Vascular Injury After Knee Dislocation: A Meta-Analysis Update.

INTRODUCTION: Multisystem injuries affecting vasculature and nerves can be detrimental sequelae of knee dislocations (KDs). The purpose of this study was to provide an update of the current literature since the conducted search used in the publication of Medina et al on May 3, 2013, to evaluate (1) the frequency of vascular and neurologic injury after KD, (2) the frequency with which surgical intervention was conducted for vascular injury in this setting, and (3) the frequency with which each imaging modality was used to detect vascular injury. METHODS: A two-author screening process was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the MEDLINE database. Frequency of vascular injury, surgical intervention, and amputation after KD were analyzed. Diagnostic modalities used in the acute-care setting were also evaluated. RESULTS: Nineteen articles were analyzed for a total of 37,087 KDs. Of these, 10.7% sustained vascular injuries and 19.6% sustained nerve injuries. Overall, 62.2% of patients with vascular injury underwent surgical repair and 2.2% limbs resulted in amputation. Angiography was the most frequently used diagnostic modality (91.7%). DISCUSSION: This review updates our understanding on the clinical implications of KDs including frequency of vascular injury (10.7%), amputation (2.2%), and nerve injuries (19.6%). Compared with prior literature, there was an increased prevalence of KD1 (32.4%) and lateral KDs (80.4%). Most vascular injuries after KD undergo surgical repair (62.2%).

Characteristics and Trends of the Most Cited Publications in The Journal of Arthroplasty.

Background: This study aims to identify the most frequently cited articles published in the Journal of Arthroplasty (JOA) and to analyze the trends in the content and contributors of the literature within the journal. Methods: The 100 most cited articles published in the JOA were accessed using the Scopus database. The number of citations, year of publication, level of evidence (LOE), article type, country of origin, and contributing institution were each recorded for each article. Results: The United States (63%) was the most prolific publishing nation. The 1990s (30%) and 2000s (47%) were the most productive decades. The most common article category was clinical outcomes (33%), followed by technical note (16%) and biomechanics (14%). The plurality of the top 100 articles were well-designed case-control or cohort studies of LOE II (46%) followed by LOE V (32%) and LOE I (11%). Conclusions: Using citation analysis, the most influential articles in the JOA were comprehensively and objectively analyzed. The most popular fields of research involved clinical outcomes (33%) and technical note (16%), both of which increase an article's likelihood of being highly cited. Knowledge of the most influential articles in the JOA allows for appreciation of current and potential future areas of literature regarding diagnosis, management, and outcome of a patient undergoing arthroplasty.

The Associations of Spine Surgeon Training, Office Wait Times, and Social Media Presence with Reviews on Physician Rating Websites.

This study evaluated the associations of demographics and social media (SM) usage on physician review websites for spine surgeons in New Jersey and Pennsylvania. Three physician rating websites were accessed to obtain training history, number of ratings/reviews, and overall rating (0-5). Surgeon web pages and publicly searchable SM accounts on Facebook (FB), Twitter (T), and/or Instagram (IG) were recorded. Of 246 spine surgeons included, 95.9% had a personal/institutional website while 12.2% were present on at least one SM platform. Physician age was inversely correlated with Healthgrades.com (HG), Vitals.com (V), and Google.com (G) ratings (p < 0.0001). Physicians with SM had higher ratings on HG (p = 0.006) and V (p = 0.006). Spine surgeons with SM received more ratings, comments, and higher scores than those without SM. All review sites agree that SM presence correlated with the number of ratings and comments across physician review websites, suggesting SM may influence patient feedback. (Journal of Surgical Orthopaedic Advances 31(4):256-262, 2022).

Return to Golf Following Cervical and Lumbar Spinal Fusion: A Systematic Review.

BACKGROUND: There is a paucity of literature about return to play (RTP) for golf protocols following cervical and lumbar fusions. The timing of return to this sport is a common question among patients. The aim of this review was to analyze and report the current protocols for RTP following cervical and lumbar spinal fusion. METHODS: A systematic search was conducted using the following databases: MEDLINE, PubMed, Web of Science, Scopus, and Google Scholar. A 3-step, multiauthor screening process was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria included peer-reviewed and published prospective, case-control, cohort, case series, or review articles. Studies had to pertain to RTP for golf following instrumented cervical or lumbar spinal fusion to be included. RESULTS: Three articles met inclusion criteria: 2 retrospective survey-based cohort studies and 1 survey-based case series study. All studies included a minimum of 1 year of follow-up. Of patients, 71.6% (n = 51) were able to RTP following surgery; 54.3%-80% were able to RTP at a similar or improved level of play as preoperatively. Postoperative pain reduction was noted in 2 articles. CONCLUSIONS: Most golfers are able to RTP within 12 months following cervical or lumbar spinal fusion. Patients generally reported decreased lower back pain and leg pain postoperatively. Following cervical or lumbar fusion, many golfers are able to RTP at the same or an increased frequency compared with preoperatively.

