Today’s Top Story

Study: What Is the Best Treatment for Multiligament Knee Injury?

A systematic review published online in Injury evaluated the treatment of multiligament knee injuries, including surgical versus nonoperative treatment, repair versus reconstruction of injured ligamentous structures, and early versus late surgery of damaged ligaments. Researchers queried PubMed from 1966 through March 2016 for relevant articles. Eligible studies defined multiligament as disruption of at least two of the four major ligaments in the knee, measured functional and clinical outcomes, and had a minimum 12-month follow-up with a mean of at least 24 months. Two studies found surgically treated patients had higher Lysholm scores, International Knee Documentation Committee (IKDC) scores, and return to sport rates. Four studies found that repair and reconstruction of damaged structures had similar mean Lysholm scores and excellent/good IKDC scores. Posterolateral corner repair had higher failure and return to sport activities rates, and cruciate repair resulted in decreased stability and range of motion (ROM). Six studies comparing early surgery (within three weeks) to delayed surgery found that early surgery resulted in higher mean Lysholm scores, more excellent/good IKDC scores, and higher mean ROM.

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Other News

Study Compares Five-year Outcomes for Different THR Approaches

A follow-up study published online in The Journal of Arthroplasty found similar five-year outcomes for total hip replacements (THRs) performed using a direct anterior approach (DAA) and posterolateral approach (PA). A previous study measured pain and functional DAA and PA outcomes at six and 12 months and found no significant differences. In the follow-up, one patient in each cohort died (unrelated to the implant or procedure), and each group lost two patients to follow-up. University of California at Los Angeles activity score, Harris Hip Score, and Hip Dysfunction and Osteoarthritis Outcome Score for Joint Replacement were not statistically different between the two groups. Seven-year survivorship was similar in both groups. Neither group had loose implants after a mean follow-up of five years.

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Study: What Influences Cost of Care in Upper Extremity Pain Conditions?

A study published online in The Journal of Hand Surgery examined factors that impact the cost of care and use of resources for common, atraumatic, painful upper extremity conditions. Researchers identified the most common upper extremity diagnoses from a single database as shoulder pain and rotator cuff tendinopathy, shoulder stiffness, shoulder arthritis, lateral epicondylitis, hand arthritis, trigger finger, wrist pain, and hand pain. The use of joint injection, surgery, MRI, and physical or occupational therapy were also evaluated. In the majority of diagnoses, the total costs came primarily from inpatient and outpatient surgery. For most conditions, older patients had a higher rate of injections. The study’s authors recommended that efforts to optimize the cost of care focus on the benefits of surgery over other treatments, as well as interventions to reduce surgery costs when possible.

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Study: Decreasing Opioid Prescriptions Following Lumbar Spine Surgery

According to a study published online in the Journal of Neurosurgery, qualitative guidelines and prescriber education may impact prescriber behavior and reduce the number of opioids prescribed to lumbar spine surgery patients at hospital discharge. An educational conference and qualitative prescribing guidelines were used to educate qualified staff. Lumbar spine surgery patients were stratified into two groups based on whether they were treated before (preintervention group, n = 1,177) or after (postintervention group, n = 1,302) the prescriber education and guidelines were integrated. Among both decompression and fusion surgeries, the preintervention group had a higher mean number of opioids prescribed at discharge compared to the postintervention group (629 oral morphine equivalent [OME] versus 490 OME). The preintervention group also had as a higher mean number of prescribed pills (81 versus 66). Tramadol prescriptions nearly doubled after prescriber education occurred (9.9 percent versus 18.6 percent).

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Study Finds Good Long-term Outcomes for Rotator Cuff Tear Patients Undergoing rTSA

A systematic review published online in the Journal of Shoulder and Elbow Surgery found positive mid- and long-term results in reverse total shoulder arthroplasty (rTSA) patients with massive irreparable rotator cuff tears (miRCTs). Researchers queried databases for studies of rTSA for miRCTs with at least level IV evidence. Eligible studies had a minimum of five years of follow-up. Studies that reported rTSA combined with tendon transfers or as revision arthroplasty were not included. Final analysis included data from eight studies spanning 365 shoulders with a mean follow-up of 9.5 years. Preoperative absolute and relative Constant scores improved from 24 to 59 points and from 33 percent to 74 percent, respectively. Preoperative Subject Shoulder Value score improved from 23 percent to 72 percent. Significant improvement was observed in anterior elevation and abduction, but active external rotation did not change.

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AAOS Now

Learn What’s New at the AAOS 2019 Annual Meeting

Don’t miss a minute of the Annual Meeting with the Gold Registration Package. This option gives you access to Annual Meeting On Demand—an online library with more than 500 hours of educational content from the 2019 Annual Meeting. Also, master in-depth, experience-based orthopaedic techniques from world-renowned surgeons during the new Instructional Course Lectures, with topics such as adult reconstruction hip, foot and ankle, practice management, and more.

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Your AAOS

Apply for the Sports Medicine/Arthroscopy Program Committee Member Position

The Sports Medicine/Arthroscopy Program Committee has four open member positions. Over the course of a three-year term, the members will rate podium and poster abstracts and symposium for the Annual Meeting. Members will also select and/or serve as moderators for podium sessions at the Annual Meeting. The application deadline is April 22.

Learn more and submit your application…(member login required)

 

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