Bone bridge technique for lateral meniscal allograft transplantation: no difference in clinical outcome compared to the soft tissue technique.

PURPOSE: There is considerable debate regarding the optimal method of fixation for lateral meniscus allograft transplantation (MAT), with bone bridge techniques technically harder but allowing maintenance of root attachments, while soft tissue techniques are potentially more challenging for healing. The aim of this study was to compare the clinical results of the bone bridge and soft tissue techniques for lateral MAT in terms of failure, re-operation rate, complications and patient reported outcomes. METHODS: Retrospective analysis of prospectively collected data for patients undergoing primary lateral MAT with a minimum of 12-month follow-up. Patients following surgery utilising the bone bridge technique (BB) were compared with historical control patients who underwent MAT with the soft tissue technique (ST). Outcome was assessed by failure rate, defined as removal or revision of the meniscus transplant, survivorship by Kaplan-Meir analysis, re-operation rates, and other adverse event. Patient-reported outcome measures (PROMs) were compared using data at the 2-year point or 1 year if not reached 2 years. RESULTS: One-hundred and twelve patients following lateral meniscal transplants were included, 31 in the BB group and 81 in the ST historical control group, with no differences in demographics between both groups. Median follow-up for the BB group was 18 (12-43) months compared to 46 (15-62) months for the ST group. There were 3 failures (9.6%) in the BB group v 2 (2.4%) in the ST group (n.s.) with a mean time to failure of 9 months in both groups. 9 patients (29%) required a re-operation (all cause) in the BB group v 24 patients (29.6%) in the ST group (n.s). There was no difference in complications between both groups. There was significant improvement (p < 0.0001) in all PROMs (Tegner, IKDC, KOOS and Lysholm) between baseline and 2-year follow-up for both groups but no between-group differences. CONCLUSION: Lateral MAT has a high success rate for symptomatic meniscal deficiency with significant benefits irrespective of the fixation technique. There is no advantage in performing the more technically demanding BB technique over ST fixation. LEVEL OF EVIDENCE: Level 2.

Cement Mantle Quality and Stem Alignment in Cemented Collarless Polished Tapered Stems Implanted via the Direct Anterior and Direct Lateral Approaches: A Single Institution Experience.

BACKGROUND: The aim of this study was to compare the stem alignment and the quality of cement mantle of collarless polished tapered cemented stems inserted through the direct anterior approach (DAA) and the direct lateral approach (DLA). METHODS: A comparative retrospective study of 232 hybrid total hip arthroplasties using a cemented collarless polished tapered stem through either the DAA (n = 147) or DLA (n = 85) was performed. Radiographic evaluation included stem alignment, cement mantle quality, and cement mantle thickness. RESULTS: On anteroposterior radiographs, stems implanted through the DLA were more likely to be in neutral alignment, than those implanted through the DAA (83.5%[n = 71] versus 71.4% [n = 105]; P = <.001). No difference between approaches was noted for stem alignment on lateral radiographs or cement mantle quality. Multivariate analysis revealed factors associated with suboptimal cement mantle and included Dorr type B or C femur as well as male gender. A mean cement mantle thickness ≥2mm was achieved in all Gruen zones for both approaches. CONCLUSION: In our series, the DAA was associated with a higher incidence of coronal plane stem malalignment compared to the DLA when using cemented tapered polished femoral components for total hip arthroplasty. No difference in lateral stem alignment or cement mantle quality was found.

Can We Predict Fracture When Using a Short Cementless Femoral Stem in the Anterior Approach?

