Post-Operative Physical Therapy Following Cervical Spine Surgery: Analysis of Patient-Reported Outcomes.

Introduction Post-operative physical therapy (PT) following anterior cervical discectomy and fusion (ACDF) surgery is often performed to improve a patient's functional ability and reduce neck pain. However, current literature evaluating the benefits of post-operative PT using patient-reported outcomes (PROs) is limited and remains inconclusive. Here we compare post-operative improvement between patients who did and did not undergo formal PT after ACDF using Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Methods A retrospective observational study examining patients who underwent one- or two-level primary ACDF or cervical disc replacement (CDR) at an academic orthopedic hospital and who had PROMIS scores recorded pre-operatively and through two-year follow-up. Patients were stratified according to whether or not they attended formal postoperative PT. PROMIS scores and patient demographics were compared using the Mann-Whitney U test, Fisher's exact test, chi-square test of independence, and Student's t-test within and between cohorts. Results Two hundred and twenty patients were identified. Demographic differences between PT and no PT groups include age (PT 54.1 vs. no PT 49.5, p=0.005) and BMI (PT 28.1 vs. no PT 29.8, p=0.028). The only significant difference in post-operative PROMIS scores was in physical health scores at three months post-operatively (no PT 43.9 vs. PT 39.1, p=0.008). Physical health scores improved from baseline to one-year follow-up in both cohorts (PT +3.5, p=0.025; no PT +6.6, p=0.008). There were no significant differences when comparing improvements in physical health scores between groups at six months and one year. Conclusion In conclusion, there was no significance to support the benefits of post-operative PT as measured by PROMIS scores. No significant differences in PROMIS were observed between groups from pre-operative baseline scores to six-month and one-year follow-ups.

Reoperation Rates Due to Adjacent Segment Disease Following Primary 1 to 2-Level Minimally Invasive Versus Open Transforaminal Lumbar Interbody Fusion.

STUDY DESIGN: Retrospective analysis of prospectively collected data. OBJECTIVE: To investigate the effect of the approach of the transforaminal lumbar interbody fusion [TLIF; open vs . minimally invasive (MIS)] on reoperation rates due to ASD at 2 to 4-year follow-up. SUMMARY OF BACKGROUND DATA: Adjacent segment degeneration is a complication of lumbar fusion surgery, which may progress to adjacent segment disease (ASD) and cause debilitating postoperative pain potentially requiring additional operative management for relief. MIS TLIF surgery has been introduced to minimize this complication but the impact on ASD incidence is unclear. MATERIALS AND METHODS: For a cohort of patients undergoing 1 or 2-level primary TLIF between 2013 and 2019, patient demographics and follow-up outcomes were collected and compared among patients who underwent open versus MIS TLIF using the Mann-Whitney U test, Fischer exact test, and binary logistic regression. RESULTS: Two hundred thirty-eight patients met the inclusion criteria. There was a significant difference in revision rates due to ASD between MIS and open TLIFs at 2 (5.8% vs . 15.4%, P =0.021) and 3 (8% vs . 23.2%, P =0.03) year follow-up, with open TLIFs demonstrating significantly higher revision rates. The surgical approach was the only independent predictor of reoperation rates at both 2 and 3-year follow-ups (2 yr, P =0.009; 3 yr, P =0.011). CONCLUSIONS: Open TLIF was found to have a significantly higher rate of reoperation due to ASD compared with the MIS approach. In addition, the surgical approach (MIS vs . open) seems to be an independent predictor of reoperation rates.

"Bones and Joints" The Role of Cannabidiol (CBD) in Musculoskeletal Health.

Cannabis has a rich history as a therapeutic tool with wide ranging applications. The efficacy of cannabidiol (CBD), the non-psychoactive component of cannabis, has been well demonstrated for pain management. Further, recent orthopedic studies have demonstrated positive effects of CBD on wound healing, inflammation, bone marrow density, and fracture healing. Despite the growing interest in CBD, there is a paucity of research on its impact on fracture risk and bone density in human clinical trials and the existing literature has significant limitations. As the rate of cannabis consumption increases, further research is essential to delineate the therapeutic qualities of CBD and its long-term effects on fracture healing and bone metabolism in order to optimize patient outcomes.

Carpometacarpal Arthroplasty What's the Rule of Thumb?

