November 19, 2018
Today’s Top Story

Study Compares Safety and Efficacy of Nonsurgical eECRB Treatments to Placebo

In a systematic review and meta-analysis published online in The American Journal of Sports Medicine, researchers found that nonoperative pain relief treatment options for enthesopathy of the extensor carpi radialis (eECRB) may increase the risk of adverse events (AEs) and only provide little relief of pain. They reviewed 36 randomized, placebo-controlled trials that evaluated 11 different treatment options and included 2,746 patients. Only local corticosteroid improved short-term pain but was associated with worse pain than placebo at long-term follow-up. Laser therapy and local botulinum toxin injection relieved pain at midterm follow-up. At long-term follow-up, extracorporeal shock wave therapy alleviated pain. Only laser therapy outperformed placebo in improving grip strength. Compared to placebo, all treatment options increased the likelihood of AEs at similar rates. At short-term follow-up, 2 percent of patients receiving placebo reported mild pain compared to 92 percent at midterm follow-up.

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Other News

Study Assesses Correlation Between Sarcopenic Obesity and Falls in Multiethnic Cohort of Older Women

A prospective cohort study published online in the Journal of the American Geriatrics Society observed an association between sarcopenic obesity and falls in postmenopausal women. Researchers evaluated data on 9,924 postmenopausal women enrolled in three Women’s Health Initiative clinical centers. All women underwent dual-energy X-ray absorptiometry (DEXA) at baseline. Sarcopenia was defined as the lowest 20th percentile of appendicular lean mass and obesity was defined as a body fat percentage greater than 42 percent. The fall outcome was defined as falling two or more times in any year during the seven-year follow‐up. The risk of falls increased in sarcopenic obese women aged 50 to 64 years and 65 to 79 years. Hispanic women had a greater risk of sarcopenic obesity-related falls than non-Hispanic white women.

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Study Evaluates Efficacy of Pain in Other Joints or Spine on Long-term THA Outcomes

Total hip arthroplasty (THA) patients with significant spine pain may have worse two-year postoperative outcomes compared to patients without spinal pain, according to a study published online in Arthroscopy. THA patients treated by a single surgeon between Jan. 1, 2012, and July 16, 2015, received a preoperative musculoskeletal morbidity (MSM) score based on pain in other joints and the spine (grade 1, hip only; grade 2, hip and other major joints without spine; grade 3, hip with spine; and grade 4, hip and other major joints with spine). Researchers measured patients’ Hip Outcome Score-Activities of Daily Living (HOS-ADL) preoperatively and two years after surgery, and they calculated the percentage of patients who achieved a minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS). A total of 700 patients completed two years of follow-up. MSM grade 1 patients had a higher HOS-ADL than grade 2 patients prior to operation, but no differences were observed between grades 1 and 3 patients and grades 1 and 4 patients. Preoperative HOS-ADL did not differ among grades 2, 3, and 4 patients. Grades 1 and 2 patients tended to be younger than grades 3 and 4 patients. After two years, HOS-ADL values were higher in grade 1 patients than grades 3 and 4 patients Among all patients, 84 percent achieved an MCID, and 72 percent achieved an HOS-ADL PASS. The four grades did not have significant differences regarding MCID or PASS.

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Study Assesses AMCL Insertion on Sublime Tubercle

A study published online in the Journal of Shoulder and Elbow Surgery described the insertional anatomy of the anterior medial collateral ligament (AMCL) at the sublime tubercle. Using 83 elbows from 43 embalmed human specimens, researchers measured the AMCL’s most ventral extensions at the sublime tubercle in relation to a horizontal line (baseline) landmark. The baseline originated on the lesser sigmoid notch in a right angle to the ulnar ridge. From the coronoid process tip to the baseline, the mean distance was 4 mm. Between the ventral extension of the AMCL and the horizontal line, the mean distance was 3.7 mm. The average horizontal distance from the AMCL’s ventral aspect to the coronoid tip was 13.7 mm. The researchers believe this information may be helpful for classifications of coronoid fractures and to estimate the involvement of the AMCL in fractures of the sublime tubercle.

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Study: High-intensity Exercise Improves BMD in Adolescent Boys

Vigorous physical activity (VPA) is the most effective activity intensity associated with improved bone mineral density (BMD) and content in early pubertal boys, according to a study published online in Bone. Researchers evaluated BMD and content in 180 healthy boys aged 11 to 13 years using DEXA scans at the whole body, femoral neck (FN), and lumbar spine, and measured their physical activity for one week via an accelerometer. Vigorously intense exercise was the activity most significantly associated with bone mineral parameters, particularly at the FN. Patients whose VPA bouts lasted five minutes or longer had higher FN BMD compared to those who did not complete five minutes of VPA. Exercise duration of 15 consecutive minutes was the most beneficial. Patients with a low volume of physical activity and a VPA bout had better FN BMD than patients with a high volume of physical activity and no VPA bout. High-volume physical activity and VPA bout patients had the best FN BMD.

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International Perspectives: Panelists Speak About Periprosthetic Joint Infection Management

Over the past decade, prevention, diagnosis, and treatment techniques for periprosthetic joint infection (PJI) have been introduced, including AAOS’ clinical practical guideline on diagnosing hip and knee PJI. During the 2018 Musculoskeletal Infection Society Annual Meeting, a panel of expert surgeons and basic scientists from around the world discussed preoperative risk factors and treatments for PJI.

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New Member Benefit: AAOS Webinars OnDemand

AAOS members and residents can now enjoy complimentary access to a growing library of recorded AAOS webinars. The Webinars OnDemand collection presents a range of topics from clinical insights across all orthopaedic specialties to advocacy, practice management, quality, and more. Experience the convenience of online instruction anytime with recorded Webinars OnDemand. Accessible on the Academy’s new online learning platform, webinars range from 60 to 90 minutes and include a transcript of the spoken lectures. To view the selection, visit the catalog and filter by learning format. Check back regularly for new content.

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