Both Quadriceps and Bone-Patellar Tendon-Bone Autografts Improve Postoperative Stability and Functional Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review.

Purpose: To compare postoperative knee stability, functional outcomes, and complications after anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) versus quadriceps tendon autograft. Methods: In accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, the PubMed, Embase, and Cochrane Library databases were searched for studies published in 2002 or later. Studies were included if they met the following criteria: randomized controlled trials that included patients who underwent ACL reconstruction with BPTB or quadriceps tendon autograft including all soft tissue and bone-quadriceps tendon and in which measures of postoperative stability and functional outcomes were reported. Studies that were not written in English and those that analyzed animals or cadavers, were not randomized controlled trials, or used other grafts (e.g., hamstring) were excluded. Results: The initial search identified 348 studies, 6 of which were included in this systematic review. Two of the six studies found no significant difference in performance outcomes or complications between quadriceps and BPTB autografts. One study found that patients receiving quadriceps autograft self-reported improved knee functional status compared with those receiving BPTB autograft. Another study found that quadriceps autograft resulted in a significantly reduced Quadriceps Index postoperatively compared with BPTB autograft (69.5 vs 82.8, P = .01) but found no difference in postoperative quadriceps strength. An additional study found that the outcomes of quadriceps tendon and BPTB autografts were equivalent per the International Knee Documentation Committee scale, but anterior knee pain was less severe in patients with quadriceps tendon autograft. Furthermore, one study revealed the overall International Knee Documentation Committee score was reported as normal significantly more often in patients who underwent ACL reconstruction with BPTB autograft (85% vs 50%, P < .001) and that donor-site morbidity was greater in patients with quadriceps autograft. No significant difference was found in complications requiring reoperation across studies. Conclusions: Patients undergoing ACL reconstruction with either BPTB or quadriceps tendon autograft reported improved postoperative knee stability and functional outcomes. There is no significant difference in complications between quadriceps autograft use and BPTB autograft use. Level of Evidence: Level III, systematic review of Level III retrospective studies.

The Top 50 Articles on Knee Posterolateral Corner Injuries.

Purpose: To identify and characterize the most cited publications in orthopaedic research related to posterolateral corner (PLC) injuries of the knee. Methods: The Science Citation Index Expanded was queried for PLC injury articles. The 50 most-cited studies from 1976 to 2021 were selected. Article characteristics, including number of citations, citation density, year of publication, source journal, country of origin, article type, article subtype, and level of evidence, were analyzed. Results: The number of citations for individual articles ranged from 47 to 205. The 50 most cited articles were published in 16 journals. Eleven of the 50 articles (22%) were published in Arthroscopy-The Journal of Arthroscopic and Related Surgery. The largest proportion of the articles (n = 22, 44%) were classified as clinical, with the rest classified as reviews (n = 15, 30%), and basic science research (n = 13, 26%). The most common level of evidence for clinical articles was IV (14/22, 63.6%). Nine countries contributed to the top 50 articles, with the majority published in the United States (n = 35, 70%). Conclusions: In the last 20 years, papers published on the diagnosis and surgical management of PLC injuries have a high citation frequency. Future high-quality research is needed to establish best-practice guidelines for the management of PLC injuries due to the low overall level of evidence of existing clinical studies. Clinical Relevance: This research provides a comprehensive list for practitioners and may help educators identify articles to include in the curriculum for residents and fellows.

Social Media and Its Use in Orthopaedic Surgery Resident Education and Training.

¼: The use of social media by health-care professionals and medical educators has been increasing over the past decade. ¼: Online social networks, professional networks, blogs, microblogs, forums, podcasts, and video-sharing platforms can be used effectively to communicate and engage with, as well as learn from, other residents and attending physicians worldwide. ¼: Social media platforms and other web-based applications can serve as powerful educational tools to enhance orthopaedic resident learning, collaboration, teaching, and case discussion.

Systematic Review of Outcome Measures Used After Proximal Hamstring Repair.

BACKGROUND: Patient-reported outcome measures are important to determine outcomes after orthopaedic procedures. There is currently no standard for outcome measures in the evaluation of patient outcomes after proximal hamstring repair. PURPOSE: To identify and evaluate outcome measures used after proximal hamstring repair. STUDY DESIGN: Systematic review; Level of evidence, 4. METHODS: A systematic review was performed to identify all English-language articles assessing outcomes after proximal hamstring repair in PubMed, Embase, CINAHL via EBSCOhost, MEDLINE via OvidSP, and Web of Science between 2000 and 2019. After duplicates were removed, studies were selected using eligibility criteria established by the authors. Image reviews, anatomic/histology studies, literature reviews, surgical technique reports, systematic reviews, narrative reviews, case studies, and studies with <5 patients were excluded. Extraction, synthesis, and analysis of outcome measure data were performed using Microsoft Excel. Quality assessment of included studies was performed using Methodological Index for Non-Randomized Studies criteria. RESULTS: After duplicate articles were removed, a total of 304 unique articles were identified and 27 met the inclusion criteria. The mean number of patients with proximal hamstring repairs per study was 40. The most frequently reported outcome measures were return to sport (14/27; 51.9%), custom survey/questionnaire (13/27; 48.1%), and isokinetic hamstring strength testing (13/27; 48.1%). Six of the 10 most commonly used outcome measures were validated and included Lower Extremity Functional Scale, 12-Item Short Form Health Survey, visual analog scale for pain, Perth Hamstring Assessment Tool (PHAT), Single Assessment Numeric Evaluation, and Tegner Activity Scale. Of those, PHAT was the only validated outcome measure designed for proximal hamstring repair. CONCLUSION: There is currently no consensus on the best outcome measurements for the evaluation of patients after proximal hamstring repair. We recommend an increased commitment to the use of return to sport, isokinetic strength testing, Lower Extremity Functional Scale, and PHAT when assessing such injuries. Future studies should aim to define the most reliable methods of outcome measurement in this patient population through consistent use of tools that are clinically relevant and important to patients and can easily be employed in a variety of clinical scenarios.