BACKGROUND: Short cementless femoral stems may allow for easier insertion with less dissection. The use of short stems with the anterior approach (AA) may be associated with a considerable perioperative fracture risk. Our aim was to evaluate whether patient-specific femoral and pelvic morphology and surgical technique, influence the perioperative fracture risk. Furthermore, we sought to describe important anatomical thresholds alerting surgeons. METHODS: A single-center, multi-surgeon retrospective, case-control matched study was performed. Thirty nine periprosthetic fractures (3.4%) in 1,145 primary AA THAs using short cementless stems were identified. These were matched with 78 THA nonfracture controls for factors known to increase the fracture risk. A radiographic analysis using validated software measured femoral (canal flare index [CFI], morphological cortical index [MCI], and calcar-calcar ratio [CCR]) and pelvic (Ilium-ischial ratio [IIR], ilium overhang, and anterior superior iliac spine [ASIS] to greater trochanter distance) morphologies and surgical techniques (% canal fill). A multivariate and Receiver-Operator Curve (ROC) analysis was used to identify fracture predictors. RESULTS: CFI (3.7 ± 0.6 vs 2.9 ± 0.4, P < .001) and CCR (0.5 ± 0.1 vs 0.4 ± 0.1, P = .006) differed. The mean IIR was higher in fracture cases (3.3 ± 0.6 vs 3.0 ± 0.5, P < .001). Percent canal fill was reduced in fracture cases (82.8 ± 7.6 vs 86.7 ± 6.8, P = .007). Multivariate and ROC analyses revealed a threshold CFI of 3.17 which was predictive of fracture (sensitivity: 84.6%/specificity: 75.6%). The fracture risk was 29 times higher when patients had CFI >3.17 and II ratio >3 (OR: 29.2 95% CI: 9.5-89.9, P < .001). CONCLUSION: Patient-specific anatomical parameters are important predictors of a fracture-risk. A careful radiographic analysis would help identify those at a risk of early fracture using short stems, and alternative stem options should be considered.

Supine versus lateral position for total hip replacement: accuracy of biomechanical reconstruction.

BACKGROUND: Restoration of normal hip anatomy and biomechanics is a key surgical goal for success in total hip arthroplasty. The aim of this study was to evaluate the influence, if any, that patient positioning in the supine and lateral decubitus positions has in achieving this goal. MATERIALS AND METHODS: A single center multi-surgeon case-matched series from a tertiary level referral center of patients undergoing primary unilateral THA for osteoarthritis between April 2018 and December 2019 was retrospectively analyzed. Patients (n = 200) were divided into two matched groups: supine (anterior approach, n = 100) and lateral decubitus (direct lateral or posterior/SuperPATH™ approaches, n = 100). Post-operative anteroposterior pelvic radiographs were analyzed using a previously validated software (SurgiMap, Nemaris Inc., USA) for parameters of reconstruction of the hip in the coronal plane; leg length discrepancy, vertical and horizontal displacement of the center of rotation, femoral offset, and total offset. RESULTS: Mean absolute leg length discrepancy in the supine group was 0.6 ± 3.3 mm (95% [CI] - 0.1 to 1.2 mm) versus 2.4 ± 3.8 mm (95% [CI] 1.6 to 3.1) in the lateral decubitus position (p < 0.001). The center of rotation was displaced medially by a mean of 3.2 ± 2.7 mm in the supine group versus 1.3 ± 4.0 mm in the lateral decubitus group (p < 0.001). For a surgical target of reconstructing both leg length and total offset within 5 mm of native anatomy, the supine group was more than twice as likely to achieve these goals with fewer outliers (OR 2.631, 95% [CI] 1.901-3.643) (76% v 30%, p < 0.001). CONCLUSION: Total hip arthroplasty through the anterior approach in the supine position is more consistent and accurate for the restoration of leg length and total offset. Further study is required to assess how this translates with outcome. LEVEL OF EVIDENCE: III-retrospective cohort study.

High reported rate of return to play following bone marrow stimulation for osteochondral lesions of the talus.

