Validity of Video-Based Analysis for Analyzing Shoulder Injuries in the National Basketball Association.

Background: Shoulder injuries are very common in athletes playing in the National Basketball Association (NBA). With increasing injury video uploads available online, we may be able to identify and systematically describe the mechanism of these injuries in these athletes. Purpose: To (1) determine the validity of video-based analysis to evaluate mechanisms of shoulder injuries in NBA players during the 2010-2020 seasons and (2) report on commonly sustained injuries, circumstances associated with injury, and number of games missed owing to injury. Study Design: Cross-sectional study; Level of evidence, 3. Methods: An injury report data set was queried for shoulder injuries among NBA players between the 2010-2011 season and the 2019-2020 season, and results were cross-referenced using YouTube.com to identify high-quality videos of the injuries. Out of 532 shoulder injuries in this time frame, video evidence from 39 (7.3%) were evaluated for mechanism of injury and other corresponding situational data. From the remaining shoulder injuries, a randomly selected control cohort of 50 injuries occurring in the same interval was assessed for descriptive injury data, incidence of recurrence, necessity for surgery, and number of games missed, to compare with corresponding data from injuries in the videographic evidence cohort. Results: In the videographic evidence cohort, the most common mechanism of injury was lateral contact to the shoulder (41%; P < .001), which was associated with an injury to the acromioclavicular joint (30.8%; P < .001). Injuries occurred more often when the team was on offense (58.9%; P < .001) versus defense. Players who required surgery missed 33 more games on average than players who did not require surgery (P < .001). For the injured players, a 33% incidence of reinjury was identified in the 12 months after their initial injury. As compared with the control cohort, no significant differences were noted in injury laterality, recurrence rates, necessity for surgical management, time in the season, or number of games missed. Conclusion: Despite its low yield of 7.3%, video-based analysis may be a useful tool to determine the mechanism of shoulder injuries in the NBA, given the similarities of injury characteristics as compared with the control group.

Quantifying Surgeon Intuition Using a Judgment Analysis Model: Surgeon Accuracy of Predicting Patient-Reported Outcomes in Patients Undergoing Hip Arthroscopy for Femoroacetabular Impingement Is Moderate at Best.

Purpose: To quantify surgeon intuition, determine whether a surgeon's prediction of outcomes after hip arthroscopy correlates with actual patient-reported outcomes (PRO), and identify differences in clinical judgment between expert and novice examiners. Methods: This prospective, longitudinal study was conducted at an academic medical center on adults undergoing primary hip arthroscopy for treatment of femoroacetabular impingement. A Surgeon Intuition and Prediction (SIP) score was completed preoperatively by an attending surgeon (expert) and physician assistant (novice). Baseline and postoperative outcome measures included legacy hip scores (e.g., Modified Harris Hip score) and Patient-Reported Outcomes Information System tools. Mean differences were assessed using t-tests. Generalized estimating equations assessed longitudinal changes. Pearson correlation coefficients (r) evaluated associations between SIP score and PRO scores. Results: Data from 98 patients (mean age 36 years, 67% female) with complete data sets at 12-month follow-up were analyzed. Weak-to-moderate strength correlations were seen between SIP score and PRO scores (r = 0.36 to r = 0.53) for pain, activity and physical function. Significant improvements were seen in all primary outcome measures at 6 and 12 months postoperatively when compared to baseline scores (P < .05), with about 50% to 80% of patients achieving the minimum clinically important difference and patient acceptable symptomatic state thresholds postoperatively. Conclusions: An experienced, high-volume hip arthroscopist had only weak-to-moderate ability to intuitively predict PRO. Surgical intuition and judgment were not superior in an expert examiner compared to a novice. Level of Evidence: Level III, retrospective comparative prognostic trial.

Efficacy of antimicrobial washes before shoulder surgery against Cutibacterium: a systematic review and meta-analysis.