Carpometacarpal (CMC) arthritis of the thumb is one of the most common pathologies encountered in clinical hand and orthopedic surgery practices. Anatomy of the CMC joint and its biomechanics are theorized to predispose the articulation to laxity and subsequent degenerative changes. Diagnosis of CMC arthritis is primarily based on history, physical examination, and imaging findings, all of which coalesce to guide treatment. There are a multitude of treatment options for CMC arthritis, each with its own set of pearls and pitfalls with treatment decision making shared by surgeon and patient. Continued research and longitudinal data on outcome measures will assist in determining the ultimate "rule of thumb" for the treatment of CMC arthritis.

Primary Biceps Tenodesis Is Superior to Revision Following Failed SLAP Repair.

Purpose: To compare satisfaction and return to play (RTP) rates between patients undergoing primary biceps tenodesis for a symptomatic SLAP tear and patients undergoing secondary biceps tenodesis following a failed SLAP repair. Methods: A retrospective review of patients who underwent subpectoral mini-open biceps tenodesis following failed SLAP repair between January 2011 and October 2019 was performed. Inclusion criteria included age older than 16 years, skeletal maturity, and a minimum follow-up of 12 months. Both athletes and nonathletes were included across all types of sport. Patients who had anterior or posterior instability or rotator cuff tears were excluded; in addition, those requiring concomitant procedures were excluded. Case-control matching was performed using age, sex, indication, follow-up, and type of sport, to generate a 3:1 control group for the primary biceps tenodesis cohort. Primary outcome measurements were collected via telephone in 2020 and included the American Shoulder and Elbow Surgeons score, visual analog scale score, Subjective Shoulder Value score, patient satisfaction, willingness to undergo surgery again, and revisions. RTP and timing of RTP were evaluated as secondary outcomes. A P value of <.05 was considered to be statistically significant. Results: The current study included 76 patients in total; 57 patients with primary biceps tenodesis, and 19 patients with secondary biceps tenodesis. The mean age was 39 years (19-48 years), 100% were male, and the mean follow-up was 54 months (16-99 months). Patient reported outcomes were obtained postoperatively via telephone survey. Overall, we found that primary biceps tenodesis patients reported greater American Shoulder and Elbow Surgeons scores (89.9 vs 76.4, P = .0162), lower visual analog scale scores (1.0 vs 3.1, P = .0034), and greater Subjective Shoulder Value scores (86.7 vs 64.7, P = .0004). Overall, there was no significant difference in the total rate of RTP (84% vs 75%, P = .5025), or timing of RTP (8.2 months vs 8.1 months, P = .9529) between patient groups. Patients reported playing tennis, swimming, golf, rock climbing, and basketball. No patients required a further shoulder surgery after undergoing biceps tenodesis. Conclusions: In this study, patients undergoing primary biceps tenodesis had significantly better functional outcomes compared with secondary biceps tenodesis following a failed SLAP repair. Level of Evidence: III, retrospective comparative study.

No Difference in Outcomes After Arthroscopic Bankart Repair With Remplissage or Arthroscopic Latarjet Procedure for Anterior Shoulder Instability.

Purpose: To evaluate the outcomes of arthroscopic Bankart repair with remplissage (ABRR) compared with the arthroscopic Latarjet (AL) procedure for anterior shoulder instability in patients with a labral tear and a concomitant engaging Hill-Sachs lesion. Methods: A retrospective review of patients who underwent either ABRR or the AL procedure for a diagnosis of anterior shoulder instability with a concomitant engaging Hill-Sachs lesion between 2011 and 2019 was performed. Recurrent instability, the visual analog scale score, the Subjective Shoulder Value, the Western Ontario Shoulder Instability score, patient satisfaction, willingness to undergo surgery again, and return to work or sport were evaluated. Results: Our study included 41 patients treated with ABRR and 26 treated with the AL procedure. At final follow-up, there was no difference between patients who underwent ABRR and those who underwent the AL procedure in the reported Western Ontario Shoulder Instability score (21.8% vs 28.2%, P = .33) or any of its components, the visual analog scale score (0.9 vs 1.4, P = .32), the Subjective Shoulder Value (78.4 vs 74.5, P = .6062), the rate of satisfaction (81.6% vs 85.6%, P = .54), or whether patients would undergo surgery again (81.6% vs 96.1%, P = .16). Overall, 5 patients in the ABRR group and 2 patients in the AL group had recurrent instability events (12.2% vs 7.8%, P = .70), with no significant difference in the rate of recurrent dislocation (12.2% vs 3.8%, P = .39). Conclusions: In patients with anterior shoulder instability and a concomitant Hill-Sachs lesion, both ABRR and the AL procedure were shown to be reliable treatments, with a low rate of recurrent instability and excellent patient-reported outcomes in appropriately selected patients. However, our study could not determine whether there was critical glenoid bone loss in patients undergoing ABRR, and surgeons should still exercise caution in performing ABRR in patients with high-grade glenoid bone loss or in those with failed prior stabilizations. Level of Evidence: Level III, retrospective cohort study.