PURPOSE: The purpose of this study is to systematically review the literature and to evaluate the reported rehabilitation protocols, return to play guidelines and subsequent rates and timing of return to play following bone marrow stimulation (BMS) for osteochondral lesions of the talus (OLT). METHODS: MEDLINE, EMBASE and the Cochrane Library were searched according to the PRISMA guidelines in September 2017. The rate and timing of return to play was assessed. The rehabilitation protocols were recorded, including time to start range of motion, partial weight-bearing and complete weight-bearing. RESULTS: Fifty-seven studies with 3072 ankles were included, with a mean age of 36.9 years (range 23-56.8 years), and a mean follow-up of 46.0 months (range 1.5-141 months). The mean rate of return to play was 86.8% (range 60-100%), and the mean time to return to play was 4.5 months (range 3.5-5.9 months). There was large variability in the reported rehabilitation protocols. Range of motion exercises were most often allowed to begin in the first week (46.2%), and second week postoperatively (23.1%). The most commonly reported time to start partial weight-bearing was the first week (38.8%), and the most frequently reported time of commencing full weight-bearing was 6 weeks (28.8%). Surgeons most often allowed return to play at 4 months (37.5%). CONCLUSIONS: There is a high rate of return following BMS for OLT with 86.8% and the mean time to return to play was 4.5 months. There is also a significant deficiency in reported rehabilitation protocols, and poor quality reporting in return to play criteria. Early weightbearing and early postoperative range of motion exercises appear to be advantageous in accelerated return to sports. LEVEL OF EVIDENCE: Level IV.

Primary appendicular soft-tissue sarcoma resection: What tumour parameters affect wound closure planning?

Wound closure after wide, local excision of an appendicular soft-tissue sarcoma (STS) can be challenging. This study evaluates the value of magnetic resonance imaging (MRI)-based tumour parameters in planning wound closure. A total of 71 patients with a primary limb-based STS, excluding vascular or osseous involvement, excluding the shoulder or hand and hip or foot were included. Axial MRI images were used to measure the circumferences and cross-sectional areas of the limb, bone, and tumour. The tumour diameter, length, and depth at the level of maximal tumour dimension were measured to identify the tumour's relative contribution to the planning of optimal wound closure management through primary closure (PC) or reconstructive surgery (RS). Eighteen patients required planned wound RS. Wound complications occurred in 14% overall. Tumours, which were closed by PC, were of significantly greater depth, shorter radial diameter, and shorter tumour circumference relative to those closed by RS. On multivariate analysis, tumour depth was the greatest contributory factor in predicting type of wound closure. A quantitative analysis of MRI-based tumour parameters demonstrates tumour depth as the most predictive factor in planning for the type of wound closure and may prove beneficial in providing greater insight into planned wound management of sarcoma resection.

Oral care and nursing home-acquired pneumonia.

Data sources Cochrane Oral Health Trials Register, Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, Chinese Biomedical Literature Database, China National Infrastructure, US National Institutes of Health Ongoing Trials Registry, WHO Clinical Trials Registry, Sciencepaper Online, 19 Chinese dental and nursing journals. Reference lists of included studies were also screened.Study selection Studies were included if they explored oral care with the purpose of reducing pneumonia compared to no oral care, usual care or other oral care measures. Only randomised controlled trials were included which could be either parallel design or cluster RCTs with randomisation by care facility. No restrictions were placed on language, year of publication or publication status.Data extraction and synthesis Two independent reviewers undertook screening for inclusion, data extraction and assessment of risk of bias. The Cochrane tool for risk of bias was used to assess quality of the studies. Synthesis was mainly narrative, though numerical results were combined where feasible.Results Four studies were included, all of which were parallel RCTs. All were judged to be at high risk of bias due to lack of blinding. One study suggested that oral care may reduce pneumonia associated death, though evidence was low quality and should be treated with caution. There was no high quality evidence available to indicate which oral care methods may be most effective in reducing pneumonia.Conclusions It was not possible to establish the effects of professional oral care on nursing home-acquired pneumonia due to the limited number of studies and low quality evidence. Further trials are needed to draw reliable conclusions.