Background: Cutibacterium acnes is a commensal intradermal microorganism that is commonly isolated at revision shoulder arthroplasty. Standard practice chlorhexidine gluconate (CHG) skin preparation agents have limited effectiveness at eradicating C. acnes in the dermis. Benzoyl peroxide (BPO) has demonstrated effectiveness against C. acnes. This meta-analysis compares the efficacy of at-home shoulder decolonization before surgery using CHG vs. BPO to reduce shoulder C. acnes burden. Methods: This was a Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic review. PubMed and MEDLINE databases were searched for studies evaluating the effects of CHG and BPO in reducing C. acnes at the shoulder. Trial results were extracted and pooled using a random effects model, separating data from randomized controlled trials (RCTs) and non-RCTs. Methodologic quality of studies was assessed using the Cochrane Risk of Bias Assessment Tools. Results: Ten studies (589 patients) were included. RCTs showed that both BPO and CHG led to significant reductions in culture positivity compared with negative controls (risk ratio [RR] with 95% confidence interval [CI] = 0.20 [0.13, 0.30], P < .0001 and 0.46 [0.37, 0.57], P < .0001, respectively). Non-RCT data demonstrated similar results comparing BPO and CHG to the control (RR with 95% CI = 0.34 [0.21, 0.57], P < .0001 and 0.31 [0.20, 0.49], P < .0001, respectively). Comparing BPO and CHG, RCT data showed a significant reduction in culture positivity with BPO (RR with 95% CI = 0.46 [0.27, 0.77], P < .009). Of RCTs, 5 were low and one was of moderate risk of bias. Of non-RCTs, 3 had low risk of bias, whereas one had moderate risk of bias. Conclusion: This review demonstrated that preoperative CHG and BPO can reduce C. acnes at the shoulder. However, BPO exhibits greater efficacy than CHG, potentially because of the compound's ability to penetrate the dermis. BPO is a simple and economical agent that may reduce joint exposure to C. acnes in shoulder surgery.

Indications and Guidelines for Debridement and Implant Retention for Periprosthetic Hip and Knee Infection.

PURPOSE OF REVIEW: Prosthetic joint infection is one the most common causes of revision surgery after hip or knee replacement. Debridement and implant retention (DAIR) is one method of treating these infections; however, significant controversy exists. The purpose of our review was to describe current knowledge about indications, intraoperative/postoperative patient management, and outcomes of DAIR. RECENT FINDINGS: Patient selection affects the success of DAIR. Medical comorbidities, duration of symptoms, and nature of infectious organism all influence outcomes. Intraoperative techniques such as open arthrotomy, extensive debridement, copious irrigation, and exchange of modular parts remain current standards for DAIR. Postoperative administration of antibiotics tailored to operative cultures remains critical. Antibiotic suppression may increase the success of DAIR. DAIR provides reasonable infection eradication between 50 and 80% with improved outcomes in appropriately selected patients. More research is needed on the use of adjuvant therapies intraoperatively and the role of postoperative antibiotic suppression.

Risk Factors Associated With Cephalomedullary Nail Cutout in the Treatment of Trochanteric Hip Fractures.

OBJECTIVES: To evaluate the association of cephalomedullary nail cutout in trochanteric femur fractures with the presence of the following radiographic variables: lateral wall fracture, posteromedial fragment, angular malreduction, residual basicervical fracture gapping, screw placement, and tip-apex distance. DESIGN: Retrospective review. SETTING: Academic medical center. PATIENTS: A total of 362 patients were included in the study. The average age was 83 years and the majority was female. All sustained low-energy trochanteric femur fractures treated operatively with cephalomedullary nails. Minimum radiographic follow-up was 3 months, with an average of 11 (range 3-88) months. INTERVENTION: Cephalomedullary nailing with either a lag screw or helical blade. MAIN OUTCOME MEASURES: Cutout of the lag screw or helical blade. RESULTS: A total of 22 (6%) cutouts occurred. Univariate analysis showed significantly (P ≤ 0.01) more frequent cutout with fracture of the lateral wall, posteromedial fragment, residual gapping (>3 mm) at basicervical component, neck-shaft malreduction >5 degrees varus or 15 degrees valgus, and tip-apex distance >25 mm, and superior screw/blade positioning. There was no difference with unstable fracture pattern (P = 0.58) or fellowship training (P = 0.21). Multivariate regression analysis demonstrates that lateral wall fracture (Odds ratios [OR] = 8.0, 95% confidence interval [CI], 2.4-27.1), neck-shaft malreduction (OR = 4.3, CI, 1.3-14.7), and residual basicervical gapping (OR = 3.6, CI, 1.0-13.0) were associated with fixation cutout. CONCLUSIONS: Risk factors for cutout of trochanteric fractures in our study can be viewed as modifiable or nonmodifiable factors. Statistically significant factors included lateral wall fracture (nonmodifiable) as well as basicervical gapping and malreduction (modifiable). LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.