par la pandémie COVID-19 permet de limiter les conséquences liées à l'absence de kinésithérapeutes et a montré des résultats équivalents à ceux obtenus après rééducation standard avec un recul de 6 mois postopératoire. L'étude montre que l'auto-rééducation après chirurgie du genou est utile en postopératoire après chirurgie du LCA et pourrait être généralisée en complément des protocoles habituellement utilisés chez le kinésithérapeute. Niveau de preuve: IV;Étude rétrospective monocentrique de cohorte. © 2022 Elsevier Masson SAS

Comparison of the Effectiveness of Two Management Strategies in the Pandemic COVID-19 Period in Patient Visits (Face-to-Face Visits vs. a Smartphone) in follow-up the Range of Motion of the Knee in Patients with Anterior Cruciate Ligament Reconstruction.

Background: As the prevalence of the coronavirus increases, there is now more emphasis on reducing "face-to-face" patient visits. Therefore, the use of smartphones and their special medical applications can play an important role in following up patients. The aim of this study was to evaluate the use of smartphone in evaluating clinical outcomes and range of motion (ROM) of patients after anterior cruciate ligament reconstruction (ACLR). Materials and Methods: From January to December 2020, 112 patients between 20 and 50 years old were randomly selected at our orthopedic sports center. All patients were visited online through smartphone by a knee fellowship surgeon in the morning (case group) and again all of them were visited online through smartphone in the evening by another knee fellowship surgeon (control group). Both visits were done at regular intervals in the 2nd, 6th, and 12th week after surgery. Patients were evaluated for function outcomes and joint ROM. Results: The two groups were similar in terms of mean International Knee Documentation Committee score, Lysholm knee score, and Tegner Knee Score and did not show statistically significant difference (P < 0.05) There was no significant difference in knee ROM measurements between the two groups (face-to-face visits and online through smartphone visits) during the follow-ups (P > 0.05). Conclusion: Smartphone apps are highly effective in assessing postoperative condition of knee ROM after ACLR, especially in the short time. However, this ability has been reduced in evaluating the long term. Hence, evaluation is still necessary through direct examination in the presence visit.

Time to return to school following ACL reconstruction: influence of the COVID-19 pandemic.

INTRODUCTION: ACL reconstruction is commonly performed in school-aged patients for whom missed time from school can have an impact on their education. Additionally, the COVID-19 pandemic has led to different ways of accessing school content. We sought to determine how many days of school school-aged patients should expect to miss following ACL reconstruction and how the availability of remote learning during the COVID-19 pandemic affected this. METHODS: We evaluated 53 ACL reconstruction patients in grades 7-12 undergoing surgery during the school year. Demographic, medical, and educational information were collected. Patients were placed into 1 of 2 cohorts: Group A (surgery before the COVID-19 pandemic) or Group B (surgery during the COVID-19 pandemic). We calculated days missed from school after surgery until return to either virtual or in-person school. RESULTS: Overall, patients returned to school after missing an average of 4.4 (SD, 3.0) days of school after ACL reconstruction surgery. Patients in Group A missed an average of 5.5 (SD, 2.9) school days, while patients in Group B missed an average of 2.3 (SD, 1.4) school days (p <.001). Eighty-nine percent of Group B patients first returned to school utilizing a virtual option. Among those returning virtually, these patients missed an average of 1.9 (SD, 0.9) school days. CONCLUSIONS: A virtual distance learning option results in fewer missed days of school post ACL reconstruction. When given this option, school-aged patients can expect to return to school within two days post-op. Otherwise, patients should expect to miss about one week of in-person schooling. In this regard, the COVID-19 pandemic has positively impacted educational opportunities for students post-surgery, and physicians should advocate for continuing virtual options for students receiving medical treatment.

Short-Term Clinical Outcomes After Anterior Cruciate Ligament Reconstruction In Adolescents During The COVID-19 Pandemic