Is there an association between prenatal oral healthcare and early childhood caries prevention?

Data sources Database searches included Pubmed, Embase, Scopus, Web of Science, LILACS, Cochrane Library and ClinicalTrials.gov.Study selection This review included studies that assessed the impact of pre-natal oral health care on early childhood caries experience and/or oral carriage of S. mutans. The review included case control studies, retrospective or prospective cohort studies, randomised or non-randomised controlled trials. In vitro studies, animal studies, literature reviews, cross sectional studies and literature reviews were excluded.Data extraction and synthesis Two calibrated and independent reviewers screened the literature using a data extraction form based on defined inclusion and exclusion criteria. A PRISMA flow diagram is presented showing the process of reviewing the literature. The Cochrane Risk of Bias Tool for Randomised Trials and an adapted version of the Downs and Black score were used to assess the quality of the included studies. A qualitative synthesis of five included studies is presented. A Forest Plot then presents quantitative data from four of the studies. A meta analysis did not take place. A generalised linear mixed effects model was applied to results from four of the studies.Results Five studies were included in the qualitative syntheses, three of the studies were randomised controlled trials, one was a prospective cohort study and one was a nested case-control in a cohort study. Two of the studies were assessed as high quality with three assessed as moderate quality. Odds ratios of children experiencing early childhood caries are reported for four studies demonstrating a reduced risk of early childhood caries in intervention groups compared to controls. A generalised linear mixed effects model using combined results from the four studies shows a reduced risk of developing early childhood caries in children up to the age of three years old whose mothers receive pre natal oral care. Above age three years the results of the modelling become non-significant. Based on the results of two studies the authors report a reduction in levels of S. mutans in the oral cavity of children whose mother had prenatal oral care.Conclusions The authors conclude that prenatal oral healthcare has a positive effect on incidence of early childhood caries and S. mutans carriage in children.

A prospective evaluation of bone marrow aspirate concentrate and microfracture in the treatment of osteochondral lesions of the talus.

BACKGROUND: The term osteochondral lesion (OCL) refers to a defect involving the chondral surface and or subchondral bone. These lesions are associated with ankle injuries with bony and soft tissue and cause pain, decreased range of motion, swelling and impact adversely on quality of life. To date the standard treatment has been isolated microfracture (BMS). The aim of this study was to compare the outcomes of BMS alone to BMS augmented with bone marrow aspirate concentrate (BMAC) in the treatment of ankle OCLs. METHODS: This study was a prospective cohort study carried out from 2010-2015 in a single surgeon's practice. Patients from 2010-2012 were treated with microfracture alone while patients from 2013-2015 were treated with micro fracture augmented with bone marrow aspirate concentrate and fibrin glue. Self-reported patient outcome measures were measured. Complications, revision rates, and visual analogue pain scores were compared. RESULTS: 101 patients were included in the study. 52 patients were in the microfracture group while 49 patients were in the microfracture/BMAC group. The minimum follow-up for both groups was 36 months. Both groups had a statistically significant improvement in pain scores, quality of life scores, participation in sport and activities of daily living. The revision rate was 28.8% in the microfracture group versus 12.2% in the microfracture/BMAC group, which was statistically significant, p=0.0145. The majority of the lesions were less than 1.5cm2 in diameter in both cohorts. CONCLUSIONS: Microfracture and bone marrow aspirate concentrate appears to be a safe and effective treatment option for osteochondral lesions of the talus. The addition of bone marrow aspirate concentrate does not result in any increase in ankle or donor site morbidity. It is a well-tolerated therapy which decreases revision rates for treatment of the osteochondral lesions when compared to microfracture alone. LEVEL OF EVIDENCE: Level III.

Oral health literacy, oral health behaviours and dental outcomes.

