August 16, 2019
Today’s Top Story

Study Evaluates Meniscal Allograft Transplantation Outcomes by Age

Patients older than 50 years may have worse outcomes compared to younger patients following meniscal allograft transplantation (MAT), according to a case-control report published in the August issue of Arthroscopy. MAT patients older than 50 years (O-MAT, n = 26) with at least five years of follow-up were matched to MAT patients younger than 30 years (Y-MAT, n = 26). Mean follow-up was 7.3 years. Both cohorts had significantly improved clinical outcomes compared to baseline, but clinical scores were significantly lower in the O-MAT group compared to the Y-MAT group. The overall failure rate was 31 percent in the O-MAT group and 15 percent in the Y-MAT group. The O-MAT group had a shorter mean survival time free from replacement or graft compared to the Y-MAT group (11.6 years versus 12.3 years).

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In Other News

Study Measures Advanced Glycation End Products’ Effect on Rotator Cuff

A study published in the August issue of the Journal of Shoulder and Elbow Surgery observed a correlation between advanced glycation end products (AGEs) and rotator cuff degeneration. Researchers cultured rotator cuff-derived cells in three media: regular medium with 500 μg/mL AGEs (high-AGEs), regular medium with 100 μg/mL AGEs (low-AGEs), and regular medium alone (control). Post-cultivation observations included cell viability, secretion of vascular endothelial growth factor, and the expressions of hypoxia-inducible factor-1α, reactive oxygen species, and apoptosis. Compared to the control group, the high-AGEs group had significantly suppressed cell viability. Both the high- and low-AGEs groups had significantly greater vascular endothelial growth factor secretion than the control group. Relative to the control group, both AGEs groups, through immunofluorescence stain, presented enhancement of hypoxia-inducible factor-1α and reactive oxygen species expressions and cell apoptosis. The control group had significantly increased tensile strength in ex vivo mechanical testing compared to both AGEs groups.

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Study Assesses Sports Participation Following Radial Head Arthroplasty

Return-to-sport rates may be low among elbow injury patients treated with radial head arthroplasty, according to a retrospective study published in the August issue of the Journal of Shoulder and Elbow Surgery. The study included 57 recreational athletes (mean age, 49 years) with nonreconstructible radial head fractures who underwent radial head arthroplasty and were followed for a mean 8.4 years. Just over half (n = 30, 53 percent) of patients returned to sports. After surgery, there was a significant decline in mean sports frequency (5.2 hours/week to 2.2 hours/week). Patients were also stratified by whether they returned to sports; among those who did, 84 percent returned to the same sports activity, and 17 percent switched to a less demanding activity. Patients who returned to sports, compared to those who did not, had significantly better Mayo Elbow Performance Score (MEPS) (84 points versus 63 points, respectively); Disabilities of the Arm, Shoulder and Hand score (16 versus 46, respectively); and arc of flexion (114 degrees versus 89 degrees, respectively). Factors associated with a lower return-to-sport rate were a secondary radial head prosthesis and MEPS < 85 points. Radiographic outcomes did not differ between patients who did and did not return to sport.

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Study: Providence Nighttime Bracing for the Management of Adolescent Idiopathic Scoliosis

A study published online in the European Spine Journal evaluated the efficacy of the Providence nighttime brace in adolescent idiopathic scoliosis patients with curves between 20 degrees and 40 degrees. Patients underwent Providence nighttime treatment for eight hours; females continued treatment until two years after the first occurrence of menstruation, and males continued until six-month growth arrest. Standing radiographs were used during treatment and six and 12 months after bracing termination. Of the 124 patients included, 80 terminated bracing and were available for follow-up. The treatment was successful in 89 percent of the overall cohort, 88 percent of patients with curves between 20 degrees and 29 degrees, 93 percent of patients with curves between 30 degrees and 39 degrees, and 77 percent of patients with curves between 40 degrees and 45 degrees. Nine patients presented curve progression and five were referred to surgery due to progression (n = 4) and cosmetic concerns (n = 1).

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The Role of Pharmacy Benefit Managers in Medicare

A report from the Government Accountability Office (GAO) analyzed how pharmacy benefit managers (PBMs) affect Medicare Part D plans, including how Part D plan sponsors use PBMs, year-to-year trends in rebates for Part D drugs, and how PBMs benefit monetarily for their Part D services. GAO found that from 2014 to 2016, the growth of rebates and other price concessions outpaced that of Part D expenditures: gross expenditures increased 20 percent, while rebates and other price concessions increased 66 percent, constituting 20 percent of gross expenditures in 2016.

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August AAOS Now Is Now Available Online

AAOS members will soon receive the print edition of the August issue of AAOS Now, but the electronic edition is already available on the AAOS Now website and on iOS and Android devices through the AAOS Access app. This month’s issue includes an interview with Lieutenant General Nadja Y. West, surgeon general of the U.S. Army; an update on AAOS’ latest advocacy efforts; and a study on the durability of smoking cessation for elective surgery.

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OrthoInfo Helps Doctors Educate Patients

OrthoInfo, the AAOS patient education website, is a free member resource that provides orthopaedic surgeons and patients with authoritative, in-depth information about musculoskeletal health. The website features more than 400 articles, videos, and animations on common orthopaedic problems, surgical procedures, nonsurgical treatments, injury prevention, and healthy living All content is developed and peer reviewed by AAOS members. Written in simple language, OrthoInfo articles can help your patients be better informed and participate more fully in their care and recovery.

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