The 50 Most-Cited Papers on Bankart Lesions.

PURPOSE: To analyze the 50 most-cited articles pertaining to "Bankart lesions," also known as anteroinferior labral tears, by means of citation analysis as well as to provide analysis and summary of the origins and trends of research on Bankart lesions. METHODS: Scopus was used to query the literature on Bankart lesions. Included articles were related to Bankart lesions and the indications, risk factors, techniques, and outcomes of arthroscopic and open Bankart repair. The 50 most-cited articles were analyzed in the following areas: year of publication, citations in the most recent year, total citation count, contributing authors, institutions, countries, and journals, article classifications, and level of evidence. RESULTS: Years of publication ranged from 1938 to 2013. There were 608 total citations in the most recent year. Total citation count was 12,441. Regarding country, journal, and authorship, United States, R. A. Arciero, and Arthroscopy were the highest respective contributors. Rush University had the greatest number of publications. The most common article classification was clinical outcomes. Of 49 clinical articles, the most frequent Level of Evidence was IV. The majority of the top 50 Bankart literature consisted of case series and retrospective studies performed in the United States. CONCLUSIONS: Our findings are consistent with the hypothesis that the 50 most-cited articles about Bankart lesions are predominantly U.S.-based, produced by academic orthopaedic groups, clinical outcomes articles, and of Level IV and V evidence. This list of articles should serve as a reference tool for any orthopaedist looking to review Bankart literature.

Characteristics and Trends of the Most Cited Spine Publications.

STUDY DESIGN: Bibliometric literature review. OBJECTIVE: The aim of this study was to recognize and analyze the most frequently cited manuscripts published in the journal Spine. SUMMARY OF BACKGROUND DATA: Although the journal Spine is considered a premiere location for distributing influential spine research, no previous study has evaluated which of their publications have had the most impact. Knowledge and appreciation of the most influential Spine publications can guide and inspire future research endeavors. METHODS: Using the Scopus database, the 100 most cited articles published in Spine were accessed. The frequency of citations, year of publication, country of origin, level-of-evidence (LOE), article type, and contributing authors/institutions were recorded. The 10 most cited articles (per year) from the past decade were also determined. RESULTS: "Guidelines For The Process Of Cross-Cultural Adaptation Of Self-Report Measures" by Beaton DE was the most cited article with 2960 citations. 2000 to 2009 (n = 46) was the most productive period. A LOE of III (n = 35) followed by II (n = 34) were the most common. Deyo RA (n = 8), Bombardier C (n = 6), and Waddell G (n = 6) produced the most articles. University of Washington (n = 8) and University of Toronto (n = 8) ranked first for institutional output. Clinical Outcome (n = 28) was the most recurring article topic. The United States (n = 51) ranked first for country of origin. CONCLUSION: Using citation analysis as an objective proxy for influence, certain publications can be distinguished from others due to their lasting impact and recognition from peers. Of the top cited Spine publications, many pertained to clinical outcomes (28%) and had a LOE of I, II, or III (60%). Although older publications have had longer time to accrue citations, those in the most recent decade comprise this list almost 2:1. Knowledge of these "classic" publications allows for a better overall understanding of the diagnosis, management, and future direction of spine health care.Level of Evidence: 3.

Social Media Presence Correlated with Improved Online Review Scores for Spine Surgeons.

