Matrix-Induced Autologous Chondrocyte Implantation (MACI) is Largely Effective and Provides Significant Improvement in Patients With Symptomatic, Large Chondral Defects: A Systematic Review and Meta-Analysis.

INTRODUCTION: The purpose of this study was to perform a meta-analysis for long-term patient-reported outcome (PRO) measures in Matrix-induced Autologous Chondrocyte Implantation (MACI) patients using the Knee Injury and Osteoarthritis Outcome Score (KOOS) model. MATERIALS AND METHODS: A literature search under the PubMed/Medline and Embase databases was conducted. Statistical significance was determined between the mean pre- and postoperative scores at each time point (1-, 2-, and 5-years). Cohen's d analysis was used to measure the effect size (ES) in each group when compared to preoperative measurements to determine clinical responsiveness. RESULTS: KOOS subscales at all long-term postoperative follow ups measured in this study showed significant (p-value < 0.001) improvement when compared to preoperative scores. Furthermore, apart from KOOS sports and recreation (KOOS-SR) at 1-year postoperative follow up that showed a medium ES (ES, 0.761), all other KOOS subscales at long-term follow up periods showed a large (>0.8) ES on mean preoperative KOOS. CONCLUSION: Review of the literature demonstrate an absence of large meta-analyses for long-term PRO measures with the MACI procedure. It was found that all subscales were largely responsive when evaluated at >2 years after surgery. Based on these results, MACI is an effective treatment option for patients with symptomatic, full-thickness cartilage defects about the knee.

Retraction: A Cautionary Tale of a Complex Peri-Trochanteric Fracture in a Very Important Person (VIP) Patient at a Community-Based Hospital: A Case Report.

[This retracts the article DOI: 10.7759/cureus.33150.].

A Cautionary Tale of a Complex Peri-Trochanteric Fracture in a Very Important Person (VIP) Patient at a Community-Based Hospital: A Case Report.

Peri-trochanteric fractures with an extension into the femoral neck are relatively rare. Due to the lack of a defined treatment in the literature, these fractures pose a challenge to orthopedic surgeons. This case report highlights the value of timing to surgical intervention, choosing the appropriate operative course, not treating very important person (VIP) patients differently than standard patients, and decreasing unnecessary costs for the patient and the US healthcare system. An 85-year-old male VIP patient presented to the emergency department (ED) with a left peri-trochanteric fracture with an extension into the ipsilateral femoral neck. The initial plan was to perform arthroplasty with diaphyseal fixation. However, the community-based hospital would have to wait two to three days for the proper implants, and the patient insisted on being treated at this hospital. Due to concerns about increased mortality with delayed treatment, the patient underwent short cephalomedullary nail (CMN) fixation the next day. On postoperative day (POD) 49, a pop was heard and felt while ambulating, and radiographs revealed substantial lateral cutout of the CMN and subsidence of the femoral head. On POD 54, the patient underwent a successful left total hip arthroplasty using a modular diaphyseal press-fit femoral component, which resulted in an uneventful recovery. This case illustrates a cautionary tale in choosing the appropriate operative course for a VIP patient with a peri-trochanteric fracture extending into the femoral neck (a relatively rare fracture type that has no clearly defined treatment option). This is imperative to reduce pain and length of stay for the patient, postoperative complications, and cost. Based on the results from the second procedure and weighing the risk of prolonged treatment, the authors believe that this patient would likely have benefited from a primary arthroplasty procedure given his body habitus and complex fracture pattern.

Intra-articular Fracture at the Base of the Proximal Phalanx in the Index Finger Following a Punching Mechanism in a Patient with an Ipsilateral Ulnar Claw Deformity: A Case Report.

Introduction: Altercations involving punching forces constitute 18.5% of all hand injuries. Intra-articular proximal phalanx base fractures of the index finger only account for 0.5% of all hand fractures. There is a paucity of ulnar claw deformities discussed in the literature, likely because ulnar neuropathies rarely remain untreated long enough to progress to deformity. We present the first reported case of a chronic ulnar claw deformity leading to an uncommon finger fracture pattern through an altered punching mechanism. Case Report: A 62-year-old right-hand dominant male who presented to the emergency department for a behavioral health examination was found to have an intra-articular fracture at the base of the proximal phalanx in the left index finger. This occurred secondary to an altered punching mechanism influenced by an existing ulnar claw deformity. Radiographs of the left hand revealed a simple, non-angulated, and minimally displaced oblique fracture at the base of the proximal phalanx. Diffuse edema and ecchymosis of the index finger and gross hypothenar, intrinsic, and adductor pollicis muscle atrophy were observed. A single source of ulnar clawing could not be elicited on the clinical examination alone. Management involving non-operative treatment with buddy-tape and non-weight bearing for 2 weeks was instituted. The patient did not follow-up with orthopedics for repeat evaluation. Conclusion: This case demonstrates a unique fracture that likely occurred due to altered punching biomechanics from an ulnar claw deformity. The authors recommend that clinicians use their best judgment when comparing clinical findings to seemingly benign imaging studies. Early immobilization is crucial to prevent collapse and surgical intervention of intra-articular phalangeal fractures.

A Case of Recurrent Compartment Syndrome with Concomitant Use of Eliquis.

Introduction. Acute compartment syndrome (ACS) occurs secondary to increasing pressure within a fascial compartment that exceeds perfusion pressure. This can be caused by spontaneous hematomas, which can be secondary to prolonged anticoagulation therapy. Eliquis® has not been associated with ACS of the thigh in any of the currently published literature. Identifying ACS early is important because it can reduce the risk of permanent structural damage, limb amputations, and mortality rates. Case Report. A 43-year-old male with past medical history of unprovoked Deep Vein Thrombosis (DVT) eight months prior to presentation on Eliquis® presented to the emergency department for significant right thigh pain after riding a roller coaster. There was increased tone/firmness of the anterior compartment and tenderness on palpation of the proximal two-thirds of the anterior thigh. Imaging, clinical findings, and Stryker needle measurements confirmed ACS secondary to hematoma, which required fasciotomy and evacuation of the hematoma. The patient was temporarily switched to aspirin for DVT prophylaxis postoperatively to prevent new hematoma formation. Six weeks later, the patient arrived at the ED with a DVT that was treated with Eliquis®. Eight months later, the same patient presented with acute right thigh pain that started while lying in bed. A diagnosis of recurrent ACS in the right anterior thigh was made, requiring a fasciotomy. Surgery was successful without any complications. Discussion. Eliquis® is associated with an increased risk of hematoma formation, which can lead to ACS. This is a rare adverse effect that providers should be aware of because it requires early management to prevent ACS-associated complications. This is significant because no currently published literature has identified an association of Eliquis® with ACS in the thigh. In cases of atraumatic ACS, we were unable to find any protocols advocating for or against the use of DVT prophylaxis postfasciotomy in the literature.