Corticosteroid Injection in the Operative Hand Prior to a Trigger Finger or Carpal Tunnel Release: If It Is Not at the Surgical Site Then What Is the Big Deal?

BACKGROUND: Patients who have had a corticosteroid injection at the surgical site within 90 days of trigger finger release (TFR) or carpal tunnel release (CTR) have an elevated risk of postoperative infection. Currently, it remains unknown if a preoperative injection in proximity to the surgical site for a separate complaint alters the risk of a postoperative infection. METHODS: A retrospective chart review was performed on all patients who underwent TFR or CTR between 2010 and 2022. Patients who had a corticosteroid injection at or near the surgical site within 90 days of surgery were included. Outcome measures included uncomplicated healing, superficial infection requiring antibiotics, and deep infection (DI) requiring surgical debridement. RESULTS: There were 564 cases in which a corticosteroid injection was performed within 90 days of TFR or CTR. Superficial infections occurred in 12 (2.1%), and DIs occurred in 6 (1.1%) cases. There was no significant difference in infection rates between the two groups relative to the location of the injection nor timing of the injection (0-30, 31-60, or 61-90 days prior to surgery). CONCLUSIONS: Patients who had an injection at the surgical site within 90 days of TFR or CTR had an elevated rate of postoperative infection compared with published rates in the literature. This study is unique in that preoperative injections at an adjacent site in the palm also correlated with an elevated rate of infection, similar to patients who had an injection at the surgical site. LEVEL OF EVIDENCE: Level 4.

Quantitative and qualitative disparities exist between baseball and softball peer-reviewed pitching-related literature: a systematic review from 1990 to 2020.

Background: Baseball and softball are popular sports with similar rates of injury, especially among pitchers. However, parity between the two sports is lacking, as baseball receives greater research attention than softball. The purpose of this study was to describe the discrepancy between baseball and softball in terms of quantity and quality of research. We hypothesized baseball literature would outnumber softball literature, be published in higher-impact journals, and be of higher quality. Methods: A systematic review was performed to identify original research articles related to baseball and softball from 1990 to 2020. Articles pertaining to pitching were identified via literature searches of PubMed, the Physiotherapy Evidence Database, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials and further screened by two independent reviewers. Age group studied, journal impact factor, type of research, and level of evidence were compared between pitching-related baseball and softball articles. Injury-related studies were also subanalyzed, and a meta-analysis was performed to assess rates of shoulder and elbow injuries between baseball and softball pitchers. Results: There were 813 baseball publications and 158 softball publications that met our inclusion criteria. More baseball articles were published per year than softball (5:1, P < .001). Baseball had 368 articles related to pitching, while softball had significantly fewer at 49, and there were more baseball pitching articles published per year than softball pitching articles (7.5:1, P < .001). Pitching-related baseball articles were published in journals with a higher mean impact factor than softball pitching articles (3.1 vs. 2.0, P = .049). There was no difference in methodological index for non-randomized studies criteria for rigorous reporting (P = .678), and among all groups, most articles were level III evidence. Baseball pitching articles included more clinical articles than softball pitching articles (63% vs. 43%, P = .004). Despite the fact that softball pitchers have an odds ratio of shoulder and elbow injury slightly higher than baseball (4.02 vs. 3.60), injury-related studies focused on baseball outnumbered softball studies 7 to 1. Conclusion: Softball is under-represented in the literature when compared to baseball with over 5 times fewer peer-reviewed research articles, despite having slightly higher shoulder and elbow injury rates than baseball. Pitching-related softball articles are nearly 8 times less frequent compared to baseball pitching articles and published in journals with a lower impact factor. Further research directed at softball is important to provide evidence-based injury prevention, practice guidelines, and treatment decisions.

Examining the safety profile of a standard dose tranexamic acid regimen in spine surgery.

