November 27, 2019
Today’s Top Story

Study Evaluates Outcomes in Adolescent ACL Reconstruction Patients with the Quadriceps Tendon-patellar Bone Autograft

A study published online in The American Journal of Sports Medicine assessed two-year outcomes for adolescent patients who underwent primary anterior cruciate ligament (ACL) reconstruction with the quadriceps tendon-patellar bone autograft (QPA). A single surgeon performed QPA ACL reconstruction on 81 patients aged 10 to 18 years (mean age, 15.9 years). During 36 months of follow-up, the cumulative incidence of graft failure and rate of ipsilateral non-ACL injuries were 1.2 percent for each. Overall, 9.8 percent of cases presented contralateral ACL and non-ACL injuries necessitating operative treatment. The median Pediatric International Knee Documentation Committee and Lysholm scores were 94.0 and 99.5, respectively. After 36 months, 87.9 percent of patients had returned to play.

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In Other News

Study: Outcomes after Extra-articular Hip Joint Resection

A retrospective study published online in the Journal of Surgical Oncology observed acceptable oncological and functional outcomes among patients who underwent extra-articular resection of the hip joint. Between 1996 and 2016, 34 patients underwent extra-articular resection of the hip joint. In 76 percent of patients, the pelvis was the primary tumor site; the femur was the primary site in the remaining eight patients. Patients were followed for a median 38 months. In 31 patients (91 percent), the surgical margins attained were clear. Seven patients (21 percent) developed local recurrence; the majority of these patients (n = 6) had pelvic tumors. The three-year survival rate was 63 percent; survival did not largely differ between tumor groups. Deep infection (n = 7) and dislocation (n = 7) were the most prevalent complications and were more likely to present in pelvic tumor patients. Two pelvic tumor patients sustained implant failure; no failures occurred in the femoral tumor group. The overall median Musculoskeletal Tumor Society score was 69 percent and was slightly higher for femoral tumor patients (73 percent) than pelvic tumor patients (67 percent).

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Study Examines Use of Platelet-rich Plasma in Achilles Tendon Rupture

A randomized, placebo-controlled trial published online in The BMJ observed no significant differences between platelet-rich plasma (PRP) and placebo in patients with acute Achilles tendon rupture. The study spanned secondary care trauma units in 19 U.K.-based hospitals and included 230 adult patients (average age, 46 years; 25 percent were female) with acute Achilles tendon rupture who presented within 12 days of injury and did not receive operative treatment. Patients were randomized 1:1 to receive PRP (n = 114) or placebo (n = 116) injection; both groups received standard rehabilitation care. After 24 weeks, 202 patients (88 percent) completed the heel rise endurance test and 216 (94 percent) completed patient-reported outcomes. Muscle tendon function did not differ between the PRP and placebo groups (limb symmetry index, mean 34.7 percent versus 38.5 percent); secondary outcome and adverse event rates were also comparable between groups.

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Study Compares Midterm Outcomes for Microendoscopic Selective Laminectomy versus Conventional Laminoplasty in Degenerative Cervical Myelopathy

A study published online in BMC Musculoskeletal Disorders observed similar outcomes between patients with degenerative cervical myelopathy treated with microendoscopic selective laminectomy versus conventional laminoplasty. Between May 2008 and April 2015, 232 eligible patients underwent either laminoplasty or cervical microendoscopic interlaminar decompression and had more than two years of follow-up; 87 patients had single- or two-level spinal cord compression, 46 underwent cervical microendoscopic interlaminar decompression, and 41 underwent laminectomy. Both procedures were associated with improved neurological outcomes. Cervical microendoscopic interlaminar decompression patients had better postoperative axial pain and quality of life. Two cases of C5 palsy and one case of hematoma were identified, both in the laminoplasty group. The laminoplasty group had poorer postoperative range of motion and larger postoperative degree of posterior spinal cord shift.

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Study: Which Wrist Orthosis Is Superior in CTS?

A study published online in Musculoskeletal Science and Practice compared outcomes in nocturnal use of commercial versus custom wrist orthosis to treat mild-to-moderate carpal tunnel syndrome (CTS). CTS patients were randomized to wear either a commercial (n = 12) or custom (n = 12) orthosis at night for 45 days. During the study, patients performed gliding exercises during the day. Outcomes included pain, symptom severity, functional status, pinch strength, and electromyographic activity of forearm muscles. Both groups presented improved tripod pinch strength, symptoms, and function. The custom orthosis group presented better outcomes, but the difference did not reach statistical significance.

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Q&A with Expert Attorneys Covers How to Avoid Audits and Takebacks

Government and private payers use computer algorithms to identify atypical billing patterns and coding outliers. Cheryl Toth, MBA, talked with Patricia Hofstra, JD, a partner at Duane Morris LLC, and Michael J. Sacopulos, JD, president of the Medical Risk Institute, about what orthopaedic surgeons can do to reduce the risk that their billing and coding could trigger an audit or takeback.

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Submit an Application for the Mark Frankle, MD, Health Care Policy Award

The American Shoulder and Elbow Surgeons (ASES), in partnership with the AAOS Orthopaedic Political Action Committee, is seeking applications for the Mark Frankle, MD, Health Care Policy Award, which provides selected ASES fellows unprecedented involvement in federal and state legislative policy. Each applicant must be an ASES resident fellow or candidate/associate member Winners will receive a fellowship at the AAOS Office of Government Relations in Washington, D.C.; $12,500 for fellowship expenses; an opportunity to present findings at the ASES Annual Meeting in October 2020 in New York City; and exposure to health policy through Capitol Hill visits and events such as the AAOS National Orthopaedic Conference and AAOS Board of Specialty Societies and Board of Councilors session. The deadline to submit an application is Jan. 15, 2020. Contact Steve Mlodoch, membership and special projects coordinator for ASES, at with any questions.

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