High rates of return to sport following management of osteochondritis dissecans of the femoral trochlea: A systematic review.

PURPOSE: To summarize management strategies and associated clinical outcomes in patients with osteochondritis dissecans (OCD) of the femoral trochlea. METHODS: Three databases were searched from inception to 2 October 2023, for studies describing outcomes posttreatment for femoral trochlear OCD. The authors adhered to the preferred reporting items for systematic reviews and meta-analyses and revised assessment of multiple systematic reviews guidelines as well as the Cochrane Handbook for Systematic Reviews of Interventions. Data on demographics, injury characteristics, and operative details were extracted. Outcomes included patient reported outcome measures (PROMs), complications, and revision and return to sport (RTS) rates. RESULTS: Twenty studies comprising 105 patients (119 knees) were included. Females comprised 10.1% (range: 0%-100%) of patients and the mean age of patients was 14.5 (range: 11-28) years. A total of 89 (74.7%) of knees received operative management, with 28 of 34 (82.4%) known open procedures being open reduction internal fixation (ORIF), and nine of 29 (31%) known arthroscopic procedures receiving arthroscopic reduction internal fixation (ARIF) or drilling. Lysholm and International Knee Documentation Committee scores in 20 patients each ranged from 93.4 to 100 and 74.7 to 96.6, respectively. The revision rate for operative procedures was 9.0%, and the overall RTS rate was 93.3%. CONCLUSION: There is very little high quality evidence investigating patients with femoral trochlear OCD lesions. Drilling, ARIF, and ORIF were the most common surgical options for this patient population. Patients treated with either nonoperative or operative management returned to sport at a high rate, and those requiring operative management had a low revision rate. LEVEL OF EVIDENCE: Level V.

Characterizing the Practices of Canadian Orthopedic Surgeons in the Management of patients With Anterior Glenohumeral Instability.

OBJECTIVE: To determine the practice patterns of Canadian orthopedic surgeons in the management of patients with anterior glenohumeral instability (AGHI). DESIGN: Cross-sectional survey. SETTING: Canada. PATIENTS OR OTHER PARTICIPANTS: Canadian orthopedic surgeons with membership in the Canadian Orthopedic Association or Canadian Shoulder and Elbow Surgeon group who had managed at least 1 patient with AGHI in the previous year. INTERVENTIONS: A survey including demographics and questions on the management of patients with AGHI was completed. Statistical comparisons (χ 2 ) were completed with responses stratified using the instability severity index score (ISIS) in practice, years of practice, and surgical volumes. MAIN OUTCOME MEASURES: Summary statistics were compiled, and response frequencies were considered for consensus (75%). Case series responses were stratified on use of the ISIS in practice, years of experience, and annual procedure volumes (χ 2 , P < 0.05). RESULTS: Eighty orthopedic surgeons responded, with consensus on areas of diagnostic workup of AGHI, nonoperative management, and operative techniques. There was no consensus on indications for soft tissue and bony augmentation or postoperative management. There was no difference in practices based on the use of ISIS, years in practice, or surgical volumes. CONCLUSIONS: Canadian orthopedic surgeons manage AGHI consistently with consensus achieved in preoperative diagnostics and operative techniques, although debate remains as to the indications for soft tissue and bony augmentation procedures.

Hardware complications and reoperations following precontoured plate fixation of the olecranon: a population-based study.