OBJECTIVE: Perioperative blood loss during spinal surgery is associated with complications and in-hospital mortality. Weight-based administration of tranexamic acid (TXA) has the potential to reduce blood loss and related complications in spinal surgery; however, evidence for standardized dosing is lacking. The purpose of this study was to evaluate the impact of a standardized preoperative 2 g bolus TXA dosing regimen on perioperative transfusion, blood loss, thromboembolic events, and postoperative outcomes in spine surgery patients. METHODS: An institutional review board approved this retrospective review of prospectively enrolled adult spine patients (> 18 years of age). Patients were included who underwent elective and emergency spine surgery between September 2018 and July 2021. Patients who received a standardized 2 g dose of TXA were compared to patients who did not receive TXA. The primary outcome measure was perioperative transfusion. Secondary outcomes included estimated blood loss and thromboembolic or other perioperative complications. Descriptive statistics were calculated, and continuous variables were analyzed with the two-tailed independent t-test, while categorical variables were analyzed with the Fisher's exact test or chi-square test. Stepwise multivariate regression analysis was performed to examine independent risk factors for perioperative outcomes. RESULTS: TXA was administered to 353 of 453 (78%) patients, and there were no demographic differences between groups. Although the TXA group had more operative levels and a longer operative time, the transfusion rate was not different between the TXA and no-TXA groups (7.4% vs 8%, p = 0.83). Stepwise multivariate regression found that the number of operative levels was an independent predictor of perioperative transfusion and that both operative levels and operative time were correlated with estimated blood loss. TXA was not identified as an independent predictor of any postoperative complication. CONCLUSIONS: A standardized preoperative 2 g bolus TXA dosing regimen was associated with an excellent safety profile, and despite increased case complexity in terms of number of operative levels and operative time, patients treated with TXA did not require more blood transfusions than patients not treated with TXA.

Surgical Management of Lateral Epicondylitis: A Retrospective Review of Technique Success.

BACKGROUND: Lateral epicondylitis usually stems from overuse and failed tendon healing. Following attempt of conservative management, surgery is often considered, although there is variation in techniques and outcomes cited in the literature. METHODS: This retrospective review analyzed 293 operative patients for lateral epicondylitis following conservative management. The primary outcome was change in pain from preoperative status, including pain-free, improved, unchanged, or worse. Positive outcomes included pain-free or improved symptoms postoperatively. Negative outcomes were unchanged or worse pain. Patients returned 2 weeks, 6 weeks, and 3 months postoperatively. We analyzed patients' profession, handedness, operating surgeon, surgical technique, sex, magnetic resonance imaging findings, concomitant procedures, age, race, revisions, and complications. One surgeon repaired the common extensor using a suture anchor, whereas 2 surgeons performed a side-side repair of the extensor carpi radialis longus and extensor digitorum communis interval. RESULTS: By the 3-month visit, 41% were pain-free and 52% improved compared with preoperatively. None were worse, and 7% were unchanged. Mean pain scores at the 2-week, 6-week, and 3-month visits were 4.22/10, 3.61/10, and 3.44/10, respectively. There were 7 revisions (2.4%) and 6 complications (2%). Manual laborers experienced more negative outcomes than sedentary workers (P = .04). The remaining parameters were insignificant, including the operative technique. CONCLUSIONS: Surgery is successful for both techniques, with 93% positive outcomes by 3 months. There was no statistical difference in postoperative pain between patients who had suture repair versus anchor repair. Therefore, surgeons should consider suture-only repair given the cost of anchors.

Anterior cruciate ligament reconstruction with all-soft tissue quadriceps tendon versus quadriceps tendon with bone block.

