Outcomes for ulnar collateral ligament reconstruction: a retrospective review using the KJOC assessment score with two-year follow-up in an overhead throwing population.

BACKGROUND: Injury to the ulnar collateral ligament (UCL) often results in valgus elbow instability requiring reconstruction. No standardized and validated outcome measure has compared outcomes between surgical techniques and institutions in the overhead throwing athlete. The aim of this study was to use the Kerlan-Jobe Orthopaedic Clinic shoulder and elbow score (KJOC score) to report functional outcomes in overhead throwing athletes undergoing UCL reconstruction. We predict that the KJOC score in our general throwing population will provide an accurate assessment of postoperative outcomes consistent with previously published reports. METHODS: A retrospective review of 33 patients undergoing UCL reconstruction was carried out during a 5-year period between 2004 and 2009. Minimum follow-up was 2.2 years with an average of 3.7 years. All surgeries were performed by fellowship-trained surgeons using either the docking (n = 12) or modified Jobe technique (n = 21). Age, sport, position, and return to play status were obtained. The KJOC score was administered to assess final functional outcome. RESULTS: A total of 33 athletes underwent UCL reconstruction-30 baseball players and 3 javelin throwers. Of these, 27 (82%) returned to their sport at their previous level in an average of 12.25 months. The overall average KJOC score was 76. Athletes who returned to their previous level of play had a mean KJOC score of 77. Those who were unable to return to play had a mean score of 69. CONCLUSION: Our study demonstrates consistent outcomes for UCL reconstruction using the KJOC shoulder and elbow score compared with previously reported data.

Patient Perceptions of Same-Day Discharge Versus Overnight Stay After Total Joint Arthroplasty: Results of a Survey.

Background: In the COVID-19 era, there has been increasing interest in same-day discharge (SDD) after total joint arthroplasty (TJA). However, patient perception of SDD is not well reported. Purpose: We sought to understand patients' perceptions and preferences of postoperative care by surveying patients who have completed both an overnight stay (ONS) and an SDD after TJA. Methods: We emailed survey links to 67 patients who previously underwent either 2 total hip arthroplasties (THAs) or 2 total knee arthroplasties (TKAs). Results: Fifty-two patients (78%) responded to the survey. Thirty-four (65%) patients underwent staged, bilateral TKAs, and 18 (35%) patients underwent staged, bilateral THAs. Overall, 63% of patients preferred their SDD, 12% had no preference, and 25% preferred their ONS, with no difference in preference between TKA and THA groups. Those who preferred their SDD reported being more comfortable at home. Those who preferred their ONS felt their pain and concerns were better addressed. No differences were found in comfort, sleep quality, appetite, burden on family, return to function, feelings of being discharged too soon, overall experience, 30-day emergency department (ED) visits, or readmissions within 30 days between patients' SDD and ONS. There was a small statistically significant difference between patients' perception of safety between SDD and ONS. Conclusion: Our survey found that most patients reported a preference for SDD after TJA over ONS. Although there was a small difference in patient perception of safety, there were no differences in return to the ED or readmissions after SDD and ONS.

Outcomes after distal biceps repair in patients with workers' compensation claims.

BACKGROUND: Prior studies have suggested that patients with workers' compensation (WC) related injuries have less successful postsurgical outcomes compared to the general population. The purpose of this study was to determine the functional outcome and return to work for WC patients who have undergone distal biceps tendon repair (DBTR). A group of patients without a WC claim (non-WC) served as a control. METHODS: From July 2002 to December 2009, 60 WC patients and 63 non-WC patients who underwent unilateral, acute (<6 weeks) DBTR and had a minimum of 12 months of postoperative follow-up were contacted. Data pertaining to patient age, sex, handedness, smoking status, occupation, time to return to work, and ability to return to original occupation were obtained. Functional outcomes were primarily assessed with the DASH, DASH-Work Module, and DASH Sports/Performance Arts Module questionnaires. Outcomes in the WC group were compared to the non-WC group. RESULTS: Average length of follow-up was 3.55 years (range, 1.5-8.9) in the WC group and 3.64 years (range, 2.2-8.0) in the non-WC group. Mean DASH, DASH-Work Module, and Sports/Performance Arts Module scores were significantly greater (poorer outcome) in the WC group than in the non-WC group. Average time to return to full duty was 3.95 months in the WC group and 1.35 months in the non-WC group. CONCLUSION: WC patients who underwent distal biceps tendon repair took longer to return to work and had worse DASH scores than non-WC patients. LEVEL OF EVIDENCE: Level III, Retrospective Cohort Study, Treatment Study.

Confirming Proper Button Deployment of Suspensory Fixation During ACL Reconstruction.