Revision Anterior Cruciate Ligaments and the Role of Osteotomies.

Anterior cruciate ligament (ACL) injuries are one of the most common and debilitating injuries experienced by athletes. While many patients successfully undergo ACL reconstructions, long-term failure rates have been reported between 2% to 27% resulting in the need for revisions. One of the main causes for the failure of ACL reconstruction is osseous malalignment (coronal versus sagittal). This review discusses the pathology behind osseous malalignment and provides insights into the origins that helped advance our understanding of our treatment, the high tibial osteotomy.

The History of Tourniquet Usage and Modern Utilization in Total Knee Arthroplasty.

The usage of tourniquets in orthopedic surgery is commonplace. This review will describe the history of tourniquet usage throughout medicine and trace this device's evolution to the modern device used today. Several basic principles of tourniquet usage will also be explored, debunking common myths regarding upper time-limits of tourniquet inflation, the ideal pressure of inflation, and tourniquet usage in patients with pre-existing vascular diseases. Additionally, special attention is paid to the utility of lower extremity tourniquets in total knee arthroplasty with regards to cementation, blood loss, pain control, and functional outcomes. Finally, the future of tourniquet usage is discussed.

Return to Play After Biceps Tenodesis for Isolated SLAP Tears in Overhead Athletes.

BACKGROUND: Performing open subpectoral biceps tenodesis in overhead athletes with a superior labrum anterior to posterior (SLAP) tear may affect their ability to return to overhead sports. PURPOSE: To investigate clinical outcomes in overhead athletes undergoing biceps tenodesis for the treatment of symptomatic, isolated SLAP tears involving the biceps-labral complex. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: A retrospective review of overhead athletes who underwent biceps tenodesis for a SLAP tear was performed. The American Shoulder and Elbow Surgeons (ASES) score, visual analog scale (VAS) score for pain, subjective shoulder value (SSV), patient satisfaction, willingness to undergo surgery again, revision procedures, and return to play were evaluated. Psychological readiness to return to sport was evaluated using the SLAP-Return to Sport after Injury (SLAP-RSI) score. A P value of <.05 was considered to be statistically significant. RESULTS: The current study included 44 overhead athletes. The mean age was 34.9 years (range, 16-46 years), 79.5% were male, and the mean follow-up was 49.0 months (range, 18-107 months). Overall, 81.8% of patients returned to play their overhead sport after biceps tenodesis, and 59.1% of patients returned to the same or higher level of play. It took patients, on average, 8.7 months to return to play after biceps tenodesis. The mean SLAP-RSI score was 69.4, and 70.5% of patients passed the SLAP-RSI threshold of 56. The mean ASES score, VAS score, SSV, and satisfaction were 92.0, 0.8, 80.6, and 87.9%, respectively. No patients in our cohort required revision surgery. CONCLUSION: This study found that athletes undergoing biceps tenodesis for the treatment of a symptomatic, isolated SLAP tear had a high rate of return to play, good functional outcomes, and a low rate of revision surgery.

High Rate of Satisfaction and Return to Play at 5-Year Follow-Up After Arthroscopic Superior-Labrum Anterior-Posterior Repairs.