Data sourcesEight electronic databases were searched: Medline (through PubMed), ISI Web of Science, Scopus, The Cochrane Library, National Institute for Health and Clinical Excellence, Lilacs and the Brazilian Library of Dentistry, Controlled-trials database of Clinical Trials and Clinical Trials-US National Institute of Health. A grey literature search was also conducted and reference lists of included studies were interrogated.Study selectionInclusion criteria were studies which examined the relationship between oral health literacy and one of the pre-defined outcomes including oral health behaviours, perception, knowledge and dental treatment outcomes. Epidemiological studies (such a case-control, cohort, cross-sectional and clinical trials) were included but qualitative studies, systematic reviews and those which examined unrelated outcomes were excluded.Data extraction and synthesisTwo independent reviewers carried out screening, risk of bias assessment and data extraction for all studies against pre-agreed inclusion and exclusion criteria. The Newcastle-Ottawa Scale (a modified version for cross-sectional studies) and the Cochrane Risk of Bias tool were used for quality appraisal. A narrative synthesis was presented, with meta-analysis of a small sub-group of studies relating to one outcome.ResultsTwenty-five studies were included in the final review; 21 cross-sectional, two cohort, one case-control and one clinical trial. Most (17) were considered to be at high risk of bias and there was a high degree of clinical and methodological heterogeneity. No evidence was found of a significant association between oral health literacy and the outcomes considered.ConclusionsThe authors concluded that the current scientific evidence suggests that no association exists between oral health literacy and any of the outcomes investigated. Further prospective studies with high methodological quality are needed.

Peroneus Tertius Tendon Tear Causing Lateral Ankle Pain in a Child.

The peroneus tertius muscle arises in the anterior compartment of the leg and demonstrates significant morphologic variation. Its function is not yet clearly delineated. We present the case of a 12-year-old patient with an isolated tear of the peroneus tertius tendon that resulted in lateral based ankle pain. After surgical reconstruction, the patient's pain resolved, and he was able to return to his normal activities.

Prospective Evaluation of Intra-Articular Sodium Hyaluronate Injection in the Ankle.

Viscosupplementation by injection of hyaluronic acid into the ankle can be used to provide pain relief and to delay the need for surgery in patients with osteoarthritis of the ankle. In the present investigation, we prospectively evaluated 50 consecutive patients (25 males and 25 females) undergoing a 3-injection protocol of sodium hyaluronate viscosupplementation in the ankle from January 2014 to January 2015. The Foot and Ankle Outcomes Score was used to compare the patients' pre- and post-treatment opinions about their ankle problems. The mean pretreatment Foot and Ankle Outcomes Score was 48 ± 6.3 (range 25 to 84) and the 6-month post-treatment score was 78 ± 5.8 (range 48 to 100). This difference was statistically significant (p = .003). From our findings in the present prospective cohort study, we have concluded that intra-articular injection of sodium hyaluronate viscosupplementation is a useful conservative therapy for osteoarthritis of the ankle.

Single Oblique Incision for Simultaneous Open Reduction and Internal Fixation of the Posterior Malleolus and Anterior Syndesmosis.

Several surgical approaches to the posterior malleolus have been described. However, these approaches may make it difficult for fixation of associated lateral malleolar and anterior syndesmotic fractures. A single incision approach is described that allows safe access to the posterior malleolus while also facilitating access to the lateral malleolus and anterior syndesmosis.

Primary ankle arthrodesis for neglected open Weber B ankle fracture dislocation.

Primary ankle arthrodesis used to treat a neglected open ankle fracture dislocation is a unique decision. A 63-year-old man presented to the emergency department with a 5-day-old open fracture dislocation of his right ankle. After thorough soft tissue debridement, primary arthrodesis of the tibiotalar joint was performed using initial Kirschner wire fixation and an external fixator. Definitive soft tissue coverage was later achieved using a latissimus dorsi free flap. The fusion was consolidated to salvage the limb from amputation. The use of primary arthrodesis to treat a compound ankle fracture dislocation has not been previously described.