BACKGROUND: Suspensory fixation of anterior cruciate ligament (ACL) reconstruction (ACLR) grafts has emerged as a popular device for femoral graft fixation. However, improper deployment of the suspensory fixation can compromise proper graft tensioning, leading to failure and revision. Also, soft tissue interposition between the button and bone has been associated with graft migration and pain, occasionally requiring revision surgery. Many surgeons rely on manual testing and application of distal tension to the graft to confirm proper button deployment on the lateral cortex of the femur for ACL graft fixation. PURPOSE: To determine the reliability of the manual resistance maneuver when applying distal tension to deploy the suspensory device along the lateral cortex of the femur. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: All patients undergoing ACLR with a suture button suspensory device for femoral fixation were eligible for enrollment in the study. The surgeries were performed by 3 board-certified, sports medicine fellowship-trained orthopaedic surgeons at a single outpatient surgical center between May 2018 and June 2019. All grafts were passed in a retrograde manner into the femoral tunnel, and a vigorous manual tensioning maneuver in a distal direction was placed on the graft to deploy and secure along the lateral cortex of the femur. Intraoperative mini c-arm fluoroscopy was obtained to demonstrate proper suture button positioning. If interposing tissue or an improperly flipped button was identified, rectifying steps were undertaken and recorded. RESULTS: A total of 51 patients with a mean age of 33.3 years were included in the study. Of these patients, 74.5% had normal suture button positioning identified via intraoperative fluoroscopic imaging, while 15.7% had interposed soft tissue and 9.8% had an improperly flipped button. In all cases, the surgeon was able to rectify the malpositioning intraoperatively. CONCLUSION: Despite the manual sensation of proper suspensory button positioning, intraoperative fluoroscopy identified suture button deployment errors in ACLR 25% of the time. Correcting the malpositioning is not technically demanding. These findings advocate for routine intraoperative surveillance to confirm appropriate suture button seating during ACLR.

An unusual case of pigmented villonodular synovitis after total knee arthroplasty presenting with recurrent hemarthrosis.

Pigmented villonodular synovitis (PVNS) is a benign proliferative joint disease, which is a rare finding after total knee arthroplasty (TKA). There is currently no link between PVNS and TKA, and it has been described infrequently in the literature. Its presentation has varied along with the time that it presents postoperatively. We describe a case of a patient who presents with recurrent hemarthrosis 4 years after TKA. The patient had no previous history of PVNS and had an arthroscopy 1 year after the index operation with no evidence of synovitis. We present details of the first case with a review of imaging and pathology and a brief review of the literature on PVNS occurring after TKA.

A prospective cohort study investigating the effect of generalized joint hypermobility on outcomes after arthroscopic anterior shoulder stabilization.

OBJECTIVES: Generalized joint laxity has been proposed as a significant risk factor for failure after arthroscopic anterior shoulder stabilization. The purpose of this study was to prospectively measure joint mobility in patients undergoing arthroscopic anterior shoulder stabilization and to determine whether hypermobility is a risk factor for worse outcomes compared with patients having normal joint mobility. METHODS: Patients with anterior shoulder instability were prospectively enrolled. Generalized joint hypermobility was measured using the Beighton Hypermobility Score and the Rowe, UCLA, SANE, SST, and WOSI scores were administered and reported as patient outcomes preoperatively and following arthroscopic anterior shoulder stabilization at 6 weeks, 6 months, 12 months, and 24 months postoperatively. Patients were stratified into two groups based on their Beighton Hypermobility Score, with scores ≥ 4/9 indicative of joint hypermobility. RESULTS: Sixteen patients with joint hypermobility (JH) and 18 non-hypermobile patients (NJH) were enrolled. At baseline, there were no significant differences in demographic characteristics or baseline patient-reported outcomes. Significantly more patients in the NJH group had SLAP tears (n = 10) compared to the JH group (n = 2) (p = .013). At all follow-up times, there were no significant differences between the NJH and JH groups with regard to patient-reported outcome scores (p > .05). In the JH group, 17% of patients reported recurrent instability at two years postoperatively compared to 25% of patients in the NJH group. There was no significant difference in failure rate (p = .67). CONCLUSION: There was no significant difference in patient-reported outcomes or recurrent instability in patients with versus without joint hypermobility undergoing arthroscopic anterior shoulder stabilization.

Conflict of interest in sports medicine: does it affect our judgment?

The American Academy of Orthopaedic Surgeons (AAOS) and other orthopedic societies require authors to disclose conflicts of interest (COIs). We conducted a study to evaluate how a hypothetical research team's reported COI would influence the perceived value of its data. Using a hypothetical prospective study, we asked orthopedic surgeons and nonoperative sports medicine specialists to rate the value of the data, given different study designs, statistical significance, and research institutions (academic vs private). The fictional research team disclosed the project was funded by a pharmaceutical company and all team members received consulting compensation. Eighty percent of 522 respondents thought COI disclosure is important in the interpretation of study results, 41% reported always using this information when interpreting data, and 24% reported that a case series with significant positive results at an academic center was likely trustworthy (this percentage decreased to 5% when the study was set in a community hospital). When no significant difference was found in results, 42% thought the study was trustworthy. When the study design yielded level I evidence (randomized controlled trial) at an academic center, 57% thought the study was trustworthy (when the study was set in a community hospital, this percentage decreased to 39%). When the results of the design showed no difference among groups, the majority of respondents (62%) thought the study was trustworthy. Although the majority of respondents thought disclosure is important, fewer than half reportedly used this information when interpreting study results. Randomized controlled trial status improved the perceived reliability of the data over a case series but was not as important as reporting "negative" results.