PURPOSE: The purpose of this study was to evaluate the outcomes of patients 5 years postoperatively following arthroscopic SLAP repair, and to evaluate factors associated with satisfaction. METHODS: A retrospective review of patients who underwent SLAP repair with a minimum of 5-year follow-up was performed. Recurrence, visual analog scale (VAS) score, Subjective Shoulder Value (SSV), American Shoulder & Elbow Surgeons (ASES) score, satisfaction, whether they would undergo the same surgery again, and the rate, level and timing of return to play (RTP) were evaluated. Multilinear regression models were used to evaluate factors affecting postoperative satisfaction. RESULTS: Overall, 122 patients who underwent SLAP repair were included, with a mean age of 33.4 years. 81% were males, and 58.2% were participating in sport preoperatively. The mean follow-up was 86.4 ± 14.4 months. At final follow up, the mean satisfaction was 87.7%, and the mean SSV was 82.9. Overall, the rate of RTP was 85.9%, with 64.8% returning at the same level at a mean of 10.5 ± 8 months. Ultimately, 13 (10.7%) patients had a further surgery, including 10 (8.2%) patients that had a biceps tenodesis. VAS during sport (P = .025), SSV (P < .001), and time to RTP (P = .0056), were associated with higher satisfaction. CONCLUSION: There was a high rate of satisfaction at 5-year follow-up, with excellent patient-reported outcomes but with one-tenth of patients requiring revision surgeries. Additionally, while there was an overall high rate of RTP, there was only a modest rate of RTP at their preinjury level, and overhead athletes took longer to RTP. LEVEL OF EVIDENCE: IV, case series.

Open Subpectoral Biceps Tenodesis May Be an Alternative to Arthroscopic Repair for SLAP Tears in Patients Under 30.

PURPOSE: The purpose of the current study is to compare the outcomes of open subpectoral biceps tenodesis (BT) to arthroscopic repair (AR) for SLAP tears in patients under the age of 30 years. METHODS: A retrospective review of patients under the age of 30 years who underwent either isolated BT or AR for a diagnosis of a SLAP tear between 2011 and 2019 was performed. Patients were included if they were >16 years old at the time of surgery, had an isolated SLAP tear involving instability of the biceps-labral anchor (types II-IV), were skeletally mature, and had a minimum follow-up of 12 months. The American Shoulder & Elbow Surgeons score, visual analog scale, Subjective Shoulder Value, patient satisfaction, willingness to undergo surgery again, revisions, and return to play (RTP) were evaluated. A P value of <.05 was considered statistically significant. RESULTS: Our study included 103 patients in total; 29 patients were treated with BT, and 74 were treated with AR. The mean age was 24.8 years, and the mean follow-up duration was 60 months. At final follow-up, there was no difference between treatment groups in any of the functional outcome measures assessed (P > .05). Overall, there was no significant difference in the total rate of RTP (BT: 76.3%, AR: 85%; P = .53), timing of RTP (BT: 8.8 months, AR: 9.4 months; P = .61), and total rate of RTP among overhead athletes (BT: 84.2%, AR: 83.3%; P > .99). Among those undergoing AR, 9 required a revision procedure (11.5%) compared to none treated with BT (P = .11). CONCLUSIONS: In patients under the age of 30 years with a symptomatic isolated SLAP tear, BT may be a reliable alternative to AR. LEVEL OF EVIDENCE: Level III, retrospective comparative study.

Both Open and Arthroscopic Latarjet Result in Excellent Outcomes and Low Recurrence Rates for Anterior Shoulder Instability.

PURPOSE: The purpose of this study is to evaluate the patient-reported outcomes of open Latarjet (OL) compared to arthroscopic Latarjet (AL) for anterior shoulder instability. METHODS: A retrospective review of patients who underwent either OL or AL for anterior shoulder instability between 2011 and 2019 was performed. Recurrent instability, visual analog scale (VAS) score, Shoulder Instability-Return to Sport after Injury (SIRSI), Subjective Shoulder Value (SSV), Western Ontario Shoulder Instability (WOSI) score, patient satisfaction, willingness to undergo surgery again, and return to work/sport (RTW/RTS) were evaluated. A P value of < .05 was considered to be statistically significant. RESULTS: Our study included 102 patients in total; 72 patients treated with OL, and 30 treated with AL. There were no demographic differences between the two groups (P > .05 for all). At final follow up (mean of 51.3 months), there was no difference between those that underwent OL or AL in the reported WOSI, VAS, VAS during sports, SSV, and SIRSI scores, nor in patient satisfaction, or whether they would undergo surgery again (P > .05). Overall, there was no significant difference in the total rate of RTP (65% vs 60.9%; P = .74), or timing of RTP (8.1 months vs 7 months; P = .35). Additionally, there was no significant difference in the total rate of RTW (93.5% vs 95.5%; P = .75). Overall, 3 patients in the OL group and 2 patients in the AL group had recurrent instability events (6.9% vs 6.7%; P = .96), with no significant difference in the rate of recurrent dislocation (4.2% vs 3.3%; P = .84). CONCLUSION: In patients with anterior shoulder instability, both the OL and AL are reliable treatment options, with a low rate of recurrent instability, and similar patient-reported outcomes.