November 21, 2018
 
Today’s Top Story

Study: Factors Associated with Correction Loss Following Distal Chevron Osteotomy for Hallux Valgus

A study published online in Foot & Ankle International found that preoperative deformity and sesamoid position may indicate loss of correction in patients who undergo distal chevron osteotomy for hallux valgus. The study involved 524 patients who underwent distal chevron osteotomy for hallux valgus correction at a single institution between 2002 and 2012. Researchers evaluated weightbearing radiographs preoperatively and postoperatively, as well as at six weeks and three months. They assessed the intermetatarsal angle (IMA), hallux valgus angle (HVA), distal metatarsal articular angle (DMAA), joint congruity, and position of the sesamoids. Significant improvements were observed in the IMA (12.9 degrees to 4.5 degrees) and HVA (27.5 degrees to 9.1 degrees) During follow-up, mean loss of correction in HVA and IMA was 4.5 degrees and 1.9 degrees, respectively. A linear correlation with correction loss and preoperative IMA and HVA was observed, as well as a correlation between preoperative DMAA and sesamoid position.

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Other News

Study Proposes Classification of Peri-implant Femoral Fractures

An international, multicenter study published online in Injury described a potential new way to classify peri-implant femoral fractures. Researchers based their proposed method on a topographical classification that utilized alphanumeric coding. Cases were stratified based on implant type (nail, screw, or plate) and fracture location relative to the original implant and the affected femoral segment. Data were collected for 143 peri-implant femoral fractures between January 2013 and December 2016. In five cases (3.5 percent), consensus could not be reached without discussion. The most commonly observed peri-implant femoral fractures were found at the diaphyseal segment and associated with nails or plates (51 percent), at the proximal segment (39 percent), and at the distal femoral segment (10 percent). The authors said further research would be required to determine the classification’s efficacy in a clinical setting.

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Study Evaluates Prevalence of Geniculate Artery Injury During Primary TKA

Geniculate artery (GA) injury rates during primary total knee arthroplasty (TKA) may be relatively high, according to a retrospective study published online in the American Journal of Orthopedics. Between November 2015 and February 2016, 100 consecutive primary TKAs were performed at a single institution GA injury occurred in 38 percent of patients. Lateral inferior GA injury (31 percent) was more prevalent than middle GA injury (15 percent). Overall or isolated GA injury rates did not largely differ whether patients received intravenous (n = 84) or topical (n = 14) tranexamic acid. Compared to routine tourniquet use, tourniquet use only during cementation did not impact GA injury rate, blood loss, or drain output.

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Study Finds Arthroscopic SCR May Reverse Profound Shoulder Pseudoparalysis in Massively Torn Rotator Cuffs without Arthritis

Patients with massive, irreparable rotator cuffs without arthritis may achieve active forward elevation (aFE) of the arm after arthroscopic superior capsular reconstruction (SCR), according to a retrospective study published online in Arthroscopy. Ten patients underwent SCR for an incompletely reparable massive rotator cuff tear between October 2014 and October 2016. Patients had a preoperative aFE of less than 45 degrees with full passive elevation, an intact or reparable subscapularis tendon, radiographic classification Hamada 0–3, and 12-month clinical follow-up. After surgery, nine patients (90 percent) regained active overhead arm use. Postoperative aFE improved to 159 degrees. After one year, all patients had improvements in visual analog scale (4.6 to 0.5), American Shoulder and Elbow Surgeons score (52 to 89), subjective shoulder value (36 to 91), and active external rotation (24 degrees to 43 degrees). MRI showed fully healed SCR grafts in seven patients. No complications or reoperations were reported.

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Improper Medicare Payments Reach Lowest Rates in a Decade

According to a report from the Centers for Medicare & Medicaid Services, the 2018 Medicare Fee-for-service (FFS) improper payment rate is 8.12 percent—the lowest since 2010, representing a $4.59 billion decrease in estimated improper payments from 2017 to 2018. This is also the second year in a row that the FFS improper payment rate is below the 10 percent threshold.

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AAOS Now

Study Compares Tendon Autografts for ACL Reconstruction in Young Females

Using bone-patellar tendon-bone (BTB) autograft for anterior cruciate ligament (ACL) reconstruction in female patients between 15 and 20 years of age may be more effective than quadruple hamstring (HS) autograft, according to a recent study. When evaluating younger patients, BTB patients had a lower rate of retears than HS patients; this was not observed in older cohorts. Kevin Freedman, MD, of Rothman Orthopaedics in Philadelphia, presented these findings during the American Orthopaedic Society for Sports Medicine 2018 Annual Meeting.

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Your AAOS

AAOS Member Advantage Program—Student Loan Refinancing

To help ease the burden of student loan debt, AAOS has partnered with SoFi to offer members a limited-time 0.5 percent rate discount when they refinance their student loan through the provider. Members can check their rates quickly with no impact on their credit score.

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