A prospective review of Cauda Equina Syndrome referrals received by an on-call orthopaedic department at a major trauma unit.

INTRODUCTION: Cauda Equina Syndrome (CES) is one of the genuine orthopaedic emergencies. Diagnosis of acute CES is challenging and may be missed, resulting in considerable medicolegal claims. In Ireland, nearly €21 million in compensation has been paid out over a 10-year period due to the diagnosis being missed. As a result, defensive practices have resulted in an increased number of referrals for CES to the on-call orthopaedic service in a major trauma unit. METHODS: A prospective data-capturing exercise was carried out of all referrals for acute CES to the orthopaedic on-call department in a tertiary-level university-affiliated teaching hospital between August and November 2023. Qualitative data was captured including referral source, referring clinician grade, in-hours or out-of-hours referral, MRI on referral, red flags as identified by the referring team, red flags as identified by the orthopaedic team, and outcome. RESULTS: Forty referrals for CES were made over the duration of this audit. Seventeen (42.5%) referrals were made in-hours, and 23 (57.5%) were referred out-of-hours. Only five (12.5%) of these referrals had an MRI done at the time of the referral. No patients were transferred for an out-of-hours MRI to another hospital. Only five (12.5%) patients required surgical decompression-none of these patients required an out-of-hours emergent decompression. CONCLUSION: There is a lack of understanding as to what exactly is being referred-resulting in a referral volume which is over ten times the expected number of CES cases being made to our unit. The lack of out-of-hours MRI access poses a significant concern for patient outcomes.

Contemporary, non-navigation, cup orientation techniques improve accuracy and eliminate differences seen between the anterior and posterior approach in THA.

BACKGROUND: This study aimed to: (1) Determine the ability to achieve the surgeons' desired cup orientation, without navigation, using contemporary measures with the anterior- (AA) and posterior- approaches (PA); and (2) assess whether surgical approach is associated with cup orientation accuracy, as previously reported, when contemporary measures are used. METHODS: A prospective, 2-centre, multi-surgeon study of 400 THAs (200 AA; 200 PA) was performed. Intraoperative radiographs were obtained with the AA. A digital inclinometer and 3-point pelvic support were used with the PA. With the PA, intraoperative cup inclination at impaction was recorded. Radiographic inclination/anteversion (RI/RA) was measured from intraoperative radiographs (AA-only) and from postoperative radiographs for all cases. Optimum inclination/anteversion was defined as 40°/20° (±10°). The difference between intra- and postoperative orientations allowed for determination of the difference in pelvic position at impaction. RESULTS: Optimum RI and RA were achieved in 91.3% (n = 365) and 92% (n = 368) of cases respectively. Optimum cup orientation was detected in 84% of cases (n = 336). There was equivalent ability to achieve cup orientation between approaches (AA: 82.5% vs. PA: 85.5%; p = 0.41). The use of an inclinometer in the PA was associated with a smaller variability of inclination at implantation (10° vs. 14°) and counteracted the greater difference in pelvic position (4.4° vs. 2.1°) seen with the PA. CONCLUSIONS: Over 80% of cases can have optimum orientation without navigation, using simple, cheap contemporary measures. Such measures eliminate differences between approaches, related to patient position. Narrower implantation angles will further reduce variability in cup orientation achieved.

Acute traumatic spinal injury following bicycle accidents: a report of three cases.

Although the vast majority of injuries suffered while cycling are minor, acute spinal injuries have been reported. We describe three cases of acute spinal injury occurring while cycling. All three patients reported being thrown over the handlebars, while travelling downhill at speed. Two of the cases resulted in profound neurological deficit. These cases show that there is a spectrum of spinal injury due to bicycle accidents, ranging from no neurological deficit to profound insult, and from high cervical injury to mid-thoracic spinal injury. In cases of bicycle accidents, increased awareness of the possibility of such spinal injury is advisable.