BACKGROUND: Several fixation techniques have been described to treat acute olecranon fractures. Plate fixation is often used because of its superior mechanical properties. The reported rates of reoperation after olecranon plate fixation have been quite heterogeneous. The purpose of this study was to establish an updated reoperation rate based on modern precontoured plate constructs. METHODS: This retrospective cohort study used population-level administrative data to identify all surgically treated adult patients with olecranon fractures at 4 hospitals in Edmonton, AB, Canada, between 2010 and 2015. Radiographic review was conducted to identify patients who underwent precontoured olecranon plate fixation. Fracture characteristics including Mayo fracture classification and other concomitant upper-extremity injuries were identified. Chart reviews were performed to determine patient characteristics and patients who required reoperation. The primary reason for and type of reoperation were determined. RESULTS: Six hundred patients were surgically treated for olecranon fractures. Precontoured plate fixation was used in 321 patients. The average age of included patients was 56 years (standard deviation [SD], 19.4 years), and there were 173 female patients (53.9%). Reoperation was required in 90 patients (28%). For 50 patients, implant-related irritation was the primary reason for reoperation, representing 55.6% of the patients who underwent reoperation (50 of 90) and 15.6% of the total cohort (50 of 321). Other reasons for reoperation included hardware failure in 17 patients (5.3%), infection in 9 (2.8%), and contracture in 9 (2.8%). Patients who required reoperation were significantly younger (52.9 years [SD, 18.1 years] vs. 57.7 years [SD, 19.4 years]; P = .048) and had significantly higher rates of type III olecranon fractures (17.8% [16 of 90] vs. 8.2% [19 of 231]; P = .04) and Monteggia fractures (13.3% [12 of 90] vs. 4.8% [11 of 231]; P = .008). A multivariate logistic regression model also demonstrated increased odds ratios (ORs) for overall reoperation in patients with Monteggia fractures (OR, 2.99 [95% confidence interval, 1.25-7.17]; P = .014) and for reoperation due to implant-related irritation in younger patients (OR, 0.98 [95% confidence interval, 0.96-0.996]; P = .018). No discerning factors were identified for the 50 patients who underwent hardware removal for implant-related irritation compared with the whole reoperation group (n = 90). CONCLUSION: This study found that patients with olecranon fractures treated with precontoured plates experienced a hardware removal rate of 15.6% for implant-related irritation. Patients who sustained more complex fractures, such as Monteggia injuries, demonstrated higher rates of reoperation. Increasing age may be associated with lower rates of reoperation. In patients who required reoperation, there were no identifiable radiographic or clinical characteristics that were associated with implant-related irritation as their primary reason for reoperation.

Small-scale intraspecific patterns of adaptive immunogenetic polymorphisms and neutral variation in Lake Superior lake trout.

Many fishes express high levels of intraspecific variability, often linked to resource partitioning. Several studies show that a species' evolutionary trajectory of adaptive divergence can undergo reversals caused by changes in its environment. Such a reversal in neutral genetic and morphological variation among lake trout Salvelinus namaycush ecomorphs appears to be underway in Lake Superior. However, a water depth gradient in neutral genetic divergence was found to be associated with intraspecific diversity in the lake. To investigate patterns of adaptive immunogenetic variation among lake trout ecomorphs, we used Illumina high-throughput sequencing. The population's genetic structure of the major histocompatibility complex (MHC Class IIß exon 2) and 18 microsatellite loci were compared to disentangle neutral and selective processes at a small geographic scale. Both MHC and microsatellite variation were partitioned more by water depth stratum than by ecomorph. Several metrics showed strong clustering by water depth in MHC alleles, but not microsatellites. We report a 75% increase in the number of MHC alleles shared between the predominant shallow and deep water ecomorphs since a previous lake trout MHC study at the same locale (c. 1990s data). This result is consistent with the reverse speciation hypothesis, although adaptive MHC polymorphisms persist along an ecological gradient. Finally, results suggested that the lake trout have multiple copies of the MHC II locus consistent with a historic genomic duplication event. Our findings indicated that conservation approaches for this species could focus on managing various ecological habitats by depth, in addition to regulating the fisheries specific to ecomorphs.

Postoperative weight-bearing restrictions and rehabilitation protocols after hip arthroscopy for femoroacetabular impingement: a systematic review.

Despite recent increased interest in hip arthroscopy for the management of femoroacetabular impingement (FAI), there is little evidence to guide weight-bearing recommendations and rehabilitation postoperatively. The primary objective of this study was to determine if sufficient evidence exists to recommend specific weight-bearing restrictions postoperatively. This study was registered with PROSPERO (CRD42021247741). PubMed, MEDLINE and Embase were searched on 3 March 2023 for Level I-IV studies including patients over the age of 18 years, with a minimum 1-year follow-up and reporting of a weight-bearing status, a patient-reported outcome measure (PROM) and a clinical outcome. Meta-analysis was precluded due to heterogeneity in the included studies, and a descriptive analysis was undertaken. Methodological quality and risk of bias were assessed with the methodological index for non-randomized studies (MINORS). Twenty-four studies including 2231 patients who underwent hip arthroscopy for treatment of FAI were included (follow-up interval 33.2 ± 24.7 months). Most articles (62.5%) were case series. There were seven terms describing weight-bearing recommendations, with 83% being some variation of 'partial weight-bearing'. Eight PROMs were reported, with 83% using the modified Harris Hip Score and 87.5% of studies reporting reoperation rates. Only 75% of studies reported rehabilitation protocols. The average MINORS score was 11.07 ± 1.10 out of 16 for non-comparative studies and 18.22 ± 1.48 out of 24 for comparative studies. The reporting of weight-bearing status, clinical outcomes, PROMs and rehabilitation parameters remains poor. At present, sufficient comparative evidence does not exist to make specific weight-bearing recommendation postoperatively.