PURPOSE: The purpose of this study was to evaluate whether there was a difference in clinical outcomes between patients who underwent primary ACL reconstruction (ACLR) with all-soft tissue quadriceps tendon (sQT) autograft versus QT with bone block (bQT). METHODS: A retrospective cohort study of 708 patients who underwent QT ACLR was conducted. Primary ACLR patients with at least 1 year of follow-up were identified and those who received sQT were compared to those who received bQT. Data collection entailed patient demographics, surgical variables, patient reported outcomes (PROs), knee stability testing, and complications. The primary outcome of interest was International Knee Documentation Committee (IKDC) score, reported as mean score, pre- and postoperative difference, and number who met minimum clinically important difference (MCID). Secondary outcomes included Lachman and pivot shift grade, other patient reported outcomes (PROs), complication rates, and return to sport (RTS). RESULTS: A total of 195 patients (147 sQT, 48 bQT) who underwent primary QT ACLR met criteria for analysis, with mean follow-up of 17.0 ± 7.9 months. No difference was detected between cohorts with respect to postoperative IKDC score (sQT: n = 120, 81.0 ± 18.9, bQT: n = 10, 80.9 ± 20.4, n.s.), proportion of patients who met MCID (sQT: 68/78 [87%], bQT: 6/7 [86%], n.s.), or results of stability testing. In the sQT cohort, 86% (106/123) of athletes achieved full RTS, compared to 85% (34/40) in the bQT cohort (n.s.). Time to RTS was less than a year in both cohorts (sQT: 10.5 ± 3.8 months [n = 106], bQT: 11.1 ± 3.9 months [n = 31], n.s.). Graft rupture occurred in 7 (5%) sQT patients and 3 (6%) bQT patients (n.s.), and all clinical failures were due to graft rupture (n.s.). No differences were detected for rates of postoperative complications. CONCLUSION: No differences in clinical outcomes were detected between patients who underwent primary ACLR with sQT autograft versus bQT autograft. Currently, the decision to employ sQT or bQT is largely determined by surgeon preference. This study demonstrates excellent outcomes with both preparations and supports the use of either graft type at the discretion of the treating surgeon. LEVEL OF EVIDENCE: III.

Stemless Total Shoulder Arthroplasty With Orthobiologic Augmentation.

Total shoulder arthroplasty (TSA) has evolved over the years and is used for a variety of indications, with arthritis being the most common. Stemless TSA is a unique bone-preserving design that can eliminate rotational malalignment. Additionally, recent literature has found utility in the use of biological mesh and a platelet-rich plasma injection to improve healing. The purpose of this article is to outline the process of TSA using a stemless system and how to incorporate the use of amnion matrix and platelet-rich plasma into the surgical technique.

Inside-Out Bucket-Handle Meniscus Repair With a Single-Handed Self-Advancing Zone-Specific Meniscus Repair Device.

Meniscus tears are among the most common knee injuries in the general population and often are treated arthroscopically with a meniscus repair. Of the various meniscus repair techniques available, the inside-out meniscus tear is considered the gold standard due to its versatility and good clinical outcomes. The purpose of this Technical Note and accompanying video is to describe an inside-out bucket-handle meniscus repair using a single handed, self-advancing meniscus repair device with an interchangeable zone-specific multicannula system to decrease the technical difficulty and operative time of the repair.

The Tibial Tug Test: An Intraoperative Test to Assess Tibial Fixation During Anterior Cruciate Ligament Reconstruction.

The anterior cruciate ligament (ACL) is commonly injured, especially in athletes performing twisting and pivoting motions. ACL reconstruction is a standard procedure; however, there is no way to intraoperatively assess one of the causes of failure: the lack of adequate graft fixation on the tibial side. Different fixation devices can be used to ensure fixation, but there is as yet no consensus on which is the most effective. Moreover, there is no reliable way to assess their strength in the intraoperative setting. The tibial tug test is meant to be an important resource to help avoid fixation failure by evaluating the tibial fixation device intraoperatively and giving the surgeon the opportunity to revise the tibial fixation if deemed inadequate. The aim of this article is to describe an empirical and simple test that can demonstrate to the surgeon adequate tibial fixation during ACL reconstruction surgery.

Submeniscal Portal for Horizontal Cleavage Tear with Parameniscal Cyst of the Lateral Meniscus.

Horizontal cleavage tears of the medial and lateral meniscus can be difficult to treat using the standard anteromedial or anterolateral arthroscopy portals. In this Technical Note, we present a new surgical technique to better manage the inferior leaflet of horizontal cleavage tears of the medial and lateral meniscus and their associated parameniscal cysts.