Today’s Top Story

Study Compares Operative Versus Nonoperative Management of Grade III MCL Injuries

According to a prospective, multicenter study published in the May issue of Arthroscopy, operative and nonoperative management of grade III medial collateral ligament (MCL) injuries during anterior cruciate ligament (ACL) reconstruction were both associated with good outcomes. A total of 2,586 patients underwent primary ACL reconstruction and were available for two-year follow-up; 27 patients (1.1 percent) had grade III MCL tears, of whom 16 underwent surgery and 11 received nonoperative treatment. The operative group had a higher reoperation rate for arthrofibrosis than the nonoperative group (19 percent versus 9 percent). Although both groups demonstrated improvement after two years, the nonoperative group had better outcomes in terms of minimal clinically important differences; however, these differences were not statistically significant.

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Other News

Study: Is Opiate Type Associated with Discharge Opioid Quantity?

A study published in the May 1 issue of the Journal of the AAOS observed an association between persistent opiate use and discharge opioid quantity—not the opioid type—after orthopaedic surgery. The study included 17,961 opiate-naïve patients undergoing surgery for a musculoskeletal injury. Researchers calculated discharge prescription in morphine milligram equivalents (MMEs). Unadjusted analysis showed prolonged opioid use (prescribing > 90 days after injury) was more likely among patients discharged on hydromorphone or morphine versus hydrocodone. When adjusting for discharge MME, however, the only predictor of prolonged use was opioid quantity.

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Study Evaluates Efficacy of Combination IV Dexamethasone/Dexmedetomidine

Coadministration of intravenous (IV) dexamethasone and dexmedetomidine could significantly delay the first request for rescue analgesic after single-shot interscalene brachial plexus block (ISBPB) in shoulder arthroscopy patients, according to a randomized, controlled trial published in the May issue of the European Journal of Anaesthesiology. A total of 66 arthroscopic shoulder surgery patients with ISBPB with 15 mL of 0.5 percent ropivacaine with 1:200,000 epinephrine were randomized to one of three groups: IV 0.9 percent saline (control), IV dexamethasone 0.11 mg kg -1 (D1 group), or coadministered IV dexamethasone 0.11 mg kg -1 and IV dexmedetomidine 1.0 μg kg -1 (D2 group). The D2 group had the longest median time to first rescue analgesic request (66.3 hours) compared to the D1 (17.4 hours) and control (10.9 hours) groups. Compared to the control cohort, the D1 and D2 groups both exhibited reduced pain scores, reduced postoperative opioid consumption, less sleep disruption, and improved patient satisfaction. At postoperative day one, elevated blood glucose concentrations were not significantly different among the three groups.

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Study Finds No Increased Complications for Inpatient Single-level Cervical Total Disk Replacement

A retrospective study published in the May 1 issue of Spine found that single-level cervical total disk replacement (CTDR) can be safely performed in the inpatient setting. Data on 373 outpatient (length of stay < 1 day) and 1,612 inpatient single-level CTDR procedures were collected from the National Surgical Quality Improvement Program database. When controlling for confounding factors, researchers observed no significant between-group differences in perioperative complications rates or readmissions. When comparing outpatient single-level CTDR versus matched outpatient single-level anterior cervical diskectomy and fusion, there were no difference in rates of perioperative adverse events.

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CBO Report Outlines Issues Associated with Single-payer Healthcare System

A new report from the Congressional Budget Office (CBO) detailed components and considerations that would be involved in implementing a single-payer healthcare system in the United States. Potential problems with a single-payer system include provider capacity issues and lack of health benefit and insurer choice, while benefits may include stronger purchasing power and reduced administrative costs.

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Read the CBO report…

 
 
 
AAOS Now

Pros and Cons of Emerging Payment Models

At the core of the surgeon-patient relationship is a shared goal of relieving pain, restoring function, and improving health in the most appropriate, convenient, and efficient way possible for the patient’s condition. But this agreement is not reflected by the fee-for-service reimbursement model, which incentivizes greater volume and intensity of services regardless of appropriateness. In part one of a two-part series, AAOS Now evaluates the positive and negative factors associated with alternative payment models.

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Your AAOS

Apply for the OrthoInfo Sports Medicine Section Editor Position

The Academy is seeking a section editor for the sports medicine section of the OrthoInfo website. Over the course of a six-month term, the editor will oversee content development of the OrthoInfo Sports Medicine Section, including identifying article topics and recruiting qualified authors, as well as working with AAOS staff and the OrthoInfo editor-in-chief to edit and revise sports medicine articles. The application deadline is May 31.

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

 

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