BACKGROUND: In the next decade, health care reimbursement will be more aligned to patient clinical outcomes. These outcomes are influenced by the patient's perceived opinion of his or her care. An evaluation into the role of surgeon demographics, social media (SM) accessibility, and office wait times was conducted to identify correlations with these among 3 online review platforms. METHODS: A total of 206 (148 orthopedic, 58 neurosurgery trained) spine surgeons were included. Spine surgeon ratings and demographics data from 3 physician rating websites (Healthgrades.com [HG], Vitals.com, Google.com [G]) were collected in November 2019. Using the first 10 search results from G we then identified if the surgeons had publicly accessible Facebook, Twitter, or Instagram (IG) accounts. RESULTS: The mean age of the cohort was 54.3 years (±9.40 years), and 28.2% had one form of publicly accessible SM. Having any SM was significantly correlated with higher scores on HG and G. An IG account was associated with significantly higher scores on all 3 platforms, and having a Facebook account correlated with significantly higher scores on HG in multivariate analysis. An office wait time between 16 and 30 minutes and >30 minutes was associated with worse scores on all 3 platforms (all P < 0.05). An academic practice was associated with higher scores on all 3 platforms (P < 0.05). CONCLUSIONS: A shorter office wait time and an academic setting practice are associated with higher patient satisfaction scores on all 3 physician review websites. Accessible SM accounts are also associated with higher ratings on physician review websites, particularly IG.

Trends in Leadership at Spine Surgery Fellowships.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To illustrate demographic trends among spine fellowship leaders (FLs). SUMMARY OF BACKGROUND DATA: No previous study in the orthopedic literature has analyzed the demographic characteristics or past surgical training of FL in an orthopedic sub-specialty. We attempt to illustrate demographic trends among spine fellowship leadership including fellowship directors (FDs) and co-fellowship directors (co-FDs). We also highlight the institutions that have trained these leaders at various levels. METHODS: Our search for FDs was constructed from the 2018 to 2019 North American Spine Surgery (NASS) Fellowship Directory. Datapoints gathered included: age, sex, residency/fellowship training location, time since training completion until FD appointment, length in FD role, and personal research H-index. RESULTS: We identified 103 FLs consisting of 67 FDs, 19 co-FDs, and another 16 individuals with a synonymous leadership title. 96.1% (99) of the leadership consisted of males while 3.9% (4) were female. The mean age was 52.9 years old and the mean h-index of the FLs was 23.8. FLs were trained in orthopedic surgery (n = 89), neurosurgery (n = 13), or combined orthopedic surgery and neurosurgery training (n = 1). The top fellowships programs producing future FLs were: Case Western Reserve University, Cleveland (n = 10), Washington University, St. Louis (n = 9), and Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia (n = 7). CONCLUSION: Spine surgery fellowship directors are more likely to have graduated from certain residency and fellowship programs. This finding could be a result of the training provided by these centers or the institution's predilection to select applicants that are more likely to later seek academic leadership roles post-training. LEVEL OF EVIDENCE: 4.

Is There a Correlation Between Preoperative or Postoperative Vitamin D Levels with Pseudarthrosis, Hardware Failure, and Revisions After Lumbar Spine Fusion?

BACKGROUND: Vitamin D deficiency is a well-known cause of postoperative complications in patients undergoing orthopedic surgery. Orthopedic complications seen in vitamin D deficiency include nonunion, pseudarthrosis, and hardware failure. We seek to investigate the relationship between vitamin D deficiency and outcomes after lumbar spinal fusions. METHODS: A retrospective patient chart review was conducted at a single center for all patients who underwent lumbar spinal fusions from January 2015 to September 2017 with preoperative or postoperative vitamin D laboratory values. We recorded demographics, social history, medications, pre-existing medical conditions, bone density (dual-energy x-ray absorptiometry) T-scores, procedural details, 1-year postoperative Visual Analog Score (VAS), documented pseudarthrosis, revisions, and hardware failure. A total of 150 patients were initially included in the cohort for analysis. RESULTS: Overall, preoperative and postoperative vitamin D levels were not significantly associated with a vast majority of the patient characteristics studied, including comorbidities, medications, or surgical diagnoses (P > 0.05). Age at surgery was significantly associated with vitamin D levels; older patients had higher serum levels of vitamin D both preoperatively (P = 0.03) and postoperatively (P = 0.01). Those with a higher average body mass index had lower vitamin D in both groups (P = 0.02). Vitamin D levels were not significantly associated with rates of postoperative pseudarthrosis, revision, or hardware complications (P > 0.05). VAS pain score at 1 year and smoking status preoperatively or postoperatively were not associated with vitamin D levels (P > 0.05). CONCLUSIONS: Both preoperative and postoperative vitamin D levels were not significantly associated with an increased or decreased risk of pseudarthrosis, revision surgery, hardware failure, or 1-year VAS pain score after lumbar spine fusion surgery.

The 100 most influential spine fracture publications.