Background/Purpose The COVID-19 pandemic has impacted adolescents across multiple areas of health. While many factors influence outcomes following anterior cruciate ligament reconstruction (ACLR), the impact of the COVID-19 pandemic on early patient outcomes after ACLR is currently unknown in an adolescent population. The purpose of this study was to determine if short-term clinical outcomes were different in adolescents after ACLR for those who underwent surgery pre-COVID versus during the COVID-19 pandemic timeframe. Design Retrospective cohort Methods A retrospective review of records occurred for patients who underwent ACLR with a quadriceps tendon autograft. Two separate review timeframes were defined according to date of surgery (control: September 2017 - October 2019;COVID: March 2020 - May 2021). Patients were classified into pre-COVID (control) and COVID groups by surgical date and were then age- and sex-matched. Three-month postoperative outcomes were included for analysis, including normalized isometric quadriceps and hamstring peak torque, Anterior Cruciate Ligament - Return to Sport after Injury (ACL-RSI), and the Pedi International Knee Documentation Committee Form (Pedi-IKDC) scores. Results Sixty patients met the inclusion criteria (34 females, 56.7%). Follow-up testing occurred at 3.2 months (98.13 +/- 14.91 days) postoperative. A significant difference was found between groups for normalized quadriceps peak torque on the uninvolved limb, with the control group (2.03 +/- 0.47 Nm/kg) demonstrating decreased peak torque compared to the COVID group (2.49 +/- 0.61 Nm/kg) (p =0.002, effect size (d) = 0.84). For the involved limb, no difference in normalized quadriceps peak torque was observed between the control group (1.25 +/- 0.33 Nm/kg) and those who underwent surgery during the COVID-19 pandemic (1.49 +/- 0.70 Nm/kg) (p = 0.09). No differences were identified between groups for any of the other strength outcomes (p = 0.31 - 0.87). Similarly, no differences in patient reported outcomes were found for Pedi-IKDC or ACL-RSI between groups (p = 0.12 - 0.43). Conclusion At roughly three months after ACLR, normalized quadriceps peak torque on the uninvolved limb was reduced by 18.5% for adolescents who underwent surgery pre-COVID versus during the COVID-19 pandemic timeframe. No group differences were observed for other isometric strength outcomes, Pedi-IKDC, or ACL-RSI scores.

DID THE COVID-19 PANDEMIC AFFECT PSYCHOLOGICAL READINESS TO RETURN-TOSPORT IN YOUNG ATHLETES UNDERGOING ACL RECONSTRUCTION?

Background: Return-to-sport (RTS) following anterior cruciate ligament reconstruction (ACLR) is influenced by multiple physical and psychological variables. Psychological readiness has been associated with improved patient reported outcomes as well as RTS rates in young athletes. The COVID-19 pandemic may have altered the typical recovery process for patients undergoing ACLR. Hypothesis/Purpose: To compare 6-month postoperative levels of psychological readiness to RTS in ACLR patients before and during the pandemic. Methods: Patients were prospectively enrolled 6 months after primary ACLR at a single academic sports medicine practice, from December 2018 until May 2021. Patients were categorized into pre-COVID (enrollment prior to March 13, 2020) and COVID groups (March 13, 2020 - May 26, 2021). Demographic information, outcomes scores including the ACL-Return to Sport after Injury Scale (RSI) and PROMIS Psychological Stress Experiences (PROMIS-PSE), and physician RTS clearance were obtained and compared for both groups. Comparisons were performed utilizing Chi-square, Student's t-tests and linear regression. A matched analysis was conducted between groups controlling for age, sex, and graft type. Results: 231 patients were included in the present study (89 males, 142 females;mean age 16.9 years), with 76% (176/231) in the pre-COVID group and 24% (55/231) in the COVID group. There were no significant differences in age and sex between the two population cohorts. There was a significant difference in time from surgery to enrollment in the COVID group compared to the pre- COVID group (7.1 vs 6.2 months, p<0.001). In the matched cohort (n=126, 37/126 COVID group), the COVID group was cleared earlier by their physician to RTS compared to the pre-COVID group (6.9 months vs 8.5 months, p<0.001). While there was no significant difference between groups in 6 month ACL-RSI scores (63.8 pre-COVID vs 66.6 COVID, p=0.48), both groups yielded globally low scores. There were no significant associations between matched groups in PROMIS-PSE (p=0.71), IKDC (p=0.55), Pedi-IKDC (p=0.15), and Pedi-FABS (p=0.77) scores (Table 1). Conclusion: Young athletes demonstrated similar levels of psychological readiness to RTS at 6 months following ACLR prior to and during the COVID-19 pandemic. Patient-reported outcome scores were similar in pre-COVID and COVID ACLR patients, suggesting that the pandemic may not have played a detrimental role in perceptions of recovery. Psychological readiness may not be fully optimized at 6 months post-ACLR and young athletes may benefit from additional time and training for progressive confidence, muscle strength, and performance.

Massive cutback in orthopaedic healthcare services due to the COVID-19 pandemic.