Gluteal compartment syndrome following bone marrow biopsy: a case report.

Compartment syndrome is a well described limb-threatening and potentially life-threatening condition. Compartment syndromes of the upper and lower limbs are well documented in the literature. The gluteal region, however, is often not considered as a compartment despite having three osseofascial boundaries. We report a case of gluteal compartment syndrome which resulted from a bone marrow biopsy. The patient was anticoagulated at the time. The outcome was residual right sided foot drop due to sciatic nerve palsy. This case describes an unusual presentation of a rare condition. Gluteal compartment syndrome is a potential complication of bone marrow biopsy.

The accuracy in determining pelvic tilt from anteroposterior pelvic radiographs in patients awaiting hip arthroplasty.

Spinopelvic mobility affects outcome after THA. Whether the sacro-femoral-pubic (SFP) angle, measured on AP radiographs, can be reliably used to estimate pelvic tilt (PT) in hip osteoarthritis patients is unknown. This study aimed to (1) validate the use of the SFP angle in the calculation of PT from AP radiographs, and (2) identify individual patient factors affecting the estimation of PT. A cohort of 100 patients awaiting THA for end-stage hip osteoarthritis was prospectively studied. AP and lateral radiographs, taken in the standing and relaxed-seated positions were evaluated for spinopelvic measurements (SFP, PT, and pelvic incidence [PI]). To validate the SFP angle, estimated PT values using the formula [PT = 75°-SFP] were compared to the true, measured values from the lateral radiographs. Despite good agreement for the estimated and true PT (16.2 ± 5.9° vs. 15.5 ± 8.6°; p = .315), a significantly poorer agreement could be found between the two methods at high or low values of PT. Patient-specific PI correlated with the difference between the two measurement methods (Pearson's r = -0.644; p < .001). However, the change in SFP angle equaled approximately the change in pelvic tilt (∆PT = 2°-∆SFP; Pearson's r = -0.934; p < .001). Absolute values for the sagittal PT should not be estimated from AP pelvic radiographs in patients awaiting total hip arthroplasty. However, the relative change in PT between different positions equals approximately the change in SFP angle. This may allow functional cup orientation after THA to be determined between different postures from an AP radiograph of the pelvis. The SFP angle has moderate accuracy in determining a patient's pelvic tilt; however, it can accurately determine a patient's change in pelvic tilt in different positions.

Improving participation and engagement with a COVID-19 surveillance programme in an outpatient setting.

BACKGROUND: On 3 August 2020, Public Health Scotland commenced a prospective surveillance study to monitor the prevalence of COVID-19 among asymptomatic outpatients attending dental clinics across 14 health boards in Scotland. OBJECTIVES: The primary aim of this quality improvement project was to increase the number of COVID-19 tests carried out in one of the participating sites, Glasgow Dental Hospital and School. The secondary aim was to identify barriers to patient participation and staff engagement when implementing a public health initiative in an outpatient setting. METHOD: A quality improvement working group met weekly to discuss hospital findings, identify drivers and change ideas. Details on reasons for patient non-participation were recorded and questionnaires on project barriers were distributed to staff. In response to findings, rapid interventions were implemented to fast-track increases in the numbers of tests being carried out. RESULTS: Over 16 weeks, 972 tests were carried out by Glasgow Dental Hospital and School Secondary Care Services. The number of tests per week increased from 19 (week 1) to 129 (week 16). This compares to a similar 'control' site, where the number of tests carried out remained unchanged; 38 (week 1) to 36 (week 16). The most frequent reason given for non-participation was fear that the swab would hurt. For staff, lack of time and forgetting to ask patients were identified as the most significant barriers. CONCLUSION: Public health surveillance programmes can be integrated rapidly into outpatient settings. This project has shown that a quality improvement approach can be successful in integrating such programmes. The key interventions used were staff engagement initiatives and front-line data collection. Implementation barriers were also identified using staff questionnaires.