Allograft anterior cruciate ligament reconstruction in patients younger than 30 years: a matched-pair comparison of bone-patellar tendon-bone and tibialis anterior.

We conducted a study to compare patient-reported outcomes and graft-rupture rates of bone-patellar tendon-bone (BPTB) and tibialis anterior (TA) allograft primary anterior cruciate ligament (ACL) reconstruction in patients younger than 30 years. Patients were retrospectively identified as having undergone ACL reconstruction with either a BPTB (n = 20) or a TA (n = 20) allograft. Each patient in the BPTB group was matched to a patient in the TA group based on sex, age at time of surgery, height, weight, and preoperative activity level. The Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form were administered at a minimum of 1 year after surgery. Mean Lysholm scores were 92.9 (BPTB) and 93.0 (TA), and mean IKDC scores were 92.6 (BPTB) and 90.3 (TA). The differences were not statistically significant. Overall graft-rupture rates for the study period were 4.7% (BPTB) and 1.9% (TA) (P = .18). There was no statistically significant difference in patient-rated outcomes and graft-rupture rates between BPTB and TA allografts for ACL reconstruction at a minimum of 1 year after surgery. Future research efforts should focus on mid- and long-term follow-up and objective outcomes.

Repair of pectoralis major ruptures: single-surgeon case series.

Rupture of the pectoralis major is an uncommon injury that can lead to pain, loss of strength, and cosmetic deformity. The purpose of this study was to analyze the outcome of pectoralis major repairs by a single surgeon. Twenty-four patients who underwent pectoralis major repair by the senior author (M.D.L.) between May 2005 and March 2011 were retrospectively identified. Patients were assessed at least 6 months postoperatively with the use of various questionnaires, including the Penn Shoulder Score, American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form, and Single Assessment Numeric Evaluation (SANE). All patients were men with an injury to the sternal head of the pectoralis. Most (16/24; 67%) patients sustained the injury while bench or incline bench pressing. Nineteen (79%) patients were successfully contacted for follow-up. Of these, an average preinjury bench press of 318 lb (range, 145-525 lb) was restored to an average of 264 lb (range, 100-500 lb) at follow-up. Average preoperative Penn Shoulder Score was 60 points (range, 33-77 points), improving to 94 points (range, 64-100 points) at last follow-up (P=.011). Average postoperative ASES and SANE scores were 96 points (range, 60-100 points) and 93 points (range, 50-100 points), respectively. All but 1 patient were rated excellent (14/19; 74%) or good (4/19; 21%) by the Bak criteria. Operative treatment of pectoralis major rupture yields high patient satisfaction and allows predictable return of comfort, range of motion, cosmesis, and overall limb strength, with a slightly less predictable return of maximum bench press strength.

Outcomes of arthroscopic repair of panlabral tears of the glenohumeral joint.

BACKGROUND: Combined lesions of the glenoid labrum involving tears of the anterior, posterior, and superior labrum have been infrequently reported in the literature. PURPOSE: To evaluate the clinical outcomes of arthroscopic repair of these lesions in a general population using validated scoring instruments, presence of complications, and need for revision surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Fifty-eight patients who had arthroscopic labral repair of tears involving the anterior, posterior, and superior labrum (defined as a panlabral repair) were identified at our institution by retrospective review. All patients underwent arthroscopic labral repair with suture anchor fixation by a uniform approach and with a standardized postoperative protocol. Forty-four patients had a minimum 16-month postoperative follow-up. Outcomes were assessed postoperatively by the American Shoulder and Elbow Surgeons (ASES) score and the Penn Shoulder score. Complications were also documented, including need for revision surgery. RESULTS: The mean age at the time of surgery was 32 years (range, 15-55 years) in the 44 patients. Presenting shoulder complaints included pain alone (40%), instability alone (14%), or pain and instability (45%). Mean number of anchors per repair was 7.9 (range, 5-12). Mean follow-up was 42 months (range, 16-78 months). Mean ± standard deviation ASES score at final follow-up was 90.1 ± 17.7 (range, 22-100), and mean Penn Shoulder score was 90.2 ± 15.3 (range, 38-100). Three of the 4 patients with outcome scores of 70 or less at final follow-up had undergone prior surgery. Thirteen postoperative complications (30%) occurred, with 3 (7%) requiring a second surgery. Five patients (11%) had an instability event following panlabral repair, but only 1 of these patients (2%) required revision surgery for a recurrent labral tear. CONCLUSION: Combined tears of the anterior, posterior, and superior glenoid labrum represent a small but significant portion of labral injuries. Arthroscopic repair of these injuries can be performed with good postoperative outcomes and a low rate of recurrent labral injury.