BACKGROUND: Management of spine fractures has advanced considerably even over the past decade. A review of the current and historical literature can lead to a better appreciation of current management protocols. This is the first comprehensive review of the most influential articles related to spine fracture management. The purpose of this study is to identify and analyze the 100 most cited publications in spine fracture management. METHODS: Using the Clarivate Analytics Web of Science, search phrases were used to identify publications pertaining to spine fractures (110,809 publications). The 100 most cited articles were isolated. The frequency of citations, year of publication, country of origin, journal of publication, level-of-evidence (LOE), article type, and contributing authors/institutions were recorded. We also highlighted the ten most cited articles (per year) from the past decade. RESULTS: The publications included ranged from 1953-2010, with the majority published between 2000-2009 (n=41). Total citations ranged from 154 to 1,076. A LOE of IV had the plurality at 36%. The most cited article was "The 3 Column Spine and Its Significance in The Classification of Acute Thoracolumbar Spinal-Injuries" (Spine 1983) by F Denis. The majority of papers originated in the United States (n=65), and the highest number were published in Spine (n=27). Osteoporotic fractures were the specific topic in 34 publications. In the past decade, the article with the most citations/year was "A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures" by DF Kalmes in 2009. CONCLUSIONS: Despite less time for citation than other decades, the 2000s contain the plurality of the influential publications. This may indicate that some of the most important changes to spine fracture management pertain to improved imaging modalities and surgical technologies. This review provides a guide for a comprehensive understanding of the historical and current literature pertaining to spine fracture management.

The Most Influential Publications in Odontoid Fracture Management.

OBJECTIVE: Management of odontoid fractures has improved and evolved due to advancing diagnostic guidelines and understanding of long-term outcomes. The aim of this study was to quantify the most frequently cited publications pertaining to odontoid fractures and determine their validity as a tool to practice evidence-based medicine. METHODS: A Clarivate Analytics Web of Science search was used to identify all articles related to odontoid fractures. The 50 most cited articles were reviewed. Criteria included the frequency of citation, year of publication, countries of origin, journal, levels of evidence (LOE), article types, and supporting authors and institutions. RESULTS: The top 3 most cited papers were "Radiological and anatomical evaluation of the atlantoaxial transarticular screw fixation technique" (Madawi 1997), "Atlantoaxial fixation using, plate and screw method: A report of 160 treated patients" (Goel 2002), and "The anatomical suitability of the C1-2 complex for transarticular screw fixation" (Paramore 1996). Spine (n = 13; 26%) was the most common journal, and the most frequent decade was 2000-2009 (n = 18; 36%). The United States was associated with the greatest number of publications, and the most common article type was clinical outcomes (n = 16; 32%). The most recurring LOE was IV (n = 20; 40%). CONCLUSIONS: This review provides a comprehensive understanding of the historical literature pertaining to odontoid fracture management. There is a paucity of high LOE publications regarding this topic, and clinicians should strive to provide more high-level studies. This article can help practitioners navigate the vast body of literature about this topic and identify high-impact publications.

The most influential publications in cervical myelopathy.

Management of cervical myelopathy (CM) has continued to evolve through a better understanding of the long-term outcomes of this diagnosis as well as improved diagnostic guidelines. More recent literature continues to expand the field, but certain publications can be distinguished from others due to their lasting impact. Using the Clarivate Analytics Web of Science, search phrases were used to identify publications pertaining to CM. The fifty most cited articles were isolated. The frequency of citations, year of publication, country of origin, journal of publication, level of evidence (LOE), article type, as well as contributing authors and institutions were recorded. We also highlighted the five most cited articles (per year) from the past 10 years. Publications included ranged from 1952-2011, with the plurality of articles published during 2000-2009 (n=21; 42%). The most cited paper was Hillibrand's 1999 reporting of adjacent segment disease rates following cervical fusions, followed by Hirabayashi's 1983 review of his cervical laminoplasty outcomes. The third most cited was Brain's 1952 review of the manifestations of cervical spondylosis. Spine contributed the most publications (n=26; 52%). A LOE of III was the most common (n=30; 60%). Clinical outcome articles were the most frequent type (n=28; 56%). Osaka University (Japan) and Kazou Yonenobu had the most contributions. Ames or Fehlings were the first or last author in each of the five most influential articles from the past 10 years. This bibliometric citation analysis identifies the most influential articles regarding CM. There are few publications with a high LOE, and more high powered studies are needed. Knowledge of these "classic" publications allows for a better overall understanding of the diagnosis, treatment, and future direction of research of CM.