PURPOSE: Due to the lack of evidence, it was the aim of the study to investigate current possible cutbacks in orthopaedic healthcare due to the coronavirus disease 2019 pandemic (COVID-19). METHODS: An online survey was performed of orthopaedic surgeons in the German-speaking Arthroscopy Society (Gesellschaft für Arthroskopie und Gelenkchirurgie, AGA). The survey consisted of 20 questions concerning four topics: four questions addressed the origin and surgical experience of the participant, 12 questions dealt with potential cutbacks in orthopaedic healthcare and 4 questions addressed the influence of the pandemic on the particular surgeon. RESULTS: Of 4234 contacted orthopaedic surgeons, 1399 responded. Regarding arthroscopic procedures between 10 and 30% of the participants stated that these were still being performed-with actual percentages depending on the specific joint and procedure. Only 6.2% of the participants stated that elective total joint arthroplasty was still being performed at their centre. In addition, physical rehabilitation and surgeons' postoperative follow-ups were severely affected. CONCLUSION: Orthopaedic healthcare services in Austria, Germany, and Switzerland are suffering a drastic cutback due to COVID-19. A drastic reduction in arthroscopic procedures like rotator cuff repair and cruciate ligament reconstruction and an almost total shutdown of elective total joint arthroplasty were reported. Long-term consequences cannot be predicted yet. The described disruption in orthopaedic healthcare services has to be viewed as historic. LEVEL OF EVIDENCE: V.

Disruptions in standard care: anterior cruciate ligament reconstruction outcomes during the SARS-COV2 pandemic.

OBJECTIVE: The SARS-COV2 pandemic led to massive disruptions of care for orthopedic patients. Although many elective procedures were put on hold, a cohort of patients who underwent surgery prior to the outbreak of the pandemic were rendered unable to participate in standard post-operative care. The purpose of this study was to determine the methods of post-operative care in arthroscopic anterior cruciate ligament reconstruction patients who received care during an early height of the pandemic to those who received standard of care in the prior year. We aimed to correlate those results with 1-year clinical outcomes in the form of subjective surveys. METHODS: Retrospective chart review was used to identify patients who underwent primary anterior cruciate ligament reconstruction in February and March of 2020 (case) and 2019 (control) at a single institution. Workman's compensation patients were excluded. Identified patients were asked to report post-operative care received, satisfaction with care, and complete the IKDC and Lysholm outcome measures. Surveys were conducted minimum 1-year post-operative. RESULTS: 236 patients were identified, including 103 in 2020 and 133 in 2019. Follow-up data was collected for 73 patients (70.9%) in 2020 and 97 patients (72.9%) in 2019. Fifty-one COVID cohort patients (69.9%) had at least one clinical visit conducted via telehealth, compared to zero in the control. There were no differences in IKDC (82.8 ± 13.2 vs 85.0 ± 12.0, P = 0.29) and Lysholm (89.2 ± 11.3 vs 89.6 ± 10.8, P = 0.82) between groups. There were no differences in patient satisfaction with the care received (82.9 ± 22.4 vs 81.9 ± 21.8, P = 0.79). CONCLUSION: Despite disruptions in care, anterior cruciate ligament reconstruction patients have excellent 1-year outcomes during the pandemic. Telehealth follow-up appointments may be appropriate for anterior cruciate ligament reconstruction patients beyond the pandemic and do not seem to adversely affect short-term patient reported outcome measures.

It is not 'business as usual' for orthopaedic surgeons in May 2020- the Austrian-German-Swiss experience.

PURPOSE: To document the status-quo of orthopaedic health-care services as the COVID-19 pandemic recedes, and to determine the rate of resumption of orthopaedic surgery in the German-speaking countries in May 2020. METHODS: A prospective online survey was sent out to 4234 surgeons of the AGA - Society of Arthroscopy and Joint-Surgery (Gesellschaft für Arthroskopie und Gelenkchirurgie, AGA). The survey was created using SurveyMonkey software and consisted of 23 questions relating to the reduction of orthopaedic services at the participating centres and the impact that the pandemic is having on each surgeon. RESULTS: A total of 890 orthopaedic surgeons responded to the online survey. Approximately 90% of them experienced a reduction in their surgical caseload and patient contact. 38.7% stated that their institutions returned to providing diagnostic arthroscopies. 54.5% reported that they went back to performing anterior cruciate ligament reconstructions (ACLR), 62.6% were performing arthroscopic meniscus procedures, and 55.8% had resumed performing shoulder arthroscopy. Only 31.9% of the surgeons were able to perform elective total joint arthroplasty. 60% of the participants stated that they had suffered substantial financial loss due to the pandemic. CONCLUSION: A gradual resumption of orthopaedic health-care services was observed in May 2020. Typical orthopaedic surgical procedures like ACLR, shoulder arthroscopy and elective total joint arthroplasty were reported to be currently performed by 54%, 56% and 32% of surgeons, respectively. Despite signs of improvement, it appears that there is a prolonged curtailment of orthopaedic health-care at present in the middle of Europe.